Vestibular nerve fiber proliferation in vulvar vestibulitis syndrome.

OBJECTIVE: To evaluate nerve fiber density in vestibular specimens from women operated upon for vulvar vestibulitis. METHODS: Forty-seven women with vulvar vestibulitis syndrome underwent modified posterior vestibulectomies. Vestibular specimens were analyzed after being stained for S-100 neural tissue protein. Women were followed up for 2 years. RESULTS: In specimens from 44 of 47 patients, the densities and numbers of nerve fibers per square unit in the preparations were greater than those in specimens from six control women. In the patients, a statistically significant linear correlation was found between inflammation and nerve bundle density in the preparations (Spearman rank correlation coefficient rs=.41; P=.005). There were no signs of infectious etiology in any preparation. No or slight postoperative dyspareunia was reported by 38 of 42 women after 6 months, 36 of 39 after 12 months, and 26 of 28 after 24 months. CONCLUSION: Vestibular neural hyperplasia may provide a morphologic explanation of the pain in vulvar vestibulitis syndrome.

Chlamydia and its effect on reproduction.

PIP: Epididymitis in the male and salpingitis in the female may cause permanent functional damage to the reproductive tract, resulting in infertility. Agents with proven connection to post-infection infertility are Neisseria gonorrhoeae and Chlamydia trachomatis. In men, infertility after chlamydia-associated epididymitis is uncommon, whereas in women sequelae after salpingitis--including chlamydia-associated disease--are the most common cause of acquired infertility. In a prospectively followed cohort of women who all sought pregnancy after one episode of laparoscopically verified acute salpingitis, 79/1025 (7.8%) were infertile because of post-salpingitic tubal occlusion, compared with 4/448 control women (0.9%). Important factors in post-salpingitic infertility were: number of episodes [relative risk (RR) after none, 1, 2, and 3 or more episodes were 1.0, 5.2, 11.3, and 19.8, respectively, amounting to a total infertility rate after salpingitis of 15%]; in women with only one episode, the severity of infection (mild, moderate, and severe; RR, 1.0, 1.8, and 5.6, respectively) and delayed care (less than 3 days and 3 or more days; RR, 1.0 and 3.0, respectively); use of contraceptives (non-contraceptors, pill users, IUD users, and 'other'; RR, 1.0, 0.3, 0.5, and 0.8, respectively); and non-chlamydial and chlamydial infection (RR, 1.0 and 1.7, respectively). Observations in infertile women suggest that an equally large number of women may have post-infectious tubal infertility also after asymptomatic salpingitis; in the majority of cases with serologic evidence of a passed genital chlamydial infection. Recently, a hypothesis has been presented that antigen-antibody reactions to chlamydial heat-shock proteins might be an important factor for the morphological tissue damage and scarring leading to impaired fertility. Post-pelvic inflammatory disease associated with sexually transmitted disease infertility is acquired and, hence, preventable.^ieng

Sexually transmitted diseases and infertility.

In both men and women, STD-associated genital infections may cause permanent damage to the reproductive tract resulting in sub- or infertility. In men, the wide zone between sterility and normal fertility makes it difficult to demarcate the precise role of infection on post-infection fecundity, but it seems less important than in women. The reproductive events were studied in a cohort of 1,309 pregnancy-seeking women, < or = 35 years of age, after laparoscopically verified acute salpingitis, and 451 women with normal laparoscopy. Tubal factor infertility (TFI) was diagnosed in 12.1% of the patients and 0.9% of the controls, and the first pregnancy was ectopic in 7.8% and 1.3%, respectively. Of independent importance for infertility, ectopic pregnancy, and time between PID and first intrauterine pregnancy were number of infections, severity of the infections, contraception at the index laparoscopy, age, and delayed treatment. STD-associated in-subfertility is acquired and, hence, preventable.

Chlamydia trachomatis--clinical significance and strategies of intervention.

Chlamydia trachomatis is currently the most common sexually transmitted bacterial infection in the industrialized countries. In sexually active persons less than or equal to 25 years of age, prevalences up to 20% have been noted; urethritis/epididymitis in men and cervicitis/endometritis/salpingitis in women being the most common clinical expressions. Despite uncomplicated genital chlamydial infections often being asymptomatic or clinically indolent, sequelae to their complications are of importance in constituting the most common cause of acquired infertility in humans. Their commonness, high proportion of asymptomatic disease, and their serious postcomplication sequelae, make the genital chlamydial infections a major health problem; active search for genital chlamydial infections seems to be the most important means of intervention.