The Role of Vaginal Secretory Immunoglobulin a, Gardnerella Vaginalis, Anaerobes, and Chlamydia Trachomatis in Post Abort al Pelvic Inflammatory Disease

Abstract

In a prospective study of 129 women undergoing induced first-trimester abortion, 14 (10.9%) contracted postabortal pelvic inflammatory disease (PID). Samples of vaginal secretion for quantitation of secretory immunoglobulin A (sIgA) as well as isolates from cervix/urethra for the culture of anaerobes and aerobes, including Bacteroides fragilis et melaninogenicus and Gardnerella vaginalis, were obtained at the preoperative visit. Two blood samples from each woman with postabortal PID were analysed for antibodies against G. vaginalis. Twenty-five per cent of women with a history of PID developed postabortal PID, and 25% with vaginitis contracted postabortal infection (p less than 0.001 and p less than 0.005). Twenty-five per cent of women harboring C. trachomatis at the time of abortion developed infection. The presence of anaerobes or G. vaginalis was not associated with the frequency of postabortal PID (all p-values greater than 0.1). One woman with postabortal PID produced a culture positive for G. vaginalis and a rise in specific antibody titer. The levels of vaginal sIgA were not significantly associated with a positive history of PID (p greater than 0.6), with postabortal PID (p greater than 0.4) or with the presence of anaerobes or G. vaginalis at the time of abortion (p greater than 0.3). However, significantly elevated levels of sIgA were found in women harboring C. trachomatis (p less than 0.05). Thus, the study could not demonstrate any correlation between vaginal sIgA and PID, but increased sIgA in Chlamydia-positive women. A history of PID and vaginitis entailed a significant risk of contracting postabortal PID.

Bacterial vaginosis

“…Others have reported similar findings (82,106,117). In another study (71), postabortal pelvic inflammatory disease occurred in 9 (25%) of 36 women who had vaginitis during the previous year compared with 4 (5%) of 74 without prior vaginitis (P < 0.005). Association with specific organisms from cervical cultures collected at the time of pelvic inflammatory disease could not be made.…”

Immunoglobulin Contents in Cervical Secretions of Women with Chlamydial Cervicitis

“…Osser and Persson [7] found that local IgA antibodies offered no protection against salpingitis and probably also endometritis. Heisterberg et al [17] came to the same conclusions. Brunham et al [6] demonstrated an inverse correlation with S-IgA and recovery of C trachomatis from the cervix.…”

Complications from first-trimester aspiration abortion: a systematic review of the literature

“…Information on treatment for Chlamydia-positive women was not available in the 1987 study by Heisterberg et al [44], and only results for Chlamydia negative women, who did not receive prophylaxis, were included in four other studies [36,41,49,50]. Among women randomized to receive antibiotic prophylaxis in three RCTs [35,37,42], there was a lower incidence of PID at follow-up (4.8-5.5%) than for women assigned to the control group (8.6-10.9%).…”

“…A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 9 Although the majority of studies reported on multiple interventions for minor and major complications, one study reported on every outcome considered in this review [20]; six studies only had information on treatment for infection [37,38,41,44,50,61] and two only reported on interventions for anesthesia-related complications [31,68]. The inclusion and exclusion criteria were clearly defined, but several studies reported excluding women who tested positive for a sexually transmitted infection or recently had been treated with antibiotics.…”