Describe the clinical evolution of a person with recurrent gonococcal cervicitis despite appropriate treatment and lack of reinfection. We used the tolerance detection test to confirm that all three culture-positive gonococcal isolates were tolerant to ceftriaxone. Over a period of 6 months, a transgender man with gonococcal cervicitis experienced eight episodes of treatment failure despite receiving ceftriaxone 1 g intramuscularly on each occasion. The isolate remained susceptible to ceftriaxone throughout this period. His Neisseria gonorrhoeae infection was then successfully eradicated with a prolonged course of ceftriaxone. We propose that bacterial tolerance be considered a possible cause of treatment failure in N. gonorrhoeae. A tolerance detection test can be used to diagnose tolerance.

Background: Urogenital chlamydia is one of the most prevalent sexually transmitted infections, often asymptomatic and associated with infertility and pregnancy loss. Treating chlamydial cervicitis in women with cicatricial cervical deformity is particularly challenging, as structural abnormalities promote chronic infection and reduce the effectiveness of standard antibiotic therapy.Aims: To improve treatment outcomes for chlamydial infections of the lower genital tract in women with cicatricial cervical deformity through a combined approach that includes reconstructive surgery.Materials and methods: This single-center, nonrandomized, prospective study enrolled 91 women aged 18 to 45 years with laboratory-confirmed urogenital Chlamydia trachomatis infection. Participants were allocated into three groups: group A (n = 30) included women with cicatricial cervical deformity who underwent reconstructive surgery (Eltsov-Strelkov technique) combined with antibiotic therapy (doxycycline, 100 mg twice daily for 21 days); group B (n = 31) consisted of women with cicatricial cervical deformity who received antibiotic therapy alone; group C (n = 30, control) comprised women with normal cervical canal architecture treated with doxycycline only. Recurrence of chlamydial infection was assessed clinically and by polymerase chain reaction (PCR) at 1- and 12-months posttreatment.Results: At 1 month posttreatment, the efficacy of doxycycline monotherapy in women with cicatricial cervical deformity (group B) was 83.3%, compared with 96.7% in patients with normal cervical anatomy (group C). The combined approach in group A achieved a 96.8% success rate. At 12 months, a significant decrease in treatment efficacy was observed in group B, dropping to 76.7% (p<.05), while the outcomes in group A remained stable (96.8%) and were comparable to those in the control group (96.7%).Conclusions: Combining reconstructive surgery with antibiotic therapy significantly improves treatment outcomes for urogenital chlamydia in women with cicatricial cervical deformity by reducing recurrence and enhancing local immune responses.

Uterine cervicitis in women requires careful selection of a suitable and straightforward treatment. This study aimed to examine the effect of Nika vaginal cream on the symptoms of uterine cervicitis in women. This double-blind, randomized, controlled clinical study was conducted on 66 women who where reffered to Hamadan health centers in 2021(33 people in each group). The participants in the intervention group were instructed to use Nika vaginal cream every night for 14 nights, along with a single dose of one gram of azithromycin, 400 mg of cefixime, and 500 mg of metronidazole twice a day for both the patient and her husband. The control group received a placebo cream and the same drugs as the intervention group. After the 14-day treatment period, clinical signs were assessed through examinations, and participants completed questionnaires again. The study found that participants in the Nika user group experienced a 69.70% improvement in symptoms related to uterine cervicitis. This improvement was significantly higher than the control group, which only showed a 45.50% improvement. Although the Risk Ratio (RR) between the two groups was 53% higher in the intervention group, this difference was not statistically significant (p=0.06). However, the Risk Difference (RD) of 0.24 between the groups was found to be statistically significant (p=0.04). Additionally, participants in the intervention group reported a 76.00% reduction in dyspareunia (p=0.03) and an 84.00% reduction in urinary frequency (p=0.05). According to the result of RD, Nika vaginal cream had a significant effect on the improvement of cervicitis symptoms.

Objectives: To find the seroprevalence of the Chlamydia Trachomatis (CT) infection in women who suffer from infertility, mucopurulent cervicitis and ectopic pregnancy and to investigate the possible role of the Chlamydial serology as a screening test by detection of the anti-Chlamydia IgG antibodies using ELISA. Methods: Over period of two years, total of 160 women who attended the gynecology OPD of Government Lalla Ded hospital, Srinagar, were screened for presence of Chlamydia Trachomatis IgG antibodies. Patients were categorized based on clinical diagnosis into 2 groups. Group I: Comprising of 120 patients [40 patients in each sub group. I (a) - Women with mucopurulent cervicitis (MPC); I (b) - Women with infertility; I (c) - Women with ectopic pregnancy.] Group II: Fertile women with no clinical signs and symptoms of mucopurulent cervicitis and no history of ectopic pregnancy and infertility. Venous blood samples from all these women were collected and screened for IgG antibodies to Chlamydia Trachomatis. Results: In our study 32.5% women with mucopurulent cervicitis were positive for CT IgG. In the infertile group, 22.5% of women were positive for Chlamydia IgG antibodies. 30% of ectopic pregnancies were positive for Chlamydia Trachomatis IgG. Out of 40 patients who were taken as controls, 7.5% screened positive for Chlamydia IgG antibodies. 56.7% of women who were positive for CT IgG antibodies were from rural areas. In our study the overall seroprevalence of Chlamydia Trachomatis was 23.12%. Conclusion: Chlamydia Trachomatis is the most common cause of sexually transmitted bacterial infection worldwide. Our study has shown that significant proportion of Kashmiri women also harbor this infection. So it becomes imperative that health and screening programs be employed to prevent the spread of this infection and its long term residual sequelae in women of childbearing age.

Chlamydia infection represents an important cause for concern for public health worldwide. Chlamydial infection of the genital tract in females is mostly asymptomatic at the early stage, often manifesting as mucopurulent cervicitis, urethritis, and salpingitis at the later stage; it has been associated with female infertility, spontaneous abortion, ectopic pregnancy, and cervical cancer. As an obligate intracellular bacterium, Chlamydia depends heavily on host cells for nutrient acquisition, energy production, and cell propagation. The current review discusses various strategies utilized by Chlamydia in manipulating the cell metabolism to benefit bacterial propagation and survival through close interaction with the host cell mitochondrial and apoptotic pathway molecules.

ABSTRACTNeisseria gonorrhoeae has developed resistance to all previous antibiotics used for treatment. This highlights a crucial need for novel antimicrobials to treat gonococcal infections. We previously showed that carbamazepine (Cz), one of the most commonly prescribed antiepileptic drugs, can block the interaction between gonococcal pili and the I-domain region of human complement receptor 3 (CR3)—an interaction that is vital for infection of the female cervix. We also show that Cz can completely clear an established N. gonorrhoeae infection of primary human cervical cells. In this study, we quantified Cz in serum, saliva, and vaginal fluid collected from 16 women who were, or were not, regularly taking Cz. We detected Cz in lower reproductive tract mucosal secretions in the test group (women taking Cz) at potentially therapeutic levels using a competitive ELISA. Furthermore, we found that Cz concentrations present in vaginal fluid from women taking this drug were sufficient to result in a greater than 99% reduction (within 24 h) in the number of viable gonococci recovered from ex vivo, human, primary cervical cell infections. These data provide strong support for the further development of Cz as a novel, host-targeted therapy to treat gonococcal cervicitis.

Vaginal discharge is a common complaint among women attending the sexually transmissible infections (STIs) clinic and is a cause for concern and mental distress. It can be attributed to physiological or pathological causes. This study aims to understand the prevalence of various etiologies of vaginal discharge, which would help frame health policies based on local needs. (1) To estimate the prevalence of discharge per vaginum among sexually active women attending the STI clinic at a tertiary care center during a 1-year period, (2) To identify the organisms causing vaginal discharge, (3) To have a clinicoetiological correlation of the cases, and (4) To identify the subspecies of Candida causing vaginal candidiasis. A total of 126 patients with vaginal discharge attending the STI clinic at a tertiary care center were included in the study. A detailed clinical history, physical examination of the external genitalia, and vaginal examination were done on each patient. Five swabs were taken from the posterior fornix and lateral vaginal wall for evaluation of the organisms. The mean age of the study population was 31.51 ± 7.9 years. Vulvovaginal candidiasis (VVC) was found to be the most common cause of vaginal discharge, followed by bacterial vaginosis, mucopurulent cervicitis, herpes genitalis, and trichomoniasis. The most common species of Candida was found to be Candida albicans. Even though VVC still remains the major cause, other viral infections like herpes significantly contribute. Vaginal discharge is an important indicator of women's reproductive health and its detailed evaluation helps identify the prevalence of various STIs in the community.

Difficulty in diagnosing Chlamydia trachomatis infections, including chlamydial cervicitis, is a notable challenge in managing sexually transmitted infections in Indonesia. Gram staining is usually done to make a presumptive diagnosis despite its low sensitivity and specificity. Polymerase chain reaction (PCR) is considered the gold standard, but it is costly, technically demanding, and difficult to be performed in low-resource settings. Thus, rapid point-of-care tests with high sensitivity and specificity are needed to diagnose chlamydial cervicitis. This cross-sectional study included symptomatic and asymptomatic high-risk women in the Mulya Jaya Sex Workers Rehabilitation Center in June to July 2020. Endocervical swabs from each participant were taken for QuickStripe™ chlamydia rapid test (CRT), Gram staining, and real-time PCR. A total of 41 participants were enrolled. The sensitivity and specificity for QuickStripe™ CRT were 73.6% (95% CI: 48.80%-90.85%) and 81.82% (95% CI: 59.72%-94.81%). Positive and negative predictive values were 77.78% (95% CI: 58.09%-89.84%) and 78.05% (95% CI: 62.39%-89.44%). Proportion of chlamydial cervicitis in study participants based on real-time PCR was 46.3%. We concluded that QuickStripe™ CRT can be recommended as an alternative diagnostic test for high-risk populations in Jakarta.

Female genital tract chronic inflammation is common in clinics; the pathogenesis is not fully understood yet. House dust mite (HDM) involves the pathogenesis of many chronic diseases in human. This study aims to identify HDM-specific allergic response in the cervix of patients with cervical inflammation. Patients (n = 80) with chronic cervicitis (CC) and non-CC control (NC) subjects (n = 80) were recruited into this study. Vaginal lavage fluids (VLF) were collected from CC patients and NC subjects. Cellular components and fluid part of VLF were separated by centrifugation, and analyzed by flow cytometry and enzyme-linked immunosorbent assay. We found that a portion (52 out of 80) of CC patients responded to HDM, manifesting positive skin prick test, and HDM-specific IgE and IgG was detected in the VLF (designated CCp patients). VLF of CCp patients showed a Th2-dominant profile. HDM-specific Th2 cells were detected in VLF in CCp patients. Exposure to HDM in the culture induced proinflammatory cytokine release from CCp VLF CD4+ T cells. Exposure to CCp VLF CD4+ T cell-conditioned medium induced de novo Th2 response. Direct exposure to HDM induced allergic response in the cervix of CCp patients. In summary, a portion of CC patients respond to HDM challenge in the cervix. Exposure to HDM induces an allergy-like response in the cervix of CCp patients.

Expanded Histopathology and Tropism of Ebola Virus in the Rhesus Macaque Model: Potential for Sexual Transmission, Altered Adrenomedullary Hormone Production, and Early Viral Replication in Liver

BackgroundWhile the contribution of Mycoplasma genitalium (MG) to symptoms in men is well described, less is known about its association with common genital symptoms in women. We aimed to determine...

Genital Chlamydia trachomatis infection and infertility in Malaysia

Chlamydia trachomatis (Ct) is a Gram-negative bacterium with an obligatory intracellular life cycle. Tropism manifests through columnar epithelia in the uterine cervix, rectum, lungs, and eyes. The literature review of the Medline database identified 3,458 papers. The WHO estimates that over 100 million new cases of infection by Ct occur worldwide annually, with an increase of 4.1% since the last global evaluation conducted in 2006. Chlamydia trachomatis is the most frequent sexually transmissible bacterium in the United States with a yearly incidence of more than one million reported cases. Approximately 50 to 75% of infected women show no symptoms of the infection or appear to be mucopurulent cervicitis. Pain caused by cervical motion or evaluation of the accessories in response to a bimanual exam suggests the infection has moved on to the upper genital tract leading to endometritis, salpingitis and peritonitis and its consequences: pelvic pain, infertility, ectopic pregnancy. Chlamydia trachomatis may also be the etiologic agent of bacterial urethritis, in which case, despite the patient’s report of dysuria, the urine culture is negative for the usual urinary pathogens. Since bacteria favor columnar epithelia, the Skene and the Bartholin vestibular glands may also be a site of infection and attendant symptoms. The nucleic acid amplification test is the most recommended for its higher sensitivity and specificity and is currently the gold standard for diagnosis. The antibiotics for the treatment should be chosen for their intracellular penetration ability and should have a half-life of 36 to 48 hours to cover the bacterium’s life cycle. Azithromycin is excellent at intracellular penetration, has a half-life of 5 to 7 days, and can be administered in a single dose; it may also be given to pregnant women. A recent meta-analysis showed a small increase (3%) of better outcome in the use of doxycycline against azithromycin in the treatment of urogenital infection.

Introduction: The major target of HIV is the immune system and the abdominal pathologies are second most commonly found in patients of AIDS after pulmonary manifestations. These abdominal manifestations are on increase may be due to immunocompromised status of these patients and due to antiretroviral therapy which has increased life expectancy in these patients. Purpose of this study is to describe abdominal findings and to evaluate clinical utility of USG in HIV patients with the use of abdominal probe, high frequency probe and Color Doppler USG. Methods: This Retrospective Analytical study involved 60 randomly selected HIV patients attending to Local ART Units . Prior Consent was obtained from Local ART Centre to see the records of the patients from there MRD .Patients of all age groups and both sex having cataract were included in the study Results: This study includes 60 HIV patients, 37 patients were male and 23 patients were female. Age group studied was 20 yrs to 65 yrs referred from ART Department . Most prevalent age group was from 40 - 49 yrs that was 23 patients, next was 30 - 39 yrs i.e. 20 patients, third in declining order was 20 - 29 yrs i.e. 12 patients and less prevalent age groups were from 50 - 59 yrs and above 60 - 70 yrs. These patients had diverse abdominal findings. Out of 60 patients 3 had no abdominal findings. Hepatomegaly was found in 33 patients, fatty hepatic changes in 14 patients and in one case there was Hepatic abscess. Lymphadenopathy was found in 28 cases. Splenomegaly was found in 20 cases and in 6 cases there were also having splenic abscesses. Ascites was found in 12 cases it was septated and non septated ascites. Cholecystitis in 4 cases. Bowel wall thickening in 5 cases in most of cases it was thickening of ileum and Ileocaecal junction thickening. Other findings were renal parenchymal disease in 2 cases, Bulky pancreas in 2 cases, cervicitis in 2 cases, one case each of cystitis and pyocele. Testicular abscess in 2 cases and gluteal abscess in one case along with other abdominal findings. Many patients had two or more pathologies. Conclusion: AIDS is multisystem disease but its demographic and clinical pattern remains same globally. USG is optimally suited for its clinical management especially in developing countries like India. Results of sonographically evaluated cases of abdominal findings are comparable to other diagnostic modalities like CT scan. The ease of availability, diagnostic accuracy of USG and its affordable cost and interventional and follow up advantages makes USG first choice of investigation for evaluation of abdominal findings. Clinico-pathological correlations can further increase its diagnostic accuracy.

Objective To analyze the distribution of mycoplasma of secretion in patients with cervicitis and the sensitivity to antibiotics. Methods 200 cases of cervicitis patients were included in the department of gynecology and dermatology of our hospital from June 2018 to June 2019. The cervical secretions were collected for mycoplasma culture and drug susceptibility test, and their sensitivity to 9 antibiotics were analyzed. Results The detection rate of mycoplasma in 200 patients with cervicitis was 48.5%, of which Mh accounted for 1.5%, Uu accounted for 33.5%, Uu+Mh accounted for 13.5%. The sensitivity of Uu to antibiotics ranked as minocycline (97.0%), josamycine (95.5%), clarithromycin (95.5%), and doxycycline (91.0%), the resistance to antibiotics ranked as sparfloxacin (34.3%) and ofloxacin (29.9%); the sensitivity of Uu+Mh to antibiotics ranked as minocycline (85.2%), josamycin (81.5%), doxycycline (70.4%), the resistance to antibiotics ranked as roxithromycin (88.9%), azithromycin (81.5%), clarithromycin (74.1%), and sparfloxacin (74.1%). Conclusion The Uu and Uu+Mh are the main types of mycoplasma infection in patients with cervicitis. Clinically, antibiotics should be selected in combination with drug sensitivity test to ensure the best therapeutic effect. Key words: Cervicitis; Secretion; Mycoplasma detection; Antibiotics; Sensitivity

Sexually transmitted infections (STIs) are among the most common causes of infectious illness worldwide, and therefore, familiarity with the recognition and management of these infectious pathogens is critical for physicians. This chapter reviews the epidemiology and transmission of STIs and describes the principles of taking a sexual history, reporting STIs, and screening for them. Urethritis, vulvovaginitis, mucopurulent cervicitis, pelvic inflammatory disease (PID), and genital ulcer disease are discussed. STIs in men who have sex with men is discussed, as is anorectal STIs in women. One figure shows a Gram stain in gonorrhea; the other shows ectopic pregnancy and tubal infertility in PID. This review contains 2 figures, 24 tables, and 89 references. Keywords Vulvovaginitis, sexually transmitted infection, herpes, gonorrhea, urethritis, human papilloma virus, syphilis, chlamydia, viral hepatitis, pelvic inflammatory disease

目的 探讨持续连贯性护理健康教育对慢性宫颈炎患者疾病认知、遵医行为及满意度的影响。 方法 选取山西省人民医院2017年9月至2018年9月治疗的慢性宫颈炎患者70例为观察对象，采用随机数字表法分为对照组(35例)和观察组(35例)。对照组患者采用常规护理，观察组患者在常规护理的基础上进行持续连贯性护理健康教育。比较两组患者疾病认知情况、治疗依从性及护理满意度。 结果 观察组患者疾病认知评分[(87.68±16.65)分]、治疗完全依从率(62.86%)均明显高于对照组[(65.45±13.05)分、34.29%，]，差异均有统计学意义(t＝6.217、χ2＝5.719，均P<0.05)。观察组患者护理非常满意率和总满意率(62.86%、97.14%)均明显高于对照组(34.29%、80.00%)，差异均有统计学意义(χ2＝5.719、5.081，均P<0.05)。 结论 慢性宫颈炎患者实施持续连贯性护理健康教育能够有效提高患者对疾病的认知度，促进患者治疗依从性提高，同时也能提高患者护理满意度，从而促进患者恢复和提高患者生活质量。

Objective To observe the therapeutic effect of recombinant human interferon combined with microwave for chronic cervicitis complicated with high-risk human papillomavirus (HPV) infection. Methods 86 cases of chronic cervicitis complicated with high-risk HPV infection treated in our hospital from July, 2015 to June, 2018 were divided into a control group and an observation group by random number table, 43 cases for each group. The control group received microwave treatment, while the observation group recombinant human interferon and microwave treatment. The clinical efficacy, negative conversion rate of HPV infection, recurrence rate, and adverse reactions of the two groups were observed. Results The total effective rate and negative rate of HPV infection were higher and the recurrence rate of HPV infection was lower in the observation group than in the control group (95.35% vs. 79.07%, 65.12% vs. 41.86%, 4.65% vs. 18.60%) (all P 0.05). Conclusion The combination of recombinant human interferon and microwave is safe and feasible for patients with chronic cervicitis complicated with high-risk HPV infection. The healing effect of cervical erosion is good, which is conducive to improving the negative conversion rate of HPV infection and reducing the recurrence rate of HPV infection. Key words: Chronic cervicitis; High-risk HPV infection; Recombinant human interferon; Microwave; Negative HPV infection

Chlamydia trachomatis (Ct) is the causative agent of bacterial sexually transmitted diseases (STDs) worldwide. The incidence of Ct infection has exceeded that of Neisseria gonorrhoeae, and becomes the highest in STDs in many countries. Ct infection can lead to urethritis, epididymitis, prostatitis and infertility in males, and cervicitis, endometritis, pelvic inflammatory disease, infertility in females, and neonatal conjunctivitis. Additionally, urogenital Ct infection is always ignored due to its concealed symptoms, leading to a long clinical course, recurrence or repeated infections. Furthermore, Ct infection can increase the risk of human immunodeficiency virus and human papilloma virus infections. Therefore, how to prevent and control the transmission of Ct has become one of the global public health issues. Currently, a growing body of researches have focused on the molecular epidemiological characteristics of Ct, which are aiming to identify the mutant strains, elaborate transmission dynamics, investigate the distribution of Ct serotypes in different populations, so as to provide molecular epidemiological evidence for the prevention and control of Ct infection. This review summarizes the epidemic status and research methods for molecular epidemiological characteristics of Ct, as well as application of Ct serotyping in clinical practice, providing references for the prevention, control and research of Ct infection. Key words: Chlamydia trachomatis; Chlamydia infections; Molecular epidemiology; Genotyping techniques; Multilocus sequence typing

Objective To investigate the application value of typing detection of human papillomavirus (HPV) and cervical vaccine in the prevention and treatment of cervical cancer. Methods A total of 1 450 women aged 35-60 years old in Huizhou area from January 2017 to December 2017 were selected as research subjects. According to the histological examination, enrolled patients were divided into healthy group, chronic cervicitis group, cervical intraepithelial neoplasm (CIN) Ⅰ group, CIN Ⅱ group and CIN Ⅲ group. All patients underwent HPV typing test. HPV infection condition in different age groups and HPV infection condition in patients with different grades of cervical lesion were analyzed. Results A total of 352 patients were found with HPV infection, and the detection rate of HPV was 24.3%. The increase in age was positively correlated with HPV infection rate. The infection rate of HPV would increase with ages, and there was a significant difference in HPV infection rate among different age groups (P<0.05). The HPV infection rate would increase with increase in degree of cervical lesion, which indicated importance of regular cervical cancer screening for sexually active women. There were significant differences in HPV infection rate between cervical lesions of different grades (P<0.05). Conclusions The combined application of HPV typing test and cervical vaccine is conducive to the fluent progress of screening cervical cancer, and it can provide important reference basis for the prevention and treatment of cervical cancer. Key words: Human papilloma virus; Cervical vaccine; Cervical cancer; Prevention and control; Effect