Etiology and Outcome of Acute Pelvic Inflammatory Disease

Brunham, Robert C.; Binns, B. A. O.; Guijon, Fernando B.; Danforth, Douglas R.; Kosseim, M. L.; Rand, F.; McDowell, J.; Rayner, Eleanor

doi:10.1097/00006254-198906000-00021

Cited by 25 publications

(34 citation statements)

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“…To our knowledge, there are no definitive data on the numbers of gonococci present in the FT of humans diagnosed with salpingitis. Several studies on the polymicrobial etiology of PID have reported that gonococci were recovered less often from the human FT than from the cervix (5,8,11,17,42), but no comparative data were presented. Some indication of comparative bacterial numbers was afforded by a study with a murine model of long-term genital tract infection, which reported that following intravaginal infection with approximately 10 6 CFU of gonococci per mouse, a low level of gonococci (10 2 to 10 3 CFU) was recovered from the uterine horns (34).…”

Section: Discussionmentioning

confidence: 99%

Infection of Human Fallopian Tube Epithelial Cells withNeisseria gonorrhoeaeProtects Cells from Tumor Necrosis Factor Alpha-Induced Apoptosis

et al. 2006

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Following infection withThe female reproductive tract is an immunologically unique site which must respond to a diverse array of sexually transmitted pathogens and must also be tolerant to allogeneic sperm and to conceptuses. Pelvic inflammatory disease (PID) is an acute clinical syndrome associated with the ascending spread of microorganisms through the female reproductive tract (80). PID encompasses a multitude of inflammatory conditions of the upper reproductive tract organs, with the majority of proven cases of PID being caused by Chlamydia trachomatis and Neisseria gonorrhoeae (gonococcus) (32), and coinfection with both pathogens is common.Neisseria gonorrhoeae is the etiologic agent of gonorrhea, and the organism infects the mucosal epithelia of the male urethra and the lower genital tracts (vagina/cervix) of women. Localized infection with gonococci leads to a mucopurulent cervicitis in women, but it is also frequently asymptomatic. However, in approximately 10 to 25% (7,26,70) of untreated individuals, infection may ascend into the upper reproductive tract to involve the endometrium, ovaries, myometrium, parametrium, and Fallopian tubes (FT) (32, 46). The host response to this ascending infection is manifested as endometritis, pelvic (tubal or ovarian) peritonitis, tubal abscess, and salpingitis in the FT, and all of these inflammatory conditions encompass the clinical syndrome of PID. Long-term sequelae that develop in individuals presenting with PID, such as chronic pelvic pain, tubal damage, and ectopic pregnancy (7,26,70), are recognized as important public health problems worldwide (32,46).The FT is essentially a muscular organ whose lumen is lined by columnar ciliated cells and secretory cells with microvilli (68), and it plays a critical role in mammalian reproduction, functioning as a channel and storage organ for spermatozoa, a collecting vessel for oocytes released from the ovaries, the site of fertilization and zygote formation, and a means for transporting the early embryo to the uterus (54, 68). It is recognized that salpingitis induced by gonococcal infection causes significant tissue damage in the FT, which is resolved by a process of repair by infiltrating fibroblasts that leads to scarring. These events cause functional impairment of the tubes and irreversible infertility (80). However, little is known of the molecular mechanisms involved in the early stages of infection of the FT by ascending gonococci that initiate the inflammatory response. Studying the pathogenesis of gonococcus-induced salpingitis has relied on the use of ex vivo human FT organ tube

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Section: Discussionmentioning

confidence: 99%

Infection of Human Fallopian Tube Epithelial Cells withNeisseria gonorrhoeaeProtects Cells from Tumor Necrosis Factor Alpha-Induced Apoptosis

et al. 2006

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“…The urogenital infection contributes to the most common bacterial sexually transmitted diseases (STDs) in both industrialized and developing countries, with an estimated 90 million new cases each year worldwide (51). Serious sequelae of chlamydial STD include pelvic inflammatory disease (PID), infertility, and ectopic pregnancy (5,36). In addition, chlamydial STDs are risk factors in cervical squamous cell carcinoma (1) and human immunodeficiency virus transmission (9).…”

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confidence: 99%

Chlamydia trachomatis-Infected Patients Display Variable Antibody Profiles against the Nine-Member Polymorphic Membrane Protein Family

et al. 2009

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Genomic analysis of the Chlamydiaceae has revealed a multigene family encoding large, putatively autotransported polymorphic membrane proteins (Pmps) with nine members in the sexually transmitted pathogen Chlamydia trachomatis. While various pathogenesis-related functions are emerging for the Pmps, observed genotypic and phenotypic variation among several chlamydial Pmps in various Chlamydia species has led us to hypothesize that the pmp gene repertoire is the basis of a previously undetected mechanism of antigenic variation. To test this hypothesis, we chose to examine the serologic response of C. trachomatis-infected patients to each Pmp subtype. Immune serum samples were collected from four populations of patients with confirmed C. trachomatis genital infection: 40 women with pelvic inflammatory disease from Pittsburgh, PA; 27 and 34 adolescent/young females from Oakland, CA, and Little Rock, AR, respectively; and 58 adult male patients from Baltimore, MD. The Pmp-specific antibody response was obtained using immunoblot analysis against each of the nine recombinantly expressed Pmps and quantified by densitometry. Our results show that nearly all C. trachomatis-infected patients mount a strong serologic response against individual or multiple Pmp subtypes and that the antibody specificity profile varies between patients. Moreover, our analysis reveals differences in the strengths and specificities of the Pmp subtype-specific antibody reactivity relating to gender and clinical outcome. Overall, our results indicate that the Pmps elicit various serologic responses in C. trachomatis-infected patients and are consistent with the pmp gene family being the basis of a mechanism of antigenic variation.

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“…Infections of the genital tract are a major cause of sexually transmitted diseases, causing acute urethritis and cervicitis (26) that frequently progress into chronic inflammatory disease. The most significant of these is chronic salpingitis, an inflammatory disease of the fallopian tube(s) that can result in pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility (8). It is unclear whether reinfection alone or persistent infection consisting of altered forms of chlamydiae also contributes to the resulting pathological changes observed in chronic diseases.…”

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confidence: 99%

Bactericidal Activity of First-Choice Antibiotics against Gamma Interferon-Induced Persistent Infection of Human Epithelial Cells by Chlamydia trachomatis

Reveneau

Crane

Fischer

2005

Antimicrob Agents Chemother

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Chlamydia trachomatis is responsible for clinically important chronic inflammatory diseases of humans, including trachoma and pelvic inflammatory disease. Persistent infection of mucosal sites may contribute to the development of these chronic inflammatory diseases. Standard clinical therapy results in satisfactory cure rates of acute infections; however, chronic infection associated with persistence has been suggested to be less responsive to antibiotic therapy. We report the efficiency of two first-line chlamydial antibiotics, azithromycin and doxycycline, under conditions of eradication of C. trachomatis persistent infection using the in vitro model of gamma interferon (IFN-␥)-mediated persistence and reactivation from persistence. Doxycycline was superior in eradicating acute (minimal bactericidal concentration [MBC] 100 ‫؍‬ 2.5 to 5.0 g/ml) compared to persistent (MBC 100 ‫؍‬ 10 to 50 g/ml) infection. In contrast, azithromycin was significantly more effective in eradicating persistent infection (MBC 100 ‫؍‬ 2.5 to 5.0 g/ml) than acute infection (MBC 100 ‫؍‬ 10 to 50 g/ml). The superior bactericidal effect of azithromycin against persistent infection was found to correlate with the enhanced uptake of the drug by IFN-␥-treated infected epithelial cells. Based on these findings, we hypothesize that azithromycin should be a particularly efficacious anti-infective agent for the eradication of IFN-␥-induced chlamydial persistent infection in vivo.

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Etiology and Outcome of Acute Pelvic Inflammatory Disease

Cited by 25 publications

References 0 publications

Infection of Human Fallopian Tube Epithelial Cells withNeisseria gonorrhoeaeProtects Cells from Tumor Necrosis Factor Alpha-Induced Apoptosis

Infection of Human Fallopian Tube Epithelial Cells withNeisseria gonorrhoeaeProtects Cells from Tumor Necrosis Factor Alpha-Induced Apoptosis

Chlamydia trachomatis-Infected Patients Display Variable Antibody Profiles against the Nine-Member Polymorphic Membrane Protein Family

Bactericidal Activity of First-Choice Antibiotics against Gamma Interferon-Induced Persistent Infection of Human Epithelial Cells by Chlamydia trachomatis

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