Endocervical Cultures Research Articles

Transcriptional profiling of mucus production in rhesus macaque endocervical cells under hormonal regulation.

Endocervical mucus production is a key regulator of fertility throughout the menstrual cycle. With cycle-dependent variability in mucus quality and quantity, cervical mucus can either facilitate or block sperm ascension into the upper female reproductive tract. This study seeks to identify genes involved in the hormonal regulation of mucus production, modification, and regulation through profiling the transcriptome of endocervical cells from the non-human primate, the rhesus macaque (Macaca mulatta). We treated differentiated primary endocervical cultures with estradiol (E2) and progesterone (P4) to mimic peri-ovulatory and luteal-phase hormonal changes. Using RNA-sequencing, we identified differential expression of gene pathways and mucus producing and modifying genes in cells treated with E2 compared to hormone-free conditions and E2 compared to E2-primed cells treated with P4. We pursued differential gene expression analysis on RNA-sequenced cells. Sequence validation was done using qPCR. Our study identified 158 genes that show significant differential expression in E2-only conditions compared to hormone-free control, and 250 genes that show significant differential expression in P4-treated conditions compared to E2-only conditions. From this list, we found hormone-induced changes in transcriptional profiles for genes across several classes of mucus production, including ion channels and enzymes involved in post-translational mucin modification that have not previously been described as hormonally regulated. Our study is the first to use an in vitro culture system to create an epithelial-cell specific transcriptome of the endocervix. As a result, our study identifies new genes and pathways altered by sex-steroids in cervical mucus production.

PURULENT-INFLAMMATORY COMPLICATIONS AND POSTOPERATIVE HERNIAS AFTER CESAREAN SECTION

Any surgical intervention on the abdominal cavity, including caesarean section, is accompanied by several postoperative purulent-inflammatory complications, especially in patients with concomitant diseases. The most common purulent complications occur in the laparotomy area. They are suppuration of surgical wounds, necrotizing fasciitis, phlegmon and abdominal abscess. There are different opinions on the predictors of purulent complications. The most frequently mentioned are leukocyte count, C-reactive protein, procalcitonin, ferritin, and endocervical culture. Unfortunately, peritonitis and sepsis rates have not reduced recently. Still, these complications negatively affect treatment outcome. The paper discisses the effectiveness of drainage and lavage of the abdominal cavity during cesarean section. In this regard, preventive measures reducing the number and severity of purulent-inflammatory complications becomes relevant. First of all, this concerns intraoperative antibiotic prophylaxis, which should be carried out taking into account risk factors and the individual sensitivity of genital tract microorganisms to antimicrobial drugs. Obstetricians do not have a particular pattern to follow this technique. There is also ambiguous opinion on choosing an operative approach to reduce the number of postoperative ventral hernias. Both longitudinal and transverse laparotomies have certain advantages and disadvantages. Until now, the choice of postoperative ventral hernia repair, especially in the hypogastrium, is determined by many factors, which should be taken into account. These problems reveal the need for optimal measures aimed at reducing negative consequences of cesarean delivery. Articles from Cyberleninka, e-Library, disserCat, ResearchGate, JSTOR, PubMed, and Google Scholar were analyzed for the study.

Gonococcal Pelvic Inflammatory Disease with Sepsis Criteria: Review of 2 Cases

Background: Infection caused by Neisseria Gonorrhoeae increases the risk of pelvic inflammatory disease (PID). Gonococcal PID tends to be clinically more severe than non-gonococcal ones. The main is to present two cases of gonococcal PID, with rapid clinical and analytic progression, leading to severe sepsis, but without imaging manifestations. Clinical presentation: 1. 41-year-old patient with replacement of intrauterine releasing levonorgestrel device (IUD), presented abdominal pain and green vaginal discharge. Abdominal examination revealed signs of peritoneal irritation and blood test showed leukocytosis, increased C Reactive Protein and procalcitonin, as well as coagulation abnormalities. Imaging tests (vaginal ultrasound/tomography) revealed no structural pathology, without collections. Given the criteria of severe sepsis, broadspectrum intravenous (iv) antibiotic therapy was started and laparoscopy and IUD removal were performed. Cervical and IUD cultures were positive for Neisseria gonorrhoeae. 2. 20-year-old woman, with an IUD, consulted for abdominal pain, low-grade fever and green vaginal discharge. Abdominal examination suggested peritoneal sensitivity and laboratory tests leukocytosis, increased C Reactive Protein and procalcitonin with coagulation abnormalities. Imaging tests (vaginal ultrasound/tomography) showed no structural pathology, without collections. Despite analgesia and broad-spectrum iv antibiotics, the patient worsened, proceeding to remove the IUD. Given the criteria compatible with severe sepsis, laparoscopy was decided. Endocervical and IUD cultures revealed Neisseria gonorrhoeae. Conclusions: Facing the situation of an acute PID with severe and fast clinical worsening even without findings in imaging tests, we should consider gonococcal ethiology as a possible cause. Surgical approach shouldn’t be delayed in order to control the infection and rule out other possible diagnosis.

Mucus secretions from a conditionally reprogrammed primary endocervical cell culture

To determine if the secretions collected from a conditionally reprogrammed primary endocervical cell culture are suitable surrogates for mucus studies. Experimental. University research center. Female rhesus macaque (n = 2). None. Quantitative proteomic analysis using tandem mass tag mass spectrometry liquid chromatography/tandem mass spectrometry. We identified 3,047 proteins, common proteins present in both primary endocervical cell cultures and the mucus of rhesus macaques. We found a 71% overlap in the top 500 most prevalent proteins in the samples. Cell culture secretions contained many essential mucus proteins, including MUC5B, the primary mucin of the endocervix. Similarities in secreted proteins suggest that conditionally reprogrammed primary endocervical cells could be used to study mucus secretion invitro.

Clinical Significance of Oligohydramnios in Patients with Preterm Premature Rupture of Membranes

Background. Preterm premature rupture of membranes (PPROM) is one of the main causes of perinatal morbidity and mortality. Associated oligohydramnios may further exacerbate the condition leading to intra-amniotic inflammation and adverse obstetric and perinatal outcomes in preterm labor.Aim of the research. To determine an impact of oligohydramnios on patients with preterm premature rupture of membranes.Materials and methods. We performed a retrospective analysis of two groups of patients with PPROM: 56 patients with oligohydramnios were included in the main group, 111 patients without oligohydramnios were included in the control group. The gestational age varied from 24+0 weeks to 33+6 weeks. Amniotic fluid index, endocervical culture, leukogram and neutrophil-to-lymphocyte ratio (NLR), serum procalcitonin and C-reactive protein levels were assessed in all participants.Results. We witnessed a plethora of consequences in the group of women with PPROM and oligohydramnios: shorter latent phase, higher incidence of clinical chorioamnionitis, antenatal fetal distress, higher levels of C-reactive protein, leukocytes, neutrophils and NLR, lower level of lymphocytes, and increased growth of potentially pathogenic cervical flora. Moreover, the patients with oligohydramnios demonstrated a significantly higher rate of cesarean delivery. The combination of PPROM and oligohydramnios also take a toll on the condition of the newborns: they have lower 5-minute Apgar score and higher prevalence of respiratory distress syndrome, congenital pneumonia, and necrotizing enterocolitis. Furthermore, newborns from the main group are more likely to be admitted to the neonatal intensive care unit, compared with newborns from the control group.Conclusion. Oligohydramnios in PPROM is associated with a dramatic rise of numerous complications affecting both the women and the newborns.

Gonococcal pelviperitonitis: a diagnostic challenge

Neisseria gonorrhoeae is the second most common etiological agent of pelvic inflammatory disease and is currently un-derdiagnosed due to its asymptomatic presentation in 50% of cases. When the disease presents, it may appear in the form of acute abdomen and normal imaging tests, making it a major diagnostic challenge. We present four cases of acute gonococcal peritonitis. The main symptom was acute abdominal pain, and both the gy-necological examination and complementary tests showed normal results. The only notable finding from the laparoscopy was the existence of purulent ascitic fluid. The results of the anatomical and pathological tests were all normal. Endocer-vical and ascitic fluid culture showed infection with N. gonorrhoeae, and in one case, concomitant infection with Chlamydia trachomatis. The definitive treatment applied was intravenous antibiotic therapy. When a sexually active young woman is diagnosed with peritonitis that has no apparent cause, it is important to rule out sexually transmitted diseases.

Unintended Consequences: The Impact of Cervical Cancer Screening Guidelines on Rates of STI Screening in Primary Care.

In 2012, cervical cancer screening guidelines in Ontario shifted from recommending yearly Pap testing to recommending Pap tests every 3 years. We sought to investigate how these changes have impacted rates of sexually transmitted infection (STI) screening in young women. We conducted a retrospective cohort study of 600 patients aged 19-25 years who presented to 1 of 2 community family health teams from May 1, 2009 to April 30, 2012 (the annual Pap test group) or from Nov 1, 2012 to Oct 31, 2015 (the triennial Pap test group). The primary outcome was the number of visits at which STI screening was performed. Secondary outcomes were presence/absence of STI screening over a 3-year period and method of screening used. A significant decrease was observed in the number of visits at which STI screening was performed, with the annual group averaging 1.21 visits/patient compared with 0.82 visits/patient for the triennial group (P = 0.001). A decrease in the proportion of patients screened over 3 years was also observed (66.8% vs. 52.8%, P = 0.007). A significant decrease in the use of endocervical culture (1.06 vs. 0.57 tests/patient, P <0.001), and a non-significant increase in urine NAAT (0.09 vs. 0.17, P = 0.07) and serum STI screening (0.37 vs. 0.47, P = 0.16) was observed. The 2012 Ontario cervical cancer screening guidelines were associated with a decrease in STI screening among women aged 19-25 years in the primary care setting. This unintended effect of guideline changes highlights a need for STI screening practices that are independent of routine pelvic examinations.

Occurrence of Mycoplasma spp. and Ureaplasma spp. in genital specimens

Mycoplasma spp. and Ureaplasma spp. belong to humans’ genitourinary microbiota and sometimes are associated with infections of the genitourinary tract. The aim of this study was to evaluate the occurrence of Mycoplasma spp. and Ureaplasma spp. in genital specimens from patients of the 15th Regional de Saúde of Paraná State, Brazil, and to correlate the results with clinical and laboratory data. A retrospective cross-sectional study was conducted, based on the analysis of results of vaginal, endocervical, urine and urethral culture for mycoplasmas from patients attended in a reference laboratory, from January 2009 to December 2016. We evaluated 2,475 results of culture for mycoplasmas. A total of 50.8% patients were positive for mycoplasmas. Of these, 76.8% had positive culture exclusively for Ureaplasma spp. and 4.7% for Mycoplasma hominis. Both microorganisms were isolated in the microbiology culture of 18.5% of patients. Among the positive culture, 81.4% had significant concentrations. Bacterial vaginosis was the most common alteration observed in association with mycoplasmas. The high positivity of cultures for mycoplasmas, especially Ureaplasma spp. found in our study, highlight the presence of these microorganisms in many of the genital tract disorders that can be sexually transmitted and, consequently, should not be neglected.

Conditionally reprogrammed macaque endocervical cells retain steroid receptor expression and produce mucus.

Cervical mucus produced by the endocervix plays an essential role as a hormonally induced regulator of female fertility. Cervical mucus fluctuates in both physical characteristics and in sperm penetrability in response to estrogens and progestogens. However, the mechanisms by which steroid hormones change mucus remains poorly understood. Current in vitro models have limited capability to study these questions as primary endocervical cells possess limited expansion potential, and immortalized cells lose in vivo characteristics such as steroid sensitivity. Here we overcome these limitations by establishing an in vitro primary endocervical cell culture model using conditionally reprogrammed cells (CRCs). CRC culture utilizes a Rho-kinase inhibitor and a fibroblast feeder layer to expand proliferative potential of epithelial cell types that have normally short in vitro life spans. In our studies, we produce CRC cultures using primary endocervical cells from adult female rhesus macaques (Macaca mulatta). We demonstrate that primary endocervical cells from the nonhuman primate can be robustly expanded using a CRC method, while retaining steroid receptor expression. Moreover, when removed from CRC conditions and switched to differentiation conditions, these cells are able to differentiate and produce mucus including MUC5B, the most prevalent mucin of the endocervix. We conclude that this method provides a promising in vitro platform for conducting mechanistic studies of cervical mucus regulation as well as for screening new therapeutic targets for fertility regulation and diseases of the endocervix.

Immunological Methods for Treatment of Vulvovaginal Infections in the Preconception Period.

Traditional therapy and extensive use of medications and intravaginal autolymphocyte therapy show different results of the treatment of vulvovaginal infections. The purpose of the article was to explore safe and highly effective methods to treat vulvovaginal infections and diseases of the pelvic organs.The standard clinical and laboratory screening of 70 patients of reproductive age was carried out to diagnose the diseases of the reproductive tract. The screening included the description of quantitative and qualitative characteristics of vaginal discharge, examining the mucous covering of the vulva and vagina, microscopic examination of Gram-stained vaginal swabs, endocervical cultures, and diagnosis of sexually transmitted infections using polymerase chain reaction. Intravaginal autolymphocyte therapy was used together with traditionally-accepted treatment schemes (etiotropic antibacterial and antifungal therapy) in the treatment of the main group (40 patients). Traditional treatment methods depending on the etiology of the development of infection were used in the control group (30 patients). The IgM, IgA, and IgG levels were also observed because of the possibility of causing embryo rejection. This study shows that in case of relapsing vulvovaginitis and mixed infections accompanied by disorders of the immune system at different levels, the use of intravaginal autolymphocyte therapy in a comprehensive therapy can be assessed as advisable and pathogenetically substantiated.

Cervical bacterial colonization in women with preterm premature rupture of membrane and pregnancy outcomes: A cohort study

One of the most important etiologies in pretermpremature rupture of membranes (PPROM) is cervical bacterial colonization. This study evaluated cervical bacterial colonization in women with PPROM and the pregnancy outcomes. In this cohort study, 200 pregnant women with PPROM at 27-37 wk of gestation who were admitted in an academic hospital of Mashhad University of Medical Sciences from March 2015 to July 2016 were studied. samples were obtained from endocervical canal for detection of routine bacteria and Gram staining. Also, we obtained one blood culture from neonates. Maternal endocervical culture, chorioamnionitis, neonatal intensive care unit admission, neonatal positive blood culture, neonatal sepsis, and mortality were documented. Most common isolated microorganism of endocervical culture were Escherichia coli (24.2%), Coagulase negative Staphylococci (27.2%), Enterococcus and candida each one (11.7%). The prevalence of GBS was only 2.2%. Simultaneous positive blood cultures were seen in 3% of neonates. Among them, Gram-negative bacilli accounted for (66.6%), while Gram-positive cocci and candida made up only (16.7%). Endocervical colonization was associated with a higher admission rate (p=0.004), but there was no significant correlation between endocervical colonization and chorioamnionitis, positive blood culture and neonatal mortality rate. With regard to low GBS colonization rate, appropriate antibiotic regimens should be considered in PPROM cases according to the most prevalent micro organisms of endocervical bacterial colonization. Maybe cervical bacterial colonization had some effects on neonatal outcomes. There was no significant association between endocervical bacterial colonization and chorioamnionitis, positive neonatal blood culture and neonatal mortality.

Fitz-Hugh-Curtis syndrome associated with tuberculous salpingitis and peritonitis: a case presentation and review of literature

BackgroundFitz-Hugh-Curtis syndrome or acute perihepatitis is considered a rare complication of pelvic inflammatory disease, mostly associated with chlamydial or gonococcal salpingitis.Peritoneal tuberculosis is a rare site of extra-pulmonary infection caused by Mycobacterium tuberculosis. Infection usually occurs after reactivation of latent tuberculous foci in the peritoneum and more seldom after contiguous spread from tuberculous salpingitis.Case presentationWe describe a case of a 21-year old female of Somalian origin diagnosed with Fitz-Hugh Curtis syndrome associated with tuberculous salpingitis and peritonitis, presenting with new onset ascites.Acid fast stained smear and polymerase chain reaction for Mycobacterium tuberculosis on ascitic fluid, endocervical culture and tuberculin skin test were all negative. Eventually, the diagnosis was made laparoscopically, showing multiple peritoneal white nodules and perihepatic “violin string” fibrinous strands.ConclusionsTo our knowledge, this is the first case where Fitz-Hugh-Curtis syndrome is associated with both peritoneal and genital tuberculosis and where ascites was the primary clinical finding. Female genital tuberculosis has only rarely been associated with Fitz-Hugh-Curtis syndrome and all cases presented with chronic abdominal pain and/or infertility. Ascites and peritoneal involvement was not present in any case. Moreover, most patients with Fitz-Hugh-Curtis syndrome show no evidence of generalized intra-abdominal infection and only occasionally have concomitant ascites.

Primary Sjögren's Syndrome Adversely Affects the Female Sexual Function Assessed by the Female Sexual Function Index: A Case-Control Study.

This study aims to evaluate the sexual function of females with primary Sjögren's syndrome (pSS) in comparison to healthy females by using the Female Sexual Function Index (FSFI). This case-control study included 31 female patients (mean age 46.0±10.2 years; range 30 to 68 years) with pSS and 27 healthy females (mean age 44.2±8.5 years; range 30 to 55 years) as control group. The sexual function of the participants was assessed by 19-item FSFI. Mean duration of pSS in the patient group was 35.9 months (range 3 to 264 months). Significantly higher number of pSS patients reported positive history for vaginal infection compared to controls (n=26, 83.9% vs. n=7, 25.9%, respectively; p<0.001) without any difference in endocervical culture result. Cervical smear assessment revealed more inflammation and atrophy in patient group compared to control group (p=0.001). Mean FSFI total score was significantly lower in patient group than control group (18.9±9.9 vs. 25.1±5.1, respectively; p=0.004). Similarly, five out of six domains of FSFI -arousal, lubrication, orgasm, satisfaction, and pain- were significantly lower in patient group. FSFI total and subscale scores, except for pain, were found to be negatively correlated with duration of pSS. The pSS causes sexual dysfunction in female patients. Furthermore, as disease duration increases, female sexual function decreases. Clinical management of female patients with pSS should cover the assessment of their sexual functionality and taking the necessary precautions to maintain satisfactory quality of life and treatment outcome.

Endocervical Swab Microbial Isolates among Women with Third Degree Uterovaginal Prolapse

Background: Uterovaginal prolapse is the descent of the uterus through the vaginal canal. This may be a predisposing factor to infections in the urogenital system. This study aimed to assess the endocervical swab microscopy, culture and sensitivity in patients with third degree uterovaginal prolapse at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria. Methodology: This is a cross-sectional prospective study to assess the endocervical swab microbial findings in patients with third degree uterovaginal prolapse using simple random sampling technique. Data on sociodemographic variables, risk factors for pelvic organ prolapse, and endocervical swab findings among women with third degree uterovaginal prolapse were collated and analysed using statistical methods. Results: The mean age and parity were 50.5 years ± 9.1 and 6.7 ± 2.0 respectively. Thirty-six (85.7%) of the clients were grandmultipara and 37 (88.1%) were farmers. Pus cells were present in all samples while 27 (64.3%) had microbial isolates. Streptococcus pyogenes was isolated in 7 (16.7%), Streptococcus faecalis in 5 (11.9%), Escherichia coli in 5 (11.9), Staphylococcus aureus in 4 (9.5%), Klebsiella pneumoniae in 2 (4.8%) and Yeast cells in 4 (9.5%) of the endocervical swabs. All isolates were sensitive to gentamicin. Bacterial isolates were resistant to amoxicillin/clavulanic acid. Conclusion: This study showed growth of pathogenic organisms from the endocervix of women with third degree uterovaginal prolapse. A 100% sensitivity to gentamicin was observed in the study.

Novel three dimensional human endocervix cultures respond to 28-day hormone treatment.

The endocervix has both anatomical and biological functions that participate in the delicate balance between tolerance necessary for conception and protection from pathogens. Our goal was to develop a robust 3-dimensional (3D) endocervix model that was a reliable representation of the in vivo tissues and to identify the physiological responses to changing levels of steroid hormones during a 28-day time period. Human endocervical cells were grown on polystyrene scaffolds, and the morphologic and hormonal responses of cultured cells were assessed in response to fluctuating levels of estradiol (E2) or progesterone (P4). Morphologically, the 3D cultures were composed of a mixed population of cells, including epithelial and stromal cells. Treatment with E2 and P4 (d 28) increased cell growth and proliferation as compared with no treatment control. Cells expressed estrogen receptor and P4 receptor and produced both neutral and acidic mucins, including Mucin 16. In addition, a 45-plex Luminex assay identified numerous factors secreted and regulated by hormones. Specifically, IL-1β and leukemia inhibitory factor significantly decreased in the presence of E2 and P4 as compared with the no hormone control at day 26. Cotreatment with RU486 (mifepristone) attenuated the inhibition of IL-1β and leukemia inhibitory factor secretion. In summary, a robust, novel 3D endocervical culture was developed, and physiologic responses to the menstrual cycle mimic of E2 and P4 levels for a period of 28 days were identified.

Update on pelvic inflammatory disease

Pelvic inflammatory disease (PID) is the major cause of tubal infertility, the risk of which increases markedly after recurrences, which are common. It also increases the risk of ectopic pregnancy. Diagnosis is difficult and treatment may not prevent tubal damage and scarring so prevention or prompt treatment of sexually transmissible infection (STI) that often precedes it is a priority. The diagnosis of PID is usually based on a history of pelvic pain and evidence of cervical and adnexal tenderness but symptoms are often non-specific or absent. There is poor correlation between clinical and laparoscopic findings. In a recent study only 20% of women with pelvic pain (and only 55% of those considered, clinically, to have PID) had laparoscopic evidence of active salpingitis. Identifying the microbiological causes is also difficult; the predominant pathogens are Chlamydia trachomatis (by far the most common), Neisseria gonorrhoeae, Mycoplasma genitalium and/or mixed endogenous vaginal bacteria (the latter especially when PID is associated with genital trauma e.g., pregnancy termination or complications). Investigations of suspected PID should include urine nucleic acid tests for major STI pathogens and endocervical cultures for predominant facultative bacteria, including N. gonorrhoeae . However, cervical microbiology does not always reflect tubal flora and therapy is usually empirical.

Optimal Sampling Strategy for the Detection of C.Trachomatis (CT) and N.Gonorrhoeae (NG) in Adolescent Females Using Nucleic Acid Amplification Testing

Until recently, the gold standard for CT and GC detection was culture of an endocervical specimen obtained by speculum exam. Nucleic acid amplification tests (NAATs) provide greatly increased sensitivity of detection for CT and GC, but have not been studied rigorously in the adolescent population. The objective of this study was to identify the optimal and preferred sampling method for detecting CT and GC by comparing NAAT technology to endocervical culture in adolescent females receiving STI testing.

Conventional Agar-Based Culture Method, and Nucleic Acid Amplification Test (NAAT) of the cppB Gene for Detection of Neisseria gonorrhea in Pregnant Women Endocervical Swab Specimens

BackgroundNeisseria gonorrhea is the etiological agent of the sexually transmitted disease (STD) gonorrhea, and primarily infects the mucous membranes of the urethra, endocervix, pharynx or rectum of females which may result in substantial morbidity. N. gonorrhea also causes disseminated infection, with complications that may result in ectopic pregnancy, tubal infertility, chronic pelvic pain or maternal transmission of gonorrhea, and also increases susceptibility to HIV.ObjectivesIn the present investigation, we used conventional agar-based culture method, and nucleic acid amplification of CCPB gene for detection of Neisseria gonorrhea in endocervical swabs samples collected from pregnant women studiedPatients and MethodsEndocervical swabs specimens for this study were obtained from 1100 pregnant women who presented to Shiraz (Iran) Hospitals from 2009 to 2011. In the present investigation we used conventional agar-based culture method, and nucleic acid amplification test (NAAT) of CCPB gene for detection of Neisseria gonorrhea in endocervical swabs samples collected from pregnant women studied. From each pregnant woman two endocervical swabs were taken: one swab placed in tubes containing phosphate buffered saline for Polymerase Chain Reaction, and the other to inoculate on culture media.ResultsAmong 1100 endocervical swabs examined, 13 (1.18%) samples had positive results by polymerase chain reaction (PCR) on Neisseria gonorrhea CCPB gene. All endocervical swabs culture had negative results for Neisseria gonorrhea. 84 (7%) of the women had vaginal discharge, in whom PCR on endocervical swabs of these individuals had negative findings.ConclusionsNucleic acid amplification tests (NAATs) are very appropriate in detection of infected individuals. Detection techniques such as NAATs are independent of bacterial viability, and have a potential to limit false negative samples, therefore, in our country, the application of different laboratory diagnosis methods including NAATs with culture as gold standard for determination antimicrobial susceptibility is essential.

Assessment of self taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study

Objective To compare gonorrhoea detection by self taken vulvovaginal swabs (tested with nucleic acid amplification tests) with the culture of urethral and endocervical samples taken by clinicians.Design Prospective study of...

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