Diagnostic accuracy of pelvic imaging for acute pelvic inflammatory disease: protocol for a systematic review and meta-analysis v1 (protocols.io.bvsdn6a6)

ABSTRACTBackgroundMycoplasma genitaliumis increasingly seen as an emerging sexually transmitted pathogen, and has been likened toChlamydia trachomatis, but its natural history is poorly understood. The objectives of this systematic review were to determineM. genitaliumincidence, persistence, concordance between sexual partners, and the risk of pelvic inflammatory disease (PID).MethodsWe searched Medline, EMBASE, LILACS, IndMed and African Index Medicus from 1 January 1981 until 17 March 2018. Two independent researchers screened studies for inclusion and extracted data. We examined results in forest plots, assessed heterogeneity and conducted meta-analysis where appropriate. Risk of bias was assessed for all studies.ResultsWe screened 4634 records and included 17 studies; five (4100 women) reported on incidence, five (636 women) on persistence, 10 (1346 women and men) on concordance and three (5139 women) on PID. Incidence in women in two very highly developed countries was 1.07 per 100 person-years (95% CI, 0.61 to 1.53, I2 0%). Median persistence ofM. genitaliumwas estimated from one to three months in four studies but 15 months in one study. In ten studies measuringM. genitaliuminfection status in couples, 39-50% of male or female sexual partners of infected participants also hadM. genitaliumdetected. In prospective studies, the incidence of PID was higher in women withM. genitaliumthan those without (RR 1.68, 95% CI 0.59 to 2.77, I20%, 2 studies).DiscussionBased on findings from this and our linked review of prevalence, concordantM. genitaliummight be less common than forC. trachomatisand the age distributions of the infections differ. The synthesised data about prevalence, incidence and persistence ofM. genitaliuminfection are inconsistent. Taken together with evidence about antimicrobial resistance in the two infections,M. genitaliumis not the new chlamydia.Registration NumbersPROSPERO: CRD42015020420, CRD42015020405KEY MESSAGESThere are calls for widespread screening forMycoplasma genitalium, but the natural history of this emerging sexually transmitted pathogen is poorly understood.M. genitaliumincidence was 1.07 (95% confidence intervals, CI 0.61 to 1.53) per 100-person years in women in highly developed countries, 39-50% of infected individuals had a heterosexual partner withM. genitaliumand the risk ratio for pelvic inflammatory disease was 1.68 (95% CI 0.59 to 2.77).The duration of untreatedM. genitaliuminfection is probably longer than persistent detection ofM. genitalium, as measured in most cohort studies, in which inadvertent treatment cannot be ruled out.The results of this systematic review and other evidence sources show important differences in the epidemiology and dynamics ofM. genitaliumandChlamydia trachomatisinfection.

Download Full-text

Antibiotic therapy for pelvic inflammatory disease: an abridged version of a Cochrane systematic review and meta-analysis of randomised controlled trials

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053693 ◽

2018 ◽

Vol 95 (1) ◽

pp. 21-27 ◽

Cited By ~ 6

Author(s):

Ricardo F Savaris ◽

Daniele G Fuhrich ◽

Rui V Duarte ◽

Sebastian Franik ◽

Jonathan D C Ross

Keyword(s):

Systematic Review ◽

Pelvic Inflammatory Disease ◽

Inflammatory Disease ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Controlled Trials ◽

Quality Of Evidence ◽

Randomised Controlled

ObjectiveTo assess the effectiveness and safety of antibiotic regimens used to treat pelvic inflammatory disease (PID).DesignThis is a systematic review and meta-analysis of randomised controlled trials (RCTs). Risk of bias was assessed using the criteria outlined in the Cochrane guidelines. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation.Data sourcesEight electronic databases were searched from date of inception up to July 2016. Database searches were complemented by screening of reference lists of relevant studies, trial registers, conference proceeding abstracts and grey literature.Eligibility criteriaRCTs comparing the use of antibiotics with placebo or other antibiotics for the treatment of PID in women of reproductive age, either as inpatient or outpatient treatment.ResultsWe included 37 RCTs (6348 women). The quality of evidence ranged from very low to high, the main limitations being serious risk of bias (due to poor reporting of study methods and lack of blinding), serious inconsistency and serious imprecision. There was no clear evidence of a difference in the rates of cure for mild-moderate or for severe PID for the comparisons of azithromycin versus doxycycline, quinolone versus cephalosporin, nitroimidazole versus no use of nitroimidazole, clindamycin plus aminoglycoside versus quinolone, or clindamycin plus aminoglycoside versus cephalosporin. No clear evidence of a difference between regimens in antibiotic-related adverse events leading to discontinuation of therapy was observed.ConclusionsWe found no conclusive evidence that one regimen of antibiotics was safer or more effective than any other for the treatment of PID, and there was no clear evidence for the use of nitroimidazoles (metronidazole) compared with the use of other drugs with activity against anaerobes. More evidence is needed to assess treatments for women with PID, particularly comparing regimens with or without the addition of nitroimidazoles and the efficacy of azithromycin compared with doxycycline.

Download Full-text

Systematic Review and Meta-Analysis of Randomized Controlled Trials of Fuke Qianjin Tablet

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/8861631 ◽

2021 ◽

Vol 2021 ◽

pp. 1-24

Author(s):

Pan Jie ◽

Zuo Kai-Ni ◽

Wang Xiao-Mei ◽

Zhang Meng-Pei ◽

Wang Zhi-Heng ◽

...

Keyword(s):

Pelvic Inflammatory Disease ◽

Inflammatory Disease ◽

Conventional Therapy ◽

Clinical Symptoms ◽

Endometrial Thickness ◽

Meta Analysis ◽

Reaction Rates ◽

Inflammatory Factors ◽

Cochrane Library ◽

Acute Pelvic Inflammatory Disease

Purpose. The aim of the research was to evaluate the efficacy and safety associated with Fuke Qianjin tablet combined with conventional therapy in the treatment of pelvic inflammatory diseases and associated complications (endometritis) using a meta-analysis approach. Patients and Methods. We searched 8 electronic databases up to December 31, 2019, including PubMed, the Cochrane Library, Embase, Web of Science, CNKI, WanFang, VIP, and SinoMed. Eligible studies were clinical trials of Fuke Qianjin tablet combined with conventional therapy used in the treatment of acute pelvic inflammatory disease, chronic pelvic inflammatory disease, and endometritis. The meta-analysis was performed using STATA15 software. Results. A total of 125 RCTs (n = 14,494) were shortlisted for the meta-analysis, which included 23 trials for acute pelvic inflammatory disease, 69 trials for chronic pelvic inflammatory disease, and 33 trials for endometritis. The overall analysis illustrated Fuke Qianjin tablet combined with conventional therapy was significantly more efficacious than conventional therapy alone across all types of antibiotics treatment for acute pelvic inflammatory disease (OR = 5.57, 95% CI 4.09–7.58, Z = 10.90, p = 0.001 ), chronic pelvic inflammatory disease (OR = 4.70, 95% CI 4.07–5.42, Z = 21.21, p = 0.001 ) and endometritis (OR = 5.09, 95% CI 4.03–6.43; Z = 13.63, p = 0.001 ) in both primary endpoints and secondary endpoints. There is also a trend that Fuke Qianjin tablet combined with conventional therapy has lower adverse reaction rates than conventional therapy alone. Conclusion. Fuke Qianjin tablet combined with conventional therapy showed better clinical efficacy in the treatment of acute pelvic inflammatory disease, chronic pelvic inflammatory disease, and endometritis. There were no obvious drug-related adverse reactions. Fuke Qianjin tablet presented advantages in shortening the remission time of clinical symptoms, reducing the concentration of serum inflammatory factors, improving endometrial thickness, menstruation, and reducing relapse rate.

Download Full-text