Genital Tract Research Articles

Assessment of the Impact of Numerous Medicinal Plants on Trichomonas Vaginalis: A Review

The most common non-viral sexually transmitted illness in the world, trichomoniasis, is caused by the etiological agent Trichomonas vaginalis. Trichomoniasis is a prevalent, global health issue that is becoming worse. While infections in males are typically asymptomatic, infections in the female genital tract can result in a variety of symptoms, including vaginitis and cervicitis. This condition has historically been underdiagnosed and under researched due to its generally mild symptoms and the absence of any evidence for any major repercussions. The attempts to identify and treat patients harbouring this parasite have risen, however, in light of mounting evidence that T. vaginalis infection is linked to various disease states with high morbidity in both men and women. Recent research has highlighted the complex interactions between the parasite and host, commensal microbiota, and associated symbionts. The pathophysiology of trichomoniasis is produced by damage to the host epithelia, mediated by a multitude of events during infection. The number of accessible diagnostic alternatives has increased as a result of the commercial introduction of several nucleic acid amplification tests (NAATs). Immunoassay based Point of Care testing is currently available, and a recent initial evaluation of a NAAT Point of Care system has given promising results, which would enable testing and treatment in a single visit. Keywords: Clinical, diagnostics, point of care, trichomoniasis, trichomonas vaginalis, parasitic infection

Primary Malignant Melanoma of the Cervix with Rapidly Progressing Metastases

Introduction: Mucosal melanomas only account for 0.03% of newly diagnosed cancer cases. Female genital tract melanomas account for only 3% of all melanomas, with melanoma of the cervix accounting for less than 3% of all female genital tract melanomas. It is difficult to understand how mucosal melanomas arise as the pathogenesis is still unknown. The incidence of cutaneous melanoma has greatly increased over the years whereas the incidence of mucosal melanomas has stayed relatively steady. Given the rarity of melanoma of the cervix, a standard of care treatment has not been established. Based on the limited cases that have previously been treated, the first option is surgery for early stage melanomas with adjuvant radiation therapy indicated in some cases. The use of systemic chemotherapy is still controversial as it has not been shown to prevent metastases. Case Report: A 66-year-old postmenopausal female presented with heavy vaginal bleeding. A transvaginal ultrasound showed a complex cystic structure in the cervix and she was referred to gynecologic oncology. She was up to date on her pap smears, and they have always been normal. Patient was found to have a fungating 4 x 5 cm mass in the upper vagina and pathology demonstrated poorly differentiated malignant neoplasm. The patient was diagnosed with FIGO Stage IIA2 cervical cancer. Patient’s initial PET/CT demonstrated hypermetabolic area in the cervix consistent with known cervical carcinoma with no other uptake in the uterus. Weekly chemosensitization with cisplatin and external beam radiation was initiated. On clinical examination after treatment by the gynecologic oncologist, visible disease was seen confined to the cervix. An MRI of the pelvis showed response with the suspected tumor limited to the cervical stroma in the anterior and lateral portion of the cervix with no definitive parametrial tumor and no evidence of nodal metastasis. Second opinion from pathology review was received and results showed poorly differentiated malignant neoplasm immunohistochemically consistent with “melanoma”. After 25 fractions of daily radiotherapy with weekly cisplatin, patient underwent exploratory laparotomy for radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node sampling. Final pathology of the uterus and cervix showed invasive poorly differentiated melanoma with deepest invasion of melanoma measuring 8mm and negative surgical margins. All lymph nodes removed during surgery were negative for malignancy. Adjuvant Pembrolizumab was started at this time. Two months postoperatively, the patient underwent CT surveillance again due to new onset chest wall and axillary nodules varying in size from 2-4 cm. Right chest wall axilla biopsy pathology was consistent with melanoma. At this time Pembrolizumab was discontinued and the patient was transitioned to Nivolumab and Ipilimumab 19 days after discontinuing Pembrolizumab. Four months postoperatively, additional CT scans were performed showing widespread metastatic disease in the lungs, chest wall, liver, peritoneum, retroperitoneum and left eye. Patient underwent left frontal craniotomy with tumor resection, and pathology was consistent with metastatic melanoma. Subsequent to craniotomy, the patient underwent three treatments with stereotactic radiosurgery. Despite treatment, six months postoperatively, the patient’s symptoms continued to progress with slurred speech, generalized weakness and abdominal pain. Ultimately, the patient passed away nine months after the diagnosis and four months after a combination of external beam radiotherapy, surgery, and vaginal brachytherapy. Discussion: Melanoma of the cervix is a rare type of cervical cancer with poor prognosis. Globally, 5-year survival is 18.8% for stage I, 11.1% for stage II, and 0% for stages III–IV. It has been shown that median overall survival time decreases with increasing FIGO stage. Risk factors have not been identified for gynecologic melanomas or most other mucosal melanomas. Pembrolizumab is most effective for cutaneous melanomas, however, has been shown to prolong progression free survival in mucosal melanomas. The median overall survival is significantly shorter for patients with mucosal melanoma (11.3 months) as compared to patients with a cutaneous primary (23.5 months). Primary malignant melanoma of the cervix (PMMC) remains a rare tumor and the prognosis is generally poor. Radical hysterectomy, chemoradiation, and immunotherapy have all been utilized in the treatment of PMMC. Further investigation of primary melanoma of the cervix is necessary to formulate a standard of care treatment.

PURULENT-INFLAMMATORY COMPLICATIONS AND POSTOPERATIVE HERNIAS AFTER CESAREAN SECTION

Any surgical intervention on the abdominal cavity, including caesarean section, is accompanied by several postoperative purulent-inflammatory complications, especially in patients with concomitant diseases. The most common purulent complications occur in the laparotomy area. They are suppuration of surgical wounds, necrotizing fasciitis, phlegmon and abdominal abscess. There are different opinions on the predictors of purulent complications. The most frequently mentioned are leukocyte count, C-reactive protein, procalcitonin, ferritin, and endocervical culture. Unfortunately, peritonitis and sepsis rates have not reduced recently. Still, these complications negatively affect treatment outcome. The paper discisses the effectiveness of drainage and lavage of the abdominal cavity during cesarean section. In this regard, preventive measures reducing the number and severity of purulent-inflammatory complications becomes relevant. First of all, this concerns intraoperative antibiotic prophylaxis, which should be carried out taking into account risk factors and the individual sensitivity of genital tract microorganisms to antimicrobial drugs. Obstetricians do not have a particular pattern to follow this technique. There is also ambiguous opinion on choosing an operative approach to reduce the number of postoperative ventral hernias. Both longitudinal and transverse laparotomies have certain advantages and disadvantages. Until now, the choice of postoperative ventral hernia repair, especially in the hypogastrium, is determined by many factors, which should be taken into account. These problems reveal the need for optimal measures aimed at reducing negative consequences of cesarean delivery. Articles from Cyberleninka, e-Library, disserCat, ResearchGate, JSTOR, PubMed, and Google Scholar were analyzed for the study.

When synchronous mucinous metaplasia and neoplasia of the female genital tract and peutz-jeghers syndrome meet: a case report and literature reviews

BackgroundPeutz-Jeghers syndrome (PJS) is characterized by the presence of hamartomatous polyps in the gastrointestinal tract and mucocutaneous pigmentation on the lips, oral mucosa, nose, fingers, and toes. Synchronous mucinous metaplasia and neoplasia of the female genital tract (SMMN-FGT) refers to the occurrence of multifocal mucinous lesions in at least two sites, including the cervix, uterus, fallopian tubes, and ovaries, in the female genital tract. SMMN-FGT and PJS are rare diseases with a very low incidence, especially when occurring simultaneously.Case presentationWe report a case in which a woman with a large mass on the left ovary underwent a gynecological surgery and was diagnosed with cervical gastric-type adenocarcinoma and mucinous lesions in the endometrium, bilateral fallopian tubes, and ovary, i.e., SMMN-FGT, by postoperative paraffin pathology. The patient sought medical attention for abdominal distension and enlargement. A gynecological ultrasound revealed a multilocular cystic mass in the pelvis, while serum tumor markers were within normal limits, with mildly elevated carbohydrate antigen 199 and carbohydrate antigen 125 levels. Cervical thin-prep cytology test result was negative. The patient had a family history of PJS with black spots on her skin and mucous membranes since the age of 8 years. She underwent multiple partial small bowel resections and gastrointestinal polypectomy owing to intestinal obstruction and intussusception. She underwent left adnexectomy, hysterectomy, right salpingectomy, greater omental resection, appendectomy and right ovary biopsy, and received six courses of adjuvant chemotherapy with Lopressor plus Carboplatin. Genetic testing revealed a heterozygous serine threonine kinase 11 germline mutation and there were no signs of recurrence during the 18-month follow-up period after treatment.ConclusionsThis is a rare case in which PJS was complicated by SMMN-FGT. Owing to its extreme rarity, there are no guidelines, but reported cases appear to indicate a poor prognosis. We retrospectively reviewed all cases of collisions between PJS and SMMN-FGT and explored the clinical features, pathological characteristics, diagnosis, treatment methods, and prognosis when the two diseases coexisted. The aim is to deepen the clinicians’ understanding of this disease for early detection, diagnosis and treatment.

Local Power: The Role of Tissue-Resident Immunity in Human Genital Herpes Simplex Virus Reactivation.

From established latency, human herpes virus type 2 (HSV-2) frequently reactivates into the genital tract, resulting in symptomatic ulcers or subclinical shedding. Tissue-resident memory (TRM) CD8+ T cells that accumulate and persist in the genital skin at the local site of recrudescence are the "first responders" to viral reactivation, performing immunosurveillance and containment and aborting the ability of the virus to induce clinical lesions. This review describes the unique spatiotemporal characteristics, transcriptional signatures, and noncatalytic effector functions of TRM CD8+ T cells in the tissue context of human HSV-2 infection. We highlight recent insights into the intricate overlaps between intrinsic resistance, innate defense, and adaptive immunity in the tissue microenvironment and discuss how rapid virus-host dynamics at the skin and mucosal level influence clinical outcomes of genital herpes diseases.

Endometriosis: A Narrative Review

Although much progress has been made since endometriosis was first scientifically described centuries ago, numerous unanswered questions still surround this chronic, inflammatory condition. For instance, one theory on the pathogenesis of endometriosis suggests that the condition begins from retrograde menstrual flow implanting on surfaces in the abdomen and pelvis (Samson’s theory), which is a logical mechanism given the high rates of endometriosis in patients with obstructive anomalies of the lower genital tract and significant retrograde flow. This explanation has many shortcomings however, as retrograde menstruation occurs more commonly than the reported 10% prevalence of endometriosis. Additionally, endometriosis lesions can be found in areas quite remote from the pelvis, such as the thoracic cavity. As such, research has been increasingly focused on identifying immune, genetic, and local environmental factors that likely play critical roles in the development of endometriosis. This growth of benign endometrial-like tissue outside of the uterus can sometimes be asymptomatic, but it can also cause debilitating pain, infertility, ovarian cysts (endometriomas), and can invade surrounding organs such as the bowel or bladder. There are three main phenotypes of endometriosis: superficial lesions, deeply infiltrating endometriosis (including nodules), and ovarian endometriomas. While the exact etiology may be obscure, the societal and economic impacts of this condition are undeniable. Patients diagnosed with endometriosis are at a significantly higher risk of absenteeism from work or school, lower quality of life, chronic pelvic pain, and are more likely to receive a mental health diagnosis such as depression or anxiety. Apart from direct and indirect incurred costs to patients (estimated at approximately $5000 per patient annually), at a national level the economic burden of endometriosis exceeds $2 billion annually in Canada, and approaches $80 billion in the USA.

Synchronous double primary vulvar melanoma: a not so rare possibility. A clinical and dermoscopic case study.

Vulvar melanoma is considered rare, but it is the second most frequent vulvar neoplasm; 2% of melanomas in women arise in the vulvar area. It is important to highlight how the characteristics of vulvar melanoma differentiate it from classic cutaneous melanoma. Vulvar melanoma has different risk factors and clinical and dermoscopic characteristics; moreover, it has a higher recurrence rate and a greater likelihood of multifocality. Here, we present a case of a 44-year-old patient with two primary vulvar melanomas located on opposite sides of her vulva. The lesions were both flat, but they had distinct clinical and dermoscopic appearances. Melanoma of the genital tract is likely the result of a multifocal disorder of the melanocytes within the mucosa that inhabit the perineal squamous epithelium. The risk factors of vulvar melanoma differ from those of classical cutaneous melanomas. Vulvar melanoma occurs in an area shielded from ultraviolet radiation; the primary risk factors include chronic inflammatory disease, genetic susceptibility, irritant agents and viral infections. This case study reveals how a close examination of the genital area is important and how dermoscopy can aid in the differential diagnosis of vulvar lesions. Inspections of the genital area should be particularly thorough if a melanoma is detected there, given the higher risk of multifocality in that part of the body.

Stability, enrichment, and quantification of total and HPV16-specific IgG present in first-void urine

First-void urine (FVU) samples, containing human papillomavirus (HPV)-specific IgG from female genital tract secretions, provide a non-invasive option for disease monitoring and vaccine impact assessment. This study explores the utility of FVU for IgG quantification, exploring stability and compatibility with DNA preservation methods, alongside various IgG enrichment methods. Healthy female volunteers provided FVU and serum samples. FVU was collected with or without urine conservation medium (UCM) and stored under different conditions before freezing at −80 °C. Four IgG enrichment methods were tested on FVU samples. All samples were analyzed using three total human IgG quantification assays and an in-house HPV16-specific IgG assay. Samples stored with UCM buffer had higher total and HPV16-specific IgG concentrations (p ≤ 0.01) and IgG remained stable for at least 14 days at room temperature. Among IgG enrichment methods, Amicon filtration (AM) and AM combined with Melon Gel purification (AM-MG) provided similar HPV16-IgG concentrations, correlating strongly with serum levels. Protein G magnetic beads methods were incompatible with time-resolved fluorescence-based assays. This study highlights FVU as a reliable and convenient sample for IgG quantification, demonstrating stability for at least 14 days at room temperature and compatibility with UCM DNA preservation. It emphasizes the need to select appropriate IgG enrichment methods and confirms the suitability of both AM and AM-MG methods, with a slightly better performance for AM-MG.

Fetomaternal Outcome in Antepartum Hemorrhage After 34 Weeks of Gestation.

Antepartum hemorrhage is defined as any bleeding from or into the genital tract during pregnancy, after the period of viability until delivery of the fetus. APH complicates 2-5% of pregnancies and is a primary cause of perinatal and maternal mortality globally. Aim of this study is to evaluate maternal and perinatal outcome in patients with APH at a tertiary care hospital. The present study was a cross sectional study conducted in Obstetrics and Gynaecology department of Paropakar Maternity and Women's Hospital, during a period of 5 months from December 2022 to April 2023. 50 cases of APH were enrolled with gestational age ≥ 34 weeks of gestation. Incidence of APH after 34 weeks of gestation was 0.51%. The most common type of APH was abruption placenta (44%) followed by placenta previa (32%) and undetermined (24%). The age range of 26 to 30 years old accounted for the highest number of APH patients i.e., 21(42%). In placenta previa, 75% and in abruption placenta 63.64% were multigravida. APH was presented mostly between 37-40 weeks. Around 26% of the patients had anemia at the time of admission. Most common mode of delivery was cesarean section (82%). Most common maternal complications were PPH (40%), blood transfusion (28%), DIC (4%), cesarean hysterectomy (4%). Low birth weight and preterm were the most common causes of fetal complications. Maternal mortality was 2% and perinatal mortality was 18% overall. APH is primary cause of maternal and perinatal morbidity and mortality. In our study, an abruption placenta was the most frequent cause of APH. Cesarean section was the most commonly used mode of delivery. PPH with blood transfusion was the most prevalent maternal complication, while fetal complications included low birth weight and preterm..

Novel Insights on Group B Streptococcus in Pregnancy.

Group B Streptococcus (GBS) is a frequent colonizer of the human genital and gastrointestinal tract. In pregnant or postpartum persons, colonization is often asymptomatic and can contribute to infectious morbidity in both the parturient and the newborn. The prevalence of invasive GBS disease has dramatically decreased over the past 3 decades. However, despite standardized clinical algorithms, GBS disease remains a public health concern. Our review summarizes the GBS bacteria pathophysiology, morbidity, management guidelines, and summarizes ongoing research. While novel testing and parturient vaccination are being explored, barriers exist, preventing guideline updates and widespread implementation.

Cytotoxic CD4+ T Cells Are Induced during Infection with Chlamydia trachomatis.

Chlamydia trachomatis is the most common cause of bacterial sexually transmitted infection in both men and women. Immunity to C. trachomatis involves many cell types, but CD4+ T cells play a key role in protecting the host during natural infection. Specifically, IFN-γ production by CD4+ T cells is the main effector responsible for bacterial clearance, yet the exact mechanism by which IFN-γ confers protection is poorly defined. In our efforts to define the specific mechanisms for bacterial clearance, we now show that IFN-γ upregulates expression of MHC class II (MHCII) on nonhematopoietic cells during C. trachomatis infection invivo. We also find that MHCII expression on epithelial cells of the upper genital tract contributes to the efficient clearance of bacteria mediated by pathogen-specific CD4+ Th1 cells. As we further cataloged the protective mechanisms of C. trachomatis-specific CD4+ T cells, we found that the T cells also express granzyme B (GzmB) when coincubated with infected cells. In addition, during C. trachomatis infection of mice, primed activated-naive CD4+ Th1 cells displayed elevated granzyme transcripts (GzmA, GzmB, GzmM, GzmK, GzmC) compared with memory CD4+ T cells invivo. Finally, using intracellular cytokine staining and a GzmB-/- mouse strain, we show that C. trachomatis-specific CD4+ Th1 cells express GzmB upon Ag stimulation, and that this correlates with Chlamydia clearance invivo. Together these results have led us to conclude that Chlamydia-specific CD4+ Th1 cells develop cytotoxic capacity through engagement with nonhematopoietic MHCII, and this correlates to C. trachomatis clearance.

Study of prevalence and evolution of uterine fibroids during pregnancy in patients of the Medical Center and Medical Specialties FOB of Guayaquil

Fibroids or leiomyomas are the most common benign tumors of the upper portion of the female genital tract; They can reach large sizes and generally do not require surgical treatment during pregnancy. Most of these masses present asymptomatically and are discovered as an incidental finding in ultrasounds during pregnancy or at termination in the case of a cesarean section. Knowing the prevalence of fibroids in the pregnant population is of utmost importance to understand its possible impact on the health of the mother and fetus. Determining the prevalence and evolution of fibroids during pregnancy allows us to identify the number of women with this condition that may be affected by this pathology. The objective of this study is to evaluate the prevalence and evolution of uterine fibroids during pregnancy and determine their complications in women between 20 and 45 years old at the Medical Center and Medical FOB Specialties of Guayaquil. From the results of this study it can be concluded that fibroids during pregnancy are related to maternal age and their size does not increase, but rather tends to decrease. Its association with pregnancy increases the risk of complications. Pregnant patients with fibroids have a higher risk of uterine atony and bleeding after cesarean section than patients who terminated their pregnancy by delivery. Understanding the prevalence of fibroids during pregnancy is crucial to improve knowledge, clinical management, and prevention and care strategies in this population

(006) GENITAL VASCULAR RESISTANCE AS A PREDICTOR OF CARDIOVASCULAR RISK ACCORDING TO THE ANALYSIS OF THE PROGETTO CUORE IN PREMENOPAUSAL WOMEN

Abstract Introduction Gender disparity persists in the relationship between sexual dysfunction and cardiovascular risk (CV). It is well- known that erectile dysfunction (ED) represents a sign of subclinical CV pathology and that alterations in color Doppler penile ultrasound parameters serve as predictive markers of major CV events. Female sexual dysfunction (FSD) is a complex condition that involves psychological and organic components, including the cardiovascular system, and affects the quality of life of over a third of women. However, despite its high prevalence, little attention has been paid to the vascular system responsible for blood supply to the female genital apparatus. In men, the hypothesis of penile artery size is a proposed pathophysiological mechanism to address the relationship between the onset of ED symptoms and cardiovascular disease. In recent years, it has also been highlighted that compromised genital vascularization may be a precursor to cardiovascular diseases in women. Objective Our ami gas to investigate the association between clitoral pulsatility index (PI), evaluated through Clitoral color Doppler ultrasound (CDU), and cardiometabolic risk factors in women referred to the Andrology, Women’s Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy. Methods In an observational study, a total of 361 women with a mean age of 45.1 (±13.3) years were evaluated. All patients underwent a thorough medical history assessment, an evaluation of anthropometric parameters, blood sampling for measurement of metabolic and hormonal parameters and a Doppler ultrasound of the clitoral cavernous artery to measure the PI. Results 23.5% of the patients were overweight and 11.6% were obese, 16.3% had hypertension, and 18.6% had metabolic syndrome. In the multivariate analysis, after adjusting for age, the PI was positively correlated with body mass index (BMI) (ß=0.160, p=0.003) and waist circumference (ß=0.186, p=0.002). Furthermore, all women underwent cardiovascular risk assessment, as indicated by Progetto CUORE, assigning a score based on the presence of risk factors (blood pressure, cholesterol levels, smoking, diabetes, age, gender) to estimate the absolute global cardiovascular risk over the next 10 years. We observed that, particularly in women of reproductive age, the clitoral PI was positively correlated with the Progetto CUORE score (r=0.136, p=0.035). Conclusions Clitoral PI increases in relation to several cardiometabolic risk factors. It is therefore relevant to understand how common cardiometabolic alterations may influence vascular function in the female genital tract and whether treating these alterations leads to an improvement in clitoral ultrasound indices, especially in young premenopausal women. Disclosure No.

Comparative study of Candidiasis among Single and Married women at Rwanda Military Hospital

Background: Genital tract is the portal of entry for numerous sexually and non-sexually trans­mitted diseases. A number of bacterial and non-bacterial infections exist that affect the female reproductive tract and cause vaginal discharge. Candida species are among im­portant opportunistic pathogens causing candidiasis in human worldwide. These yeast species are of public health concern nowadays. Aim: This study aimed at comparing the prevalence of candidiasis among single and married women attending Rwanda Mili­tary Hospital. The study population comprises of single and married women. Methodology: This was a retrospective study where data was collected from Rwanda Military Hospital. Results: The re­sults of this study showed that the incidence of candidiasis was higher in married women when compared with single women. The prevalence of candidiasis in married women was 128(74.4%), while in single women is 44(25.6%). It was observed in this study that the distribution of candidiasis among married and single is statistically sig­nificant (p<0.05). Results also show that out of 172 single and married women, more cases of candidiasis were observed within the age range of 21-30 years, 66 (44.2%) were infected with candida albicans, 31-40 years had a prevalence of 55(32%) and 11-20 years had a prevalence of 13(7.6%). The overall of cases of candida other than C. albicans observed was 15.1%. Conclusion: This study showed that married and single women are predisposed to candidiasis. It is therefore important to give opportunistic pathogens like Candida species attention in women especially among married ones as they are mostly affected by this candidiasis. Keywords: Candidiasis, C. albicans, Vaginal discharge, Urinary tract infection, bacterial vaginosis, aerobic vaginitis.

Assessment and correction of local antimicrobial protection factors in women with chronic recurrent vulvovaginal candidiasis and type 2 diabetes mellitus

Aim. Evaluation and correction of local antimicrobial protection factors in women with type 2 diabetes mellitus (DM 2) and chronic recurrent vulvovaginal candidiasis (rVVC). Materials and methods. The study involved 100 women undergoing outpatient follow-up at the age of 40.9±5.8 years, with a body mass index of 29.8±3.5. The period was 2022–2023. The examination included anamnesis, collection of anthropometric data, calculation of body weight, microscopic examination of smears from the cervical canal and vagina, Gram-stained before treatment, in the 1st and 3rd months after its completion, identification pathogenic microorganisms using PCR, colposcopy, ultrasound of the pelvic organs. Indicators of glycosylated hemoglobin in the subjects at the control points of the study: at 1 month the average values were 5.9±2.9%, at 3 months – 5.9±3.0%, the average value was 5.9±3.1%. Candida species were identified by the bacteriological method using Sabouraud dextrose agar (growth of colonies of fungi of the genus Candida in an amount of more than 103 CFU/ml). Immunological methods for studying antimicrobial protection factors included studying the number of neutrophil granulocytes (NG) on the surface of the mucous membranes of the vulva and vagina, their phagocytic and NBT-reducing activity in a latex test. Randomization of patients into groups: group 1 included 50 (50%) women with DM 2 who, as part of complex therapy for rVVC received the drug Genferon® 1 intravaginal suppository of 500 thousand units 2 times a day for 10 days and fluconazole 150 mg orally three times with an interval of 72 hours at the first stage of treatment; group 2 included 50 (50%) women who received therapy with fluconazole 150 mg three times with an interval of 72 hours. The maintenance anti-relapse course therapy in both groups included the use of fluconazole 150 mg once a week for 6 months. In group 1st anti-relapse therapy was supplemented by the administration of the drug Genferon® 1 intravaginal suppository of 500 thousand units at night 3 times a week for 3 months, after which the vaginal microbiota was corrected for 2 weeks using vaginal suppositories, containing Lactobacillus acidophilus in an amount of at least 108 CFU. In group 2nd, basic anti-relapse antimycotic therapy was not accompanied by the prescription of any immunomodulatory or probiotic drugs. Results. The etiological agents of rVVC in women of late reproductive age in 79% (n=79) и 28% (n=28), respectively, were C. albicans and C. glabrata, which during the period of acute of the disease were detected by culture in the vaginal discharge at more than 104 CFU/ml. Chronic recurrent course of vulvovaginal candidiasis in women with DM 2 was characterized by exacerbations 4 or more times a year, accompanied by the corresponding clinical picture: white or yellowish-white cheesy discharge from the genital tract, itching or burning in the anogenital area, discomfort in the external genital area, dyspareunia, dysuria, decreased phagocytic activity of NG in vaginal secretions by 25.8%, impairment of their spontaneous and latex-induced NBT-reducing activity by 35.2%, functional reserve by 23.0% relative to reference values. The use of the drug Genferon® as part of complex therapy for rVVC contributed to a decrease in the number of Candida spp. in 1st and 3d months of observation after completion of anti-relapse therapy, normalization of cellular factors of innate immunity of the mucous membranes, faster resolution of the clinical manifestations of an episode of the disease. The decrease in the number of relapses over a 12-month observation period compared to the control group was also facilitated by an increase in the protective properties of the vaginal mucosa due to the restoration of the vaginal microbiota with the help of lactobacilli acidophilus. Conclusion. The etiological agents of rVVC in women of late reproductive age are C. albicans and C. glabrata. Subcompensated DM 2 is a risk factor for rVVC, which requires additional monitoring of microbiological parameters of the vaginal microbiota. rVVC in women with DM 2 is associated with an increase in the number of NG in the vaginal secretion, a decrease in their phagocytic activity and functional reserve compared to the reference values. Combination therapy of rVVC with topical recombinant interferon α2b, benzocaine and taurine in the formulation of Genferon® (suppositories) is an effective method to improve the clinical and immunological efficacy of therapy.

A group B streptococcal type VII secreted LXG toxin mediates interbacterial competition and colonization of the female genital tract.

Group B Streptococcus (GBS) asymptomatically colonizes the vagina but can opportunistically ascend to the uterus and be transmitted vertically during pregnancy, resulting in neonatal pneumonia, bacteremia and meningitis. GBS is a leading etiologic agent of neonatal infection and understanding the mechanisms by which GBS persists within the polymicrobial female genital mucosa has potential to mitigate subsequent transmission and disease. Type VIIb secretion systems (T7SSb) are encoded by Firmicutes and often mediate interbacterial competition using LXG toxins that contain conserved N-termini important for secretion and variable C-terminal toxin domains that confer diverse biochemical activities. Our recent work characterized a role for the GBS T7SSb in vaginal colonization and ascending infection but the mechanisms by which the T7SSb promotes GBS persistence in this polymicrobial niche remain unknown. Herein, we investigate the GBS T7SS in interbacterial competition and GBS niche establishment in the female genital tract. We demonstrate GBS T7SS-dependent inhibition of mucosal pathobiont Enterococcus faecalis both in vitro using predator-prey assays and in vivo in the murine genital tract and found that a GBS LXG protein encoded within the T7SS locus (herein named group B streptococcal LXG Toxin A) that contributes to these phenotypes. We identify BltA as a T7SS substrate that is toxic to E. coli and S. aureus upon induction of expression along with associated chaperones. Finally, we show that BltA and its chaperones contribute to GBS vaginal colonization. Altogether, these data reveal a role for a novel T7b-secreted toxin in GBS mucosal persistence and competition.

Pitfalls in Diagnosis of Endometrial Adenocarcinoma in Biopsy Specimens

Endometrial Adenocarcinoma is one of the common malignancies of the female genital tract. It is associated with specific risk factors, which can be acquired and genetic. There are various precursor lesions of this condition, which warrants detection by proper screening methods to aid in earlier diagnosis and thereby treat these conditions to prevent their progression to well established adenocarcinoma. There are Several Histo-pathological mimickers which simulate Adenocarcinoma, that need to be differentiated by proper clinicopathological evaluation, so the correct diagnosis is made, which helps in overall management of patient. This study is an attempt to describe various precursor lesions of Endometrial Adenocarcinoma and also the differentiation of Pathological conditions that are the look alike of Endometrial Adenocarcinoma. In addition various clinicopathological methods will be described which help to arrive at proper diagnosis. Risk categories for Endometrial carcinoma will be identified which helps in early diagnosis of Disease.

Infection route associated with invasive group A streptococcal toxic shock syndrome in maternal deaths: Nationwide analysis of maternal mortalities in Japan

ObjectivesTo clarify the infection route in maternal death due to invasive group A streptococcal (GAS) infection and toxic shock syndrome (TSS). MethodsA retrospective study was conducted on maternal deaths due to GAS-TSS in Japan between January 2010 and March 2024. The final causal diagnosis of maternal death and the infection routes of GAS were analysed using medical records, laboratory data and autopsy findings. ResultsAmong the 616 maternal deaths during the study period, 48 (8%) involved infectious diseases. The most common infection was invasive GAS (56%, n = 27), 21 (78%) and six cases occurred during the antepartum and puerperium periods, respectively. In the GAS-TSS group, 71% (15/21) infections were originated the upper respiratory tract. However, in the puerperium cases, 67% (4/6) were infected from the genital tract. In addition, no maternal deaths due to GAS-TSS were reported during the COVID-19 pandemic period in Japan from 2020 to 2023. ConclusionMost antepartum GAS infections were from the upper respiratory tract. They may be reduced by preventive measures, including frequent disinfection, wearing masks and isolation from persons at high risk of carrying GAS, such as symptomatic children. On the other hand, GAS-TSS during puerperium infection via the genital tract.

Colorectal endometriosis – a challenging, often overlooked cause of colorectal pathology: a clinicopathological review of 114 cases

The colon is the most common site for endometriosis outside the genital tract. It has a varied presentation and can mimic numerous other conditions, both clinically and pathologically. We investigated the clinicopathological features of a series of colorectal endometriosis with a particular emphasis on the features seen in cases with colonic mucosal involvement. A total of 114 consecutive cases of colorectal endometriosis were reviewed. Forty-eight percent did not have a prior diagnosis of endometriosis and in 34 patients (30%) the endometriosis was determined as the cause for the presentation. Mucosal involvement was present in 31 specimens. Features of chronic colitis were seen in the adjacent mucosa in 90% of cases whilst there were glandular changes mimicking adenocarcinoma in two cases (1.8%). Fifty percent of cases with mucosal involvement also showed glands with a hybrid intestinal-endometrial phenotype by morphology and/or by immunohistochemistry. Endometriosis is an important mimic of other conditions.

Impact of Experimental Tuberculosis on Fertility of Female BALB/c Mice.

The study revealed no effects of pregnancy and childbirth on the course of tuberculosis in female BALB/c mice after aerosol infection with Mycobacterium tuberculosis. However, we demonstrated a negative effect of tuberculosis infection on the fertility of infected females, which manifested in a longer period from mating to pregnancy and in a smaller litter size. Impaired reproductive function in response to the effect of the systemic infectious process was accompanied by the development of immunosuppression confirmed by an immunological test (delayed-type hypersensitivity to tuberculin) and the formation of genital tract dysbiosis during pregnancy and postpartum period.