Genital Infections In Women Research Articles

Effect of blue light emitting diode therapy on recurrent vulvovaginal candidiasis: A randomized assessor-blinded controlled trial.

Vulvovaginal Candidiasis (VVC) is a prevalent genital infection in women of reproductive age and requires effective non-drug therapies. Therefore, this study aimed to investigate the effect of blue light emitting diode (LED) therapy as an alternative treatment for recurrent VVC due to its proven antimicrobial properties. The safety and non-invasiveness of LED therapy make it a promising option for sensitive tissue applications. This randomized controlled trial recruited 60 women with culture-confirmed VVC. Participants were randomly allocated to two groups. Group A (control group) received standard antifungal treatment with Gynoconazol 0.8% vaginal cream for three consecutive nights (n=30). Group B (study group) received the same antifungal treatment plus two 60-min sessions of blue LED therapy directed at the vagina and vulva, with the sessions separated by two days (n=30). Candida count (via CHROMagar™ Candida) and vaginal pH (via AD110-AD111m) were assessed at baseline and one week after initiating treatment. Post-treatment, group (B) demonstrated a significantly greater reduction in Candida count compared to group (A) (mean difference (MD) 8.267; 95% Confidence Interval (CI) 6.723-9.811; p=0.0001). However, there was no statistically significant difference in vaginal pH between the groups (MD -0.03; 95% CI -0.244-0.178; p=0.749). Blue LED therapy effectively reduces Candida count in women with recurrent VVC without adversely affecting the vaginal pH, highlighting its safety and efficacy as a treatment modality.

The role of bacterial genital infections in spontaneous preterm delivery: a case-control study.

Spontaneous preterm delivery is defined as the beginning of the birth process before the 37th week of pregnancy. The presence of microorganisms in the fetal membranes is accompanied by an increase in the production of prostaglandin, one of the important factors associated with the prevalence of preterm birth. The invasion of microorganisms leads to the production of protease, coagulase, and elastase, which directly stimulate the onset of childbirth. We investigated the role of genital infections in women with preterm birth. The present case-control study was conducted in the west of Iran on 100 women with spontaneous preterm delivery (following 24 weeks of gestation and before 36 weeks and 6 days) as the case group and 100 women with normal delivery as controls. A questionnaire was applied to collect the data. Polymerase chain reaction and pathological examination of the placenta were performed. The average age in women with normal delivery (30.92 ± 5.10) in women with spontaneous preterm delivery (30.27 ± 4.93). The prevalence of Chlamydia trachomatis, Neisseria gonorrhea, Listeria monocytogenes, and Mycoplasma genitalium infections was zero in both groups. The highest prevalence of Gardnerella vaginalis was 19 (19%) in the case group and Ureaplasma parvum 15 (15%) in the control group. Also, Placental inflammation was zero in controls and 7(7%) in the patient group. There was a significant relationship between Gardnerella vaginalis bacteria and spontaneous preterm delivery. The results of our study showed that except for Gardnerella vaginalis bacteria, there is no significant relationship between the above bacterial infections and spontaneous preterm birth. Moreover, despite the significant reduction in the prevalence of many sexually transmitted infections in this research, it is still suggested to increase the awareness of people, including pregnant women, about the ways it can be transmitted by gynecologists and health and treatment centers.

IFNγ insufficiency during mouse intra-vaginal Chlamydia trachomatis infection exacerbates alternative activation in macrophages with compromised CD40 functions

Chlamydia trachomatis (C.tr), an obligate intracellular pathogen, causes asymptomatic genital infections in women and is a leading cause of preventable blindness. We have developed in vivo mouse models of acute and chronic C. trachomatis genital infection to explore the significance of macrophage-directed response in mediating immune activation/suppression. Our findings reveal that during chronic and repeated C. trachomatis infections, Th1 response is abated while Treg response is enhanced. Additionally, an increase in exhaustion (PD1, CTLA4) and anergic (Klrg3, Tim3) T cell markers is observed during chronic infection. We have also observed that M2 macrophages with low CD40 expression promote Th2 and Treg differentiation leading to sustained C. trachomatis genital infection. Macrophages infected with C. trachomatis or treated with supernatant of infected epithelial cells drive them to an M2 phenotype. C. trachomatis infection prevents the increase in CD40 expression as observed in western blots and flow cytometric analysis. Insufficient IFNγ, as observed during chronic infection, leads to incomplete clearance of bacteria and poor immune activation. C. trachomatis decapacitates IFNγ responsiveness in macrophages via hampering IFNγRI and IFNγRII expression which can be correlated with poor expression of MHC-II, CD40, iNOS and NO release even following IFNγ supplementation. M2 macrophages during C. trachomatis infection express low CD40 rendering immunosuppressive, Th2 and Treg differentiation which could not be reverted even by IFNγ supplementation. The alternative macrophages also harbour high bacterial load and are poor responders to IFNγ, thus promoting immunosuppression. In summary, C. trachomatis modulates the innate immune cells, attenuating the anti-chlamydial functions of T cells in a manner that involves decreased CD40 expression on macrophages.

Genital Infections and Associated Risk Factors in Women on Contraception Monitored at the Bacteriology and Virology Laboratory of Aristide Le Dantec Hospital

Background: Contraception is a strategy of choice for spacing births but also for avoiding early and unwanted pregnancies. However, through hormonal modification, this contraception constitutes a favorable state for the proliferation in the genital tract of agents responsible for vaginal infections. The objective of this study was to evaluate the prevalence of genital infections in women on contraception followed up at the bacteriology-virology laboratory of Aristide Le Dantec Hospital.
 Methods: This is a retrospective descriptive study conducted over a one-year period between January 2019 and December 2020. Microbial assessemnets were performed on genital secretions according to standard bacteriology laboratory procedures. Sociodemographic data and bacteriological examination results obtained were entered using File Maker Pro Advanced (version 16) software. Statistical analyses were performed using SPSS software (version 20).
 Results: This research studied 1771 women, of whom 1609 were on contraceptives. The most represented age group was over 40 years (27.06%). The majority of patients were women on oral contraceptives (32.07%). Women with secondary education (31.45%) and women with 1 to 3 children (43.03%) were most often on contraception. The germs most frequently detected in women on contraception were Gardnerella vaginalis (51.78%) and Candida albicans (24.19%) and the use of intrauterine device (IUD) as a means of contraception was statistically associated with vaginal infection (p=0.0004).
 Conclusion: This study showed a high frequency of vaginal infections in women on contraception and that the intrauterine device was significantly associated with the occurrence of these infections.

Role of Colposcopy to Detect Genital Infection in Women in Goma City, Democratic Republic of Congo

Role of Colposcopy to Detect Genital Infection in Women in Goma City, Democratic Republic of Congo

Factors Affecting The Success Of Vaginitis Treatment In Pregnant Women ; A Prospective Cohort Study

Introduction
 Anatomy, physiology, and flora of the female genital system change due to pregnancy-related hormonal, metabolic, endocrinological, and immunological reasons. Dysbiosis increases the risk of spontaneous preterm birth with chronic inflammatory processes by causing infections in the fetoplacental unit by the ascending or hematogenous route. 
 Our study aimed to reveal the bad personal habits and practices predispose to vaginitis, create resistance to treatment, and cause recurrences in pregnant women with vaginitis. 
 
 Material-Methods
 Our descriptive study was conducted on a group of patients who applied to the Department of Obstetrics and Gynecology, between December 2021 and April 2022, with the ethics committee's approval. Our study group consists of 178 pregnant women over 18 who are literate, cooperative, and volunteered to answer all the questions in the questionnaire.
 
 Results
 Vaginal douching in 71.9% (128 people) of the participants, not ironing their underwear at all in 67.4% (120 people), cleaning the perineum from back to front in 66.9% (119 people), 61.2% daily pad use in 61.2% (109 people), synthetic laundry use in 41% (73 people), use of genital cleaning products in 16.3% (29 people), hand washing underwear in 7.3% (13 people) and 5.6% (10 people) had frequent sexual intercourse behavior. Regarding genital area cleaning, 11.2% (20 people) of the patients knew about using white vinegar, and 3.4% (6 people) used the acidic mixture. 6.7% (12 people) of the participants knew the use of vaginal probiotics.
 Conclusion
 Considering the results of our study, it can be said that wrong practices regarding genital hygiene continue, especially in women from low socio-economic and cultural levels.
 In this respect, the women need training on genital hygiene as a preventive measure due to the mistakes they make in practice related to genital hygiene and the possibility of experiencing a genital infection in a significant part of them.
 In conclusion, considering that the most significant deficiency in the occurrence of genital infections in women is the lack of education, it is recommended that all health professionals develop a training plan to prevent genital infections and apply it to women in the regions they work.

Chlamydia trachomatisinfection renders M2 generation to mediated immunosuppression.

Abstract Chlamydia trachomatis (C.tr) cause asymptomatic genital infections in women and is also a leading cause of preventable blindness. Limited mouse model of chronic C.tr infection are available to study the host immune response. We have developed BALB/c mice models of acute and chronic infections for C. trachomatisto explore the significance of macrophage-directed response in mediating immune activation/suppression. We observed that chronic and repeated infections accompanied abbrogated IFN-g and promoted enhanced TGF-β and IL-10 secretion. The signs of T cell exhaustion and anergy were also indicated during chronic and secondary infection. This skewed T cell response was established to be the regulated by alternatively-activated macrophages with low CD40 expression leading to sustained C. trachomatis genital infection. Macrophages under the influence of C. trachomatis infection or its secretome demonstrate an M2-macrophage subset phenotype which responded poorly to IFN-g owing to decreased IFNg-RI and IFNg-RII expression which correlated with decreased expression/release of MHC-II, CD40, iNOS and NO even following IFN-g treatment. Alternatively-activated M2 macrophages with low CD40 expression harbored high bacterial load and rendered the generation of immunosuppressive Th2 and Treg cells. Thus, C. trachomatis modulate the innate immune cells attenuating the anti-chlamydial functions of T cells in a manner that involves alleviated CD40 expression on macrophages.

Intravaginal Practices and Genital Infections: A Cross Sectional Study in the Yaoundé University Teaching Hospital

Cultural beliefs and educational factors strongly influence intravaginal practices of women in Sub Saharan Africa. These behaviors appear common in different population across Africa. Previous research has suggested that vaginal douching modifies vaginal flora and was associated with genital infections. The aim of this study was to evaluate the contribution of intravaginal practices in the acquisition of genital infections in women. For bacterial vaginosis diagnosis, vaginal smears were heat-fixed and Gram-stained then examined by light microscopy the results were interpreted by using a standardized method for diagnosing bacterial vaginosis, as described by Nugent. The mycological examination consisted of culturing on the CHROM agar Candida medium the vaginal swabs. The results were as follows: The majority of respondents were in the age group of 29-39 years (44%). The majority of participants were students with a prevalence of 42.60%. The results showed that 71% of women performed intravaginal practices and the most used vaginal practice was scraping the vaginal walls with the fingers (69.2%). Women with University level of education were statistically more adept at these practices (55.0%) than women with secondary level of education (30.8%) and primary level (14.2%) respectively, and the difference was significant (P<0.05).The prevalence of vaginal candidiasis in female who did intravaginal practices was higher (64.7%) than in those who did not do intravaginal practices (35.3%). Same result was observed with bacterial vaginosis which was more common in women who did intravaginal practices (76.6%). However, no significant association was found between intravaginal practices and the occurrence of vaginal candidiasis and bacterial vaginosis in women (P>0.05). Women who performed intravaginal practices were more co-infected with vaginal candidiasis and bacterial vaginosis (20.72%) than those who did not (10.34%); but the difference was not significant (p> 0.05). Intravaginal practices expose women to genital infections.

Screening for Low-Tract Genital Infections in Women with Threatened Preterm Labor: Which Role?

Objectives: The aim of this study was to evaluate the possible relationship between cultural specimens and preterm birth in women admitted for threatened preterm labor. Preterm birth is the leading cause of neonatal mortality and antenatal hospitalization; several risk factors including intrauterine infections have been identified, but its real causes remain poorly understood. Design: This is a retrospective, multicenter, cohort study including 250 women admitted for threatened preterm labor. Methods, Participants/Materials, Setting: All women admitted for threatened preterm labor, i.e., presenting with cervical changes and uterine activity before 37 weeks at the obstetrics unit of the hospitals of Modena, Monza, Carate, and Vimercate were included in the study. We excluded twin pregnancies and cases with preterm premature rupture of membranes at admission. Data about maternal history, pregnancy complications, cervical length, vaginal swabs, and urine culture at admission and gestational age at delivery were collected from clinical records in order to compare the incidence of preterm birth according to some known risk factors, cervical length, and microbiological test at admission. Results: 250 women were included in the study; preterm birth at less than 37 weeks occurred in 44.4% women admitted for threatened preterm labor. The incidence of preterm birth was not different between those with a positive or a negative vaginal swab (48.3 vs. 38.4%, p = 0.22) or positive versus negative urine culture (31.8 vs. 42.1%, p = 0.23) at admission. A shorter cervical length at admission was found in women with subsequent preterm birth (17 vs. 19.5 mm, p = 0.03). Cervical length <15 mm (OR 1.82, 95% CI: 1.03–3.23, p = 0.039) predicted the risk of preterm birth. Furthermore, only the history of a previous preterm birth (p = 0.02) and a previous uterine curettage (p = 0.045) was associated with preterm birth. Limitations: The observational and retrospective nature of the study and its small sample size are important limitations of the study. Moreover, women were not systematically or randomly assigned to the screening for vaginal or urinary infections. Conclusions: There is no evidence that the search for vaginal or urinary infections in women admitted for threatened preterm labor is helpful to identify those at increased risk of preterm birth. Although several studies have explored the role of screening for bacterial vaginosis in asymptomatic women and some studies evaluated vaginal or urinary infections in women with preterm birth, none of them focused on the possible role of microbiological specimens as a predictive tool in women admitted for threatened PTL. No association was found in our study, but prospective randomized controlled trials are required to confirm the results of this observation.

The prevalence of gonococcal and non-gonococcal infections in women referred to obstetrics and gynecology clinics.

Bacterial vaginosis is a condition caused by changes in the vaginal microbial ecosystem and increases the risk of preterm delivery, premature rupture of membranes, endometritis, and weight loss of the baby. This study aimed to evaluate the frequency of gonococcal and non-gonococcal genital infections in women referred to clinics in Ilam, Iran. Two swab samples were taken from each patient using a sterile swab, one swab was placed in a THB medium for the culture of Streptococcus agalactiae and the other in PBS buffer for PCR. PCR method was conducted for the identification of the other bacterial agents such as Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, and also S. agalactiae. Sampling was performed on 169 women with symptomatic vaginosis. The frequency of S. agalactiae by culture and PCR methods was 4.7% (8 samples) and 13.6% (23 samples) respectively. Also, 6.5% (11 samples), 3.5% (6 samples), 4.1% (7 samples), 1.2% (2 samples), and 0% of the samples were positive for N. gonorrhoeae, M. genitalium, M. hominis, U. urealyticum and C. trachomatis by PCR method. Except for a significant association between S. agalactiae colonization and abortion, there was no significant correlation between the prevalence of these bacteria and the patient's age, age of marriage, number of deliveries, and number of abortions. Overall, the prevalence of gonococcal and non-gonococcal infection in women referred to clinics in Ilam is similar to the other parts of Iran.

Lower Genital Infections: Which Germs Cause? At the Obstetrics Gynecology Service of the Reference Health Center of the Commune of Kalaban – Coro Circle of Kati Mali

Introduction This study was the first at the level of the obstetrics gynecology department of the Reference Health Center (CSRef) of Kalaban-coro Kati Mali. The objective was to determine the profile of the pathogenic germs identified and their proportion in case of imbalance of the vaginal flora in the genesis of lower genital infections in women at the level of our service. Methods: This was a descriptive study of the cross-sectional survey type which took place in the gynecology department of the Reference Health Center (CSRef) in the municipality of Kalaban – coro circle of Kati Koulikoro Mali. The study extended over a period of 12 months from February 2015 to January 2016 and involved patients seen in outpatient gynecology at our Center. The size of our sample consisted of 90 patients who agreed to participate in our study. The data was collected through a previously established survey form. Word processing was processed on World 2007 software and data entry and analysis were performed on SPSS 23.0 fr software. The statistical test used was the Chi2 considered significant when P&lt;0.05. Results: The frequency of genital infections was 10.01%. The most represented age group was 20 to 35 years old with 61.1%. The main germs identified were respectively: Candida albicans, Escherichia coli, Klebsiella and Gram-negative Bacilli with 16.7%, 15.7%, 13.4% and 11.1% respectively. Conclusion: At the end of this study, we found that the most frequent germs of lower genital infections were mainly represented by: Candida albicans, Escherichia coli, Klebsiella and Gram-negative bacilli.

MO636: How to Prevent Genital Infections in Post-Menopausal Women with Type 2 Diabetes Mellitus Upon Initiation of Sodium–Glucose Cotransporter-2 (SGLT2) Inhibitors: A Real-Life Multi-Center Observational Study

Abstract BACKGROUND AND AIMS Patients with type 2 diabetes mellitus (T2DM) often discontinue sodium–glucose cotransporter-2-inhibitors (SGLT2 i) despite high efficacy and safety due to genital infection (GI). SGLT2i, also called gliflozins, represent the newest class of anti-hyperglycemic agents [1] whose effects depend on the ability to dramatically reduce the threshold for maximum glucose tubular resorption rate in patients with type 2 diabetes mellitus (T2DM), with consequently enhanced glycosuria. Due to elevated urinary glucose output, T2DM increases the risk for urinary tract infections (UTIs) and non-sexually transmitted genital infections (GIs) [15]. Massive glycosuria might, indeed, already cause commensal genital microorganism overgrowth in people with T2DM [16] and is likely to increase the risk for GIs and UTIs when further aggravated by SGLT2i. To assess real-life GI risk profile in post-menopausal T2DM patients educated on strict hygiene-based prevention practices (SHBPPs) due to their intrinsic GI susceptibility. METHOD 21 post-menopausal T2DM patients willing to follow SHBPPs were randomly assigned to three different SGLT2-Is (intervention group, IG, n = 318) or other drugs (control group, CG, n = 403) for 3 months. Before and after treatment, they underwent routine lab tests and completed a specific questionnaire. The present study was carried out by a network of five identically organized outpatient diabetes care units (DCUs) previously documented to attain the same performance levels and to come from a single institution. For the study, we specifically prepared the Female Genital Infection Symptoms Questionnaire (FGISQ) based on GIPR recommendations and checked for appropriate question comprehension and answer concordance as described below by previously administering it to 40 post-menopausal women with T2DM three times at 5-day intervals. Answer concordance was 97%. Based on a specific nurse’s inquiry and help request rate by patients completing the test, question comprehension was 98%. FGISQ consisted of sections A and B (Figure 1/A and 1/B). In greater detail, we changed question n.5 from Section A by considering that some women had Figure 1A: Female Genital Infection Symptoms Questionnaire. Part A (FGISQ-A) is addressed to the general prevention recommendations of GIs in women, taken from the recommendations (reference number 28, and Supplementary data, Table S1A, supplementary material), only six of which have been transformed into general questions. Part B (FGISQ-B), investigating GI symptoms and sexual habits is unscored and resumes GIPR questions 5 and 8 (see supplementary material), kept sexually active, and question n.8 to assess the intensity of eventually occurring GI symptoms. We also refrained from formulating any question related to recommendation n.9 as useless (all were post-menopausal, indeed). RESULTS: GIs more often occurred (9.6%; P &amp;lt; 0.001) among IG women non-adhering to SHBPPs (41.5%) versus the 2.9% of adhering ones. Conversely CG women had superimposable GI rates (2.7% versus 3.1%, respectively, p n.s.) whether or not adhering to SHBPPs (51.4% versus 49.6%, respectively, p n.s.). The typical profile of women on SGLT2-Is at higher risk for GIs included (i) poor adherence to SHBPPs, (ii) older age, (iii) higher BMI, (iv) poor glucose control as witnessed by high HbA1c levels, and (v) antihypertensive drug utilization. CONCLUSION Physicians should consider the importance of strict hygiene control in their post-menopausal T2DM patients undergoing SGLT2-I treatment and thus utilize better-focused education strategies in that specific subgroup to prevent or rehabilitate from repeated GIs.

A Syndemic Approach to Explore Factors Associated with Bacterial Vaginosis.

Bacterial vaginosis (BV) is the most common genital infection in women and is associated with an increased risk of sexually transmitted infections and HIV. This study uses a syndemic approach to evaluate factors associated with BV. Non-pregnant, HIV-negative, sexually active, cis-gender women aged 18-45 years living in Miami, Florida were recruited from Nov.2018- Jun.2021. Participants completed a sociodemographic and behavioral questionnaire along with gynecological examinations. BV was diagnosed by Amsel criteria and confirmed by a Nugent score ≥ 4. A syndemic score was calculated as the sum of factors associated with BV. The association between syndemic score and BV was assessed using logistic regression. Of 166 women included, 60.2% had BV. Race, ethnicity, education, vaginal sex, recent cannabis use, and reasons for intravaginal practices were included in the syndemic score. Higher odds of BV were found in women with a score of ≥ 3 compared to women with a score of 0/1. A higher syndemic score was associated with increased odds of having BV. Multilevel interventions to decrease BV are needed to decrease women's risk of acquiring HIV.

Inhibitory effects of Lactobacillus casei Shirota against both Candida auris and Candida spp. isolates that cause vulvovaginal candidiasis and are resistant to antifungals

BackgroundVulvovaginal candidiasis (VVC), the second leading cause of genital infection in women of reproductive age, is caused by yeasts of the genus Candida. Treatment is usually empirical and performed with azoles, which have shown increasing ineffectiveness due to resistance from these species. This therapeutic challenge has led to the search for new treatment strategies. Lactobacillus spp. produce several components with microbicidal effects, such as lactic acid. These species are the main components of a healthy vaginal microbiota and have been used as probiotics. The aim of this work was to investigate the in vitro inhibitory effects of Lactobacillus casei Shirota on both the Candida spp. that cause VVC and on C. auris.MethodsThe microbicidal effects of L. casei Shirota on the main VVC-causing species, C. albicans, C. tropicalis, C. norvegensis and C. parapsilosis, in addition to C. auris were investigated by counting the Colony-forming Units (CFUs) after cocultivation. The antifungal activity of lactic acid against these Candida strains was assessed using the microtiter broth dilution method to determine the minimum inhibitory concentrations (MICs). The effects of L. casei Shirota on hyphal and early biofilm formation was measured by optical microscopy.ResultsL. casei Shirota showed inhibitory action against all tested Candida spp., ranging from 66.9 to 95.6% inhibition depending on the species. This inhibition is possibly related to the production of lactic acid, since lactic acid has shown microbicidal action against these same Candida spp. at a concentration of 5 mg/mL, which corresponds to half of the normal physiological concentration. In addition, L. casei Shirota was able to reduce the formation of C. albicans hyphae and early biofilms, showing strong anti-Candida effects.ConclusionsThese results suggest that L. casei Shirota has antifungal activity against the Candida species that cause VVC. L. casei also has microbicidal action against C. auris.

Mycoplasma genitalium, en route vers la multirésistance !

AbstractMycoplasma genitalium is a urogenital mycoplasm not belonging to the genital commensal flora. It is a proven agent of sexually transmitted infections (STIs), responsible for urethritis in men, cervicitis and more rarely upper genital infections in women. However, a majority of infections remain asymptomatic. Its prevalence of 1 to 3% in the general population can rise to 35% in specialized STI centers. The detection of M. genitalium is done only by molecular biology but should be performed only in the case of symptomatic infection. Only a few molecules among the macrolides, tetracyclines and fluoroquinolones are active. In recent years, acquired resistance to macrolides, first-line antibiotics, has been increasing sharply worldwide. This resistance reached nearly 35% in France in 2019. It is therefore recommended to search for macrolide resistance at the same time as the detection of M. genitalium. Minute treatment with azithromycin 1g should not be used onM. genitalium. A 5-day treatment with azithromycin is recommended in the absence of macrolide resistance. Resistance to moxifloxacin, a second-line antibiotic, is also increasing, measured at 15.6% in France in 2019. Faced with the risk of therapeutic deadlock in the event of double resistance, M. genitaliumis now on the “Watch list” of the U.S. Center for Diseases Control.

670. Rapid, Non-invasive Detection of Invasive Mycoplasma hominis Infection using the Karius Test, A Next-Generation Sequencing Test for Microbial Cell-free DNA in Plasma

Background Mycoplasma hominis is typically associated with genital infections in women and is a rare cause of musculoskeletal infections often in immunocompromised hosts. Diagnosis of invasive Mycoplasma hominis infections are difficult due to challenges in culturing these organisms. Molecular diagnostics require an index of suspicion which may not be present at the time of tissue sampling. Accurate, rapid diagnosis of Mycoplasma hominis infections are important for antibiotic management.MethodsTwo cases of invasive Mycoplasma hominis infections are presented in which the Karius test (KT) was used to make the diagnosis. The KT is a CLIA certified/CAP-accredited next-generation sequencing (NGS) plasma test that detects microbial cell-free DNA (mcfDNA). After mcfDNA is extracted and NGS performed, human reads are removed and remaining sequences are aligned to a curated database of > 1400 organisms. Organisms present above a statistical threshold are reported. Case review was performed for clinical correlation.ResultsA young woman with lupus nephritis status post renal transplant developed persistent fever with progressive multifocal culture-negative osteoarticular infection despite empiric ceftriaxone. An adolescent female presented with an ascending pelvic infection progressing to purulent polymicrobial peritonitis (see table) requiring surgical debridement and cefipime, metronidazole and micafungin therapy; her course was complicated by progressive peritonitis/abscesses. Karius testing detected high-levels of Mycoplasma hominis mcfDNA in both cases – at 3251 molecules/microliter (MPM) in the first case and 3914 MPM in the second case. The normal range of Mycoplasma hominis mcfDNA in a cohort of 684 normal adults is 0 MPM. The patients rapidly improved with atypical coverage with doxycycline and levofloxaxin.Clinical findings in 2 patients with M. hominis infection detected by the Karius Test ConclusionOpen-ended, plasma-based NGS for mcfDNA provides a rapid, non-invasive method to diagnose invasive Mycoplasma hominis infection. This case series highlights the potential to diagnose infections caused by fastidious pathogens to better inform antimicrobial therapy and achieve favorable outcomes.DisclosuresWilliam V. La Via, MD, Karius (Employee)

SUN-618 Decision Analysis for Glucagon-Like Peptide Receptor Agonists vs. Sodium-Glucose cotransporter2 Inhibitors in Type 2 Diabetes Mellitus

Background: Cardiovascular outcome trials (CVOT) of glucagon-like peptide-1receptor agonists (GLP-1 RA) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) demonstrated reduction of major adverse cardiovascular events (MACE), cardiovascular deaths (CVD), and renal outcomes (RO). Objective. Evaluation of data to assist in the prescribing decision with regard to severity of illness and risk for adverse events. Study Design: Systemic review of the major CVOT and previous meta-analyses. Main Outcome Measures: Analysis of six trials on GLP-1 RA and 4 trials on SGLT2i, showed both drug classes reduced MACE and CVD compared to controls, with neither class preferred (comparison GLP1-RA vs SGLT2i: (relative rate, rr MACE= 1.09, 95%CI;0.98,1.22, p= 0.129; rr, CVD =1.04, CI;0.87,1.24, p=0.657). Hospitalization for heart failure (HHF) improved with SGLT2i (rr=0.68, CI; 0.61,0.76, p<0.001) but not with GLP-1 RA, (rr = 0.94, CI; 0.86,1.03, p=0.17). Both GLP-1 RA and SGLT2i showed significant reduction in RO (GLP-1RA, rr=0.83, CI; 0.75,0.912, p=<0.001, SGLT2i, rr=0.0.67, CI; 0.57,0.79, p=0.001) without a preferential difference between the classes (GLP-1 RA vs SGLT2i, relative difference (rd) =0.005, CI;-0.011,0.021, p=0.532, number needed to treat (NNT)=200). Serious adverse events (SAE) for SGLT2i were predominantly mycotic genital infections in women (number needed to harm (NNH) =13 and diabetic ketoacidosis NNH=595. Gastrointestinal intolerance was the major SAE in the GLP1-RA class (NNH=35). Conclusion: Both GLP-1 RA and SGLT2i classes showed similar reduction in MACE, CVD, and RO. SGLT2i have advantages over GLP-1 RA in reduction in HHF especially in those with more severe cardiovascular disease risk.

&lt;I&gt;Vulvovaginal candidasis&lt;/I&gt; among female patients attending Yusuf Dantsoho Memorial Hospital and Barau Dikko Specialist Hospital Kaduna

Vulvovaginal candidiasis (VVC) is a major cause of lower genital infections in women, especially in developing countries and cause significant morbidity and financial burden on the already weak economy. The objective was to isolate and identify Candida spp responsible for Vulvovaginitis. Two hundred (200) vaginal swabs were collected from female patients 15years and above, attending Yusuf Dantsoho Memorial Hospital (YDMH) and Barau Dikko Specialist Hospital (BDSH) all within Kaduna metropolis. The samples were analysed for the presence of Candida spp using standard procedures of microscopy, culture and biochemical identification. The overall incidence of VVC was 79.5% (159/200), with higher incidence among patients attending Yusuf Dantsoho Memorial Hospital 84.8% (117/138), than Barau Dikko Memorial Hospital 67.7% (42/62). Four (4) yeast species were isolated and identified which include Candida krusie, Candida parapsilosis and Candida glabrata. C. krusie had the highest percentage occurrence of 42.5% (39/159), while C. parapsilosis had the least percentage occurrence of 11.3% (18/159). Higher incidence was recorded among age group 40 and above 92.8% (13/14) and lowest among age group 31-40 76.5% (39/51). Highest incidence was also recorded among widow 100% (18/18) and lowest among married 76.8% (109/142). The high percentage of positive samples is an indication that there is a high incidence of candidiasis among the study population. There is need for regular screening of women for VVC and other sexually transmitted infections.&#x0D; Key words: Incidence, Vulvovaginal Candidiasis, Isolation, Kaduna.

Glucagon-like Peptide-1 Receptor Agonists versus Sodium-Glucose Cotransporter Inhibitors for Treatment of T2DM.

ContextCardiovascular outcome trials (CVOT) of glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) demonstrated reduction of major adverse cardiovascular events (MACE), cardiovascular deaths (CVD), and renal outcomes.ObjectiveAssist in the prescribing decision regarding severity of illness and risk for adverse events.DesignMeta-analysis of the major CVOT and previous meta-analyses.Main Outcome MeasuresSix trials of GLP-1 RA (51 762 subjects) and 4 trials of SGLT2i (33 457 subjects) showed both drug classes reduced MACE and CVD versus controls, with neither class preferred (comparison GLP1-RA vs SGLT2i: relative rate [rr] MACE 1.04, 95% confidence interval [CI] 0.94, 1.16, P = ns; rr CVD 1.04, 95% CI 0.87, 1.24, P = ns). Hospitalization for heart failure (HHF) improved with SGLT2i (rr 0.68, CI 0.61, 0.76, P < 0.001) but not with GLP-1 RA, (rr 0.93, CI 0.86,1.03, P = ns). Meta-regression suggested benefits of the SGLT2i on CVD and HHF were accentuated with the underlying rate of MACE in the cohort (i.e., >10 events/1000pt*year). GLP-1 RA and SGLT2i showed reduction in renal outcomes (GLP-1 RA rr 0.83, CI 0.75, 0.91, p ≤ 0.001, SGLT2i rr 0.67, CI 0.57, 0.79, P < 0.001) without a preferential difference (GLP-1 RA vs SGLT2i, rr 1.24, CI 0.95, 1.61, P = ns; relative difference (rd) 0.005, CI -0.011, 0.021, P = ns). Serious adverse events for SGLT2i were mycotic genital infections in women (number needed to harm [NNH] = 13 and diabetic ketoacidosis NNH = 595. Gastrointestinal intolerance was the serious adverse event in the GLP1-RA class (NNH = 35).ConclusionGLP-1 RA and SGLT2i classes showed similar reduction in MACE, CVD, and renal outcomes. SGLT2i have advantages over GLP-1 RA in reduction in HHF.

Genital infections and reproductive complications associated with Trichomonas vaginalis, Neisseria gonorrhoeae, and Streptococcus agalactiae in women of Qom, central Iran

Trichomonas vaginalis (T.vaginalis) and Neisseria gonorrhoeae (N.gonorrhoeae) are two most common non-viral sexually transmitted infections in the world. No data are available regarding the epidemiology of genital infections in women of Qom, central Iran. Epidemiological investigation of sexually transmitted infections in genital specimens of women referred to the referral gynecology hospital in Qom, central Iran. Genital swab specimens were collected from women volunteers and used for identification of bacterial and protozoal infections by conventional microbial diagnostics, porA pseudo gene LightCycler® real-time PCR (for N.gonorrhoeae) and ITS-PCR (for T.vaginalis). Of 420 volunteers, 277 (65.9%) had genital signs/symptoms, including 38.3% malodorous discharge, 37.9% dyspareunia, and 54.8% abdominal pain. Totally, 2 isolates of Streptococcus agalactiae were identified. Five specimens (1.2%) in Thayer-Martin culture and 17 (4.1%) in real-time PCR were identified as N.gonorrhoeae. Fifty-four specimens (12.9%) in wet mount, 64 (15.2%) in Dorset's culture, and 81 (19.3%) in ITS-PCR showed positive results for T.vaginalis. Five mixed infections of T.vaginalis+ N.gonorrhoeae were found. The risk of T.vaginalis infection was increased in women with low-birth-weight (p=0.00; OR=43.29), history of abortion (p=0.00; OR=91.84), and premature rupture of membranes (PROM) (p=0.00; OR=21.75). The probability of finding nuclear leukocytes (p=0.00; OR=43.34) in vaginal smear was higher in T.vaginalis infection. The significant prevalence of trichomoniasis and gonorrhea emphasizes the need for accurate diagnosis and effective surveillance to prevent serious reproductive complications in women.