Novel Bacterial Pathogens in Pelvic Inflammatory Disease

盆腔炎是年轻女性的常见病，会导致严重的后遗症。 包括不孕不育、复发和慢性盆腔疼痛。虽然淋病奈瑟菌和/或衣原体 沙眼可以从大约三分之一到一半的患有盆腔炎的妇女中恢复过来，在其他妇女中 病因通常是不明的。一些研究已经将细菌性阴道病(BV)与产后应激联系起来，但其作用 几种新发现的BV相关细菌，如血细毛杆菌/羊膜纤毛菌，阿托布氏菌 细菌性阴道病相关细菌(BVAB)在PID中的研究较少。支原体 解脲支原体与盆腔炎和不孕症有关，尽管结果喜忧参半。最近，美国政府采取了一系列措施。 解脲支原体已被分成两个生物群，微小U(生物群1)，已被发现是非致病的 在一些研究中，男性和解脲支原体(生物群2，UU-2)，这已经与男性尿道炎有关。 UU-2在女性生殖疾病中的作用尚未得到充分研究。绝大多数美国女性 对疑似PID的患者采用针对淋病和衣原体PID的抗生素方案治疗。 支原体已经表现出对四环素的相当大的抗药性，而对 新发现的BV病原体的治疗。我们建议感染这些细菌的妇女在上半身 用目前的PID方案治疗生殖道的患者可能会经历持续性感染和生殖 发病率。我们提出了一种聚合酶链式反应(聚合酶链式反应)研究血链纤毛虫/羊膜纤毛虫，A. 在正在进行的PID评估和临床健康研究中，对831名妇女进行了阴道、BVAB和UU-2检测。vbl.使用 保存基线和30天的宫颈和子宫内膜标本，我们建议：1)确定以下危险因素 下生殖道和上生殖道感染；2)确定这些病原体之间的联系， 子宫内膜炎和宫颈炎症；3)确定这些细菌与BV之间的关系；4)评估 这些感染对头孢西丁和多西环素的治疗反应；以及5)评估这些药物的影响 感染对生殖发病率的影响。探索新病原体在慢性盆腔炎中的作用势在必行 诊断和治疗，并预防妇女中的生殖疾病 非淋球菌/非衣原体感染。这项拟议的研究将首次对不孕症、慢性盆腔疼痛和复发盆腔炎进行比较。 使用当前推荐的抗微生物方案治疗的盆腔炎患者的疾病(PID)。考虑到稀缺的 关于目前对患有血吸虫/羊膜肺炎妇女的PID治疗的有效性的信息，A. 阴道、BVAB、UP和UU-2，这项拟议的研究势在必行，以优化对所有患有 并设计有针对性的干预策略，无论是衣原体/淋球菌还是厌氧菌来源。 了解该病的危险因素、临床特点、治疗效果和发病率。 血吸虫/羊膜肺炎、阴道沙门氏菌、BVAB和UU-2 PID将指导未来的临床和公共卫生 建议。

Pelvic Inflammatory Disease (PID) is a common disease among young women that results in serious sequelae including infertility, recurrence, and chronic pelvic pain. Although Neisseria gonorrhoeae and/or Chlamydia trachomatis are recovered from approximately a third to a half of women with PID, in the other women the etiologic agent is often unidentified. Several studies have linked bacterial vaginosis (BV) with PID, but the role of several newly identified BV-associated bacteria, such as Leptotrichia sanguinegens/amnionii, Atopobium vaginae, and Bacterial Vaginosis Associated Bacteria (BVAB) in PID has been little studied. The mycoplasma U. urealyticum has been associated with PID and infertility, although with mixed results. Recently, U. urealyticum has been split into two biovars, U. parvum (biovar 1), which has been found to be nonpathogenic in men in some studies, and U. urealyticum (biovar 2, UU-2), which has been associated with urethritis in men. The role of UU-2 in reproductive disease in women is understudied. The great majority of American women with suspected PID are treated with antibiotic regimens directed toward gonorrheal and chlamydial PID. Mycoplasmas have demonstrated considerable resistance to tetracyclines, and little is known about the treatment of newly identified BV pathogens. We propose that women infected with these bacteria in the upper genital tract who are treated with current PID regimens may experience persistent infection and reproductive morbidity. We propose a polymerase chain reaction (PCR) study of Leptotrichia sanguinegens/amnionii, A. vaginae, BVAB, and UU-2 among 831 women in the ongoing PID Evaluation and Clinical Health Study. Using stored baseline and 30 day cervical and endometrial specimens, we propose to: 1) identify the risk factors for infections of the lower and upper genital tract; 2) determine the associations between these pathogens, endometritis, and cervicitis; 3) determine the associations between these bacteria and BV; 4) assess the treatment response of these infections to cefoxitin and doxycycline; and 5) evaluate the impact of these infections on reproductive morbidity. Exploring the role of novel pathogens in PID is imperative to optimize diagnosis and treatment and to prevent reproductive morbidity among women with nongonococcal/nonchlamydial PID. The proposed study will be the first to compare infertility, chronic pelvic pain, and recurrent pelvic inflammatory disease (PID) in PID patients treated with currently recommended anti-microbial regimens. Given the scarcity of information regarding the effectiveness of current PID treatment for women with L. sanguinegens/amnionii, A. vaginae, BVAB, UP, and UU-2, the proposed study is imperative in order to optimize treatment for all women with PID and design targeted intervention strategies, whether of chlamydial/gonococcal or anaerobic origin. Knowledge of the risk factors, clinical characteristics, treatment efficacy, and morbidity of L. sanguinegens/amnionii, A. vaginae, BVAB, and UU-2 PID will direct future clinical and public health recommendations.