Novel Bacterial Pathogens in Pelvic Inflammatory Disease

盆腔炎中的新型细菌病原体

• 批准号: 7608705
• 负责人: CATHERINE L HAGGERTY
• 金额: $ 53.19万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-15 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7608705
• 关键词: Abscess; Adnexal Mass; Aftercare; Age; Alcohol or Other Drugs use; American; Anaerobic Bacteria; Antibiotic Therapy; Antibiotics; Atopobium vaginae; Bacteria; Bacterial Vaginosis; Black race; Case Study; Case-Control Studies; Cefoxitin; Cervical; Cervicitis; Characteristics; Chlamydia trachomatis; Clinical; Contraceptive Usage; Data; Diagnosis; Disease; Doxycycline; Effectiveness; Endometrial; Endometritis; Epidemiologic Studies; Etiology; Exhibits; Female; Fever; Future; Genital system; Goals; Health; Hormonal; Infection; Infertility; Inflammation; Intervention; Knowledge; Leptothrix; Leptotrichia; Link; Mammalian Oviducts; Measures; Morbidity - disease rate; Mycoplasma; Neisseria gonorrhoeae; Organism; Patients; Pelvic Inflammatory Disease; Play; Polymerase Chain Reaction; Postpartum Period; Public Health; Publishing; Recombinant DNA; Recommendation; Recurrence; Resistance; Rest; Risk Factors; Role; Salpingitis; Sexually Transmitted Diseases; Signs and Symptoms; Specimen; Symptoms; Testing; Tetracyclines; Treatment Efficacy; Treatment Protocols; Undifferentiated; Ureaplasma; Urethritis; Vagina; Vaginal Douching; Woman; antimicrobial; chronic pelvic pain; design; experience; gram negative anaerobic rods; high risk sexual behavior; low socioeconomic status; men; microbial; novel; pathogen; prevent; reproductive; research clinical testing; treatment response

DESCRIPTION (provided by principal investigator): 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. PUBLIC HEALTH RELEVANCE: 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.

描述（由主要研究者提供）：盆腔炎（PID）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/或沙眼衣原体从大约三分之一至一半的PID妇女中回收，但在其他妇女中，病原体通常无法识别。多项研究已将细菌性阴道病（BV）与PID联系起来，但对几种新发现的BV相关细菌（例如血红多毛菌/羊水菌、阴道变形菌和细菌性阴道病相关细菌（BVAB））在PID中的作用研究甚少。支原体U。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.在一些研究中发现，在男性中无致病性的小孢子虫（生物型1）和U。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。绝大多数疑似PID的美国妇女接受针对淋病和衣原体PID的抗生素治疗。支原体对四环素类抗生素有相当大的耐药性，但对新发现的BV病原体的治疗知之甚少。我们认为，在上生殖道感染这些细菌的妇女谁是目前PID方案治疗可能会遇到持续感染和生殖系统疾病。本文采用聚合酶链反应（PCR）技术对血红纤毛菌（Leptotrichia sanguinegens/Leptotrichia sanguonii，A.正在进行的PID评估和临床健康研究中，对831名女性进行了阴道、BVAB和UU-2检测。使用储存的基线和30天的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感染的危险因素; 2）确定这些病原体、尿道炎和宫颈炎之间的关系; 3）确定这些细菌和BV之间的关系; 4）评估这些感染对头孢西丁和强力霉素的治疗反应;和5）评估这些感染对生殖发病率的影响。探索新病原体在PID中的作用对于优化诊断和治疗以及预防非淋球菌/非衣原体PID女性的生殖疾病至关重要。公共卫生关系：这项拟议的研究将是第一个比较不孕症，慢性盆腔疼痛和复发性盆腔炎（PID）患者接受目前推荐的抗微生物治疗方案。由于缺乏关于目前PID治疗对患有L的妇女的有效性的信息。sanguinegens/sanguonii，血吸虫A.阴道，BVAB，UP和UU-2，为了优化所有PID女性的治疗并设计有针对性的干预策略，无论是衣原体/淋球菌还是厌氧起源，所提出的研究都是必要的。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。