Vaginal Discharge Research Articles

Engineering vaginal film platform for mucoadhesion and sustained drug release for HIV-1 prevention.

User adherence contributes to the effectiveness of topical pre-exposure prophylactic products designed to protect against human immunodeficiency virus type 1 (HIV-1) infection. Long-acting approaches that do not require daily or coitally-dependent use could potentially improve user adherence. This study aims to develop a long-acting vaginal film to deliver an integrase inhibitor, MK-2048, for prevention of HIV-1 infection. To this end, a film platform fabricated with thiolated chitosan and poly(lactide-co-Ɛ-caprolactone) (PLACL) was designed to achieve long residence time and sustained drug release profile, respectively. A series of PLACLs were synthesized with different lactic acid (LA) to caprolactone (CL) ratios and were chemically and thermally characterized. Films containing thiolated chitosan and PLACL copolymers were manufactured using solvent-casting and characterized for their physicochemical properties. The in vitro release of MK-2048 formulated in thiomer PLACL films was tested. The lead film composed of thiomers and PLACL 80 showed comparable elasticity with the marketed VCF® film (vaginal contraceptive film) and slower drug release rate compared to other compositions. The tissue mucoadhesion and permeability of MK-2048 were significantly improved by incorporation of thiolated chitosan in the film matrix. Importantly, the film showed no evidence of toxicity in excised human ectocervical tissue and demonstrated comparable anti-HIV activity as free MK-2048. The lead film evaluated in pigtail macaques showed drug concentrations above the IC95 (41 nM) in vaginal fluids and tissues for a period of at least 2 weeks, with no evidence of toxicity. Overall, these in vitro and in vivo studies demonstrate that this strategy can be applied to rationally develop polymeric film platforms that can sustain drug release in vivo, potentially improving user adherence.

Syphilis Infection During Pregnancy: The Possible Effect on the Course of Pregnancy and Fetal Outcomes—A Case Report and Literature Review

Background/Objectives: A wide range of syphilis-related pregnancy complications are encountered in clinical practice. Active surveillance of the epidemiological situation in different countries and a series of retrospective data analyses allow for a comprehensive assessment of the feasible consequences of syphilis infection during pregnancy. The negative effects of infection on reproductive health are also described. Risk-increasing factors (inadequate or late treatment, partner coinfection) and protective factors (timely diagnostics and treatment) are distinguished. The importance of adequate and timely management as well as the accessibility of healthcare and socioeconomic status, which influence health outcomes, are stressed. This article presents a rare case of untreated syphilis infection during pregnancy. The infection was diagnosed during the first antenatal visit; how-ever, treatment was not initiated. At the 33rd week of gestation, the patient was admitted to the hospital because of sparse bloody vaginal discharge. Following sudden fetal hypoxia, an urgent cesarean section was performed at 33 weeks of gestation. A preterm newborn was delivered in critical condition, and congenital syphilis was diagnosed. Methods: We searched the PubMed, Cochrane, and MeSH databases using the key search terms “treponema pallidum”, “sexually transmitted infections”, “pregnancy”, “congenital infection”, “syphilis”, and “congenital syphilis”, as well as their combinations. A total of 28 papers published over a ten-year period were included in the literature review. A clinical case was analyzed. Results: The impact of syphilis on pregnancy is quite evident. Our case showcased one of the most common impacts, i.e., premature birth, of congenital infections with associated bacterial meningitis, respiratory distress syndrome, multiple organ damage, and insufficient weight. Such associations with many adverse pregnancy outcomes as well as congenital syphilis and neonatal defects are often avoidable. Conclusions: Considering the potential consequences of infections, the issue of sexually transmitted diseases remains relevant, and improving diagnostic and treatment opportunities becomes of paramount importance as cases increase.

Primary malignant melanoma of the vagina: A case report of a rare disease that is difficult to diagnose.

Malignant melanoma is a rare cancer that accounts for approximately 1% of all cancers. Primary malignant melanoma of the female genital tract accounts for approximately 3% to 7% of all malignant melanomas, and 0.3% to 0.8% of all melanomas in women. It affects postmenopausal women ages 60 to 80 years. Various hormonal factors, including puberty, pregnancy, menopause, oral contraceptive use, and human papillomavirus infection are associated with primary malignant melanoma of the vagina. Symptoms often include vaginal bleeding, discharge, and pain; however, it can also present as pigmented or nonpigmented lesions, making diagnosis challenging. Diagnosis involves detailed history, physical examination, and imaging (CT, MRI, and positron emission tomography). Immunohistochemical staining for markers, such as human melanoma black-45 and Melan-A, is crucial for confirmation. The diagnosis was made through careful physical examination, imaging studies, and immunohistochemistry. The treatment includes wide local excision, radical surgery, radiotherapy, chemotherapy, and immunotherapy. The prognosis of primary malignant melanoma of the vagina is usually poor owing to late diagnosis, and the 5-year survival rate is 5% to 25%. To consider the possibility of primary malignant melanoma of vagina, postmenopausal women, particularly those who with human papillomavirus infection, should be performed thorough examination regardless of symptoms of vaginal bleeding or discharge.

Isolation of New Strains of Lactic Acid Bacteria from the Vaginal Microbiome of Postmenopausal Women and their Probiotic Characteristics

Lactic acid bacteria (LAB), traditionally consumed as fermented foods, are now being applied to the medical field beyond health-functional food as probiotics. Therefore, it is necessary to continuously discover and evaluate new strains with suitable probiotic characteristics, mainly focusing on safety. In this study, we isolated eight new strains from postmenopausal vaginal fluid using culturomics approaches, an emerging area of interest. Data showed that most strains possessed significant cell surface hydrophobicity (≥ 76%), auto-aggregation capacity (17 to 61%), strong adhesion activity (8 to 34%), and excellent resistance to gastric acid, bile salt, and digestive enzyme, enhancing their survival in the gastrointestinal tract. Moreover, the strains exhibited functional characteristics, including substantial antibacterial activity with a minimal inhibitory concentration (MIC) ranging from 12.5 to 50%. They also harbored bacteriocins genes, produced short-chain fatty acids (acetate and propionate), exhibited significant phagocytic activity, possessed high antioxidative properties, rapidly depleted sodium nitrite, and exhibited proteolysis and β-glucosidase activity. In addition, heat-killed LAB strains significantly reduced the gene expressions of proinflammatory cytokines such as IL-β, IL-6, and iNOS in macrophages. Safety assessment revealed no cytotoxicity in macrophage cell lines. All strains tested negative for biogenic amine or H2O2 production, displayed no gelatinase or hemolytic activity, lacked virulence genes or detrimental enzymes, and displayed antibiotic susceptibility. In summary, these newly isolated strains demonstrate excellent probiotic functionality with a strong focus on safety, making them promising candidates for future drug development in the relevant fields.

Jiawei Ermiao Granules (JWEMGs) clear persistent HR-HPV infection though improving vaginal microecology.

Jiawei Ermiao Granules (JWEMGs), a traditional Chinese herbal formulation, has been widely used in China for the treatment of human papillomavirus (HPV) infections. However, the underlying mechanisms through which it exerts its antiviral effects remain poorly understood. This study aimed to investigate the potential mechanisms by which JWEMGs modulate vaginal microecology and clear HPV infections, utilizing clinical trials, metagenomic sequencing, and in vitro models. Clinical indicators related to vaginal microecology, such as vaginal pH, cleanliness, Nugent score, Donders score, catalase, neuraminidase, and leukocyte esterase, were evaluated in 65 patients with high-risk HPV (HR-HPV) infection. The study examined the impact of two courses of oral JWEMGs on these clinical parameters. Additionally, metagenomic sequencing was performed on vaginal lavage samples from 33 patients to assess the alteration of the vaginal microbiome following JWEMGs treatment. Immunohistochemistry was used to detect ALPK1 expression in cervical exfoliated cells, and ELISA was employed to measure cytokine levels in vaginal lavage fluid. JWEMGs intervention was applied to HaCaT-HPV E6/E7 cells to evaluate its effects on restoring α-kinase 1 (ALPK1) expression and promoting the secretion of cytokines and chemokines. Treatment with JWEMGs significantly improved several clinical indicators, including cleanliness, pH, Nugent score, Donders score, catalase, neuraminidase, and leukocyte esterase, in HR-HPV-infected patients. Furthermore, JWEMGs therapy led to an increased abundance of Lactobacillus species, especially Lactobacillus crispatus, and a marked reduction in Gardnerella species. JWEMGs treatment also significantly promoted ALPK1 expression in cervical exfoliated cells and augmented the secretion of key cytokines, including IL-6, IL-8, and TNF-α. In parallel, in vitro results showed that JWEMGs substantially enhanced IL-6, IL-8, TNF-α, CCL2, CCL5, and CCL7 secretion in HaCaT-HPV E6/E7 cells, which correlated with the activation of the ALPK1/NF-κB signaling pathway. In conclusion, JWEMGs treatment effectively remodels the vaginal microbiota and bolsters mucosal immunity in the lower genital tract, thereby improving the vaginal microecology in HR-HPV-infected individuals. In vitro findings further demonstrated that JWEMGs promote cytokine and chemokine expression, activating the ALPK1/NF-κB pathway.

Women with persistent/recurrent vaginal discharge should be offered multiplex-7 PCR testing.

Recurrent vaginal discharge is an important cause of repeated visits to the gynaecologists. Failure to correctly identify the causative organism with standard microscopy and culture techniques results in repeated unsuccessful treatment and the risk of developing antibiotic resistance. Multiplex PCR test is increasingly being used for investigating infections where multiple organisms may be involved. This was a retrospective review of women attending the Feto Maternal Centre, Doha Qatar with the complaint of persistent/recurrent vaginal discharge over a period of 8years who were tested by both the standard approach and a multiplex 7-PCR. A total of 536 women with vulvovaginal discharge (474 with persistent/recurrent discharge and 62 with first episode) had been investigated with 7-PCR and treated. 7-PCR was able to identify a possible infective organism in 85% of those with persistent/recurrent discharge and 95% of those presenting with symptoms for the first time. The most common microorganisms were the sexually transmitted infections Ureplasma urealyticum, Mycoplasma genitalium and Gardnerella vaginalis. At follow-up 88.2% of symptoms had been eradicated. Multiplex 7-PCR is more likely to identify an infective cause of vulvovaginal discharge than standard microbiology tests. The most common organisms identified were Ureplasma urealyticum, Mycoplasma genitalium and Gardnerella vaginalis. While the standard tests can identify other pathogens that may be associated with vulvovaginal discharge 7-PCR offers an advantage in that it is able from a single swab to screen for 7 organisms. Since it does not screen for Candida albicans, we feel that whenever this is offered, standard screening for candida should be offered unless the PCR test kit included screening for candida. We suggest that multiplex-PCR should be considered as the standard screening test for women presenting with first episode or recurrent vulvovaginal discharge.

Application of a new composite genetic marker semen-specific methylation-microhaplotype in the analysis of semen-vaginal fluid mixtures.

DNA mixtures containing semen and vaginal fluid are common biological samples in forensic analysis. However, the analysis of semen-vaginal fluid mixtures remains challenging. In this study, to solve these problems, it is proposed to combine semen-specific CpG sites and closely related microhaplotype sites to form a new composite genetic marker (semen-specific methylation-microhaplotype). Six methylation-microhaplotype loci were selected. To further improve discrimination power, five methylation-SNP loci were also included. The methylation levels and genotypes of these selected loci were obtained using massively parallel sequencing technology. Except for loci MMH04ZHA019 and MMH17ZHA059, the remaining nine loci were successfully sequenced. For the successfully sequenced loci, they performed well in identifying individuals and body fluids. An allele categorization model was developed using K-nearest neighbour algorithm, which was then used to predict allele types in semen-vaginal fluid mixtures. These loci were able to confirm the presence of semen and link semen to a true donor in semen-vaginal fluid mixtures with mixing ratios of 10:1, 9:1, 5:1, 4:1, 1:1, 1:3, 1:4, 1:8 and 1:9 (semen:vaginal fluid). This preliminary study suggests that this new composite genetic marker has great potential as a supplementary tool to commonly used genetic markers (STR, etc.) for analysing semen-vaginal fluid mixtures.

Pregnancy after advanced ovarian cancer with spontaneous uterine rupture in second trimester: A case report and review of the literature.

Fertility-preserving surgery (FPS) in advanced ovarian cancer (AOC) is extremely rare and consequently, information about the pregnancies of these patients is anecdotal. Therefore, management of the pregnancy after AOC is challenging, especially if an unexpected situation arises. A 31-year-old nulliparous woman was admitted to our tertiary hospital in the 18th week of twin pregnancy with sudden severe abdominal pain. Her medical history included a low-grade AOC stage IIIc diagnosed 2 years before pregnancy and treated by debulking FPS and systemic therapy with carboplatin/paclitaxel and bevacizumab. Clinical examination described normal vital signs and peritoneal irritation without any vaginal discharge. Sonography revealed free fluid in the pouch of Douglas and intact twin pregnancy. Laboratory work showed elevated leukocytes with neutrophilia. To evaluate appendicitis magnetic resonance imaging of the abdomen was indicated. This revealed a uterine rupture with the now extra-cavitary position of the twins. Simultaneously, the patient's symptoms deteriorated, and emergency surgery was necessary where hemoperitoneum with avital fetuses were present. Despite excessive blood loss the uterus could be repaired and preserved. Previous resection of the uterine serosa during her debulking FPS, administration of bevacizumab affecting smooth muscles, and overstretching the uterus in the twin pregnancy were considered as possible risk factors for the presenting uterine rupture. Pregnancy after AOC is possible but should be monitored closely, especially due to the hidden long-term consequences of its therapy. In the differential diagnosis of sudden abdominal pain during pregnancy uterine rupture should be considered even in patients with an unscared uterus.

Healthcare utilization and costs following molecular diagnostic testing among patients with vaginitis.

Aim: Vaginitis and other vaginal discharge syndromes lead to high healthcare utilization. Molecular tests like syndromic multiplex real-time (RT) polymerase chain reaction (PCR)-based tests are highly sensitive and specific at diagnosing the infectious causes of vaginitis. This study compared the healthcare resource utilization (HCRU) and direct all-cause healthcare costs among patients with vaginitis in the US receiving next-day syndromic multiplex RT-PCR tests with those receiving other PCR tests or no diagnostic test of interest. Patients & methods: This retrospective study utilized claims data from IQVIA PharMetrics® Plus database to identify adult patients with a diagnosis for vaginitis (first claim=index) from January 2021 to April 2023, with 6months of continuous enrollment prior to (baseline) and after index (follow-up). Pairwise comparisons were conducted between RT-PCR and 1:1 propensity matched Other PCR and No Test subcohorts for all-cause HCRU and costs during follow-up. Results: Each of the RT-PCR, Other PCR and No Test subcohorts included 1946 matched patients. Mean(SD) follow-up total cost was significantly lower for the RT-PCR than the No Test subcohort ($5607[$15,122] vs $6680[$20,751], p=0.0023). Mean(SD) overall outpatient and other medical service costs were lower for RT-PCR versus Other PCR (outpatient: $2964[$9666] vs $3174[$7113], p=0.0110; other medical: $1961[$9244] vs $2099[$6475], p=0.0002) and No Test subcohorts (outpatient: $2964 [$9666] vs $4067[$12,341], p<0.0001; other medical: $1961[$9244] vs $2973[$11,685]; p<0.0001). A lower proportion had any outpatient service HCRU in RT-PCR versus Other PCR subcohort (92.6% vs 94.2%, p=0.0349). A lower proportion had any other medical service claim in RT-PCR versus Other PCR (78.3% vs 83.2%, p<0.0001) and No Test subcohorts (78.3% vs 83.0%, p=0.0001). Physician office, emergency room (ER), prescription use and costs were similar between the subcohorts. Conclusion: The use of syndromic multiplex RT-PCR diagnostics with next day test results in patients with vaginitis was associated with lower outpatient costs and total healthcare costs than those in the no test cohort over 6months. These findings indicate that use of syndromic multiplex RT-PCR diagnostics may contribute to improved patient management compared with clinical diagnosis alone.

Clinicopathological characteristics of invasive stratified mucinous carcinoma of the cervix and the expression and clinical significance of SLC7A11, SLC3A2 and PD-L1.

Invasive Stratified Mucin-producing Carcinoma (ISMC) of the cervix is a newly named cervical adenocarcinoma associated with Human Papilloma virus (HPV). Due to its relative rarity, clinical data, pathological features, and molecular characteristics of ISMC are still under exploration. This study aims to retrospectively analyze the clinical data and pathological features of ISMC patients, summarizing the clinical and pathological morphological characteristics of ISMC. Immunohistochemistry for SLC7A11, SLC3A2, and PD-L1 will be performed on tumor tissues from ISMC patients to preliminarily explore potential therapeutic targets for ISMC. We retrospectively reviewed the electronic medical records and pathological slides of 22 ISMC patients, and performed immunohistochemical staining for solute carrier family 7 member 11 (SLC7A11), solute carrier family 3 member 2 (SLC3A2), and programmed death-ligand 1 (PD-L1). The patients were aged between 31 and 70 years old. The most common symptoms were abnormal vaginal bleeding and unusual vaginal discharge. HPV testing indicated that the infection rate of HPV type 18 was the highest. All patients underwent extensive hysterectomy and pelvic lymph node dissection. The progression-free survival (PFS) ranged from 3 to 112 months, with a postoperative recurrence rate of 22.7% (5/22). ISMC exhibited diverse characteristic microstructures. Immunohistochemistry results showed that the positive rates of SLC7A11 and SLC3A2 were both 91.0% (20/22). The staining intensity of SLC7A11 in frequent ISMC recurrence cases was significantly stronger than in non-recurrent ISMC cases. PD-L1 positivity was observed in 86.4% (19/22) of cases, defined as having a Combined Positive Score(CPS)≥1. ISMC demonstrates a high rate of lymph node metastasis and a high recurrence rate, indicating strong invasiveness. Additionally, ISMC exhibits a wide morphological spectrum. SLC7A11, SLC3A2, and PD-L1 are all highly expressed in ISMC tissues. The high expression of SLC7A11 may indicate a high recurrence rate for ISMC. Immunotherapy with checkpoint inhibitors and iron death-related treatments show potential in the treatment of ISMC, with SLC7A11, SLC3A2, and PD-L1 serving as potential therapeutic targets for ISMC.

Safety and adherence to self-administered intravaginal 5-fluorouracil cream following cervical intraepithelial neoplasia (CIN) 2/3 treatment among HIV-positive women in Kenya: A phase 1 clinical trial.

To determine the safety, tolerance, and adherence to self-administered intravaginal 5% fluorouracil (5FU) cream as adjuvant therapy following cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) treatment among women living with HIV (WLWH) in Kenya. A phase I pilot trial was performed among 12 WLWH in Kenya, aged 18-49 years between March 2023 and February 2024 (ClinicalTrial.gov NCT05362955). Participants self-administered 2 g of 5FU intravaginally every other week for eight applications. Safety was assessed using a standardized grading scale, and adherence was evaluated using self-report, inspection of used applicators, and weighing of the study drug. The mean age and CD4 count were 43.9 years and 781 cells/mm3, respectively. Seven (58%) had an eighth-grade education or less. All 12 reported at least one grade I adverse event (AE), one (8%) reported a grade 2 AE, no grade 3 or 4 AEs were reported. Increased vaginal discharge (n = 9, 75%) and irritation (n = 5, 42%), with a mean duration of 3.2 and 2.8 days, respectively, were the most commonly reported AEs. Provider-observed AEs included grade 1 cervical erythema and superficial abrasions. All participants tolerated all eight 5FU doses, and 96% adherence was demonstrated. Self-administered 5FU following CIN2/3 treatment among WLWH in Kisumu, Kenya, was safe, tolerable, and associated with high adherence. Randomized trials are needed to investigate whether adjuvant 5FU can improve treatment outcomes or serve as primary cervical precancer treatment in sub-Saharan Africa. A self-administered therapy may be transformative in increasing access to treatment and, hence, secondary prevention of cervical cancer.

Review of Albanian studies suggests the need for further efforts to counteract significant hepatitis B virus prevalence.

Hepatitis B virus (HBV) is categorized as one of the smallest enveloped DNA viruses and is the prototypical virus of the Hepatoviridae family. It is usually transmitted through body fluids such as blood, semen, and vaginal secretions. The majority (more than 95%) of immunocompetent adults infected with HBV spontaneously clear the infection. In the context of the high prevalence of HBV infection in Albania, the research gap is characterized by the lack of studies aimed at advancing the current understanding and improving the prevailing situation. The main objective of this study was to address the low rate of HBV diagnosis and the lack of a comprehensive national program to facilitate widespread diagnosis. To analyze the prevalence of HBV infection in Albania and elucidate the persistently high prevalence despite efforts and measures implemented. Using a systematic literature review, we collected existing research on the epidemiology of HBV in Albania from PubMed, Cochrane Library, Google Scholar, and Albanian Medical Journals, focusing on studies published after the 1980s and conducted solely in the Albanian population. The findings reveal a dynamic shift in HBV prevalence in Albania over several decades. Initially high, the prevalence gradually declined following the implementation of screening and vaccination programs. However, the prevalence rates have remained notably high, exceeding 8% in recent years. Contributing factors include vertical transmission, inadequate healthcare infrastructure, and challenges in screening and diagnosis. Studies among Albanian refugees in neighboring countries also reported high prevalence rates, emphasizing the need for transnational interventions. Despite advancements in screening, vaccination, and healthcare infrastructure, Albania continues to face a substantial burden of HBV infection. The persistence of high prevalence underscores the complexity of the issue, requiring ongoing efforts to ensure a comprehensive understanding and effective mitigation. Addressing gaps in vaccination coverage, improving access to screening and diagnosis, and enhancing public awareness are crucial steps toward reducing HBV prevalence in Albania.

Budidaya Lebah Madu Trigona pada Kelompok Sadar Wisata (POKDARWIS) Sungai Jawi Kelurahan Sei selincah Kecamatan Kalidoni Kota Palembang

Trigona bee honey is a honey that has a unique taste compared to other honey, this is because trigona honey has a sour taste and a thinner texture. This does not make trigona honey lose its popularity, trigona honey is still widely favored because of its properties such as being rich in antioxidants, anti-bacterial, overcoming inflammation, overcoming fertility disorders, overcoming menstrual disorders, helping to relieve nausea in pregnant women, overcoming vaginal discharge, moisturizing the skin, preventing diabetes, healing wounds, curing cataracts, anti-cancer, and others. Therefore, the Sungai Jawi Tourism Awareness Group cultivates trigona bees so their properties can still be utilized. However, currently, the quantity of honey produced is not comparable to customer demand, so the Community Service Team of the Indo Global Mandiri University proposed a service by increasing the number of hives from the initial 12 hives to 25 hives in the hope of increasing the quantity of honey and increasing partner income. The addition of this new hive uses a different method than before, the new hive uses the rapid split method, namely a colony separator in a more practical, fast, and safe way to minimize the risk of failure. The use of this rapid split method will be guided by the PKM Team and resource persons through product quantity improvement training. In addition, marketing training is also implemented in this activity with the aim of reaching a wider market by utilizing online sales/e-commerce such as Tokopedia and Shoppee and attractive packaging is also one of the customer attractions. Keywords : Honey, Trigona Bee Cultivation, Devotion, Production, Marketing.

New cheaper human papilloma virus mass screening strategy reduces cervical cancer incidence in Changsha city: A clinical trial

BACKGROUND Cervical cancer is the second leading cause of death in women worldwide, second only to breast cancer. Around 80% of women have been infected with human papillomavirus (HPV) in their lifetime. Early screening and treatment are effective means of preventing cervical cancer, but due to economic reasons, many parts of the world do not have free screening programs to protect women’s health. AIM To increase HPV cervical cancer screening in Changsha and reduce the incidence of cervical cancer. METHODS Cervical cancer screening included gynecological examination, vaginal secretion examination and HPV high-risk typing testing. Cervical cytology examination (ThinPrep cytology test) was performed for individuals who test positive for HPV types other than 16 and 18. Vaginal colposcopy examination was performed for HPV16 and 18 positive individuals, as well as for those who were positive for ThinPrep cytology test. If the results of vaginal colposcopy examination were abnormal, histopathological examination was performed. We conducted a cost-benefit analysis after 4 years. RESULTS From 2019 to 2022, 523437 women aged 35-64 years in Changsha city were screened and 73313 were positive, with a 14% positive rate. The detection rate of precancerous lesions of cervical cancer was 0.6% and the detection rate of cervical cancer was 0.037%. Among 311212 patients who underwent two cancers examinations, the incidence rate was reduced by more than half in the second examination. The average screening cost per woman was 120 RMB. The average cost of detecting early cases was 10619 RMB, with an early detection cost coefficient of 0.083. CONCLUSION Our screening strategy was effective and cost-effective, making it valuable for early diagnosis and treatment of cervical cancer. It is worth promoting in economically limited areas.

Examining pessary use and satisfaction in managing pelvic organ prolapse: results from a cross-sectional multicentre patient survey

BackgroundVaginal pessaries are a common method of managing pelvic organ prolapse (POP), as well as different types of urinary incontinence, allowing patients to successfully improve overall quality of life. Yet despite their positive attributes, there are several reasons why patients may choose to discontinue using pessaries and proceed with surgery to treat their condition instead. This study aimed to explore patients’ experiences of pessary use in treating POP.MethodsParticipants completed an online survey regarding pessary use and ideal characteristics of a pessary. Participants were recruited from social media advertisements, online support groups for women’s health-related conditions, and pelvic floor clinics.ResultsA total of 100 participants were recruited, of which 77 fully completed the survey. The biggest age group of participants was above 65 years, with 48.1% of participants falling into this category, followed by 35–44 years accounting for 20.8% of respondents. Respondents cited pelvic pain (35.2%), excess vaginal discharge and odor (32.4%), as well as difficulty with pessary placement as the most common issues related to pessary use (41.9%). Easy insertion, removal (81.8%), and relief from side effects (81.8%) were the most commonly reported ideal characteristics for pessary use.ConclusionPatients had important concerns with pessary use and a high number either stopped or were considering stopping even when it improved their POP. Whilst pessaries can help in the management of POP, further improvement is warranted to increase pessary use, such as through the development of user-friendly designs, or applicators to aid with fitting.

Uji Daya Hambat Ekstrak Daun Jambu (Psidium guajava) Terhadap Pertumbuhan Jamur Candida albicans Secara In Vitro

Fungi are one of the microorganisms that cause disease in humans. A disease caused by fungi in humans is called mycosis. Types of mycosis are divided into two, namely superficial mycosis and systemic mycosis. Superficial mycosis is an infection by fungi that spread on the surface of the body only, while systemic mycosis is an infection by fungi that attack the entire body. One type of pathogenic fungus is Candida albicans which causes canker sores, vaginal discharge, skin irritation to cancer. This study aims to determine the effect of guava leaf extract (Psidium guajava) on the growth of Candida albicans fungi. This type of research is purely experimental. Guava leaf extract (P.guajava) was obtained by maceration technique using 96% ethanol solvent. Inhibitory power testing of extracts using the Kibry-Bauer method with blank discs. Candida albicans was obtained from the Microbiology Laboratory of FMIPA USU. The results of the study obtained the diameter of the inhibitory zone of guava leaf extract against the growth of Candida albicans fungus 14.6 mm at a concentration of 100% guava leaf extract which is classified as a strong inhibitory zone criterion

Role of surgical vaginoscopy through no-touch hysteroscope in the treatment of female reproductive polyps

BackgroundThe study aims to investigate the application of surgical vaginoscopy via a no-touch hysteroscopic approach for the management of female genital polyps. The primary objective is to assess the feasibility of this technique in treating intrauterine pathologies in both pregnant and non-pregnant women.MethodsA total of forty-six patients diagnosed with genital polyps underwent operative vaginoscopy at a university-affiliated hospital between April 1, 2017 and May 31, 2023. A retrospective analysis was conducted on the collected data, encompassing patient complaints, clinical presentations, surgical outcomes, and pathological diagnoses. Additionally, the success rate of the vaginoscopic procedures was determined.ResultsForty-six patients with an average age of 33.0 ± 8.8 years were included in this study. Among them, 25 were non-pregnant (3 with and 22 without a sexual history). The most common clinical manifestation was irregular vaginal bleeding (11/25, 44%) followed by conscious vaginal protrusion (10/25, 40%). Among the 21 pregnant patients, the main symptom was irregular vaginal bleeding during pregnancy (100%). The postoperative pathological diagnoses included 11 endometrial polyps, 33 cervical polyps, 1 multiple vaginal polyps, and 1 vaginal stump polyps. The coincidence rate between the intraoperative vaginoscopic diagnosis and postoperative pathological diagnosis was 100%. Among the non-pregnant patients, 11 were diagnosed with endometrial polyps, with an average length of 2.2 ± 1.2 cm, 1 patient had vaginal residual polyps after total hysterectomy, with a polyp length of 0.3–0.7 cm, and 1 had multiple vaginal polyps, with a length of 0.5–3 cm. Twelve patients had cervical polyps with an average length of 3.4 ± 1.2 cm. Twenty-one pregnant patients were diagnosed with cervical polyps, the average length of 2.4 ± 1.4 cm. All patients successfully underwent vaginoscopic surgery, for an average surgical duration of 23.5 ± 14.9 min, a bleeding volume of 1–10 mL(4.5 ± 3.4 mL), and an average hospitalisation of 2.7 ± 1.3 days. Throughout the surgical procedures, no complications were encountered, including water intoxication or uterine perforation. Postoperatively, no patients experienced discomforts such as fever or moderate to severe abdominal pain. Furthermore, all non-pregnant women were monitored for a two-month period following surgery, and throughout this interval, there were no reports of abnormal vaginal bleeding, unusual vaginal discharge, or abdominal pain. None of the 21 pregnant women experienced abnormal vaginal bleeding after the surgery. Nineteen of them delivered at full term, and one underwent caesarean delivery at 31 weeks owing to placental abruption. All the newborns had Apgar scores of 10, 10, and 10, and one had a miscarriage at 18 weeks of gestation.ConclusionVaginoscopic surgery through no-touch hysteroscope represents a minimally invasive and highly effective method for addressing female reproductive tract polyps. This approach holds significant clinical value, particularly in the management of cervical polyps during pregnancy.

Accuracy of symptom checker for the diagnosis of sexually transmitted infections using machine learning and Bayesian network algorithms

BackgroundA significant proportion of individuals with symptoms of sexually transmitted infection (STI) delay or avoid seeking healthcare, and digital diagnostic tools may prompt them to seek healthcare earlier. Unfortunately, none of the currently available tools fully mimic clinical assessment or cover a wide range of STIs.MethodsWe prospectively invited attendees presenting with STI-related symptoms at Melbourne Sexual Health Centre to answer gender-specific questionnaires covering the symptoms of 12 common STIs using a computer-assisted self-interviewing system between 2015 and 2018. Then, we developed an online symptom checker (iSpySTI.org) using Bayesian networks. In this study, various machine learning algorithms were trained and evaluated for their ability to predict these STI and anogenital conditions. We used the Z-test to compare their average area under the ROC curve (AUC) scores with the Bayesian networks for diagnostic accuracy.ResultsThe study population included 6,162 men (median age 30, IQR: 26–38; approximately 40% of whom had sex with men in the past 12 months) and 4,358 women (median age 27, IQR: 24–31). Non-gonococcal urethritis (NGU) (23.6%, 1447/6121), genital warts (11.7%, 718/6121) and balanitis (8.9%, 546/6121) were the most common conditions in men. Candidiasis (16.6%, 722/4538) and bacterial vaginosis (16.2%, 707/4538) were the most common conditions in women. During evaluation with unseen datasets, machine learning models performed well for most male conditions, with the AUC ranging from 0.81 to 0.95, except for urinary tract infections (UTI) (AUC 0.72). Similarly, the models achieved AUCs ranging from 0.75 to 0.95 for female conditions, except for cervicitis (AUC 0.58). Urethral discharge and other urinary symptoms were important features for predicting urethral gonorrhoea, NGU and UTIs. Similarly, participants selected skin images that were similar to their own lesions, and the location of the anogenital skin lesions were also strong predictors. The vaginal discharge (odour, colour) and itchiness were important predictors for bacterial vaginosis and candidiasis. The performance of the machine learning models was significantly better than Bayesian models for male balanitis, molluscum contagiosum and genital warts (P < 0.05) but was similar for the other conditions.ConclusionsBoth machine learning and Bayesian models could predict correct diagnoses with reasonable accuracy using prospectively collected data for 12 STIs and other common anogenital conditions. Further work should expand the number of anogenital conditions and seek ways to improve the accuracy, potentially using patient collected images to supplement questionnaire data.

Antibiofilm Activity of Epinecidin-1 and Its Variants Against Drug-Resistant Candida krusei and Candida tropicalis Isolates from Vaginal Candidiasis Patients.

Background/Objective: Indwelling intrauterine contraceptive devices (IUDs) have surfaces that facilitate the attachment of Candida spp., creating a suitable environment for biofilm formation. Due to this, vulvovaginal candidiasis (VVC) is frequently linked to IUD usage, necessitating the prompt removal of these devices for effective treatment. In this study, we evaluated the susceptibility of antimicrobial peptides in vitro against biofilm forming, Amphotericin B (MIC50 > 2 mg L-1) resistant Candida krusei and Candida tropicalis isolated from IUD users who had signs of vaginal candidiasis (hemorrhage, pelvic pain, inflammation, itching, and vaginal discharge). Three antimicrobial peptides, namely, epinecidin-1 (epi-1) and its two variants, namely, variant-1 (Var-1) and variant-2 (Var-2), which were reported to have enhanced antibacterial activity were tested against IUD isolates (C. krusei and C. tropicalis) with pathogenic form of Candida albicans as control. Variants of epi-1, namely, Var-1 and Var-2 were created by substituting lysine in the place of histidine and alanine. Methods: The antimicrobial activity was measured using the microbroth dilution method to determine the minimum inhibitory concentration (MIC) of peptides against C. albicans, C. krusei and C. tropicalis. The MIC of each peptide was used for biofilm assay by Crystal violet staining, Scanning Electron Microscopy, and Reactive Oxygen Species (ROS) assay. To find the possible mechanism of anti-biofilm activity by the peptides, their ability to interact with Candida spp. cell membrane proteins such as Exo-β-(1,3)-Glucanase, Secreted Aspartic Proteinase (Sap) 1, and N-terminal Domain Adhesin: Als 9-2 were determined through PatchDock. Results: The MIC values of peptides: epi-1, var-1 and var-2 against C. albicans are 128 μg mL-1, 64 μg mL-1 and 32 μg mL-1, C. tropicalis are 256 μg mL-1, 64 μg mL-1, and 32 μg mL-1 and C. krusei are 128 µg mL-1, 128 µg mL-1 and 64 µg mL-1, respectively. Both the variants outperformed epi-1. Specifically for tested Candida spp., var-1 showed two- to four-fold enhancements and var-2 showed two- to eight-fold enhancements compared to epi-1. Electron microscopy confirmed that the mechanism of action involves pore formation thus inducing reactive oxygen species in Candida spp. cell membrane. Computational analysis showed that the peptides have a high tendency to interact with Candida spp. cell membrane proteins such as Exo-β-(1,3)-Glucanase, Secreted Aspartic Proteinase (Sap) 1, and N-terminal Domain Adhesin: Als 9-2, thereby preventing biofilm formation. Conclusions: The in vitro evidence supports the potential use of epi-1 and its variants to be used as an anti-biofilm agent to coat IUDs in the future for therapeutic purposes.

Acute urinary retention in an adolescent female with Herlyn–Werner–Wunderlich syndrome

Introduction and importance: Herlyn–Werner–Wunderlich syndrome (HWWS) is a rare congenital anomaly characterized by the triad of uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. However, atypical presentations such as acute urinary retention are uncommon and pose diagnostic challenges. Early identification and treatment are crucial to prevent long-term complications like endometriosis and infertility. Case presentation: A 12-year-old female presented with the unusual symptom of acute urinary retention, which was likely caused by compression of the bladder neck due to hematocolpos. Imaging via ultrasound and MRI confirmed the presence of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis, consistent with HWWS. Surgical excision of the vaginal septum was performed to relieve the hematocolpos, with the patient experiencing a full recovery. Clinical discussion: Congenital abnormalities of Mullerian Duct are rare, and atypical presentations such as acute urinary retention, vaginal discharge, and even pyocolpos or hematosalpinx have been reported. MRI played a crucial role in confirming the diagnosis and guiding treatment. The importance of early detection and long-term monitoring is highlighted, though limitations exist due to the inability to assess future reproductive outcomes. Conclusion: This case emphasizes the importance of recognizing atypical presentations of HWWS, such as acute urinary retention. Timely diagnosis and appropriate surgical intervention are critical for preventing complications and restoring normal function. Early recognition of this rare syndrome, especially in patients with unusual symptoms such as urine retention, is essential for ensuring optimal clinical outcomes.