Pelvic inflammatory disease and obstetric infections

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A prospective study showed that repeated chlamydial infection, the presence of antibody to heat-shock protein 60, and the presence of the HLA-A31 determinant were independent risk factors for chlamydial pelvic inflammatory disease. A protective effect of oral contraceptive use against chlamydial pelvic inflammatory disease was confirmed. Co-infection with Trichomonas vaginalis increased the risk of pelvic inflammatory disease in women infected with Chlamydia trachomatis. Screening for chlamydial infection may, however, significantly reduce the risk of upper genital tract infection. In developing countries, syphilis may be an important risk factor for third trimester intrauterine foetal death. Pregnant women infected in the genital tract with human papillomavirus often transmit the infection to the infant, who may then have a persistent infection for at least 6 months. The health of pregnant women infected with HIV does not deteriorate as a result of their pregnancy, but there is an increased risk of complications if they have to undergo caesarian section. The risk of vertical transmission of the infection is increased with prematurity, prolonged rupture of the membranes, high maternal HIV-1 RNA plasma levels, and low serum vitamin A levels. The risk that a child of an HIV-infected mother will be separated from her is considerable; 5 years after delivery 14% of the women will have died and 24% will have developed stage IV disease (Centers for Disease Control classification).

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