Chapter 13 : Infections of the Female Genital Tract

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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
Toxic Shock Syndrome
Scanning Electron Microscopy
Transmission Electron Microscopy
Scanning Electron Microscopy
Transmission Electron Microscopy
Urinary Tract Infections
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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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