[Contraception and @entity5280 in XXXX ].

@entity1 @entity2954 @entity249 @entity2953 @entity25605 @entity2371 @entity5860 @entity490 @entity4134 @entity5280 @entity221
Although @entity2953 are a major public health problem at the international level, the relationship between contraception and @entity5280 is seldom examined. Numerous @entity2953 are more difficult to diagnose, more frequent, and more serious in @entity1 than in @entity1 . Differential diagnosis between @entity5280 has been a concern for practitioners for years, and many @entity5280 are probably never diagnosed. Lower @entity490 and sensitivity as well as @entity221 , leucocytosis, accelerated sedimentation rate, inflammatory annexial mass evident on sonography, and microorganisms in the pouch of Douglass and presence of leucocytes in the peritoneal fluid are diagnostic criteria. Apart from errors in treatment resulting from errors in diagnosis, @entity5280 are often inadequately treated, especially in the initial phase before symptoms are confirmed. The exact incidence of @entity5280 in the US is unknown, but @entity4134 ( @entity4134 ) accounted for over 200,000 hospitalizations per year between 1970-75. @entity4134 carries grave risks of subsequent ectopic pregnancy, chronic @entity2371 , and @entity249 which is more likely as the number of acute episodes increases. The female genital tract has diverse microenvironments propitious for growth of microorganisms of different types, aerobic and anaerobic. Each anatomic site has specific features conditioning bacterial growth. Histological modifications during the menstrual cycle and pregnancy affect the microbial flora. Except in the case of @entity2954 , it is not known how many @entity5860 spread to the upper tract. Since 1970, several studies have domonstrated a growing diversity of cervical and vaginal flora in asymptomatic subjects. The principal risk factors for @entity4134 have been well described in the literature. All contraceptive methods except the IUD provide some degree of protection against @entity4134 . Even among IUD users the risk of @entity4134 is probably not greater than among @entity1 with a comparable risk of exposure to @entity2953 . The protective effect of condoms has been recognized since the era of Casanova, but it is difficult to quantify. Studies describing the protective effects of spermicides used one against @entity5280 are very rare, and protective effects have usually been demonstrated only in vitro. Surfactants such as @entity25605 probably have viricidal properties against herpes simplex. Condoms and diaphragms have been seen to exercise a protective effect independent of spermicide, with relative risks of .6 and .4 compared to nonouse of contraception. There is as yet no consensus on changes in risk of @entity4134 during oral contraceptive (OC) use, but several studies have shown OCs to have a protective effect. Risks of @entity4134 in IUD users apparently stem from contamination during insertion or of the thread during prolonged use, but both possibilities remain controversial. The use of @entity1 not using contraception as controls in studies of relative risks of PId may not be appropriate because their sexual behavior and risks of exposure to @entity2953 may differ. At the moment of ovulation, when the mucus is most receptive, IUDs do not place any barrier in the way of ascension of sperm and bacteria to the upper genital tract.
