Endocervical Swabs Research Articles

Detection of biofilm formation in multi-drug resistant Staphylococcus aureus among clinical isolates in Zaria metropolis, Kaduna, Nigeria

Antimicrobial resistance are associated with several virulence factors such as biofilm. The biofilm formation ability of S. aureus complicates effective therapeutic management of infections. In this research, we intend to observe biofilm formation in S. aureus using two in vitro phenotypic methods: tissue culture plate and Congo red agar as well as biofilm associated genes Ica A B & D and 16SrRNA. A total of 150 presumptive coagulase positive staphylococcal isolates from all specimens (blood, urine, high vaginal swab, wound swab, ear swab, endocervical swab) submitted to the microbiology laboratory of the selected hospitals were collected. Seventy-three (73) or 48.7% of the isolates were identified as coagulase positive Staphylococcus using microbiology standard methods (tube coagulase test, growth on mannitol salt agar & Dnase agar). Using microgen staph identification kit, the isolates were further characterized into various Staph spp. Disc agar diffusion method was used for eleven (11) antibiotics susceptibility test while vancomycin screening agar and BMD (Broth Micro dilution) MIC test was used for vancomycin susceptibility evaluation. Indirect observation of biofilm was performed using congo red agar (CRA) and Microtitre plate assay method. PCR and sequencing were conducted on the isolates to molecularly detect the presence of 16SrRNA, IcaA, IcaB, IcaD genes. Susceptibility of S aureus (21%) isolates tested against 12 different categories of antibiotics shows 4(27%) not multidrug resistant (MDR), 7(47%) were MDR and 4 (27%) were extensively drug resistant (XDR). High percentage (74%) of Multiple antibiotic resistant index at ≥0.3 suggested that the isolates originated from an environment where antibiotics are often used. Biofilm assessment of MDR S aureus isolates revealed that 9(82%) and 11 (100%) of the isolates were biofilm formers using Congo Red Agar method and Microtiter plate assay respectively. All isolates amplified with 16SrRNA primer signifying all are S. aureus, 100% of the isolates amplified with IcaA, 90% isolates amplified with IcaD, and 50% isolates amplified with IcaB. We can conclude that there is high prevalence of Biofilm forming S. aureus strains in the hospitals studied. This result should be born in mind by clinicians while prescribing medication for S. aureus positive conditions. Hospital managements should be proactive in preventing the preservation of the biofilm formers in their hospital environment through adequate sanitary and disinfection protocols. It is also necessary for clinician to note that nitrofurantoin, linezolid and vancomycin were most effective against the biofilm producing S. aureus and microtitre plate assay method was observed to be most reliable assay in the study of biofilm.

High prevalence and incidence of gonorrhoea and chlamydia in young women eligible for HIV pre-exposure prophylaxis in South Africa and Zimbabwe: results from the HPTN 082 trial

IntroductionWe investigated the prevalence, incidence and factors associated with sexually transmitted infections (STIs) among young African women seeking HIV pre-exposure prophylaxis (PrEP).MethodsHPTN 082 was a prospective, open-label PrEP study enrolling...

Prevalence of Chlamydia trachomatis, Ureaplasma parvum and Mycoplasma genitalium in Infertile Couples and the Effect on Semen Parameters.

Chlamydia trachomatis, Ureaplasma parvum, and Mycoplasma genitalium are common sexually transmitted microorganisms. Our study aimed to determine the prevalence of C. trachomatis, U. parvum, and M. genitalium in infertile and fertile couples and the effect of these microorganisms on semen parameters. In this case-control study, samples were collected from 50 infertile couples and 50 fertile couples and were subjected to the routine semen analysis and Polymerase chain reaction (PCR). C. trachomatis and U. parvum were detected in 5 (10%) and 6 (12%) of semen samples from infertile men. Also, out of 50 endocervical swabs from the infertile women, C. trachomatis and M. genitalium were detected in 7(14%) and 4 (8%) of swab specimens, respectively. In the control groups, all of the semen samples and endocervical swabs were negative. Also, in the group of infertile patients infected with C. trachomatis and U. parvum, sperm motility was lower than uninfected infertile men. The results of this study showed that C. trachomatis, U. parvum, and M. genitalium are widespread among the infertile couples in Khuzestan Province (Southwest of Iran). Also, our results showed that these infections can decrease the quality of semen. For the prevention of the consequences of these infections, we suggest a screening program for infertile couples.

Seroprevalence of Human Papillomavirus Infection among Female Sex Workers in a Tertiary Care Hospital in Southern India

Introduction: Sexually Transmitted Infections (STIs) are generally acquired through sexual contact, and the risk is very high for Female Sex Workers (FSWs). The most common STI in FSWs is Human Papillomavirus (HPV) infection. Majority of the HPV infection is asymptomatic, while a minority of the infection is responsible for causing cervical cancer. High-Risk HPV (HR-HPV) serotypes, HPV 16 and HPV 18, are known to cause cervical cancer. Aim: To determine the seroprevalence of HPV infection among FSWs attending STD clinic at a tertiary care hospital in Southern India. Materials and Methods: This cross-sectional study was done during the period between September 2015 and August 2016 in a total of 65 FSWs in Govt. Stanley Medical College, a tertiary care hospital in Chennai, Southern India. The serum was separated after 5 mL of blood was drawn to test for the presence of HPV 16 and 18, Human Immunodeficiency Virus (HIV), and syphilis. Endocervical and vaginal swab specimens were taken to look for the presence of other STIs. Necessary socio-demographic and clinical information such as mode of sex, any sexual exposure, extramarital or premarital, protected sex or not, history of associated STIs, and any history of blood transfusion, i.v. drug abuse, or surgery was also obtained. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) 20.0 software. Probability value (p-value) <0.05 was considered statistically significant. Results: Analysis of the blood samples showed that four samples were found positive for HPV infection, while two samples each were positive for HIV and syphilis. Analysis of the swab specimens showed the presence of other associated STIs in 20 samples. Among the four HPV positive samples, three were found positive for HPV 16, and one was positive for HPV 18. Risk factors such as age, marital status, HIV, and syphilis had a very strong association with HPV infection (p-value<0.01). Conclusion: The prevalence of HR-HPV serotype HPV 16 was higher than HPV 18. Hence, education about STIs, safer sexual practices, and HPV vaccination are essential in this population in order to prevent the transmission of infection to the general population.

Prevalence of Chlamydia trachomatis infection and evaluation of its genotypes among pregnant women in Tehran, Iran.

Chlamydia trachomatis is an obligate intracellular pathogen. Infection with C. trachomatis in pregnant women can result in maternal and fetal death, due to pelvic inflammatory disease. Therefore, we aimed to evaluate this infection in pregnant women and identify circulating genotypes of C. trachomatis in Tehran, Iran. Endocervical swabs were obtained from 101 pregnant women and tested by PCR assay to detect cryptic plasmid gene. Positive isolates were analyzed for C. trachomatis genotypes through amplification and sequencing of the omp1 gene and alignment with deposited sequences in Gene Bank. Infection with C. trachomatis was observed in 11 cases, yielding an overall prevalence of 10.8% in total. The majority of infected women were asymptomatic and the rate of infection was found more in women at the age of ≥30 years. However, no statistical association was found between C. trachomatis infection and risk factors in pregnant women. Analysis of isolated sequences revealed genotypes E (44.4%), D and F (both 22.2%), and K (11.2%) as main genotypes of C. trachomatis in this region. Results of this study showed the prevalence of C. trachomatis infections among pregnant women is relatively high. Identifying the precise rate of infection and associated genotypes in other regions is suggested.

Identification and Antifungal Susceptibility Profiles of Yeast Urogenital Tract Infection among Women in Benin City, Nigeria

The incidence of candida infections is on the increase globally, with laboratories not performing speciation and susceptibility testing routinely. This study aims to speciate and determine the susceptibility profile of yeast isolates recovered from urogenital specimens. A total of 115 female participants with signs and symptoms of urogenital tracts infection attending various clinics in University of Benin Teaching Hospital Benin City, Nigeria were recruited for this study. A total of 55 mid-stream urine and 60 high vaginal swabs and or endocervical swabs were collected from the participants and processed to recover yeast isolates. The yeast isolates were identified and susceptibility test performed using standard techniques. The prevalence of candiduria - 54.55% and vaginal candidiasis - 63.33%, did not differ significantly (P = 0.4426). Age did not significantly affect the prevalence of candiduria and vaginal candidiasis (P = 0.0525 and P = 0.2194, respectively). Candida albicans was the most prevalent yeast isolate recovered from urine and genital specimens. Amphotericin B and nystatin were the most active antifungal agents while fluconazole was the least active. High prevalence of yeast urogenital tract infections was observed in this study.

Meaning of the Decreased HPV Normalized Viral Load Marker in Clinical Evolution of Women with HPV Infection

(1) Background: HPV infection can progress over the years to become cervical cancer. In this study, genotype and a normalized viral load were evaluated as surrogate markers of progression to cancer. (2) Methods: A total of 558 endocervical swabs were collected from 120 women (mean, 40.1 ± 11.8 years old). Seventy-eight of the women underwent clinical intervention (CI) to clear the infection during the course of the study, while forty-two did not (NCI). Normalized viral load (NVL) was calculated using a COBAS 4800 system. The INNOLIPA genotyping system was used to classify HPV which was neither type 16 or 18. (3) Results: The mean age of CI women was 41.1 ± 11.4 (22–68) years old and that of the NCI group was 37.7 ± 12.13 (23–65) (p: 0.104). HPV16 was present in 11 (25%) NCI and 30 (35.2%) CI patients, HPVα9non16 in 20 (45%) NCI and 34 (40%) CI, and HPVnonα9 in 13 (29.5%) NCI and 21 (24.7%) CI (p = 0.48). In NCI women there was an average NVL decrease of 0.95 log after two years and a further decrease of 2.35 log at the end of the third year. At the end of the study, 34 (80%) of the NCI patients were clear of HPV. However, NVL of CI women remained at around 5 log until intervention (p < 0.001). (4) Conclusions: Viral load decreased in NCI women at follow-up in the second year. In contrast, in CI women, their viral load did not fall over the follow-up period. This work thus demonstrates that a reduction in normalized viral load was associated with good evolution.

Molecular characterization of multi drug resistant Escherichia coli isolates at a tertiary hospital in Abuja, Nigeria

Infections caused by multi-drug resistant Escherichia coli cause significant morbidity and mortality especially in developing countries. In this study, we describe the molecular characteristics of E. coli isolated from clinical specimens and the patients’ outcomes. Phenotypic methods were used in the identification and antimicrobial susceptibility testing of E. coli from clinical specimens from a tertiary hospital in Abuja, Nigeria. Whole genome sequencing was used to describe the antimicrobial resistance genes, serotypes, sequence types/clonal complexes, and mobile genetic elements. The mean age of the patients was 20.3 years with 70.1% females and majority of isolates 75% from urine, 21% from blood cultures, and 3% each from cerebrospinal fluid and endo-cervical swabs. Of the 107 non-duplicate E. coli isolates, 101 (94.3%) were resistant to ampicillin, 95 (88.8%) to trimethoprim/sulfamethoxazole, 86 (80.4%) to ceftriaxone, 60 (56.1%) to gentamicin, and eight (7.5%) to meropenem. There were 102 (95.3%) isolates that were multi-drug resistant (MDR). Expression of Extended Spectrum Beta Lactamase (ESBL) phenotype was detected in 54 (50%) and blaCTX-M-15 genes detected in 75 (70.1%) isolates. The carbapenemase genes blaNDM-1 and blaNDM-5 were detected in six (5.6%), while the AmpC gene- blaCMY-2, was detected in seven (6.5%) isolates. Two (1.9%) isolates simultaneously harboured the blaOXA-1, blaCMY-2, blaCTX-M-15, and blaNDM-5 genes. In total, 35 sequence types (STs) were found with the majority being ST131 (n = 23; 21.5%). The most common serotype was O25:H4 associated with all 23 strains of ST131, followed by O1:H6/ST648 (n = 6). The ST410, ST671, and ST101 strains displayed phenotypic resistance to wide array of antibiotic classes and harbored high numbers of antibiotic resistance genes via in-silico analysis. The ST410 strain in particular harbored a higher number of antibiotic resistance genes and was phenotypically resistant to a wider array of antibiotics. Four pairs of isolates were closely related with three isolates (ST131, ST38, ST652) having a pairwise SNP difference of zero. 71/72 75/76 52/14. The MDR E. coli lineages circulating in this setting pose a clinical and public health threat as they can hinder effective prevention and management of infections. The genetic diversity and MDR E. coli with the emergence of ST410 and ST101 clones is concerning because of the potential for rapid dissemination in hospitals and communities- further increasing the problems of antibiotic resistance. Continuous routine surveillance of E. coli infections for AMR in hospitals becomes imperative, aimed at development of effective antimicrobial stewardship programs, facilitating prudent use of antimicrobial agents, and limiting dissemination of resistant strains.

Chlamydia Trachomatis–A Cause of Infertility at Tertiary Care Hospital, Pakistan

Objective: To determine the association of Chlamydial infection with infertility in patients reporting to tertiary care set up for evaluation.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Armed Forces Institute of Pathology, from Jun 2015 to Jun 2016.
 Methodology: A total of 100 women with primary or secondary infertility were included. Endo cervical swabs were taken. PAP smear was performed. One drop of anti-chlamydial monoclonal antibody was added to each slide, incubated at 37oC for 10 minutes, and examined for Chlamydia trachomatis under the fluorescent microscope.
 Results: The mean age was 29.878±3.48 years. 89.0% of the patients had primary infertility, and 11.0% had secondary infertility. The mean age of primary infertile patients was 29.98 ± 3.51 years, while the same was 29.00 ± 3.28 years among patients with secondary infertility. Chlamydial infection was detected positive by direct immunofluorescence (Elementary Bodies) in 6 patients with mean age of 27.17 ± 1.72 years and positive in 13 patients by polymerase chain reaction with mean age of 28.38 ± 1.85 years, having a significant p-value (<0.05).
 Conclusion: There was an association between Chlamydia trachomatis infection and female infertility.

Correlation between Sociodemographic Variables and OncoE6 Cervical Swab Test Positive Cases

A cross-sectional, observational study was conducted to determine the relationship between sociodemographic variables and the development of cervical cancer through detection of detection of HPVE6 oncoprotein. A total of 47 endocervical swabs were collected from colposcopy clinic under the Department of Obstetrics & Gynaecology, Mymensingh Medical College, Mymensingh, Bangladesh, from January to December of 2015. Laboratory work was done in the Department of Microbiology of the same institution. E6 strip test is an immunochromatographic test based on detection of HPV-E6 oncoprotein in cervical swab samples. The swab specimen was treated with lysis solution and conditioning solution. Then the specimen solution was clarified by centrifugation. After that the sample solution was transferred into the detector mAb vial, wash solution vial, and finally, into developing solution vial. The test unit was then placed on a reading guide. Positive result was indicated by the appearance of purple colored test line. Out of 47 specimens, 21 (44.68%) were OncoE6 positive. Among those 21 positive cases, 19 (90.48%) were HPV-16 and 2 were (9.52%) HPV-18. Out of 11 histologically diagnosed CIN I cases, 1 (9.09%) case came out as positive. However, there were no positive cases by oncoE6 cervical swab test in CIN II and CINIII categories. Among histopathologically confirmed 22 cervical carcinoma cases, 20 (90.90%) came out as positive through this test. The results were compared with sociodemographic variables. OncoE6 is more common among ≥50 age group, and who got married before 18 years, and in multiparous women (P<0.05). Cervical cancer prevention services should be strengthen including health education, OncoE6 screening, and Anti-HPV vaccination.
 CBMJ 2022 July: vol. 11 no. 02 P: 152-157

How do general practitioners test and treat gonococcal infections in the Australian Capital Territory? Implications for disease surveillance and control.

The incidence of Neisseria gonorrhoeae (gonorrhoea) and Treponema pallidum (syphilis) infections in the Australian Capital Territory (ACT) has increased since 2014 in people reporting heterosexual exposure. This population is more likely to present to general practice rather than to specialised sexual health clinics, with potential implications for disease surveillance and control. This study aimed to explore: conformity of self-reported clinical practice with sexually transmitted infection guidelines in general practice; gaps in sexual health knowledge and skills; and areas for improved support from ACT Health Communicable Disease Control. A cross-sectional survey of general practitioners (GPs) and nurse practitioners (NPs) practicing in the ACT was conducted in December 2020, using a 17-item questionnaire and semi-structured interviews. Twenty-three GPs and one NP returned completed surveys (response rate 5.3%); four GPs and one NP participated in interviews. In its complex setting of competing demands, GP practice may not always meet national guidelines. In response to clinical vignettes, although all GPs ordered investigations for gonorrhoea, only 25% of these met the gold-standard by including endocervical or vaginal swabs. With respect to assessing antimicrobial sensitivities to guide treatment, only 58% correctly reported following up a positive gonococcal polymerase chain reaction test with a culture. Around two-thirds of respondents (62.5%) identified the appropriate antibiotic therapy and 75% correctly identified the responsibility of the diagnosing clinician to discuss contact tracing with the patient. Suggestions for increased support focussed on education, communication efficiency, and providing a 'safety net' for follow up.

Detection of Shiga Toxin-Producing Escherichia coli (STEC) in the Endocervix of Asymptomatic Pregnant Women. Can STEC Be a Risk Factor for Adverse Pregnancy Outcomes?

The presence of Escherichia coli in the vaginal microbiome has been associated with pregnancy complications. In previous works, we demonstrated that Shiga toxin-producing Escherichia coli (STEC) can produce abortion and premature delivery in rats and that Shiga toxin type 2 (Stx2) can impair human trophoblast cell lines. The hypothesis of this work was that STEC may colonize the lower female reproductive tract and be responsible for adverse pregnancy outcomes. Thus, the aim of this work was to evaluate the presence and prevalence of virulence factor genes from STEC in the endocervix of asymptomatic pregnant women. For that purpose, endocervical swabs were collected from pregnant women during their prenatal examination. Swab samples were enriched in a differential medium to select Enterobacteria. Then, positive samples were analyzed by PCR to detect genes characteristic of Escherichia sp. (such as uidA and yaiO), genes specific for portions of the rfb (O-antigen-encoding) regions of STEC O157 (rfb O157), and STEC virulence factor genes (such as stx1, stx2, eae, lpfA O113, hcpA, iha, sab, subAB). The cytotoxic effects of stx2-positive supernatants from E. coli recovered from the endocervix were evaluated in Vero cells. Our results showed that 11.7% of the endocervical samples were positive for E. coli. Additionally, we found samples positive for stx2 and other virulence factors for STEC. The bacterial supernatant from an isolate identified as E. coli O113:NT, carrying the stx2 gene, exhibited cytotoxic activity in Vero, Swan 71 and Hela cells. Our results open a new perspective regarding the presence of STEC during pregnancy.

Etiology of cervicitis: Are there new agents in play?

Considering the changing causative and resistance pattern of agents implicated in sexually transmitted infections (STIs), etiological diagnosis is imperative, especially in countries practicing syndromic management. This study was designed to identify etiological agents associated with cervicitis and to analyze their association with clinical and behavioral profile. Female STI clinic attendees presenting with cervico-vaginal discharge were examined for the presence of cervicitis. Endocervical swabs were collected for gram staining and real-time polymerase chain reaction was performed for various bacterial and viral STI agents in patients presenting with cervical discharge. A vaginal swab was also evaluated for bacterial vaginosis by Nugent's criteria. Of 64 patients with vaginal discharge, 26.6% and 12.5% patients complained of genital itching and lower abdominal pain, respectively. Mean of 36.6 pus cells/hpf were observed, appreciably greater number in patients with Neisseria gonorrhoeae and Chlamydia trachomatis infections (P = 0.0063 and 0.0032, respectively). Pus cells were high (mean 68 pus cells/hpf) in patients with Ureaplasma urealyticum, though this may be attributed to coexisting N. gonorrhoeae. Agents isolated from endocervix were N. gonorrhoeae, 17 (26.6%), Trichomonas vaginalis, 4 (6.3%), HSV1 and C. trachomatis, 1 each (1.6%), HSV2, 9 (14.1%), U. urealyticum 5 (7.8%), Ureaplasma parvum 26 (40.6%), Mycoplasma genitalium (0%), and Mycoplasma hominis 11 (17.2%). Bacterial vaginosis was diagnosed in 14 (21.9%) patients. Multiple agents were isolated in 10 (two), 6 (three), 6 (four), and 1 (five) patients. Isolation of M. hominis and U. parvum was significantly associated with bacterial vaginosis (P = 0.04 and 0.003, respectively). Nonusage of condoms and mental stress predisposed to cervicitis. We concluded that there are changing etiological patterns of cervicitis. There is need to use tests that detect wider array of organisms, and can replace standard culture methods with molecular assays, to increase the ability to diagnose more number of organisms implicated in cervicitis.

Antimicrobial Susceptibility Testing Patterns of Neisseria gonorrhoeae from Patients Attending Sexually Transmitted Infections Clinics in Six Regions in Tanzania.

Antimicrobial resistance (AMR) is global health threat that is on the increase, and it has been adversely affecting the proper management of sexually transmitted infections (STI). Data on antimicrobial susceptibility testing patterns of N. gonorrhoeae are limited in local settings. We determined in vitro antimicrobial susceptibility and phenotypic profiles of N. gonorrhoeae isolated from STI/Outpatient Department (OPD) clinics. Minimum Inhibitory Concentrations (MIC) (µg/mL) were determined using E-Test and agar dilution methods for previously and currently recommended antimicrobial agents. A total of 164 N. gonorrhoeae isolates from urethral discharge and endocervical swabs were tested. The prevalence of resistant N. gonorrhoeae to tetracycline, norfloxacin, penicillin and ciprofloxacin were 98.6%, 82.2%, 84.3% and 75.6%, respectively. None of the isolates was resistant to kanamycin. Penicillinase producing N. gonorrhoeae (PPNG) was found to be 73.7%, with 56.7% and 43.3% observed among isolates from women and men, respectively. Tetracycline resistant-N. gonorrhoeae (TRNG) was found to be 34.0%, and QRNG with HLR to ciprofloxacin was 79.9%. The overall MDR-NG was 79.9%, and XDR-NG was 3.6%. MIC50 and MIC90 were 4.0 and 8.0 and 2.0 and 4.0 µg/mL for ciprofloxacin and norfloxacin, respectively. Dendrograms showed that 44 phenotypic groups are associated with a high rate of AMR among high MDR-NG and moderate XDR-NG isolates. The predominant groups of quinolone-resistant N. gonorrhoeae (QRNG)+PPNG (34.7%) and QRNG+PPNG+TRNG (32.9%) were observed among the isolates having HLR to ciprofloxacin. We reported a high prevalence of AMR (>90%) to previously recommended antimicrobials used for the treatment of gonorrhoea. Multidrug resistant N. gonorrhoeae (MDR-NG) was highly reported, and extensively drug resistant (XDR-NG) has gradually increased to the currently recommended cephalosporins including ceftriaxone and cefixime. Heterogeneous groups of QRNG+PPNG+ and QRNG+PPNG+TRNG were highly resistant to penicillin, tetracycline, ciprofloxacin and norfloxacin. A surveillance program is imperative in the country to curb the spread of AMR.

Occurrence of vaginal candidiasis among female students of Ignatius Ajuru University of Education, Rumuolumeni, Port Harcourt, Rivers State

Vaginal disorders such as bacterial vaginosis, candidiasis, trichomoniasis, and Chlamydia trachomatis infections are common among women of reproductive age, occurring with high prevalence during pregnancy. This study investigated the incidences of vaginal candidiasis among female students in Ignatius Ajuru University of Education, Port Harcourt between Julys to September, 2021. A total population of 150 female students was used with their full consent. High vaginal swab (HVS) and endocervical swab (ES) samples was collected from each of the participating female students. The swab samples were separately inoculated onto Sabouraud dextrose agar and incubated aerobically at 37 °C for 48 hours. An overall prevalence of 38(25.3%) out of 150 female students that were sampled was observed. Out of 50 females sampled from each of the three Hostels, the highest frequency was recorded in Hostel A with 18(36%), followed by Stella Hostel with 12(24%) and the least was in Salvation Hostel with 8(6%) cases. The results revealed that students between the age range of 21-24 were more infected with the yeast with 18(36%), while those in the age range of 17-20 and 25-28 showed the same level of prevalence of 20%.The outcome of this study indicated involvement of Candida species in vulvo-vaginitis among female students of the institution. Sex-education workshops should be conducted to enlighten the female students on the clinical implications of Candida albicans in the development of vulvo-vaginal candidiasis.

Changes in the cervicovaginal microbiota composition of HPV16-infected patients after clinical treatment.

High-risk human papillomavirus (hrHPV) infection is a key factor that alters cervicovaginal microbiota patterns and causes cervical intraepithelial neoplasias (CINs) or even cervical cancer. Although local excisional treatment can clear hrHPV infection and restore the cervicovaginal microbiota, it is unclear which cervicovaginal microbiota represents recovery. Our objective was to describe the cervicovaginal microbiota before and after treatments and to assess the association between the microbiota and HPV persistence. A cohort of 91 participants was classified into four groups (healthy control women and HPV16-infected women with CIN I, CIN II/III, and squamous cell carcinoma [SCC]). Endocervical swabs were collected 3months prior to treatment and at 3months post-treatment for bacterial 16S rRNA gene pyrosequencing and for HPV DNA testing. There was an increase in the number of Lactobacillus bacterial species present after the clinical treatments, and the community state type (CST) profiles were shifted from dysbiotic CSTs II and IV to Lactobacillus-dominated CSTs I and III. Specifically, the composition of Geobacter and Prevotella before treatment and Lactobacillus secaliphilus after treatment might have been related to CIN I, the composition of Burkholderia before treatment and Lactobacillus iners after treatment might have been related to CIN II/III, and the composition of Atopobium and Aerococcus before treatment and Bacilli after treatment might have been related to SCC. Further functional predictions revealed that the composition differences were linked to infectious disease- and cancer-related genes. Our study provides an illustration of the changes in CSTs and the cervicovaginal microbiota before and after HPV16 clearance in each disease state.

Vaginal Swabs Are Non-inferior to Endocervical Swabs for Sexually Transmitted Infection testing in the Emergency Department.

Study ObjectiveEmergency department (ED) testing for sexually transmitted infections (STI) in women is typically performed with a pelvic examination and an endocervical swab. However, vaginal swabs are effective for STI testing and the preferred specimen type according to the US Centers for Disease Control and Prevention. The utility of using vaginal swabs in the ED for STI screening has not been thoroughly investigated. Our objective was to assess detection rates for two bacterial STIs before and after implementing a screening protocol using vaginal swabs.MethodsWe conducted a quasi-experimental, pre-post study using standardized data from electronic health records across nine metropolitan Detroit hospital EDs. Patients included women who were tested for Chlamydia trachomatis or Neisseria gonorrhoeae in the ED between April 2018–December 2019. Pre-implementation tests from April 2018–February 2019 were done using endo-cervical swabs, and post-implementation tests from February 2019–December 2019 were done with vaginal swabs. We used non-inferiority testing for proportion with a non-inferiority margin of one percentage point absolute difference in detection rates of STI.ResultsThe study included 22,291 encounters with 11,732 in the pre-implementation and 10,559 in the post-implementation phases. The C. trachomatis detection rates were 7.5% pre-implementation and 7.6% post-implementation (between-group difference, 0.1 percentage points; 95% confidence interval [CI]: −0.7, 0.4; p<.01 for non-inferiority). The N. gonorrhoeae detection rates were 3.1% pre-implementation and 3.6% post-implementation (between-group difference, 0.5 percentage points; 95% CI: −0.8, 0.04; p<.01 for non-inferiority).ConclusionUsing vaginal swabs for STI testing in the ED may be a non-inferior alternative to using endocervical swabs.

Molecular Genotyping of Chlamydia trachomatis in Iraqi Married Pregnant and Non-Pregnant Women.

It has been approved that the infection caused by Chlamydia trachomatis (C. trachomatis) is one of the major causes of infertility and adverse birth outcomes in populations. The C. trachomatis epidemiology among childbearing-age women in Iraq has not been recognized yet. This study aimed to detect the prevalence of C. trachomatis infection among pregnant and non-pregnant women using the polymerase chain reaction (PCR) assay and phylogenetic analysis of local isolates. In total, 200 endocervical swabs were collected from adult married pregnant (n=100) and non-pregnant women (n=100) from June to July 2021. Targeting the omp1 gene, 9% of the total samples were positive for C. trachomatis, and significant increases were reported among non-pregnant compared to pregnant women. The PCR products of five positive local isolates were selected randomly, sequenced, and documented in the National Centre for Biotechnology Information (NCBI) with the accession numbers OK094104.1, OK094105.1, OK094106.1, OK094107.1, and OK094108.1. Analysis of the homology sequence of the local and NCBI-BLAST isolates revealed a significant association with the Russian (MF288585.1) isolate. Statistical analysis of reproductive data revealed a higher prevalence, odds ratio (OD), and risk in asymptomatic, compared to symptomatic cases. Although no significant variation was detected in prevalence rate among single and multiple symptomatic women, increases were observed in OD values and risk of multiple symptomatic women. Reportedly, chronic pelvic pain was more prevalent than pelvic inflammatory diseases, ectopic pregnancy, and infertility in single symptomatic women. Regarding the demographic characteristics (i.e., age, the place of residence, and occupation), prevalence and risk of infection were higher in women who were <30 years, lived in urban areas, and had a job, compared to women who were ≥30 years, lived in suburban and rural areas, and had a free job. In conclusion, the course of chlamydial infections is usually unpredictable, diverse, and asymptomatic and has remained almost unrecognized. Therefore, PCR-based methods can apply successfully to detect C. trachomatis in both pregnant and non-pregnant women.

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

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

Isolation of multidrug-resistant Escherichia coli and Klebsiella pneumoniae from urogenital samples of patients with Pelvic inflammatory disease in North Central Nigeria

Background: Pelvic inflammatory disease (PID) is one of the most prevalent gynaecological abnormalities associated with the female reproductive organs and infertility among women in the reproductive ages. This study was conducted to determine the prevalence of multidrug-resistant (MDR) bacteria isolated from patients with PID attending three hospitals in Niger State, Nigeria. Methods: A total of 390 samples; endocervical swabs (ECS) and urine samples were collected from 390 patients, using sterile swab sticks and sample containers. Screening for the presence of Klebsiella pneumoniae and Escherichia coli was done using the streak method of inoculation on Nutrient agar and Macconkey agar. Isolates of K. pneumoniae and E. coli were identified through Gram staining and other biochemical tests. The antibiotic susceptibility profile of the isolates to ten (10) commonly prescribed antibiotics was determined using the Kirby-Bauer disc diffusion method on Mueller-Hinton agar. Results: A total of 51(21.3%) and 57 (23.8%) K. pneumoniae and E. coli isolates were obtained from both ECS and urine respectively. The antibiogram showed that 35(68.6%) K. pneumoniae isolates and 32(56.1%) E. coli isolates out of 108 bacteria isolated, expressed multidrug-resistant characteristics, and were resistant to more than three (3) classes of antibiotics. The multidrug-resistant Klebsiella pneumoniae and Escherichia coli exhibited resistance above 70% to ofloxacin, nalidixic acid, ampicillin, gentamicin, pefloxacin, streptomycin and cephalexin. Conclusion: The results of this study confirmed a high presence of multidrug-resistant Klebsiella pneumoniae and Escherichia coli in pelvic inflammatory disease (PID) patients attending tertiary hospitals in North Central Nigeria, hence there is a need for public health workers, to create awareness on the misuse of antibiotics, to prevent and curtail treatment failure due to antibiotic resistance