Cervical-vaginal Infection Research Articles

Intersections of Sociodemographic Factors and Cervical-Vaginal Infections: Implications for Preterm Birth and Abortion Outcomes

Intersections of Sociodemographic Factors and Cervical-Vaginal Infections: Implications for Preterm Birth and Abortion Outcomes

Cervical-vaginal dysbiosis: Clinical query of infections in selected private medical laboratories in Abakaliki Ebonyi State Nigeria

Cervical-Vaginal Dysbiosis refers to an imbalance or disruption in the microbial communities inhabiting the cervix and vaginal tract, leading to an altered composition of microorganisms, often accompanied by a decline in overall vaginal health. This phenomenon contrasts with the notion of a balanced and stable vaginal microbiome, which is characterized by the predominance of Lactobacillus species, known for their protective properties against infections and maintenance of a low pH environment This study evaluates the potential of cervical-vaginal dysbiosis among patients with clinical presentation of cervical vaginal infection in Private Medical Laboratories with limited diagnostics resources and specialization. It addresses the need for cytological investigation in addition to microbiological techniques. Clinical queries of cervical-vaginal infections of patients in twelve selected private medical laboratories in Abakaliki Ebonyi state Nigeria was studied. A total number of 38 patients who met the eligibility criteria were recruited into this study. Cervical- vaginal smear was collected from each subject, samples were fixed, and stained using Papanicolaou and Diff-Quick staining method. Out of these 38 smear samples, 17 (44.7%) had normal cytological features with no microbial features observed. Out of the remaining 21 smear samples, Trichomonas vaginalis occurred 9 times(42.9%), followed by fungi occurring 6 times (28.5%), Human papillomavirus occurring 4 times (19.1%) and Actinomyces occurring 2 times(9.5%). Notable cytological features were revealed, these included squamous intraepithelial lesions characterized by parabasal cells showing perinuclear halo, hyperchromatic nuclei, and slight nuclei polymorphism. Inflammatory lesions were also observed, characterized by the conspicuous number of superficial cells, inflammatory background, red blood cells, and infiltrating polymorphs. This study has highlighted the need to adopt a more proactive approach by evaluating the microbial profile of the cervical smear, which can be a risk factor for cervical malignancy; it has also buttressed the need to retrain and incorporate cytology services in private laboratories.

CLINICAL PRESENTATION OF TRICHOMONAS VAGINITIS IN TERTIARY CARE CENTRE IN KATHMANDU

Background: Cervical-vaginal infections are common problems in women of reproductive age groups. Trichomonas vaginalis is one of the major organisms causing vaginitis. Trichomonas vaginalis is an anerobic, flagellated protozoan. The main objective of this study was to study the clinical findings of women with Trichomonas vaginitis.
 Methods: This was a hospital based descriptive study carried out in the Department of Pathology and Gynaecology of Nepal Medical College Teaching Hospital in one year (January- December 2020). A total of 163 Pap smear examination were included in study. Specimen were stained using conventional Papanicolaou method. After staining, slides were examined under the light microscopy. The cytological diagnosis was correlated with the clinical findings. The collected data was analyzed using SPSS software version 16. Mean, Standard deviation, frequencies and percentages were calculated.
 Results: A total of 163 cases were evaluated. The mean age of women who underwent Pap smear examination was 37.5 10.5 years. Out of 163 cases, there were 42 cases of Trichomonas vaginitis. The prevalence of Trichomonas vaginalis was 25.8%. The common age group was 20 to 40 years. Most of the women were symptomatic (64.3%) while rest were asymptomatic (35.7%). Per vaginal discharge (35.7%) was the most common complain followed by vulval itching (16.7%).
 Conclusions: Trichomonas vaginalis are commonly found in reproductive age group presented with clinical manifestations or may be asymptomatic at all too. Vaginal discharge is the commonest presentation.

Association between common vaginal and HPV infections and results of cytology test in the Zhoupu District, Shanghai City, China, from 2014 to 2019

BackgroundHPV (human papillomavirus) is an important cause of cervical cancer. Cervical-vaginal infection with pathogens, such as herpes simplex virus (HSV), bacterial vaginosis Trichomonas vaginalis and vaginal candidiasis could be a cofactor. This study aimed to assess the relationship between vaginal infection with HPV genotype and cytology test results and analyze the relationship between vaginal and HPV infections and cervical cancer.MethodsWe performed a district-based study to elucidate the relationship among the vaginal and HPV infections and cervical cancer. We collected the cervical exfoliation data of 23,724 women admitted to the Shanghai Zhoupu Hospital and received ThinPrep cytology test (TCT) and HPV detection between 2014 and 2019.ResultsTotal vaginal infection rate was 5.3%, and the HPV-positive group had a slightly higher vaginal infection rate than the HPV-negative group (P < 0.01). The incidence rate of cervical intraepithelial neoplasia or cervical cancer with vaginal infection was higher than without vaginal infection (P < 0.001).ConclusionHPV/vaginal infection-positive women tended to have abnormal results of TCT. Women with vaginal infection were more likely to develop HPV infection. HSV combined with HPV infection was noted as a causal factor for HSIL.

Cytomorphological spectrum of cervicovaginal infections and their prevalence with clinical correlation on pap smears: A three-year retrospective study

Cervical-vaginal infections are one of the most common infections seen in women of the reproductive age group. The important infectious agents in Gardnerella vaginalis, Candida, and Trichomonas vaginalis. Pap smear cytology is used as an important screening test for various epithelial cell abnormalities and cervical cancer. It is also useful in the diagnosis of various pathogenic microorganisms causing cervicovaginal infections. To determine the prevalence of cervicovaginal infections on Pap smears, and study their cytomorphology and clinical correlation. : This is a three-year retrospective study from June 2018 to May 2021 performed on conventional Pap smears in the Pathology laboratory of a Government hospital in North India. The prevalence of various cervicovaginal infections was determined and their cytomorphological spectrum was studied. The Bethesda System of classification was followed for reporting Pap smears. All the females attending Gynaecology OPD of the hospital with various complaints were included. Females with a history of cervical cancer and unsatisfactory samples were excluded from the study. Out of the total number1344 pap smears examined during the three years, 1291 (96.058%) were reported as NILM, remaining 53(3.044%) were diagnosed as epithelial cell abnormalities and cervical cancer. Among the 1291 cases of NILM, 421(32.61%) smears were positive for specific pathogenic microorganisms. Out of, 421 smears, examined,254(60.33%) were BV followed by136 (32.30%) of candida infection. Trichomonas contributed to 22(5.22%) cases, whereas in one case (0.23%) each of Actinomyces and HSV was seen. Mixed infection by Trichomonas and leptothrix was seen in 4(0.950%) cases and Candida and leptothrix contributed to 3(0.712%) cases. Cervico-vaginal infections are an important cause of morbidity in the reproductive age group. Cervical cytology is an invaluable method to diagnose these infections. About 90% of infections are caused by Bacterial Vaginosis and Candida. All women of the reproductive age group should undergo a Pap smear examination for timely diagnosis and proper management of cervicovaginal infections.

Clinico-pathological Analysis of Cervical Pap Smear in Patients Attending Gynecology OPD of a Medical College

Background: Cervical cancer ranks the most common cancer among Nepalese women. Cervical and vaginal infections constitute the most common gynecological problems. Through Pap smear screening, early diagnosis, follow up and treatment, morbidity and mortality can be reduced by 70% and 80% respectively. &#x0D; Methods: This retrospective study was conducted to know the incidence of abnormal cervical epithelial lesions and cervico-vaginal infections. It was carried out in the Outpatient Department of Gynecology at Chitwan Medical College from April 2018 to March 2019. The data were collected and standard statistical analysis done using Microsoft Excel 2007. &#x0D; Results: The most prevalent cervical epithelial cell abnormality was atypical squamous cells of undetermined significance (3.43%) whereas the least common was low grade squamous intraepithelial lesion (0.21%). The most prevalent cervical vaginal infection was Bacterial vaginosis (12.30%) whereas the least prevalent was Trichomoniasis (0.29%). The majority of the women with epithelial cell abnormality were in the age group of 31-40 years whereas the lowest number in the age group less than 20 years. The highest prevalence of cervical vaginal infection was in the reproductive age group (31-50 years) and the lowest in the age above 51 years. Most of the patients had multiple symptoms like vaginal discharge, genital itching, whereas only (20.17%) visited for routine screening. &#x0D; Conclusion: Atypical squamous cells of undetermined significance and Bacterial vaginosis were the most common finding in Pap smear test representing abnormal cytology of cervix and cervicovaginal infection respectively.

Study of Trichomonas Vaginalis and Bacterial Vaginosis in Pap smear at a Tertiary Health Care Centre of Nepal

Cervical-vaginal infections are common problems in women of reproductive age presented with clinical features like white vaginal discharge, foul smelling odor and pruritis. Trichomonas vaginalis, Candidia and Gardnerella vaginalis are responsible for infectious vaginitis in creating anaerobic environment favoring Bacterial vaginosis caused by organisms like Gardnerella vaginalis, Chlamydia Trachomatis. Papanicolaou (Pap) smear examination is the simple, quick, painless routine screening test used for identification and detection of precancerous changes of uterine cervix as well as the cervico-vaginal infections resulting from bacterial, fungal and candida infections. The prime objective of the study was to identify the age wise distribution of cervical-vaginal infections and determine the frequency of Trichomonas vaginalis (TV) and Bacterial vaginosis (BV). A descriptive cross-sectional study was carried out in the Department of Pathology, Nepal Medical College and Teaching Hospital, Kathmandu. A total of 163 cases of TV and BV diagnosed on Pap smear were taken for the study. However, 564 Pap smears were received in the Department of Pathology for cytological evaluation during the study period. Once the smears were stained, the presence of clue cells, cannon balls and Trichomonas were observed. Out of 564 Pap smears received during the study period, 163 cases were of BV, TV and combined BV and TV. These 163 cases were included in our study. The age ranged from 20 to 65 years with majority (19.1%) of the women belonging to 35-39 years and the mean age was 38.18 ± 10.18 years. There were 97 cases (17.2%) of BV, 50 cases (8.9%) of TV and 16 cases (2.8%) of TV and BV co-infection. Bacterial vaginosis was the most predominant type of cervicovaginal infection followed by TV infection and TV and BV co-infections. Trichomonas vaginalis may create an environment favoring the development of BV. Pap screening could be the beneficial tool in early disease diagnosis and helps in preventing further complications by starting appropriate treatment.

Clinical and Microbiological Characteristics of the State of Vaginal Biocenosis among Patients with Preterm Labor

Relevance. Premature birth (PR) in the etiopathogenetic relationship is a clinical syndrome characterized by polyetiology, a chronic course of the process, the participation of the fetus in pathogenesis, a variety of clinical symptoms, and the involvement of genetic and environmental factors. The infectious factor is considered as the leading risk for the development of PR. According to the literature, more than 40% of PR is due to the presence of an infectious process. The most significant are intrauterine and cervical vaginal infections. Purpose of the study was a clinical and microbiological assessment of the state of the vaginal biotope in women with various options for spontaneous preterm birth. Materials and methods . The diagnostic complex included bacterioscopic, bacteriological, and also molecular genetic studies. The object of the study was pregnant women with timely physiological delivery and with various types of preterm birth, who were hospitalized in specialized medical organizations of the Nizhny Novgorod region. A total of 260 patients were examined, and 1000 studies were conducted. Material for research was the contents of the vagina and cervical canal. Results. The state of the vaginal biocenosis was characterized by pronounced irregularity in patients with different variants of spontaneous preterm birth. In women with premature rupture of the membranes, a local inflammatory process with the prevalence of conditionally pathogenic microflora over lactic acid bacteria was significantly frequent. Lactoflora prevailed among patients with true PR and with timely physiological labor in the composition of the vaginal biotope. In women with preterm labor with isthmic-cervical insufficiency, there were mixed disorders of the vaginal biocenosis. Conclusions. The risk of developing spontaneous preterm birth is reliably determined by the state of the vaginal biocenosis.

Extremely low gestational age and very low birthweight for gestational age are risk factors for autism spectrum disorder in a large cohort study of 10-year-old children born at 23-27 weeks’ gestation

No prospective cohort study of high-risk children has used rigorous exposure assessment and optimal diagnostic procedures to examine the perinatal antecedents of autism spectrum disorder separately among those with and without cognitive impairment. We sought to identify perinatal factors associated with increased risk for autism spectrum disorder with and without intellectual disability (intelligence quotient <70) in children born extremely preterm. This prospective multicenter (14 institutions in 5 states) birth cohort study included children born at 23-27 weeks' gestation in 2002 through 2004 who were evaluated for autism spectrum disorder and intellectual disability at age 10 years. Pregnancy information was obtained from medical records and by structured maternal interview. Cervical-vaginal "infection" refers to maternal report of bacterial infection (n= 4), bacterial vaginosis (n= 30), yeast infection (n= 62), mixed infection (n= 4), or other/unspecified infection (n= 43; eg, chlamydia, trichomonas, or herpes). We do not know the extent to which infection per se was confirmed by microbial colonization. We use the terms "fetal growth restriction" and "small for gestational age" interchangeably in light of the ongoing challenge to discern pathologically from constitutionally small newborns. Severe fetal growth restriction was defined as a birthweight Z-score for gestational age at delivery <-2 (ie, ≥2 SD below the median birthweight in a referent sample that excluded pregnancies delivered for preeclampsia or fetal indications). Participants were classified into 4 groups based on whether or not they met rigorous diagnostic criteria for autism spectrum disorder and intellectual disability (autism spectrum disorder+/intellectual disability-, autism spectrum disorder+/intellectual disability+, autism spectrum disorder-/intellectual disability+, and autism spectrum disorder-/intellectual disability-). Temporally ordered multinomial logistic regression models were used to examine the information conveyed by perinatal factors about increased risk for autism spectrum disorder and/or intellectual disability (autism spectrum disorder+/intellectual disability-, autism spectrum disorder+/intellectual disability+, and autism spectrum disorder-/intellectual disability+). In all, 889 of 966 (92%) children recruited were assessed at age 10 years, of whom 857 (96%) were assessed for autism spectrum disorder; of these, 840 (98%) children were assessed for intellectual disability. Autism spectrum disorder+/intellectual disability- was diagnosed in 3.2% (27/840), autism spectrum disorder+/intellectual disability+ in 3.8% (32/840), and autism spectrum disorder-/intellectual disability+ in 8.5% (71/840). Maternal report of presumed cervical-vaginal infection during pregnancy was associated with increased risk of autism spectrum disorder+/intellectual disability+ (odds ratio, 2.7; 95% confidence interval, 1.2-6.4). The lowest gestational age category (23-24 weeks) was associated with increased risk of autism spectrum disorder+/intellectual disability+ (odds ratio, 2.9; 95% confidence interval, 1.3-6.6) and autism spectrum disorder+/intellectual disability- (odds ratio, 4.4; 95% confidence interval, 1.7-11). Severe fetal growth restriction was strongly associated with increased risk for autism spectrum disorder+/intellectual disability- (odds ratio, 9.9; 95% confidence interval, 3.3-30), whereas peripartum maternal fever was uniquely associated with increased risk of autism spectrum disorder-/intellectual disability+ (odds ratio, 2.9; 95% confidence interval, 1.2-6.7). Our study confirms that low gestational age is associated with increased risk for autism spectrum disorder irrespective of intellectual ability, whereas severe fetal growth restriction is strongly associated with autism spectrum disorder without intellectual disability. Maternal report of cervical-vaginal infection is associated with increased risk of autism spectrum disorder with intellectual disability, and peripartum maternal fever is associated with increased risk for intellectual disability without autism spectrum disorder.

Evaluating the Pap Smear Reports of Pathology Laboratories in Ahvaz, Iran

Background & aim: Pap smear is a screening procedure for cervical cancer. The incidence and mortality rate of cervical cancer has decreased up to 90% in the regular screening in women aged 20-65 years. This study aimed to investigate the Pap smear reports of pathology laboratories in Ahvaz, Iran. Methods: In this cross-sectional study, 1,006 Pap smear reports were collected from pathology laboratories via cluster sampling method. Data was analyzed by a self-structured questionnaire. In addition, variables such as age, type of infection, grade of inflammation, metaplastic changes, and epithelial cell abnormalities in cervix were studied in this study. Data analysis was performed in SPSS V.16.0 using descriptive analysis, ANOVA, Fisher’s exact, and Chi-square tests. Results: While no infection was reported in 94.43% (n=950) of cases, the highest incidence rate of infections in the remaining samples (5.56%, n=56) was related to Candida Albicans (4.77%, n=48). Various grades of inflammation were reported in 83.69% (n=842) of the samples. Moreover, the highest grade of inflammation in fungal infections was 2+, whereas the grades in Trichomonas and bacterial infections were 1+ and 3+, respectively. Cervical dysplasia and metaplasia were reported in 0.29% (n=3) and 1.19% (n=12) of the cases, respectively. Conclusion: The prevalence of cervical-vaginal infections, cervical metaplasia, and dysplasia were relatively low in Pap smear reports of laboratories in Ahvaz.

Association of Uncontrolled Glycemia with Periodontal, Urinary Tract and Cervical Vaginal Infections in a Group of Type 2 Diabetic Women during Pregnancy and during the Postnatal Period

Association of Uncontrolled Glycemia with Periodontal, Urinary Tract and Cervical Vaginal Infections in a Group of Type 2 Diabetic Women during Pregnancy and during the Postnatal Period

The most Common Causes of Cervico-vaginal Infections Among Sudanese Women Complainingof Vaginal Discharge

Background: Cervico-vaginal infection is one of the most common problems in clinical medicine. This study aimed to the most common causes of cervical-vaginal infections among Sudanese women complaining of vaginal discharge. Method: Cross-sectional hospital based study that had carried out on one hundred non-pregnant women complaining of vaginal discharge attended at gynecology department – Khartoum teaching hospital. All subjects had signed informed consent. Smear from all collected samples were prepared and stained with Papanicolaou Stain for cytological evaluation. Descriptive and analytical statistics (chi – square test) were applied using SPSS (Version 20). Results: The result showed that the majority of subjects were from central and northern of Sudan. The mean age of women was (29) The most common microorganisms seen were bacilli bacteria (49%), followed by candida (18%), Actinomycesisraelii, Leptothrix spp. and Gardnerellavaginalis were (2%), (2%), and (1%) respectively. Statistically no significant association between infection and age group, circumcision, geographical location, and occupation, p value of all these variables was above than significant level 0.05. Conclusion: The most prevalent infections were bacterial vaginosis and candida albicans. This is consistent with the results of many studies although other studies reported different results.

Systemic inflammation in the extremely low gestational age newborn following maternal genitourinary infections.

Gestational genitourinary infections are associated with lifelong disabilities, but it is unknown if neonatal inflammation is involved. Mothers of 914 infants born before 28th gestation week reported cervical/vaginal infection (CVI), and/or urine/bladder/kidney infection (UTI), or neither. Inflammation proteins measured in baby's blood on postnatal days 1, 7, and 14 were considered elevated if in the top quartile for gestational age. Logistic regression models adjusting for potential confounders assessed odds ratios. Compared to mothers with neither UTI/CVI, those with CVI were more likely to have infants with elevated CRP, SAA, MPO, IL-1β, IL-6, IL-6R, TNF-α, RANTES, ICAM-3, E-selectin, and VEGF-R2 on day 1; those with UTI were more likely to have infants with elevated MPO, IL-6R, TNF-R1, TNF-R2, and RANTES on day 7. Placental anaerobes and genital mycoplasma were more common in pregnancies with CVI. Gestational UTI/CVI should be targeted for preventing systemic inflammation in the very preterm newborn.

Prevalence of Cervical-Vaginal Infections in the Pap-Smear Samples in Iran

Cervical-vaginal infection is one of the most common problems in clinical medicine. We aimed to determine the prevalence of cervical-vaginal infections in pap-smear samples from women in urban and rural areas. Method: It was a cross - sectional study which had done on 1448 non-pregnant women those had attended 12 health centers in the Dashte- Azadegan city during 2007-2011, Iran. After explained the aim of study, all subjects had signed informed consent, questionnaires regarding demographic and reproductive characteristics, and contraceptive methods used were completed by researcher. Also, pap-smear samples were prepared by a trained obstetrician and sent it to the pathology laboratory. All data were analyzed using SPSS (version 19). Descriptive and analytical statistics (chi – square test) were also applied. Results: The result showed that 55.9% and 44.1% of subjects were respectively in urban and rural areas. The mean age of women was 28±8.075. Pap smear results had shown that 8.8% of samples were infected with one of microorganisms such as Chlamydia, Candida, Cardnerella, and Trichomonas. A significant association was seen between contraceptive methods, education levels and place of residence with cervical-vaginal infections. Conclusion: The most prevalent pathogens by descending order were: Candida, Trichomonas and Gardenerella. The prevalence of cervical-vaginal infections was consistent with the results of many studies but it was different with the results of some studies. This could be due to the special conditions of social, economic and cultural of each area.

Frequency of Trichomonas vaginalis, Candida sp and Gardnerella vaginalis in cervical-vaginal smears in four different decades.

Vaginitis is one of the principal motives that lead women to seek out an obstetrician or gynecologist. Bacterial vaginosis, candidiasis and trichomoniasis are responsible for 90% of the cases of infectious vaginitis. To verify the frequency of the three main causative agents of vaginitis, Trichomonas vaginalis, Candida sp and Gardnerella vaginalis, in four different decades (1960's, 1970's, 1980's and 1990's). Retrospective. A tertiary referral center. Patients attended to as gynecology and obstetrics outpatients at the Faculdade de Medicina do Triângulo Mineiro during the years 1968, 1978, 1988, 1998, taken as samples of each decade. Diagnoses of infection by Trichomonas vaginalis, Candida sp and Gardnerella vaginalis were gathered from 20,356 cervical-vaginal cytology tests on patients attended to as gynecology outpatients at Faculdade de Medicina do Triângulo Mineiro during the years 1968, 1978, 1988, 1998, representing the four decades. The results were grouped according to the age group of the patients: under 20, between 20 and 29, between 30 and 39, between 40 and 49, and 50 or over. Statistical analysis was done via the chi-squared (Mantel-Haentzel) test with a significance level of 5%. In 1968 infections by Trichomonas vaginalis and Candida sp were diagnosed in 10% and 0.5% of the cytology tests and in 1978, 5.1% and 17.3%, respectively (P < 0.0001). Infection by Gardnerella vaginalis could only be evaluated in the latter two decades. In 1988, 19.8% of the women had positive tests for Gardnerella vaginalis, which was the most frequent agent in that year, diminishing in the subsequent decade to 15.9% (P < 0.0001). Candidiasis was the most frequent infection in 1998, detected in 22.5% of the tests (P < 0.0001). In a general manner, all the infections were most frequent among younger patients, especially those aged under 20, in all decades, whereas infections were least frequent among patients aged 50 or over (P < 0.05). There was a reduction in the frequency of cervical-vaginal infection by Trichomonas vaginalis and an increase in the frequency of Candida sp over the four decades studied. All the infections were most frequent in patients aged under 20 years.

Preterm labor associated with subclinical amniotic fluid infection and with bacterial vaginosis.

Maternal genital infection, particularly subclinical amniotic fluid infection, may cause preterm labor and a premature delivery. The prevalence of subclinical amniotic fluid infection was studied in 54 consecutive afebrile women in preterm labor with singleton gestations and intact fetal membranes. Microorganisms were recovered from the amniotic fluid by transabdominal amniocentesis in 13 (24%) of 54 patients. Bacteria or Candida albicans were recovered from six (11%), and genital mycoplasmas from seven (13%). Compared with women with sterile amniotic fluid, patients whose amniotic fluid contained bacteria or Candida organisms had a shorter interval from onset of preterm labor until delivery (0.6 versus 34.3 days, P less than .01), were less responsive to tocolytic therapy (0 versus 81% success rate, P less than .005), and more frequently developed subsequent intrapartum fever (83 versus 2.4%, P less than .005). In contrast, women whose amniotic fluid contained genital mycoplasmas did not differ in these parameters from those with sterile fluid. Also compared was cervical-vaginal infection among these patients in preterm labor with matched control subjects without preterm labor. In this analysis, bacterial vaginosis was identified in 43% of patients with and 14% of women without preterm labor (P = .02), yielding a relative risk of preterm labor for patients with bacterial vaginosis of 3.8. These data underscore the importance of amniotic fluid bacterial infections in preterm labor and premature delivery, and suggest that bacterial vaginosis is associated with prematurity.