Novel Bacterial Pathogens in Pelvic Inflammatory Disease

盆腔炎是一种常见于年轻女性的疾病，可导致严重的后遗症 包括不孕、复发和慢性盆腔疼痛。虽然淋病奈瑟菌和/或衣原体 大约三分之一到一半的PID妇女中发现了沙眼，在其他妇女中， 病原体往往是不明的。几项研究将细菌性阴道病（BV）与PID联系起来，但其作用 几种新鉴定的BV相关细菌，如Leptotrichia sanguinegens/Escherichonii，Atopobium 细菌性阴道病相关细菌（BVAB）在PID中的研究很少。支原体 联合解脲支原体与PID和不育有关，尽管结果不一。最近，U. 解脲脲原体分为两个生物群，U.小孢菌（生物型1），已被发现是非致病性的 在一些研究中，解脲支原体（生物型2，UU-2），与男性尿道炎相关。 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 疑似PID的患者用针对淋病和衣原体PID的抗生素方案治疗。 支原体已证明对四环素类具有相当大的耐药性，但对支原体的耐药性知之甚少。 治疗新发现的BV病原体。我们建议，女性感染这些细菌的上部， 用目前PID方案治疗的生殖道患者可能会出现持续性感染和生殖道感染。 发病率本文采用聚合酶链反应（PCR）技术对血红纤毛菌（Leptotrichia sanguinegens/Leptotrichia sanguonii，A. 阴道，BVAB和UU-2在831名妇女中进行PID评估和临床健康研究。使用 储存的基线和30天宫颈和子宫内膜标本，我们建议：1）确定 下生殖道和上生殖道的感染; 2）确定这些病原体之间的关联， 阴道炎和宫颈炎; 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 感染对生殖系统发病率的影响。探索新型病原体在PID中的作用， 诊断和治疗，并预防生殖疾病 非淋球菌/非衣原体PID。这项拟议中的研究将首次比较不孕症、慢性盆腔疼痛和复发性盆腔炎 目前推荐的抗微生物方案治疗的PID患者中的PID疾病（PID）。由于缺乏 关于目前PID治疗L. sanguinegens/sanguonii，血吸虫A. 阴道，BVAB，UP和UU-2，为了优化所有女性的治疗， PID和设计有针对性的干预策略，无论是衣原体/淋球菌或厌氧起源。 了解L. sanguinegens/sanguonii，血吸虫A. Vaginae、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.