Pelvic inflammatory disease in women; improving diagnosis and better understanding the disease process

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Pelvic inflammatory disease (PID) is a condition that involves inflammation of the upper genital tract in women that can be debilitating. This condition can result in reproductive health sequelae such as tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. Diagnosis of PID is a complex and subjective clinical process. This includes a bimanual examination to test for cervical, uterine, and adnexal motion tenderness which is considered a critical diagnostic criterion to indicate PID. The current treatment protocol for PID raises concerns as it is immediately treated with several antibiotics prior to and regardless of infections diagnosed. The increase of antibiotic resistant bacteria in the world and the rise of multiple drug-resistant sexually transmitted infections may be at further risk from this treatment protocol. The antibiotics used for PID include ceftriaxone, cefotaxime, metronidazole, doxycycline, azithromycin and moxifloxacin, with a minimum of three used in conjunction. PID can be associated with sexually transmitted infection, respiratory pathogens, instrumentation (e.g. IUD), and/or an idiopathic aetiology. This project conducted a prospective pilot study of women with PID, by comparing reproductive tract specimens from women with PID to healthy controls (Case-Control study design) and also further compared the findings in against a separate test group of women with asymptomatic or mild sexually transmitted infections. This involved three main objectives, the first being examining the bacterial compositions of the female genital tract and their potential relationship with PID. Secondly, investigating expression of a selection of human immune genes for associations with PID. Lastly, the third objective involved characterising the pathogenicity of chlamydial variants using 𝘪𝘯 𝘷𝘪𝘷𝘰 and 𝘪𝘯 𝘷𝘪𝘵𝘳𝘰 methods, with a goal to determine if a mouse model could show large pathogenic differences that will establish a system of mouse infections ready to be adapted to looking for traits in chlamydial isolates from PID Cases or Controls. […] Overall, this pilot study has established that the recruitment, specimen processing and analysis protocols are effective. The results indicate that there are potential microbiota that may influence the disease. Secondly, human immune gene expression profiles were found to correlate with PID, and these biomarkers could be used for future molecular diagnostic of PID with further supporting data. Finally, this study results and conclusions support that there is a need for a in vivo model of PID, especially in terms of investigating different organisms and potential pathogenic factors.
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