Increased prevalence of endocervical Mycoplasma and Ureaplasma colonization in infertile women with tubal factor.

OBJECTIVE: Most women suffering from tubal factor infertility do not have a history of pelvic inflammatory disease, but rather have asymptomatic upper genital tract infection. Investigating the impacts of such infections, even in the absence of clinically confirmed pelvic inflammatory disease, is critical to understanding the tubal factor of infertility. The aim of this study was to investigate whether the presence of endocervical bacteria is associated with tubal factors in women screened for infertility. METHODS: This retrospective cross-sectional study involved 245 women undergoing hysterosalpingography (HSG), screened for endocervical colonization by Chlamydia trachomatis, Neisseria gonorrhea, Ureaplasma urealyticum and Mycoplasma hominis, as part of a routine female infertility investigation between 2016 and 2017. RESULTS: endocervical bacterial colonization by Chlamydia trachomatis, Ureaplasma urealiticum, Mycoplasma hominis and other bacteria corresponded to 3.7%, 9.0%; 5.7% and 9.8%, respectively. There was no colonization by Neisseria gonorrhea. The prevalence of tubal factor was significantly higher in patients with positive endocervical bacteria colonization, regardless of bacterial species. When evaluating bacteria species individually, the women who were positive for endocervical Mycoplasma hominis had significantly higher rates of tubal factor. Associations between endocervical bacterial colonization and tubal factor infertility were confirmed by multiple regression analysis adjusted for age and duration of infertility. CONCLUSION: Besides the higher prevalence of Mycoplasma and Ureaplasma infectious agents, the findings of this study suggest the possible association of endocervical bacterial colonization - not only Chlamydia trachomatis and Neisseria gonorrhea, but also Mycoplasma species with tubal performance.

Bilateral but not unilateral tubal obstruction is associated with positive chlamydia serology.

OBJECTIVE: To assess the association between positive Chlamydia trachomatis (C. trachomatis) serology and unilateral or bilateral tubal obstruction. METHODS: This was a cross sectional study that evaluated the association of positive C. trachomatis serology (Immunofluorescence Indirect Serology, IIF or Enzyme Immune Essay, EIE), in two infertile groups: A. 243 patients (27 with unilateral obstruction and 216 without it). B. 247 patients (31 with bilateral obstruction and 216 without it). The exclusion criteria were tubal ligation (tubectomy) and tubal surgery. The statistical test (SPSS 17.0) was the Chi-Square with a p=5%. Tubal obstruction was diagnosed through hysterosalpingography (HSG). RESULTS: The mean age of the patients without obstruction was 33.6 years, SD 4.9. The mean age of the patients with unilateral obstruction was 33.7 years SD 4.9. The mean age of the patients with bilateral obstruction was 33.6 years, SD 4.9. There was no statistically significant difference between the age groups. In group A (unilateral obstruction versus serology) the Chi-Square was 0.02 (p=n.s.) and the Attributable Risk (AR) = 0.7%. In Group B (bilateral obstruction versus serology) the Chi-Square test was 9.87 (p<0.005) and the AR = 14.8%. CONCLUSION: This study found a strong and statistically significant association between bilateral tubal obstruction and C. trachomatis positive serology. The power of the test was 86%. There was no association between unilateral obstruction and positive serology.

[Prevalence of infections (Chlamydia, Ureaplasma and Mycoplasma) in patients with altered tuboperitoneal factor]. / Prevalencia de infecciones (Chlamydia, Ureaplasma y Mycoplasma) en pacientes con factor tuboperitoneal alterado.

OBJECTIVE: To determine the prevalence of Chlamydia, Ureaplasma and Mycoplasma in patients with peritoneal tubal factor infertility and altered. MATERIAL AND METHODS: A descriptive, observational, retrospec- tive, transversal, infertility patients Juarez Hospital of Mexico 2013 to 2015. Study included patients with infertility diagnosis and detection of antibodies (IgG) by ELISA for Chlamydia and vaginal cultures for Mycoplasma and Ureaplasma, hysterosalpingography and histerolapa- roscopia with chromotubation RESULTS: 46 patients with a mean age of 32.5 years. It was found that 36% were positive for these infections (n = 17): Chlamydia in 8.7% (n = 4), Ureaplasma in 21.7% (n = 10) and Mycoplasma in 6.5% (n = 3). Chlamydia patients and bilateral tubal occlusion (OTB) in 5.8% (n = 1), Ureaplasma and OTB (n = 5) were identified in 29.4% of them with pelvic inflammatory disease (PID) and tubal obstruction Ureaplasma right (OTD) in 5.8% (n = 1), Ureaplasma and tubal patency but with loose adhesions in 5.8% (n = 1) and Mycoplasma with OTB in 11.1% (n = 2), p = 0.425. Hysterosalpingography showed a sensitivity of 59% and specificity of 79%. CONCLUSIONS: Although there was no association of variables, Ureaplasma infection was more common in patients with infertility and tubal damage.

Epidemiología, resultados clínicos y costos del tratamiento del absceso tuboovárico, en un hospital público de Santiago / Epidemiology, clinical results and costs of treatment of the tuvoovarian abscess, in a public hospital in Santiago

Objetivos: Conocer frecuencia y factores de riesgo del absceso tuboovárico (ATO), complicaciones y costos del tratamiento. Método: Estudio retrospectivo de 64 pacientes operadas con el diagnóstico de ATO. Las pacientes se manejaron con criterio médico-quirúrgico: uso de antibióticos y cirugía en casos de peritonitis difusa, fiebre persistente con masa palpable y masa anexial mayor de 6 cm sin fiebre. Se evaluaron en fertilidad futura y en complicaciones: infección y dehiscencia de herida operatoria, reoperación por ATO residual, lesión intestinal, lesión vesical y complicaciones médicas. Resultados: El ATO representó el 73,6 por ciento de los casos hospitalizados por enfermedad inflamatoria pélvica, con frecuencia de 1,5 casos por mes y 17,2 por ciento de actinomicosis. La edad media de las pacientes fue 40,5 años. El dispositivo intrauterino (DIU) se asoció con ATO en 84,4 por ciento de los casos, 94,4 por ciento sin control y con media de uso de 10,2 años. El ATO unilateral fue el más frecuente (57,8 por ciento) y la anexectomía unilateral la operación más común. El 17,2 por ciento de las pacientes presentaron complicaciones y el 85,9 por ciento quedaron con infertilidad. El costo total de los 64 casos fue $86.331.713 (UF 3.788), con una media de $1.348.933 (UF 59,2). Conclusión: Existe un aumento de la frecuencia del ATO y de la actinomicosis pélvica, con incremento consiguiente de la infertilidad y de los costos, asociados al uso de DIU, sin control y por tiempo prolongado.

Objective: To determine frequency and risk factors of tuboovarian abscess (TOA) and observe complications, fertility damages and surgical costs of medical-surgical treatment. Method: Retrospective study in 64 patients operated with TOA diagnosis. Patients were managed with medical-surgical treatment: use of antibiotics and then surgery in cases of peritonitis diffuse, persistent fever with palpable mass and adnexial mass greater than 6 cm without fever. They were evaluated in future fertility and complications: infection and of surgical wound dehiscence, reoperation by residual TOA, intestinal injury, bladder injury and medical complications. Results: The TOA accounted for 73.6 percent of hospitalized cases of pelvic inflammatory disease (PID), 1.5 cases per month and 17.2 percent of actinomycosis. The mean age of patients was 40.5 years. The intrauterine device (IUD) was associated with TOA in 84.4 percent of cases, 94.4 percent uncontrolled and with a 10.2 years mean use. The unilateral TOA was the most frequent (57.8 percent) and the unilateral anexectomy the most common operation. The 17.2 percent of patients presented complications and 85.9 percent remained infertile. These results showed an increase compared with those obtained in the series published in 1993. The total cost of the 64 cases was $86.331.713 (UF 3.788), with a mean of $1.348.933 (UF 59.2). Conclusion: There is an increased frequency of the TOA and of pelvic actinomycosis, with consequent increase of infertility and costs associated with the uncontrolled and long-term use of IUD.

High titers of Chlamydia trachomatis antibodies in Brazilian women with tubal occlusion or previous ectopic pregnancy.

OBJECTIVE: To evaluate serum chlamydia antibody titers (CATs) in tubal occlusion or previous ectopic pregnancy and the associated risk factors. METHODS: The study population consisted of 55 women wih tubal damage and 55 parous women. CAT was measured using the whole-cell inclusion immunofluorescence test and cervical chlamydial DNA detected by PCR. Odds ratios were calculated to assess variables associated with C. trachomatis infection. RESULTS: The prevalence of chlamydial antibodies and antibody titers in women with tubal occlusion or previous ectopic pregnancy was significantly higher (P < .01) than in parous women. Stepwise logistic regression analysis showed that chlamydia IgG antibodies were associated with tubal damage and with a larger number of lifetime sexual partners. CONCLUSIONS: Chlamydia antibody titers were associated with tubal occlusion, prior ectopic pregnancy, and with sexual behavior, suggesting that a chlamydia infection was the major contributor to the tubal damage in these women.

Abscesso tubo-ovariano - revisão / Tubo-ovarian abscess - review

Pacientes com diagnóstico de doença inflamatória pélvica apresentam risco para desenvolver abscesso tubo-ovariano. Vários são os fatores que influem na sua epidemiologia, como o uso prolongado do dispositivo intra-uterino. O diagnóstico é baseado no quadro clínico e nas técnicas de imagem. O avanço na terapia antimicrobiana e no modo de abordar, com drenagem percutânea e transvaginal guiada por ultrasonografia, mudou o perfil terapêutico do abscesso tubo-ovariano. A presente revisão focaliza este novo perfil terapêutico, além da etiologia, epidemiologia e diagnóstico do abscesso tubo-ovariano

Is induced abortion a contributing factor to tubal infertility in Mexico? Evidence from a case-control study.

OBJECTIVE: To determine the contribution of induced abortion to tubal infertility in Mexico. DESIGN: Population- and hospital-based case-control study. SETTING: Tertiary hospitals in Mexico City. SAMPLE: Women between 20 and 40 years with infertility and controls of the same age: 251 cases, 502 hospital controls, 502 neighbourhood controls. METHODS: A case-control study was conducted in four tertiary hospitals in Mexico City with 251 cases and 1004 controls (two hospital and two neighbourhood controls per case, matched by age [+/-2 years]). Cases were infertile women, aged 20-40, with tubal occlusion confirmed by laparoscopy. Controls were fertile women, who had carried a pregnancy to term within the last two years. Participants completed a previously validated questionnaire asking about reproductive history and induced abortion. RESULTS: Our study did not show an association between induced abortion and tubal infertility among women that did not relate both events (cases vs hospital controls: OR = 1.57, 95% CI: 0.29-8.65; cases vs neighbourhood controls: OR = 0.82, 95% CI: 0.07-8.99) using conditional logistic models adjusting by marital status, number of pregnancies, age at first sexual intercourse and history of pelvic inflammatory disease. In contrast, early age at sexual debut and history of pelvic inflammatory disease significantly increased the risk of tubal infertility. CONCLUSIONS: In Mexico, the lack of association between induced abortion and tubal damage causing infertility observed in this population might be explained by a shift toward "safer" abortion practices.

Absceso Tuboovárico. Estudio retrospectivo / Tubo-ovarian abscess. Retrospective study

Se realizó un estudio retrospectivo sobre 75 casos de absceso tuboovárico (ATO) atendidos en el Hospital Nacional Cayetano Heredia de Lima, Perú, durante el período de 1981-1990, con el fin de determinar los factores de riesgo, cuadro clínico, los procedimientos diagnósticos utilizados y evaluar el manejo junuto con las complicaciones que de él se derivan. Se encontró que la la frecuencia de ATO en el este hospital fue de 1.3 por ciento. Además, el ATO ocurre con mayor frecuencia en mujeres entre la tercera y la cuarta décadas de la vida, nulíparas y con actividad sexual. El ATO ocurre independientemente del uso de dispositivo intrauterino. Otro hallazgo fue que los signos y síntomas de presentación más frecuentes del cuadro clínico del ATO son el dolor abdominal bajo o pélvico (98.63 por ciento), presencia de masa anexial (94.52 por ciento) y el dolor a la movilización cervical (73.97 por ciento) asociados a fiebre y taquicardia en 87.38 por ciento. La leucocitosis con desviación izquierda estuvo presente en 50.68 por ciento de los casos. La ecografía (realizada en 27 casos) fue positiva en el 74.07 por ciento y negativa en 25.93 por ciento, la laparoscopía (realizada en 6 casos) fue positiva en 83.33 por ciento y negativa en 16.67 por ciento. La culdocentesis (realizada en 39 casos) fue positiva en 84.61 por ciento y negativa en 15.39 por ciento. El 76.72 por ciento de los casos correspondioeron a ATO no roto, de los cuales el 21.43 por ciento recibieron tratamiento médico conservador y 78.57 por ciento recibieron tratamiento quirúrgico, de éstos el 75 por ciento fueron sometidos a histerectomía con anexectomía y 25 por ciento a anexectomía. El 23.28 por ciento de los casos fueron ATO roto, practicándose histerectomía con anexectomía en 88.24 por ciento y anexectomía sola en 11.76 por ciento. No hubo mortalidad en nuestro estudio probablemente en relación al tratamiento médico y/o quirúrgicos inmediatos.