Cefoxitin Plus Doxycycline Versus Clindamycin Plus Gentamicin in Hospitalized Pelvic Inflammatory Disease Patients: An Experience from A Tertiary Hospital

Objective: To compare the length of hospital stay (LOS) and surgical rate in patients hospitalized with pelvic inflammatory disease (PID) who received either cefoxitin plus doxycycline regimen or clindamycin plus gentamicin regimen. Methods: Medical records of patients hospitalized with PID from 2004 to 2011 were reviewed. Study population was women aged 14-40 years old who had a first-time, admitted diagnosis and a discharged diagnosis of PID. Patients who had prior hysterectomy, bilateral salpingectomy and were not sexually active were excluded. The patients received either intravenous cefoxitin (2 grams every 6 hours) plus oral doxycycline (100 mg twice a day) regimen or intravenous clindamycin (900 mg every 8 hours) plus gentamicin (240 mg once daily) regimen. Outcomes of interest were LOS and surgical rate. Results: Of 252 eligible participants, 141 (55.95%) received cefoxitin plus doxycycline and 111 (44.05%) received clindamycin plus gentamicin. The patients receiving cefoxitin plus doxycycline had statistically significant lower age and less number of cases of tubo-ovarian abscess (TOA) (P<0.05). Logistic regression showed the similar LOS and surgical rate in both groups after adjusted with age and TOA. No severe adverse effect was identified in both regimens. Conclusion: Cefoxitin plus doxycycline regimen appears as effective as clindamycin plus gentamicin regimen for treating hospitalized PID patients in terms of LOS, surgical rate and safety profile

Characteristics and Neonatal Outcomes of Teenage Pregnant Women Diagnosed with Syphilis at Siriraj Hospital

Objective: To demonstrate the characteristics of teenage pregnant women diagnosed with syphilis during pregnancy and neonatal outcomes. Methods: This is a retrospective study. Medical records of teenage pregnant women who were diagnosed with syphilis during pregnancy and delivered at Siriraj Hospital and their newborn babies from 2011 to 2016 were reviewed. Demographic data and clinical factors were retrieved. Neonatal outcomes including gestational age at birth, birth weight, and diagnosis of congenital syphilis were recorded. STATA version 12.0 was used to analyze the data and p-value less than 0.05 was considered statistically significant. Results: During 2011-2016, there were 28 eligible women. The mean age was 17.6±1.2 years. Seventy-five percent of them were unemployed and one-fourth had been educated less than or up to primary school level. The median number of partners was 4 and their sexual debut started from the age of 15.3±0.9. A quarter also had other sexually transmitted infections (STIs). Congenital syphilis was diagnosed in 12 newborns (12/28, 42.8%). The mothers of the newborns with congenital syphilis were more likely to be unemployed, had first antenatal care (ANC) after 20 weeks of gestation, had <4 ANC visits, had high initial non-treponemal titer and poor treatment of syphilis before deliveries (p<0.05 for all). Preterm birth and very low birth weight were significantly more common in newborns with congenital syphilis. Conclusion: Some socio-economic factors are associated with the risk of syphilis infection. Almost half of the teenage pregnant women diagnosed with syphilis delivered babies with congenital syphilis. Inadequate antenatal care and poor treatment of maternal syphilis are the predictive factors of congenital syphilis

Video-based versus Medical Personnel-led Training for the Knowledge on Condom Use, Partner Notification and Sexually Transmitted Infections in Rural Communities in Thailand: A Randomized Comparison Pilot Study

Objective: To compare the knowledge regarding partner notification (PN), condom use (CU) and sexually transmitted infections (STIs) after video-based or medical personnel-led training. Methods: From December 2016 to January 2017, we conducted an opened-label randomized study in four communities (20 participants/ community) in Bangsaphannoi district, Prachuabkirikhan province. In each community, the participants were randomly allocated into Group A (medical personnel-led training) or Group B (video-based training). Both trainings covered similar contents which included knowledge about STIs (5 minutes); how to safely notify their partners (10 minutes) and techniques of correct condom use (10 minutes). Participants’ knowledge was assessed by five one-best questions for each topic before and after the training. Comparison of scores within group and between groups was done by using Wilcoxon rank sum test and Wilcoxon signed rank test. P <0.05 was considered statistically significant. Results: From 160 eligible participants, 148 could complete the study (74 in Group A and 74 in Group B). Between two groups, there was no difference of participants’ characteristics, including age, education, employment, sex debut, STIs and number of partners. Both training techniques significantly improved participants’ knowledge and there was no difference between them. The lowest median score and least improvement of knowledge were found in PN. Conclusion: At the community level, both video-based training and medical personnel-led training improve the knowledge on PN, CU and STIs with comparable results

Characteristics of Patients Admitted with Tubo-Ovarian Abscess and Surgical Treatment in Siriraj Hospital

Objective: Tubo-ovarian abscess (TOA) is the most severe form of pelvic inflammatory disease (PID). We aimed to demonstrate the characteristics of patients admitted with TOA in Siriraj Hospital and to assess the prevalence of surgical treatment. Methods: The descriptive chart reviews were conducted in all patients admitted with TOA during January 2008 - December 2012. One exclusion criterion was that the diagnosis was changed during the admission. Data were presented in n (%), mean ± S.D. Chi-square and Student t-test were used for the comparison between TOA with and without surgical treatment. A p <0.05 was considered statistically significant. Results: From 122 patients admitted with TOA, 107 cases had the same diagnosis on discharge. Mean age was 33.1+ 11.8 years and mean BMI was 21.9 + 4.9 kg/m2. Around half of them were nulliparous, 55.1% were married and 67.3% were sexually active. About 14% reported multiple partners. Surgical treatment was performed in 42% of the participants. The characteristics associated with surgical treatment included older age (38.6 ± 11.2 vs. 29.1 ± 10.7 years, p<0.001) and abscess size larger than 6 cm (75.6% vs. 22.6%, p<0.001). Conclusion: Older age and abscess size larger than 6 cm are associated with surgical treatment in patients with TOA