| Abstract | Intrauterini uložak - IUD (engl. Intrauterine device) je jedna od najdjelotvornijih metoda kontracepcije, a koriste ga milijuni žena širom svijeta. Različite studije upućuju na prednosti njegove uporabe pri izboru metode kontracepcije. To su visoka učinkovitost, sigurnost, prihvatljiva cijena, dugotrajan učinak, te neometana spolna aktivnost. Negativna posljedica široke primjene intrauterinih uložaka je razvoj infekcije, pa čak i sa smrtnim ishodom. To zahtijeva veću pažnju u kontroli satava uložaka kao i pri postupku uvođenja, te što bolje razumijevanje patogeneze infekcija nastalih kao posljedica primjene IUD-a. Iz pregleda literaturnih navoda uočljivo je da su infekcije ženskoga spolnoga sustava češće u žena generativne dobi koje se koriste intrauterinim uloškom kao metodom kontracepcije nego u onih koje se takvom metodom ne koriste. Hipoteza je bila da u ispitanica koje koriste intrauterini uložak kao metodu kontracepcije postoji veća vjerojatnost razvoja infekcije vrata maternice - cervicitisa, u donosu na one žene koje nemaju uložak. Sim toga, u ispitanica koje koriste IUD očekuje se i izmjena fiziološke flore ženskoga spolnoga sustava (vrata maternice, rodnice). Stoga je pretpostavka da su žene koje duže vremena nose IUD podložnije razvoju infekcije, tj. cervicitisa. Ciljevi su bili: usporediti skupinu žena s IUD-om i kontrolnu skupinu, u odnosu na učestalost infekcija vrata maternice i vrstu uzročnika; unutar svake skupine ispitanica utvrditi zastupljenost infekcija u odnosu na udio kolonizacija; utvrditi povezanost infekcija s vrstom i vremenom primjene IUD-a; utvrditi postoji li utjecaj vrste izoliranoga mikroorganizma na displastične promjene cervikalnoga epitela. U istraživanje je bilo uključeno 236 žena generativne dobi iz ginekoloških ordinacija s područja Splitsko-dalmatinske županije. Ispitanice su podijeljene u dvije skupine. U skupini žena bez IUD-a , koja je predstavljala kontrolnu skupinu, obrađeno je ukupno 122 ispitanice, a srednja životna dob im je bila 35,2 godine. U skupini žena s IUD-om pregledano je ukupno 114 ispitanica, a srednja životna dob im je bila 37,0 godina. Kontrolna skupina su bile žene generativne dobi koje nisu koristile intrauterini uložak, a izabrane su slučajnim odabirom (obrada pri sistematskom ginekološkom pregledu). Uzorkovanje, transport, obrada uzorka u laboratoriju i interpretacija rezultata provedeni su standardnim mikrobiološkim postupcima i metodama. Rezultati: U ispitivanoj skupini žena s IUD-om uvjetno patogene bakterije izolirane su u 75 (66%) žena, dok su u kontrolnoj skupini izolirane u 40 (33%) žena, što je predstavljalo statistički značajnu razliku (p<0,001). Najčešće izolirane bakterije bile su Escherichia coli i Ureaplasma urealyticum u obje skupine sa statistički značajno većom zastupljenošću u skupini žena s IUD-om (p<0,001). Escherichia coli dokazana je u 29 (25%) žena s IUD-om, a u skupini žena bez IUD-a pronađena je u 10 (8%) žena. Ureaplasma urealyticum je također bila puno češća u skupini žena s IUD-om. Pronađena je u 30 (26%) žena s IUD-om, dok je u skupini žena bez IUD-a bilo 16 (13%) žena s takvim nalazom. Od ukupno 114 žena s IUD-om infekcija je bila prisutna u njih 33 (29%), a kolonizacija u 42 (37%) žene. U kontrolnoj skupini od 122 žene bez IUD-a, samo njih 16 (13%) su imale infekciju, a 24 (20%) žene su bile kolonizirane. I kolonizacija i infekcija bile su statistički značajno češće u skupini žena koje koriste IUD (p<0,001). Patološki rezultat PAPA testa utvrđen je samo u 1 (0,8%) ispitanice koja je imala uredan mikrobiološki nalaz, dok ih je bilo 12 (10,4 %) u ispitanica u kojih je istodobno bila izolirana uvjetno patogena bakterija, što je predstavljalo statistički značajnu razliku (p=0,001). Promijenjen nalaz PAPA testa pronađen je u 8 (17,4%) od ukupno 46 ispitanica koje su istodobno imale dokazanu Ureaplasma urealyticum, dok je takav nalaz bio prisutan u 5 (2,6%) ispitanica bez Ureaplasma urealyticum (p<0,001). Naše ispitanice su koristile različite vrste IUD-a. Nije utvrđena statistički značajna razlika u učestalosti izolacije uvjetno patogenih bakterija pri uporabi različitih vrsta IUD-a (p=0,93), niti u odnosu na vrijeme primjene IUD-a (p=0,67). Zaključak: Dokazana je statistički značajna razlika u učestalosti izolacije uvjetno patogenih bakterija, vrsti izolirane bakterije i promjeni citološkoga nalaza, u odnosu na uporabu IUD-a. Ovim istraživanjem utvrđena je neočekivano veća učestalost izolacije Ureaplasma urealyticum u žena koje koriste IUD, uz istodobno veću vjerojatnost razvoja patoloških promjena u stanicama vrata maternice u onih žena u kojih je izolirana Ureaplasma urealyticum. |
| Abstract (english) | An Intrauterine Device - IUD is one of the most efficient methods of contraception used by millions of women worldwide. Various studies indicate benefits of its use during the selection of a contraceptive method. These are high effeciency, safety, reasonable price, long-term effect, and undisturbed sexual activity. Negative effect of wide use of Intrauterine Devices refers to infection development, or even fatal outcome. It requires particular care during control of device composition as well as during the process of insertion, and better comprehension of infection pathogenesis that occurred as a result of IUD use. On the basis of literature review, it is evident that infections of female reproductive system are more frequent in women of generative age using Intrauterine Device as a contraceptive method than in those not using such method. It was assumed that subjects using an Intrauterine Device as a contraceptice method were more likely to develop the infection of cervical cells - cervicitis, in relation to women not using the device. Additionally, a change in physiological flora of female reproductive system was also expected in subjects using IUD. Therefore, it was suggested that women using IUD for a longer period were more likely to develop an infection. The aims were: to compare a group of women using IUD and a control group, in relation to frequency of the cervicitis and the type of causative agent; to determine infection rate in relation to colonization proportion within every group of subjects; to determine correlation between infections with type and time of IUD use; to ascertain if there is an effect of the type of isolated microorganism on dysplastic changes of the cervical epithelium. The survey include 236 women of generative age from gynecological offices in the area of Split and Dalmatian County. The subjects were divided into two groups. In the group of women not using IUD, which represented a control group, the overall of 122 subjects were treated, and the median age was 35.2 years. In the group of women using IUD, the overall of 114 subjects were examined, and the median age was 37.0 years. The control group included randomly selected women of generative age not using intrauterine device (workup at systematic gynecological examination). Sampling, transport, sample processing in the laboratory and interpretation of results were condacted using standard microbiological processes and methods. The results: In the analyzed group of women using IUD, conditionally pathogenic bacteria were isolated in 75 (66%) women, whereas in the control group it was isolated in 40 (33%) women, which represented statistically significant difference (p<0.001). The most frequently isolated bacteria were Escherichia coli and Ureaplasma urealyticum in both groups with a statistically significantly higher rate in the group of women using IUD (p<0.001). Escherichia coli was reported in 29 (25%) women using IUD, while in the group of women not using IUD Escherichia coli was found in 10 (8%) women. Ureaplasma urealyticum was also more frequent in the group of women using IUD. It was detected in 30 (26%) women using IUD, whereas in the group of women not using IUD there were 16 (13%) women with such test result. Out of total 114 women using IUD, the infection developed in 33 (29%) of them, and the colonization in 42 (37%) women. In the control group of 122 women not using IUD, only 16 (13%) developed the infection, and 24 (20%) women were colonized. Both, the colonization and the infection represented statistically significant higher rate in the group of women using IUD (p<0.001). Pathological result of PAPA test was found in only 1 (0.8%) subject whit normal microbiological test result, whereas there were 12 (10.4%) of them in subjects whit concurrently isolated conditionally pathogenic bacteria (p=0.001). Changes in PAPA test results were found in 8 (17.4%) out of a total 46 subjects with concurrently established Ureaplasma urealyticum, whereas such test results were found in 5 (2.6%) out of 190 subjects with no Ureaplasma urealyticum, hich represented statistically significant difference (p<0.001). Our subjects used different types of IUDs. There was no statistically significant difference neither in the frequency of conditionally pathogenic bacteria isolation on usage of different IUD types (p=0.93), nor in relation to time of IUD use (p=0.67). Conclusion: Statistically significant difference in the frequency of conditionally pathogenic bacteria isolation, type of isolated bacteria and change of cytological test results in relation to IUD use was established. This survey proved unexpected higher frequency of Ureaplasma urealyticum isolation in women using IUDs, with concurrently higher odds of developing pathological changes in cervical cells of women whom Ureaplasma urealyticum was isolated. |
