1. Introduction

According to statistics all over the world in recent years there has been an increase in the frequency of inflammatory diseases and the reproductive system of women. In Uzbekistan, over the past 5 years, the incidence of PID has increased by 30% and continues to grow. At the same time, more than half of the cases of modern PID have erased clinical symptoms, and each of the generally accepted diagnostic and laboratory indicators has deviations from the norm in less than half of the cases. [3,9].

Inflammatory diseases of the pelvic organs pelvic inflammatory disease (PID) characterized by different symptoms depending on the level of destruction and the force of the inflammatory response. The disease develops as a result of the penetration of the pathogen in sexual ways and in the presence of favorable conditions for its reproduction. Such conditions are created in the post-partum and post-abortion period, during menstruation, for different intrauterine manipulations [1,5].

The decisive role in causing inflammation play: the state of the microorganism, the massiveness of infection, virulence of the etiological agent [2].

It was found that opportunistic pathogen bacterium (OPB) does not only cause of inflammation of the pelvic organs and cause of fetal and neonatal infections [1].

In this regard, microbiological tests have a high diagnostic value in the diagnostic of PID. Along with bacteriological diagnostics methods in recent years, other methods are widely used, in particular immunoassay - ELISA [4].

ELISA is an immunological laboratory method of qualitative determination and quantitative measurement of antigens. ELISA is based on the principle of interaction immunosorbent - pathogen antigen with antibodies in conjunction antigen-antibody complex with immunoglobulins containing enzyme label [3].

2. The Aim of the Study

Study and definition of the diagnostic value of detection of antibody titers to the antigens of some etiologic agents of PID in women of childbearing age.

3. Materials and Methods

To achieve the goal were studied 304 women of reproductive age with pelvic inflammatory disease. All patients were treated in the Khorezm branch of the Republican Scientific Center for Emergency Medical Care Ministry of Health of Uzbekistan. They were distributed by age as follows: 18-21 years - 12 patients (3,9 ± 1,1%), 22-29 years - 136 patients (44,7 ± 2,9%), 30-35 years - 56 patients (18,5 ± 2,2%), 36-49 years - 100 patients (32,9 ± 2,7%).

The main number of women were married (97,7 ± 0,9%), rural residents accounted for 69,4 ± 2,6%, and the urban 30,6 ± 2,6%. Among all women surveyed took a major amount of housewives and non-working women (84,5 ± 2,1%).

Patients often revealed acute salpingitis, oophoritis, piosalpinks (98,4 ± 0,7%). The diagnosis was verified by means of clinical, clinical, instrumental and laboratory studies on the proposals of the National Center for Disease Control and Prevention (CDC, USA, 2006).

For setting up ELISA were used diagnostic test systems for the determination of serum antibodies to the antigens of Chlamydia spp, Toxoplasma gondi, Mycoplasma spp, Cytomegalovirus, Herpes simplex virus type 1 and 2 - HSV 1,2 ( «XEMA» company's test systems, RF) Ureoplasmaurealyticum (test-system of the company "Vector-Best", Russia). The principle of the method lies in the qualitative detection of antibodies to the above mentioned antigens by indirect ELISA test on polystyrene. The results were obtainedbyspectrophotometricallymethod at a wavelength of 492 nm.

Duringcarry out this research were observed all the ethical principles for medical research involving human subjects, the Helsinki Declaration adopted by the World Medical Association in 1964 (the latest addition in Seoul on the 59th General Assembly of the World Medical Association in 2008).

Statistical analysis of the material performed by traditional methods of variation statistics, all the results and conclusions based on the principles of evidence-based medicine.

The results of research and discussion. The obtaining results showed that antibodies are not detected by the above pathogensalways. Most of the time the women surveyed revealed antibodies to Mycoplasma spp, they were detected in 120 cases (39,5 ± 2,8%). It is known that the genus Mycoplasma in practical medicine the main place is occupied kinds M.hominus, M.genitalium and M.pneumoniae. All these types are common antigenic determinants and ELISA method to determine them separately is not possible. If we consider that Mycoplasma spp causes acute and chronic inflammatory diseases of the urinary tract, they may be etiologic agents of PID in women [7].

On the next place on detectability were antibodies to Chlamydia spp - 27,0 ± 2,5% (n = 82). The main representative of this kind, which may be the causative agent of TORCH-infections is C.trachomotis, other (C.psittaci and C.pneumoniae) rarely cause disease in humans [8]. Detection of specific serum IgG-antibodies activity reflects the extent of reproduction Chlamydia spp. Determination of IgG antibodies may be used for establishing and monitoring of disease recurrence of the infection.

A distinctive feature of our research was that most frequently detected antibodies to such antigens - Cytomegalovirus (CMV) and Herpes simplex virus type 1 and 2 (HSV 1,2) respectively in 20,4 ± 2,3% (n = 62) and 12,5 ± 1,9% (n = 38) cases. If we consider that CMV is found in 60-90% of the adult population, the CMV problem in women, especially pregnant women, it is very serious. [9] Although IgG-antibodies do not protect against reactivation of latent virus, but can serve as an indirect indicator of CMV activity in the body of women. HSV 1 & 2 (herpes simplex virus type 1 and 2) are also seen very often, hit about 90% of the population [6]. Women particularly common HSV 2 (genital herpes) and identification of IgG-antibodies indicates a remission or recurrence of herpes simplex disease.

Relatively few have been identified antibodies to Toxoplasma gondi (5,9 ± 1,4%, n = 18) and Ureoplasmaurealyticum (3,3 ± 1,0%, n = 10). It is known that the IgG antibodies to Toxoplasma gondi have a protective function, and provide a stable immunity against re-infection [10], so the definition of IgG antibodies to Toxoplasma gondi is used for the purpose of state immunity anti-toxoplasmonic of women. The same diagnostic objective pursued determining IgG antibodies to Ureaplasmaurealyticum [8].

There were revealed total 330 cases of detection of positive samples from 304 women, but it is necessary to take into account that 7,6 ± 1,5% (n = 23) of the women surveyed were found negative samples. Consequently, the 330 positive samples were found in the surveyed 281 women with PID. The percentage of detection of antibodies in healthy women who have not had PID was low and significantly different from women with pelvic inflammatory disease (P <0.001).

Given the fact that the identification of positive samples was observed in the form of monocultures and microbial associations, we were interested to study the relationship between detection of each another.

The results show that most often encountered in associations and CMV antigens from different Chlamydia spp microorganisms (for n = 20) and Mycoplasma spp (n = 14).

In most cases the association was observed with the following organisms: CMV and HCV 1,2 to 3,3 ± 1,0% (n = 10); And Mycoplasma spp CMV in 2,6 ± 0,9% (n = 8); Chlamydia spp and Mycoplasma spp in 2,6 ± 0,9% (n = 8); CMV, Chlamydia spp and HSV 1,2 to 2,0 ± 0,8% (n = 6) patients. Other associations met from 0,7 ± 0,5% (n = 2) to 1,3 ± 0,6% (n = 4) cases.

The detected associations were observed between 2 and 5 microorganisms. They were as follows: 2 in association microorganism was 13,8 ± 2,0% (n = 42), 3 in the microorganism 5,3 ± 1,3% (n = 16) 4 microorganisms 1.3 ± 0.6% (n = 4) and to 5 microorganisms 0.7 ± 0.5% (n = 2) samples.

It is interesting to note that the monoculture of microorganisms identified (n = 266) occurred 4.2 times more frequently than the association of these microorganisms (n = 64). The presence of a certain number of negative samples (7,6 ± 1,5%, n = 23) antigen above microorganisms in these studies points to the discovery of other etiologic agents (gram-negative bacteria, gram-positive cocci, anaerobes), pelvic inflammatory disease in women of childbearing age who are found bacteriological methods.

The findings indicate that in addition to bacteriological methods of qualitative determination of antibodies in the serum of women against antigens of various microorganisms using the ELISA method has a certain diagnostic value and along with other methods can be used for the diagnosis of PID.

4. Conclusions

1. In the serum examined women with PID most commonly detected IgG antibodies to antigens of Mycoplasma spp, Chlamydia spp, Cytomegalovirus, and Herpes simplex virus type 1 and 2, the least frequently detected IgG antibodies to antigens of Toxoplasma gondi, Ureoplasmaurealyticum.

2. Total 330 positive samples were found, which samples with 64monocultures and 266 microorganisms association. Monoculture occurred in 4.2 times more frequently than the association of microorganisms, 7,6 ± 1,5% cases were found negative samples.

3. Women who were surveyed most often in association met Cytomegalovirus and Chlamydia spp 20 times, Mycoplasma spp 14 times with other microorganisms and each other.