- Email: [email protected]
Self-reported pelvic inflammatory disease in the united states, 1988
68
Citations from the Literature
Department of Obstetrics and Gynecology, University of Tennessee, 853 Jefferson Avenue, Memphis, TN 38103. USA
AM J OBSTET GYNECOL 1991 165161(1731-1737) A long-sought goal of medical genetics has been development of prenatal diagnostic procedures that do not endanger the conceptus. Reliable and universal screening for cytogenetic disorders would require analysis of fetal cells isolated from the maternal circulation. This would be applicable to all pregnant women, irrespective of their ages or histories. In the current study fetal nucleated erythrocytes were flow sorted on the basis of four parameters: cell size, cell granularity, transferrin receptor and glycophorin-A cell surface molecule. By polymerase chain reaction with oligonucleotide primers flanking singlecopy Y-specific deoxyribonucleic acid sequences, male fetuses were correctly identified among flow-sorted samples in 12 of 12 (100%) pregnancies; female fetuses were correctly identified in 5 of 6 (83%) pregnancies. We also achieved the prenatal diagnosis of fetal aneuploidies by use of flow-sorted nucleated fetal erythrocytes and in situ hybridization with chromosomespecific deoxyribonucleic acid probes: one case of trisomy 21 that was detected in maternal blood taken 1 week after chorionic villus sampling and one case of trisomy 18 that was detected in maternal blood taken immediately before chorionic villus sampling. Although our results are promising,‘additional data on the background sensitivity and specificity of in situ hybridization in flow-sorted fetal cells will be necessary to minimize subjective interpretation and permit clinical application.
INFECTIOUS
DISEASES
Diagnosing pelvic inflammatory disease: A comprehensive analysis and considerations for developing a new model
Kahn JG; Walker CK; Washington AE; Landers DV; Sweet RL Institute for Health Policy Studies, School of Medicine, Vniversity of Caltfomia. 1388 Sutter St, San Francisco, CA 94109, USA
J AM MED ASSOC 1991 266/18 (2594-2604) Objective - To examine the accuracy of existing diagnostic indicators for pelvic inflammatory disease and to develop guidelines for a new diagnostic model. Data Sources - Studies were identified for the period 1969 through 1990. A Medline search of the English-language literature was conducted using the subject terms pelvic inflammatory disease or salpingitis and diagnosis. In addition, abstracts and bibliographies of articles and books were reviewed. Study Selection - Studies were selected if pelvic inflammatory disease was diagnosed using laparoscopic findings or narrow clinical rules. Of the 15 reports identified, 12 were included in this analysis. The selected studies were grouped by a quality rating based on subject selection, definition of pelvic inflammatory disease, data analysis and other measures. Data Extraction - Diagnostic findings were divided into four categories: historical (symptoms), clinical examination (signs), laboratory, and combinations of the above. Sensitivity and specificity were extracted using raw data.
Int J Gynecol Obstet 39
Data were classified by quality rating. Data Synthesis Historical findings were usually not statistically significant predictors of pelvic inflammatory disease and when they were they tended toward low sensitivity and high specificity, while clinical findings were somewhat more sensitive and about as specific. Several laboratory tests showed consistent value in pelvic inflammatory disease diagnosis, with high sensitivity and specificity. Combinations of indicators permitted high sensitivity or high specificity but not both simultaneously. Conclusions - No single or combination diagnostic indicator was found to reliably predict pelvic inflammatory disease. Combining published evidence with practical clinical considerations, a diagnostic approach is proposed that emphasizes diagnostic sensitivity when clinical presentation is mild and more thorough evaluation when a woman is severely ill. Research is needed to evaluate the accuracy and acceptability of specific diagnostic models and to investigate new diagnostic indicators. Cost of and payment source for pelvic inflammatory diseaw: Trends and projections, 1983 through 2000
Washington AE; Katz P Center for
Reproductive
Health
Medicine, University of California. cisco, CA 94109, USA
Policy
Research,
School of
1388 Sutter St, San Fran-
J AM MED ASSOC 1991 266/18 (2565-2569) Pelvic inflammatory disease (PID) and its sequelae affect millions of women in the United States at substantial costs. To estimate these total costs annually and to determine payment sources, we analyzed data from local, state and national sources. Direct costs for PID and PIDasscciated ectopic pregnancy and infertility were estimated to be $2.7 billion and indirect costs were estimated to be $1.5 billion, for a total cost of $4.2 billion in 1990. Overall, private insurance covered the largest portion of the direct costs of PID (41%), followed by public payment sources (30%). However, the proportion of payments made by private insurance appears to be decreasing, while that by public payment sources is increasing. In the year 2000, costs associated with PID are-projected to approach $10 billion if the current PID incidence persists, with an increasing proportion of this expense burdening public institutions. Prevention of PID is needed both to reduce human suffering and to contain rising costs. Self-reported pelvic inilammatory disease in the United Stat1988 Aral SO; Mosher WD, Cates W Jr Division of STD/HIV Prevention, Center for Prevention Services, Centers for Disease Control, Mailstop E-44, Atlanta, GA 30333, USA J AM MED ASSOC 1991 266/18 (2570-2573)
Objective - To assess any changes in the characteristics of women with self-reported pelvic inllammatory disease (PID) between 1982 and 1988 and to evaluate the role of additional behavioral factors. In 1982, PID was a frequent problem among American women of reproductive age, occurring in one in seven. It was also more common among older (B 30 years) than younger women, more common among blacks than
Citations from the Literature
among whites and more common among formerly married women than among those currently married. Design - We analyzed data on self-reported PID from the cycle IV National Survey of Family Growth, conducted in 1988. Sample - The survey was conducted with a multistage probability sample of 8450 women. Results - The findings from 1982 were all replicated. Additional variables available in 1988 show that PID is more common among women with multiple (two or more) sexual partners (10% to 22%) compared with those with only one lifetime partner (7%) and among women who report a history of sexually transmitted disease (STD) (26%) compared with those with no STD history (10%). Controlling for other variables, age, race, vaginal douching, age at first intercourse, STD history, and number of lifetime partners emerged as independent predictors of self-reported PID among American women of reproductive age. Conclusion - PID is still a widely prevalent condition among American women; PID is associated with a variety of risk factors for STD. Prevention of lower genital tract infection is crucial to avoiding PID and its sequelae. Preventing pelvic inflanunatory
disease
Washington AE; Cates W Jr; Wasserheit JN Center for Reproductive Health Policy Research, School of Medicine, University of California, 1388 Sutter St, San Francisco, CA 94109, USA
J AM MED ASSOC 1991 266/18 (2574-2580) Effective strategies for preventing pelvic inflammatory disease (PID) are crucial to protect women from adverse reproductive consequences and to avoid substantial economic losses. To identify current PID prevention options and assess their efficacy, we conducted a literature search and examined relevant data in published reports. We organized our review by level of participation (i.e., individuals, providers and communities) and prevention (i.e., primary, secondary and tertiary). For individuals, several prevention strategies related to personal protection appear promising, but few have been appropriately evaluated. For providers of health care, five prevention measures are recommended, including such primary prevention activities as counseling and patient education in addition to the usual diagnosis and treatment. Specific evidence supporting the efficacy of these provider practices, however, is limited. For communities, maintaining comprehensive sexually transmitted disease control strategies to prevent lower genital tract chlamydial and gonococcal infection is most important in reducing both symptomatic and asymptomatic PID. We provide specific recommendations for preventing PID and outline research needs. Pathogenesis of pelvic inflammatory
disease:
What
are the
questions?
Rice PA; Schachter J Maxwell FinlandLaboratory of Infectious Diseases, Boston City Hospital,
774 Albany St, Boston, MA 02118, USA
J AM MED ASSOC 1991 266/18 (2587-2593) Pelvic inflammatory disease is usually caused by Chlamydia trachomatis or Neisseria gonorrhoeae. Chlamydiae and
69
gonococci are primary pathogens of the cervix and often ascend. Resultant damage to the cervix may permit organisms to move upward, but this mechanism of action is not well understood. Puberty and hormones, particularly oral contraceptives, may enhance chlamydial infection, but the mechanisms and likelihood of spread to the upper tract are ill defined. Upper tract infection with C. trachomatis involves an acute phase, characterized by an influx of polymorphonuclear leukocytes and a chronic or persistent phase characterized by the presence of mononuclear cells (delayed hypersensitivity). Gonococci invade nonciliated epithelial cells, but are toxic to ciliated cells, due to elaborated lipooligosaccharides and peptidoglycan. Certain gonococci stimulate chemotaxis of polymorphonuclear leukocytes whose release of toxic metabolites may damage tissue. The immunologic mechanisms that permit specific host responses to these two organisms are now being elucidated and should receive more attention by researchers. Pelvic inflammatory disease: Key treatment issues and options Peterson HB; Walker CK; Kahn JG; Washington AE; Eschenbath DA; Faro S WornenS Health and Fertility Branch, Division of Reproductive Health, Centers for Disease Control, Mailstop K-34, 1600 Clifton Rd NE, Atlanta. GA 30333, USA
J AM MED ASSOC 1991 26608 (2605-2611) Objective - To examine available data regarding optimal antimicrobial therapy for pelvic inflammatory disease (PID) and to address selected treatment issues confronting clinicians caring for women with PID. Data Sources - Studies evaluated to help establish the Centers for Disease Control’s 1989 Sexually Transmitted Diseases Treatment Guidelines and other reports published since 1985. A MEDLINE search of Englishlanguage literature was conducted using the indexing terms ‘pelvic inflammatory disease’ or ‘pelvic infections’ or ‘salpingitis’and ‘treatment.’ In addition, abstracts and bibliographies of articles and books were reviewed. Study Selection - Studies were selected for detailed review if they evaluated the effectiveness of an antimicrobial regimen for treatment of PID. Data Extraction - All studies were evaluated to determine the numbers of women treated and the percentage with clinical or microbiologic evidence of cure. Data Synthesis - A variety of combination antimicrobial regimens are highly effective in providing clinical and microbiologic evidence of cure; few data are available to assess optimal therapy for prevention of late sequelae. Because PID is polymicrobial in cause, recommended antimicrobial regimens are broad-spectrum in coverage. Conclusions - No single agent that provides sufficient coverage is currently available. Several combination regimens appear highly effective clinically even among women with tuboovarian abscess formation. Uncertainties regarding the effectiveness of antimicrobial therapy for prevention of late sequelae complicate decisions regarding the choice among regimens and the appropriateness of ambulatory treatment of women with PID. Pending better data, hospitalization should be strongly considered, where feasible, particularly for those women with PID desiring further childbearing. Sex partners of all women with PID should be treated. Int J Gynecol Obstet 39
Citations from the Literature
Department of Obstetrics and Gynecology, University of Tennessee, 853 Jefferson Avenue, Memphis, TN 38103. USA
AM J OBSTET GYNECOL 1991 165161(1731-1737) A long-sought goal of medical genetics has been development of prenatal diagnostic procedures that do not endanger the conceptus. Reliable and universal screening for cytogenetic disorders would require analysis of fetal cells isolated from the maternal circulation. This would be applicable to all pregnant women, irrespective of their ages or histories. In the current study fetal nucleated erythrocytes were flow sorted on the basis of four parameters: cell size, cell granularity, transferrin receptor and glycophorin-A cell surface molecule. By polymerase chain reaction with oligonucleotide primers flanking singlecopy Y-specific deoxyribonucleic acid sequences, male fetuses were correctly identified among flow-sorted samples in 12 of 12 (100%) pregnancies; female fetuses were correctly identified in 5 of 6 (83%) pregnancies. We also achieved the prenatal diagnosis of fetal aneuploidies by use of flow-sorted nucleated fetal erythrocytes and in situ hybridization with chromosomespecific deoxyribonucleic acid probes: one case of trisomy 21 that was detected in maternal blood taken 1 week after chorionic villus sampling and one case of trisomy 18 that was detected in maternal blood taken immediately before chorionic villus sampling. Although our results are promising,‘additional data on the background sensitivity and specificity of in situ hybridization in flow-sorted fetal cells will be necessary to minimize subjective interpretation and permit clinical application.
INFECTIOUS
DISEASES
Diagnosing pelvic inflammatory disease: A comprehensive analysis and considerations for developing a new model
Kahn JG; Walker CK; Washington AE; Landers DV; Sweet RL Institute for Health Policy Studies, School of Medicine, Vniversity of Caltfomia. 1388 Sutter St, San Francisco, CA 94109, USA
J AM MED ASSOC 1991 266/18 (2594-2604) Objective - To examine the accuracy of existing diagnostic indicators for pelvic inflammatory disease and to develop guidelines for a new diagnostic model. Data Sources - Studies were identified for the period 1969 through 1990. A Medline search of the English-language literature was conducted using the subject terms pelvic inflammatory disease or salpingitis and diagnosis. In addition, abstracts and bibliographies of articles and books were reviewed. Study Selection - Studies were selected if pelvic inflammatory disease was diagnosed using laparoscopic findings or narrow clinical rules. Of the 15 reports identified, 12 were included in this analysis. The selected studies were grouped by a quality rating based on subject selection, definition of pelvic inflammatory disease, data analysis and other measures. Data Extraction - Diagnostic findings were divided into four categories: historical (symptoms), clinical examination (signs), laboratory, and combinations of the above. Sensitivity and specificity were extracted using raw data.
Int J Gynecol Obstet 39
Data were classified by quality rating. Data Synthesis Historical findings were usually not statistically significant predictors of pelvic inflammatory disease and when they were they tended toward low sensitivity and high specificity, while clinical findings were somewhat more sensitive and about as specific. Several laboratory tests showed consistent value in pelvic inflammatory disease diagnosis, with high sensitivity and specificity. Combinations of indicators permitted high sensitivity or high specificity but not both simultaneously. Conclusions - No single or combination diagnostic indicator was found to reliably predict pelvic inflammatory disease. Combining published evidence with practical clinical considerations, a diagnostic approach is proposed that emphasizes diagnostic sensitivity when clinical presentation is mild and more thorough evaluation when a woman is severely ill. Research is needed to evaluate the accuracy and acceptability of specific diagnostic models and to investigate new diagnostic indicators. Cost of and payment source for pelvic inflammatory diseaw: Trends and projections, 1983 through 2000
Washington AE; Katz P Center for
Reproductive
Health
Medicine, University of California. cisco, CA 94109, USA
Policy
Research,
School of
1388 Sutter St, San Fran-
J AM MED ASSOC 1991 266/18 (2565-2569) Pelvic inflammatory disease (PID) and its sequelae affect millions of women in the United States at substantial costs. To estimate these total costs annually and to determine payment sources, we analyzed data from local, state and national sources. Direct costs for PID and PIDasscciated ectopic pregnancy and infertility were estimated to be $2.7 billion and indirect costs were estimated to be $1.5 billion, for a total cost of $4.2 billion in 1990. Overall, private insurance covered the largest portion of the direct costs of PID (41%), followed by public payment sources (30%). However, the proportion of payments made by private insurance appears to be decreasing, while that by public payment sources is increasing. In the year 2000, costs associated with PID are-projected to approach $10 billion if the current PID incidence persists, with an increasing proportion of this expense burdening public institutions. Prevention of PID is needed both to reduce human suffering and to contain rising costs. Self-reported pelvic inilammatory disease in the United Stat1988 Aral SO; Mosher WD, Cates W Jr Division of STD/HIV Prevention, Center for Prevention Services, Centers for Disease Control, Mailstop E-44, Atlanta, GA 30333, USA J AM MED ASSOC 1991 266/18 (2570-2573)
Objective - To assess any changes in the characteristics of women with self-reported pelvic inllammatory disease (PID) between 1982 and 1988 and to evaluate the role of additional behavioral factors. In 1982, PID was a frequent problem among American women of reproductive age, occurring in one in seven. It was also more common among older (B 30 years) than younger women, more common among blacks than
Citations from the Literature
among whites and more common among formerly married women than among those currently married. Design - We analyzed data on self-reported PID from the cycle IV National Survey of Family Growth, conducted in 1988. Sample - The survey was conducted with a multistage probability sample of 8450 women. Results - The findings from 1982 were all replicated. Additional variables available in 1988 show that PID is more common among women with multiple (two or more) sexual partners (10% to 22%) compared with those with only one lifetime partner (7%) and among women who report a history of sexually transmitted disease (STD) (26%) compared with those with no STD history (10%). Controlling for other variables, age, race, vaginal douching, age at first intercourse, STD history, and number of lifetime partners emerged as independent predictors of self-reported PID among American women of reproductive age. Conclusion - PID is still a widely prevalent condition among American women; PID is associated with a variety of risk factors for STD. Prevention of lower genital tract infection is crucial to avoiding PID and its sequelae. Preventing pelvic inflanunatory
disease
Washington AE; Cates W Jr; Wasserheit JN Center for Reproductive Health Policy Research, School of Medicine, University of California, 1388 Sutter St, San Francisco, CA 94109, USA
J AM MED ASSOC 1991 266/18 (2574-2580) Effective strategies for preventing pelvic inflammatory disease (PID) are crucial to protect women from adverse reproductive consequences and to avoid substantial economic losses. To identify current PID prevention options and assess their efficacy, we conducted a literature search and examined relevant data in published reports. We organized our review by level of participation (i.e., individuals, providers and communities) and prevention (i.e., primary, secondary and tertiary). For individuals, several prevention strategies related to personal protection appear promising, but few have been appropriately evaluated. For providers of health care, five prevention measures are recommended, including such primary prevention activities as counseling and patient education in addition to the usual diagnosis and treatment. Specific evidence supporting the efficacy of these provider practices, however, is limited. For communities, maintaining comprehensive sexually transmitted disease control strategies to prevent lower genital tract chlamydial and gonococcal infection is most important in reducing both symptomatic and asymptomatic PID. We provide specific recommendations for preventing PID and outline research needs. Pathogenesis of pelvic inflammatory
disease:
What
are the
questions?
Rice PA; Schachter J Maxwell FinlandLaboratory of Infectious Diseases, Boston City Hospital,
774 Albany St, Boston, MA 02118, USA
J AM MED ASSOC 1991 266/18 (2587-2593) Pelvic inflammatory disease is usually caused by Chlamydia trachomatis or Neisseria gonorrhoeae. Chlamydiae and
69
gonococci are primary pathogens of the cervix and often ascend. Resultant damage to the cervix may permit organisms to move upward, but this mechanism of action is not well understood. Puberty and hormones, particularly oral contraceptives, may enhance chlamydial infection, but the mechanisms and likelihood of spread to the upper tract are ill defined. Upper tract infection with C. trachomatis involves an acute phase, characterized by an influx of polymorphonuclear leukocytes and a chronic or persistent phase characterized by the presence of mononuclear cells (delayed hypersensitivity). Gonococci invade nonciliated epithelial cells, but are toxic to ciliated cells, due to elaborated lipooligosaccharides and peptidoglycan. Certain gonococci stimulate chemotaxis of polymorphonuclear leukocytes whose release of toxic metabolites may damage tissue. The immunologic mechanisms that permit specific host responses to these two organisms are now being elucidated and should receive more attention by researchers. Pelvic inflammatory disease: Key treatment issues and options Peterson HB; Walker CK; Kahn JG; Washington AE; Eschenbath DA; Faro S WornenS Health and Fertility Branch, Division of Reproductive Health, Centers for Disease Control, Mailstop K-34, 1600 Clifton Rd NE, Atlanta. GA 30333, USA
J AM MED ASSOC 1991 26608 (2605-2611) Objective - To examine available data regarding optimal antimicrobial therapy for pelvic inflammatory disease (PID) and to address selected treatment issues confronting clinicians caring for women with PID. Data Sources - Studies evaluated to help establish the Centers for Disease Control’s 1989 Sexually Transmitted Diseases Treatment Guidelines and other reports published since 1985. A MEDLINE search of Englishlanguage literature was conducted using the indexing terms ‘pelvic inflammatory disease’ or ‘pelvic infections’ or ‘salpingitis’and ‘treatment.’ In addition, abstracts and bibliographies of articles and books were reviewed. Study Selection - Studies were selected for detailed review if they evaluated the effectiveness of an antimicrobial regimen for treatment of PID. Data Extraction - All studies were evaluated to determine the numbers of women treated and the percentage with clinical or microbiologic evidence of cure. Data Synthesis - A variety of combination antimicrobial regimens are highly effective in providing clinical and microbiologic evidence of cure; few data are available to assess optimal therapy for prevention of late sequelae. Because PID is polymicrobial in cause, recommended antimicrobial regimens are broad-spectrum in coverage. Conclusions - No single agent that provides sufficient coverage is currently available. Several combination regimens appear highly effective clinically even among women with tuboovarian abscess formation. Uncertainties regarding the effectiveness of antimicrobial therapy for prevention of late sequelae complicate decisions regarding the choice among regimens and the appropriateness of ambulatory treatment of women with PID. Pending better data, hospitalization should be strongly considered, where feasible, particularly for those women with PID desiring further childbearing. Sex partners of all women with PID should be treated. Int J Gynecol Obstet 39