Cervical Swabs Research Articles

Distribution of HPV Genotypes Differs Depending on Behavioural Factors among Young Women.

Risk factors for the different human papillomavirus (HPV) genotypes are not well understood, although the risk of cancer is known to vary among them. Our aim was to evaluate the association of diverse behavioral and reproductive factors with genotype-specific HPV prevalence among 879 unvaccinated women aged 18–75 years referred to the colposcopy clinic at Helsinki University Hospital in Finland. Cervical swabs for HPV genotyping were collected in the first visit and assessed for 34 high-risk (hr) and low-risk (lr) HPV genotypes. Participants completed a questionnaire on behavioral, reproductive, and lifestyle factors. Differences in genotype-specific HPV prevalence were analyzed overall and in age groups using binary logistic regression. Smoking was associated with higher prevalence in HPV16 compared with other hrHPV genotypes together with decreasing age, being highest among younger women <30 years old, odds ratio (OR) 3.74 (95% CI 1.42–9.88). The later the sexual debut, the more it seemed to protect from HPV16 infection. The best protection was achieved when the sexual debut took place at >20 years of age, with an OR of 0.43 (95% CI 0.23–0.83). This association was not seen with other hrHPV genotypes. Methods of contraception seemed not to have an effect on hrHPV positivity, regardless of the HPV genotype. The genotype specific hrHPV prevalence differs, depending on behavioral factors, especially among younger women referred to colposcopy.

Identification of SARS-CoV-2 in the vaginal fluid and cervical exfoliated cells of women with active COVID-19 infection: A pilot study.

SynopsisIn women with confirmed COVID‐19, a negative RT‐PCR test result does not rule out the possibility of a low level of SARS‐CoV‐2 in the female genital tract.

INVESTIGATION OF THE FREQUENCY, GENOTYPE DISTRIBUTION AND PROBABLE RISK FACTORS OF HUMAN PAPILLOMAVIRUS (HPV) AMONG WOMENS ATTENDING TO FAMILY HEALTH CENTER

It is important to understand the frequency of Human Papilloma Virus (HPV) and the factors associated with HPV infections, to determine prevention, control and measures to be taken. In this study, it was aimed to investigate the HPV prevalence, genotype distribution and possible risk factors in women applying to the Family Health Center. Sexually active, clinically asymptomatic fifty women aged 30-65 who applied to Safranbolu Family Health Center between October 2018 and March 2019 were included in the study. In order to compare HPV-DNA positivity and socio-demographic characteristics, the education status, number of pregnancies, age of first sexual intercourse, presence of chronic disease, pap smear test and HPV vaccine status, etc. information was recorded and cervical swab samples were taken for detection of HPV-DNA. Viral DNA was isolated with the QIAamp® Viral DNA Kit (QIAGEN, Germany) according to the manufacturer's protocol. The presence of HPV-DNA was investigated using the MY09 / MY11 primers by the Polymerase Chain Reaction (PCR) method, positive samples were amplified using type-specific primers by PCR method and HPV typing was performed. HPV-DNA positivity was detected as 6% (3/50) in the study. Two samples were typed as HPV16; and one samples was typed as HPV31. It was observed that all HPV DNA positive samples were high risk oncogenic HPV types. When the probable risk factors are examined; It was observed that the first sexual intercourse age of patients was 16-21 years, and the number of pregnancies was ≥3 among the HPV-DNA positive women. A statistically significant relation was found with HPV-DNA positivity between the age of first sexual intercourse and the number of pregnancies (p &lt;0.05). HPV-DNA positivity was not observed in any woman protected by a condom, which is considered to be the safest in terms of to protect sexualy transmission infections. It was observed that any women participating in the study knew the availability of HPV vaccine and did not get the HPV vaccine. It is necessary to perform studies showing the prevalence of HPV and common genotypes in a region at certain time intervals; it is thought that the results will guide cervical cancer prevention and vaccination.

Prevalence of oncogenic human papillomavirus (HPV 16/18) infection, cervical lesions and its associated factors among women aged 21-49 years in Amhara region, Northern Ethiopia.

Human papillomavirus (HPV) infection is considered as the major risk factor for the development of cervical cancer, second most frequent cancer in Ethiopia. However, the magnitude of the problem and the associated factors remain unrevealed in the Amhara region. This study aimed to determine the prevalence of HPV infection and factors contributing to the progression of HPV infection to cervical cancer. Facility-based cross-sectional study design was employed among women aged 21 to 49 years of age who came for routine cervical cancer screening to 4 randomly selected hospitals (2 general and 2 referral) of Amhara region from May to October, 2019. The sample size was calculated by using the single population proportion formula, proportionated to hospitals, and women were recruited consecutively. Socio demographic and clinical data were collected using a pretested questionnaire and detection of HPV infection was done using HPV test (OncoE6TM Cervical Test) specific to HPV16/18 in cervical swabs. Visual inspection with acetic acid (VIA) was used to determine cervical lesions (precancerous and cancerous). Descriptive statistics and bivariate and multivariate logistic regression were used to describe HR-HPV and cervical lesions burden and association between HR-HPV, and cervical lesions and potential risk factors. Among 337 women 21 to 49 years (median age of 35 years ±SD = 7.1 years) of age enrolled in the study, The overall prevalence of oncogenic HPVs (HPV16/18) and the VIA-positivity rate, possible an indicative of cervical lesions, were 7.1% and 13.1%, respectively. Logistic regression analysis showed a significant association between early age of first sexual intercourse (COR = 2.26; 95% CI: 1.0-5.05) and level of education (COR = 0.31; 95% CI: 0.12-0.78) with cervical lesions. Higher odds of HPV positivity (COR = 1.56; 95% CI: 0.59-4.11, p = 0.36) and VIA positivity (COR = 1.39; 95% CI: 0.64-3.00, p = 0.39) were observed among participants who had a history of sexually transmitted illnesses (STIs). There was a relatively low prevalence of oncogenic HPV 16/18 and VIA-positivity in women attending four hospitals in the Amhara Region. Early age sexual contact, high parity, and being uneducated/low level of education were independently associated factors with HR-HPV infection and development of cervical lesions, highlighting the importance of prioritizing the limited HPV testing to those risk groups.

Preinvasive cervical lesions and high prevalence of human papilloma virus among pregnant women in Cameroon.

With the exception of breast cancer, gynecologic neoplasms constitute the most common cancers that complicate pregnancy. Pregnancy therefore presents a window of opportunity for all pregnant women who do not take part in routine free cervical cancer screening program to undergo a free voluntary cytological test and human papillomavirus (HPV) DNA testing. This study aimed to determine prevalent HPV genotypes among pregnant women using exfoliated cells from cervical swabs and determine risk factors responsible for the upsurge of cervical precancerous lesions. In a cross-sectional study conducted from October 2017 to March 2018, a total of 482 pregnant women were enrolled. Cervical swabs and samples for cytology were collected from each enrolled participant during their routine prenatal consultation. The Papanicolaou's (Pap) staining technique was performed and all cervical swab samples were amplified through conventional PCR. HPV genotypes were identified using the Roche Linear Array Genotyping Assay. SAS 9.2 software (SAS Institute Inc., USA) was used for statistical analysis and p values >0.05 were considered significant. Among the 482 participants, 354 (73.4%) had normal cytology and 128 (26.6%) had abnormal cytology. HPV DNA was identified in 62/464 (13.4%). The most prominent HPV types identified were HPV 16 (24%), HPV 18 (36.4%), HPV 45 (28%), HPV 53 (18.9%) and HPV 67 (24.3%). Early intercourse, number of sexual partners and age at first pregnancy were some of the risk factors that influenced the etiology of preinvasive cervical lesion. Prevalent HPV types identified in our study were HPV 16, 18, 45, 53 and 67. Organizing effective screening programs in prenatal care facilities is crucial in order to detect prevalent HR-HPV types and precursors for cervical lesions. The addition of HPV vaccination in the national immunization program with focus on the different epidemiological HPV genotypes circulating in the country is warranted.

English

BACKGROUND Pelvic inflammatory disease is a spectrum of diseases affecting the female upper genital tract. It is a poly microbial infection and Chlamydia trachomatis is the most common causative agent. We have undertaken this study with the objective of determining the prevalence of Chlamydia trachomatis infection in pelvic inflammatory disease (PID). METHODS This cross-sectional study consisted of 100 non-pregnant women with clinical features of PID. Endocervical, vaginal swabs and blood samples were collected from them. Polymerase-chain-reaction test (PCR) and enzyme-linked immunosorbent assay (ELISA) for chlamydial detection and Gram’s staining &amp; culture for other pathogens were performed. Chi-square and Fisher’s exact tests were used to study association between the clinical features and Chlamydia trachomatis positivity. RESULTS The prevalence rate of chlamydia was 15.1 %. The other organisms isolated were candida species in 12.9 % and Escherichia coli in 5.3 % of the study population. There was no association between the various demographic variables, menstrual problems, fever, urinary symptoms, history of infertility, abortions, instrumentations and the presence of Chlamydia trachomatis. A significant association was found between the lower abdominal pain which increased during menstruation (P = 0.013) and the two clinical signs, cervical motion tenderness and uterine tenderness (P = 0.001) with the presence of Chlamydia trachomatis and other cervical infections. CONCLUSIONS The prevalence rate of Chlamydia trachomatis in pelvic inflammatory disease was 15 % and other organisms isolated from the cervical swabs were candida species and Escherichia coli. KEY WORDS Pelvic Inflammatory Diseases, Chlamydia trachomatis

Cytological physiognomies and genotype distribution of human papillomaviruses among HPV/HIV co-infected and HPV mono-infected women.

Co-infection of High Risk Human Papillomavirus (HR-HPV) and HIV is thought to favour initiation of intraepithelial squamous cell lesion and subsequent progression to cervical carcinoma. Evaluation of cytological physiognomies in relation to possible age influence and the genotype distribution of human papillomaviruses among HPV/HIV co-infected and HPV monoinfected women in Kisii, Kenya. The case-control study enrolled 42 HPV/HIV co-infected and 42 HPV monoinfected women. Cervical swabs were collected in ThinPrep vials for HPV tying and cytological analysis. HPV subtypes were assayed by Xpert® HPV system (GXHPV-CE-10). Mono-infected women aged 30-39 years had the highest proportion of low grade squamous intraepithelial lesion (LSIL) at 14 (16.67%) while the co-infected aged 50-59 years had the highest proportion of high grade squamous intraepithelial lesion (HSIL) at 9 (10.71%). HPV-16 genotype was the most predominant and it increased with age rise. Older coinfected and mono-infected women (>40 years) had HSIL and LSIL as the most predominant cytological grade respectively. The predominance of HPV-16 and HPV-18/45 genotypes in the study setting is a consideration that would benefit targeted prophylactic vaccination programs. HPV testing and cervical cancer screening for young and older women on a regular basis ought to be reinforced.

Triaging abnormal cervical cancer screening tests using p16INK4a detection by ELISA on fresh cervical samples.

Cervical cancer screening strategies in the United States include cotesting (human papillomavirus (HPV) with cytology), primary HPV with genotyping and reflex cytology, and cytology alone. An ongoing challenge is the appropriate triage of patients to colposcopy to those at highest risk. We investigated whether incorporation of p16INK4a immunodetection by enzyme-linked immunosorbent assay (ELISA) on fresh cervical samples obtained at the time of screening could improve appropriate referral to colposcopy. A derivation group comprised of cervical swabs collected from subjects with high-grade dysplasia or cancer (positive control) and from subjects with negative screening history (negative control). Samples collected from colposcopy were used to evaluate the existing screening strategies individually and with incorporation of p16INK4a ELISA. Histology was used as the gold standard. Among 163 subjects recruited, 138 were included. In the derivation group, mean p16INK4a level was 2.86ng/mL (n=31) and 0.58ng/mL (n=20) among positive and negative controls respectively (p=0.002) with an area under the receiver operator characteristic curve of 0.79 (p<0.001). Among colposcopy subjects, sensitivity/specificity for cotesting, primary HPV, and cytology were 94%/42%, 88%/45%, and 88%/49%, respectively. Incorporation of p16INK4a resulted in similar sensitivity and improved specificity (cotesting+p16 88%/58%, primary HPV+p16 88%/57%, cytology+p16 81%/62%; p=0.23/p=0.008) with decrease in colposcopy referrals by 15% to 22% (p=0.01). These results demonstrate the feasibility of quantifying p16INK4a by ELISA in fresh cervical samples, and its potential as an adjunct to existing screening strategies in the identification of high grade-dysplasia while reducing the number of colposcopic referrals.

Association Between Leptotrichia Amnionii and Atopobium Vaginae as A Risk Factor For Miscarriage States in A Specimens of Iraqi Women

Miscarriage is one of the fundamental complications occurring in pregnant women. Many fastidious and uncultivated bacterial species are related to miscarriage and have a significant role in the infection. The association between inverse pregnancy outcomes and infections of abnormal bacteria has been rarely investigated. Therefore, this study aimed to determine Leptotrichia amnionii and Atopobium vaginae as a risk factor for miscarriage states. A total of 80 cervical swabs and blood samples were obtained from females (34 non-pregnant with recurrent spontaneous miscarriage, 11 pregnant who had previous miscarriage, and 35 without miscarriage as control) who were referred to a hospital in Baghdad city. The relationship between demographic characteristics and miscarriage groups indicates a positive association between the age of 30 years and &gt;45 years and miscarriage states, while no significant association (p&gt;0.05) was found for the other parameters compared with the control. Also, no association was observed between the levels of TORCH IgM , antiphospholipid (APL) IgM, and anticardiolipidin (ACL) IgM antibodies and spontaneous miscarriage. The findings of RT-PCR detection revealed that, out of 45 samples of recurrent spontaneous miscarriage, 17 were detected with high-risk of L. aminonia compared with two samples from the control group. Also, 7 samples of recurrent spontaneous miscarriage were shown to be infected with A. vaginae compared with five samples from the control group. The adjusted odd ratios (ORs) of L. anmionii for spontaneous miscarriage and pregnancy states were 7.89 (CI 95%, 1.60 - 39.00) and 9.43 (CI 95%, 1.43 - 61.9), respectively, with highly significant difference between the study groups compared with the control. While no significant result was recorded between the adjusted ORs of A. vaginae for spontaneous miscarriage and pregnancy states, which were 1.23 (CI 95%, 0.416 - 3.67) and 0.636 (CI 95%, 0.083 - 4.88), respectively, compared with the control.

Characterization of microbes associated with cervico-vaginal adhesion in the reproductive system of camels (Camelus dromedaries).

Vaginal and cervical adhesions are severe long-standing reproductive disorder in dromedaries and consequently result in a high culling rate. This study was designed to compare the microbial communities of the vaginae, cervices, and uteri of normal (n = 10) camels versus camels suffering from cervico-vaginal adhesion (n = 23). Vaginal, cervical, and uterine swab samples were collected from control and affected animals. Furthermore, serum samples were obtained for serological testing of Chlamydiosis and Coxiellosis. For bacteriological and fungal examination, swab samples were plated on Columbia and Saboraud's dextrose agar, respectively. Polymerase chain reaction (PCR) assay was applied to samples expressed seropositive for Chlamydiosis. Vaginal swab bacterial cultures showed that the affected animals were significantly infected with Staphylococcus aureus (P =0.0322, CI: 0.25-0.95) than the control, while mycological cultures showed that both control and affected animals were infected with Cryptococcus and Candida albicans. Corynebacterium spp. (22.7%), Pseudomonas spp. (4.5%), Klebsiella spp. (9.1%), T. pyogenes (18.2%), and anaerobic bacteria (Fusobacterium necrophorum and Clostridium spp.; 34.78%) were also identified in affected animals. Cervical samples from affected animals were distinguished by the existence of S. aureus (27.8%), Klebsiella spp. (5.6%), Corynebacterium spp. (22.2%), Cryptococcus (16.7%), Proteus spp. (11.1% (, T. pyogenes (11.1%), Pseudomonas spp. (5.6%), and Fusobacterium necrophorum (17.4%). Uterine samples from affected animals were characterized by the presence of S. aureus (22.2%), Streptococcus (22.2%), Corynebacterium spp. (11.1%), E. coli (11.1%), and Pseudomonas spp. (11.1%). Anaerobic bacteria were not isolated from control nor affected animals. Enzyme immunoassays revealed that 50% and 34.8% of the control and affected animals were positive for Coxiella burnetii, respectively, Chlamydia was detected in 43.5% of samples from affected animals, only 60% of which were confirmed positive. These results show that microbial communities linked with cervico-vaginal adhesion in dromedary camels are likely to be polymicrobial. The findings of this study are helpful in designing antimicrobial therapies toward reducing the incidence for cervico-vaginal adhesion.

High prevalence of qnrA and qnrB genes among fluoroquinolone-resistant Escherichia coli isolates from a tertiary hospital in Southern Nigeria

BackgroundThis study was aimed to determine the prevalence of qnr genes among fluoroquinolone-resistant Escherichia coli (FREC) isolates from Nigeria. Antimicrobial susceptibility testing was performed by disc diffusion technique. Polymerase chain reaction was used to identify Escherichia coli (E. coli) and for the detection of qnr genes.ResultsA total of 206 non-duplicate E. coli were isolated from 300 clinical specimens analyzed. In all, 30 (14.6%) of these isolates were FREC; the resistance to fluoroquinolones among these 30 FREC showed 80% (24), 86.7% (26), 86.7% (26), 100% (30), 86.7% (26), 93.3% (28) and 86.7% (26) were resistant to pefloxacin, ciprofloxacin, sparfloxacin, levofloxacin, nalidixic acid, ofloxacin and moxifloxacin, respectively. The distribution of FREC among the various sample sources analyzed showed that 14%, 10%, 13.3%, 16.7% and 20% of the isolates came from urine, stool, high vaginal swab, endo cervical swab and wound swab specimens, respectively. More FREC were isolated from female samples 73.3% (22) compared to male samples 26.7% (8) and were more prevalent among the age group 26–35 years (40%). Twenty eight out of the 30 (93.3%) FREC isolates possessed at least one fluoroquinolone resistance gene in the form of qnrA 10 (33.3%) and qnrB 18 (60%), respectively; qnrS was not detected among the FREC isolates analyzed and 13.5% of the isolates possessed both the qnrA and qnrB genes. Phylogenetic analysis showed that these isolates were genetically diverse.ConclusionsThese findings suggest a possible resistance to fluoroquinolone is of high interest for better management of patients and control of antimicrobial resistance in Nigeria.

Evaluation of the potential of Pap test fluid and cervical swabs to serve as clinical diagnostic biospecimens for the detection of ovarian cancer by mass spectrometry-based proteomics

BackgroundThe purpose of this study was to determine whether the residual fixative from a liquid-based Pap test or a swab of the cervix contained proteins that were also found in the primary tumor of a woman with high grade serous ovarian cancer. This study is the first step in determining the feasibility of using the liquid-based Pap test or a cervical swab for the detection of ovarian cancer protein biomarkers.MethodsProteins were concentrated by acetone precipitation from the cell-free supernatant of the liquid-based Pap test fixative or eluted from the cervical swab. Protein was also extracted from the patient’s tumor tissue. The protein samples were digested into peptides with trypsin, then the peptides were run on 2D-liquid chromatography mass spectrometry (2D-LCMS). The data was searched against a human protein database for the identification of peptides and proteins in each biospecimen. The proteins that were identified were classified for cellular localization and molecular function by bioinformatics integration.ResultsWe identified almost 5000 proteins total in the three matched biospecimens. More than 2000 proteins were expressed in each of the three biospecimens, including several known ovarian cancer biomarkers such as CA125, HE4, and mesothelin. By Scaffold analysis of the protein Gene Ontology categories and functional analysis using PANTHER, the proteins were classified by cellular localization and molecular function, demonstrating that the Pap test fluid and cervical swab proteins are similar to each other, and also to the tumor extract.ConclusionsOur results suggest that Pap test fixatives and cervical swabs are a rich source of tumor-specific biomarkers for ovarian cancer, which could be developed as a test for ovarian cancer detection.

Cervicovaginal bacterial communities in reproductive-aged Tanzanian women with Schistosoma mansoni, Schistosoma haematobium, or without schistosome infection.

Schistosome infection is recognized as a potentially modifiable risk factor for HIV in women by the World Health Organization. Alterations in cervicovaginal bacteria have been associated with HIV acquisition and have not been studied in schistosome infection. We collected cervical swabs from Tanzanian women with and without S. mansoni and S. haematobium to determine effects on cervicovaginal microbiota. Infected women were treated, and follow-up swabs were collected after 3 months. 16S rRNA sequencing was performed on DNA extracted from swabs. We compared 39 women with S. mansoni with 52 uninfected controls, and 16 with S. haematobium with 27 controls. S. mansoni-infected women had increased abundance of Peptostreptococcus (p = 0.026) and presence of Prevotella timonesis (p = 0.048) compared to controls. High-intensity S. haematobium infection was associated with more diverse cervicovaginal bacterial communities than uninfected controls (p = 0.0159). High-intensity S. mansoni infection showed a similar trend (p = 0.154). At follow-up, we observed increased alpha diversity in S. mansoni (2.53 vs. 1.72, p = 0.022) and S. haematobium (2.05 vs. 1.12, p = 0.066) infection groups compared to controls. Modifications in cervicovaginal microbiota, particularly increased diversity and abundance of taxa associated with bacterial vaginosis and HIV (Peptostreptococcus, Prevotella), were associated with schistosome infection.

Deep Septic Pelvic Thrombophlebitis – a Life-Threatening Condition in Postpartum Period

SUMMARYDeep septic pelvic thrombophlebitis is a rare but potentially devastating complication in the puerperium. Early diagnosis and aggressive treatment of this postpartum complication is essential. We report a case of a 23-year-old multipara, who presented with persistent high fever and abdominal pain two days after delivery. Diagnosis of deep septic pelvic thrombophlebitis was suspected and confirmed by using contrast-enhanced computerized tomography. Upon admission in the intensive care unit, she developed shortness of breath together with hypoxemia, which was attributed to septic pulmonary emboli. Streptococcus pyogenes group A was cultured from cervical swab. Treatment consisted of broad spectrum antibiotic therapy and low molecular weight heparin. She was dismissed for home care symptom-free fourteen days after delivery and referred to hematologist to diagnose the possible causes of thrombophilia.

Prevalence of human papillomavirus 16 genotype in Anuppur district, Madhya Pradesh.

India contributes to 1/3rd of worldwide cervical cancer deaths caused by HPV. High risk human papillomavirus (hr-HPV) 16 and 18 infections are responsible for more than 70% of cases. Early detection of hr-HPV infection can help in prevention and disease management. In rural India, HPV infection is uncontrolled due to poor hygiene, lack of awareness, screening, and vaccination. Hence, our study aims to screen HPV infection in central India starting with Anuppur district of MP. Married women above 15 and women with or without clinical conditions were recruited for the study. Unmarried, pregnant and women with cervical cancer history were excluded. A cross-sectional study was conductedon 782 enrolled married adolescents and middle aged women by obtaining clinical information and cervical swabs between March 2019 to March 2020. Genomic DNA wasextracted and screened for HPV using MY09/11 and HPV-16specific primers, data was analysed using IBM-SPSS statistics software. An overall prevalence of 7.1% HPV infection was observed, and a significant incidence (95%) of hr-HPV 16 genotypewas found. There was a considerable decrease in HPV prevalence with age; young adults between 15 and 29 years (86.4%) followed by women aged between 30 and 54 years (13.2%). Among positives, hr-HPV-16 prevalence was not significantly different among the different age-groups (p > 0.05). Hr-HPV-16 infection was detected highest in Scheduled Tribes (ST) 70%, followed by other categories. Interventions such as screening and awareness programs will help in better management of HPV infection.

Characteristics of species composition, biochemical and pathogenic nature of the microbiota of mammary gland and the reproductive tract in dairy cows

This research is dedicated to a relevant topic in veterinary medicine, which is connected with studying of specific features in systems that are responsible for productive and reproductive functioning in cattle. The reported study was funded by RFBR and Sverdlovsk region, project number 20-416-660004 «Molecular genetic and phenotypic characteristics of the microbiota in the reproductive system of cattle». Samples of secretory product of the mammary gland and cervical swabs of 81 cows and 5 dairy farms of Sverdlovsk region (Russia) were analyzed. A number of pathogenic and opportunistic microorganisms (S.aureus, S.lugdunensis, Streptococcus spp., Enterobacter spp., Enterococcus faecium, Enterococcus faecalis, Escherichia coli, Proteus vulgaris, Bacillus spp.)and mold fungi (Mucor spp., Penicillum spp., Aspergillus spp.) were isolated as a result of microbiological testing of the biological samples. The microbiota structure of the reproductive tract and the lacteal gland is demonstrated in physiologically normal state and during the inflammatory process. The phenotypic characteristic of isolated microorganisms, as well as evaluation of biochemical parameters and pathogenicity were indicated.

Performance of Point-of-Care Tests for the Detection of Chlamydia Trachomatis Infections: A Systematic Review and Meta-Analysis

Background: Chlamydia trachomatis (CT) is the most prevalent sexually transmitted infection (STI) globally but has been inadequately detected for intervention. Introduction of point-of-care tests (POCTs) for CT is critical for filling the intervention gaps. We conducted a systematical review and meta-analysis on diagnostic performance of POCTs for CT to assist in guiding the application of these assays in CT screening and detection. Methods: We searched PubMed/Medline and Embase databases, from January 2004 to Nov 2020, for studies reporting the performance of POCTs for identifying CT using specimens collected from urethral, vaginal, cervical, anorectal, or pharyngeal site or of urine. Two investigators independently screened and extracted data for controlling the quality of data extraction. Any discordant data were discussed to meet consensus by involvement of the third investigator. We only included studies with sufficient data to estimate sensitivity and specificity, and used laboratory-based nucleic acid amplification test (NAAT) as the reference standard. The main outcomes were pooled sensitivity, specificity, and diagnostic odds ratio (DOR) and their corresponding 95% confidence intervals (CIs). Summary estimates were calculated using a random-effects model and summary receiver operator curves (SROC) was generated using the Moses-Littenberg method. STATA 14.0 and Meta-DiSc 1.4 were used for statistical analysis. Findings: Of 2856 records identified, 37 studies (41,976 specimens) were included in the study, including 14 studies on evaluation of antigen detection (AD)-based and 23 on NAAT-based POCTs. The overall pooled sensitivity, specificity and DOR were 56% (95% CI 45%-67%), 99% (95% CI 98%-99%) and 86 (95% CI 46-163), respectively, for AD-based POCTs and corresponding values for NAAT-based POCTs were 94% (95% CI 92%-96%), 99% (95% CI 99%-100%) and 2,477 (95% CI 1,471-4,170), respectively. The pooled sensitivity of AD-based POCTs varied significantly across the types of specimens, 46% for cervical swabs (95% CI 37%-56%; range 22.7%-71.4%), 52% for vaginal swabs (95% CI 34%-70%; range 17.1%-86.8%) and 57% for male urine (95% CI 36%-75%; range 20.0%-82.6%). For NAAT-based POCTs, the pooled sensitivity was 93% (95% CI 87%-96%) for anorectal swabs, 94% (95% CI 92%-96%) for cervical swabs, 94% (95% CI 86%-98%) for vaginal swabs and 95% (95% CI 91%-97%) for urine specimens with a specificity ranging from 99% to 100%. Interpretation: NAAT-based POCTs for CT have a significantly better performance particularly in sensitivity for diagnosing the infection with CT than the AD-based POCTs. Funding Statement: The National Science and Technology Major Project for Belt and Road Initiative (2018ZX10101-001-001) and the Chinese Academy Medical Sciences Initiative for Innovative Medicine (2016-I2M-3-021) in China. Declaration of Interests: We declare no competing interests.

A comparative study of prevalence of Chlamydia trachomatis infection among infertile and fertile women at a tertiary care center

Background and Aim: Chlamydia trachomatis is an obligate intracellular Gram-negative bacterium causing sexually transmitted infection leading to urogenital infections which are asymptomatic. If untreated, leads to complications such as chronic pelvic pain, inflammation, and occlusion of the fallopian tubes, resulting in infertility and ectopic pregnancy. The association is found between C. trachomatis infection and female infertility with a prevalence rate of 15%–30%. The aim was to determine the prevalence of C. trachomatis infection in women with infertility. Materials and Methods: This was a hospital-based cross-sectional study of patients presenting with or without infertility. Group A (75 cases) cases with infertility with or without symptoms of pelvic inflammatory disease. Group B (75 cases) with no infertility matching age, symptoms with Group A. After history, physical examination cervical swab for chlamydial antigen and serology sample was taken and processed. Positive cases were followed by hysterosalpingography (HSG) and laparoscopy. Results: Out of 150 patients, 14 were positive for chlamydia in cases and 4 in the control group. Chlamydial prevalence was four times more in cases as compared to the control group, which is significant. The mean age was 27.97 + 4.520 years. Out of 14 positive cases, 8 (57.14%) had symptoms, whereas 6 (42.85%) were asymptomatic; in controls, 2 were symptomatic, whereas 2 were asymptomatic. HSG and laparoscopy were positive in chlamydia positive cases. Conclusion: It can be presumed that there is a significant role of C. trachomatis in infertility and also there is an association between chlamydia antigen detection and tubal factor infertility.

Evaluation of the prevalence of sexually transmitted bacterial pathogens in Northern Cyprus by nucleic acid amplification tests, and investigation of the relationship between these pathogens and cervicitis.

Objective:To evaluate the prevalence of pathogens, Chlamydia trachomatis, Neisseria gonorrhea and Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, and Ureaplasma parvum in women via multiplex-polymerase chain reaction (PCR)-deoxyribonucleic acid (DNA).Materials and Methods:Cervical swabs of 273 women in reproductive age who underwent gynecologic examination in our outpatient clinic were evaluated using the multiplex-PCR-DNA method. The presence of cervicitis, contraceptive methods, marital status, and the number of partners were evaluated.Results:One hundred six (39%) of the 273 women had at least one bacterium, 25 women (9.8%) had two bacteria, and three women (1%) had three bacteria. U. urealyticum was the most frequently encountered bacterium (13.9%), followed by M. hominis (12.8%), U. parvum (12.4%), C. trachomatis (5.4%), M. genitalium (2.9%), N. gonorrhea (2.5%), and T. vaginalis (0.3%). Bacterial infection was detected more frequently in women aged <25 years, single, who had multiple partners, and clinically diagnosed with cervicitis. The cervicitis rate was 39% in our study. M. genitalium was significantly more frequent in women with cervicitis than in women without cervicitis (5.6 vs. 1.2%, p=0.005). C. trachomatis and N. gonorrhea, which are often associated with cervicitis, were comparable in women with and without cervicitis.Conclusion:Women with clinically diagnosed cervicitis or even with a normal-appearing cervix should be tested using multiplex-real-time PCR-nucleic-acidamplification tests on suspicion of such an infection. M. genitalium is an emerging bacterial agent for cervicitis along with C. trachomatis and N. gonorrhea.

Cervical cytomegalovirus reactivation, cytokines and spontaneous preterm birth in Kenyan women.

Genital cytomegalovirus (CMV) reactivation is common during the third trimester of pregnancy. We hypothesized that cervical CMV shedding may increase risk of spontaneous preterm birth (sPTB) through the release of inflammatory cytokines in the cervix. We conducted a nested case-control analysis to determine the relationship between CMV shedding and sPTB using data and samples from a prospective cohort study in western Kenya. Women who delivered between 28+0 and 33+6weeks gestation were matched by gestational age at sample collection to controls who delivered ≥37+0weeks. Levels of CMV DNA and interleukin (IL)-1 beta (β), IL-6, IL-8 and tumor necrosis factor (TNF)-α were measured in cervical swabs. We used conditional logistic regression to assess relationships between CMV shedding, cervical cytokine levels and sPTB. Among 86 cases and 86 matched controls, cervical CMV levels were not significantly associated with sPTB [odds ratio (OR)=1·23, 95% confidence interval (CI)=0·59-2·56], but were significantly associated with higher levels of cervical IL-6 (β=0·15, 95% CI=0·02-0·29) and TNF-α (β=0·14, 95% CI=0·01-0·27). In univariate analysis, higher odds of sPTB was associated with higher cervical IL-6 levels (OR=1·54, 95% CI =1·00-2·38), but not with other cervical cytokines. In this cohort of Kenyan women, we did not find a significant association between cervical CMV shedding and sPTB before 34 weeks.