Cervicitis Research Articles

Effect of Vaginal Cream with the Combination of Honey, Olive, and Propolis on the Symptoms of Uterine Cervicitis Symptoms in Women: A Double-Blind Randomized Controlled Clinical Trial Study

Background: 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. Materials and Methods: 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. Results: 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). Conclusions: According to the result of RD, Nika vaginal cream had a significant effect on the improvement of cervicitis symptoms.

Seroprevalence of Chlamydia Trachomatis infection in Kashmiri women of reproductive age with mucopurulent cervicitis, infertility and ectopic pregnancy - a hospital based study

Seroprevalence of Chlamydia Trachomatis infection in Kashmiri women of reproductive age with mucopurulent cervicitis, infertility and ectopic pregnancy - a hospital based study

Chlamydia Infection Remodels Host Cell Mitochondria to Alter Energy Metabolism and Subvert Apoptosis.

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.

Clinicoetiological study on vaginal discharge among sexually active women attending a tertiary center in North Kerala, India.

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.

Diagnostic value of the QuickStripe™ chlamydia rapid test among high-risk women in Jakarta.

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.

Characterization of allergic inflammation in chronic uterine cervicitis.

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

The pathogenesis of Ebola virus disease (EVD) is still incomplete, in spite of the availability of a nonhuman primate modelfor more than 4 decades. To further investigate EVD pathogenesis, a natural history study was conducted using 27 Chinese-origin rhesus macaques. Of these, 24 macaques were exposed intramuscularly to Kikwit Ebola virus and euthanized at predetermined time points or when end-stage clinical disease criteria were met, and 3 sham-exposed macaques were euthanized on study day 0. This study showed for the first time that Ebola virus causes uterine cervicitis, vaginitis, posthitis, and medullary adrenalitis. Not only was Ebola virus detected in the interstitial stromal cells of the genital tract, but it was also present in the epididymal and seminal vesicular tubular epithelial cells, ectocervical and vaginal squamous epithelial cells, and seminal fluid. Furthermore, as early as day 3 after exposure, Ebola virus replicative intermediate RNA was detected in Kupffer cells and hepatocytes. These findings in the nonhuman model provide additional insight into potential sexual transmission, possible disruption of sympathetic hormone production, and early virus replication sites in human EVD patients.

The clinical indications for testing women for Mycoplasma genitalium

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

Background: Genital Chlamydia trachomatis infection can cause pelvic inflammatory disease and infertility in female by damaging cervical columnar epithelial cells. Recent reports have shown increased cases of newly reported chlamydial infection worldwide. However, at present, there is no effective vaccine available for the prevention of genital chlamydial infection. Insights into the host response of the human cervical epithelial cells against C. trachomatis infection are crucial to design a better prevention and vaccination strategy. Methods and materials: Here, we examined the prevalence of the C. trachomatis infection and the association with women's health in Malaysia. To investigate the influence of the C. trachomatis infection on human epithelial cells, we applied isobaric tags for relative and absolute quantitation (iTRAQ) labeling technique and liquid chromatography-tandem mass spectrometry (LC-MS3) analysis for elucidation of host proteome changes in the C. trachomatis-infected HeLa-229 human cervical epithelial cells. In addition, cytokine response following stimulation with multiple C. trachomatis antigens (CPAF, HSP60 and MOMP) were also examined. Results: Here, we reported that the prevalence of genital chlamydial infection among the ostetrics and gynecology patients was alarmingly high at 51.1% (92/180). Our data also showed that genital C. trachomatis infection was associated with infertility issues, inflammation in the reproductive tract (mucopurulent cervicitis or endometriosis), irregular menstrual cycles and polycystic ovarian syndrome (PCOS). Our proteomic work discovered a significant array of host proteins which participated in the early C. trachomatis infection. We highlighted involvement of eukaryotic initiation factor 2 (eIF2), mammalian target of rapamycin (mTOR), ubiquitination, clathrin-mediated endocytosis, tRNA charging and glycolysis signaling pathways in the host cells to eradicate the bacteria invasion. The bacteria infection was also associates with other complications such as increased inflammation and pro-inflammatory cytokines (TNF-α, IL-1β and IL-6) were robustly secreted following antigenic exposure. Conclusion: Our study describes a high prevalence of C. trachomatis among Malaysian O&G patients and highlights distinct ability of C. trachomatis in manipulating host proteins and triggering pro-inflammatory response.

Chlamydial infections in women

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.

An Evaluation of Abdominal Manifestations by Ultrasonography in Immunodeficiency Patients

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.

Vaginitis and Sexually Transmitted Diseases

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

Effect of continuous and consistent nursing health education program on disease cognition, compliance behavior and satisfaction of patients with chronic cervicitis

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。

Molecular epidemiological characteristics of genital Chlamydia trachomatis

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

Rationale for a Neisseria gonorrhoeae Susceptible-only Interpretive Breakpoint for Azithromycin.

Azithromycin (AZI) is recommended with ceftriaxone (CRO) for treatment of uncomplicated gonococcal urethritis and cervicitis in the United States, and an AZI-susceptibility breakpoint is needed. Neither the Food and Drug Administration (FDA) nor the Clinical and Laboratory Standards Institute (CLSI) has set interpretive breakpoints for AZI susceptibility. As a result, AZI antimicrobial susceptibility testing (AST) cannot be interpreted using recognized standards. This has contributed to increasingly unavailable clinical laboratory AST, although gonorrhea is on the rise with >550 000 US gonorrhea cases reported to the Centers for Disease Control and Prevention in 2017, the highest number of cases since 1991. This article summarizes the rationale data reviewed by the CLSI in June 2018. The CLSI decided to set a susceptible-only interpretive breakpoint at the minimum inhibitory concentration of ≤1 µg/mL. This is also the epidemiological cutoff value (ECV) (ie, the end of the wild-type susceptibility distribution). This breakpoint presumes that AZI (1-g single dose) is used in an approved regimen that includes an additional antimicrobial agent (ie, CRO 250 mg, intramuscular single dose). Having a breakpoint can improve patient care and surveillance and allow future development and FDA regulatory approval of modernized AST to guide treatment. The breakpoint coincides with a European Committee on AST decision to remove previously established, differing AZI breakpoints and use the ECV as guidance for testing. The CLSI breakpoint is now the recognized standard that defines AZI susceptibility for gonococcal infections.

Nongonococcal cervicitis: The most common cause of fluor albus in female sex workers

Female sex workers have a high risk of suffering from sexual transmitted infections (STIs). If the female sex workers suffer from STIs, besides affecting themselves, they also have potential to transmit the disease to their clients. Fluor albus is one of the symptoms of STIs. The purpose of this research is to evaluate the type of STIs that the female sex workers suffer from. This research was conducted retrospectively on 100 female sex workers in Puskesmas Putat Surabaya in 2013-2014. The result of this research showed that from 100 female sex workers, 14 subjects (14%) suffered from gonococcal cervicitis, 51 subjects (51%) suffered from nongonococcal cervicitis, 10 subjects (10%) suffered from nongonococcal cervicitis accompanied by bacterial vaginosis, 9 subjects (9%) suffered from bacterial vaginosis, 1 subject (1%) suffered from trichomoniasis, and 14 subjects (14%) had no data. This research concluded that nongonococcal cervicitis is the most major cause of STIs suffered by female sex workers. Therefore, the vigilances to prevent transmission of nongonococcal infection to the clients is highly needed.

Current status of Neisseria gonorrhoeae cervicitis in pregnant women in Japan.

We evaluated the current prevalence of gonococcal cervicitis among pregnant women in institutes that either do or do not routinely screen for gonococcal infection in Japan. We requested 2,330 obstetrical facilities to provide information on Neisseria gonorrhoeae cervicitis in pregnant women. A total of 1,876 (80.5%) of them responded. The universal screening test for gonococcal cervicitis, involving nucleic acid amplification for all pregnant women, was performed in 281 institutes (13.9% of institutes across Japan). The total rate of pregnant women with gonococcal cervicitis was 1.3% in the institutes performing the screening test during pregnancy, while it was only 0.2% (p < 0.01) in those not performing it. This suggests that 84% of infected women may have been missed in the institutes that do not routinely perform the screening test for gonococcal cervicitis. It may be time to examine the cost-effectiveness of providing gonococcal screening for all pregnant women in Japan.

Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non-pregnant women.

Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non-pregnant women.

Low intensity laser effects on factors of congenital immunity and cytokine balance in secretions of female reproductive system affected with chlamydia infection

Therefore, we defined the objective of our research: to study the factors of uterine cervix tissue im- munity for women with Chlamydia infection and to estimate the effect of low-intensity laser therapy (LILT) on these factors due to a wavelength of 632 nm and a power of 30 mW. Materials and methods. Clinical immunologic studies of cervical secretion were carried out on 184 women of reproductive age 25,9 ± 4,22 in 2016–2018. Chlamydia infection Chlamydia trachomatis was found by the methods of real-time polymerase chain reaction (Rt-PCR) tests. Code by Classifier of the International Standard Classification of Diseases and Related Health Problems 10th Revision is А 56.0, Chlamydial infections of the lower sections of the urogenital tract. Urethra and canalis cervicis uteri scrapings were used as the material for detecting C. trachomatis. All patients with chlamydial infection of the lower part of the urogenital system were divided into two groups: a group of 100 women who were treated by using the local influence of the low-intensity laser of 632 nm as a part of complex treatment, the comparison group (basic treatment) consisted of 84 women who took azithromycin of 1 g once a day for the 1st, 5th, 10th days of treatment. 50 healthy women without any pathology and infections of the genitourinary system made the control group. A system of cytokines was studied by interleukin's level IL-8. IL-1 α, IL-1 β, TNF-α and IFN-γ content in cervical mucus. Results Course. The results of the study showed a high clinical and immunological efficacy of treating chlamydial cervicitis using a low intensity laser with a wavelength of 632 nm. An imbalance of cellular factors of innate immunity revealed before starting a therapy: a decrease in the oxygen-dependent metabolism of neutrophilic granulocytes of the cervical secretion.

The Effectiveness of Single-Dose Azithromycin Versus its Combination With Moxifloxacin Based on the Treatment of Chlamydial Cervicitis: A Study Protocol for a Randomized Clinical Trial

Objectives: Chlamydia trachomatis is globally reported as a pathogenic infection and is the most common bacterial cause of sexually transmitted infection (STI) in most countries. In addition, chlamydial cervicitis and the adverse complications of the first line treatment, namely, azithromycin failure are highly prevalent. Thus, the present study will be conducted to determine and compare the effects of single-dose azithromycin and its combination with moxifloxacin based on syndromic and etiologic methods in the diagnosis and treatment of chlamydial cervicitis. Materials and Methods: This is a study protocol for a randomized clinical trial which will be performed at the Women’s Clinics and Health Centers in Amol, Iran during 2018. Further, the study will evaluate women with cervicitis complaints, who have a proven case of chlamydial cervicitis through syndromic or etiologic diagnostic methods and meet the inclusion criteria for the study population. Discussion: To the best of our knowledge, this trial will be the first study to explore the effects of single-dose azithromycin in combination with moxifloxacin in the treatment of chlamydial cervicitis. The results of this trial will further reveal the diagnostic value of syndromic and etiologic methods in the diagnosis of chlamydial cervicitis.