Genital Inflammation Research Articles

A young patient with chronic epididymal-orchitis develops testicular ischemia: a serious complication of a common disorder

BACKGROUND AND AIM: Rare complications of acute epididymitis include ischemia and infarction of the testicles. Both clinically and radiologically, it is challenging to distinguish from testicular torsion. The project aims to increase the radiologist's digital picture library to facilitate a prompt and accurate differential diagnosis. This instance emphasizeshow crucial it is to perform a comprehensive radiological assessment and how a multidisciplinary approach is necessary to guarantee an accurate diagnosis. METHODS: A 24-year-old man experienced severe left testicular pain; he didnt come to the Emergency Department while the clinical situation was acute; but two weeks after he came to the Hospital, arrived at the Radiology Department, and reported that he had painful ejaculation, pain during intercourse (dyspareunia), redness/swelling at the scrotal level, genital inflammation, chills, swollen inguinal lymph nodes, dysuria and still today he has a few pains at scrotal region. All diagnostic procedures are done: first US and after MRI was required by the urologist. RESULTS: The results of the imaging show that he had left testicular ischemia, and a chronic orchid-epididymitis was suspected cause the clinic was positive. So, the young patient didnt have a leftorchidectomy but only medical therapy, cause the ischemia area was not too large. The patient has also a left varicocele. CONCLUSIONS: The images acquired with the different MRI sequences were carefully examined. Is important to consider that a rare instance of epididymal-orchitis, has been described as a potentially dangerouscomplication of epididymitis and needs to be considered if sudden, severe scrotal pain is experienced. This information can help with optimal patient management and help avoid needless interventions.

Brief Report: Genital Microbiome, Inflammation, and Tenofovir Levels in Transgender Men and Cisgender Women Taking Oral PrEP

Background: Little is known about the efficacy of preexposure prophylaxis (PrEP) or what biologic factors may influence HIV transmission in transgender men (TGM). In this study, we sought to explore the effect of testosterone on the vaginal microbiome, cervicovaginal fluid (CVF) tenofovir concentrations, and levels of CVF inflammatory markers in TGM on PrEP. Methods: Cervicovaginal fluid was collected from 13 TGM (7 using testosterone) and 32 cisgender women (CGW) on PrEP. The vaginal microbiome, CVF tenofovir concentrations, and CVF inflammatory markers were determined and compared. Results: The proportion of CVF Lactobacillus was significantly higher in CGW than in TGM (78% vs 24%, P < 0.001). Among TGM, the proportion of CVF Lactobacillus was lower, though not statistically significant, in those taking testosterone than in those not taking testosterone (14% vs 35%, P-value = 0.3). Interestingly, mean CVF tenofovir concentrations were the lowest in TGM on testosterone at 884 ng/mL compared with 3150 ng/mL in TGM not on testosterone and 1932 ng/mL in CGW; however, this difference was not statistically significant. There was no statistically significant difference in any of the genital inflammatory markers between groups and no correlation between inflammation and tenofovir levels. Conclusions: Our findings suggest a potential correlation between testosterone use, Lactobacillus dominance, and lower TFV concentrations in CVF, which may have implications on HIV acquisition from vaginal sex in TGMT. Future studies with larger sample sizes are needed to further investigate these relationships.

Are violence, harmful alcohol/substance use and poor mental health associated with increased genital inflammation?: A longitudinal cohort study with HIV-negative female sex workers in Nairobi, Kenya.

Violence, alcohol use, substance use and poor mental health have been linked with increased HIV acquisition risk, and genital inflammation enhances HIV susceptibility. We examined whether past 6 month experience of these exposures was associated with increased genital inflammation, thereby providing a biological link between these exposures and HIV acquisition risk. The Maisha Fiti study was a longitudinal mixed-methods study of female sex workers in Nairobi, Kenya. Behavioural-biological surveys were conducted at baseline (June-December 2019) and endline (June 2020-March 2021). Analyses were restricted to HIV-negative women (n = 746). Women with raised levels of at least 5 of 9 genital inflammatory cytokines were defined as having genital inflammation. Multivariable logistic regression models were used to estimate (i) baseline associations between genital inflammation and violence, harmful alcohol/substance use, and poor mental health, and (ii) longitudinal associations between these exposures at different survey rounds, and genital inflammation at follow-up. Inflammation data was available for 711 of 746 (95.3%) women at baseline; 351 (50.1%) had genital inflammation, as did 247 (46.7%) at follow-up. At baseline, 67.8% of women had experienced physical and/or sexual violence in the past 6 months, 33.9% had harmful alcohol use, 26.4% had harmful substance use, 25.5% had moderate/severe depression/anxiety, and 13.9% had post-traumatic stress disorder. In adjusted analyses, there was no evidence that these exposures were associated cross-sectionally or longitudinally with genital inflammation. We report no associations between past 6 month experience of violence, harmful alcohol/substance use, or poor mental health, and immune parameters previously associated with HIV risk. This suggests that the well-described epidemiological associations between these exposures and HIV acquisition do not appear to be mediated by genital immune changes, or that any such changes are relatively short-lived. High prevalences of these exposures suggest an urgent need for sex-worker specific violence, alcohol/substance use and mental health interventions.

Microbial Etiology, Antimicrobial Resistance, and Risk Factors of Surgical Site Infections in Gestational Diabetes Mellitus Patients Undergoing Elective Pre-Labor Cesarean Deliveries.

Gestational Diabetes Mellitus (GDM) significantly increases the risk of adverse pregnancy outcomes, including elective pre-labor cesarean deliveries. Postoperative surgical site infections (SSIs) pose a significant concern, underscoring the need for a detailed investigation into their causes and preventative measures. The aim of this study is to systematically identify and analyze the microbial etiology and antimicrobial resistance profiles of pathogens responsible for SSIs in GDM patients undergoing elective pre-labor cesarean deliveries. Additionally, this research aims to elucidate the risk factors contributing to SSIs, with a specific focus on operation duration, amniotic fluid contamination, and genital tract inflammation, and their correlation with the incidence of SSIs. A retrospective analysis was conducted at our Hospital between September 2018 and July 2023, involving 150 GDM patients who underwent elective pre-labor cesarean deliveries. Patients were categorized into infected and uninfected groups based on postoperative SSIs. Clinical data were meticulously collected and analyzed using SPSS software (version 27.0). Independent sample t-tests and chi-square tests were employed for statistical analysis. Microbial profiling revealed that Gram-negative bacteria, primarily E. coli, constituted approximately 59.46% of the isolated strains, exhibiting significant resistance to commonly used antibiotics such as ampicillin and cefotaxime. Elevated levels of biomarkers, including Procalcitonin (PCT) and Hemoglobin A1c (HbA1c), were significantly associated with SSIs. Multivariate logistic regression analysis identified operation time ≥1-hour, amniotic fluid contamination, and genital tract inflammation as significant risk factors. This study highlights the microbial etiology, resistance patterns, and risk factors for SSIs in GDM cesarean patients, emphasizing the need for tailored preoperative evaluations.

Female genital tract host factors and tenofovir and lamivudine active metabolites.

We previously reported the effect of contraception on cervical tenofovir concentrations in Ugandan women living with HIV. Here we explored the role of cervicovaginal cytokines and drug metabolizing enzymes and transporters (DMETs) to elucidate FGT drug disposition in a Ugandan cohort. Cervicovaginal fluid and cervical biopsies were collected from Ugandan women living with HIV receiving tenofovir/lamivudine-based therapy and intramuscular depot medroxyprogesterone acetate (DMPA-IM; n=25), copper IUD (cuIUD; n=12), or condoms (n=13) as contraception. Cytokines were measured in cervicovaginal fluid (CVF). Ectocervical tenofovir diphosphate (TFVdp) and lamivudine triphosphate (3TCtp), dATP/dCTP concentrations, and immune marker/DMETs gene expression were measured in cervical biopsies. Cervical 3TCtp was not correlated with any CVF cytokines. Cervical TFVdp was correlated with IL-10, IL-7, and IL-17 in CVF. CCR5 mRNA expression in cervical biopsies was higher in cuIUD-users versus condoms-users. Using multivariable linear regression, CVF IL-17, tissue dATP, plasma estradiol, and plasma tenofovir were all significant predictors of cervical TFVdp. Tissue dCTP and plasma lamivudine were significant predictors of cervical 3TCtp. TFVdp concentrations in cervix appear to be influenced by local inflammation. In contrast, 3TCtp FGT exposure was not affected by genital inflammation or DMETS. CuIUD users have more immune cells present, which may in turn influence local TFVdp disposition.

Vaginal and rectal microbiome contribute to genital inflammation in chronic pelvic pain

BackgroundChronic pelvic pain (CPP) is a multifactorial syndrome that can substantially affect a patient’s quality of life. Endometriosis is one cause of CPP, and alterations of the immune and microbiome profiles have been observed in patients with endometriosis. The objective of this pilot study was to investigate differences in the vaginal and gastrointestinal microbiomes and cervicovaginal immune microenvironment in patients with CPP and endometriosis diagnosis compared to those with CPP without endometriosis and no CPP.MethodsVaginal swabs, rectal swabs, and cervicovaginal lavages (CVL) were collected among individuals undergoing gynecologic laparoscopy. Participants were grouped based on patients seeking care for chronic pain and/or pathology results: CPP and endometriosis (CPP-Endo) (n = 35), CPP without endometriosis (n = 23), or patients without CPP or endometriosis (controls) (n = 15). Sensitivity analyses were performed on CPP with endometriosis location, stage, and co-occurring gynecologic conditions (abnormal uterine bleeding, fibroids). 16S rRNA sequencing was performed to profile the microbiome, and a panel of soluble immune mediators was quantified using a multiplex assay. Statistical analysis was conducted with SAS, R, MicrobiomeAnalyst, MetaboAnalyst, and QIIME 2.ResultsSignificant differences were observed between participants with CPP alone, CPP-Endo, and surgical controls for body mass index, ethnicity, diagnosis of ovarian cysts, and diagnosis of fibroids. In rectal microbiome analysis, both CPP alone and CPP-Endo exhibited lower alpha diversity than controls, and both CPP groups revealed enrichment of irritable bowel syndrome-associated bacteria. CPP-Endo exhibited an increased abundance of vaginal Streptococcus anginosus and rectal Ruminococcus. Patients with CPP and endometrioma (s) demonstrated increased vaginal Streptococcus, Lactobacillus, and Prevotella compared to other endometriosis sites. Further, abnormal uterine bleeding was associated with an increased abundance of bacterial vaginosis-associated bacteria. Immunoproteomic profiles were distinctly clustered by CPP alone and CPP-Endo compared to controls. CPP-Endo was enriched in TNF⍺, MDC, and IL-1⍺.ConclusionsVaginal and rectal microbiomes were observed to differ between patients with CPP alone and CPP with endometriosis, which may be useful in personalized treatment for individuals with CPP and endometriosis from those with other causes of CPP. Further investigation is warranted in patients with additional co-occurring conditions, such as AUB/fibroids, which add additional complexity to these conditions and reveal the enrichment of distinct pathogenic bacteria in both mucosal sites. This study provides foundational microbiome-immunoproteomic knowledge related to chronic pelvic pain, endometriosis, and co-occurring gynecologic conditions that can help improve the treatment of patients seeking care for pain.

Vaginal fungi are associated with treatment-induced shifts in the vaginal microbiota and with a distinct genital immune profile.

Vaginal colonization by fungi may elicit genital inflammation and enhance the risk of adverse reproductive health outcomes, such as HIV acquisition. Cross-sectional studies have linked fungi with an absence of bacterial vaginosis (BV), but it is unclear whether shifts in vaginal bacteria alter the abundance of vaginal fungi. Vaginal swabs collected following topical metronidazole treatment for BV during the phase 2b, placebo-controlled trial of LACTIN-V, a Lactobacillus crispatus-based live biotherapeutic, were assayed with semi-quantitative PCR for the relative quantitation of fungi and key bacterial species and multiplex immunoassay for immune factors. Vaginal fungi increased immediately following metronidazole treatment for BV (adjusted P = 0.0006), with most of this increase attributable to Candida albicans. Vaginal fungi were independently linked to elevated levels of the proinflammatory cytokine interleukin (IL) 17A, although this association did not remain significant after correcting for multiple comparisons. Fungal relative abundance by semi-quantitative PCR returned to baseline levels within 1 month of metronidazole treatment and was not affected by LACTIN-V or placebo administration. Fungal abundance was positively associated with Lactobacillus species, negatively associated with BV-associated bacteria, and positively associated with a variety of proinflammatory cytokines and chemokines, including IL-17A, during and after study product administration. Antibiotic treatment for BV resulted in a transient expanded abundance of vaginal fungi in a subset of women which was unaffected by subsequent administration of LACTIN-V. Vaginal fungi were positively associated with Lactobacillus species and IL-17A and negatively associated with BV-associated bacteria; these associations were most pronounced in the longer-term outcomes.IMPORTANCEVaginal colonization by fungi can enhance the risk of adverse reproductive health outcomes and HIV acquisition, potentially by eliciting genital mucosal inflammation. We show that standard antibiotic treatment for bacterial vaginosis (BV) results in a transient increase in the absolute abundance of vaginal fungi, most of which was identified as Candida albicans. Vaginal fungi were positively associated with proinflammatory immune factors and negatively associated with BV-associated bacteria. These findings improve our understanding of how shifts in the bacterial composition of the vaginal microbiota may enhance proliferation by proinflammatory vaginal fungi, which may have important implications for risk of adverse reproductive health outcomes among women.

An analysis of the vaginal microbiota and cervicovaginal metabolomics in cervical lesions and cervical carcinoma

BackgroundTo explore the role of vaginal microbiota and metabolomics in the progression of cervical dysplasia. MethodsThe patient group consists of female patients with low-grade, high-grade cervical dysplasia, and cervical cancer. Normal cervix samples from health volunteers were used as controls. The metabolic fingerprints of cervicovaginal lavage were analyzed using liquid chromatography-mass spectrometry, while the vaginal microbiota was examined through 16S rRNA sequencing. Bioinformatic analysis was adopted to investigate the interplay between hosts and microbes. The vaginal metabolic and microbiota profiles of 90 female patients with cervical dysplasia and 10 controls were analyzed to discover the biological characteristics underlying the progression of cervical cancer. ResultsWe found that Valyl-Glutamate, N, N′-Diacetylbenzidine, and Oxidized glutathione, which were involved in oxidative stress response, were discriminators to distinguish the normal cervix, invasive cervical carcinomas, and CIN3 from others. Cervical carcinoma was characterized by a large variety of vaginal microbes (dominated by non-Lactobacillus communities) compared to the control. These microbes affected amino acid and nucleotide metabolism, producing metabolites with cervical carcinoma and genital inflammation compared to the control group. ConclusionsThis study revealed that cervicovaginal metabolic profiles were determined by cervical cancer, vaginal microbiota, and their interplays. ROS metabolism can be used to discriminate normal cervix, CIN3, and invasive cervical carcinoma.

Vaginal Lactobacillus crispatus persistence following application of a live biotherapeutic product: colonization phenotypes and genital immune impact

BackgroundBacterial vaginosis (BV) increases HIV acquisition risk, potentially by eliciting genital inflammation. After BV treatment, the vaginal administration of LACTIN-V, a live biotherapeutic containing the Lactobacillus crispatus strain CTV-05, reduced BV recurrence and vaginal inflammation; however, 3 months after product cessation, CTV-05 colonization was only sustained in 48% of participants.ResultsThis nested sub-study in 32 participants receiving LACTIN-V finds that 72% (23/32) demonstrate clinically relevant colonization (CTV-05 absolute abundance > 106 CFU/mL) during at least one visit while 28% (9/32) of women demonstrate colonization resistance, even during product administration. Immediately prior to LACTIN-V administration, the colonization-resistant group exhibited elevated vaginal microbiota diversity. During LACTIN-V administration, colonization resistance was associated with elevated vaginal markers of epithelial disruption and reduced chemokines, possibly due to elevated absolute abundance of BV-associated species and reduced L. crispatus. Colonization permissive women were stratified into sustained and transient colonization groups (31% and 41% of participants, respectively) based on CTV-05 colonization after cessation of product administration. These groups also exhibited distinct genital immune profiles during LACTIN-V administration.ConclusionsThe genital immune impact of LACTIN-V may be contingent on the CTV-05 colonization phenotype, which is in turn partially dependent on the success of BV clearance prior to LACTIN-V administration.

Impact of chlorhexidine and povidone-iodine antiseptic solutions on the cervicovaginal microenvironment during laparoscopic hysterectomies: a pilot study

The use of chlorhexidine gluconate (CHG) as surgical preparation solution has been advocated due to reduced bacterial loads compared with povidone-iodine (PI). We aimed to investigate changes to the vaginal microenvironment among patients who had laparoscopic hysterectomy and were surgically prepped using 4% CHG compared to 7.5% PI. Premenopausal women who underwent laparoscopic hysterectomy for benign conditions and were prepped with either CHG or PI per surgeon’s choice were enrolled. Vaginal swabs and cervicovaginal lavages were collected prior to vaginal preparation and at 4–6 week post-operative visits for microbiome (α and β diversity, bacterial relative abundances, vaginal pH) and immune marker analyses (protein profiles and concentrations). Antimicrobial activity of clinical CHG and PI formulations were tested in vitro using minimal inhibitory and bactericidal concentration assays. Between February 2021 and June 2022, 41 patients were enrolled. Seven patients either withdrew consent or met exclusion criteria for vaginal bleeding. Thirty-four patients had pre-operative samples collected; 13 patients were lost to follow-up. A total of 21 patients with longitudinal samples of pre- and post-operative collection contributed to this study: 13 in the CHG group and 8 in the PI group. Prior to surgery, 75–77% of women in both groups exhibited Lactobacillus dominance. PI did not change overall vaginal microbiome profiles; however, CHG impacted Lactobacillus iners-dominant profiles, shifting to other lactobacilli (50%) or dysbiotic anaerobes (33%). Lactobacillus crispatus-dominant profiles, which are optimal for vaginal health, were not impacted by either antiseptic solution. In vitro assays further confirmed higher susceptibility of L. iners to CHG solution compared to other vaginal lactobacilli species. Pro-inflammatory cytokines or chemokines were not increased in the CHG or PI group. Our study suggests that CHG does not increase the rate of post-operative vaginal dysbiosis, or genital inflammation compared to PI. Species-specific effects of CHG on vaginal lactobacilli and its clinical impact require further investigation.

Seminal plasma S100A8/A9 as a potential biomarker of genital tract inflammation.

Infections and inflammatory reactions in the male genital tract are the leading causes of male infertility with a prevalence of 6%-10%, primarily affecting testicular and epididymal function and ultimately compromising sperm quality. However, most infertile patients with genital infection/inflammation are asymptomatic and easily overlooked. Traditional indicators, including white blood cells, elastase, and other components in semen, can reflect inflammation of the genital tract, but there is still a lack of a uniform standard method of detection. Therefore, it is necessary to explore reliable markers in semen that reflect the inflammatory status of the genital tract. Using the experimental autoimmune orchitis (EAO) model to simulate noninfectious chronic orchitis, we successfully collected ejaculated seminal fluid from EAO rats using optimized electrical stimulation devices. Proteomic analysis was performed using isobaric tags for relative and absolute quantification (iTRAQ). Compared to the control group, 55 upregulated and 105 downregulated proteins were identified in seminal plasma samples from the EAO group. In a preliminary screening, the inflammation-related protein S100A8/A9 was upregulated. We further verified that S100A8/A9 was increased in seminal plasma and highly expressed in testicular macrophages of the EAO model. In patients with oligoasthenospermia and genital tract infections, we also found that S100A8/A9 levels were remarkably increased in seminal plasma and testicular macrophages. S100A8/A9 in semen may be a potential biomarker for chronic genital inflammation. Our study provides a new potential biomarker for early diagnosis and further understanding of male infertility caused by genital inflammation.

Novel point-of-care cytokine biomarker lateral flow test for the screening for sexually transmitted infections and bacterial vaginosis: study protocol of a multicentre multidisciplinary prospective observational clinical study to evaluate the performance and feasibility of the Genital InFlammation Test (GIFT)

IntroductionA prototype lateral flow device detecting cytokine biomarkers interleukin (IL)-1α and IL-1β has been developed as a point-of-care test—called the Genital InFlammation Test (GIFT)—for detecting genital inflammation associated with sexually...

Study of The Prevalence of Trichomonas Vaginalis Parasite in Females Suffering from Vaginal Inflammations

Background & Objective: Infection of trichomoniasis is accountable for disease transmitted by sex (non-virally), called trichomoniasis or vaginitis the most popular disease worldwide. The goal of current research was to determining spread rate of Trichomonas vaginalis among females suffering from genital inflammation in Najaf city of Iraq. Methods: Two hundred and sixty four of the participating women were included in our current study, They were going to Al-Manathra Hospital, Al-Najaf Hospital, Al-Furat Hospital, and a few outpatient clinics between January and June of 2023. One hundred and thirty two were included as a control group and one hundred and thirty two were included as patients (they were suffering from vaginal inflammation). All participants in the study underwent direct microscopic examination and then immediately cultured in diamond culture media by taking a swab from the vagina to confirm the presence of the parasite Trichomonas Vaginalis. Results: Out of (264) swab samples that which examined microscopically for T. vaginalis by using light microscope under (40x), Trichomoniasis infection detected in 70 (53.03%) out of 132 women undergoing from vaginal inflammation while there was 62 (46.97%) of women negative for T.vaginalis, and this difference was statistically non-significant (Chi-square=0.618, P-value=0.432), while in the control subjects 116 (91.67%) of (132) were negative for Trichomoniasis infection, except 11 women (8.33%) were positive for T.vaginalis, but not suffered from any symptoms, this difference was significant in statistic (Chi-square = 86.811, P-value = 0.000). Out of (264) swab samples that which cultured on diamond liquid media, Trichomoniasis infection detected in 74 (56.07%) out of 132 women undergoing from vaginal inflammation while there was 58 (43.93%) of these women were negative for T.vaginalis parasite, and this difference according to Chi-square value (2.206) and p-value (0.137), it was statistically non-significant. regarding the control subjects, 112 (88.64%) of (132) were negative for Trichomoniasis infection, and 15 women (11.36%) were positive for T.vaginalis, but not suffered from any symptoms. This difference was statistically significant according to the Chi-Square (74.087) and P value (0.000). Conclusions: The prevalence of the Trichomonas vaginalis parasite in Najaf Governorate, according to the results of the current study, is 56%, and this is considered a high and interesting percentage.

Salivary and Serum Levels of Both Uric Acid and C-Reactive Protein (CRP) Biomarkers in Patients with Behçet's Disease

Behçet's disease (BD) is a systemic vasculitis identified by recurrent oral and genital ulcerations, skin inflammations and uveitis, with unknown etiology. This study had been designed to assess the level of salivary and serum uric acid (UA) and C - reactive protein (CRP) markers in BD patients as activity markers and to explore their relations in disease existence. Fifty BD patients :( 32 males and 18 females) with mean age (35.3 ± 7.6) years and fifty healthy subjects (30 males and 20 females) with mean age (34.8± 9.1) years were involved in this study that extend during the period of (2014-2016). All of patients and healthy subjects were analyzed for UA by (colorimetric spectrophotometric assay that based on oxidation of UA by uricase enzyme to allantoin) and CRP by (qualitative analysis: antigen-antibody interaction Latex agglutination test) in both saliva and serum. Data was analyzed using descriptive statistics, t-test, P (ANOVA) test, Chi-square (2) test, and Pearson’s linear correlation coefficient statistical analyses. Results of this study show that salivary uric acid was significantly elevated in BD patients than in healthy subjects. (P<0.001). Although serum UA was higher in patients than the healthy subjects but statistically not significant. (P=0.57). On the other hand, out of fifty patients there were thirteen patients (26%) significantly expressed CRP positive in their serum and saliva. The results of this study revealed that UA can act as prooxidant (pro inflammatory) marker and CRP as inflammatory marker that could be related to impaired endothelial function in BD.

Prevalence of Vaginal Inflammation Due to Candida sp., Trichomonas vaginalis and Associated Factors Among Patients Visiting the Gynecology Clinic at Hoang Anh Gia Lai University Medical Hospital

Candida spp., T.vaginalis infections can cause genital inflammation in women, leading to many adverse effects such as increased risk of infertility and severely impacting the patient's health and quality of life. Objective: To determine the prevalence of vaginal inflammation due to Candida spp., T. vaginalis infections and identify associated factors. Subjects and methods: Cross-sectional research. The research subjects were women of reproductive age (18-49 years old) who visited the gynecology clinic at Hoang Anh Gia Lai University Medical Hospital, Gia Lai province. Results: The prevalence of vaginal inflammation due to Candida spp., T.vaginalis infection was 26.7% (of which Candida sp. was 99.1% and T.vaginalis was 0.9%). The group using unsanitary water sources had a 1.6 times higher risk of infection (95% CI: 1.1-2.6), and the group that did not regularly undergo gynecological examinations had a 1.8 times higher risk of infection (95% CI: 1.1-2.9). Conclusion: The prevalence of Candida spp., T.vaginalis infection was 26.7%, and was associated with the use of unsafe water sources and irregular gynecological checkups.

Vitamin D effects on Chlamydia trachomatis infection: a case-control and experimental study.

Vitamin D deficiency is the most common nutritional deficiency worldwide. Chronic vitamin D deficiency causes immune system dysfunction, which increases susceptibility to pathogens such as bacteria, especially intracellular parasites, and viruses. Chlamydia trachomatis (C. t) is an obligate intracellular parasitic bacterium that causes a variety of sequelae. We speculated that vitamin D might be associated with C. t infection. This study aimed to address this gap in knowledge by investigating the relationship between vitamin D and C. t infection using both in vitro and in vivo models. The addition of calcitriol to McCoy cell culture in vitro delayed and reduced the quantity and volume of inclusions compared to the control group. Macrophages of peritoneally lavaged mice co-cultured with McCoy decreased the infection rate and delayed the appearance of inclusions. In mice models of vitamin D deficiency, mice in the VD-group exhibited more severe genital tract inflammation and a longer duration of infection after inoculation with C. t in the genital tract. Supplementing these mice with vitamin D3 during treatment enhanced the therapeutic effect of antibiotics. We also conducted a case-control study involving 174C. t-positive patients (95 males and 79 females) and 380 healthy volunteers (211 males and 169 females) aged 20-49 from January 2016 to March 15, 2017. Serum 25-(OH)D concentration was measured by assessing morning fasting blood samples of healthy volunteers and C. t-positive patients 1 day before antibiotic treatment and the next day after one course of treatment. The patients were followed up for 1 month and evaluated for recovery. The results showed that vitamin D deficiency was a risk factor for C. t infection and treatment failure. In summary, findings from experimental and clinical studies indicate a close association between vitamin D levels and C. t infection and treatment outcomes. Given the affordability and safety of vitamin D, both healthy individuals and patients should focus on vitamin D intake. Vitamin D supplementation could enhance treatment success and should be used as an adjunctive therapy alongside antibiotic therapy for C. t infections, pending confirmation in larger, prospective, randomized controlled trials.

Genital tract infections, the vaginal microbiome and gestational age at birth among pregnant women in South Africa: a cohort study protocol

IntroductionPreterm birth complications are the most common cause of death in children under 5 years. The presence of multiple microorganisms and genital tract inflammation could be the common mechanism driving...

Abstract C091: Newly identified Fannyhessea species contributions in HPV infection, cervical dysplasia, and cancer in two Arizonan cohorts

Abstract The vaginal microbiome can impact gynecologic health and disease. It is still unclear the extent to which the microbiome plays in the progression and development of gynecologic cancers. Fannyhessea vaginae is a key vaginal bacterium linked to bacterial vaginosis, HPV acquisition, and cervical cancer. F. vaginae was recently proposed for reclassification as three species: F.vaginae, Fannyhessea massiliense, and Fannyhessea species type 2. We hypothesize that these Fannyhessea species vary in terms of their host-microbe interactions which contribute to cancer progression/severity. We investigated the prevalence of Fannyhessea species in two of our Arizona-based HPV and cervical cancer cohorts recruited in Phoenix or Flagstaff area. The Phoenix (Phx) cohort included: women diagnosed with invasive cervical cancer (ICC=9), high-grade squamous intraepithelial lesion (HSIL=27), and low-grade squamous intraepithelial lesion (LSIL=11), as well as controls who were either HPV-positive=20 or HPV-negative without dysplasia=31. While the Flagstaff cohort (Flg) consisted of 31 women that were HPV-positive=7 or HPV-negative=24. The 16S rDNA sequencing information was analyzed with DADA2 and QIIME2 to identify the microbial composition of the cervicovaginal profiles of these patients. Statistical analyses are ongoing, utilizing survey data on these species to decipher their clinical associations with factors such as HPV status and genotype. The cohorts had a prevalence of 59.2% of Atopobiaceae bacteria in Phx and 38.7% prevalence in Flg cohort. We observed F. vaginae (50% and 38.7%, respectively), Fannyhessea species type 2 (16.4% and 25.0%, respectively), F. massiliense (21.0% and 18.8%, respectively) in these cohorts. Interestingly, in both dysplasia groups of the Phx cohort these species had an increased abundance, but it did not reach significance. Other clinical and demographic factors in both cohorts, vaginal pH (p = 0.0005 and 0.47, respectively), Native American race (p=0.002) and Hispanic ethnicity (p= 0.013 and 0.63, respectively), indicated significant species-specific differences in the prevalence of Atopobiaceae. Additionally, genital inflammation scores were higher in profiles that contained Atopobiaceae species (p= 0.05) in Phoenix cohort. In addition, microbial co-occurrence analysis identified that Fannyhessea species highly co-occurred with one another. Sneathia amnii, Sneathia sanguinegens, and other BV-associated bacteria also co-occurred with Fannyhessea species, indicating an association between multiple Fannyhessea species and a potential link to cancer that requires further investigation. This research highlights potential associations of BV-associated bacteria and their role in HPV infection and cervical cancer and investigates the relationship of underexplored Fannyhessea species in historically understudied populations that have the highest disease burden. The overall data from our study provide foundational knowledge on putative oncogenic bacteria that could be exploited to modulate the microbiome and improve cancer outcomes. Citation Format: Nicole R. Jimenez, Paweł Łaniewski, Naomi R. Lee, J. Gregory Caporaso, Melissa M. Herbst-Kralovetz. Newly identified Fannyhessea species contributions in HPV infection, cervical dysplasia, and cancer in two Arizonan cohorts [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C091.

Abstract PR016: Viewing Native American cervical cancer disparities through the lens of the vaginal microbiome: A pilot study

Abstract Cervical cancer disproportionally affects Native American (NA) women who have higher rates of cervical cancer, are often diagnosed at later stages and are more likely to die from the disease compared to White women. This cancer disparity is primarily attributed to a lack of screening and unequal access to healthcare; however, other factors in NA women might contribute. Vaginal dysbiosis has been implicated in persistent HPV infection and cervical cancer. Yet, there is a paucity of data on the HPV infection patterns and the vaginal microbiota composition in NA communities. Here, we aimed to elucidate the relationships between HPV, microbiome, and genital inflammation to better understand how these factors relate to increased cervical cancer risk in NA women. In this cross-sectional study, we enrolled 31 women at the Native American for Community Action clinic (Flagstaff, AZ). Participants provided two self- or physician-collected vaginal swabs. Vaginal pH was also measured. One vaginal swab was used for DNA extraction and subsequent HPV genotyping and 16S rRNA gene sequencing. The microbiome analysis was conducted using QIIME 2. Levels of 48 immune mediators in the second vaginal swab were quantified by Bio-Plex. Most participants identified as American Indian or Alaska Native (n=16), White (n=11) or Hispanic (n=5). The average age was 29 years old (ranging from 18 to 46). High-risk HPV genotypes (HPV 39, 45, 52, 53, 58, 59) were detected in 23% of women (5 NA and 2 non-NA). Intriguingly, the current nonavalent HPV vaccine does not target half of genotypes detected in this cohort. Vaginal microbiota profiles were dominated by Lactobacillus in 56% of NA women, which was similar to levels observed in non-NA participants but overall lower than in previously reported non-Hispanic White cohorts. The most prevalent Lactobacillus species included L. crispatus (associated with optimal health) and L. iners (considered non-optimal). Lactobacillus-depleted profiles consisted of typical communities of anaerobes associated with bacterial vaginosis: Gardnerella, Fannyhessea, Prevotella, and Sneathia. Lactobacillus dominance was highly associated with low (≤4.5) vaginal pH (p=0.0017). Moreover, HPV-positive women tended to have lower Lactobacillus abundance compared to HPV-negative women, though this relationship was not statistically significant (p=0.07). Immune marker profiles also related to the vaginal microbiota composition with proinflammatory cytokines (IL-1beta, IL-12, IL-15 and TNFalpha) being significantly elevated (p<0.05) in women with Lactobacillus depletion. In addition, GM-CSF levels were decreased in women with Lactobacillus depletion, as well as in HPV-positive women. In conclusion, our pilot study suggests an interplay between HPV, vaginal microbiota and host defense may play a role in cervical cancer health disparity among NA women. Future longitudinal studies are ongoing to determine the mechanistic role of vaginal microbiota in HPV persistence, toward the long-term goal of reducing health disparities between White and NA populations. Citation Format: Pawel Laniewski, Tawnjerae R. Joe, Tristen L. Eddie, Skyler J. Bordeaux, Verity Quiroz, Donna J. Peace, J. Gregory Caporaso, Naomi R. Lee, Melissa M. Herbst-Kralovetz. Viewing Native American cervical cancer disparities through the lens of the vaginal microbiome: A pilot study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR016.

Incidence, temporal trends and risk factors of puerperal infection in Mainland China: a meta-analysis of epidemiological studies from recent decade (2010–2020)

BackgroundPuerperal infection (PI) is a severe threat to maternal health. The incidence and risk of PI should be accurately quantified and conveyed for prior decision-making. This study aims to assess the quality of the published literature on the epidemiology of PI, and synthesize them to identify the temporal trends and risk factors of PI occurring in Mainland China.MethodsThis review was registered in PROSPERO (CRD42021267399). Putting a time frame on 2010 to March 2022, we searched Cochrane library, Embase, Google Scholar, MEDLINE, Web of Science, China biology medicine, China national knowledge infrastructure and Chinese medical current contents, and performed a meta-analysis and meta-regression to pool the incidence of PI and the effects of risk factors on PI.ResultsA total of 49 eligible studies with 133,938 participants from 17 provinces were included. The pooled incidence of PI was 4.95% (95%CIs, 4.46–5.43), and there was a statistical association between the incidence of PI following caesarean section and the median year of data collection. Gestational hypertension (OR = 2.14), Gestational diabetes mellitus (OR = 1.82), primipara (OR = 0.81), genital tract inflammation (OR = 2.51), anemia during pregnancy (OR = 2.28), caesarean section (OR = 2.03), episiotomy (OR = 2.64), premature rupture of membrane (OR = 2.54), prolonged labor (OR = 1.32), placenta remnant (OR = 2.59) and postpartum hemorrhage (OR = 2.43) have significant association with PI.ConclusionsMaternal infection remains a crucial complication during puerperium in Mainland China, which showed a nationwide temporal rising following caesarean section in the past decade. The opportunity to prevent unnecessary PI exists in several simple but necessary measures and it’s urgent for clinicians and policymakers to focus joint efforts on promoting the bundle of evidence-based practices.