[Pelvic Inflammatory Disease - Synergies between Family Practices and Gynaecological Specialised Assessment]. / Pelvic Inflammatory Disease ­ Schnittstellen zwischen Hausarztpraxis und gynäkologischer Spezialabklärung.

Pelvic Inflammatory Disease - Synergies between Family Practices and Gynaecological Specialised Assessment Abstract. The 'pelvic inflammatory disease' (PID) describes an ascending inflammation of the upper female genital tract, beginning with a local cervicitis and proceeding to endometritis and adnexitis. It is a common clinical picture with rising numbers in recent years, and it occurs both in gynaecological and general practice. The symptoms are often unspecific, discrete or althogehter lacking. In order to reduce long-term risks of chronic pelvic pain, sterility and/or ectopic pregnancies, rapid diagnosis followed by immediate therapy and a good interdisciplinary cooperation are necessary. Screening programs for chlamydia and gonococcus as the most common pathogens of PID have not yet been implemented in Switzerland so far.

[CME Sonography 91: Differential Diagnosis of Lower Abdominal Pain]. / CME-Sonografie 91: Differenzialdiagnose von Unterbauchschmerzen CME-Fragen.

CME Sonography 91: Differential Diagnosis of Lower Abdominal Pain Abstract. Pain in the lower abdomen is a frequent reason for further imaging clarification by sonography. The most frequent causes are appendicitis and diverticulitis, in addition to ureteral stones, ovarian and tubal pathology as well as various hernias. Appendicitis has a characteristic clinical presentation and can be diagnosed by CT or ultrasound. In children, the differential diagnosis is that of mesenteric lymphadenitis. Diverticulitis, often right-sided, can also be reliably diagnosed with CT or ultrasound. Not to be forgotten is the left-sided diverticulitis, which occurs more frequently in Asian persons. Appendicitis epiploica should be recognized to avoid unnecessary operations. The iliopsoas syndrome, which is diagnosed by sonopalpation, often remains undetected.

Tubo-ovarian abscess with endometrial cyst probably infected by Campylobacter fetus: Two cases.

Campylobacter fetus often causes systemic infection in immunocompromised or older patients, and prenatal infection, but Campylobacter has rarely been reported as a cause of adnexitis in healthy young women. Here we report two cases of endometriotic cysts infected by C. fetus for the first time. In case 1, a 28-year-old woman with a left adnexal cyst was hospitalized for left tubo-ovarian abscess and underwent left salpingo-oophorectomy. In case 2, a 22-year-old woman with a right adnexal cyst was hospitalized for a bilateral tubo-ovarian abscess and underwent right salpingo-oophorectomy and left salpingectomy. In both cases, C. fetus was detected on culture, and histopathology indicated a purulent endometriotic cyst. The present findings suggest that endometriotic cyst can be a focus of C. fetus infection.

Therapeutic observation of acupuncture plus heat-sensitive moxibustion for chronic pelvic inflammatory disease / 针灸推拿医学（英文版）

Objective:To observe the therapeutic efficacy of acupuncture plus heat-sensitive moxibustion in treating chronic pelvic inflammatory disease (CPID), for selecting an effective acupuncture-moxibustion method in treating chronic pelvic inflammation. Methods:Eighty CPID subjects were enrolled and divided into two groups by randomized single-blind method, 40 in each group. The observation group was intervened by acupuncture plus heat-sensitive moxibustion, while the control group was by acupuncture plus box-moxibustion, once every other day, 10 sessions as a treatment course, but the period time was skipped. The therapeutic efficacy was observed after 3 treatment courses. Results:The recovery rate was 45.0% and the total effective rate was 95.0% in the observation group, versus 20.0% and 80.0% in the control roup. There were significant differences in comparing the recovery rate and the total effective rate between the two groups (P<0.05). Conclusion:Acupuncture plus heat-sensitive moxibustion can produce a higher therapeutic efficacy in treating CPID than acupuncture plus box-moxibustion, and this is an easy-to-operate and safe method without adverse effect.

Clinical Study on Abdominal Acupuncture plus Herbal Medicine for Chronic Pelvic Pain Due to Qi Stagnation and Blood Stasis / 上海针灸杂志

Objective To observe the clinical efficacy of abdominal acupuncture plus herbal medicine in treating chronic pelvic pain due to qi stagnation and blood stasis after pelvic inflammatory diseases.Method Sixty patients with chronic pelvic pain due to qi stagnation and blood stasis after pelvic inflammatory diseases were randomized into a treatment group and a control group, 30 in each group. The treatment group was intervened by abdominal acupuncture plus herbal medicine, while the control group was by herbal medicine alone. After 3 menstrual cycles, the Visual Analogue Scale (VAS) for abdominal pain and McCormack scale were observed.Result After intervention, the abdominal VAS score and McCormack score were changed significantly in both groups (P<0.01,P<0.05). After intervention, there were significant differences in comparing the VAS score and McCormack score between the two groups (P<0.01).Conclusion Abdominal acupuncture plus herbal medicine can reduce chronic pelvic pain due to qi stagnation and blood stasis after pelvic inflammatory diseases.

Therapeutic Observation of Acupuncture plus TDP and Auricular Point Sticking for Chronic Pelvic Infection / 上海针灸杂志

ObjectiveTo observe the clinical efficacy of acupuncture plus TDP (specific electromagnetic treatment apparatus) and auricular point sticking in treating chronic pelvic infection.MethodSixty patients diagnosed with chronic pelvic infection were randomized into two groups. Thirty cases in the treatment group were intervened by acupuncture plus TDP and auricular point sticking, while the other 30 in the control group were by acupuncture plus TDP, 10 d as a treatment course in both groups, and the therapeutic efficacies were compared after 3 courses.ResultThe total effective rate was 96.7% in the treatment group versus 83.3% in the control group, and the difference was statistically significant (P<0.05).ConclusionAcupuncture plus TDP and auricular point sticking can produce a marked therapeutic efficacy in treating chronic pelvic infection, and its total effective rate is higher than that of acupuncture plus TDP.

Relationship Between Endometrial Integrin-?_v?_3 Expression and Steroid Hormone Level in Patients with Infertility Induced by Chronic Pelvic Inflammatory Disease / 广州中医药大学学报

0.05),while that of serum P was significant(P

Relationship Between TCM Syndrome Pattern and Immuno-endocrine Function in Patients with Infertility Induced by Chronic Pelvic Inflammation / 广州中医药大学学报

0.05) . Serum P level was much decreased in pattern 2 patients as compared with those in other pattern patients ( P0.05). [Conclusion] Serum P level is lower in the patients with CPI-induced infertility than that in the healthy, and varies in the patients with different patterns.

Effect of External Application of Osmosis-Improving Herbal Medicine and Enema with Blood-Activating and Stasis-Removing Herbal Medicine for Chronic Pelvic Inflammation / 广州中医药大学学报

[Objective] To investigate the effect of external application of osmosis-improving herbal medicine and enema with blood-activating and stasis-removing herbal medicine for chronic pelvic inflammation. [Methods] Single-blind and randomized trial was performed on 120 cases of chronic pelvic inflammation. The cases were randomized to two groups: group A ( n = 57) was treated by enema with blood-activating and stasis-removing herbal medicine and group B ( n = 63) by the combination of enema and external application of osmosis-improving herbal medicine. Fourteen days constituted one course of treatment and the therapeutic effect was evaluated after two courses. [Results] In group A, 30 cases were cured, 21 effective, 6 ineffective and the total effective rate was 89.5%; 43 were cured, 18 effective, 2 ineffective and the total effective rate was 96.8% in group B. The result of Ridit analysis showed that the effect of group B was better than that of group A ( t = 3.08, P

Pathogens of transmitted disease in the pathogenesis of acute pelvic inflammatory disease / 中华妇产科杂志

Objective To study the pathogenesis of pathogens of sexually transmitted disease (STD) in acute pelvic inflammatory disease (PID) Methods Neisseria gonorrhoeae, chlamydia trchomatis, ureaplasma urealyticum were cutured respectively in 130 patients with acute PID Results The pathogens of STD had been found in 55 patients The detective rate of Neisseria gonorrhoeae was 6 9% (9/130), about half of them were mixed infection; the detective rate of chlamydia trachomatis was 4 6% (6/130), all of them were mixed infection; the positive percentage of ureaplasma urealyticum was 37 7% (49/130), one third of them were mixed infection Conclusion The pathogens of STD might cause acute PID or only play a synergetic role in it

A Pharmacodynamic Study of Penyan Qing Capsule / 广州中医药大学学报

Objective To explore the main pharmacological actions of Penyan Qing Capsule (PQC) for chronic pelvic inflammation. Methods The analgesic action of PQC was studied by mouse hot_plate method. Experiments of mouse auricular swell ing and rat agar_induced granuloma were carried out to investigate the anti_infl ammatory action of PQC. Effects of PQC on function of mouse mononuclear phagocyt es and rat mesenteric microcirculation were also studied. Results PQC increa sed the rat pain threshold, reduced mouse auricular swelling induced by xylene a nd the weight of rat agar_induced granuloma. PQC could also improved rat mesente ric microcirculation disorder induced by noradrenline and increase the function of mouse mononuclear phagocytes. Conclusion PQC exerts good anti_inflammatory and analagisic action and can improve microcirculation. This will supply pharm acodynamic evidence for the application of PQC in clinic.

Transcervical recanalization of strictures in the postoperative fallopian tube.

PURPOSE: To evaluate use of transcervical recanalization in patients with reocclusion of the proximal fallopian tube after failed surgery to reverse sterilization or failed tuboplasty to treat inflammatory disease. MATERIALS AND METHODS: The standard technique for transcervical recanalization was attempted in seven patients after failed reversal surgery and in 12 after failed tuboplasty. Four of seven patients with failed reversal surgery had fistular tracts and one also had a stricture; the remaining three patients and all 12 patients treated after failed tuboplasty and tube reimplantation had strictures at the site of implantation or anastomosis. RESULTS: Transcervical recanalization failed in all patients with fistulas but succeeded in 13 of 15 with stenoses. Three patients became pregnant 1-16 months after recanalization and two after in vitro fertilization and embryo transfer. Reocclusion occurred in two of 10 patients reexamined 6-36 months after recanalization. CONCLUSION: Transcervical recanalization is recommended as an alternative to repeat microsurgical reimplantation or tuboplasty.

PIP: Transcervical tubal recanalization was performed in 19 patients in whom previous surgery had failed to reverse sterilization (n=7) or to reconstruct fallopian tubes obstructed from inflammatory disease (n=12). The patients were 25-41 years old, had been infertile for more than 18 months after the failed surgery and had no other clinical cause of infertility. 4 of the cases of failed reversal surgery had fistular tracts, and 1 also had a structure. The other 3 reversal patients and all 12 failed tuboplasty and tube reimplantation patients has strictures at the site of implantation or anastomosis. The standard technique for transcervical recanalization was followed. The transcervical recanalization only succeeded in 13/15 patients with stenoses. 3 of these became pregnant naturally 1-16 months after recanalization and 2 after in vitro fertilization and embryo transfer. Reocclusion occurred in 2 of 10 patients reexamined 6-36 months postoperatively. It was concluded that transcervical recanalization is a suitable alternative to repeat microsurgical reimplantation or to tuboplasty in cases such as these.

Use of the diaphragm without spermicides may be just as effective in preventing unwanted pregnancy.

PIP: Researchers are exploring ways of increasing the effectiveness and acceptability of the diaphragm. According to one Brazilian study, women tend to continue use of the diaphragm, with a higher rate of effectiveness, when it is used alone without spermicides. This may be due to convenience and cost. The retrospective study comparing 441 women who used diaphragms in conjunction with spermicides to 215 who used diaphragms alone demonstrated a significantly higher failure rate in the former group (9.8 per 100) than in the latter (2.8 per 100). There were also significantly more discontinuations for vaginal discharge and other medical reasons in the first group. The Coletivo Feminista Sexualidade e Saude in Sao Paulo, Brazil reports a high diaphragm acceptance rate with a high 1-year continuation rate (72%) among its clients. The clinic emphasizes adequate training of its clients in the use of the diaphragm, including follow up visits, which is important to the success of the method. Studies show that diaphragms used with spermicides also provide significant protection against sexually transmitted diseases. Women using this method are less likely (p .05) to have cervical gonorrhea (relative risk = .32) or trichomoniasis (relative risk = .24), or to be hospitalized for pelvic inflammatory disease.^ieng

HLA-DQ Alleles in Patients with Pelvic Inflammatory Disease Caused by Chlamydia Trachomatis in Han Nationality of Northern China / 中华皮肤科杂志

Objective To investigate the possible association of HLA-DQ alleles with pelvic inflammatory disease (PID) caused by Chlamydia trachomatis in Han nationality in Northern China. Methods Thirty five Han Chinese patients with PID caused by Chlamydia trachomatis and 98 unrelated healthy individuals from the same area were genotyped for HLA-DQ gene alleles by the PCR-sequence specific oligonucleotide (SSO) method. Results Compared with the healthy controls, the frequencies of HLA-DQA1*0501 and HLA-DQB1*0301 allele were significantly increased and also associated with the antibody response to Chlamydia trachomatis heat-shock protein 60 (CHSP60). Conclusions These results may provide clues to reveal the susceptibility gene of chlamydial pelvic inflammatory disease in China and the immunogenetic mechanisms of the disease.

Acute pelvic infection following hysterosalpingography at the Kenyatta National Hospital, Nairobi.

A total of 150 women who had hysterosalpingography (HSG) for investigation of infertility, at the Kenyatta National Hospital over a five month period, were recruited into the study to determine the prevalence of pelvic infection following the procedure. 44.0% of the total study group developed pelvic infection disease (PID) within the first week after the procedure. There were no obvious determining factors. It is possible that most women with infertility have quiescent genital tract infection, prior to HSG, with the latter only facilitating the entry of micro-organisms into the upper genital tract, thus causing pelvic infection or reactivating a pre-existing infections. Further studies should be conducted to determine the microbial patterns of the infection. There should be routine provision of prophylactic antimicrobial agent(s) to all women undergoing HSG in our unit to minimise the risk of developing pelvic infection and further damage to the uterine tubes which will worsen the prognosis.

PIP: Between September 1988 and January 1989 in Kenya, health care providers recruited 150 infertile women, 15-39 years old, who had gone to a gynecological outpatient clinic at Kenyatta National Hospital in Nairobi to undergo hysterosalpingography to determine the condition of the uterus and fallopian tubes. The aim of the study was to determine whether there was an association between hysterosalpingography and pelvic inflammatory disease (PID) and the determinants for PID. Most women were between 20-29 years old, married, and had a primary education (67.3%, 90.7%, and 55.3%, respectively). One week after hysterosalpingography, 44% developed acute PID, defined as having at least 2 of the following signs or symptoms: lower abdominal pain, rebound tenderness, cervical/adnexal tenderness, foul smelling vaginal discharge, adnexal mass(es), and fever of at least 38 degrees Celsius. The most frequent signs and symptoms were lower abdominal pain and tenderness. Married women were more likely to have PID than unmarried women (47.1% vs. 14.3%). The small numbers of unmarried women made it difficult to determine the significance of the difference, however. Sexual intercourse within the 1st week after hysterosalpingography was not associated with PID (45.2% for PID cases vs. 42.1% for non-PID cases). The researchers believed that hysterosalpingography pushed existing pathogens in the vagina into the uterus, or the women already had asymptomatic PID. They recommended further studies to determine whether physicians should administer prophylactic antibiotic therapy to all women undergoing hysterosalpingography.

Three consecutive recurrent ectopic pregnancies.

A case of three consecutive repeated ectopic pregnancies is presented in a 36-year-old woman who was being managed for infertility. The first two ectopic pregnancies occurred in the right fallopian tube, and both were treated conservatively. All three ectopic pregnancies were confirmed histopathologically. The aetiology, symptoms and management of the case are discussed, and the literature is reviewed.

PIP: Staff of the infertility clinic at King Khalid University Hospital in Riyadh, Saudi Arabia, cared for a Yemeni woman who had a poor obstetric history. She had had pelvic inflammatory disease. Her 1st pregnancy concluded in a full term vaginal delivery, but gastro-enteritis caused the infant's death at 4 months. She delivered her 2nd child at 32 weeks gestation and the infant died 3 days later. Her 3rd and 4th pregnancies occurred in the right tube. A laparotomy, conservative evacuation of the conceptus from the right tube, and peritoneal lavage were used to treat the ectopic pregnancies. She experienced spontaneous abortion of the 5th pregnancy at 10 weeks. The woman presented at the hospital's gynecology clinic at 40 days amenorrhea with low abdominal pain and a small amount of vaginal bleeding. She had not passed any clots or tissue. The general examination was normal. The pregnancy test was positive. Since she had past ectopic pregnancies, the physicians conducted an ultrasound, which revealed no intrauterine pregnancy and a heterogenous 4.5 cm x 5.5 cm mass near the left tube. Laparoscopy confirmed a normal size uterus, a mass on the left tube, and bleeding into the peritoneum. Laparotomy was performed to remove the unruptured left ampullary ectopic pregnancy in such a way as to preserve the patency of the tube and therefore fertility. The surgeons also conducted peritoneal lavage with dextran saline to remove the blood in the peritoneum. The surgeons lysed the adhesions they found between the omentum, abdominal wall, and the uterus. Both ovaries were in good condition. The right tube was in good condition. She did fine postoperatively and was released 7 days after operation. The physicians could not determine the patency of the left tube, because she was lost to follow up. This case shows that conservative management of the tubes to retain tubal patency was successful, since she was able to conceive, but recurrent ectopic pregnancies may damage the tubes.

HIV infection among patients with acute pelvic inflammatory disease at the Kenyatta National Hospital, Nairobi, Kenya.

AIDS continues to exert considerable strain on the economy, as well as social aspects of our lives. Previous studies have identified the categories of people most at risk of contracting and developing HIV infection and AIDS. In this study, 20.9% of women with acute pelvic infection at the Kenyatta National Hospital, were found to be seropositive for HIV, much higher than the general population in Kenya. Though there was no direct correlation between one's age and serological status, most of the women with pelvic inflammatory disease (PID) were young, quite sexually active, and involved with several partners. 49.0% of the entire group and 53.7% of the women who were seropositive, were married. This underlines the fact that marital status does not appear to offer any protection against HIV infection. The fact that majority of these women had started coitus quite early, they were not using any protective measure against STDs or HIV infection, and that they were involved with several partners, indicate that we are very far from winning the fight against HIV infection and AIDS. There is need to revise the currently operative programmes with a view to making them more effective, in preventing transmission and spread of HIV infection.

Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy.

Infection of the upper genital tract after abortion is well recognised, but routine screening for infection before termination is rare, and few centres are aware of the prevalence of post-abortion complications in their population. We undertook a study to assess the prevalence and sequelae of genital-tract infection in patients undergoing termination of pregnancy and to estimate the costs and potential benefits of introducing screening and prophylaxis for the most commonly found organisms. The study in Swansea, UK, was of 401 consecutive patients attending for termination of pregnancy; only 1 patient refused to take part. Immediately before the termination procedure vaginal and cervical swabs were taken for microscopic examination and culture of Trichomonas vaginalis, Neisseria gonorrhoeae, and candida species. We sought Chlamydia trachomatis by enzyme-linked immunosorbent assay. 112 (28%) women had the typical bacterial flora of anaerobic (bacterial) vaginosis, 95 (24%) had candidal infection, 32 (8%) chlamydial infection, 3 (0.75%) trichomonas infection, and 1 (0.25%) gonorrhoea. Postoperative follow-up of 30 of the women with chlamydial infection showed that pelvic infection developed in 19 (63%), of whom 7 were readmitted to hospital. 9 male partners of women with chlamydial (plus gonococcal in 1 case) infection were examined; 8 were symptom-free, 3 had C trachomatis infection, and 1 N gonorrhoeae. Estimated costs of hospital admissions for complications of chlamydial infection were more than double the costs of providing a routine chlamydia screening programme and prophylactic treatment. Screening for chlamydial infection before termination of pregnancy is essential. Prophylactic treatment for both chlamydial infection and anaerobic vaginosis should also be considered. Male partners of women infected with chlamydia are often symptom-free, but they must be traced to avoid reinfections.

PIP: Between October 1990 and March 1991, 401 women at Hill House Hospital in Swansea, Wales, undergoing an abortion enrolled in a study to determine the prevalence and sequelae of lower genital tract infection and to assess the costs and potential benefits of screening and of prophylaxis for the most common pathogens. The physicians administered 500 mg oxytetracycline for 10 days for women with uncomplicated chlamydia infection and for 14=21 days for those with chlamydia-related pelvic inflammatory disease (PID). A 5-day course of oral metronidazole (400 mg/2/times/day) treated anaerobic vaginosis and trichomonas infections. 51.7% had at least 1 lower genital tract infection, 28% had anaerobic vaginosis, 24% had candida infection and 32 women (8%) were infected with Chlamydia trachomatis. Some of these women also had anaerobic vaginosis, anaerobic vaginosis and candidosis, Escherichia coli infection, and candidosis (15, 1, 1, and 6 women, respectively). Anaerobic vaginosis was more likely to be present in women with chlamydia infection than in those without chlamydia infection (53% vs. 26%; p .05). 19 of 30 women (63%) with chlamydia infection who could be followed postoperatively developed PID. 7 women had to be readmitted to the hospital. 9 males partners of 26 women also attended the Genito-Urinary Medicine clinic. 8 had not symptoms, but 3 had C. trachomatis infection and 1 had Neisseria gonorrhoea infection. The physicians estimated the costs of hospital admissions for pelvic infection to be 2.4 times more costly than providing routine prophylactic screening and treatment (16,800 vs. 6960 UK pounds). These results showed the need to be screen for chlamydia infection before termination of pregnancy and to provide prophylactic treatment for chlamydia infection and anaerobic vaginosis. The physicians also recommended tracing the male partners of chlamydia-infected women to prevent reinfections.

Chlamydia trachomatis, infertility, and population growth in sub-Saharan Africa.

In sub-Saharan Africa, Neisseria gonorrhoeae and Chlamydia trachomatis are common infections. These pathogens are also the major causes of post-salpingitis tubal infertility, and infertility is a frequent problem in this region. A mathematical model, recently devised to estimate the effect of gonococcal infection on population growth, was used to estimate the potential effect of chlamydial infection on population growth. The model predictions for chlamydial infection were compared with those previously reported for gonococcal infection. The model predicts that both infections may be exerting severe effects on population growth at realistic prevalence rates of infection. The model also predicts that N. gonorrhoeae produces a steeper reduction in population growth than does C. trachomatis because its transmission dynamics result in a higher force of infection (incidence rate) at any given prevalence of infection. Large scale changes in the epidemiology of these infections can be expected to occur in sub-Saharan Africa because of improved sexually transmitted disease (STD) diagnosis and treatment services as a component of AIDS prevention. Changes in the epidemiology of gonococcal and chlamydial infection are predicted to result in accelerated population growth unless STD control programs are linked to effective contraception programs.

PIP: Researchers applied estimates of Chlamydia trachomatis transmission and disease parameters to a compartmental mathematical model of heterosexual, sexually transmitted disease (STD) transmission to determine the potential effect of chlamydia infection via its link to tubal infertility on population growth in sub-Saharan Africa. Epidemiologic parameters included transmission efficiency, salpingitis rate per cervical infection, tubal fertility rate per salpingitis episode, and average duration of infectivity. Sexual behavior parameters were sexual partner change and networks of sexual mixing. Demographic parameters consisted of a constant mortality rate (.02/year), a mean life expectancy (50 years), age of menarche (15 years), age of menopause (45 years), and maximum potential fertility rate. The mathematical model estimated that as the probability of infertility due to chlamydia infection increases, population growth falls almost linearly at various values of basic reproductive rates. In fact, 10% decline in population growth accompanies a 10% chlamydia prevalence. When the researchers applied estimates of gonorrhea transmission to the model, they learned that a 10% prevalence of gonorrhea results in a 30% reduction in population growth, indicating that gonorrhea has more of an effect on population growth than does chlamydia infection. Gonorrhea has higher transmissibility and shorter duration of infectivity than chlamydia infection, resulting in a higher incidence rate at any given prevalence of infection. Improved diagnosis and treatment of STDs as a result of AIDS prevention programs should result in considerable changes in the epidemiology of gonorrhea and chlamydia infection. These changes will likely speed up population growth unless STD control programs are integrated with effective family planning programs.

Sexually transmitted diseases in the age of AIDS.

Sexually transmitted diseases (STD) are common illnesses in the world. There is at least one new sexually transmitted disease consultation for every 100 persons a year in industrialised countries. Today the World Health Organisation estimates that there are 250 million new cases of STD every year world-wide, and over 20 distinct pathogens are currently recognised. While the overall incidence of STD have remained high in industrialised countries, the rates of increase of many bacterial STD such as syphilis and gonorrhoea were beginning to stabilise; but currently there is again a trend for these bacterial STD to rise in urban populations.

PIP: WHO estimates 250 million new cases worldwide of sexually transmitted diseases (STDs) each year. STDs of growing concern are chlamydial infections responsible for pelvic inflammatory disease (PID) in women and pneumonia and ophthalmia in newborns, and incurable viral infections, including Herpes simplex virus, human papilloma virus (HPV), hepatitis B virus, and HIV infection. HPV types 16 and 18 are associated with cervical intraepithelial neoplasia, one of the most serious complication of STDs. PID is another serious STD complication because it tends to recur and causes chronic abdominal pain, eventually resulting in hysterectomy, infertility, ectopic pregnancy, or chronic backache. STDs adversely affect pregnancy, often leading to ectopic pregnancy, stillbirth, prematurity, congenital and perinatal infections, and puerperal maternal infections. Genital ulcer diseases, e.g., chancroid, facilitate HIV transmission. HIV infection boosts the virulence of STD pathogens, e.g., Herpes simplex virus. Many people with STDs are asymptomatic and the clinical profile of STDs is always in flux, thus resulting in less than optimal case detection. Obstacles of STD treatment include antibiotic resistance of betalactamase-producing Neisseria gonorrhoea strains and the immunocompromising effect of HIV infections. Tourists are responsible for introducing HIV infection into many countries. Some countries (e.g., Saudi Arabia) require a negative HIV test before foreigners can work in those countries. Health resources are not keeping up with the spread of STDs and HIV. Governments should embark on health education campaigns to stem the spread of HIV. They should also integrate AIDS prevention with the control of other STDs.