Endocervical Samples Research Articles

Molecular Exploration of Mycoplasma fermentans and Mycoplasma genitalium in Mexican Women with Cervicitis

Genital Mycoplasmas are implicated in adverse pregnancy outcomes and the development of infertility. However, the role of Mycoplasma fermentans in these outcomes has not been adequately studied; therefore, its participation in these sufferings requires further investigation. This study aimed to evaluate the prevalence of M. fermentans in pregnant and non-pregnant women. End-point PCR was used to analyze two hundred and twenty-eight endocervical samples for M. hominis, M. genitalium, M. fermentans, M. pirum, Ureaplasma urealyticum, and U. parvum diagnoses. The prevalence of Mycoplasma spp. was as follows: U. parvum was found in 83 samples (36.4%), U. urealyticum in 39 instances (17.1%), M. hominis in 36 (15.7%), M. fermentans in 32 (14%), M. genitalium in 15 (6.6%), and M. pirum in 0 samples. No association was found between the Mycoplasma spp. and some infertility conditions or adverse pregnancy. However, M. fermentans and M. hominis were found to be associated with bacterial vaginosis (RR = 3.4 CI 95% 1.85–6.3, p < 0.005). In conclusion, M. fermentans and M. hominis were isolated more often in women with bacterial vaginosis, which suggests that these bacteria could contribute to the development of this pathology.

Assessing the Effectiveness of Wet Mount and PCR Methods in Diagnosing Trichomonas vaginalis Infections in Endocervical and Urine samples

Trichomonas vaginalis is the cause of trichomonas’s infection, which is referred to be the global sexually transmitted disease (STD) worldwide. This parasite primarily spreads through sexual activity, though it can also spread through intimate. Vaginal inflammation in females causes a variety of clinical symptoms, such as a profusion of greenish-yellow, frothy, foul-smelling discharge, valvar enlargement, itching, and punctate erythematous lesions of the cervix, commonly referred to as "strawberry cervix." There are numerous scenarios in which women may be sick but not exhibit any symptoms. The purpose of the current study is to compare the diagnostic efficacy of polymerase chain reaction (PCR) and wet mount preparation for detecting T. vaginalis in various sample types, including endocervical discharge, endocervical swabs, and urine, of 300 female patients (married and single), ages ranging from 15 to 62, who were referred to Dohuk Maternity Hospital, Shariya Camp, either inside or outside of Dohuk city. Based on the clinical symptoms of the patients, the diagnosis of parasite infection was validated by microscopically confirming the infection in the laboratory using two methods: PCR and direct wet mount preparation. The study findings demonstrated, out of 240 samples, 61 (25.4%) at Dohuk Maternity Hospital and 15 (25%) out of 60 samples in Shariya Camp were contaminated with T. vaginalis. Of the 300 samples, 74 (24.6%) had wet mount preparation infection, and 75 (25.0%) had PCR infection. In the current study, 42 single women had 10 (23.8%) and 258 married women had 66 (25.5%) infected. The age range of 15 to 25 had a higher infection rate (32.8%).

Clinical significance of atypical glandular cells on cytology: 10 years' experience of a colposcopic referral center.

'Atypical glandular cells' (AGC) is an uncommon cytological result of cervical Pap smears which includes a wide of histopathological diagnoses, from benign to premalignant and malignant cervical disorders, endometrial cancer and, occasionally, other genital malignancies. This study aims to provide a comprehensive overview of AGC, assessing risk factors and clinical and histological features in affected patients. A retrospective analysis was conducted on a cohort of 239 women diagnosed with AGC between 2012 and 2022 at the 'Regional Referral Center for Prevention, Diagnosis and Treatment of HPV-related Genital Disorders', Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Following AGC detection, patients underwent colposcopy with endocervical sampling and endometrial assessment via pelvic ultrasound. Selective cases also received endometrial biopsies. Among a total of 190 women who underwent both colposcopy and endometrial assessment, 116 (61%) had negative clinical and histopathological findings. The remainder displayed various abnormalities: 36 women (18.9%) were found to have endometrial or cervical polyps, 23 (12.1%) were diagnosed with preinvasive cervical neoplasia, and 21 (10.9%) with invasive cervical or endometrial disease. Menopause, multiparity, and older age were all significantly associated with endometrial cancer, but none of the abovementioned variables were significantly associated with cervical neoplasia. Our data confirm that AGC may reveal the presence of a wide range of histopathological conditions. Patients diagnosed with AGC should undergo a careful evaluation including both colposcopy with endocervical sampling and an endometrial assessment.

Antimicrobial resistance of genitalmycoplasmas recovered from nonpregnant women in Greece: trends over the last 15years.

Aim: To study antimicrobial susceptibilities of genital mycoplasmas recovered from endocervical samples of reproductive-age, nonpregnant women (n =8,336). Materials & methods: For isolation and susceptibility testing, the Mycoplasma IST2 kit was used. Results: As many as 2093 samples were positive for mycoplasmas. The vast majority (>96%) of Ureaplasma urealyticum remained susceptible to tetracycline, doxycycline, josamycin and pristinamycin, whereas susceptibility rates to azithromycin and fluoroquinolones were significantly decreased. Mycoplasma hominis exhibited high susceptibility rates to doxycycline, pristinamycin and josamycin (98.1-100%), while susceptibilities to tetracycline and fluoroquinolones were considerably lower. Conclusion: Doxycycline remained highly potent for treating mycoplasmas; nevertheless, susceptibilities to other antimicrobials were significantly diminished.

Abstract 7312: Construction of a gene panel for liquid biopsy-based diagnostics of gynecologic cancer

Abstract Background: Ovarian carcinoma (OC) is the leading cause of death from gynecologic cancers mainly due to late detection, where most patients are diagnosed at advanced stages (51% in stage III; 29% in stage IV). Despite an overall more favorable prognosis, endometrial carcinoma (EC) is the most common gynecologic cancer, with an increasing incidence and where some subtypes are associated with a poor prognosis. Identification of DNA mutations from precancerous lesions or early-stage OC and EC would allow for early intervention. Liquid biopsies through routine sampling such as endocervical sampling, or blood collection for isolation and analysis of ctDNA have previously been assessed for their use in detection of OC and EC. These studies have provided evidence that tumor-derived mutations can be detected in endocervical samples, supporting endocervical liquid biopsies as a potential source of ctDNA. Herein, we aimed to construct a diagnostic gene panel corresponding to common mutation profiles of OC and EC to detect early-stage malignancy through a non-invasive approach. Methods: Using the NGS-method, Simple multiplexed PCR-based barcoding of DNA for sensitive mutation detection using sequencing (SiMSen-Seq), a gene panel was constructed targeting hotspot mutations in known OC- and EC-associated genes. Hotspots were identified using the Catalogue of Somatic Mutations in Cancer (COSMIC) database or retrieved from the literature and assays were designed for amplification of short DNA fragments. Precise assay development was carried out including multiple steps of careful validation to ensure high specificity and efficient amplification. Individual assays were validated in multiple steps using qPCR and fragment analysis. Results: The gene panel was designed as two non-overlapping subunits for comprehensive diagnosis of OC and EC. The two constructed multiplexes, together composed of 125 single assays target genomic regions in 34 EC and OC-associated genes e.g., PTEN, TP53, PIK3CA and CTNNB1. Included assays had a median amplicon size of 92 bp (range 57-111 bp). Both multiplexes displayed good performance with distinguishable libraries at low DNA input (10 ng). Validation of individual assays showed high specificity and efficient amplification where >80% of assays displayed a sequencing coverage >500 UMI counts at a consensus depth of 3. Patient coverage calculations of COSMIC data suggested comparable coverage as similar published approaches. Conclusion: The results suggest that the constructed gene panel has great potential to detect mutations in liquid biopsies collected from the gynecologic tract, despite low tumor DNA levels. Validation of the two multiplexes by fragment analysis and sequencing showed high performance, hence, prospective for the approaching sequencing of liquid biopsies. Citation Format: Sara Schumacher, Therese Carlsson, Jacob Malchau Lauesgaard, Anna Linder, Amanda Olsson Widjaja, Karin Sundfeldt. Construction of a gene panel for liquid biopsy-based diagnostics of gynecologic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7312.

Abstract 6081: DNA integrity and preanalytical handling of endocervical samples for use in liquid biopsy-based diagnostics and monitoring of gynecological cancer

Abstract Background: Liquid biopsies from the gynecological tract can be useful for analysis of cell free DNA (cfDNA) (1, 2, 3). Sampling procedure and optimal preanalytical handling are poorly investigated. In this study, we aimed to evaluate how the profile and integrity of DNA, sampled from the female genital tract, were affected by preanalytical handling. Methods: Biobanked/archival (stored at -80℃ after 48h at room temperature (RT)) and freshly obtained clinical samples were analyzed together with standardized in vitro samples. Archival and in vitro samples were preserved in methanol-based solution, imitating clinical handling of endocervical samples which are initially stored at RT for 48h before further handling. The fragmentation profile of archival and in vitro samples was analyzed. Time series of in vitro samples at RT and 4℃, with extraction at 6-hour intervals from 0 to 96h, were performed. The fresh clinical samples were collected from the endocervix in methanol-based solution and from the vagina in a solution designed to preserve DNA and placed at 4℃ resp RT. Extraction was performed within 4h and at 48h. Results: Accumulation of short DNA fragments were observed in the archival samples and in the in vitro samples, indicating that fragmentation was initiated prior to 48h. Time series showed that the quantity of short DNA fragments gradually increased with time at both RT and 4℃ but at a slower rate in 4℃. At RT the percentage of fragments between 100-350bp increased 12-fold (0.39% vs 4.75%, p=0.002). The freshly obtained endocervical samples showed a similar significant increase in short fragments in samples stored at RT compared with samples stored at 4℃ (p= 0.02 for 100-230bp; p= 0.007 for 230-350bp; p= 0.03 for 100-2500bp) at 4h-48h. Conclusion: Pre-analytical handling of endocervical samples can be optimized. Lowering temperature from RT to 4℃ immediately haltered DNA fragmentation. Citation Format: Jacob Malchau Lauesgaard, Therese Carlsson, Anna Linder, Sara Schumacher, Karin Sundfeldt. DNA integrity and preanalytical handling of endocervical samples for use in liquid biopsy-based diagnostics and monitoring of gynecological cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6081.

Factors associated with human papillomavirus persistence after loop electrosurgical excision procedure in patients with cervical squamous intraepithelial lesion.

To seek the high-risk factors of human papillomavirus (HPV) persistence and residual lesion or recurrence after loop electrosurgical excision procedure (LEEP) focus on the predictive value of intraoperative human papilloma virus (IOP-HPV) testing. Intraoperative endocervical sample was obtained with a cytobrush from the remained cervix of 292 patients immediately after LEEP. HPV Genotyping was performed using a polymerase chain reaction technique. All patients followed by HPV genotyping and cytology every 3-6 months. The IOP-HPV testing results and possible risk factors such as age, cytology grade, menopause status, margin involvement, preoperative HPV status, and cervical lesion grade were assessed in predicting persistence of HPV and residual lesion or recurrence after surgery. There were 61 (20.9%) patients presented persistent HPV infection. Multivariate analyses showed that IOP-HPV positive, post-menopause and preoperative HPV multiplex infection was strongly associated with HPV persistence after LEEP, IOP-HPV positive and post-menopause was also associated with residua or recurrent disease after LEEP. IOP-HPV positive, post-menopause, and preoperative HPV multiplex infection are independent predictors of HPV persistence in patients with cervical squamous intraepithelial lesion treated by LEEP. IOP-HPV test is a new approach that may potentially allow for early identification of patients at high risk of HPV persistence and residua or recurrent disease after LEEP, thereby possibly facilitate an attenuated follow-up schedule for negative patients those at low risk of persistent HPV infection.

Comparison of External and Internal Site Genital Sampling to Detect High-Risk HPV DNA in Women.

Human papillomavirus (HPV), the most common pathogen causing sexually transmitted diseases worldwide, is also an oncogenic virus. Due to the inadequacy of serologic tests in the diagnosis of HPV, NAATs (nucleic acid amplification tests), such as PCR (polymerase chain reaction), represent the gold standard today. Endocervical brush sampling in women has been successfully used for HPV genotyping for many years. The aim of this study was to determine the diagnostic efficacy for PCR HPV genotyping of multisite samples taken simultaneously with a swab from the external genitalia in addition to endocervical brush sampling in women applying for Hr-HPV screening. This study included 105 asymptomatic patients who came to the Gynecology Polyclinic of the University of Health Sciences Tepecik Training and Research Hospital between February 2023 and June 2023 for control purposes. Both the samples taken with a brush from the cervical area and the samples taken with a swab from the external genital area were sent to a screening laboratory for testing for Hr-HPV DNA. The samples were analyzed by real time PCR. The success rate of positive detection of swab samples of HPV type 16 was significantly higher, with a difference of 17.6% (p < 0.0001). For HPV type 18, the swab sample had a significantly higher positive detection rate, with a difference of 60.0% (p = 0.002). The results of this study show that HPV genotyping from the external genital area can be performed as an alternative to cervical sampling in sexually active women to increase the reach of a screening program.

Socioclinical risk factors for cervical dysplasia and presence of human papillomavirus among women attending a tertiary care teaching hospital of Central Odisha

Abstract Introduction: Carcinoma cervix being the second-most common gynecological malignancy in India contributes nearly 14% of all cancers in females. Cervical dysplasia and presence of human papillomavirus (HPV) DNA are the two most important factors for developing cervical cancer. Hence, our study aims to be a flag bearer to raise the awareness for cervical screening with the main objective (i) to estimate the magnitude and distribution of cervical dysplasia among the women of 21–65 years and (ii) to find association between different socio-clinical risk factors and cervical dysplasia and HPV infection among the study subjects. Methods: It was a cross-sectional study carried out in a tertiary care hospital of Central Odisha, with a sample size of 176. Purposive sampling was done. Predesigned pretested questionnaire along with Pap smear and endocervical smear sample for HPV determination were used for data collection. Results: Nearly 62% of women suffered from cervical dysplasia. Women aged ≥35 years were found to have nearly thrice the risk of having cervical dysplasia. Nearly 20% of women tested positive for HPV DNA and these women were found to be 11 times more prone for developing cervical dysplasia compared to women tested negative for HPV DNA. Conclusion: Women with repeated genital infection with HPV and aged more than 35 years were more susceptible to cervical dysplasia. Those with early age at menarche, itching per vaginum, postcoital bleeding, and postmenopausal bleeding, etc., had a significant risk for developing cervical dysplasia. Hence, such symptomatic women should be made aware to undergo screening for cervical cancer at the earliest.

Unique microbial diversity, community composition, and networks among Pacific Islander endocervical and vaginal microbiomes with and without Chlamydia trachomatis infection in Fiji.

Chlamydia trachomatis (Ct) is the most common sexually transmitted bacterium globally. Endocervical and vaginal microbiome interactions are rarely examined within the context of Ct or among vulnerable populations. We evaluated 258 vaginal and 92 paired endocervical samples from Fijian women using metagenomic shotgun sequencing. Over 37% of the microbiomes could not be classified into sub-community state types (subCSTs). We, therefore, developed subCSTs IV-D0, IV-D1, IV-D2, and IV-E-dominated primarily by Gardnerella vaginalis-to improve classification. Among paired microbiomes, the endocervix had a significantly higher alpha diversity and, independently, higher diversity for high-risk human papilloma virus (HPV) genotypes compared to low-risk and no HPV. Ct-infected endocervical networks had smaller clusters without interactions with potentially beneficial Lactobacillus spp. Overall, these data suggest that G. vaginalis may generate polymicrobial biofilms that predispose to and/or promote Ct and possibly HPV persistence and pathogenicity. Our findings expand on the existing repertoire of endocervical and vaginal microbiomes and fill in knowledge gaps regarding Pacific Islanders.

Association between polymorphonuclear leukocytes in the cervical mucosa and fertility in dairy cows

The relationship between cervicitis and fertility has been poorly studied in dairy cows. Endocervical inflammation, determined by an increase of polymorphonuclear leukocytes (PMN), is linked with lower hazard of pregnancy. The objective of the present study was to evaluate if an increase in PMN in the cervical mucosa is associated with decreased fertility in dairy cows. Endocervical samples were collected from dairy cows (n = 243) between 30 and 40 days postpartum. All cows had completed their uterine involution and did not show clinical uterine diseases. A cytological sample was taken by passing the first ring of the cervix using an endocervical brush. A smear was made and stained using the diff quick technique. One hundred cells were counted, and the proportion of PMN was obtained. The cut-off point for the percentage of PMN that corresponded to a decrease in fertility was obtained by analyzing the ROC curve. The cut-off point for the proportion of PMN influencing a decreased fertility was 6%. Thirty-five percent (86/243) of the cows had ≥ 6% PMN. The conception rate at first service was higher in cows with < 6% PMN (43%) than in cows with ≥ 6% PMN (31.4%) [odds ratio = 1.74, CI = 1.0–3.0 (P = 0.047)]. The cumulative proportion of pregnant cows at day 210 postpartum was higher in cows that had < 6% PMN (82%) than cows with ≥ 6% PMN (69%) [odds ratio = 2.2, CI = 1.1–3.9 (P = 0.017)]. Cows with < 6% PMN had a reduced interval from calving to conception than cows with ≥ 6% PMN [97 days (89–106 days) vs. 110 days (89–123 days); median (95% CI); P < 0.05]. In conclusion, a higher proportion of PMN in the cervical mucosa is associated with decreased fertility in dairy cows.

Prevalence and Predictors of Chlamydia trachomatis and Neisseria gonorrhoeae Among HIV-Negative Pregnant Women in Kenya.

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in pregnancy contribute to adverse perinatal outcomes. We identified predictors of CT and/or NG infection among pregnant Kenyan women. Women without HIV were enrolled at 2 antenatal clinics in Western Kenya. Both CT and NG were assessed using endocervical samples for nucleic acid amplification tests. Poisson regression models were used to evaluate potential CT/NG risk factors. Classification and regression trees were generated to evaluate the joint effects of predictors. Overall, 1276 women had both CT and NG assessments. Women enrolled at a median of 26 weeks' gestation (interquartile range, 22-31 weeks), median age was 22 years (interquartile range, 19-27 years), and 78% were married. In total, 98 (7.7%) tested positive for CT/NG: 70 (5.5%) for CT and 32 (2.5%) for NG, 4 of whom (0.3%) had coinfections. Two-thirds (66%) of CT/NG cases were asymptomatic and would have been missed with only syndromic management. Risk factors of CT/NG included age <22 years, crowded living conditions, being unmarried, being in partnerships for <1 year, abnormal vaginal discharge, sexually transmitted infection history, and Trichomonas vaginalis diagnosis ( P < 0.1). Classification and regression tree analyses identified unmarried women <22 years in relationships for <1 year as 6.1 times more likely to have CT/NG compared with women without these characteristics (26% vs. 6%, adjusted prevalence ratio = 6.1, 95% confidence interval = 3.55-10.39, P < 0.001). Chlamydia trachomatis / Neisseria gonorrhoeae was frequently asymptomatic and common among young unmarried women in newer partnerships in this cohort. Integrating CT/NG testing into routine antenatal care may be beneficial, especially for young women in Kenya.

Analysis of Membrane Type-1 Matrix Metalloproteinase (MT1-MMP, MMP14) in Eutopic and Ectopic Endometrium and in Serum and Endocervical Mucus of Endometriosis.

Membrane type-matrix metalloproteinases (MT-MMPs) are a subgroup of the matrix metalloproteinases (MMPs) family and are key molecules in the degradation of the extracellular matrix. Membrane type-1 matrix metalloproteinase (MT1-MMP, MMP14) is often deregulated in different cancer tissues and body fluids of human cancer patients; however, MT1-MMP levels in endometriosis and adenomyosis patients are currently unknown. Tissue samples from patients with and without endometriosis or adenomyosis were analyzed with immunohistochemistry for the localization of MT1-MMP. Serum and endocervical mucus samples from patients with and without endometriosis or adenomyosis were investigated with MT1-MMP ELISAs. MT1-MMP was localized preferentially in the glands of eutopic and ectopic endometrium. MT1-MMP protein levels are significantly reduced in ovarian endometriosis (HSCORE = 31) versus eutopic endometrium (HSCORE = 91) and adenomyosis (HSCORE = 149), but significantly increased in adenomyosis (HSCORE = 149) compared to eutopic endometrium (HSCORE = 91). Similarly, analysis of the levels of MT1-MMP using enzyme-linked immune assays (ELISAs) demonstrated a significant increase in the concentrations of MT1-MMP in the serum of endometriosis patients (1.3 ± 0.8) versus controls (0.7 ± 0.2), but not in the endocervical mucus. Furthermore, MT1-MMP levels in the endocervical mucus of patients with endometriosis were notably reduced in patients using contraception (3.2 ± 0.4) versus those without contraception (3.8 ± 0.2). Taken together, our findings showed an opposite regulation of MT1-MMP in the tissue of ovarian endometriosis and adenomyosis compared to eutopic endometrium without endometriosis but increased serum levels in patients with endometriosis.

A-310 Infections Associated With Infertility and Success of In Vitro Fertilization

Abstract Background Preimplantation genetic analysis aims selecting the best embryo to transfer increasing the chance of a successful pregnancy. However, failure in the implantation of euploid embryos is frequent in the practice of assisted human reproduction, observed in approximately 30 to 50% of transfers, with no cause found in most cases. Previous or active infectious may be associated with infertility, but this topic still lacks deeper studies. Our aim was to analyze the occurrence of sexually transmitted infections in women who underwent the transfer of euploid embryos with different gestational outcomes. Methods A prospective cohort study was carried out for which 36 plasma (EDTA) samples and 17 endocervical smears (Digene HC2 DNA Collection Device) were collected from patients who would be submitted to assisted reproduction cycles (using euploid blastocysts) shortly after the collections, at a private assisted reproduction center. The collections were performed on the 3rd day after the start of luteal phase support with progesterone (clinic protocol). After collection, the samples were placed in a freezer at -80°C until the time of analysis. Women with signs of cervicitis at the time of collection, deep endometriosis, patients over 40 years of age, cases of severe male factor, chronic pelvic pain, patients who would transfer more than one embryo, transfer of aneuploid embryos or with chromosomal mosaicism were also excluded. Samples were submitted to IIFT (EUROIMMUN) to diagnostic specific anti-IgG antibodies against Chlamydia trachomatis (MIF), Neisseria gonorrhoeae, Herpes simplex virus 1 and 2, Mycoplasma hominis, Ureaplasma urealyticum and Treponema pallidum. Active infection was verified by Microrray technic using EUROArray STI 11 kit (EUROIMMUN) to detect Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus 1 and 2, Haemophilus ducreyi, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, Ureaplasma urealyticum, Treponema pallidum and Trichomonas vaginalis. Results From the 36 plasma samples analyzed for IgG antibodies presence, the following were seropositive: 30 anti-herpes simplex 1 and 2, 3 anti-Treponema pallidum, 10 anti-Chlamydia MIF and 32 anti-Mycoplasma hominis and anti-Ureaplasma urealyticum. From the 16 endocervical smears samples analyzed, Ureaplasma parvum was detected in 3 women, who failed to get pregnant. No other infectious agent was detected in the samples. For the statistical analysis of the descriptive results, Fisher's exact test was used, the qualitative variables were presented by absolute and relative frequency, the confidence interval level adopted was 95%. The P value was calculated using the statistical program Stata version 14.0, and no statistic difference was observed between the group got pregnant through IVF and the group didn't. Conclusion Although, a high prevalence of IST specific antibodies anti-IgG in this cohort and 3 patients with active infection was found, a statistical significant difference was no obtained between groups who have succeed on IVF and not, against to the bibliography. In another hand all the patients with active infection of Ureaplasma parvum didn't have success on IVF which suggests that infection increase the unsuccess IVF. On this context, a larger sampling will clarify the hypotheses of associations of STIs as a cause of failed IVF.

Evidence of emerging sexually transmitted Mycoplasma genitalium infection among women detected using multiplex and uniplex PCR

Background The Centre for Disease Control has recognised Mycoplasma genitalium as an emerging sexually transmitted infection. Sparse literature is available in India regarding Mycoplasma genitalium infection. Aims To evaluate the prevalence of Mycoplasma genitalium, its detection from samples obtained from various sites, evaluate co-infections and follow up after treatment. Methods A prospective study was conducted among 341 sexually active women presenting with the complaints of lower genital tract infection to the Municipal STD clinic and ART Centre. Endocervical swabs, vaginal swabs and urine samples were tested for Mycoplasma genitalium using uniplex and multiplex real-time PCR kits. Gram stain was used for diagnosing bacterial vaginosis and candidiasis. Data on HIV, RPR, TPHA, Hepatitis C and HBsAg were also collected. Results The mean age of the participants was 33.4 ± 5.7 years. Mycoplasma genitalium was found in 23 (6.7%) patients, while Neisseria gonorrhoeae and Chlamydia trachomatis were detected in 8 (2.3%) of the participants. The highest Mycoplasma genitalium positivity was in the endocervical swab sample at 6 (26%), followed by the urine sample at 4 (17.3%). The most common coinfection was HCV (33.3%), followed by syphilis (14.3%). The uniplex and multiplex kits showed 47.8% concordance for Mycoplasma genitalium in endocervical swab samples. Tobacco addiction was a significant risk factor for the Mycoplasma genitalium infection. Out of the 6 women who attended the follow up visit at the end of three months, a positive test for cure was seen in 4 (66.6%). Limitations Significant numbers of patients were lost to follow up. Also, the presence of anti-microbial resistance was not evaluated. Conclusion Mycoplasma genitalium is prevalent among women with high-risk behaviours, highlighting the need for further studies are needed among other high-risk populations.

Preventive Oncology International: A brief history of HPV self-collected vaginal specimens for cervical cancer screening

Since 1998, Preventive Oncology International, Inc. (POI) has been at the forefront of studying human papillomavirus (HPV) self-collection for cervical cancer screening, with a significant focus in China. Through multiple clinical trials over the past 25 years, POI has explored various aspects related to self-collection methodologies. In 2004–2006, POI established that self-collection could be equivalent to direct endocervical samples. Subsequently, a large randomized trial involving 10,000 patients in 2010 further confirmed that self-collected vaginal specimens, tested for high-risk HPV (hrHPV) using a PCR-based assay with high analytic sensitivity, could effectively replace endocervical specimens with minimal loss of sensitivity and a slight decrease in specificity. Throughout the years, POI's research has encompassed several crucial topics, including patient acceptance, the development of new cost-effective, simpler, and faster assays, exploring different collection devices, devising efficient methods of specimen transport, and implementing population-based screening systems. The findings strongly support the integration of self-collection methodologies into cervical cancer control programs worldwide, particularly in medically underserved regions. As HPV self-collection continues to evolve, ongoing research and innovations are expected to play a pivotal role in achieving the global mission of combating cervical cancer.

Histopathological Findings in Postmenopausal Bleeding

Introduction: Postmenopausal bleeding is commonly considered a significant and alarming indicator of genital diseases. The term "postmenopausal bleeding" typically refers to uterine bleeding. Since it is a sign of many different etiologies and has a strong correlation with malignancy and conditions with substantial morbidity and mortality, prompt identification and treatment are desired for postmenopausal bleeding. Materials and Methods: It is a retrospective cross-sectional observational study carried out in the pathology division of KIST Medical College and Hospital, Lalitpur, Nepal. From July 2017 to July 2022, 270 endometrial and endocervical biopsy samples with a history of postmenopausal bleeding were included. Following microscopic analysis, frequencies of histological findings in various age groups were generated. To determine whether the difference was significant, chi-square and proportions were used; the cutoff value was set at p 0.05. Results: On average, the patients were 51.9 years old, plus or minus 6.6 years. Of the 270 samples included, 222 (82.2%) were endometrial biopsies, and the remaining samples were cervical biopsies. Endometrial hyperplasia was the most common histological finding overall, occurring in 67 (24.8%) of the patients. With a mean age of 65.33 years, endometrial and cervical cancer patients were between the ages of 51 and 79. Endometrial and cervical carcinomas were together present in 31 (11.48%) of the patients. Leiomyoma was one discovery; others included endometritis, adenomyosis, endometrial polyps, hormonal deviations, and disordered proliferative endometrium. Endometrial hyperplasia was discovered in 20 patients over the age of 50 and 47 patients under the age of 50; this finding is statistically significant at a p-value of 0.05. Conclusion: In postmenopausal bleeding, benign diseases predominated, but the proportion of endometrial and cervical cancers and pre-malignant disorders was rather high. Our study demonstrates the significance of the endometrial sample, particularly in peri/postmenopausal women who have atypical uterine bleeding.

Immune-checkpoint proteins, cytokines, and microbiome impact on patients with cervical insufficiency and preterm birth.

Microenvironmental factors, including microbe-induced inflammation and immune-checkpoint proteins that modulate immune cells have been associated with both cervical insufficiency and preterm delivery. These factors are incompletely understood. This study aimed to explore and compare interactions among microbiome and inflammatory factors, such as cytokines and immune-checkpoint proteins, in patients with cervical insufficiency and preterm birth. In particular, factors related to predicting preterm birth were identified and the performance of the combination of these factors was evaluated. A total of 220 swab samples from 110 pregnant women, prospectively recruited at the High-Risk Maternal Neonatal Intensive Care Center, were collected between February 2020 and March 2021. This study included 63 patients with cervical insufficiency receiving cerclage and 47 control participants. Endo- and exocervical swabs and fluids were collected simultaneously. Shotgun metagenomic sequencing for the microbiome and the measurement of 34 immune-checkpoint proteins and inflammatory cytokines were performed. First, we demonstrated that immune-checkpoint proteins, the key immune-regulatory molecules, could be measured in endocervical and exocervical samples. Secondly, we identified significantly different microenvironments in cervical insufficiency and preterm birth, with precise cervical locations, to provide information about practically useful cervical locations in clinical settings. Finally, the presence of Moraxella osloensis (odds ratio = 14.785; P = 0.037) and chemokine CC motif ligand 2 levels higher than 73 pg/mL (odds ratio = 40.049; P = 0.005) in endocervical samples were associated with preterm birth. Combining M. osloensis and chemokine CC motif ligand 2 yielded excellent performance for predicting preterm birth (area under the receiver operating characteristic curve = 0.846, 95% confidence interval = 0.733-0.925). Multiple relationships between microbiomes, immune-checkpoint proteins, and inflammatory cytokines in the cervical microenvironment were identified. We focus on these factors to aid in the comprehensive understanding and therapeutic modulation of local microbial and immunologic compositions for the management of cervical insufficiency and preterm birth.

Cervical Precancerous Lesions and Associated Factors Among Women Screened in Two Hospitals in the City of Douala, Cameroon.

Cervical cancer remains the second leading cause of death amongwomen in Cameroon despite the new strategies put in place. This study was conducted in order to determine the prevalence of precancerous cervical lesions and its associated factors in Douala (Cameroon). A cross-sectional study was conducted over a period of nine months in two hospitals of the city of Douala, Cameroon (Laquintinie Hospital and Gyneco-Ostetric and Pediatric Hospital). Cervico-vaginal and endocervical samples were taken from women attending the above-mentioned hospitals in order to identify and characterize precancerous lesions by cytological examinationand to genotype for human papillomavirus (HPV) using the Abbott RealTime High-Risk (HR) HPVkit. Data of sociodemographic characteristics, clinical history, and knowledge about cervical cancer were collected using a questionnaire. Of the 196 women included in this study, 17% had precancerous lesions, including 1.53% for atypical glandular cells (AGC), 4.53% for atypical squamous cells (ASC), 4.53% for low-grade squamous intraepithelial lesion (LSIL), 5.61% for high-grade squamous intraepithelial lesion (HSIL), 0.51% for atypical squamous cells of undetermined significance (ASC-US), and 0.51% for atypical squamous cellscannot exclude HSIL (ASC-H). In addition, the prevalence of HPV infection was 18%, of which 2% was for HPV 16, 2% for HPV 18, and 14% for undetermined HPV. A positive association was recorded between the occurrence of precancerous lesions and HPV infection (P=0.01), age, and school level. Moreover, the occurrence of precancerous lesions was positively associated with the participants' level of knowledge (P=0.01). Precancerous lesions were predominantly HSIL, and the factor most associated with these lesions was HPV infection. This study demonstrates that diagnosis is made at a relatively late stage due to a low level of knowledge about cervical cancer in the population.

Human papillomavirus genotype distribution by cytological status and associated risk factors in the general population of Congolese women living in urban and rural areas: Implications for cervical cancer prevention

IntroductionCervical cancer related to high risk-human papillomavirus (HR-HPV) is the second female cancer in the Republic of Congo (Congo). We herein evaluated the molecular epidemiology of cervical HPV infection and associated risk factors in Congolese women living in urban (Brazzaville) and rural (Plateaux department) settings. Patients and methodsA population-based, cross-sectional survey was conducted to collect demographic and behavioral data among Congolese women, and to obtain endocervical swab samples for HPV DNA molecular detection (Anyplex II HPV28, Seegene, Seoul, South Korea). ResultsA total of 284 women (mean age: 37.8 years; HIV-1-positivity: 18.6%) were included. The prevalence of HPV DNA cervical shedding was 64.4% [HR-HPV: 80.9%, mainly HPV-16 (15.8%), and HPV-35 and HPV-52 (15.3%); multiple HPV infections: 60.6%; 9-valent HPV Gardasil-9® vaccine genotypes: 42.6%]. 91.6% and 100% of low-grade squamous intraepithelial neoplasia (LSIL) and cervical cancer, respectively, showed HR-HPV. HR-HPV prevalence was higher among students (aOR: 7.9) and HIV-infected women (aOR: 3.1) in Brazzaville, and among women aged between 21–30 years (aOR: 7.2) and HIV-infected women (aOR: 5.1) in the Plateaux department. ConclusionCervical HR-HPV infection is particularly frequent in young or HIV-infected Congolese women. Prophylactic HPV vaccination combined with primary molecular screening of HR-HPV infection in this country should be extended.