Novel Bacterial Pathogens in Pelvic Inflammatory Disease

盆腔炎中的新型细菌病原体

基本信息

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
项目类别：
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

项目摘要

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）：骨盆炎性疾病（PID）是年轻女性的常见疾病，导致严重的后遗症，包括不育，复发和慢性骨盆疼痛。尽管淋病奈瑟氏菌和/或沙眼衣原体是从大约三分之一到一半的患有PID的女性的回收率，但在其他女性中，病因学剂通常是未识别的。多项研究将细菌性阴道病（BV）与PID联系起来，但是在PID中很少有研究中几种新鉴定的BV相关细菌的作用，例如Leptotrichia sanguinegens/anguinegens/amnionii，阴道Atobobium caginae和细菌性阴道相关细菌（BVAB）的作用很少。分枝杆菌U.尿素与PID和不育症有关，尽管结果混合了。最近，U.尿素被分为两个生物媒体，分为U. Parvum（Biovar 1），在某些研究中，该研究在男性中被发现是非人为的，而U.尿素（Biovar 2，UU-2）与男性尿素炎有关。 UU-2在女性生殖疾病中的作用进行了研究。具有疑似PID的美国妇女中绝大多数妇女接受针对淋病和衣原体PID的抗生素治疗。分枝杆菌表现出对四环素的耐药性，对新鉴定的BV病原体的治疗知之甚少。我们建议，在当前的PID方案治疗的上部生殖道中感染了这些细菌的妇女可能会经历持续的感染和生殖发病率。我们在正在进行的PID评估和临床健康研究中，在831名妇女中，提出了一项针对瘦素的天生/amnionii，A. daginae，bVAB和UU-2的聚合酶链反应（PCR）研究。使用储存的基线以及30天的颈椎和子宫内膜标本，我们建议：1）确定上下生殖道感染的危险因素； 2）确定这些病原体，子宫内膜炎和宫颈炎之间的关联； 3）确定这些细菌与BV之间的关联； 4）评估这些感染对头孢辛蛋白和强力霉素的治疗反应； 5）评估这些感染对生殖发病率的影响。必须探索新病原体在PID中的作用，对于优化诊断和治疗，并防止非核菌/非牙菌性PID的女性的生殖发病率。公共卫生相关性：拟议的研究将是第一个比较不孕症，慢性骨盆疼痛和复发性骨盆炎症性疾病（PID）的研究，该研究中的PID患者目前接受了当前推荐的抗菌治疗。鉴于有关当前PID治疗对患有L. sanguinegens/amnionii，A。vaginae，A. a. daginae，bVAB，UP和UU-2女性有效性的信息的稀缺性，必须进行拟议的研究，以优化所有具有PID和设计有针对性的干预策略的妇女，无论是chamydial/chamydial/goonydial/goonydial/goonydial/goonydial/goonycoccaccal of Conecoccaccal还是致。了解L. sanguinegens/amnionii，A。daginae，BVAB和UU-2 PID的危险因素，临床特征，治疗功效以及发病率的知识将指导未来的临床和公共卫生建议。