In part 1 of this article, the author discusses the physiology and symptoms associated with cervical ectropion, and the treatment options available for symptomatic women. Copyright © 2009 Wiley Interface Ltd
The objective of the study was to assess the prevalence of Chlamydia trachomatis in our colposcopy clinic. A total of 337 consecutive patients newly referred to the colposcopy clinic between May and November 2003 were screened for chlamydia trachomatis. All our patients were referred by their GPs and none of the patients had had a recent chlamydia test performed. Four patients screened positive, overall giving a prevalence of 1.2% [95% CI 0.04-2.36%]. Three of those with positive results were in the 21 - 30 year age group (139 in the group, which equals 2.2% prevalence [95% CI 0 - 4.6%]). The fourth positive result was in the group over the age of 60. None of those screened in the other age groups was positive (< or =20, 31 - 40, 41 - 50, 51 - 60 years). Numbers screened in each of those groups were: 14, 115, 53 and 12, consecutively. Our study, though small in sample size, supports the view that the prevalence of chlamydia is not high in all colposcopy clinic attenders. Women younger than 30 years old are more likely to be infected than older women; hence opportunistic screening should target this age group. The prevalence rate may be low due to the enzyme linked immunosorbent assay giving a poor detection rate for chlamydia screening.
In part 1 of this article, the author explained the physiology, associated features and treatment of cervical ectropion. Here, she outlines the results of a survey undertaken to develop a local protocol to manage women presenting with symptomatic cervical ectropion. Copyright © 2009 Wiley Interface Ltd
twisted, necrotic left tube and ovary were found ( Figure 1). A laparoscopic left salpingo-oophorectomy was performed. The histology report showed extensive haemorrhage and necrosis of the left ovary and fallopian tube, but no evi dence of trophoblastic tissue to suggest ectopic pregnancy.Subsequently, a pelvic ultrasound scan showed a viable intrauterine pregnancy equivalent to eight weeks' gestation. She had vaginal progesterone support for the rest of the fi rst trimester. Her 20-week anomaly scan was normal and she gave birth to a healthy baby girl, at 39 weeks of gestation, by caesarean section for breech presentation. DiscussionTorsion of an ovary and fallopian tube is rare in pregnancy and poses a considerable diagnostic challenge. 1,2 The prevalence of this condition has been estimated at 1 in 1800, 3 but we believe this to be an overestimation.In the case reported here, the pregnancy was initially unrecognised because of a false-negative pregnancy test kit. False-negative qualitative urine pregnancy tests are well documented. 4-8 Qualitative point-of-care and home pregnancy tests both have limitations and are not 100 per cent sensitive in detecting pregnancy. In one study, 5 only 44 per cent of 18 brands gave a clearly positive result at serum beta-human chorionic gonadotrophin (β-hCG) levels of 100mIU/ml. In other words, 56 per cent were falsely negative. In a woman of childbearing age with abdominal pain, we therefore suggest that a negative qualitative urine pregnancy test should be confi rmed by quantitative serum β-hCG measurement.Laparoscopic salpingo-oophorectomy was performed because the tissues appeared necrotic and persistent fever suggested early sepsis. The necrosis was subsequently confi rmed histologically. However, successful detorsion of twisted adnexa has been described regardless of delay in diagnosis and the appearance of the adnexum. 1 A 33-year-old woman was referred to the urology team with a four-day history of left loin pain, syncope and vomiting. She had tachycardia (108 beats per minute), a mildly raised temperature (37.3°C) and tenderness in the left lumbar region and iliac fossa. Urine pregnancy test was negative, but a trace of haemolysed blood was found on ward urinalysis. An intravenous urogram showed no ureteric obstruction. A diagnosis of pyelonephritis was made.However, her pain failed to settle on antibiotics, and a gynaecological opinion was sought two days after admission. On questioning, her last menstrual period transpired to be three months before presentation. She was cardiovascularly stable, but examination revealed abdominal peritonism, a bulky uterus and cervical excitation. A repeat pregnancy test was positive. A clinical diagnosis of ectopic pregnancy was made.The authors present a case history of a pregnant woman with abdominal pain who was found to have torsion of an ovary and fallopian tube. This condition is rare in pregnancy and the case highlights the diagnostic challenges involved. Twisted adnexum Necrotic left tube Necrotic left ovary a b Figure 1. La...
The authors describe the case of a postmenopausal woman who presented with sudden-onset abdominal pain and vomiting, found to be caused by a torted haemorrhagic ovarian cyst. The case highlights the occurrence of ovarian cyst formation and endometrial stimulation in patients treated with tamoxifen.A 56-year-old woman presented to the accident and emergency department with sudden onset of left iliac fossa pain and vomiting. The pain was constant and non-radiating. She had associated vomiting of recently eaten food, but no fever and no history of diarrhoea. She had had a left mastectomy and radiotherapy fi ve years previously for intraductal adenocarcinoma of the breast.The breast cancer was weakly oestrogen-receptor positive and progesterone-receptor negative. She had been on tamoxifen for more than four years. This had been changed to an aromatase inhibitor (letrozole) two weeks before presentation.She had no history of postmenopausal bleeding. Examination revealed a normal pulse rate, blood pressure and temperature. Her abdomen moved with respiration and was soft but tender in the left iliac fossa with no palpable mass. A pelvic ultrasound scan revealed a small axial uterus. The size of the right ovary was 16 × 8 × 12mm; the right adnexa had a thickwalled cyst of 90 × 60 × 67mm. It had homogeneous low-level echoes (Figure 1) and appeared to have a thick septum across the superior pole. The left ovary was not identifi ed. Free fl uid was noted posterior to the cyst.Her temperature remained normal. Full blood count, electrolytes and urea were normal. Cancer antigen (CA-125), carcino-embryonic antigen (CEA) and liver function tests were also requested. She was admitted for pain relief and had improved by the next day, when she was allowed home to await the results of the serum cancer markers and to have a computerised tomography (CT) scan arranged. She was due to be followed up in the gynaecology outpatient clinic two weeks later.
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