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Introduction: Point-of-care ultrasound (POCUS) is a screening and diagnostic modality frequently used in the emergency department to assess patients with abdominal pain.Case Report: We present a case describing the unusual finding of intraperitoneal fluid with loculations visualized in the right upper quadrant of the abdomen in a patient ultimately diagnosed with pelvic inflammatory disease (PID) with ruptured tubo-ovarian abscess caused by group A streptococcus (GAS), a pathogen rarely implicated in the disease.Conclusion: Uncommon findings on abdominal POCUS should trigger further investigation. In a patient not responding to antibiotics administered for typical PID coverage, GAS should be considered as a possible etiology and a penicillin-based antibiotic administered to prevent progression to tubo-ovarianabscess formation, peritonitis, and sepsis.

Background and aim: The present meta-analysis aims to investigate a potential link between pelvic inflammatory disease (PID) and an increased risk of genitourinary cancers (ovarian, cervical, uterus, and vagina cancers). While previous research has hinted at a possible link, this meta-analysis seeks to delve deeper into the available evidence. Understanding this association is crucial for preventive strategies and improving clinical management practices. Methodology: A comprehensive literature search was conducted across various databases, covering studies published between 2016 and 2024. We included 13 observational studies meeting stringent criteria, followed by meticulous data extraction and quality assessment. Meta-analytical techniques were then employed to calculate pooled odds ratios (ORs), adjusted hazard ratios (HRs), and 95% confidence intervals (CIs), with heterogeneity assessed using the I2 statistic. Results: Our analysis revealed significant findings, underscoring the association between PID and increased risks of genitourinary cancers. Specifically, individuals with a history of PID demonstrated notably higher odds of developing ovarian cancer (OR = 1.477, 95% CI 1.033–2.207), uterine cancer (OR = 1.263, 95% CI 0.827–2.143), cervical cancer (OR = 1.000, 95% CI 0.900–1.100), and vaginal cancer (OR = 2.500, 95% CI 1.400–4.000) compared to those without such a history. The overall heterogeneity across studies was high (I2 = 82.92%), suggesting varying trends across different populations and study designs. Conclusion: This meta-analysis provides updated evidence supporting a significant association between PID and an increased risk of cervical, ovarian, and uterine cancers. Early detection and management of PID are crucial in potentially mitigating the risk of these cancers. [ABSTRACT FROM AUTHOR]

Distinguishing between primary (PID) and secondary (SID) immunodeficiencies, particularly in relation to hematological B-cell lymphoproliferative disorders (B-CLPD), poses a major clinical challenge. We aimed to analyze and define the clinical and laboratory variables in SID patients associated with B-CLPD, identifying overlaps with late-onset PIDs, which could potentially improve diagnostic precision and prognostic assessment. We studied 37 clinical/laboratory variables in 151 SID patients with B-CLPD. Patients were classified as "Suspected PID Group" when having recurrent-severe infections prior to the B-CLPD and/or hypogammaglobulinemia according to key ESID criteria for PID. Bivariate association analyses showed significant statistical differences between "Suspected PID"- and "SID"-groups in 10 out of 37 variables analyzed, with "Suspected PID" showing higher frequencies of childhood recurrent-severe infections, family history of B-CLPD, significantly lower serum Free Light Chain (sFLC), immunoglobulin concentrations, lower total leukocyte, and switch-memory B-cell counts at baseline. Rpart machine learning algorithm was performed to potentially create a model to differentiate both groups. The model developed a decision tree with two major variables in order of relevance: sum κ + λ and history of severe-recurrent infections in childhood, with high sensitivity 89.5%, specificity 100%, and accuracy 91.8% for PID prediction. Identifying significant clinical and immunological variables can aid in the difficult task of recognizing late-onset PIDs among SID patients, emphasizing the value of a comprehensive immunological evaluation. The differences between "Suspected PID" and SID groups, highlight the need of early, tailored diagnostic and treatment strategies for personalized patient management and follow up. [ABSTRACT FROM AUTHOR]

Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are widespread, treatable sexually transmitted infections (STIs) of global significance, affecting millions annually. Left untreated, they pose significant risks, including pelvic inflammatory disease (PID), infertility, and complications during pregnancy. The U.S. Centers for Disease Control recommends annual chlamydial screening for sexually active women to address these risks. Responding to this global challenge, the World Health Organization (WHO) has formulated a global health sector strategy on sexually transmitted infections, outlining priority actions to strengthen STI responses in countries. However, STI epidemiological studies encounter challenges in developing nations like Egypt due to socio-cultural factors, poverty, and limited diagnostic facilities. In Egypt, STI diagnosis primarily relies on clinical presentations, lacking structured screening programs for CT and NG. This study's main objective is to estimate the prevalence of Chlamydial and gonorrheal infections, advocating for supportive STI strategies in Egypt. Additionally, the study aims to provide a foundation for national prevalence estimates of CT and NG infections. Methods: A cross-sectional study encompassed five antenatal clinics in different regions of Egypt. A total of 1040 pregnant women attending these clinics were consecutively sampled. Data collection involved structured questionnaires, and urine samples were subjected to the GeneXpert CT/NG qualitative real-time PCR test. Results: The prevalence of CT infections was 0.29% (95% CI, 0.10–0.86%), with no detected NG infections. The three CT-positive cases were distributed across different recruitment centers, with no statistically significant differences observed between infected and non-infected participants. Notably, 40.3% of recruited women reported gynecological symptoms, primarily discharge. Additionally, 9.6% had undergone previous testing for sexually transmitted infections, with 8.2% receiving positive results. Conclusions: This study provides valuable data on the prevalence of CT and NG infections among pregnant women attending ANC clinics in Egypt. The findings underscore the importance of ongoing surveillance, routine screening, and targeted interventions to ensure the reproductive health and well-being of pregnant women and their infants. Further research is warranted to explore the broader implications of STIs in different populations and to inform evidence-based guidelines for screening and management in diverse settings. Trial registration: IRB no.: 17,400,017; WHO ERC Protocol Id. A66005. [ABSTRACT FROM AUTHOR]

Patients who undergo organ transplantation are advised to use contraception for health optimization, yet limited data exists on safe contraceptive options for this population. This study investigates the infection risk of intrauterine devices (IUDs) in patients who have received a solid organ transplant by evaluating the incidence of pelvic inflammatory disease (PID). We performed a retrospective chart review of subjects with a solid organ transplant who used an IUD between the years of January 2007 to February 2021. We included subjects ages 22–55 years at the time of IUD placement. We abstracted demographic information, transplant type, IUD type, immunosuppressive medications, screening for sexually transmitted infections, and diagnosis of PID. We identified 29 subjects that met the inclusion criteria. Six subjects had a copper IUD (21%) and 23 had a levonorgestrel IUD (79%). The most common organ transplanted was a kidney (n = 10) and liver (n = 10) while five subjects had multiple organs transplanted. Twenty‐five (86.2%) subjects took immunosuppressive medications at the time of IUD insertion. Twenty‐four (82.8%) patients had their IUD placed after transplantation. The average time of IUD use was 2.5 years.. In our study of IUD use in patients with solid organ transplantation, no patients developed PID. IUDs are a safe contraceptive option for immunosuppressed transplant patients. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to assess the female circumcision (FC) experiences, healthcare needs, and access to health services of foreign university students who are victims of female genital mutilation and studying in Turkey. Methods: This descriptive qualitative study was conducted in the Faculty of Health Science in a state university in Turkey from December 2021 to January 2022. Eight students who had been subjected to FC participated in this study. Data were collected by conducting in‐depth, semistructured online interviews and using a pilot‐tested interview guide. The data were analyzed using inductive thematic analysis. Results: Four themes emerged: "reasons for performing FC, 'health effects of FC,' 'psychological problems linked to FC,' and 'FC survivors' access to health services.'" Students stated that they exposed to this practice because of limiting their womanhood, they experienced problems, such as pelvic pain, infection, loss of sexuality, fear of pregnancy and birth, and they had healthcare needs due to FC but face some barriers. Conclusions: FC negatively affects women's health and has specific healthcare needs. Studying in a different country can be turned into an opportunity to solve the health problems they experience. For this, the right approach with knowledgeable and culturally sensitive health professionals can change stereotypes towards practice. [ABSTRACT FROM AUTHOR]

Purpose: The vaginal microbiota offers valuable insights into women's sexual health and the risk of developing sexually transmitted infections (STIs) and bacterial vaginosis. Despite the public health implications of changes in the vaginal environment, existing data on this topic remain sparse. Methods: Following the PRISMA statement guidelines, we consulted five bibliographic databases, focusing on five main daily habits and behaviors. We included only studies published up to October 2023, investigating the influence of personal hygiene, sexual behaviors, hormonal contraception, smoking, alcohol consumption, and psychosocial stress on the vaginal microbiota using next-generation sequencing. Results: Based on our inclusion criteria, we incorporated 37 studies into this review. Hormonal contraception and personal hygiene were found to promote eubiosis of the vaginal microbiota. In contrast, sexual behaviors, smoking, alcohol consumption, and psychosocial stress were associated with an increased susceptibility to bacterial vaginosis, STIs, and severe pelvic inflammatory diseases due to a modified vaginal microbiota. Black ethnicity emerged as a confounding factor, with this population showing unstable vaginal microbiota. Oral contraception and a stable male sexual partner were found to favor Lactobacillus colonization, acting as a protective factor. Conversely, non-hormonal contraception and unprotected or non-penile/vaginal sexual activity increased the incidence of vaginal inflammation and bacterial vaginosis by disturbing the vaginal microbiota and reducing Lactobacillus abundance. Conclusion: Daily habits and lifestyle can influence the composition of the vaginal microbiota, thereby affecting vaginal health. Disturbances in the vaginal microbiota could be associated factors for STIs and vaginosis. Therefore, prioritizing more appropriate management of the vaginal microbiota is crucial. [ABSTRACT FROM AUTHOR]

Scarce data is available regarding primary immunodeficiency-associated cancers in children in low-middle-income countries. This study aimed to determine the incidence, clinical features and outcomes of primary immunodeficiencies (PIDs)-associated cancers in children presenting to Pakistan's largest public-sector specialised pediatric oncology center. Among 5,748 children with cancers registered over 5 years, only eight patients were found to have PID-associated pediatric malignancies with an incidence of 1.4 per 1,000 cases. The median age at the time of diagnosis was 6.5 years with a male-to-female ratio of 7:1. Only four types of PIDs were found to be associated with cancer in children at our center: Ataxia Telangiectasia in 37.5% (n = 3), hyper-IgE syndrome and IgG deficiency in 25% (each n = 2) and one case (12.5%) of common variable immune deficiency. Six different types of pediatric cancers were associated with PID with a predisposition towards hematological malignancies (n = 7, 87.5%). Only two patients (25%) survived. The median survival of the cohort was 3.5 months. Infection-related mortality was the cause of death in four patients (66%), and the type of PID was the only statistically significant factor associated with the outcome. It is concluded that a lesser proportion of PID-associated pediatric cancers are found in our center as compared to the reported data from high-income countries. PID-associated cancers in children have an abysmal prognosis and infection- related mortality is the major cause of treatment failure. Sensitisation of oncologists to look for any underlying PID, the introduction of PID-screening programs in children and consideration of PID-associated malignancies as a high-risk group for treatment may help improve the outcomes. [ABSTRACT FROM AUTHOR]

This review will describe histological features of infectious diseases involving the urogenital tract, and is organized by organ or location. Emphasis is placed on selected parasitic, viral and bacterial infections that either occur more frequently in the urogenital tract than elsewhere (schistosomiasis), or are of particular importance to the pathologist because of their common occurrence and relation to malignancy (human papillomavirus), or relationship to pelvic inflammatory disease (actinomycosis). Detailed discussions of the life cycle of schistosomiasis and the characteristics of human papillomavirus are included because knowledge of their interactions with the human host is important in order to understand the histological features seen in these infections. The histological features of these infections will be discussed, as well as selected inflammatory conditions that may mimic infection. Only brief comments will be made of bacterial and other viral infections, many of them sexually transmitted, that occur in the urogenital tract and are more commonly diagnosed by means other than histological examination, or may involve the urogenital tract as part of a systemic infection. Cervical cytology is not discussed. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy and mechanism of Gongyanping capsule combined with levofloxacin and ornidazole in the treatment of chronic pelvic inflammatory disease (CPID) based on inflammatory immune regulation, in order to provide clinical guidance for the treatment of CPID patients. Methods: A total of 96 CPID patients admitted to our hospital from March 2021 to March 2023 were selected and divided into study group (n = 48) and control group (n = 48) by random number table method. The control group was treated with levofloxacin and ornidazole, and the study group was treated with Gongyanping capsule combined with lev- ofloxacin and Ornidazole. The clinical efficacy, clinical symptom improvement time, menstrual volume, pelvic inflammatory mass diam- eter, pelvic effusion depth, inflammatory response, immune function, incidence rate of adverse reactions and recurrence rate were com- pared between the two groups. Results: The total effective rate of the study group was 95.83% (46/48), higher than that of the control group (79.17% (38/48) (P < 0.05) The clinical symptom improvement time, in the study group was shorter than that in the control group (P < 0.05), and the menstrual volume was less (P < 0.05) After treatment, the pelvic inflammatory mass diameter was shortened (P < 0.05) and the pelvic effusion depth was decreased (P < 0.05) and the pelvic inflammatory mass diameter in the study group was shorter than that in the control group (P < 0.05), and the pelvic effusion depth was lower(P<0.05). After treatment, the levels of interleukin-1ẞ (IL-1β), tumor necrosis factor-a(TNF-α), monocyte chemoattractant protein-1(MCP-1) and interferon-y(IFN-y) in two groups were decreased P < 0.05 ), and the levels in the study group were lower than those in the control group(P<0.05). After treatment, CD4+, CD4+/CD8+ increased in both groups (P < 0.05), and CD8+, immunoglobulin A (IgA), immunoglobulin G (IgG) and immunoglobulin M (IgM) decreased (P < 0.05) and CD4+, CD4+/CD8+ in the study group were higher than those in the control group (P < 0.05) CD8+, IgA, IgM and IgG were lower P < 0.05 ). There was no significant difference in the incidence rate of adverse reactions between the two groups (P > 0.05) . The recurrence rate of the study group was 2.08%(1/48), which was lower than that 16.67%(8/48) of the control group (P < 0.05) Conclusion: Gongyanping capsule combined with levofloxacin and Ornidazole has high clinical efficacy in the treatment of CPID patients, which can accelerate the relief of clinical symptoms, reduce menstrual volume, improve the pelvic inflammatory mass diameter and pelvic effusion depth, without increas- ing adverse reactions and avoiding disease recurrence, the mechanism of action may be related to the regulation of inflammatory and im- mune function of patients. [ABSTRACT FROM AUTHOR]

Background: Inadequate surgical interventions can lead to serious complications such as tubo-ovarian abscesses in the upper female genital system, often resulting from untreated pelvic inflammatory disease. Pelvic inflammatory disease, caused by infections like Chlamydia trachomatis and Neisseria gonorrhoeae, leads to scarring and adhesions in the reproductive organs, with common risk factors including intrauterine device use and multiple sexual partners. Pelvic inflammatory disease primarily affects sexually active young women and can manifest with varied symptoms, potentially leading to complications like ectopic pregnancy, infertility, and chronic pelvic pain if untreated. Case presentation: This case report presents a unique scenario involving a 17-year-old sexually inactive female who experienced concurrent tubo-ovarian abscess, acute cystitis, and pancolitis following laparoscopic ovarian cystectomy. Pelvic inflammatory disease and its complications are well-documented, but the simultaneous occurrence of acute cystitis and pancolitis in this context is unprecedented in the medical literature. The patient's presentation, clinical course, and management are detailed, highlighting the importance of considering diverse and severe complications in individuals with a history of gynecological surgeries. Conclusions: Our case report highlights the need for healthcare professionals to remain vigilant for atypical presentations of gynecological complications and emphasizes the value of interdisciplinary collaboration for optimal patient care. We encourage further research and awareness to enhance understanding and recognition of complex clinical scenarios associated with gynecological procedures. [ABSTRACT FROM AUTHOR]

Background While Korea maintains a low prevalence of human immunodeficiency virus (HIV), the number of newly diagnosed cases has been steadily rising, reaching approximately 1,000 annually in recent years. The 2022 annual report from the Korea Disease Control and Prevention Agency revealed that women living with HIV (WLWH) constitute 6.4% of the total confirmed people living with the HIV population, totaling 1,219 individuals. Despite this, only a few studies have focused on WLWH in Korea. This study aims to analyze the epidemiological and clinical characteristics of WLWH in Korea. Materials and Methods We retrospectively collected data by reviewing the medical records of all WLWH who visited 10 urban referral hospitals across Korea between January 2005 and May 2023. Results A total of 443 WLWH were enrolled in this study. The predominant risk exposure was heterosexual contact, with 235 (53%) participants either married or cohabiting with a male partner at their initial clinic visit. Among the participants, 334 (77.7%) were Korean, 27 (6.1%) were Southeast Asian, and 19 (4.3%) were African. Antiretroviral therapy was initiated by 404 WLWH (91.2%). We observed 118 pregnancies in WLWH following their HIV diagnosis, resulting in 78 live births (66.1%), 18 induced abortions (15.2%), 10 pre-viable fetal losses (8.5%), and four stillbirths (3.4%). Over a cumulative follow-up duration of 3,202.1 years, the incidence rates of breast and cervical cancers were both 2.18 per 1,000 person-years. Additionally, the incidence rates of pelvic inflammatory disease, cervical intraepithelial neoplasm (above grade II), and osteoporosis were 4.67, 11.21, and 13.39 per 1,000 patient-years, respectively. Conclusion This is the first multicenter study to investigate the clinical and epidemiological characteristics of WLWH in Korea. The incidence and prevalence of diseases in women, including breast cancer, cervical cancer, and chronic comorbidities, are high in WLWH in Korea; therefore, further research and efforts are needed to manage these diseases. [ABSTRACT FROM AUTHOR]

Pelvic inflammatory disease is an infectious condition affecting women's upper genital tract, including the uterus, fallopian tubes, and ovaries. It primarily arises from an infection that spreads upward from the lower genital area. The relationship between chronic pelvic pain and coexisting conditions is a key focus in its diagnosis and treatment. This type of pain is also considered a form of reflex dystrophy, involving both neurological and psychological components, the first line treatment consists in antibiotherapy. For patients with complex or severe pelvic abscesses, surgical intervention may be considered in selected cases. The primary surgical techniques employed are open and laparoscopic surgery, both aimed for abscess removal. MRI or Doppler ultrasonography may be employed when there is a suspicion of adnexal torsion, adenomyosis or deep pelvic endometriosis, especially if the ultrasound results are unclear or inconclusive Laparoscopic surgery has increasingly become favored by both healthcare professionals and patients. Moreover, laparoscopy has emerged as the most valuable tool for diagnosing chronic pelvic pain. The approach to treating pelvic abscesses in women of reproductive age depends greatly on clinical assessments, individual patient factors, and the desire to preserve fertility. However, laparoscopy may present technical difficulties in patients with severe pelvic abscesses, particularly those with extensive adhesions or a closed-off pelvic area, requiring advanced surgical expertise. Women with associated conditions such as endometriosis often experience a more severe form of pelvic inflammatory disease, which is less responsive to antibiotics and more frequently requires surgical resolution. The surgical treatment should be performed individualized to the clinical condition of the patient and the time of intervention must be carefully chosen. [ABSTRACT FROM AUTHOR]

To compare the physical and mental health of sexual and gender minority (SGM) parents to SGM non-parents. A cross-sectional analysis using 2018–2020 data from The PRIDE Study, a national longitudinal cohort of SGM adults. We used Poisson regression adjusted for age, gender, relationship status, race/ethnicity, household income, and education to assess the association between parental status and each outcome. Among 9625 SGM participants, 1460 (15 %) were parents. Older participants were more likely to be parents: 2% of participants aged 18–30, 18% aged 30–39, and 38% aged 40+ were parents. In adjusted analyses, parenthood was associated with greater depression, anxiety, and post-traumatic stress symptoms as well as ever cigarette smoking. Among individuals assigned female sex at birth, parents were twice as likely to have been diagnosed with pelvic inflammatory disease compared to non-parents. There was no association between parenthood status and alcohol use, substance use, diabetes, HIV, hypertension, or autism. In this national cohort of SGM adults, parenthood was associated with differences in physical and mental health measures. Understanding how parenthood influences the health and well-being of the estimated 3 million SGM parents in the US will help our health systems support diverse families. [ABSTRACT FROM AUTHOR]

Tubo-ovarian abscesses (TOAs) are identified as a severe and complex form of inflammatory disorder, marking an advanced progression of pelvic inflammatory disease (PID), mainly resulting from the escalation of polymicrobial infections within the female genital tract. This literature review is dedicated to elucidating the contemporary management strategies and associated complications of TOAs, amalgamating the current scholarly discourse while spotlighting the emerging therapeutic trends. The inherent complexity of TOAs, manifesting through a broad array of clinical presentations from mild symptoms to acute pelvic discomfort and fever, necessitates a comprehensive, multidisciplinary approach to achieve effective management. Traditional management has predominantly focused on antibiotic therapy, the cornerstone of initial treatment modalities. Nonetheless, this review expands on the increasing acknowledgment of minimally invasive surgical interventions, like ultrasound-guided drainage, especially in scenarios where medical therapy falters or in the presence of sizable abscesses, underscoring scenarios where antibiotic treatment may be insufficient. The discourse further explores the pivotal decision-making concerning surgical interventions, juxtaposing the benefits of abscess resolution against potential risks and complications, such as damage to adjacent structures and implications for future fertility. The review emphasizes the criticality of addressing PID's risk factors and root causes to avert TOA development. It also ventures into the ramifications of the emergence of antibiotic-resistant bacterial strains for empirical antibiotic therapy selection, highlighting the imperative for continuous research and the adaptation of therapeutic guidelines. The complications associated with TOAs, including sepsis, infertility, and chronic pelvic pain, are meticulously examined to underscore the potential for significant long-term morbidity. Advocating for prompt diagnosis and encompassing management strategies to curtail these adverse outcomes, the review ultimately calls for intensified, quality research to refine TOA management further, particularly against the backdrop of evolving microbial resistance and the advancements in minimally invasive surgical technologies. [ABSTRACT FROM AUTHOR]

Aim: Primary immunodeficiencies (PIDs) are a heterogeneous disorder group characterized by an impaired immune system, leading to an increased susceptibility to infections and a wide range of clinical manifestations, including gastrointestinal (GI) complications. This study aimed to assess the GI manifestations of PID patients and highlight the significance of atypical gastrointestinal symptoms in the early diagnosis of these patients. Methods: A retrospective analysis was conducted on pediatric patients diagnosed with PIDs at Selcuk University Medical Faculty from 2011 to 2021. The study focused on demographic data, clinical presentation, genetic mutations, and GI manifestations, including endoscopic evaluation. Patients were categorized according to the International Union of Immunological Societies (IUIS) PID classifications. Statistical analyses were performed to identify significant associations between PID types and GI manifestations. Results: The cohort comprised 101 patients, with 46% presenting with GI symptoms, including malnutrition and chronic diarrhea, as the most common findings. Primary antibody deficiency (PAD) emerged as the most prevalent PID with GI involvement, followed by combined immunodeficiencies (CID) with associated or syndromic features. Endoscopic evaluations revealed inflammatory bowel disease (IBD)-like colitis in a significant subgroup of patients. The analysis showed that some GI symptoms were more common in specific PID categories, highlighting the importance of early gastroenterological assessment in PID patients. Conclusion: Recognition of common GI symptoms in pediatric patients with PIDs may facilitate early diagnosis and prompt multidisciplinary management, potentially improving patient outcomes. The study highlights the necessity of considering PIDs in diagnosing persistent or severe GI symptoms in children. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for readmission following methotrexate treatment for tubal pregnancy. Methods: A retrospective study undertaken in two tertiary medical centers, including all individuals with medically treated tubal pregnancy (N = 511), between December 2009 and June 2021. Individuals with and without readmission following methotrexate treatment were compared. The primary outcome was the readmission rate. Secondary outcomes included the rate of post‐discharge gynecological emergency department visits, tubal rupture rate, and the eventual need for surgical treatment. Results: Readmission following methotrexate treatment occurred in 224/511 patients (43.8%). Most readmissions were due to abdominal pain or suspicion of treatment failure. Readmitted individuals were more likely to have a history of pelvic inflammatory disease and pretreatment serum human chorionic gonadotropin (hCG) >2000 mIU/mL. Both factors remained significantly associated with higher readmission rates in a logistic regression analysis (adjusted odds ratio [OR] 6.28, 95% confidence interval [CI] 1.30–30.45, and adjusted OR 2.73, 95% CI 1.83–4.07, respectively) after adjustment for age, endometriosis, tubal pathology, abdominal pain, and presence of yolk sac or embryo at diagnosis. A dose‐dependent association was observed between pretreatment serum hCG levels and readmission rate (P < 0.001). Pretreatment hCG levels were also associated with tubal rupture and the eventual need for surgical treatment (P < 0.001 for both). A prediction model using hCG was not sufficiently accurate to predict readmission risk. Conclusion: Readmission following methotrexate treatment for tubal pregnancy was independently associated with previous pelvic inflammatory disease and pretreatment serum hCG levels. The latter was also associated with surgical intervention rate. Synopsis: Readmission following methotrexate treatment for tubal pregnancy was associated with previous PID and pretreatment hCG levels. The latter was also associated with surgical intervention rate. [ABSTRACT FROM AUTHOR]

The "Guidelines of the Polish Society of Gynecologists and Obstetricians on the management of women with endometriosis" offer recommendations for treating and managing endometriosis, emphasizing personalized clinical evaluation, imaging tests, and pharmacotherapy. Surgical options like laparoscopy and excision of endometriotic foci are suggested in specific cases, along with adjunctive treatments like dietary changes and psychological counseling. Endometriosis can cause symptoms like pelvic pain and infertility, and treatment involves a multidisciplinary approach including surgery, medication, and assisted reproductive techniques to improve quality of life and fertility outcomes. Ongoing research explores the potential link between endometriosis and certain cancers, although the absolute risk increase is small. [Extracted from the article]

Background: The implantation and growth of the blastocyst outside of the endometrial lining of the uterine cavity are known as ectopic pregnancy. In our nation, ectopic pregnancy continues to be a major cause of maternal mortality in the first trimester, accounting for about 9% of pregnancy-related deaths. It can have very bad and deadly consequences, including as severe bleeding and maternal death. Therefore, this study is critical to the prevention of problems and enhancement of maternal outcomes by early and correct diagnosis through clinical presentation and investigation. Aim and Objectives: The study aimed to evaluate the clinical presentations and maternal outcomes of ectopic pregnancy cases attending a tertiary care hospital. Materials and Methods: This observational cross-sectional study was conducted in a tertiary care hospital. The 12-months study ran from January 1, 2023, to December 31, 2023, in the dept. of Obstetrics and Gynaecology of Midnapore Medical College and Hospital in West Bengal, India. This study comprised 100 diagnosed cases of ectopic pregnancy. To evaluate the age, socioeconomic status, gravida, gestational period, risk factors, clinical presentation, and maternal outcome of an ectopic pregnancy, data on these patients were recorded and statistical analysis was performed. Results: Of the 100 diagnosed cases of ectopic pregnancy, 72% were aged 21-30, and all were from rural areas. Most patients (61%) had a poor socioeconomic status. The obstetric status varied, with G3 being the most common (33%). A majority (62%) presented between 6 and 8 weeks of amenorrhea. Risk factors included pelvic inflammatory disease (21%), previous surgery (21%), and abortions (16%). Common symptoms were amenorrhea (98%), abdominal pain (85%), and vaginal bleeding (66%). Physical examinations revealed forniceal fullness (72%) and tenderness (65%). Positive pregnancy tests were universal, and 82% had USG findings suggesting ectopic pregnancy. The right fallopian tube was the most common site (63%), with 86% presenting with ruptured ectopic pregnancies. Most (94%) required emergency surgery, predominantly salpingectomy (85%). Blood transfusions were needed in 60% of cases, and 20% required ICU admission. Post-operative complications occurred in 14% of patients, with no mortality reported during the study period. Conclusion: Community education is crucial to urge women to attend health facilities as soon as they develop symptoms, as tubal rupture is a common occurrence in our system. For women who experience ectopic pregnancies, this strategy can greatly lower the risk of complications and improve outcomes. Overall, our study underscores the importance of early recognition, accurate diagnosis, and prompt intervention to optimize maternal outcomes in the management of ectopic pregnancy. By outlining the risk factors as well as the clinical course of ectopic pregnancy in our hospital setting, our findings aim to improve clinical practice and direct future research efforts in this field. [ABSTRACT FROM AUTHOR]

Objective: Fitz-Hugh-Curtis Syndrome (FHCS) is an inflammation of the liver capsule as a complication of pelvic inflammatory disease (PID) in sexually active women, mostly associated with Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae. Classically presenting as sharp right upper quadrant pain, usually accompanied salpingitis and ascites. With nonspecific clinical presentation and poor specificity, definitive diagnosis needs tissue biopsy and culture by laparoscopy. Case report: We report the case of a 22-year-old female with a 2-month history of abdominal pain and distention. Symptomatic relief when supportive treatments were given, with the ultrasound and PET-CT suggested advanced bilateral ovarian cancer. After metagenomic next-generation sequencing (mNGS) detected C. trachomatis in ascitic fluid. Following anti-infective medication, clinical improvement was satisfactory and the patient was discharged. Conclusion: FHCS with distention was rare and challenging to diagnose. The mNGS would be a potent, non-invasive pathogen detection method with significant sensitivity and specificity.

Pelvic inflammatory disease is an infectious condition affecting women’s upper genital tract, including the uterus, fallopian tubes, and ovaries. It primarily arises from an infection that spreads upward from the lower genital area. The relationship between chronic pelvic pain and coexisting conditions is a key focus in its diagnosis and treatment. This type of pain is also considered a form of reflex dystrophy, involving both neurological and psychological components, the first line treatment consists in antibiotherapy. For patients with complex or severe pelvic abscesses, surgical intervention may be considered in selected cases. The primary surgical techniques employed are open and laparoscopic surgery, both aimed for abscess removal. MRI or Doppler ultrasonography may be employed when there is a suspicion of adnexal torsion, adenomyosis or deep pelvic endometriosis, especially if the ultrasound results are unclear or inconclusive Laparoscopic surgery has increasingly become favored by both healthcare professionals and patients. Moreover, laparoscopy has emerged as the most valuable tool for diagnosing chronic pelvic pain. The approach to treating pelvic abscesses in women of reproductive age depends greatly on clinical assessments, individual patient factors, and the desire to preserve fertility. However, laparoscopy may present technical difficulties in patients with severe pelvic abscesses, particularly those with extensive adhesions or a closed-off pelvic area, requiring advanced surgical expertise. Women with associated conditions such as endometriosis often experience a more severe form of pelvic inflammatory disease, which is less responsive to antibiotics and more frequently requires surgical resolution. The surgical treatment should be performed individualized to the clinical condition of the patient and the time of intervention must be carefully chosen.

Abstract Background Inadequate surgical interventions can lead to serious complications such as tubo-ovarian abscesses in the upper female genital system, often resulting from untreated pelvic inflammatory disease. Pelvic inflammatory disease, caused by infections like Chlamydia trachomatis and Neisseria gonorrhoeae, leads to scarring and adhesions in the reproductive organs, with common risk factors including intrauterine device use and multiple sexual partners. Pelvic inflammatory disease primarily affects sexually active young women and can manifest with varied symptoms, potentially leading to complications like ectopic pregnancy, infertility, and chronic pelvic pain if untreated. Case presentation This case report presents a unique scenario involving a 17-year-old sexually inactive female who experienced concurrent tubo-ovarian abscess, acute cystitis, and pancolitis following laparoscopic ovarian cystectomy. Pelvic inflammatory disease and its complications are well-documented, but the simultaneous occurrence of acute cystitis and pancolitis in this context is unprecedented in the medical literature. The patient’s presentation, clinical course, and management are detailed, highlighting the importance of considering diverse and severe complications in individuals with a history of gynecological surgeries. Conclusions Our case report highlights the need for healthcare professionals to remain vigilant for atypical presentations of gynecological complications and emphasizes the value of interdisciplinary collaboration for optimal patient care. We encourage further research and awareness to enhance understanding and recognition of complex clinical scenarios associated with gynecological procedures.

Objective To investigate the key elements for model establishment and determine the evaluation indicators of animal models for pelvic inflammatory disease (PID), providing a reference for improving modelling methods and optimizing the application of PID animal models. Methods The search query "Pelvic Inflammatory Disease" AND "Animal Model" OR "Rat" OR "Mouse" OR" Guinea Pig" OR "Rabbit" OR "Dog" OR "Pig" was used to retrieve relevant literature on PID animal models published from 2013 to 2023 in China Knowledge Network Infrastructure (CNKI), Wanfang, and PubMed databases. The studies were analyzed and categorized based on experimental animal types, modelling methods, modelling cycles, detection indicators, positive control drugs, and administration duration. A database was established for statistical analysis. Results A total of 214 research articles on PID animal models meeting the inclusion criteria were identified. The most commonly used model animals are Sprague Dawley (SD) rats, followed by Wistar rats. The most frequently employed modelling method is a combination of mechanical injury and bacterial infection, followed by the phenol mucilage method. The most common modelling cycles for acute pelvic inflammatory disease (APID) and chronic pelvic inflammatory disease (CPID)/sequelae of pelvic inflammatory disease (SPID) are 8 to 14 days, while for PID models without specific staging, the cycles are 7 days. High-frequency detection methods and indicators include histopathological observation using hematoxylin-eosin staining, enzyme-linked immunosorbent assay (ELISA) for serum-related indicators, morphological changes of tissues observed with the naked eye, and immunohistochemical detection of related protein expression in uterine tissues, and pathological scoring. The most frequently used positive control drugs are Fuke Qianjin Tablets, followed by Jingangteng Capsules. The most common administration duration for APID is 7 days, and for CPID/SPID models, it ranges from 15 to 21 days. Conclusion Currently, SD rats and Wistar rats are commonly used as experimental animals for PID models. The dual modelling method of mechanical injury combined with mixed bacterial infection aligns closely with clinical pathogenesis and can be used to establish a PID model that simulates postoperative uterine cavity infection. Depending on the research objectives, different positive drugs and detection indicators should be selected for comprehensive evaluation. Most existing PID animal model studies are based on western medical diagnosis, with fewer studies focusing on Traditional Chinese Medicine (TCM) syndromes. There is a need to integrate TCM theories of etiology and pathogenesis to construct PID animal models that are more in line with TCM clinical symptoms.

Objectives: Doxycycline is commonly prescribed as the primary prophylactic treatment for women undergoing hysterosalpingography (HSG). This study aimed to compare the prophylactic effectiveness and safety of azithromycin and doxycycline in terms of treating infections caused by HSG. Materials and Methods: This double-blind randomized clinical trial enrolled 107 women referred to Amiralmomenin Hospital in Arak, Iran, for HSG. After evaluation based on inclusion and exclusion criteria, the participants were randomly allocated to either the doxycycline or azithromycin group. The primary outcome was the incidence of adverse effects. The patients were also followed up to determine PCR test results for the clearance of chlamydia infection. Results: The cumulative incidence of side effects was 1.85% in the doxycycline group, with adverse effects observed in only one patient. Conversely, no adverse effects were reported in the azithromycin group (P = 0.505). In the doxycycline group, one patient (1.85%) tested positive in the PCR test, while no positive PCR tests were recorded in the azithromycin group. Neither group exhibited cases of fever or required additional treatments. The results of statistical analyses did not reveal any statistically significant differences between the compared groups (P > 0.05). Conclusions: A single dose of azithromycin could be considered interchangeable with a 1-week course of doxycycline as antibiotic prophylaxis in women undergoing HSG, as it provides similar effectiveness and safety.

The sequelae of pelvic inflammatory disease (SPID) is a gynecological disease that seriously affects the reproductive health and quality of life of women of childbearing age, which is repeated and intractable. In traditional Chinese medicine (TCM), it belongs to the categories of women's abdominal pain, zhengjia, infertility, etc. The uterus xuanfu-collaterals can maintain the orderly progress of female physiological function by adjusting the circulation of qi and liquids, and also play an important role in the pathological process of SPID. If the opening and closing of the uterus xuanfu-collaterals are orderly, and the qi and liquids are circulating smoothly, the pelvic microcirculation will maintain a balance of homeostasis. If the uterus xuanfu-collaterals are stagnated, the qi and liquids do not circulate smoothly, the pelvic microcirculation will be disordered, leading to the occurrence of SPID. Therefore, from the perspective of the pathogenesis of xuanfu-collaterals stasis, taking opening xuanfu and dredging collaterals as the treatment method, it can be used to smooth qi, relieve stagnation, supplement deficiency, and remove blockage in order to restore the microcirculation in the pelvic region, which can provide new ideas and methods for the treatment of SPID with TCM. [ABSTRACT FROM AUTHOR]

Objective To investigate the key elements for model establishment and determine the evaluation indicators of animal models for pelvic inflammatory disease (PID), providing a reference for improving modelling methods and optimizing the application of PID animal models. Methods The search query "Pelvic Inflammatory Disease" AND "Animal Model" OR "Rat" OR "Mouse" OR" Guinea Pig" OR "Rabbit" OR "Dog" OR "Pig" was used to retrieve relevant literature on PID animal models published from 2013 to 2023 in China Knowledge Network Infrastructure (CNKI), Wanfang, and PubMed databases. The studies were analyzed and categorized based on experimental animal types, modelling methods, modelling cycles, detection indicators, positive control drugs, and administration duration. A database was established for statistical analysis. Results A total of 214 research articles on PID animal models meeting the inclusion criteria were identified. The most commonly used model animals are Sprague Dawley (SD) rats, followed by Wistar rats. The most frequently employed modelling method is a combination of mechanical injury and bacterial infection, followed by the phenol mucilage method. The most common modelling cycles for acute pelvic inflammatory disease (APID) and chronic pelvic inflammatory disease (CPID)/sequelae of pelvic inflammatory disease (SPID) are 8 to 14 days, while for PID models without specific staging, the cycles are 7 days. High-frequency detection methods and indicators include histopathological observation using hematoxylin-eosin staining, enzyme-linked immunosorbent assay (ELISA) for serum-related indicators, morphological changes of tissues observed with the naked eye, and immunohistochemical detection of related protein expression in uterine tissues, and pathological scoring. The most frequently used positive control drugs are Fuke Qianjin Tablets, followed by Jingangteng Capsules. The most common administration duration for APID is 7 days, and for CPID/SPID models, it ranges from 15 to 21 days. Conclusion Currently, SD rats and Wistar rats are commonly used as experimental animals for PID models. The dual modelling method of mechanical injury combined with mixed bacterial infection aligns closely with clinical pathogenesis and can be used to establish a PID model that simulates postoperative uterine cavity infection. Depending on the research objectives, different positive drugs and detection indicators should be selected for comprehensive evaluation. Most existing PID animal model studies are based on western medical diagnosis, with fewer studies focusing on Traditional Chinese Medicine (TCM) syndromes. There is a need to integrate TCM theories of etiology and pathogenesis to construct PID animal models that are more in line with TCM clinical symptoms. [ABSTRACT FROM AUTHOR]

Objective: To investigate the application value of Pelvic Inflammation No. 1 formula of transdermal meridian pointtargeted drug delivery therapy in the treatment of patients with chronic pelvic inflammatory disease (damp-heat stasis type). Methods: All patients with chronic pelvic inflammatory disease (damp-heat stasis type) visited Danzhou Hospital of Traditional Chinese Medicine from August 2017 to March 2021 and were randomly grouped, 57 patients in the control group were treated with simple Western medicine, and 57 patients in the observation group were combined with Pelvic Inflammation No. 1 formula transdermal meridian targeted transdermal medication, and the therapeutic efficacies were compared after 3 months of treatment. Results: After treatment, serum matrix metalloproteinase-9 （MMP-9）, D dimer （D-D）, IL-6 and other indexes in the observation group were lower than those in the control group, and IL-10 was higher than that in the control group, the difference was statistically significant （P<0.05）. After treatment, the carbohydrate antigen CA125 in the observation group was lower than that in the control group, and the CD4+/CD8+ and CD4+ cells in the observation group were higher than those in the control group （P<0.05）. After treatment, the score of summary of health status surveys （SF-36） in the observation group was higher than that in the control group, and the total score of TCM symptoms was lower than that in the control group （P<0.05）. The total effective rate in the observation group was 96.49%（ 55/57）, which was higher than 82.46% （46/57） in the control group （P<0.05）. Conclusion: For patients with chronic pelvic inflammatory disease （damp-heat stagnation type）, combined with Pelvic Inflammation No. 1 formula transdermal via acupoints targeted drug therapy can help to regulate inflammatory factors, regulate immune function, and improve clinical efficacy. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center. Material and methods: A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated. Results: In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% (n = 61) of CSPs were cured with MVA, 24.1% (n = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96 mm vs. 17,34 ± 9,87 mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic ınflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure (p < 0.05). Conclusion: The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases. [ABSTRACT FROM AUTHOR]

Background and Aim: Pelvic inflammatory disease (PID) is usually managed by conservative treatment, but in selected cases, especially in the presence of a tubo‐ovarian abscess (TOA), surgical management is a recognized treatment option. We compared the trends in managing PID and short‐term outcomes before and during the SARS‐CoV‐2 pandemic. Methods: This is a retrospective study performed in three Italian gynecological centers. We included patients admitted to hospital with a diagnosis of PID. Demographic characteristics, management, time to diagnosis, and time to treatment were compared before versus during the SARS‐CoV‐2 pandemic. Results: One hundred nineteen PID patients were screened, eighty‐one before the SARS‐CoV‐2 pandemic, and thirty‐eight after the onset. At admission, leukocytosis (median 19.73 vs. 13.99 WBC/mm3, p‐value = 0.02) was significantly higher in patients who underwent surgery after the onset of the pandemic. TOA incidence was higher in patients who underwent surgery during the SARS‐CoV‐2 pandemic, but the difference did not reach statistically significance (p = 0.06). The proportion of patients treated with surgery dropped to 26.3% after the onset from 46% of patients before the onset of pandemic (p = 0.03). Furthermore, a higher percentage of emergency surgical procedures on day 0 of hospital admission were performed after the onset of the pandemic (50% vs. 13.1%, p = 0.01). Conclusions: In this retrospective cohort study, we found that the SARS‐CoV‐2 pandemic influenced the clinical presentation and management of PID in favor of conservative treatment. Patients who underwent surgery during the SARS‐CoV‐2 pandemic had higher inflammatory markers. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Pelvic inflammatory disease associated with cytomegalovirus infection in immunocompetent adults might be difficult to diagnose because of the rarity and relatively inconspicuous symptoms of infectious mononucleosis. Even if the main complaint is lower abdominal pain, careful search for symptoms latent outside the abdomen could lead to the diagnosis. [ABSTRACT FROM AUTHOR]

Rationale: Huahong tablet, a commonly used clinical Chinese patent medicine, shows good efficacy in treating pelvic inflammation and other gynaecological infectious diseases. However, the specific composition of Huahong tablets, which are complex herbal formulations, remains unclear. Therefore, this study aims to identify the active compounds and targets of Huahong tablets and investigate their mechanism of action in pelvic inflammatory diseases. Methods: We utilised ultrahigh‐performance liquid chromatography Q‐Exactive‐Orbitrap mass spectrometry and the relevant literature to identify the chemical components of Huahong tablets. The GNPS database was employed to further analyse and speculate on the components. Potential molecular targets of the active ingredients were predicted using the SwissTargetPrediction website. Protein–protein interaction analysis was conducted using the STRING database, with visualisation in Cytoscape 3.9.1. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using the DAVID database. Additionally, a traditional Chinese medicine–ingredient–target–pathway network was constructed using Cytoscape 3.10.1. Molecular docking validation was carried out to investigate the interaction between core target and specific active ingredient. Results: A total of 66 chemical components were identified, and 41 compounds were selected as potential active components based on the literature and the TCMSP database. Moreover, 38 core targets were identified as key targets in the treatment of pelvic inflammatory diseases with Huahong tablets. GO and KEGG enrichment analysis revealed 986 different biological functions and 167 signalling pathways. Conclusion: The active ingredients in Huahong tablets exert therapeutic effects on pelvic inflammatory diseases by acting on multiple targets and utilising different pathways. Molecular docking confirmed the high affinity between the specific active ingredients and disease targets. [ABSTRACT FROM AUTHOR]

Background Objective Materials and methods Results Discussion and conclusions There are limited data on pelvic pain among transgender men and gender diverse people, and the impact of testosterone on pelvic pain is poorly understood.Characterize the prevalence and correlates of chronic pelvic pain (CPP) among transgender men and gender diverse people and examine the association between testosterone use and CPP.We used 2020–2022 data from The Population Research in Identity and Disparities for Equality (PRIDE) Study, an online prospective cohort study of sexual and gender minority adults in the United States, to conduct complementary cross‐sectional and longitudinal analyses. Our primary outcome was self‐reported CPP lasting 3 months or longer measured using the Michigan Body Map.Among 2579 transgender men and gender diverse people assigned female at birth included in our sample, 457 (18%) reported CPP. CPP correlates included: inflammatory bowel disease, irritable bowel syndrome (IBS), kidney stones, pelvic inflammatory disease, polycystic ovary syndrome (PCOS), uterine fibroids, current hormonal intrauterine device use, prior pregnancy, vaginal delivery, hysterectomy, and oophorectomy. Individuals with CPP reported a high prevalence of IBS (37%), PCOS (20%), uterine fibroids (9%), post‐traumatic stress disorder (51%), and severe depression and anxiety symptoms (42% and 25%, respectively). Current testosterone use was associated with a 21% lower prevalence of CPP (adjusted prevalence ratio (aPR) 0.79, 95% confidence interval [CI]: 0.65–0.96). In longitudinal analyses (N = 79), 15 (19%) participants reported any CPP after initiating testosterone: eight (56%) of whom reported CPP prior to testosterone initiation, and seven (47%) who reported new‐onset CPP.The relationship between CPP and testosterone is complex. Although testosterone use was associated with a lower prevalence of CPP, some transgender and gender diverse individuals experienced new‐onset pelvic pain after testosterone initiation. Given the significant impact that CPP can have on mental health and quality of life, future research must examine the role of testosterone in specific underlying etiologies of CPP and identify potential therapies. [ABSTRACT FROM AUTHOR]

Background: The relationship between leukocyte telomere length (LTL) and female reproductive endocrine diseases has gained significant attention and research interest in recent years. However, there is still limited understanding of the exact impacts of LTL on these diseases. Therefore, the primary objective of this study was to investigate the genetic causal association between LTL and female reproductive endocrine diseases by employing Mendelian randomization (MR) analysis. Methods: Instruments for assessing genetic variation associated with exposure and outcome were derived from summary data of published genome-wide association studies (GWAS). Inverse-variance weighted (IVW) was utilized as the main analysis method to investigate the causal relationship between LTL and female reproductive endocrine diseases. The exposure data were obtained from the UK Biobanks GWAS dataset, comprising 472,174 participants of European ancestry. The outcome data were acquired from the FinnGen consortium, including abnormal uterine bleeding (menorrhagia and oligomenorrhea), endometriosis (ovarian endometrioma and adenomyosis), infertility, polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI) and premenstrual syndrome (PMS). Furthermore, to account for potential confounding factors such as smoking, alcohol consumption, insomnia, body mass index (BMI) and a history of pelvic inflammatory disease (PID), multivariable MR (MVMR) analysis was also conducted. Lastly, a series of pleiotropy tests and sensitivity analyses were performed to ensure the reliability and robustness of our findings. P < 0.0063 was considered to indicate statistically significant causality following Bonferroni correction. Results: Our univariable MR analysis demonstrated that longer LTL was causally associated with an increased risk of menorrhagia (IVW: odds ratio [OR]: 1.1803; 95% confidence interval [CI]: 1.0880–1.2804; P = 0.0001) and ovarian endometrioma (IVW: OR: 1.2946; 95%CI: 1.0970–1.5278; P = 0.0022) at the Bonferroni significance level. However, no significant correlation was observed between LTL and oligomenorrhea (IVW: OR: 1.0124; 95%CI: 0.7350–1.3946; P = 0.9398), adenomyosis (IVW: OR: 1.1978; 95%CI: 0.9983–1.4372; P = 0.0522), infertility (IVW: OR: 1.0735; 95%CI: 0.9671–1.1915; P = 0.1828), PCOS (IVW: OR: 1.0633; 95%CI: 0.7919–1.4278; P = 0.6829), POI (IVW: OR: 0.8971; 95%CI: 0.5644–1.4257; P = 0.6459) or PMS (IVW: OR: 0.7749; 95%CI: 0.4137–1.4513; P = 0.4256). Reverse MR analysis indicated that female reproductive endocrine diseases have no causal effect on LTL. MVMR analysis suggested that the causal effect of LTL on menorrhagia and ovarian endometrioma remained significant after accounting for smoking, alcohol consumption, insomnia, BMI and a history of PID. Pleiotropic and sensitivity analyses also showed robustness of our results. Conclusion: The results of our bidirectional two-sample MR analysis revealed that genetically predicted longer LTL significantly increased the risk of menorrhagia and ovarian endometrioma, which is consistent with the findings from MVMR studies. However, we did not notice any significant effects of LTL on oligomenorrhea, adenomyosis, infertility, PCOS, POI or PMS. Additionally, reproductive endocrine disorders were found to have no impact on LTL. To enhance our understanding of the effect and underlying mechanism of LTL on female reproductive endocrine diseases, further large-scale studies are warranted in the future. [ABSTRACT FROM AUTHOR]

Chlamydia trachomatis (CT) is a sexually transmitted infection that can lead to adverse reproductive health outcomes. CT prevalence estimates are primarily derived from screening using nucleic acid amplification tests (NAATs). However, screening guidelines in the United States only include particular subpopulations, and NAATs only detect current infections. In contrast, seroassays identify past CT infections, which is important for understanding the public health impacts of CT, including pelvic inflammatory disease and tubal factor infertility. Older seroassays have been plagued by low sensitivity and specificity and have not been validated using a consistent reference measure, making it challenging to compare studies, define the epidemiology of CT, and determine the effectiveness of control programs. Newer seroassays have better performance characteristics. This narrative review summarizes the "state of the science" for CT seroassays that have been applied in epidemiologic studies and provides practical considerations for interpreting the literature and employing seroassays in future research. [ABSTRACT FROM AUTHOR]

Aim: To evaluate systematically the magnetic resonance imaging (MRI) features of tubo-ovarian abscess (TOA), the efficacy of diffusion-weighted imaging (DWI) in the assessment of TOA, and the differentiation of TOA from ovarian masses. Material and methods: PubMed/MEDLINE, Web of Science, and ResearchGate were searched with keywords: Tubo-ovarian abscess and Diffusion-weighted magnetic resonance imaging. No restrictions regarding the language or publication year were applied. Inclusion criteria regarded research papers evaluating the role of MRI and DWI in the assessment of TOA, and the differentiation of TOA from ovarian tumours. Studies appearing to meet inclusion criteria were reviewed in full. Results: A total of 14 studies were included. TOA is usually presented as a multilocular, cystic, pelvic mass with a heterogeneously high signal on T2- weighted (T2W) and low signal on T1-weighted (T1W) images with the “penumbra sign” on T1W images. Following contrast administration, septal and thick wall rim enhancement could be visualized. TOA usually demonstrated hyperintensity on DWI and hypointensity on ADC maps with lower ADC values of cystic, and higher ADC values of solid components compared to ovarian malignancy. TOA was smaller in size, and invasion into adjacent organs and tubal dilatation were more frequent in TOA than in ovarian neoplasms. In comparison to other methods, DWI possessed the highest sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in differentiating TOA from adnexal tumours. Conclusions: The addition of DWI with ADC values improves the detection, characterization, and overall diagnostic accuracy of TOA and its distinction from ovarian malignancy. The combination of DWI with MRI in the assessment of TOA is obligatory. [ABSTRACT FROM AUTHOR]

Objectives: Doxycycline is commonly prescribed as the primary prophylactic treatment for women undergoing hysterosalpingography (HSG). This study aimed to compare the prophylactic effectiveness and safety of azithromycin and doxycycline in terms of treating infections caused by HSG. Materials and Methods: This double-blind randomized clinical trial enrolled 107 women referred to Amiralmomenin Hospital in Arak, Iran, for HSG. After evaluation based on inclusion and exclusion criteria, the participants were randomly allocated to either the doxycycline or azithromycin group. The primary outcome was the incidence of adverse effects. The patients were also followed up to determine PCR test results for the clearance of chlamydia infection. Results: The cumulative incidence of side effects was 1.85% in the doxycycline group, with adverse effects observed in only one patient. Conversely, no adverse effects were reported in the azithromycin group (P = 0.505). In the doxycycline group, one patient (1.85%) tested positive in the PCR test, while no positive PCR tests were recorded in the azithromycin group. Neither group exhibited cases of fever or required additional treatments. The results of statistical analyses did not reveal any statistically significant differences between the compared groups (P > 0.05). Conclusions: A single dose of azithromycin could be considered interchangeable with a 1-week course of doxycycline as antibiotic prophylaxis in women undergoing HSG, as it provides similar effectiveness and safety. [ABSTRACT FROM AUTHOR]

The incidence of ectopic pregnancy (EP) has increased in recent years, owing to causes such as pelvic inflammatory diseases and assisted reproductive technologies (ART). The present study reported a case of a 33-year-old nulliparous woman with a history of previous ectopic pregnancies, who underwent pelvic ultrasound in August 2022, which revealed a double EP including a cervical pregnancy and a tubal stump pregnancy. Despite known risk factors and elevated beta-human chorionic gonadotropin (β-hCG) levels, a conservative approach, utilizing multiple doses of systemic methotrexate (MTX) injections, was employed to preserve fertility at the Regional Perinatal Center in Aktobe, Kazakhstan. Treatment efficacy was monitored through β-hCG levels and ultrasound imaging, with successful resolution of both EPs and preservation of reproductive function. The present case highlighted the safety and efficacy of MTX therapy in managing complex EP presentations, emphasizing the necessity of individualized treatment approaches in reproductive medicine, particularly in terms of preserving fertility in patients undergoing ART. Multiple high doses of MTX injections were beneficial for pregnancy with two distinct regions, fetal cardiac activity, and elevated serum β-hCG level. Further research is required to explore optimal treatment strategies for EP, considering patient-specific factors and treatment goals. [ABSTRACT FROM AUTHOR]

Background: Mycoplasma genitalium is an emerging pathogen, which has been linked to cervicitis, urethritis and pelvic inflammatory disease (PID). With the advent of multiplex polymerase chain reaction (PCR) panels for sexually transmitted infections, it is increasingly being identified in pregnant women. Objectives: The aim was to review international guidelines, which had explicit recommendations for treatment of M. genitalium infection in pregnancy and breastfeeding. Search Strategy: PubMed, EMBASE and Cochrane databases were reviewed with no age, species, language or date restrictions. Selection Criteria: Studies were included if they had an explicit recommendation for treatment of M. genitalium in pregnancy. Studies were excluded if there was no recommendation in pregnancy, if they referred to other international guideline recommendations or were historical versions of guidelines. Data Collection and Analysis: References were manually reviewed and 50 papers were selected for review. Only four guidelines were included in the final analysis and they were from Europe, UK, Australia and Aotearoa New Zealand. Main Results: All studies recommended azithromycin as first‐line treatment, and advised against moxifloxacin use. The dosing schedule of azithromycin, varied between guidelines, as did the utility/safety of pristinamycin for macrolide resistant infections. Safety data was generally reassuring for azithromycin but inconsistent for pristinamycin. Conclusions: Azithromycin is the first‐line treatment for macrolide susceptible or unknown resistance infections, but there is a lack of consistency regarding dosing of azithromycin or the utility/safety of pristinamycin for macrolide resistant infections in pregnancy/lactation. Synopsis: While international guidelines recommend azithromycin as first‐line treatment for M. genitalium infections in pregnancy, there are inconsistencies around second‐line treatment options and azithromycin dosing. [ABSTRACT FROM AUTHOR]

Background: pelvic inflammatory disease (PID) is a common gynecological condition. The dietary inflammatory index (DII) scoring algorithm is a novel tool for evaluating the inflammatory potential of a diet. However, the association between DII and PID remains unexplored. This study aimed to evaluate and quantify the relationship between DII and the risk for PID. Material and methods: the present study included two cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 2015 and 2018. A total of 2769 participants with complete information were enrolled. Weighted univariate and multivariate logistic regression analyses were performed to examine the association between DII and the risk for PID. Subsequently, the association was graphically represented using a restricted cubic spline (RCS). Results: univariate and multivariate regression analyses revealed a strong correlation between DII and PID occurrence. After adjusting for all covariates, the odds ratio for the effect of DII on PID remained significant (OR = 1.220, 95 % CI: 1.024-1.452). The correlation analysis revealed a linear relationship between DII and the risk for PID. Conclusions: this study unravels a significant positive correlation between DII and the risk for PID. This finding highlights the potential of anti-inflammatory diet therapy as a novel therapeutic intervention for PID. However, due to the limitations of the study design, further research is needed to explore this relationship in detail. [ABSTRACT FROM AUTHOR]

Objectives: Chlamydia trachomatis (chlamydia) is one of the most reported bacterial sexually transmitted infections (STI) worldwide. Chlamydia can cause long term complications such as pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI). Changing testing strategies, for example reduced asymptomatic testing, influence chlamydia surveillance, highlighting the need for exploring alternative ways of monitoring chlamydia. We investigated the possibility of introducing routine surveillance of chlamydia related long term complications. Methods: A qualitative study including 15 in-depth interviews with a purposive sample of gynaecologists, general practitioners (GP), sexual health and emergency doctors was conducted in the Netherlands in 2021–2022. A semi-structured interview guide focused on experiences with diagnosis and registration of PID, EP and TFI and how a change in asymptomatic chlamydia testing strategy might influence this. Interviews were transcribed and analysed using a thematic approach. Results: Analysis showed that gynaecologists most frequently reported diagnosing PID, EP and TFI. Other professions rarely diagnose these complications, with emergency doctors only diagnosing EP. Most respondents reported unique registration codes for PID and EP, but the coding for TFI is more ambiguous. They reflected that diagnosis and registration of PID, EP and TFI are handled differently within their professions. Most respondents acknowledged registration in diagnostic codes as a useful surveillance tool. They expressed concerns in representativeness (e.g. differences in interpretation of diagnosis criteria) and data quality for surveillance. Conclusions: Patient files of gynaecologists are likely to be most complete for monitoring trends of diagnosed chlamydia related long term complications in the Netherlands. However, when establishing a chlamydia complication surveillance system, professionals should be engaged in further standardizing diagnosis and registration practices. This will improve the quality and interpretability of complication surveillance and facilitate comparison between countries. [ABSTRACT FROM AUTHOR]

Introduction: Salpingitis is caused by ascending microbes from the lower reproductive tract and contributes to tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. The aim of this study was to analyze if the risk for complications and dissatisfaction after hysterectomy and adnexal surgery was increased in women reporting previous salpingitis. Material and methods: This is an observational cohort study including women undergoing gynecologic surgery from 1997 to 2020, registered in the Swedish National Quality Register of Gynecologic Surgery (GynOp). Patient‐reported previous salpingitis was the exposure. Complications up to 8 weeks and satisfaction at 1 year postoperatively were the outcomes. Multivariable logistic regression and ordinal regression were performed. Results were adjusted for potential confounders including age, body mass index, smoking and year of procedure as well as endometriosis and previous abdominal surgery. Multiple imputation was used to handle missing data. Results: In this study, 61 222 women were included, of whom 5636 (9.2%) women reported a previous salpingitis. There was an increased risk for women reporting previous salpingitis in both the unadjusted and fully adjusted models to have complications within 8 weeks of surgery (adjusted odds ratio [aOR] 1.22, 95% confidence interval [CI] 1.14–1.32). The highest odds ratios were found for bowel injury (aOR 1.62, 95% CI 1.29–2.03), bladder injury (aOR 1.52, 95% CI 1.23–1.58), and postoperative pain (aOR 1.37, 95% CI 1.22–1.54). Women exposed to salpingitis were also more likely to report a lower level of satisfaction 1 year after surgery compared with unexposed women (aOR 0.87, 95% CI 0.81–0.92). Conclusions: Self‐reported salpingitis appears to be a risk factor for complications and dissatisfaction after gynecologic surgery. This implies that known previous salpingitis should be included in the risk assessment before gynecologic procedures. [ABSTRACT FROM AUTHOR]

Objective: The sequelae of pelvic inflammatory disease (SPID) are major causes of secondary infertility. Modified Hongteng Baijiang decoction (MHTBD) has produced positive results in the treatment of patients with chronic pelvic inflammatory disease; however, its role in SPID remains elusive. Therefore, this study clarified the role of MHTBD in SPID pathogenesis. Methods: The main components in MHTBD were analyzed by using liquid chromatography‒mass spectrometry (LC/MS). An SPID rat model was established, and the rats were treated with different doses of MHTBD (0.504 g of raw drug/kg, 1.008 g of raw drug/kg, and 2.016 g of raw drug/kg). Endometrial pinopodes were observed via scanning electron microscopy, endometrial thickness and inflammatory cell infiltration were assessed via HE staining, and the expression of estrogen receptor (ER), progesterone receptor (PR), integrin β3 (ITGB3), and CD31 in the endometrium was detected by using immunohistochemistry. Western blot analysis was used to detect the protein expression of LIF, JAK2, p‐JAK2, STAT3, and p‐STAT3 in the endometrium. Moreover, the changes in the gut microbiota were analyzed via 16S rRNA sequencing. Results: MHTBD improved endometrial receptivity, attenuated endometrial pathologic damage, reduced inflammatory cell infiltration, decreased ER and PR expression in the endometrium, and promoted the expression of LIF, p‐JAK2, and p‐STAT3 in the endometrium (p <.05) in SPID rats. Additionally, MHTBD treatment affected the composition of the gut microbiota in SPID rats. Furthermore, MHTBD attenuated endometrial receptivity and pathological damage in SPID rats by promoting the LIF/JAK2/STAT3 pathway. Conclusion: MHTBD attenuates SPID in rats by promoting the LIF/JAK2/STAT3 pathway and improving the composition of the gut microbiota. MHTBD may be a valuable drug for SPID therapy. [ABSTRACT FROM AUTHOR]

This study explores the causal relationship between endometriosis and pelvic inflammatory diseases (PID). Methods: The study utilized genome-wide association study (GWAS) datasets for endometriosis ("finn-b-N14_ENDOMETRIOSIS") and PID ("finn-b-N14_OTHFEMPELINF"). Subsequently, two-sample Mendelian randomization (MR) analyses were conducted using inverse variance weighting (IVW), Egger regression (MR-Egger), and weighted median (WM) methods. Heterogeneity was evaluated using Cochran's Q test, and in case of detected outliers, they were removed for re-evaluation of MR causality. Results: From the endometriosis GWAS dataset, 33 single nucleotide polymorphisms (SNPs) were selected as instrumental variables. All three methods, IVW (OR = 1.39, P < 1× 10− 8), MR-Egger (OR = 1.41, P = 0.003), and WM (OR = 1.37, P = 1.16× 10− 5) confirmed a causal relationship between endometriosis and PID. The association between endometriosis and pelvic inflammation remained unaffected by the exclusion of individual SNPs. Lastly, Cochran's Q test and funnel plots showed no evidence of SNP asymmetry. Conclusion: The results of the MR analysis support a potential causal relationship between endometriosis and an increased risk of PID. [ABSTRACT FROM AUTHOR]

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