Prevalence of Gonorrhoeal and/or Chlamydial Infection in Hospitalized Patients with Pelvic Inflammatory Disease

Objectives:To determine the prevalence of gonorrhoeal and/or chlamydial infection in hospitalized patients with pelvic inflammatory disease (PID) and to evaluate the factors which might be associated with these infections. Study design: Cross-sectional study. Setting:Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital. Materials and Methods: Seventy-six women with pelvic inflammatory disease (PID), who were admitted at Siriraj Hospital from December 2007 to August 2008, were recruited. Gonorrhoeal and chlamydial infections were identified by polymerase chain reaction (PCR) from endocervical swab. Demographic data were utilized for assessment regarding factors associated with gonorrhoeal or chlamydial infections. The student T-test, Chi-square and multivariable regression analysis were applied for analysis. Results:The prevalence of gonorrhoeal and/or chlamydial infection in PID patients was 35.5%. Gonorrhoeal infection was detected for 23.7% of PID patients whereas Chlamydial infection was detected for 19.7%. Nevertheless, 33.3% of patients who had gonorrhoeal infection were found to have co-infection of C.trachomatis. Analysis by multivariable logistic regression, revealed that factors associated with gonorrhoeal and/or chlamydial infection were socioeconomic factor i.e. the women who had income less than 5,000 Baht per month (AOR = 3.9; 95%CI = 1.03-14.86; p-value = 0.045) and those who had sexual intercourse during menstruation period (AOR = 6.19, 95%CI = 1.42-26.9; p-value = 0.015). Conclusion:About one-third of women with PID had gonorrhoeal and/or chlamydial infection. Women who had lower socioeconomic status and had sexual intercourse during menstrual bleeding were more likely to have these infections

Prevalence, Associated Factors and Pregnancy Outcomes of Anemia during Intrapartum Period in HIV-Infected Pregnant Women

Objective:To determine prevalence, associated factors and pregnancy outcomes of anemia during intrapartum period in HIV-infected pregnant women.Materials and Methods:A prospective and descriptive study was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand from September 2011 to July 2013. One hundred and five HIV-Infected pregnant women during intrapartum period were included into the present study.Results:The prevalence of anemia at intrapartum period was 41.0% (95% confidence interval = 32.0 - 50.5). Compared with normal group, anemia group had a higher rate of no antenatal care (ANC), anemia at first ANC, viral load ≥ 400 copies/ml and positive urine amphetamine. In addition, a lower mean age and a lower rate of known case of HIV infection before current pregnancy were found in anemia group. By multiple logistic regression analysis, anemia at first ANC and viral load ≥ 400 copies/ml were only two parameters that associated with anemia at delivery (p = 0.003, OR = 1.64, 95% CI = 1.16 - 2.23 and p = 0.000, OR = 4.5, 95% CI = 1.28 - 5.89, respectively). Regarding to pregnancy outcomes, the patients in anemia group had a higher rate of preterm birth, low birth weight and blood transfusion than the other group.Conclusions: With two associated factors, anemia at first ANC and viral load ≥ 400 copies/ml, a high prevalence of anemia at delivery in HIV-infected pregnant women was found in the present study. Compared with normal group, the pregnancy outcomes in anemia group seem to be poorer. However, these conclusions should be interpreted in light of limitation of the number of patients in this study

Low Complication Rate Associated with Total Laparoscopic Hysterectomies Using the Retroperitoneal Approach: A Series of 1,092 Cases in Siriraj Hospital

Objective: This study was performed to evaluate the incidence of and risk factors for major complications associated with the Siriraj total laparoscopic hysterectomy (SiTLH) technique. Methods: In total, 1,092 patients who underwent SiTLH from January 2009 to December 2013 were enrolled in this retrospective study. The incidence of major complications such as death, vascular injury, visceral injury was the main outcome. Comparison between the patients with and without complications was such as unintended laparoconversion, vascular injury, visceral injury performed to determine associated risk factors. Patient satisfaction was also evaluated. Results: The incidence of major complications was 2.1%. There was a significantly increased risk of major complications among the patients with a uterine weight of ≥500 g (7.5% vs 1.8%, P =0.002), the patients with a uterine weight of ≥400 g and pelvic endometriosis (14.3% vs 1.9%, P =0.033), or experience of surgeon <15 years (2.9% vs 1.2%, P=0.049). In total, 1,031 (94.4%) of the patients were extremely satisfied with the results of surgery. Conclusion: SiTLH technique is feasible and safe. However, the authors believe that good surgical skills and an understanding of the pelvic anatomy are essential to ensure good outcomes using our technique

Sexually transmitted infections among HIV-infected women in Thailand

BACKGROUND: Data on sexually transmitted infections (STI) prevalence among HIV-infected women in Thailand are limited. We studied, among HIV-infected women, prevalence of STI symptoms and signs; prevalence and correlates of having any STI; prevalence and correlates of Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (GC) among women without CT and/or GC symptoms or signs; and number of women without CT and/or GC symptoms or signs needed to screen (NNS) to detect one woman with CT and/or GC overall, among pregnant women, and among women ≤25 years. METHODS: During October 2004–September 2006, HIV-infected women at 3 obstetrics and gynecology clinics were asked about sexual behaviors and STI symptoms, physically examined, and screened for chlamydia, gonorrhea, trichomoniasis, and syphilis. Multivariate logistic regression was used to identify correlates of infections. NNS was calculated using standard methods. RESULTS: Among 1,124 women, 526 (47.0%) had STI symptoms or signs, 469 (41.7%) had CT and/or GC symptoms or signs, and 133 (11.8%) had an STI. Correlates of having an STI included pregnancy and having STI signs. Among 469 women and 655 women with vs. without CT and/or GC symptoms or signs, respectively, 43 (9.2%) vs. 31 (4.7%), 2 (0.4%) vs. 9 (1.4%), and 45 (9.6%) vs. 38 (5.8%) had CT, GC, or “CT or GC”, respectively; correlates included receiving care at university hospitals and having sex with a casual partner within 3 months. NNS for women overall and women ≤25 years old were 18 (95% CI, 13-25) and 11 (95% CI, 6-23), respectively; and for pregnant and non-pregnant women, 8 (95% CI, 4-24) and 19 (95% CI, 14-27), respectively. CONCLUSIONS: STI prevalence among HIV-infected women, including CT and GC among those without symptoms or signs, was substantial. Screening for CT and GC, particularly for pregnant women, should be considered

Prevalence and cumulative incidence of abnormal cervical cytology among HIV-infected Thai women: a 5.5-year retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>Cervical cancer is one of the most common AIDS-related malignancies in Thailand. To prevent cervical cancer, The US Public Health Service and The Infectious Disease Society of America have recommended that all HIV-infected women should obtain 2 Pap smears 6 months apart after the initial HIV diagnosis and, if results of both are normal, should undergo annual cytological screening. However, there has been no evidence in supporting whether this guideline is appropriate in all settings - especially in areas where HIV-infected women are living in resource-constrained condition.</p> <p>Methods</p> <p>To determine the appropriate interval of Pap smear screenings for HIV-infected Thai women and risk factors for subsequent abnormal cervical cytology, we assessed the prevalence, cumulative incidence and associated factors of cervical cell abnormalities (atypical squamous cell of undetermined significance or higher grades, ASCUS+) among this group of patients.</p> <p>Results</p> <p>The prevalence of ASCUS+ was 15.4% at the first visit, and the cumulative incidence of ASCUS+ gradually increased to 37% in the first 3.5 years of follow-up appointments (first 7 times), and tended to plateau in the last 2 years. For multivariate correlation analysis, women with a CD4 count <350 cells/μL had a significant correlation with ASCUS+ (<it>P </it>= 0.043). There were no associations of subsequent ASCUS+ with age, pregnancy, contraceptive method, highly active anti-retroviral treatment, assumed duration of infection, or the CD4 count nadir level.</p> <p>Conclusion</p> <p>There are high prevalence and cumulative incidence of ASCUS+ in HIV-infected Thai women. With a high lost-to-follow-up rate, an appropriate interval of Pap smear screening cannot be concluded from the present study. Nevertheless, the HIV-infected Thai women may require more than two normal semi-annual Pap smears before shifting to routinely annual cytologic screening.</p

Comparison of the Oncologic Outcomes between Exploratory Laparotomy and Laparoscopic Surgery for Endometrial Cancer: Siriraj Experience

Objective: This study was undertaken to evaluate surgical and oncologic outcomes for patients with endometrial cancer, compared between exploratory laparotomy and laparoscopic surgery. Methods: In total, 324 patients who diagnosed with endometrial cancer during January 2007 to December 2016 were enrolled. The comprehensive surgical staging procedures, including total hysterectomy, bilateral salpingo-oophorectomy (BSO), pelvic lymphadenectomy (PL), and/or para-aortic lymphadenectomy (PAL) were undergone. Demographic, clinical, treatment, operative, outcome, and survival outcome were recorded and evaluated. Results: 81 patients performed laparoscopy without conversion. No significant difference in baseline characteristics and pathological characteristics between two groups was observed. When compared with laparotomy group, the laparoscopy group had longer operative time, shorter hospital stays, and lower blood loss. Two-year overall survival (OS) was 97.9% and 95.1% in the laparotomy and laparoscopy groups, respectively (p=0.263). In addition, 2-year disease-free survival (DFS) between both groups was equal (93.7% versus 88.6%, respectively; p=0.309). Conclusion: Laparoscopic surgery is an efficacious, achievable and safe technique for patients with endometrial cancer. Good surgical skills and proper surgical techniques are required to effectuate optimal outcomes

Thai Interest Group for Endometriosis (TIGE) consensus statement on endometriosis-associated pain

This consensus statement has been developed by the Thai Interest Group for Endometriosis (TIGE) for use by Thai clinicians in the diagnosis and management of endometriosis. TIGE is a group of clinical and academic gynaecologists with a particular interest in endometriosis. Endometriosis is an oestrogen-dependent inflammatory disease which causes chronic symptoms such as dysmenorrhoea, chronic pelvic pain, dyspareunia and subfertility, and it is common in reproductive-age women. There is limited overall data on its prevalence in different clinical settings in Thailand, but it is clear that the disease causes significant problems for patients in terms of their working lives, fertility, and quality of life, as well as placing a great burden on national healthcare resources. Decisions about selecting the appropriate treatment for women with endometriosis depend on many factors including the age of the patient, the extent and severity of disease, concomitant conditions, economic status, patient preference, access to medication, and fertility need. Several hormonal treatments are available but no consensus has been reached about the best option for long-term prevention of recurrence. Bearing in mind differences in environment, genetics, and access to the healthcare system, this treatment guideline has been tailored to the particular circumstances of Thai women

Increased Burden of Concordant and Sequential Anogenital Human Papillomavirus Infections Among Asian Young Adult Women With Perinatally Acquired HIV Compared With HIV-Negative Peers

BACKGROUND: Youth with perinatally acquired HIV (YPHIV) are at higher risk for anogenital human papillomavirus (HPV) infection. METHODS: We enrolled a cohort of YPHIV and HIV-negative youth in Thailand and Vietnam, matched by age and lifetime sex partners, and followed them up for 144 weeks (to 2017). Participants had annual pelvic examinations with samples taken for HPV genotyping. Concordant infection was simultaneous HPV detection in multiple anogenital compartments (cervical, vaginal, anal); sequential infection was when the same type was found in successive compartments (cervicovaginal to/from anal). Generalized estimating equations were used to assess factors associated with concordant infection, and Cox regression was used to assess factors associated with sequential infection. RESULTS: A total of 93 YPHIV and 99 HIV-negative women were enrolled, with a median age of 19 years (interquartile range, 18-20 years). High-risk anogenital HPV infection was ever detected in 76 (82%) YPHIV and 66 (67%) HIV-negative youth during follow-up. Concordant anogenital high-risk HPV infection was found in 62 (66%) YPHIV versus 44 (34%) HIV-negative youth. Sequential cervicovaginal to anal high-risk HPV infection occurred in 20 YPHIV versus 5 HIV-negative youth, with an incidence rate of 9.76 (6.30-15.13) versus 2.24 (0.93-5.38) per 100 person-years. Anal to cervicovaginal infection occurred in 4 YPHIV versus 0 HIV-negative women, with an incidence rate of 1.78 (0.67-4.75) per 100 person-years. Perinatally acquired HIV was the one factor independently associated with both concordant and sequential high-risk HPV infection. CONCLUSIONS: Children and adolescents with perinatally acquired HIV should be prioritized for HPV vaccination, and cervical cancer screening should be part of routine HIV care for sexually active YPHIV