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Chapter 13 : Infections of the Female Genital Tract

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Abstract:

Over the last quarter of a century, the use of intrauterine devices (lUDs) and tampons by millions of women worldwide has introduced four previously rare and unrecognized infections. The morbidity and mortality associated with toxic shock syndrome (TSS), spontaneous septic midtrimester abortion, pelvic actinomycosis, and lUD-associated pelvic inflammatory disease (PID) have been significant. These events have focused badly needed attention on the composition of these devices and pathogenesis of these infections. Initial insertion of the IUD is associated with bacterial colonization of the normally sterile uterine cavity. The sterile-foreignbody- induced inflammation may persist in both the endometrium and the endosalpinx, as demonstrated by histopathology and the presence of neutrophils and macrophages in uterine washes. The upper genital tract is normally sterile since the cervix provides an effective physical and chemical barrier to bacteria. The closed internal os, resistant squamous epithelium, and bacteriostatic endocervical mucus maintain the barrier. A recent prospective controlled study confirmed that infectious complications of IUDs are more frequent if the threads lead from the uterine cavity to the vagina than if they are contained within the uterine cavity. As for many other postoperative cases of TSS, most of these cases may have been secondary to wound infections.

Citation: Chesney P. 2000. Infections of the Female Genital Tract, p 265-286. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch13

Key Concept Ranking

Pelvic Inflammatory Disease
0.5404763
Toxic Shock Syndrome
0.43913704
Scanning Electron Microscopy
0.43069208
Transmission Electron Microscopy
0.43069208
Scanning Electron Microscopy
0.43069208
Transmission Electron Microscopy
0.43069208
Urinary Tract Infections
0.4222471
0.5404763
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Figures

Image of Figure 1
Figure 1

Scanning electron micrograph of a Lippes loop IUD that had been in place for 8 years. The rounded granules on the concave side are compatible with bioapatite, which is similar to dental plaque. Magnification, × 100. (Reprinted with permission from reference .)

Citation: Chesney P. 2000. Infections of the Female Genital Tract, p 265-286. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch13
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Image of Figure 2
Figure 2

(A) Scanning electron micrograph of the interuterine tip of a Copper 7 IUD. Note the moderate amount of biofilm on the surface. Bar = 500 µm. (B) Greater detail of the biofilm seen in panel A. Bar = 5 µm. (Reprinted with permission from reference .)

Citation: Chesney P. 2000. Infections of the Female Genital Tract, p 265-286. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch13
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Image of Figure 3
Figure 3

(A) Higher magnification of the biofilm seen in Fig. 2 . Note the presence of bacteria on the surface. (B) Greater detail of the bacteria seen in panel A. Both bars = 5 µm. (Reprinted with permission from reference .)

Citation: Chesney P. 2000. Infections of the Female Genital Tract, p 265-286. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch13
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References

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1. Avonts, D.,, M. Sercu,, P. Heyerick,, I. Vandermeeven,, A. Meheus,, and P. Piot. 1990. Incidence of uncomplicated genital infections in women using oral contraception or an intrauterine device: a prospective study. Sex. Transm. Dis. 17: 23 29.
2. Bank, H. L.,, and H. O. Williamson. 1983. Scanning electron microscopy of Dalkon Shield tails. Fertil. Steril. 40: 334 339.
3. Bank, H. L.,, H. O. Williamson,, and K. Manning. 1975. Scanning electron microscopy of copper containing intrauterine devices: long-term changes in utero. Fertil. Steril. 26: 503 508.
4. Barrett, K. F.,, S. Bledsoe,, B. E. Greet,, and W. Droegemueller. 1977. Tampon-induced vaginal or cervical ulceration. Am. J. Obstet. Gynecol. 127: 332 333.
5. Batar, I.,, L. G. Lainpe,, and H. Allonen. 1991. Clinical experience with intrauterine devices inserted with and without tail. Int. J. Gynaecol. Obstet. 36: 137 140.
6. Beerthuizen, R. J.,, J. A. Van Wijck,, T. K. Eskes,, A. H. Vermeulen,, and G. P. Vooijs. 1982. IUD and salpingitis: a prospective study of the pathomorphological changes in the oviducts in IUD users. Eur. J. Obstet. Gynecol. Reprod. Biol. 13: 31 41.
7. Bergdoll, M. S.,, and P. J. Chesney. 1991. Toxic Shock Syndrome. CRC Press. Inc., Boca Raton, Fla.
8. Bergdoll, M. S.,, B. A. Crass,, R. F. Reiser,, R. N. Robbins,, and J. P. Davis. 1981. A new staphylococcal enterotoxin, enterotoxin F, associated with toxic-shock syndrome Staphylococcus aureus isolates. Lancet i: 1017 1021.
9. Berkeley, A. S.,, J. P. Micha,, K. S. Freedman,, and J. C. Hirsch. 1985. The potential of digitally inserted tampons to induce vaginal lesions. Obstet. Gynecol. 66: 31 35.
10. Berkley, S. F.,, A. W. Hightower,, C. V. Broome,, and A. L. Reingold. 1987. The relationship of tampon characteristics to menstrual toxic-shock syndrome. JAMA 258: 917 920.
11. Bernstein, G. S.,, L. H. Kilzer,, A. H. Coulson, et al. 1982. Studies of cervical caps. I. Vaginal lesions associated with use of the Vimule cap. Contraception 26: 443 436.
12. Broome, C. V.,, P. S. Hayes,, G. W. Ajello, et al. 1982. In vitro studies of interactions between tampons and Staphylococcus aureus. Ann. Intern. Med. 96: 959 962.
13. Buchanan, H.,, L. Villard-Mackintosh,, M. Vessey,, D. Yeates,, and K. McPherson. 1990. Epidemiology of pelvic inflammatory disease in parous women with special reference to intrauterine device use. Br. J. Obstet. Gynaecol. 97: 780 788.
14. Buhler, M.,, and E. Papiernik. 1983. Successive pregnancies in women fitted with intrauterine devices who take antiinflammatory drugs. Lancet i: 483 484.
15. Burkman, R. T. 1981. Women's health study: association between intrauterine device and pelvic inflammatory disease. Obstet. Gynecol. 57: 269 276.
16. Burkman, R. T. 1991. Intrauterine devices. Curr. Opin. Obstet. Gynecol. 3: 482 485.
17. Burkman, R. T.,, and M. T. Damewood,. 1985. Actinomyces and the intrauterine contraceptive device, p. 427 437. In G. I. Zatuchni,, A. Goldsmith,, and J. J. Sciarra (ed.), Intrauterine Contraception: Advances and Future Prospects. J. B. Lippincott Co., Philadelphia, Pa.
18. Burnakis, T. G.,, and N. B. Hildebrandt. 1986. Pelvic inflammatory disease: a review with emphasis on antimicrobial therapy. Rev. Infect. Dis. 8: 86 94.
19. Cates, W., Jr.,, H. W. Ory,, R. W. Rochat,, and C. W. Tyler, Jr. 1976. The intrauterine devices and deaths from spontaneous abortion. N. Engl. J. Med. 29: 1155 1159.
20.CentersforDiseaseControl. 1980. Toxic-shock syndrome—United States. Morb. Mortal. Wkly. Rep. 29: 220230.
21.Centers for Disease Control. 1980. Follow-up on toxic-shock syndrome—United States. Morb. Mortal. Wkly. Rep. 29: 297299.
22.Centers for Disease Control. 1980. Follow-up on toxic-shock syndrome. Morb. Mortal. Wkly. Rep. 29: 441445.
23.Centers for Disease Control. 1984. Toxic-shock syndrome and the vaginal contraceptive sponge. Morb. Mortal. Wkly. Rep. 33: 4344.
24. Centers for Disease Control. 1990. Reduced incidence of toxic-shock syndrome. United States 1980-1990. Morb. Mortal. Wkly. Rep. 39: 421422.
25. Chain, W.,, M. Mazor,, and A. Wiznitzer. 1992. The prevalence and clinical significance of intramniotic infection with Candida species in women with preterm labor. Arch. Gynecol. Obstet. 251: 9 15.
26. Chesney, P. J.,, B. A. Crass,, and M. B. Polyak, et al. 1982. Toxic-shock syndrome: management and long-term sequelae. Ann. Intern. Med. 96: 847 851.
27. Chesney, P. J.,, and J. P. Davis,. 1992. Toxic shock syndrome, p. 1277 1295. In R. D. Feigin, and J. D. Cherry (ed.), Textbook of Pediatric Infectious Disease. 3rd ed. W. B. Saunders Co., Philadelphia, Pa.
28. Cleghorn, A. G.,, and R. G. Wilkinson. 1981. The IUCD-associated incidence of Actinomyces israelii in the female genital tract. Aust. N. Z. J. Obstet. Gynaecol. 29: 445 449.
29. Cramer, D. W.,, I. Schiff,, S. C. Schoenbaum, et al. 1985. Tubal infertility and the intrauterine device. N. Engl. J. Med. 312: 941 947.
30. Crass, B. A.,, and M. S. Bergdoll. 1986. Involvement of staphylococcal enterotoxins in nonmenstrual toxic shock syndrome. J. Clin. Microbiol. 23: 1138 1139.
31. Culliton, B. J.,, and D. S. Knopman. 1974. Dalkon Shield affair: a bad lesson in science and decision making. Science 185: 839 842.
32. Curtis, E. M.,, and L. Pine. 1981. Actinomyces in the vaginas of women with and without intrauterine contraceptive devices. Am. J. Obstet. Gynecol. 140: 880 884.
33. Daling, J. R.,, N. S. Weiss,, B. J. Metch, et al. 1985. Primary tubal infertility in relation to the use of intrauterine device. N. Engl. J. Med. 312: 937 941.
34. Danielson, R. W. 1983. Vaginal ulcers caused by tampons. Am. J. Obstet. Gynecol. 146: 547 549.
35. Dart, R. C.,, and M. A. Levitt. 1985. Toxic-shock syndrome associated with the use of the vaginal contraceptive sponge. JAMA 253: 1877.
36. Davis, J. P.,, P. J. Chesney,, P. J. Wand, and the Investigation and Laboratory Team. 1980. Toxic-shock syndrome. Epidemiologic features, recurrences, risk factors, and prevention. N. Engl. J. Med. 303: 1429 1455.
37. Donders, G. G.,, P. Moerman,, J. Caudron,, and F. A. Van Assche. 1991. Intrauterine Candida infection: a report of four infected fetuses from two mothers. Eur. J. Obstet. Gynecol. Reprod. Biol. 38: 233 238.
38. Edelman, D. A.,, G. S. Berger,, and L. Keith. 1982. The use of IUD's and their relationship to pelvic inflammatory disease: a review of epidemiologic and clinical studies. Curr. Probl. Obstel. Gynecol. 6: 33 34.
39. Eschenbach, D. A. 1980. Epidemiology and diagnosis of acute pelvic inflammatory disease. Obstet. Gynecol. 55( Suppl.): 142S 152S.
40. Eschenbach, D. A.,, J. P. Harnisch,, and K. L. Homes. 1977. Pathogenesis of acute pelvic inflammatory disease: role of contraception and other risk factors. Am. J. Obstet. Gynecol. 128: 838 850.
41. Eschenbach, D. A.,, and R. M. Soderstrom,. 1980. IUD and salpingitis, p. 140 158. In E. S. E. Hafez (ed.), IUD Pathology and Management. International Medical Publishers, Lancaster, England.
42. Evans, D. T. 1993. Actinomyces israelii in the female genital tract: a review. Genitourin. Med. 69: 54 59.
43. Faich, G.,, K. Pearson,, D. Fleming,, S. Sobel,, and C. Anello. 1986. Toxic-shock syndrome and the vaginal contraceptive sponge. JAMA 255: 216 218.
44. Farley, T. M. M.,, M. J. Rosenberg,, P. J. Rowe,, J. H. Chen,, and O. Meirik. 1992. Intrauterine devices and pelvic inflammatory disease: an international prospective. Lancet 339: 785 788.
45. Fischetti, V. A.,, F. Chapman,, R. Kakani,, J. James,, E. Grun,, and J. B. Zabriskie. 1989. Role of air in growth and production of toxic shock syndrome toxin 1 by Staphylococcus aureus in experimental cotton and rayon tampons. Rev. Infect. Dis. 11( Suppl. 1): S176.
46. Flesh, G.,, J. M. Weiner,, R. C. Corlett, Jr.,, C. Boice,, D. R. Mishell, Jr.,, and R. M. Wolf. 1979. The in trauterine contraception device and acute salpingitis: a multifactor analysis. Am. J. Obstet. Gynecol. 135: 402 408.
47. Friedell, S.,, and L. J. Mercer. 1986. Non-menstrual toxic-shock syndrome. Obstet. Gynecol. Surv. 41: 336 341.
48. Friedrich, E. G., Jr.,, and K. A. Siegesmund. 1980. Tampon-associated vaginal ulcerations. Obstet. Gynecol. 55: 149 156.
49. Galvez, R. S.,, L. Galich,, A. M. Guirola,, L. P. Cole,, and C. Waszak. 1989. A comparative study of the T Cu 200 B with and without strings. Adv. Contracept. Deliv. Syst. 6: 107 112.
50. Garbe, P. L.,, R. J. Arko,, A. L. Reingold, et al. 1985. Staphylococcus aureus isolates from patients with nonmenstrual toxic shock syndrome. JAMA 253: 2538 2542.
51. Gard, P. R.,, J. S. Malhi,, and G. W. Haulon. 1993. Uterine contamination in the guinea pig following transcervical uterine monofilament insertion. Gynecol. Obstet. Invest. 35: 49 52.
52. Ghosh, K.,, I. Gupta,, and S. K. Gupta. 1989. Asymptomatic salpingitis in intrauterine contraceptive device users. Asia Oceania J. Obstet. 15: 37 40.
53. Goldacre, M. J.,, B. Watt,, N. London,, L. J. Milne,, J. D. Loudon,, and M. P. Vessey. 1979. Vaginal microbial flora in normal young women. Br. Med. J. 1: 1450 1454.
54. Gonzalez, E. R. 1981. Calcium deposits on IUD's may play a role in infections. JAMA 245: 1625 1626.
55. Gosden, C.,, A. Ross,, and N. B. Loudon. 1977. Intrauterine deposition of calcium on copper-bearing intrauterine contraceptive devices. Br. Med. J. 1: 202 206.
56. Gupta, P. K.,, D. H. Hollandu,, and J. K. Frost. 1976. Actinomycetes in cervico vaginal smears: an association with IUD usage. Acta Cytol. 20: 2945 2947.
57. Hackett, S. P.,, and D. L. Stevens. 1993. Superantigens associated with staphylococcal and streptococcal toxic-shock-syndrome are potent inducers of tumor necrosis factor-b synthesis. J. Infect. Dis. 168: 232 235.
58. Hagenfeldt, K. 1972. Intrauterine with the copper-T device: effect on trace elements in the endometrium, cervical mucus and plasma. Contraception 6: 27 54.
59. Haukkamaa, M. P. S.,, H. Jousimies-Somer,, and A. Siitonen. 1986. Bacterial flora of the cervix in women using different methods of contraception. Am. J. Obstet. Gynecol. 154: 520 524.
60. Helgerson, S. D.,, and L. R. Foster. 1982. Toxic shock syndrome in Oregon. Epidemiologic findings. Ann. Intern. Med. 96: 909 911.
61. Hill, B. G. 1991. Eubacterium nodatum mimics actinomyces in intrauterine device-associated infections and other settings within the female genital tract. Obstet. Gynecol. 79: 534 538.
62. Hill, J. A.,, E. Talledo,, and J. Steele. 1986. Quantitative transcervical uterine cultures in asymptomatic women using an intrauterine contraceptive device. Obstet. Gynecol. 68: 700 703.
63. Holmes, K. K.,, D. A. Esclienbach,, and J. S. Knapp. 1980. Salpingitis: Overview of etiology and epidemiology. Am. J. Obstet. Gynecol. 138: 893 900.
64. Hooton, T. A.,, S. D. Finn,, C. Johnson,, P. L. Roberts,, and W. E. Stamm. 1989. Association between bacterial vaginosis and acute cystitis in women using diaphragms. Arch. Intern. Med. 149: 1932 1936.
65.Indian Council of Medical Research ,Task Force o IUD. 1989. Randomized clinical trial with intrauterine devices (levonorgestrel intrauterine device (LNG) CUT, 380 Ag. CUT 220C, and CUT 200B). Contraception 39: 3752.
66. Ishihama, A. 1959. Clinical study on intrauterine rings, especially the present state of contraception in Japan and the experiences in the use of intrauterine rings. Yokohama Med. Bull. 10: 89 105.
67. Jacobson, J. A.,, C. R. Nicholas,, and E. M. Kasworm. 1985. Toxic-shock syndrome in Utah. 1976-1983. West. J. Med. 43: 337 341.
68. Jimerson, S. D.,, and J. D. Becker. 1980. Vaginal ulcers associated with tampon usage. Obstet. Gynecol. 56: 97 99.
69. Kafka, D.,, and R. B. Gold. 1983. Food and Drug Administration approves vaginal sponge. Fam. Plann. Perspect. 15: 146 147.
70. Kahn, H. S.,, and C. W. Tyler. 1976. An association between the Dalkon Shield and complicated pregnancies among women hospitalized for intrauterine contraceptive device related disorders. Am. J. Obstet. Gynecol. 125: 83 86.
71. Kaufman, D. W.,, J. Watson,, L. Rosenberg, et al. 1983. The effects of different types of intrauterine devices on the risk of pelvic inflammatory disease. JAMA 250: 759 762.
72. Kehrberg, M. W.,, R. H. Latham,, B. T. Haslam, et al. 1981. Risk factors for staphylococcal toxic-shock syndrome. Am. J. Epidemiol. 114: 873 879.
73. Keith, L. G.,, R. Bailey,, and M. Method. 1986. Ljubljana IUD's: further observations on surface morphology. Adv. Contracept. 2: 37 54.
74. Keith, L. G.,, and G. S. Berger,. 1985. The pathogenic mechanisms of pelvic infection, p. 450 471. In G. I. Zatuchni,, A. Golsmith, and J. J. Sciarra (ed.). Intrauterine Contraception: Advances and Future Prospects. J. B. Lippincott Co., Philadelphia. Pa.
75. Kessel, E. 1989. Pelvic inflammatory disease with intrauterine device use: a reassessment. Fertil. Steril. 51: 1 11.
76. Khan, S. R.,, and E. J. Wilkinson. 1985. Scanning electron microscopy as an analytical tool for the study of calcified intrauterine contraceptive devices. Scanning Electron Microsc. 3: 1247 1251.
77. Kreiswirth, B. N.,, J. P. Handley,, P. M. Schlievert,, and R. P. Novick. 1987. Cloning and expression of streptococcal pyrogenic exotoxin A and staphylococcal toxic shock syndrome toxin-1 in Bacillus subtilis. Mol. Gen. Genet. 208: 84 87.
78. Ladipo, O. A.,, G. Farr,, E. Otolorin, et al. 1991. Prevention of IUD-related pelvic infection: the efficacy of prophylactic doxycycline at IUD insertion. Adv. Contracept. 7: 43 54.
79. Lanes, S. F.,, C. Pook,, N. A. Dryer,, and L. Lanza. 1986. Toxic-shock syndrome, contraceptive methods and vaginitis. Am. J. Obstet. Gynecol. 154: 989 991.
80. Larkin, S. M.,, D. N. Williams,, M. T. Osterholm,, R. W. Tofte,, and Z. Posalaky. 1982. Toxic shock syndrome: clinical, laboratory, and pathologic findings in nine fatal cases. Ann. Intern. Med. 96: 858 864.
81. Lee, N. C.,, G. Rubin,, H. W. Ory,, and R. T. Burkman. 1983. Type of intrauterine device and the risk of pelvic inflammatory disease. Obstet. Gynecol. 62: 1 6.
82. Linneman, C. C., Jr.,, J. L. Staneck,, S. Hornstein, et al. 1981. The epidemiology of genital colonization with Staphylococcus aureus. Ann. Intern. Med. 96: 940 944.
83. Marlow, D. E.,, R. M. Weigle,, and R. S. Stauffenbert. 1981. Measurement of Tampon Absorbency: Evaluation of Tampon Brands. Bureau of Medical Devices. Food and Drug Administration, Rockville, Md.
84. Marrie, T. J.,, and J. W. Costerton. 1983. A scanning and transmission electron microscopic study of the surfaces of intrauterine contraceptive devices. Am. J. Obstet. Gynecol. 146: 384 394.
85. Mishell, D. R., Jr. 1985. Current status of intrauterine devices. N. Engl. J. Med. 312: 984 985.
86. Mishell, D. R., Jr.,, J. H. Bell,, R. G. Good,, and D. L. Mover. 1966. The intrauterine device: a bacteriologic study of the endometrial cavity. Am. J. Obstet. Gynecol. 96: 119 126.
87. Mueller, B. A.,, M. Luz-Jimenez,, J. R. Daling,, D. E. Moore,, B. McKnight,, and N. S. Weiss. 1992. Risk factors for tubal infertility. Influence of history of prior pelvic inflammation disease. Sex. Transm. Dis. 19: 28 34.
88. Mumford, S. D.,, and E. Kessel. 1991. Was the Dalkon Shield a safe and effective intrauterine device? The contract between case-control and clinical trial study findings. Fertil. Steril. 57: 1151 1175.
89. Murray, S.,, J. B. Hickey,, and E. Houang. 1987. Significant bacteremia associated with replacement of intrauterine contraceptive device. Am. J. Obstet. Gynecol. 156: 698 700.
90. Myatt, L.,, M. A. Bray,, D. Gordon,, and J. Morley. 1975. Macrophages on intrauterine contraceptive devices produce prostaglandins. Nature (London) 257: 227 228.
91. Newton, J. R.,, and D. Tacchi. 1990. Long-term use of IUD's. Lancet 335: 1322 1323.
92. Oriel, J. D.,, B. M. Davtridge,, and M. J. Denn. 1972. Genital yeast infections. Br. Med. J. 4: 761 764.
93. Osterholm, M. T.,, J. P. Davis,, R. W. Gibson, et al. 1982. Tri-state toxic-shock syndrome study. I. Epidemiologic findings. J. Infect. Dis. 145: 431 440.
94. Pap-Akeson, M.,, F. Solheim,, G. Thorbert,, and M. Akerlund. 1992. Genital tract infections associated with the intrauterine contraceptive device can be reduced by inserting the threads into the uterine cavity. Br. J. Obstet. Gynaecol. 99: 676 679.
95. Paris, L. A.,, L. A. Herwaldt,, D. Blum,, G. P. Schmid,, K. N. Shands,, and C. V. Broome. 1982. Pathologic findings in twelve fatal cases of toxic shock syndrome. Ann. Intern. Med. 96: 852 857.
96. Petitti, D. B.,, D. Yamamoto,, and N. N. Morgenstern. 1983. Factors associated with actinomyces-like organisms on Papanicolaou smears in users of intrauterine contraceptive devices. Am. J. Obstet. Gynecol. 145: 338 341.
97. Population Information Program. 1984. New developments in vaginal contraception: barrier methods. Popul. Rep. XII(1)( SeriesH[7]): H157H190.
98. Pritchard, J. A.,, P. C. MacDonald,, and N. F. Gant (ed.). 1984. Intrauterine contraceptive devices, p. 811 835. In Williams Obstetrics, 17th ed. Appleton & Lange, Norwalk, Conn.
99. Purrier, B. G. A.,, R. A. Sparks,, P. M. Watt,, and M. Elstein. 1979. In vitro study of the possible role of the intrauterine contraceptive device tail in ascending infection of the genital tract. Br. J. Obstet. Gynaecol. 86: 374 378.
100. Rasheed, J. K.,, R. J. Arko,, J. C. Feeley, et al. 1985. Acquired ability of Staphylococcus aureus to produce toxic shock-associated protein and resulting illness in a rabbit model. Infect. Immun. 47: 598 604.
101. Reingold, A. L. 1986. Toxic-shock syndrome and the contraceptive sponge. JAMA 255: 242 243.
102. Reingold, A. L.,, N. T. Hargrett,, B. B. Dan,, K. N. Shands,, B. Y. Strickland,, and C. V. Broome. 1982. Nonmenstrual toxic-shock syndrome. Ann. Intern. Med. 96: 871 876.
103. Rossing, M. A.,, and N. S. Weiss. 1992. MD's and pelvic inflammatory disease. Lancet 340: 248 249.
104. Roy, S. 1991. Nonbarrier contraceptives and vaginitis and vaginosis. Am. J. Obstet. Gynecol. 165: 1240 1244.
105. Sagiroglu, N.,, and E. Sagrioglu. 1970. Biologic mode of action of the Lippes loop in intrauterine contraception. Am. J. Obstet. Gynecol. 106: 506 515.
106. Schlech, W. F., III,, K. N. Shands,, A. L. Reingold, et al. 1982. Risk factors for development of toxic shock syndrome: association with a tampon brand. JAMA 7: 835 839.
107. Schlievert, P. M.,, K. N. Shands,, B. B. Dan,, G. P. Schmid,, and R. D. Nishimura. 1981. Identification and characterization of an exotoxin from Staphylococcus aureus associated with toxic-shock syndrome. J. Infect. Dis. 143: 509 516.
108. Schmidt, W. A. 1982. IUD's, inflammation, and infection: assessment after two decades of IUD use. Hum. Pathol. 13: 878 881.
109. Schmidt, W. A.,, C. W. M. Bedrossian,, V. Ali,, J. A. Webb,, and F. O. Bastian. 1980. Actinomycosis and intrauterine contraceptive devices-the clinicopathologic entity. Diagn. Gynecol. Obstet. 2: 165 167.
110. Schmidt, W. A.,, and K. L. Schmidt. 1986. Intrauterine device associated pathology: a review of pathogenic mechanisms. Scanning Electron Microsc. 2: 735 756.
111. Schwartz, B.,, S. Gaventa,, C. V. Broome, et al. 1989. Nonmenstrual toxic shock syndrome associated with barrier contraceptives: report of a case-control study. Rev. Infect. Dis. 11( Suppl. 1): S43.
112. Shands, K. N.,, G. P. Schmid,, B. B. Dan, et al. 1980. Toxic-shock syndrome in menstruating women. Association with tampon use and Staphylococcus aureus and clinical features in 52 cases. N. Engl. J. Med. 303: 1436 1442.
113. Shaw, S. T., Jr., 1985. Endometrial histopathology and ultrastructural changes with IUD use, p. 276 296. In G. I. Zatuchni,, A. Goldsmith,, and J. J. Sciarra (ed.), Intrauterine Contraception: Advances and Future Prospects. J. B. Lippincott Co., Philadelphia, Pa.
114. Sheppard, B. L.,, and J. Bonnar. 1982. Scanning and transmission electron microscopy of material adherent to intrauterine contraceptive devices. Br. J. Obstet. Gynaecol. 106: 506 515.
115. Sinei, S. A.,, K. F. Schultz,, P. R. Lamptey, et al. 1990. Preventing IUCD-related pelvic infection: the efficacy of prophylactic doxycycline at insertion. Br. J. Obstet. Gynaecol. 97: 412 419.
116. Sinei, S. K.,, C. S. Morrison,, D. Sekadde-Kigondu,, M. Allen,, and D. Kokonya. 1998. Complications of the use of intrauterine devices among HIV-1 infected women. Lancet 27: 1238 1241.
117. Skieldstad, F. E. 1997. How effectively do copper intrauterine devices prevent ectopic pregnancy? Acta Obstet. Gynecol. Scand. 76: 684 690.
118. Sivian, I. 1991. Dose and age-dependent ectopic pregnancy risks with intrauterine contraception. Obstet. Gynecol. 78: 291 297.
119. Sivin, I.,, S. Etmahgoub,, T. McCarthy, et al. 1990. Long-term contraception with the Levonorgestrel 20 mcg/day (LNg 20) and the Copper T 380 Ag intrauterine devices: a five year randomized study. Contraception 42: 361 378.
120. Skangalis, M.,, C. S. Mahoney,, and W. M. O'Leary. 1982. Microbial presence in the uterine cavity as detected by varieties of intrauterine contraceptive devices. Fertil. Steril. 37: 263 269.
121. Smith, M. R.,, and R. Soderstrom. 1976. Salpingitis: a frequent response to intrauterine contraception. J. Reprod. Med. 16: 159 165.
122. Sparks, R. A.,, B. G. A. Purrier,, P. J. Watt,, and M. Elstein. 1981. Bacteriological colonization of the uterine cavity: role of tailed intrauterine contraceptive devices. Br. Med. J. 282: 1189 1191.
123. Spence, M. R.,, D. R. Stutz,, and W. Paniom. 1975. Effect of a copper-containing intrauterine contraceptive device on Neisseria gonorrhoeae in vitro. Am. J. Obstet. Gynecol. 122: 783 784.
124. Stadcl, B. V.,, and S. Schlessclman. 1984. Extent of surgery for pelvic inflammatory disease in relation to duration of intra-uterine device use. Obstet. Gynecol. 63: 171 177.
125. Stolz, S. J.,, J. Davis,, J. M. Vergeront, et al. 1985. Development of serum antibody to toxic shock toxin among individuals with toxic shock in Wisconsin. J. Infect. Dis. 151: 883 889.
126. Strithers, B. J. 1991. Copper IUD's, PID and fertility in nulliparous women. Adv. Contracept. 7: 211 230.
127. Tatum, H. J.,, and E. B. Connell-Tatum. 1981. Barrier-contraception: a comprehensive review. Fertil. Steril. 36: 1 12.
128. Tatum, H. J.,, F. H. Schmidt,, D. Phillips,, M. McCarty,, and W. M. O'Leary. 1975. The Dalkon shield controversy: structural and bacteriological studies of IUD tails. JAMA 231: 711 717.
129. Tatum, H. J.,, F. H. Schmidt,, and D. M. Phillips. 1975. Morphological studies of Dalkon Shield tails removed from patients. Contraception 11: 465 468.
130. Todd, J. K.,, M. Fishaut,, F. Kaptral,, and T. Welch. 1978. Toxic-shock syndrome associated with phage-group-1 staphylococci. Lancet ii: 1116 1118.
131. Toivonen, J. 1993. Intrauterine contraceptive device and pelvic inflammatory disease. Ann. Med. (Finland) 25: 171 173.
132. Toivonen, J.,, T. Luukkaincn,, and H. Allonen. 1991. Protective effect of intrauterine release of levonorgestrel- on pelvic infection: three years comparative experience of levonorgestrel- and copper-releasing intrauterine devices. Obstet. Gynecol. 77: 261 264.
133. Toye, B.,, C. Laferriere,, P. Claman,, P. Jessamine,, and R. Peeling. 1993. Association between antibody to the chlamydial heat-shock protein and tubal infertility. J. Infect. Dis. 168: 1236 1240.
134. Treadway, D. R.,, C. U. Umezaki,, R. Mishell, Jr.,, and D. S. Steelage. 1975. Effect of intrauterine device on sperm transport in the human being: preliminary report. Am. J. Obstet. Gynecol. 123: 734 735.
135. Trebichavsky, I.,, and O. Nylkicek. 1979. Description of the population and ultrastructure of cells on IUD's. Acta Cytol. 23: 366 369.
136. Trieman, K.,, L. Liskin,, A. Kols,, and N. Rinehart. 1995. IUDs: an update, p. 1 35. In Population Information Program. Johns Hopkins School of Public Health, Baltimore. Md.
137. Ullman, G.,, and J. Hammerstein. 1972. Inhibition of sperm motility in vitro by copper wire. Contraception 6: 71 76.
138.U. S. Food and Drug Administration. 1974. FDA investigating IUD's after deaths reported. FDA Drug Bull. 4: 19.
139. Vergeront, J. M.,, S. J. Stolz,, B. A. Crass,, D. B. Nelson,, J. P. Davis,, and M. S. Bergdol. 1983. Prevalence of serum antibody to staphylococcal enterotoxin F among Wisconsin residents: implications for toxic-shock syndrome. J. Infect. Dis. 148: 692 698.
140. Vessey, M.,, R. Doll,, and R. Peto. 1976. A longterm followup study of women using different methods of contraception. An interim report. J. Biosoc. Sci. 8: 373 378.
141. Wagner, G.,, L. Bohr,, P. Wagner,, and L. N. Petersen. 1984. Tampon-induced changes in vaginal oxygen and carbon dioxide tensions. Am. J. Obstet. Gynecol. 148: 147 150.
142. Wagner, H.,, M. Pf'autsch,, and F. K. Keller. 1976. Investigation of the Dalkon Shield by scanning and transmission electron microscopy and bacteriologic studies. Arch. Gynecol. 221: 17 20.
143. Weissberg, S. M.,, and M. G. Dodson. 1983. Recurrent vaginal and cervical ulcers associated with tampon use. JAMA 25: 1430 1431.
144. Westrom, L. 1980. Incidence, prevalence and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am. J. Obstet. Gynecol. 138: 880 892.
145. Westrom, L.,, L. P. Bengtsson,, and P. A. Mardh. 1976. The risk of pelvic inflammatory disease in women using intrauterine contraceptive devices compared to nonusers. Lancet ii: 221 225.
146.WHO Task Force Report. 1990. The T Cu 380A, Multiload 250 and Nova T IUD's at 3, 5, and 7 years of use. Contraception 42: 142158.
147. Wilkins, K. M.,, G. W. Hanlon,, G. P. Martin,, and C. Marriott. 1989. The migration of bacteria through gels in the presence of IUCD monofilament tails. Contraception 39: 205 216.
148. Willson, J. R., 1987. Family planning, p. 192 209. In W. J. Ledger,, R. K. Laros, Jr.,, S. H. Mattox,, J. R. Willson,, and E. R. Carrington (ed.). Obstetrics and Gynecology, 8th ed. The C. V. Mosby Co., St. Louis, Mo.
149. Winkler, B.,, and R. M. Richart,. 1985. Cervical/uterine pathologic considerations in pelvic infection, p. 438 449. In G. I. Zatuchni,. A. Goldsmith,, and J. J. Sciarra (ed.). Intrauterine Contraception: Advances and Future Prospects. J. B. Lippincott Co., Philadelphia, Pa.
150. Wolf, A. S.,, and D. Krieger. 1986. Bacterial colonization of intrauterine devices (IUD's). Arch. Gynecol. 239: 31 37.
151. Wolfe, S. M. 1987. Dangerous delays in tampon absorbency warnings. JAMA 258: 949 951.
152. Wolner-Hanssen, P. 1991. Pelvic inflammatory disease. Curr. Opin. Obstet. Gynecol. 3: 687 691.
153. Zatuchni, G. I.,, A. Goldsmith,, and J. B. Sciarra (ed.). 1985. Intrauterine Contraception: Advances and Future Prospects. J. B. Lippincott Co., Philadelphia, Pa.
154. Zighelboim, I.,, W. Szczedrin,, and O. Zambrano. 1990. Management of IUD users with non-visible threads. Adv. Contracept. 6: 91 104.
155. Zipper, J.,, M. Medel,, and R. Prager. 1969. Suppression of fertility by intrauterine copper and zinc in rabbits: a new approach to intrauterine contraception. Am. J. Obstet. Gynecol. 105: 529 534.

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