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：
7778369
负责人：
CATHERINE L HAGGERTY
金额：
$ 58.87万
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/7778369
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 Principal Investigator Public Health Publishing Recombinant DNA Recommendation Recurrence Regimen Resistance Rest Risk Factors Role Salpingitis Sexually Transmitted Diseases Signs and Symptoms Specimen Symptoms Testing Tetracyclines Treatment Efficacy 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 public health relevance 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）：盆腔炎（PID）是年轻女性的常见疾病，会导致严重的后遗症，包括不孕、复发和慢性盆腔疼痛。虽然大约三分之一到一半患有盆腔炎的女性可感染淋病奈瑟菌和/或沙眼衣原体，但其他女性的病因往往不明。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（如血细毛菌/羊膜菌、阴道阿托博菌和细菌性阴道病相关细菌 (BVAB)）在 PID 中的作用的研究很少。解脲支原体与盆腔炎和不孕症有关，但结果好坏参半。最近，解脲支原体被分为两个生物变种：小支原体（生物变种 1），在一些研究中发现它对男性无致病性，以及解脲支原体（生物变种 2，UU-2），它与男性相关。患有男性尿道炎。 UU-2 在女性生殖疾病中的作用尚未得到充分研究。绝大多数疑似患有 PID 的美国女性都接受针对淋病和衣原体 PID 的抗生素治疗。支原体已表现出对四环素相当大的耐药性，而对于新发现的 BV 病原体的治疗知之甚少。我们建议，在上生殖道感染这些细菌并接受当前 PID 治疗方案的女性可能会经历持续感染和生殖疾病。在正在进行的 PID 评估和临床健康研究中，我们建议对 831 名女性进行血纤毛菌/羊膜纤毛菌、阴道曲霉菌、BVAB 和 UU-2 的聚合酶链反应 (PCR) 研究。使用存储的基线和 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西丁和多西环素的治疗反应； 5) 评估这些感染对生殖发病率的影响。探索新型病原体在盆腔炎中的作用对于优化诊断和治疗以及预防非淋菌/非衣原体盆腔炎女性的生殖发病率至关重要。公共健康相关性：拟议的研究将是第一个比较接受当前推荐的抗微生物疗法治疗的 PID 患者的不孕症、慢性盆腔疼痛和复发性盆腔炎 (PID) 的情况。鉴于有关当前 PID 治疗对感染 L. sanguinegens/amnionii、A. vaginae、BVAB、UP 和 UU-2 女性的有效性的信息匮乏，拟议的研究对于优化所有患有 PID 的女性的治疗势在必行。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。了解血红乳杆菌/羊膜炎、阴道放线菌、BVAB 和 UU-2 PID 的危险因素、临床特征、治疗效果和发病率将指导未来的临床和公共卫生建议。