Background
Methods
Ethical approval
Study design
Control group | Case group | ||
---|---|---|---|
Inclusion criteria | Exclusion criteria | Inclusion criteria | Exclusion criteria |
Saudi | Non-Saudi | Saudi | Non-Saudi |
Patient age ≥ 18 and ≤ 42 years. | Patient age < 18 or > 42 years. | Patient age ≥ 18 and < 40 years. | Patient age < 18 or > 40 years. |
Cyclic women with a history of previous intrauterine pregnancy and no history of hydrosalpinx or ectopic pregnancy | Women with abnormal menstrual cycle, history of infertility treatment, history of PID, endometriosis and previous ectopic pregnancy. | Ectopic pregnancy following spontaneous conception | Ectopic pregnancy following assisted conception, using IUD, History/symptoms of urogenital infection (e.g. vaginal discharge, dysuria, PID, etc.) |
Clinical decision to undertake total abdominal hysterectomy (TAH) for benign disease not affecting the Fallopian tubes and endometrium | Vaginal or subtotal hysterectomy | Singleton pregnancy | Multiple/heterotopic pregnancy |
Clinical decision to undertake tubal ligation for sterilisation | Use of IUD ≤ 1 year prior to operation | Clinical determination that the patient is haemodynamically stable | Symptoms and signs of hypovolemia |
Study groups
Maternity Hospital-Makkah | Maternity Hospital-Jeddah | Althagar General Hospital-Jeddah | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Year 1
|
Year 2
|
Year 3
|
Total
|
Year 1
|
Year 2
|
Year 3
|
Total
|
Year 1
|
Year 2
|
Year 3
|
Total
| |
Ectopic pregnancy (n = 84)
| 10 | 11 | 9 | 30 | 7 | 16 | 13 | 36 | 5 | 8 | 5 | 18 |
Total Abdominal Hysterectomy ( n = 20)
| 4 | 3 | 3 | 10 | 3 | 2 | 4 | 9 | 0 | 1 | 0 | 1 |
Tubal Ligation (n = 31)
| 5 | 5 | 3 | 13 | 4 | 5 | 4 | 13 | 2 | 3 | 0 | 5 |
Total (n = 135)
| 19 | 19 | 15 | 53 | 14 | 23 | 21 | 58 | 7 | 12 | 5 | 24 |
Sampling and processing
Multiplex-PCR for 7 sexually transmitted pathogens in tubal tissues
Statistical analysis
Results
Subject characteristics
Prevalence of sexually transmitted infections
A. Overall prevalence
B. Prevalence of STIs in case and control groups
Control (n = 51) | EP (n = 84) | Total (n = 135) | ||
---|---|---|---|---|
CT |
Single infection
| 1 (1.9 %) | 6 (7.2 %)
*
| 7 (5.2 %) |
Co-infections
| 2 (3.9 %) | 17 (20.2 %)
*,‡
| 19 (14.1 %)
‡
| |
Total
| 3 (5.9 %) | 23 (27.4 %)*
| 26 (19.2 %) | |
NG |
Single infection
| ND | ND | ND |
Co-infections
| 1 (1.9 %) | 5 (5.9 %) | 6 (4.5 %) | |
Total
| 1 (1.9 %) | 5 (5.9 %) | 6 (4.5 %) | |
MG |
Single infection
| ND | 3 (3.6 %) | 3 (2.2 %) |
Co-infections
| 2 (3.9 %) | 14 (16.7 %)
*,‡
| 16 (11.8 %)
‡
| |
Total
| 2 (3.9 %) | 17 (20.2 %)*
| 19 (14.1 %) | |
U. Urea/Parv |
Single infection
| 1 (1.9 %) | 2 (2.4 %) | 3 (69.2 %) |
Co-infections
| 3 (5.9 %) | 7 (8.4 %)
‡
| 10 (30.8 %)
‡
| |
Total
| 4 (7.8 %) | 9 (10.7 %) | 13 (9.6 %) | |
GV |
Single infection
| ND | ND | ND |
Co-infections
| 1 (1.9 %) | 6 (7.2 %)
*
| 7 (5.2 %) | |
Total
| 1 (1.9 %) | 6 (7.2 %)*
| 7 (5.2 %) | |
TV |
Single infection
| ND | ND | ND |
Co-infections
| ND | 4 (4.7 %) | 4 (2.9 %) | |
Total
| ND | 4 (4.7 %) | 4 (2.9 %) | |
HSV-1/2 |
Single infection
| ND | 1 (1.2 %) | 1 (0.75 %) |
Co-infections
| 3 (5.9 %) | 17 (20.2 %)
*,‡
| 20 (14.8 %)
‡
| |
Total
| 3 (5.9 %) | 18 (21.4 %)*
| 21 (15.6 %) |
Makkah centre | Jeddah centres | ||||
---|---|---|---|---|---|
Control (n = 23)
|
EP (n = 30)
|
Control (n = 28)
|
EP (n = 54)
| ||
CT |
Single infection
| 1 (4.3 %) | 2 (6.7 %) | ND | 4 (7.4 %) |
Co-infections
| 1 (4.3 %) | 7 (23.3 %)a,*
| 1 (3.6 %) | 10 (18.5 %)c,*
| |
Total
|
2 (8.7 %)
|
9 (30 %)
a
|
1 (3.6 %)
|
14 (25.9 %)
c
| |
NG |
Single infection
| ND | ND | ND | ND |
Co-infections
| ND | 1 (4.3 %) | 1 (3.6 %) | 4 (7.4 %) | |
Total
|
ND
|
1 (4.3 %)
|
1 (3.6 %)
|
4 (7.4 %)
| |
MG |
Single infection
| ND | 1 (4.3 %) | ND | 2 (3.7 %) |
Co-infections
| 1 (4.3 %) | 5 (16.7 %)a,*
| 1 (3.6 %) | 9 (16.7 %)c,*
| |
Total
|
1 (4.3 %)
|
6 (20 %)
a
|
1 (3.6 %)
|
11 (20.4 %)
c
| |
U. Urea/Parv |
Single infection
| ND | 1 (3.3 %) | 1 (3.6 %) | 1 (1.9 %) |
Co-infections
| 1 (4.3 %) | 2 (6.6 %) | 2 (7.2 %) | 5 (9.2 %)*
| |
Total
|
1 (4.3 %)
|
3 (10 %)
|
3 (10.7 %)
|
6 (11.1 %)
| |
GV |
Single infection
| ND | ND | ND | ND |
Co-infections
| ND | 3 (10 %) | 1 (3.6 %) | 3 (5.6 %) | |
Total
|
ND
|
3 (10 %)
a,*
|
1 (3.6 %)
|
3 (5.6 %)
b
| |
TV |
Single infection
| ND | ND | ND | ND |
Co-infections
| ND | 1 (3.3 %) | ND | 3 (5.6 %) | |
Total
|
ND
|
1 (3.3 %)
|
ND
|
3 (5.6 %)
| |
HSV-1/2 |
Single infection
| ND | ND | ND | 1 (1.9 %) |
Co-infections
| 1 (4.3 %) | 6 (20 %)a,*
| 2 (7.1 %) | 11 (20.4 %) | |
Total
|
1 (4.3 %)
|
6 (20 %)
a
|
2 (7.1 %)
|
12 (22.2 %)
c
|
Control | EP | ||
---|---|---|---|
CT (copies/ml) |
Single infection
|
(n = 1)
|
(n = 6)
|
6.06 X106
| 2.45 X 107 ± 1.43 X 105
| ||
Co-infections
|
(n = 2)
|
( n = 17)
| |
4.19 X 106 ± 2.98 X 106
| 4.22 X107 ± 2.1 X107
| ||
NG (copies/ml) |
Single infection
|
ND
|
ND
|
Co-infections
|
(n = 1)
|
(n = 5)
| |
6.24 X 104
| 7.9 X 105 ± 2.08 X 105
| ||
MG (copies/ml) |
Single infection
|
ND
|
(n = 2)
5.23 X 106 ± 2.13 X106
|
Co-infections
|
(n = 2)
|
(n = 14)
| |
3.1 X 106 ± 1.98 X105
| 9.67 X 106 ± 3.35 X107
| ||
U. Urea/Parv (copies/ml) |
Single infection
|
(n = 1)
|
(n = 2)
|
2.2 X107
| 7.54 X107 ± 3.54 X 107
| ||
Co-infections
|
(n = 3)
|
(n = 7)
| |
1.58 X107 ± 0.88 X107
| 9.87 X107 ± 2.15 X 107
| ||
GV (copies/ml) |
Single infection
|
ND
|
ND
|
Co-infections
|
(n = 1)
|
(n = 6)
| |
3.89 X106
| 11.95 X107 ± 5.38 X 107
| ||
TV (copies/ml) |
Single infection
|
ND
|
ND
|
Co-infections
|
ND
|
(n = 3)
| |
1.38 X106 ± 0.71 X 106
| |||
HSV-1/2 (copies/ml) |
Single infection
|
ND
|
(n = 1)
|
3.05 X104
| |||
Co-infections
|
(n = 3)
|
(n = 17)
| |
3.34 X104 ± 1.41 X104
| 2.90 X105 ± 9.41 X104
|