Infectious Diseases in Obstetrics and Gynecology

From The Critics

Reviewer:Tessa E Madden, MD, MPH (Washington University School of Medicine)
Description:This is the sixth edition of a comprehensive book on many of the common organisms and infectious complications seen in obstetrics/gynecology. The book is well organized into four sections covering general considerations, organisms, problems in obstetrics, and problems in gynecology. Unfortunately, many of the chapters do not appear to have been updated since the previous edition was published in 2003.
Purpose:The preface states that this book was created to "address an unmet need for a depository of information specially focused on the uniqueness that pregnancy confers and the special considerations that differentiate the adverse impact of infectious disease entities between men and women." These are clearly important objectives and a book that addresses them in a comprehensive fashion is essential. In some ways, this book is successful in meeting these objectives. It is a good reference for perinatal infections and the associated sequelae, and the chapters on organisms commonly encountered are relevant, succinct, and readable. The preface goes on to note, "Authors are and have been chosen based upon demonstrated clinical and intellectual abilities. The editorial mandate to each is and has been to write each segment based upon a foundation derived from their patient care experience and its correspondence in the literature." The authors may have written from their patient care experience, but many of the chapters are not evidence-based.
Audience:The book is written for medical students, residents, andclinicians.
Features:The chapter on HIV infection is a particular strength; it is up to date and contains important, clinically relevant material including clinical patient scenarios and recommendations for prevention of maternal-to-child transmission. A good chapter on Gardnerella vaginalis includes a discussion about bacterial vaginosis. Readers looking for BV in the table of contents would not find it, but it is referenced in the index. The book does have a number of significant limitations. Not all chapters list an author, so it is unclear who wrote, or contributed to, the chapter. Specific sources are not referenced within the body of the text in most chapters, making it difficult for readers to refer to the primary text or decide if the information is evidence-based or the author's opinion. As an example, in chapter 2, the author describes a recent study that found the induction of immunity in the nasal mucosa appears to be the most effective method of inducing immunity in the vaginal mucosa, but the actual primary source is not cited in the text, so if one wanted to read more about this concept, one would have to look through all of the selected readings section to find the primary source. (Chapter 37 on Mobiluncus, however, is a nice discussion with citations in the body of the text with references provided at the end.) Most importantly, many of the chapters do not appear to have been updated from the previous edition. Chapter 1, on the bacteriology of the female genital tract, includes no discussion of the limitations of cultivation-based tests to identify vaginal bacterial species and the more recent studies that use cultivation-independent methods to identify bacterial species (e.g., Marrazzo et al. NEJM 2005) . These studies contributing to an evolution in thinking about the vaginal environment and deserve at least a mention. The most recent study cited in the reference is 2001 and most are from the 1980s and 1990s. In chapter 3, the most recently cited study is 1993 and there is no mention of cultivation-independent methods of identifying anaerobic species, specifically with PCR assay. Additionally, there is no discussion of antibiotic therapy other than "triples" although multiple other antibiotics have been shown to be effective in treating obstetrics/gynecology infections (e.g., the imipenams, ampicillan-sulbactam) . Chapter 15 covers HPV (human papilloma virus) and, while there have been many recent developments concerning HPV infection, manuscripts published, and some changes in recommendations for treatment, the only part of the chapter that appears to have been updated is the section on HPV vaccination, otherwise all of the cited references are from the 1980s and 1990s. Other chapters do not include current, evidence-based clinical recommendations. The chapters on infectious complications of intrauterine contraception (IUC) and legal abortion seem particularly outdated. In the summary section, the author recommends ways to avoid infectious morbidity, including patient education regarding irregular bleeding (common with the levonorgestrel IUC) , periodic pelvic exam with cytologic examination, limiting IUC use to 24 to 36 months, and removal of the IUC in all patients with any significant STI. None of these recommendations is evidence-based and they contradict clinical practice and are not in accordance with expert recommendations such as those from the World Health Organization (WHO MEC 2005) .
Assessment:In concept, a book that comprehensively addresses infections in obstetrics and gynecology would be very useful, but this sixth edition is limited by out-of-date chapters and a lack of evidence-based information and recommendations. Although a few chapters appear to be current, they don't justify replacing the previous edition.