Background and objectives: Vaginitis is a term used to describe infectious diseases and other inflammatory conditions affecting the vaginal mucosa, bacterial vaginitis appears to be associated with pelvic inflammatory disease, infectious complications after abortion or gynecological invasive procedures. The study aimed to isolate the common bacterial causes of vaginal infection and to determine the antibiotic profile of each bacteria isolated in high vaginal swab. Methods and materials: High vaginal swabs were collected from two hundred (200) women patients with vaginal infection symptoms who attend the Rizgary Hospital, Maternity Teaching Hospital and PAR Hospital in Erbil city in the period from (September 2016-February 2017). All vaginal swabs taken from married non-pregnant patients. The age of these patients ranged between (18-55) years, Swabs were transported to the lab, the samples were directly examined and specimens where inoculated to several culture media after incubation overnight at 37°C, the bacterial colonies were identified on the following medias: Muller Hinton Agar, MacConkey agar, Blood agar plate, Chocolate agar and antibacterial susceptibility profile determined for each bacterium either by VITEK® 2 PC or by disk method. Results: gram positive isolated from (58%) while gram negative isolated from (42%) of patients complaining from vaginitis, the number and percentage of isolated bacteria was as follow: Escherichia coli, Streptococcus agalactiae 28(22.5%), Klebsiella pneumoniae, Staphylococcus haemolyticus in16(12.9%), Staphylococcus aureus, Enterococcus faecalis in 12(9.8%) while Neisseria gonorrhoeae, Serratia marcescens and Staphylococcus saprophyticus in 4(3.3%) and the positive bacterial growth and the Antibiotic susceptibility profile showed that most of the pathogens were resistant to more than one Antibiotics. Conclusions: The incidence of gram positive was higher than gram negative bacteria and and the result of bacterial culture and the most of gram positive and gram negative were resistant to Ampicillin, Amoxicillin and most of these pathogens were sensitive to Amikacin, Gentamicin and Tetracycline.
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In an investigation by Limi et al. it has been shown that latex agglutination method has sensitivity of 100% for Candida spp and 86.7% for Trichomonas vaginalis infection. The specificity of this test was also 93.3% and 95.1% for Candida spp. and Trichomonas vaginalis infections respectively. In another work also it has been shown that latex agglutination test was able to diagnosis vaginal infection agents in less than 3 minutes [12-14,9]. Rajakumar et al. also showed that in comparison with conventional methods latex agglutination method was more accurate and rapid for differential diagnosis of vaginal infections agents . In another work sensitivity of latex agglutination method in comparison of culture method was investigated and showed that the sensitivity of this immunological test was 100% and 86.7% for Candida spp. and Trichomonas vaginalis respectively .
ously, we also failed to demonstrate an apparent effective role for IgA in vaginal immunity. In support of this notion, stimu- lating the type 2 pattern of reactivity, including an IgA re- sponse, appeared not to provide the type of immunity that functions best against HSV mucosal infection whatever the challenge route. It is still curious, however, that the vaginal IgA response appears not to correlate positively with the outcome of HSV vaginal infection, since IgA is an important mediator of defense against several other mucosally infectious agents (7, 20). It appears, in fact, that barrier immunity, such as is me- diated by IgA, is ineffective against HSV. Instead, infection control largely involves T-cell immunity, probably by causing an inflammatory response at tissue sites (8). Others have even shown that vaginal immunity to HSV infection proceeds nor- mally in mice genetically unable to produce IgA (29).
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This study focused on the current status of vaginal candidiasis among pregnant women attending antenatal clinics in the major hospitals in Aba, Nigeria. Candidiasis is the most common opportunistic fungal infection responsible for about 90% of the cases of vaginal infection . It is associated with pruritus and vaginal discharge, which appears like curded milk . The pregnant women are more vulnerable to both vaginal colonization and infection by yeast. It has been observed that high concentration of oestrogen hormone and glycogen content of the vaginal mucosa provides ample supply of sugar that promotes the growth of Candida albicans during pregnancy [16,17]. This study revealed a prevalence rate of 31.5% which agrees with the prevalence rate of 30.7% obtained by Kamara et al.  and 30.0% rate obtained by Okonkwo  using urine samples. Women within the age range of 19-28 years (39.7%) and in their third trimester (38.0%) had the highest prevalence rates. Okonkwo  also observed that vaginal acidity and hormonal factors influenced the rate of occurrence of candidiasis more in pregnant women, especially in their last trimester. This
Also in another works to similar our ethnopharmacological survey, the components such as: terpinolene, terpinene 4-ol, γ-terpinene, α-pinene, 1,8-cineole, borneol, β-pinene, Chamazulene and thujone were the most anti-bacterial compounds of A. millefolium, Thalictrum minus, Perovskia abrotanoides, Ditrichia sp. and Eucalyptus spp. (28-31), because in previous research these compounds have strong antibacterial activity and which have been used in traditional medicine of many countries to healing wound, treat of rheumatic pain, arthritis, urinary tract infection, cold, flu, leishmanious and vaginal infection (10,32-36).
Clinical study. (i) Subjects. The participants (see Table S1 in the supplemental material) in this prospective study were mid-trimester pregnant women who were undergoing a routine vaginal ultra- sound to assess cervical length at the obstetrical outpatient clinic at The Federal University of Sao Paulo. Patients were a mixture of women at low risk for a preterm birth and those with an identiﬁed characteristic that placed them at elevated risk: short cervical length, history of preterm birth or spontaneous miscarriage, vaginal bleeding in the ﬁrst trimester, or obesity. For ethical reasons, women with a short cervical length ( ⬍ 25 mm) received prophylactic treatment consisting of a 200-mg dose daily of vaginal progesterone (Utrogestan) until 36 weeks gestation or delivery. Cervical cerclage was not used. Exclusion criteria were the presence of a multifetal gestation, signs or symptoms suggestive of a vaginal infection, antibiotic usage in the previous 2 weeks, presence of an immune or endocrine disorder, or the inability to give informed consent. The study was approved by the Institutional Review Board at The Federal University of Sao Paulo, and all subjects gave written informed consent.
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In the recent decades, a great number of the studies have explored the physiologic labor process. However, in Iran, investigating this process has just recently been initiated, and a few numbers of studies with the low sample size in one or two clinics have revealed the advantages and disadvantages of the physiologic labor. Based on a clinical trial performed in Tabriz-Iran, to compare the impact of the physiologic and facilitated labor on the neonatal status, the FHR of the born babies in the two methods varied significantly. The heart rate of the physiologic born babies was more in the normal range compared with the under-care ones. Also babies of the two groups were noticeably different in terms of the 5 th minute Apgar score, arterial blood pH, need for neonatal resuscitation and the time length of being admitted at neonatal unit (11). However, the same group did not explore the mother outcomes in the two delivery ways. On the contrary, this study showed not only no considerable difference in babies’ Apgar scores but it also studied the mother outcomes in both the physiologic and intervention labor. It has been reported that physiologic labor shortens the duration of the first stage of the delivery (12). However, this study showed no significant difference between the two groups in terms of the first stage of the labor duration. As contrast to the results of this study, Sadler et al. in 2000 published that the labor intervention such as the oxytocin induction, repeated vaginal examinations and amniotomy make the first stage of the process short (13). According to an Iranian study, the second stage of the physiologic labor was observed to be shorter compared with the control group (14) while the results of this study showed that the first and the third stage of the labor in the intervention group was longer than the physiologic group although this difference was not considerable. Fenton et al. found that the labor intervention reduces the vaginal bleeding (15). The episiotomy in the labor process is of the great importance. The proponents of this procedure believe that the episiotomy is essential, since it prevents up- grade rupture of perineum. On the other hand, due to the complications associated with the episiotomy such as fecal incontinence after the childbirth, opponents reject it. In this study mothers of the physiologic group had noticeably a higher grade of the laceration compared with the second group whereas Costa et al. in 2006 stated that the
It was common for T. vaginalis to be defined by a positive wet preparation while both PCR samples gave negative results. For example, 17.9% (7/39) of cases shown in Table 3 had positive wet mount and negative PCR results. Women were classified as infected according to the a priori definition, but this may not have been an accurate definition. Wet preparations were read at the clinic site, and the quality of the results was not subject to further analysis, quality review, or proficiency testing. It is possible that wet preparations may have been called positive based on the presence of a species of motile trichomonad that does not contain TVK primer binding sites. If the infection status was more loosely defined as requiring at least two pos- itive results, the number of infections dropped to 31 (17.8%) and the sensitivity of the tests was 54.8, 61.3, and 96.8% for wet mount, TVA PCR, and TVK PCR, respectively. Therefore, the sensitivity of the assay may be underestimated for all compar- isons. This approach is justified since we did not attempt to measure inhibition of the PCRs, which might also explain the occurrence of wet-mount-positive/PCR-negative samples. However, even using this potentially conservative approach, the T. vaginalis PCR provided improved case finding for both men and women, as has been reported by other investigators (4, 16, 17, 26, 33, 37, 38).
logical studies consistently demonstrate that recurrent HSV increases the risk of HIV acquisition, enhances HIV replica- tion, and itself can be associated with serious morbidity and mortality, especially among neonates and immunocompro- mised hosts (5, 20). Longitudinal studies indicate that clinical and subclinical viral reactivation occurs relatively frequently and is associated with sexual transmission of HSV, even be- tween monogamous individuals. Although prophylactic antivi- ral therapy reduces the frequency and degree of viral shedding and lowers the transmission rate in discordant monogamous couples, transmission still occurs (8). With respect to HIV, a study conducted among a cohort of monogamous HIV-1 dis- cordant couples from Rakai, Uganda, demonstrated that the per-contact risk of HIV acquisition, which averaged 0.0011, was fivefold higher if the susceptible partner was HSV-2 sero- positive rather than seronegative (9). Although the probability of HIV acquisition was highest if the susceptible partner had genital ulcer disease, the risk was also increased with asymp- tomatic HSV, suggesting that subclinical reactivation is almost as important as clinical disease in increasing the risk of HIV acquisition. In contrast, symptoms of urethritis and laboratory- confirmed diagnoses of gonorrhea, Chlamydia infection, and trichomoniasis did not increase HIV risk. Additionally, several studies have shown that subclinical HSV reactivation is asso- ciated with increased replication of HIV. The quantity of HSV DNA correlates with HIV-1 RNA in cervicovaginal secretions of women without genital lesions (19, 20). Taken together, these epidemiologic studies support the hypothesis that control of HSV-2 reactivation may help reduce HIV transmission.
Mesh-related infections are relatively rare after mesh augmented pelvic loor repair procedures; however, when they do occur, they can signiicantly compromise patients’ well-being and can lead to excision of the mesh implant. This year, we sadly learnt from a newspaper article that a well-known mesh campaigner died of sepsis attributed to recurrent urinary tract infections (UTIs) developed after a mid-urethral sling implantation to treat SUI . Mesh- related complications due to infection have been reported to occur in 0–8% of all cases, but generally speaking, they appear to be less than 1% in transvaginal mesh implantations for the treatment of both SUI and POP [7, 8]. These igures relect clinically evident infection with typical systemic ind- ings (fever, malaise, etc.) and local signs of infection at the site of implantation. Mesh infection is also thought to be asymptomatic (silent), but it can actually interfere with the successful integration of the mesh into host tissues lead- ing to mesh exposure in some cases . A positive bacte- rial culture was obtained from 77% of the vaginal meshes explanted due to pain, mesh erosion, mesh infection, and recurrent UTIs . Therefore, mesh-related infections can be a solitary complication of vaginal mesh surgeries, and at the same time, it can be one of the factors in a multifactorial process underlying other mesh-related complications such as exposure and pain.
The ultimate goal of diagnostic testing is to identify infected individuals who require treatment. The overall prevalence of positive results by the different testing combinations is pre- sented in Table 5. There was a considerable increase in the number of infected individuals identified by NAATs compared to culture. In fact, the use of vaginal swabs would result in treatment of approximately 50% more women than would be treated based on use of cervical cultures. This obviously is expected from previous evaluations, which have found NAATs to be more sensitive than TC. The overall prevalence of pos- itives by the dual-culture system was 9.6% for culture (only 8.1% by culture from the cervix, which typically is the sampled site). By NAAT on cervical swabs, approximately 11.4% of the specimens were positive, for a 40% increase in women who would be identified and treated. The extremely high specificity of the NAATs has been documented in previous studies. The increment in the individuals who test positive primarily reflects identification of truly infected individuals who are falsely neg- ative in the older technologies, such as TC, antigen detection, or nonamplified nucleic acid hybridization tests.
A total of 100 healthy women (50 HPV-negative and 50 HPV-positive) with normal cervical cytology, who ac- cepted a routine gynecological examination and Thinprep Cytology Test (TCT) in Beijing Cancer Hospital from January 2012 to June 2012, were initially recruited for this study. Subsequently, TCTs were reexamined by two cy- tologists and HPV infection was reexamined by PCR. If there was a difference between the first and second TCT reports, or between the results from the two cytol- ogists performing the second TCT, the woman was ex- cluded from the study. In addition, if a recruited woman was infected with more than one HPV type, or there was a difference between the initial HPV report using Hybrid Capture II and the second HPV report using PCR, the woman was excluded from the study. A total of 30 women were excluded from the study based on these four criteria. Inclusion criteria were age <50, no BV by the Amsel method, no use of antibiotics or vagi- nal antimicrobials (orally or by topical application in vulvar/vaginal area) in the previous month, and no vagi- nal intercourse or vaginal lavage within the last 3 days. All subjects were free of systemic diseases such as diabetes, autoimmune disease, and malignant tumors. Informed written consent was obtained from all partici- pants prior to enrollment. This study was approved by the ethical committee of Peking University Cancer Hospital and Institute, Beijing, China.
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The gastrointestinal tract (GIT) is a primary site for human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV) infection, replication, and dissemination. After an initial explosive phase of infection, HIV establishes latency. In addition to CD4 T cells, macrophages are readily infected, which can persist for long periods of time. Though macrophages at various sys- temic sites are infected, those present in the GIT constitute a major cellular reservoir due to the abundance of these cells at mu- cosal sites. Here, we review some of the important findings regarding what is known about the macrophage reservoir in the gut and explore potential approaches being pursued in the field to reduce this reservoir. The development of strategies that can lead to a functional cure will need to incorporate approaches that can eradicate the macrophage reservoir in the GIT.
Prolonged labour was noted to be an independent risk factor for wound infection in this study. Women with labour duration less than 12 hours have 93.0% lower odds of developing post caesarean wound infection. This was similar to other studies . This could be attributed to the fact that most patients that had prolonged labour were unbooked and were of low socioeconomic class. Out of the sixteen women that had prolonged labour, 14 (87.5%) were unbooked and 10(62.5%) of them were of low socioeconomic status. These women were likely to labour in a dirty environment and were usually referred to the Teaching Hospital as potential septic cases.
Between January 2012 and July 2016, a retrospective cohort study was conducted at the Department of Obte- trics and Gynaecology, University Hospital Bern – Insel- spital (Switzerland). We included all consecutive women who had a labour induction > 36 0/7 weeks’ gestation. Before May 2014, MVT was routinely used off-label for labour induction in this patient population. In May 2014, MVT was replaced with the novel, approved MVI. The analysis periods were set as follows: January 2012 to 30 April 2014 for the MVT cohort and 1 May 2014 to 31 July 2016 for the MVI cohort. Data were obtained from the patients’ electronic medical records. Each patient signed an informed consent regarding data col- lection for scientific purpose. Exclusion criteria consisted in foetal malpresentation, previous CS or uterine scar- ring (e.g., previous caesarean section), < 36 + 0 weeks of gestation, premature rupture of the membranes less than 24-h before starting the induction, severe preeclampsia, body mass index (BMI) > 50, signs of maternal infections in peripheral blood samples, abnormal foetal heart rate tracings or signs of active labour at admission, and twin pregnancy. Patients received MVI (Misodel ® , Ferring Inc. , Saint-Prex, Switzerland) containing 200 μg misoprostol in a slow-release vaginal insert as a single application, left in place for a maximum of 24 h, or MVT with re- petitive dosing every 4 h as indicated. MVT were pre- pared in the hospital’s pharmacy by crushing Cytotec ®
These findings indicate that young women who initiate sexual intercourse at a young age are more vulnerable to HPV infection in part because of be- haviors and partner characteristics that place them at risk for infection. However, the modest reduction in the magnitude of the association between age of first sexual intercourse and HPV infection when these mediators are included in the model suggests that other factors are likely to play a major role in medi- ating the association. These data do not permit direct measurement of biological variables, but biological factors such as cervical immaturity may play a role in mediating the association between age of first sexual intercourse and either HPV acquisition or persis- tence. Investigators have postulated that the adoles- cent cervix is particularly vulnerable to STI for rea- sons such as inadequate production of cervical mucus, which acts as a protective barrier against infectious agents, 37 and cervical ectopy, which is
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2 weeks after infection (Figure 5A), providing additional HIV target cells to sustain and potentially spread the initial infection. These results are consistent with HIV-RNA being present in CVS within 1 week after exposure (Figure 3B), suggesting that local HIV replication occurs in the FRT and/or CVS followed by the establishment of systemic infection in all mice by 2 weeks after exposure (Figure 3B). Especially noteworthy is the timing of viral shedding into CVS after vaginal exposure, which is characterized by an early peak in viremia followed by a gradual decline (Fig- ure 3B) that mimics the HIV genital shedding profile observed in CVS of women during acute HIV infection (39). Notably, we also observed an increase in CD8 + T cells in CVS after vaginal
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ABSTRACT Zika virus (ZIKV), which can cause devastating disease in fetuses of in- fected pregnant women, can be transmitted by mosquito inoculation and sexual routes. Little is known about immune protection against sexually transmitted ZIKV. In this study, we show that previous infection through intravaginal or subcutaneous routes with a contemporary Brazilian strain of ZIKV can protect against subsequent intravaginal challenge with a homologous strain. Both routes of inoculation induced high titers of ZIKV-speciﬁc and neutralizing antibody in serum and the vaginal lu- men. Virus-speciﬁc T cells were recruited to and retained in the female reproductive tract after intravaginal and subcutaneous ZIKV infection. Studies in mice with ge- netic or acquired deﬁciencies in B and/or T cells demonstrated that both lympho- cyte populations redundantly protect against intravaginal challenge in ZIKV-immune animals. Passive transfer of ZIKV-immune IgG or T cells signiﬁcantly limited intravagi- nal infection of naive mice, although antibody more effectively prevented dissemina- tion throughout the reproductive tract. Collectively, our experiments begin to estab- lish the immune correlates of protection against intravaginal ZIKV infection, which should inform vaccination strategies in nonpregnant and pregnant women.
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Ureaplasma urealyticum colonizes the women genital tract and is frequently isolated from amniotic fluid of healthy asymptomatic pregnant women. Its association with preterm premature rupture of membranes, preterm birth and spontaneous abortion has been reported. Also embryo-fetal infections have been suggested to cause recurrent spontaneous abortions at a rate about 4% (4). Using PCR, Aydin Yet al. found the prevalence of U. urealyticum infection in the cervices of 96 pregnant women and 124 non-pregnant controls as 26% and 15.3%, respectively (14) which is higher than our results.
progressive generalization in the ﬁrst 3 months of life. On physical ex- amination, pearly papules with a central dell were noted overlying the scalp in a ring-like fashion. More than 50 pearly papules were noted on her face, chest, back (Fig 2), and inner left thigh. The child’s day care facility was anxious regarding the ex- tensive skin lesions. A diagnosis of generalized MCV infection was made, and the child was treated with short- contact topical cantharidin, which resulted in complete lesional clear- ance. The mother refused therapy.