Genital Swabs Research Articles

Vaginal Secretion Epithelium Count as a Prognostic Indicator of High Abundance of Ureaplasmas in Women with a Normal Nugent Score.

Genital tract ureaplasma infections are associated with numerous complications, ranging from inflammation, through infertility, to problematic pregnancy. In the course of ureaplasma infection, the risk of human papillomavirus infection increases. Diagnostic tests for urea-plasma infections are not always carried out, especially in women with the normal Nugent test results. The study attempts to check whether it is possible to find a prognostic indicator that could suggest a high abundance of ureaplasmas (≥ 104 CFU/ml) at the stage of the initial examination of vaginal discharge. Such a prognostic factor could qualify women for further tests to detect infections with these atypical bacteria. Six hundred twenty-seven white women with a score of 0–3 on the Nugent scale were tested, including 322 patients with a high abundance of ureaplasmas (≥ 104 CFU/ml) and 305 who tested negative for these bacteria. Ureaplasma infections were detected statistically significant in women who had few or no epithelial cells in the genital swab specimens compared to the results obtained for women with numerous or very numerous epithelial cells (p < 0.001). The risk of the high density of ureaplasmas was 38.7% higher with fewer or no epithelial cells than with high numbers. In patients aged 18–40 years with few or no epithelial cells, a high density of ureaplasmas (≥ 104 CFU/ml) was observed significantly more frequently (p = 0.003). Determining the number of epithelial cells in Gram-stained slides may be the prognostic indicator of ureaplasma infection. Testing for genital ureaplasma infection should be considered, especially in women of childbearing age (18–40 years), even if the Nugent test value is normal and pH ≤ 4.6.

English

The frequency and antibiotic resistance of N. gonorrhoeae are increasing worldwide. This study aimed to determine the prevalence of N. gonorrhoeae in genital swabs. A collaborative cross-sectional study was conducted by a team of Microbiologist, Dermato-Venerologist and Occupational Physician in Bangui, from January 2015 to December 2018. Genital samples were stained by the Gram method, grown on blood agar and the colonies identified according to the biochemical characteristics. Antibiotic sensitivity was determined by the agar diffusion method from disks. The prevalence of N. gonorrhoeae was 3.2%,&nbsp; more in males (90.5%), unschooled patients (61.1%),&nbsp; those with a history of STIs (56.8%), and female sex workers (p = 0.006) The strains of N. gonorrhoeae isolated were highly resistant to all antibiotics commonly prescribed in proportions from 60.9 to 95.8%. No resistance was observed to Ceftriaxone and Spectinomycin. This study highlights the interest of intensifying the prevention of N. gonorrhoeae infection in female sex workers, of the revision of the protocols of management of the N. gonorrhoeae infection and of a policy to ensure a better availability of new antibiotics selected. Understanding the mechanisms of resistance will be the subject of a characterization study in molecular biology. &nbsp; Key words: N. gonorrhoeae, STI, prevalence, antibiotic resistance, female sex workers, Central African Republic, Africa.

The association between viral load and concurrent human papillomavirus infection at the genital and anal sites of young women and the impact of vaccination

Concurrent genital-anal human papillomavirus (HPV) infections may impose an increased anal cancer risk in women with HPV-related genital lesions. High viral load may facilitate genital-anal HPV concurrence. Genital and anal HPV is reduced by a bivalent HPV16/18 vaccine, yet the effect on concurrent genital-anal HPV remains unclear.This study analyzed viral load in concurrent genital-anal HPV infections, relative to genital-only and anal-only HPV infections and the impact of vaccination in young women. We included 1074 women, who provided both genital and anal swabs. HPV detection and genotyping was performed using the SPF10-DEIA-LiPA25. HPV copy numbers were measured with type-specific qPCRs and corrected for cellular content to obtain the viral load.Concurrent genital-anal HPV often had significantly higher genital viral load (0.09–371 c/cell) than genital-only HPV (3.17E-04-15.9 c/cell, p < 0.0001 to p < 0.05). Moreover, nearly all concurrent genital-anal HPV types had higher genital copy numbers per PCR reaction (157-416E04 c/rxn) than anal copy numbers (0.90–884E01 c/rxn, p < 0.0001 to p < 0.001). Vaccinated women had significantly less infections with HPV16/18 vaccine-types (2.8% vs 13.7%, p < 0.0001) and HPV31/35/45 cross-protective types (7.4% vs 21.1%, p < 0.0001) than unvaccinated women.In conclusion, particularly high genital viral load is found in concurrent genital-anal HPV infections, which are effectively reduced by vaccination.

Human papillomavirus and herpes simplex virus infections in patients with mucocutaneous lesions can be linked to host TBX-21 gene polymorphism

Background and objective: Human papillomavirus (HPV) and herpes simplex-2 (HSV-2) are the common cause of genital lesions in women. The variation in host genetic makeup can determine the consequence of a viral infection in that host. T-bet gene polymorphism has been associated with the incidence of several types of infections. This study investigates the impact of T-bet polymorphism on the incidence of HPV and HSV in genital lesions. Methods: 215 women, including 71 HPV infected, 72 HSV-2 infected, and 72 controls were enrolled. Viral genotyping was done on genital swab samples using Realtime PCR. In all participants, the extracted DNA from blood was tested for T-bet gene variation at Ch17.rs17244587 G&gt;A site using ARMS-PCR. ELISA was done to participants sera to detect HSV-1 IgM. Results: Genotyping of HPV infection revealed that (73.0%) were at low risk. Most individuals (72.5%) were homozygous GG, while (20.9%) were heterozygous AG and (6.5%) were homozygous AA, of which 92.8% were HSV-2 infected patients. None of 18 (8.4%) HSV-1-IgM positive women were homozygous AA. Conclusion: T-bet gene allele A appears to be linked with more incidence of HSV-2 in genital lesions, but such influence was not observed for HPV genotypes and HSV-1. Keywords: HPV genotypes; HSV-2 infection; Genital lesion; T-bet polymorphism.

High Prevalence of Genital Human Papillomavirus Infection in Patients With Primary Immunodeficiencies

BackgroundGenital human papillomavirus (HPV)-infections are common in the general population and are responsible for relevant numbers of epithelial malignancies. Much data on the HPV-prevalence is available for secondary immunodeficiencies, especially for patients with human immunodeficiency virus (HIV)-infection. Little is known about the genital HPV-prevalence in patients with primary immunodeficiencies (PIDs).MethodsWe performed a cross-sectional study of patients with PIDs and took genital swabs from male and female patients, which were analyzed with polymerase chain reaction for the presence of HPV-DNA. Clinical and laboratory data was collected to identify risk factors.Results28 PID patients were included in this study. 10 of 28 (35.7%) had HPV-DNA in their genital swabs. 6 patients had high-risk HPV-types (21.4%). Most patients had asymptomatic HPV-infections, as genital warts were rare (2 of 28 patients) and HPV-associated malignancy was absent. Differences in the HPV-positivity regarding clinical PID-diagnosis, duration of PID, age, sex, immunosuppression, immunoglobulin replacement, or circumcision in males were not present. HPV-positive PID patients had higher numbers of T cells (CD3+), of cytotoxic T cells (CD3+/CD8+), of transitional B cells (CD19+/CD38++/CD10+/IgD+), and of plasmablasts (CD19+/CD38+/CD27++/IgD-) compared to HPV-negative.ConclusionPID patients exhibit a high rate of genital HPV-infections with a high rate of high-risk HPV-types. Regular screening for symptomatic genital HPV-infection and HPV-associated malignancy in PID patients seems recommendable.

The distribution of lagomorph syphilis caused by Treponema paraluisleporidarum in Europe

Treponema paraluisleporidarum infects both rabbits (ecovar Cuniculus) and hares (ecovar Lepus). While the occurrence of the bacterium has previously been reported for European brown hares (Lepus europaeus) and domestic rabbits (Oryctolagus cuniculus f. domestica), there are no data available that report infection in the European context. We tested a total of 1,995 serum samples and 287 genital swabs from opportunistically sampled European brown hares (Lepus europaeus; n = 2135), Mountain hares (Lepus timidus; n = 4), European rabbits (Oryctolagus cuniculus; n = 138), and pet rabbits (O. cuniculus f. domestica; n = 5). The samples originated from eight European countries. In case only serum was available, we tested the samples for the presence of anti-treponemal antibodies. For this, we utilized the Treponema pallidum-particle agglutination test (TP-PA), which is suited for the use in lagomorphs due to the antigenic cross-reactivity of anti-T. pallidum and anti-T. paraluisleporidarum antibodies. In addition, the results of 380 sera were confirmed using the fluorescent-Treponema antibody absorption test (FTA-ABS). In all cases where swab samples were available, DNA was extracted and tested using quantitative PCR to test for the presence of the lagomorph syphilis-bacterium. We were able to detect antibodies in 825 of 1,995 lagomorph sera (41.4%; brown hare: 825/1,868; rabbit: 0/127) and obtained positive qPCR results from 182 of 287 swab samples (63.4%; European brown hare: 167/267; mountain hare: 4/4; rabbit: 11/16). While all rabbit sera (n = 127) tested negative for anti-treponemal antibodies, the presence of the bacterium was confirmed in eight wild (n = 8/11) and three domestic rabbits (n = 3/5) from Germany using qPCR.

A Comparison of Treponema pallidum Subspecies pallidum Molecular Typing Systems: Multilocus Sequence Typing vs. Enhanced Centers for Disease Control and Prevention Typing.

At least 3 syphilis typing systems are proposed. Recent work suggests that multilocus sequence typing (MLST) may be superior to enhanced Centers for Disease Control and Prevention typing (ECDCT) by yielding a higher discriminatory power. The goal of this study was to compare the 2 systems and identify associations between neurosyphilis and strain types. Multilocus sequence typing for tp0136, tp0548, and tp0705 was determined for DNA from 78 Treponema pallidum subspecies pallidum isolates propagated in rabbits, 10 oral and 10 genital or non-genital lesion swabs, and 10 blood samples from patients with syphilis. These samples were chosen because they were completely typeable by ECDCT. Using both systems, association between strain types and neurosyphilis, defined as a reactive cerebrospinal fluid Venereal Disease Research Laboratory test, was determined. Partial and complete ECDCT types were also determined for samples from different anatomical sites in 35 patients, and from blood and blood isolates (rabbit propagated) from 13 patients. The MLST type could be fully determined for 100 (92.6%) of 108 samples. Although MLST subdivided 3 common ECDCT types, it failed to distinguish among others. Neurosyphilis was more common in individuals infected with type 1.1.2 and tp0705 type 2 using MLST, and tp0548 type f using ECDCT. Enhanced Centers for Disease Control and Prevention typing was stable among anatomical sites and between patient-derived and rabbit propagated organisms. Compared with ECDCT, MLST was not uniformly more discriminating. Both typing systems demonstrate that specific types may be more neurotropic than others.

AUJESZKY'S DISEASE IN HUNTED WILD BOAR (SUS SCROFA) IN THE IBERIAN PENINSULA.

Aujeszky's disease (AD, pseudorabies) eradication programs in domestic pigs are implemented in several European countries where AD virus (ADV) circulates in local wild boar (Sus scrofa), making studies on ADV infection dynamics in wild boar increasingly relevant. The objective of our study was to characterize ADV dynamics in wild boar at a site in central Portugal and compare this site to three enzootic sites in central Spain. A total of 235 wild boar were sampled during the hunting season 2014-15. We collected serum, tissues (oropharyngeal tonsils and trigeminal and sacral ganglia), and swabs (oral, nasal, and genital) and analyzed these samples to detect ADV antibodies (enzyme-linked immunosorbent assay) and DNA (PCR). An overall seroprevalence of 42.6% was found (range 12.7-57.7%), being highest in adults (54.1%; 72/133). Overall, 2.8% (3/108) oral, 6.4% (7/109) nasal, and 12.8% (12/94) genital swabs were PCR positive. We found 20.4% (20/98) of the wild boar had at least one positive swab and were considered shedders. We found ADV in tissues of five animals; of 111 tonsils, three (2.7%) were PCR positive. Trigeminal (2/48; 4%) and sacral (2/53; 4%) ganglia collected in central Portugal, pertaining to three animals, were positive for ADV DNA. Logistic regression models showed that seroprevalence was influenced by site and age, whereas ADV shedding was influenced by site. Our study describes patterns of ADV infection in wild boar in Portugal and shows that wild boar also pose a risk, albeit lower than that in central Spain, for the eradication of AD from extensively managed domestic pigs in Portugal.

Patterns of Genital Tract Mustelid Gammaherpesvirus 1 (Musghv-1) Reactivation Are Linked to Stressors in European Badgers (Meles Meles).

Gammaherpesvirus reactivation can promote diseases or impair reproduction. Understanding reactivation patterns and associated risks of different stressors is therefore important. Nevertheless, outside the laboratory or captive environment, studies on the effects of stress on gammaherpesvirus reactivation in wild mammals are lacking. Here we used Mustelid gammaherpesvirus 1 (MusGHV-1) infection in European badgers (Meles meles) as a host–pathogen wildlife model to study the effects of a variety of demographic, physiological and environmental stressors on virus shedding in the genital tract. We collected 251 genital swabs from 150 free-ranging individuals across three seasons and screened them for the presence of MusGHV-1 DNA using PCR targeting the DNA polymerase gene. We explored possible links between MusGHV-1 DNA presence and seven variables reflecting stressors, using logistic regression analysis. The results reveal different sets of risk factors between juveniles and adults, likely reflecting primary infection and reactivation. In adults, virus shedding was more likely in badgers in poorer body condition and younger than 5 years or older than 7; while in juveniles, virus shedding is more likely in females and individuals in better body condition. However, living in social groups with more cubs was a risk factor for all badgers. We discuss possible explanations for these risk factors and their links to stress in badgers.

Genesis of Antibiotic Resistance LXIV: Mechanism(s) of Attenuation of Antibiotic Resistant Bacterial Pathogen(s) (ARBP) virulence augmented by Social Engineering ‐ Break the chain of transmission of Infection

At present, the pathophysiological basis and its sequelae of antibiotic resistant bacterial pathogens induced infectious diseases (ARBID) pandemic and manageable preventive strategies are not well understood. Here we present the results from the investigation analyzing the data on the role of social distancing (SD by Shelter in / Stay home) and Contact Tracing(CT). The objective of SD/CT is to break the chain of transmission of ARBP infection by finding that infected person, identify their contacts and advise them to quarantine at home while educating them about breaking the chain of transmission of infection to mitigate the spread of infection by ARBID. According to the “Global Microbial Resistance Surveillance System,” data on antimicrobial resistance report, eight priority bacterial pathogens in humans namely: □i. Escherichia coli, ii. Klebsiella pneumonia, iii. Acinetobacter spp., iv. Staphylococcus aureus, v. Streptococcus pneumonia, vi. Salmonella spp, vii. Shigella spp, viii. Neisseria gonorrhoeae detected in blood, urine, stool, and genital swabs of patient samples are considered the greatest threat across the globe. Based on the continuum of pandemic phases and surveillance components presented in WHO/CDC report on “Global Influenza Programme,” we have extrapolated to ARP as a. interpandemic phase during which new ARBID could be detected in animals but not in humans possibly emerging low risk of human cases / high risk of human cases; b. the pandemic alert phase where detection of human cases with a possibility of increased evidence of human to human transmission of ARBID and c. pandemic phase where an increased, efficient, and sustained human to human transmission is reported as morbidity & mortality rate. According to 2019 AR Threats Report, classified as a. urgent threats, b. serious threats, and c. concerning threats, of which more than 2.8 million antibiotic-resistant infections occur in the U.S. To demonstrate the conceptual basis of SD/CT mediated attenuation, we have chosen ARBID considered as an urgent threat. The practice of social distancing by Staying six feet apart only congregate and small Gatherings when absolutely necessary would likely to bring the R zero value to a minimum reflected in the ability of an infected individual to transmit infection. Concurrently implementing CT, If the reproductive number for ARBID is between 2 and 3 so each person with this infection on average passes it along to two to three other people. By robust CT, essentially to bring the reproductive number down below one, averaging each person infected with the ARBP, infects fewer than one other person and that's when we can manage the pandemic effectively because we don't have that ongoing spread and exponential growth . We suggest that effective SD/CT would likely to alter the following microbial growth parameters such as temperature: a. Decimal reduction time (DRT or D value), b. Thermal death time (TDT) and c. Thermal death point (TDP). Taken together, an altered D, TDT, and TDP reflecting on R= zero value possibly by regression of exponential growth relieving the selection pressure causing deamplification of ARGR.

Age and sex-associated variation in the multi-site microbiome of an entire social group of free-ranging rhesus macaques

BackgroundAn individual’s microbiome changes over the course of its lifetime, especially during infancy, and again in old age. Confounding factors such as diet and healthcare make it difficult to disentangle the interactions between age, health, and microbial changes in humans. Animal models present an excellent opportunity to study age- and sex-linked variation in the microbiome, but captivity is known to influence animal microbial abundance and composition, while studies of free-ranging animals are typically limited to studies of the fecal microbiome using samples collected non-invasively. Here, we analyze a large dataset of oral, rectal, and genital swabs collected from 105 free-ranging rhesus macaques (Macaca mulatta, aged 1 month-26 years), comprising one entire social group, from the island of Cayo Santiago, Puerto Rico. We sequenced 16S V4 rRNA amplicons for all samples.ResultsInfant gut microbial communities had significantly higher relative abundances of Bifidobacterium and Bacteroides and lower abundances of Ruminococcus, Fibrobacter, and Treponema compared to older age groups, consistent with a diet high in milk rather than solid foods. The genital microbiome varied widely between males and females in beta-diversity, taxonomic composition, and predicted functional profiles. Interestingly, only penile, but not vaginal, microbiomes exhibited distinct age-related changes in microbial beta-diversity, taxonomic composition, and predicted functions. Oral microbiome composition was associated with age, and was most distinctive between infants and other age classes.ConclusionsAcross all three body regions, with notable exceptions in the penile microbiome, while infants were distinctly different from other age groups, microbiomes of adults were relatively invariant, even in advanced age. While vaginal microbiomes were exceptionally stable, penile microbiomes were quite variable, especially at the onset of reproductive age. Relative invariance among adults, including elderly individuals, is contrary to findings in humans and mice. We discuss potential explanations for this observation, including that age-related microbiome variation seen in humans may be related to changes in diet and lifestyle.4_dARqKdohA9mAZyu7q9YNVideo abstract

L’herpès génital

AbstractGenital herpes is the main cause of genital ulcers worldwide. It is caused by highly prevalent viruses in the general population: herpes simplex viruses 1 and 2 (HSV-1 and HSV-2). This infection may affect quality of life of infected individuals. Genital herpes is a cofactor of sexual transmission of human immunodeficiency virus (HIV). Vertical transmission of HSV may result in neonatal herpes. Biological diagnosis of genital herpes is performed by the detection of viral genome by PCR in genital swabs and the detection of specific antibodies in sera (serology). Therapeutic management of genital herpes is based mainly on antiviral treatments by valaciclovir, very powerful molecule with almost no side effect. To date, there is no vaccine and the use of condoms remains the best way to prevent this viral infection.

CEREBROSPINAL FLUID SAMPLING IN A BOTTLENOSE DOLPHIN (TURSIOPS TRUNCATUS) UNDER GENERAL ANESTHESIA

Brucella ceti, associated with neurobrucellosis, has been isolated from cerebrospinal fluid (CSF) of postmortem cetaceans. A 106-kg, stranded female bottlenose dolphin (Tursiops truncatus) presented with serum antibodies to Brucella spp. via competitive enzyme-linked immunosorbent assay and fluorescence polarization assay. Polymerase chain reaction (PCR) and culture of whole blood, bronchoalveolar fluid, and rectal, nasal, and genital swabs for Brucella spp. were consistently negative. Serial computed tomography revealed mild focal dilatation of brain ventricles. CSF sampling was warranted to exclude neurobrucellosis. Sedation was achieved with 30 mg diazepam (0.28 mg/kg) orally 2.5 hours prior to arrival in hospital, followed by 5.3 mg midazolam (0.05 mg/kg) intramuscularly, and anesthetic induction with 2.5 mg midazolam (0.02 mg/kg) and 200 mg propofol (2 mg/kg) administered slowly intravenously, followed by intubation and maintenance on sevoflurane using controlled mechanical and apneustic anesthesia ventilation. The atlanto-occipital joint was opened by flexing the upper cervical region with the animal in left lateral recumbency. A 20-ga × 6-inch spinal needle was advanced into the cisterna magna using radiographic guidance. CSF was collected successfully with no neurological deficits appreciable on recovery. Brucella spp. was not identified via PCR or culture. This represents the first report of an antemortem CSF tap in a cetacean.

Effects of Mustelid gammaherpesvirus 1 (MusGHV-1) Reactivation in European Badger (Meles meles) Genital Tracts on Reproductive Fitness.

Reactivation of latent Gammaherpesvirus in the genital tract can lead to reproductive failure in domestic animals. Nevertheless, this pathophysiology has not received formal study in wild mammals. High prevalence of Mustelid gammaherpesvirus 1 (MusGHV-1) DNA detected in the genital tracts of European badgers (Meles meles) implies that this common pathogen may be a sexual transmitted infection. Here we used PCR to test MusGHV-1 DNA prevalence in genital swabs collected from 144 wild badgers in Ireland (71 males, 73 females) to investigate impacts on male fertility indicators (sperm abundance and testes weight) and female fecundity (current reproductive output). MusGHV-1 reactivation had a negative effect on female reproduction, but not on male fertility; however males had a higher risk of MusGHV-1 reactivation than females, especially during the late-winter mating season, and genital MusGHV-1 reactivation differed between age classes, where 3–5 year old adults had significantly lower reactivation rates than younger or older ones. Negative results in foetal tissues from MusGHV-1 positive mothers indicated that cross-placental transmission was unlikely. This study has broader implications for how wide-spread gammaherpesvirus infections could affect reproductive performance in wild Carnivora species.

High rates of persistent and recurrent chlamydia in pregnant women after treatment with azithromycin

BACKGROUND:Chlamydia trachomatis is a common bacterial sexually transmitted infection that can persist or recur after antibiotic treatment. Universal screening for chlamydia in pregnancy is recommended to prevent adverse birth outcomes. Single-dose oral azithromycin has been the first-line therapy for chlamydia in pregnancy since 2006.OBJECTIVE:In the setting of limited data and rising sexually transmitted infection rates in the United States, our goal was to document rates and risk factors for persistent or recurrent chlamydia after azithromycin treatment in pregnancy.STUDY DESIGN:This retrospective cohort study included pregnancies with urogenital chlamydia and follow-up testing in women who delivered at an Alabama facility between November 2012 and December 2017. Pregnancies with prescribed azithromycin therapy and repeat chlamydia testing ≥21 days later were included. Chlamydia trachomatis nucleic acid amplification testing was performed on genital swab or urine samples. Descriptive characteristics and birth outcomes were compared for categories stratified by repeat test results: persistence (+ +), recurrence (+ − +), or clearance (+ −). Logistic regression models were used to identify demographic and clinical risk factors for persistent or recurrent chlamydia in pregnancy.RESULTS:Among 810 women with 840 pregnancies with repeat chlamydia testing after azithromycin treatment, 114 (14%) had persistence and an additional 72 (9%) had recurrence later in pregnancy. The median time to repeat testing was 30 days (interquartile range, 24–49 days). Concomitant gonorrhea or syphilis in pregnancy was independently associated with persistent or recurrent chlamydia (adjusted odds ratio, 1.6; 95% confidence interval, 1.1–2.4).CONCLUSION:Persistent or recurrent chlamydia after azithromycin treatment was detected in nearly 1 in 4 pregnancies with repeat testing in our urban center, highlighting the importance of performing a test of cure and ensuring partner therapy to reduce recurrent chlamydia risk.

Long-term immunogenicity, effectiveness, and safety of nine-valent human papillomavirus vaccine in girls and boys 9 to 15 years of age: Interim analysis after 8 years of follow-up

BackgroundThe nine-valent human papillomavirus (9vHPV) vaccine protects against infection and disease related to HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. The pivotal 36-month Phase III immunogenicity study of 9vHPV vaccine in 9- to 15-year-old girls and boys was extended to assess long-term immunogenicity and effectiveness through approximately 10 years after vaccination. We describe results of an interim analysis based on approximately 8 years of follow-up after vaccination. MethodsParticipants aged 9–15 years who received three doses of 9vHPV vaccine (at day 1, month 2, and month 6) in the base study and consented to follow-up were enrolled in the long-term follow-up study extension (N = 1272 [females, n = 971; males, n = 301]). Serum was collected at months 66 and 90 to assess antibody responses. For effectiveness analysis, genital swabs were collected (to assess HPV DNA by polymerase chain reaction [PCR]) and external genital examination was conducted (to detect external genital lesions) every 6 months starting when the participant reached 16 years of age. Cervical cytology tests were conducted annually when female participants reached 21 years of age; participants with cytological abnormalities were triaged to colposcopy based on a protocol-specified algorithm. External genital and cervical biopsies of abnormal lesions were performed, and histological diagnoses were adjudicated by a pathology panel. Specimens were tested by PCR to detect HPV DNA. ResultsGeometric mean titers for each 9vHPV vaccine HPV type peaked around month 7 and gradually decreased through month 90. Seropositivity rates remained >90% through month 90 for each of the 9vHPV vaccine types by HPV immunoglobulin Luminex Immunoassay. No cases of HPV6/11/16/18/31/33/45/52/58-related high-grade intraepithelial neoplasia or genital warts were observed in the per-protocol population (n = 1107) based on a maximum follow-up of 8.2 years (median 7.6 years) post-Dose 3. Incidence rates of HPV6/11/16/18/31/33/45/52/58-related 6-month persistent infection in females and males were 49.2 and 37.3 per 10,000 person-years, respectively, which were within ranges expected in vaccinated cohorts. There were no vaccine-related SAEs or deaths during the period covered by this interim analysis. ConclusionsThe 9vHPV vaccine provided sustained immunogenicity and durable effectiveness through approximately 7 and 8 years, respectively, following vaccination of girls and boys aged 9–15 years.

Early posttherapy clearance of human papillomavirus and treatment response in cervical carcinoma.

Among patients with cervical cancer, little is known about the significance of persistent human papillomavirus (HPV) expression after chemoradiation (CRT). This study evaluated associations between early posttreatment HPV clearance and patient outcomes with an added focus on the value of posttherapy positron emission tomography (PET) imaging. Included patients underwent pretreatment testing indicating a high-risk HPV infection and posttreatment testing with a messenger RNA (mRNA)-based genital swab after CRT. Posttherapy responses were stratified on the basis of HPV mRNA detection into an early clearance (EC) group (no mRNA) and a persistent expression (PE) group (detectable mRNA) on the basis of an evaluation at a median of 6weeks after therapy. The Kaplan-Meier method was used to compare outcomes, and multivariable analysis was used to identify predictors of outcomes. Seventy-two of the 97 eligible patients (74.2%) had EC. The mean follow-up time was 25months (range, 4-56months), and 2-year pelvic control (76.9% vs 50.2%; P=.01) and overall survival (OS; 80.9% vs 52.2%; P<.01) were superior among EC patients. In the multivariable analysis, EC predicted for improved survival (hazard ratio [HR] for mortality, 0.46; 95% confidence interval [CI], 0.21-0.96; P=.047), as did a complete response (CR) on posttherapy PET (HR for less than a CR on PET, 6.17; 95% CI, 2.58-14.72; P<.01). In a subset analysis of patients with a posttherapy PET CR, HPV clearance retained prognostic significance (2-year OS, 95.6% with EC vs 66.7% with PE; P=.04), whereas PE patients without a PET CR had the worst survival (35.9%; P<.01 for trend). Early posttherapy clearance of HPV is associated with improved survival in cervical cancer. Evaluating HPV expression at this 6-week time point provides prognostic information beyond posttherapy PET imaging and may aid in risk stratification and decisions for treatment escalation.

Identification of risk factors associated with Coxiella burnetii infection in cattle and buffaloes in India

The etiological agent Coxiella burnetii is a highly infectious gram-negative bacterium that can affect multiple species. Many reports confirm its presence in humans, domestic ruminants and rodents in India. This study was aimed to investigate the risk factors associated with C. burnetii infection in bovine populations in Punjab, India. This study was conducted using a stratified two-stage random sampling approach. Twenty-two villages representing all districts of the state were selected. Bovine farmers were interviewed and detailed information about their management and husbandry practices was collected using a structured questionnaire. Blood, milk and genital swab samples were collected from the cattle and buffaloes owned by the farmers. An animal was declared C. burnetii infected by using a combination of tests in parallel, i.e. if it was positive in serological or molecular tests (IgG indirect ELISA or Trans-PCR assay). A herd was considered positive if at least one animal in the herd was declared C. burnetii infected using the above definition. Three binomial logistic regression models were constructed to evaluate the association of (a) geographical location, herd characteristics, and farm management practices with the herd status (herd model), (b) individual animal related factors with the C. burnetii infection status (individual animal model), and (c) production and health related factors with C. burnetii infection status in adult females (adult female model). We collected a total of 610 blood, 610 genital swabs and 361 milk samples from 378 cattle and 232 buffaloes in 179 herds/households. The practice of throwing away aborted materials outside the farm as compared to burial/burning (adjusted odds ratio [OR] 3.0, 95 % confidence interval [CI] 1.14–7.87, p = 0.02) was associated with larger odds of being a C. burnetii infected herd. On the other hand, separation of the animals from the rest of the herd during parturition had a protective effect for being a C. burnetii infected herd (adjusted OR 0.31, 95 % CI 0.18–0.77, p = 0.01). Being cattle as compared to buffalo (adjusted OR 3.37, 95 % CI 1.23–9.20, p = 0.02) and older (adjusted OR 3.37, 95 % CI 1.23–9.20, p = 0.02) were associated with larger odds of C. burnetii infection. The current study highlights that farm practices such as improper aborted material disposal and not separating the animals from the rest of the herd during parturition are important risks for the occurrence of C. burnetii infection in the bovine populations in the state.

Does E-Coli play an important role in neonatal sepsis in preterm prelabour rupture of membrane?

Aim: The aim of this study was to detect the most common causative organism causing neonatal sepsis in women suffered preterm prelabour rupture of membranes and if it is different from that of the maternal genital swab.Materials and Methods: This study was carried out on 200 pregnant women with PPROM at gestational age between 23 weeks plus 6 days to 28 weeks. Genital swabs were taken for microbiological study and all women were managed conservatively. After delivery, buccal and nasal swab were taken from the neonates and the detected organism(s) were correlated with those detected from the mothers' swabs. Also, neonatal outcome was studied regarding incidence of neonatal sepsis, Neonatal Intensive Care Unit) admission and neonatal mortality.Results: From the 200 enrolled cases and their neonates, there were thirty-three neonates (16.5%) that were admitted to the NICU with twenty-one neonates (67.8%) of them suffering neonatal sepsis. Only thirteen neonates (61.9%) of those who had suffered sepsis shared the same organisms with their mothers. The other eight cases (38.1%) had different organisms. The most frequent organism regarding maternal vaginal swabs was Escherichia coli followed by Group B Streptococci sharing the same frequency with non-hemolytic Streptococci, Staphylococcus aureus and Group A streptococci sharing the same frequency with Klebsiella species.Conclusion: E-coli is the most common causative organism for neonatal sepsis in PPROM before 28 weeks of gestation.

Assessment of Sexual Troubles in Egyptian Women with Female Genital Mutilation

Aim: The aim of this study was to detect the most common causative organism causing neonatal sepsis in women suffered preterm prelabour rupture of membranes and if it is different from that of the maternal genital swab.Materials and Methods: This study was carried out on 200 pregnant women with PPROM at gestational age between 23 weeks plus 6 days to 28 weeks. Genital swabs were taken for microbiological study and all women were managed conservatively. After delivery, buccal and nasal swab were taken from the neonates and the detected organism(s) were correlated with those detected from the mothers' swabs. Also, neonatal outcome was studied regarding incidence of neonatal sepsis, Neonatal Intensive Care Unit) admission and neonatal mortality.Results: From the 200 enrolled cases and their neonates, there were thirty-three neonates (16.5%) that were admitted to the NICU with twenty-one neonates (67.8%) of them suffering neonatal sepsis. Only thirteen neonates (61.9%) of those who had suffered sepsis shared the same organisms with their mothers. The other eight cases (38.1%) had different organisms. The most frequent organism regarding maternal vaginal swabs was Escherichia coli followed by Group B Streptococci sharing the same frequency with non-hemolytic Streptococci, Staphylococcus aureus and Group A streptococci sharing the same frequency with Klebsiella species.Conclusion: E-coli is the most common causative organism for neonatal sepsis in PPROM before 28 weeks of gestation.