Chronic Urogenital Infections Research Articles

A Tale of Mummified Eggs in Urine of a US Veteran

Abstract Schistosomiasis is a neglected tropical disease that remains a major threat to global health. Schistosoma is known to cause chronic urogenital infections with an increased risk of bladder carcinomas. We present a case of chronic latent Schistosoma haematobium infection in a US veteran identified several years after his active military duty in Iraq and Kuwait. This case highlights the need for proactive screening of returning veterans from endemic areas. It also leads us to wonder how many infected veterans remain undiagnosed, and how many of those who develop urothelial carcinomas had prior exposure to schistosomiasis during their service.

Epigenetic changes induced by pathogenic Chlamydia spp.

Chlamydia trachomatis, C. pneumoniae, and C. psittaci, the three Chlamydia species known to cause human disease, have been collectively linked to several pathologies, including conjunctivitis, trachoma, respiratory disease, acute and chronic urogenital infections and their complications, and psittacosis. In vitro, animal, and human studies also established additional correlations, such as between C. pneumoniae and atherosclerosis and between C. trachomatis and ovarian cancer. As part of their survival and pathogenesis strategies as obligate intracellular bacteria, Chlamydia spp. modulate all three major types of epigenetic changes, which include deoxyribonucleic acid (DNA) methylation, histone post-translational modifications, and microRNA-mediated gene silencing. Some of these epigenetic changes may be implicated in key aspects of pathogenesis, such as the ability of the Chlamydia spp. to induce epithelial-to-mesenchymal transition, interfere with DNA damage repair, suppress cholesterol efflux from infected macrophages, act as a co-factor in human papillomavirus (HPV)-mediated cervical cancer, prevent apoptosis, and preserve the integrity of mitochondrial networks in infected host cells. A better understanding of the individual and collective contribution of epigenetic changes to pathogenesis will enhance our knowledge about the biology of Chlamydia spp. and facilitate the development of novel therapies and biomarkers. Pathogenic Chlamydia spp. contribute to epigenetically-mediated gene expression changes in host cells by multiple mechanisms.

Tactic of treatment of infertility on a background a chronic urogenital infection for multiparous women

Do the results of the conducted researches testify that the changes of system immunity for multiparous patients with a chronic urogenital infection carry reliable not character, but violation of local immunity characterized by the reliable increase (р<0,05) of maintenance of IgМ and β-lysine at the simultaneous decline (р<0,05) of level of IgА; basic parameters of phagocytosis and lysozyme. A chronic urogenital infection accompanies to development of violations of menstrual function in 32,0% cases and reliable dishormonal changes: in a 1 phase of menstrual cycle is a decline of maintenance of estradiol and follicle-stimulating hormone at the simultaneous increase of level of luteinizing hormone, aldosterone, cortisol and thyrotropic hormone; in II phase of menstrual cycle is a decline of maintenance of progesterone and increase of level of luteinizing hormone, cortisol and thyrotropic hormone. The use of the offered treatment-and-prophylactic measures with subsequent pregravid preparation is instrumental in the increase of frequency of offensive of pregnancy in 2,1 time and to the decline of level of obstetric and perinatal complications: premature births – in 2,1 time; to placenta disfunction – in 1,5 time; anomalies of childbirth – in 2,1 time; fetal distress – in 1,6 time; middling-heavy forms of asphyxia new-born – in 1,7 time and perinatal losses – in 2,1 time. Decline of frequency of obstetric and perinatal complications for multiparous women with a chronic urogenital infection in anamnesis it is needed to begin with the stage renewals of genesial function with the next passing to pregravid preparation. Taking into account circumstance that the women of this group have a high risk of the intra-amniotic infecting, predefined by the whole complex of negative influence from the carried urogenital infection basis of next obstetric and perinatal complications. The got results appeared a convincing enough ground for developed by us treatment-and-prophylactic method. A substantial increase of frequency of renewal of genesial function on a background the decline of frequency of obstetric and perinatal complications is foundation for wide introduction of the offered method in a practical health protection

Etiopatogenetic feature of recurrent underlying cervical disease

For patients with the recurrent underlying cervical disease a disbalance is marked from the side of cellular and humoral immunity, and also decompensated change of the functional state of phagocutosis and cytokine status. To our opinion it contingently negative influence of chronic urogenital infection, by the confirmed high-frequency of semination of sexual ways pathogenic and de bene esse pathogenic a microflora. The got results are a ground for the leadthrough of specific preparation with the obligatory use of immunocorrection and sanitation of sexual ways.

Threatened abortion in women with retrohorial hematomas in the first trimester

The objective: to study the features of the clinical course of the first trimester of pregnancy, complicated by the threat of abortion with the formation of retrochorial hematoma (RCH). Materials and methods. 100 pregnant women aged 18–44 years (average age 28.08±3.5 years) in 6–13 weeks of gestation were examined. The main group consisted of 70 patients and was divided into two subgroups: subgroup A (n=40) – 40 primigravida women with the threat of abortion and RCH; subgroup B (n=30) – 30 multigravida women with the threat of abortion and RCH and a complicated obstetric and gynecological history. Control group (n=30) – primi- and multigravida women with physiological course of the current and previous pregnancies. All women had a complete clinical and laboratory examination, ultrasound examination of the uterus and fetus with Doppler, determination of the infectious profile (bacterioscopy).Results. The majority of the patients in all groups had a complicated somatic history, while in half of the cases there was a combination of two or more somatic diseases – in 45.7% of pregnant women in the main group and 33.3% – control group. 32.9% of women in the main group had a genetically determined form of thrombophilia. A complicated obstetrical and gynecological history was established in 22.5% of patients in subgroup A, 30% – subgroup B and 16.6% of pregnant women in the control group. Mostly, inflammatory diseases of the pelvic organs were detected in the main group – 15–21.4% (in both subgroups) and previous surgery on the pelvic organs (11.4% in total). A high incidence of spontaneous miscarriages was found in patients of subgroup B (13–43.3%). Every fourth pregnant woman in the main group had a 3–4 degree of purity of vaginal smears. For the first time, the hematoma was diagnosed before 6 weeks of gestation in 8% of pregnant women of subgroup A (2.5% of these patients had a spontaneous abortion at 9–10 weeks) and in 30% of women in subgroup B (23.3% of them had an interruption of pregnancy at 7–12 weeks). The corporal location of RCH was found in 28.6% of patients in the main group (15.7% and 12.9% in subgroups, respectively), supracervical – 71.4% (almost the same in both subgroups), while hematomas of more than 25 cm3 were detected in 8 patients of the main group (25% and 75% in subgroups, respectively), all of such RCH were located corporally. In 70% of supracervical RCH, a small and medium volume of hematoma was diagnosed, which was in 1.5 times more often detected in pregnant women of subgroup A. Hematomas of a larger size were found in 3 times more often in women of subgroup B. The main clinical symptoms of threatened abortion with the formation of RCH were bleeding from the genital tract (53–75.7%), pain syndrome (48–68.5%), uterine hypertonus or a combination of these symptoms (39–55.7%).Conclusions. The presence of chronic extragenital pathology, chronic urogenital infection, surgical interventions on the pelvic organs, a high frequency of artificial and spontaneous abortions, recurrent miscarriage, a history of missed pregnancy in combination with a large volume of RCH, the corporal location of PCH, the term of gestation in which a hematoma is found, as well as ultrasound signs of uterine hypertonus are unfavorable predictors of early miscarriage and reproductive losses.

Capabilities of combined peptide drugs in the correction of male infertility (literature review)

Acute and chronic urogenital infections are associated with male infertility. Besides "traditional" sexually transmitted infections, there is a significant increase in inflammatory diseases of reproductive system caused by opportunistic pathogens. Studies show that sperm fertility is influenced by direct exposure to sexually transmitted infections, as well as dysfunction of the blood-testicular barrier, leading to autoimmune infertility. In a number of clinical trials, Prostatilen AC was shown to have benefitial effects on the ejaculate.

The Menstrual Disorders in Women of Reproductive Age with Obesity

Introduction. In this article, the authors present the results of studies on reproductive health features in 25 women with obesity seeking medical help for infertility. Objective: to study the nature of menstrual disorders in women of childbearing age with obesity. Materials and methods. We have studied the features of reproductive health in 25 obese women seeking medical assistance for infertility in the Republican specialized scientific and practical centre of endocrinology in 2014–2015, who were included in the first study group. The second group consisted of 25 women with normal weight-for-stature values and without menstrual disorders. All the patients underwent the following tests, including complete blood count, blood biochemistry, radioimmunoassays of the blood hormones (prolactin, luteinizing hormone (LH), follicle stimulating hormone (FSH), insulin, estradiol, progesterone, free testosterone, thyroxine, anti-Műllerian hormone, dehydroepiandrostenedione, ultrasound of the uterus and ovaries with folliculometry on 11–14th days of the menstrual cycle. All patients underwent magnetic resonance imaging of the pituitary gland. Results. In the history of the patients in both groups, diseases of the upper respiratory tract and gastrointestinal diseases were most common among somatic pathology. Among gynecological diseases, in both groups the most frequent disorders were chronic urogenital infection, candida vaginitis and bacterial vaginosis. Emphasis is placed on the data about the presence of hormone-dependent proliferative diseases in women with overweight: cervical pseudoerosions, endocervicosis, uterine fibroids, a history of endometriosis. The analysis of biochemical parameters in the first study group found increased triglycerids levels < 1.7 mmol/L in 15 %, a decrease in high-density lipoprotein cholesterol < 1.2 mmol/l — in 12 % of women, increased levels of low-density lipoprotein cholesterol > 3.0 mmol/L — in 34 %. The first group of patients had low values of the average parameters of LH, FSH, free and total testosterone (normogonadotropic hypogonadism) against normoprolactinemia. The levels of adrenocorticotropic hormone, thyroid-stimulating hormone, free thyroxine, and cortisol were within normal limits. Folliculometry results showed a high incidence of follicular persistence, anovulatory disorders and follicular atresia. Conclusions. In young women with the metabolic syndrome, secondary amenorrhea prevails in the structure of menstrual dysfunction — 8 (32.0 %) cases. Hyperandrogenic anovulation following hyperinsulinemia underlies the menstrual dysfunction.

Clinical features and etiology of postpartum endometritis in women with a high risk of purulent-septic complications

Hypothesis/Aims of study. Postpartum purulent-septic complications continue to rank third in the structure of maternal mortality. In the etiology of postpartum endometritis, the key role is played by opportunistic microflora, including associations of microorganisms, as well as a history of chronic urogenital infection, bacterial vaginosis, and sexually transmitted infections. Despite numerous studies, the question of which microorganisms colonizing the birth canal are potentially dangerous in relation to the development of infectious and inflammatory pathology of the postpartum period is still a subject of discussion. The aim of this research was to study the etiology and identify the clinical features of postpartum endometritis in puerperas with risk factors for the development of purulent-septic complications.
 Study design, materials and methods. This retrospective comparative study included 199 puerperas, who were divided into two groups: the main group consisted of women who developed postpartum endometritis (n = 72), and the comparison group comprised women with the physiological course of the postpartum period (n = 127). Bacteriological examination of lochia was performed on the third day of the postpartum period, as well as with the development of postpartum endometritis before empirical antibiotic therapy was started.
 Results. During the bacteriological study of lochia in the main group of patients, potentially pathogenic microorganisms were observed in 68 % of puerperas, with the pathogen of endometritis not detected with repeated crops of lochia in 32 % of postpartum women. In the comparison group, this proportion was only 15 % (p 0.005). During pregnancy, the release of microorganisms from the cervical canal was observed in 26.4 % of cases in the main group and in 7 % of cases in the comparison group of puerperas (p 0.005). Despite the absence of clinical symptoms, all patients received systemic antibacterial therapy. Subsequently, 90 % of maternity patients in the main group revealed the ineffectiveness of empirical therapy due to antibiotic resistance of the identified microflora. When analyzing the species composition of microorganisms, intestinal microflora in monoculture was more often isolated in the patients of the main group: Escherichia coli (40 % vs. 2.4 % in the comparison group) and Enterococcus faecalis (25 % vs. 4.7 % in the comparison group). In 10 % of postpartum women with severe purulent-septic complications (sepsis, parametritis, pelvioperitonitis), the composition of the released microflora in lochiae did not differ from that of maternity women with endometritis without severe purulent-septic complications, and microbial associations were only detected in two cases.
 Conclusion. The etiological cause of postpartum endometritis in puerperas with risk factors for the development of purulent-septic complications is intestinal bacteria (Escherichia coli, Enterococcus faecalis) more often detected as a monoculture. The species composition of microorganisms that cause severe forms of postpartum purulent-septic complications does not differ in principle from the pathogens of uncomplicated forms of postpartum infection. Unreasonable antibacterial therapy during pregnancy is associated with antibiotic resistance of microorganisms that cause postpartum endometritis, which poses significant difficulties in the selection of antibacterial drugs for its treatment.

СТРУКТУРА ИММУННЫХ ДИСФУНКЦИЙ У БОЛЬНЫХ С ХРОНИЧЕСКИМИ УРОГЕНИТАЛЬНЫМИ ИНФЕКЦИЯМИ

In recent years, the growth of urogenital infections, often transforming into chronic forms, is one of the most common causes of reproductive damage in women. The aim of the research was to study the structure of immune dysfunctions in patients with chronic urogenital infection. A one-stage observational study of 80 women of reproductive age with chronic urogenital infections was carried out. The control group consisted of 40 healthy women-donors. The main outcome of the study was the severity of the immunocomprometry of the female. The contents of different subpopulations of lymphocytes (CD3+, CD4+ and CD8+ T-lymphocytes, CD20+ B-), phagocytic activity of granulocytes and monocytes were determined, the migration index, the migration inhibition index, and the exponential function were calculated. The complex of immune dysfunctions established in such patients included a decrease in the number of T-cells and, primarily, CD4+ lymphocytes and their low mitogenic reactivity, an increase in the proportion of natural killer cells, a decrease in the number of actively phagocytic neutrophils and monocytes, the last hydrogen peroxide, an increase in the production of IgA and IgG. Typical were combinations of these violations. Conclusions: T-lymphocyte-monocyte immune deficitiency with the activation of the humoral link and the defectiveness of phagocytosis is a distinctive characteristic of chronic urogenital infection.

Study of products of IL-12 and IL-18 in sperm and blood of men, suffering on oligosymptomatic forms of a chronic urogenital infection

In order to increase the success of treating by family doctor male with infertility, developing the right tactics and optimal treatment regimens, verification of various factors of male infertility is required. From the accuracy of determining the causes of male infertility depends the further study of the pathogenesis of reproduction impairment, which will contribute to the development of effective therapies. More and more facts are being accumulated that point to the important role of immune processes in the pathogenesis of infertility, which provides the basis for studying the levels of cytokines in patients with chronic urogenital inflammatory processes. The objective : study the production of IL-12 and IL-18 cytokines in seminal plasma in males with low asymptomatic forms of chronic urogenital infection depending on fertility. Materials and methods . The patients (n=72) were examined for small asymptomatic forms of chronic inflammation of the urogenital tract, aged from 22 to 40 years. All surveyed are divided into two groups: the first (35 people) – infertile men and the second (37 people) – fertile men. Duration of infertility in patients of the І th group was 3 6 years. Polymerase chain reaction (PCR) method was used to detect Chlamidia trachomatis, M. hominis, U. urealyticum, V. herpes in seminal plasma. At the beginning of the survey, it took more than a year after the completion of the previous treatment. Sperm studies were performed and sperm morphology was determined using staining for Papanicolaou. Levels of IL-12 and IL-18 cytokines were studied in serum and in the semen. Control parameters of cytokine concentrations were obtained during the study of 24 fertile men without clinical signs of a disease of a similar age composition. Results . Investigation of cytokine levels in patients, depending on fertility, found that in the I group (male infertility), the level of IL-12 in the semen tended to decrease, with its concentration in blood in patients in this group did not differ from the norm. As for the group of fertile men (group II), an immunological study indicates diverse shifts in concentrations of IL-12 and IL-18 in both serum and seminal plasma. An increase in the content of the studied cytokines is much more pronounced in the semen than in the serum. The spermometry of both groups of patients showed that hyperfertility and microsomal type of sperma was observed in infertility men, and in fertile men, although there was a normospermia, however, in that part of the patients of the II group, which showed a decrease in the concentrations of IL-12 and IL-18 in the semen we stated an increase in the pathological forms of sperm. The data obtained indicate, in our opinion, the participation of IL-12 and IL-18 in the course of inflammation (mainly increased concentrations) and participation in the process of maturation of sperm. Conclusion . Microenvironment is important during maturation of the germ cells. An important role in this is played by cytokines, in particular IL-12 and IL-18. The study of the concentration of IL-12 and IL-18 in semen is more appropriate than in serum when the inflammatory process is established in the urogenital tract. Reduced concentrations of IL-12 and IL-18 in semen indicate the development of infertility, as evidenced by the presence of pathospermia. Immunocorrection therapy in men with oligosymptomatic forms of chronic inflammation of the urogenital tract complicated by infertility should take into account the shift of the cytokine profile both in serum and in the semen.

Characteristics of TLR reactions to the urogenital infections pathogens in pregnancy

Simultaneous TLR gene expression estimation (the prognosis of abortion and miscarriage), mucosal microbiocenoses types, mucosal immunity state estimation, presence or absence of clinical manifestation of miscarriage, pregnancy course (unfavorable prognosis-immunological rejection of the fetus or complicated pregnancy course and miscarriage, favorable prognosis-immunological irritation or normal fetal development, abortion-miscarriage), presence or absence of infection and/or clinical manifestation of infectious and inflammatory conditions can be objective additional criteria for estimation and prognosis of pregnancy course as well as to personalize the adequate treatment and prevention of abortion and miscarriage. Pathogenetic (concomitant increased reaction of mucosal epithelial cells receptors for developing fetus and infectious process leads to abortion and miscarriage) and TLR diagnostic role in pregnancy is established. In obstetric infections in pregnant women levels of gene expression of TLR-2 – 21.2 and above, TLR-4 – 23.0 and above, TLR-8 – 25.7 and above indicate a high degree of infection with clinical manifestations of urogenital infections, and in the levels of genes expression of TLR-8 - 26 and below verifies chronic urogenital infections, while levels of gene expression TLR-8 above 26 verifies acute course of urogenital infections TLR-8 level above 28 is a predictor of pregnancy termination and miscarriage.

THE PLACENTA AS THE EPIDEMIC FACTOR OF VERTICAL HIV TRANSMISSION RISK IN CONDITIONS OF COMORBIDITY

A multifactorial in-depth study of 78 placentas obtained during delivery of HIV infected women in St. Petersburg between 2009 and 2011. We studied clinical anamnestic and laboratory parameters on the basis of the retrospective analysis, respectively, in 78 HIV-positive postpartum women (mean age 27,1±4,1 years) and their newborn children, of whom 12 have mother-to-child transmission of HIV. Most of the women who gave birth to infected children who were users of psychoactive drugs all took place co-infection with hepatitis C virus, about half of them were observed chronic urogenital infections. The complexity of communication, contacts instability did not allow any of the women who have realized the vertical transmission of HIV, antiretroviral therapy to conduct in full. In obstetrical establishment turned 11 women, but due to the onset of labor and/or premature rupture of membranes that are not allowed to use the elective caesarean section as a method of prevention of vertical transmission of HIV. All infants were signs posthypoxic encephalopathy. It was noted that in HIV infection in the placental tissue is imbalance between pro-angiogenic (VEGF, bFGF, CD31) and anti-angiogenic (TGF-β1, Tsp-1) factors in favor of the latter, which is the basis of a dissociated maturation chorionic villi and chronic placental insufficiency. With the implementation of intrauterine infection of HIV in placental tissue sharply reduced macrophage content, primarily CD68+ and, to a lesser extent, CD14+. Violation placental barrier greatly facilitates and determines the penetration of HIV to the fetus. In this case, targeted prevention, treatment for opportunistic infections and drug correction of placental insufficiency in HIV-infected women should, obviously, be regarded as justified pathogenetic approaches to reduce mother-to-child transmission of HIV.

Treatment of chronic urogenital infection in woman using the methods of extracorporeal blood correction

Aim. To study of the effectiveness of treatment of patients with chronic urogenital infection by antibiotic therapy and extracorporeal immunotherapy. Methods. Clinical, microbiological, immunological and statistical methods were used. The main group consisted of 70 women with chronic urogenital infection previously treated with conventional treatment. Women received the extracorporeal antibiotic therapy and immunotherapy using moxifloxacin and metronidazole in combination with local therapy - suppositories with chlorhexidine, metronidazole and miconazole. For antibiotic and extracorporeal immunotherapy selected leukocyte cell suspension was incubated with an antibiotic and was stimulated by leukinferon and then was returned to the patient. In a control group patients received conventional drug treatments, ornidazole administered in conjunction with local therapy. When mixed infection was diagnosed josamycin additionally was administered. The diagnosis was verified by means of the polymerase chain reaction, bacteriological and microscopic methods. Results. The main complaints of the patients were excreta from the genital tract, itching, burning. The results of treatment were evaluated at 2 weeks, 1 and 2 months. After 2 weeks, in the main group more rapid regression of clinical manifestations and the improvement of the general state were registered, in the control group the symptoms persisted in more than 50% of women. After one month there were no complaints in the main group, while in the control group, the symptoms persisted in 30% of patients. After 2 months, patients of the main group had no complaints, but 0.4% had leukocytosis in the smear and marked growth of Trichomonas. In the control group excreta was maintained in 6.7%, positive culture on Trichomonas registered in 3.3% of patients. Conclusion. Our research indicates the clinical efficacy of extracorporeal antibiotic therapy and immunotherapy in the treatment of chronic urogenital infections compared with traditional methods, it promotes more rapid bacterial eradication and relief of the inflammatory process.

Drug therapy options for oligoasthenoteratozoospermia syndrome

Medical treatment of oligoasthenoteratozoospermia (OAT) syndrome includes many different treatment concepts. The targeted causes in the treatment of OAT syndrome are either hormonal, as for example hypothalamic, pituary, or, seldom, hyperprolactinemic disturbances, or acute or chronic urogenital infections, as well as ejaculatory disorders. Often no pathogenic reason for OAT syndrome can be found and targeted. Most treatment concepts in the past tried to improve sperm quality. Administration of antiestrogens, antioxidants, hormones, and micronutrients has been tried and used to improve sperm quality. The present article provides an overview of current medical treatment options for OAT syndrome, including former unsuccessful treatment concepts. The article furthermore sketches out potential treatment options, which might be available in the future.

HIV-1 infection in gynecologyand obstetric

HIV infected women have an increased morbidity caused by acute and chronic urogenital infections and their sequels. Up to 2/3 of the patients develop symptoms of genital infections and in around 1/3 cervical neoplasia is diagnosed. In 1/4 chronic lower abdominal discomfort and late sequels of PID will arise. Although cervical carcinoma(– 5 %) fulfills already the AIDS definition, it manifests usually early in the course of the HIV disease and is rarely associated with other opportunistic diseases. Increased disturbances of menstruation like amenorrhoea (17 %) or hypermenorrhoea has been observed. Major complication of prenancy are preterm labor (– 15 %) and preterm delivery. An increased progression of the maternal HIV disease in association with pregnancy has not been observed. Risks of perinatal HIV-1 infection of the fetus are associated either with an already advanced or progressing HIV infection of the mother indicated by high viral load, p24 antigenemia and low CD4+ cells or obstetrical events like preterm delivery, preterm labor, amnionitis, duration of rupture of membranes and labor and contamination of amniotic fluid with maternal blood. Maternofetal HIV-1 transmission can be reduced by antiretroviral prophylaxis of the mother and the fetus (6–8 %), by elective caesarian (4–6 %) or most successfully by elective caesarian and antiretroviral prophylaxis (< 2 %).

Recurrent Haemospermia-Underlying Urogenital Anomalies and Efficacy of Imaging Procedures

Recurrent haemospermia is often regarded as "essential". Following routine diagnostic procedures, we found an associated factor in 54 of 72 patients (75%). With one exception (prostatic carcinoma), the benign character of the disease was confirmed. Urogenital infection was the most frequent concomitant finding (50%); in 26 men chronic prostatis was diagnosed. Other disorders such as hypertension and coagulation disorders played a minor role. Additional investigation of the prostate gland and seminal vesicles by transrectal prostatic ultrasonography revealed persistent asymmetry of the latter glands as the main finding in 20 men (28%). In every case seminal vesicle carcinoma was excluded; haemorrhage due to cystic distension, inflammatory lesions or ductal obstruction was associated in all cases with congenital abnormalities, chronic urogenital infection, coagulation disorders or hypertension.