Gynecologic Infections Research Articles

Advances in soft nanoparticle-based platforms for human and veterinary trichomoniasis therapy: A scoping review.

This scoping review focuses on drug delivery systems based on soft materials designed for the administration of drugs with anti-Trichomonas vaginalis activity. It primarily examines their use in addressing human trichomoniasis, exploring their physicochemical characteristics, in vitro and in vivo evaluation and identifying existing challenges and gaps. Given the economic burden and the One Health approach, formulations developed aiming at treating animal infections - cattle and poultry - were also discussed. The review involved searching electronic databases, such as PubMed, Scopus, and Web of Science, to find studies published until May 2024; out of the 103 articles retrieved, 18 fulfilled the eligibility criteria. This study investigated soft-nanoparticle formulations, including polymericand lipid-based systems, and their incorporation into suitable formulations for topical application, including hydrogels and polymeric films. Additionally, the discussion covered toxicology and highlighted the knowledge gaps related to the potential use of these formulations in humans. Anti-trichomonas soft nano-based formulations emerge as promising candidates for treating gynecological and animal infections. In conclusion, further preclinical testing is necessary, as none of the formulations have progressed to human clinical trials and have only been evaluated in animal models.

UM RELATO DE CASO SOBRE DESLOCAMENTO ESPONTÂNEO DO DIU PARA A CAVIDADE ABDOMINAL

Introduction: The intrauterine device (IUD) is the most widely used reversible female contraceptive method in the world today. The most common complications include, for example, gynecological infections, uterine bleeding, and dyspareunia. A rare and serious complication is IUD migration or uterine perforation. The main risk factors for IUD migration suggested are insertion by an inexperienced operator, extremely ante or retroverted uterus, insertion in the immediate postpartum period, or breastfeeding. Regarding treatment, laparoscopy offers a safe and easy surgical procedure to locate and remove the IUD. Discussion: The IUD is considered a practical, low-cost, and long-acting contraceptive method. However, it can generate complications for its users, even if rare. Among the complications, we have uterine perforation, as presented in the case. Uterine perforation is the most common cause of IUD loss and can occur both during insertion and after insertion of the device. The case presented also portrays the need for patient monitoring after implantation of the contraceptive method, through examinations such as transvaginal pelvic ultrasound. Conclusion: Uterine perforation and migration of the IUD to another region outside the uterine cavity occur most commonly during insertion of the device. A fast and effective treatment, performed through laparoscopy, would be possible in both asymptomatic and symptomatic patients, as this method has advantages such as less pain and better recovery time.

Three-Dose Antifungal Treatment Improves the Efficacy for Severe Vulvovaginal Candidiasis

Vulvovaginal candidiasis (VVC) is a prevalent gynecological infection characterized by high incidence and recurrent episodes, causing significant distress in women. This study aims to assess the effectiveness of different clotrimazole and fluconazole treatment regimens for severe vulvovaginal candidiasis (SVVC). A retrospective analysis was conducted on 1303 cases of SVVC among first-time visitors to the gynecology outpatient department at Peking University Shenzhen Hospital between January 2013 and December 2022. Vaginal secretions were systematically collected for fungal culture, with species identification conducted using Chromogenic culture medium and API Candida test reagents. Mycological cure rates were assessed at days 7–14, days 25–35, and day 35 to 6 months after treatment. The three-dose clotrimazole regimen demonstrated significantly higher mycological cure rates (85.7%, 80.0% and 74.6% at three follow-up periods, respectively) compared to the two-dose clotrimazole regimen (76.0%, 61.6%, and 59.8%, all P < 0.05). The three-dose fluconazole regimen showed no significant difference to three-dose clotrimazole regimen, with cure rates of 82.8%, 79.3%, and 75.9% (all P > 0.05). The two-dose fluconazole regimen had cure rates of 74.3%, 56.4% and 51.1%, with no significant difference from two-dose clotrimazole regimen at days 7–14 and 25–35, but lower than three-dose fluconazole regimen at days 25–35 and 35 to 6 months. The three-dose clotrimazole regimen demonstrated higher cure rates in Candida albicans and non-albicans Candida SVVC cases than two-dose regimen. These findings suggest that three-dose antifungal regimens may be more efficacious than two-dose regimens for SVVC. The three-dose clotrimazole regimen could serve as a promising alternative for SVVC management.

Gynecologic infection rates after ablation treatment for cervical intraepithelial neoplasia grade 2 and higher (CIN2+): Secondary analysis of a non-inferiority randomized trial.

Although concerns have been raised regarding potential infection and morbidity in women undergoing ablation treatment for cervical precancer in low- and middle-income countries (LMIC), there is extremely limited data to substantiate this claim. This is a secondary analysis of a randomized non-inferiority trial (id: NCT03084081) that compares the efficacy and safety of three ablation treatments for biopsy-confirmed cervical intraepithelial neoplasia grade 2 or higher (CIN2+): CO2 gas-based cryotherapy, non-gas cryotherapy, and thermal ablation (TA). Here, we present findings regarding the incidence of sexually transmitted infections (STI) and vaginitis post-treatment. Samples were collected at enrollment and again at 6 weeks post-treatment and assessed for STIs (Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and Trichomonas vaginalis (TV)) and vaginitis (Bacterial vaginosis (BV) and/or Candida albicans (Candida)). This analysis reflects 864 women with baseline and 6-week follow-up data. None of the ablative treatments put women at increased risk for STIs (CT, NG, TV) or vaginitis (BV, Candida). While most women adhered to post-treatment recommendations (97%) and no difference by treatment arm was observed, the incidence of STIs at follow-up in women that did not adhere with a given recommendation was higher compared to their adherent counterparts. The incidence of gynecologic infection did not increase with any of the ablation treatments from baseline to the six-week follow-up. Non-gas cryotherapy and TA emerge as safe alternatives to gas-based cryotherapy with respect to gynecologic infection rates.

Focus on lomefloxacin: effectiveness and safety

The results of clinical studies on the use of lomefloxacin for various diseases are presented.The purpose of this study was to analyze the effectiveness and safety of lomefloxacin based on the results of clinical studies published in the scientific literature. Extensive clinical experience with the use of fluoroquinolones in millions of patients indicates their high effectiveness in treating infections of various origins and localities. Lomefloxacin, a difluorinate representative of the fluoroquinolone group, is a bactericidal agent with a wide spectrum of antimicrobial activity against gram-negative and gram-positive microorganisms. The most important property of lomefloxacin is its high bioavailability — more than 98 % when administered orally.The effectiveness of oral lomefloxacin against respiratory tract, urinary tract, obstetric, and gynecological infections, joint infections, skin infections, and mouth, ears, nose, throat, and eyes infections has been studied. Moreover, lomefloxacin has been used as an otic solution to treat otitis media and in the form of an ophthalmic solution to treat eye infections.In studies conducted in Western countries, 72 to 94 % of patients with respiratory tract infections treated with lomefloxacin (400 mg once daily) experienced improvement in clinical symptoms: the causative bacteria were eliminated in 80 to 90 % of cases. Lomefloxacin was well tolerated, and most adverse effects were mild to moderate and reversible. The most common adverse events were gastrointestinal symptoms (nausea, diarrhea, pain/discomfort). In addition, headache, dizziness, transient insomnia, skin hypersensitivity reactions, including photosensitivity, were reported in fewer patients.Based on extensive clinical experience with the use of lomefloxacin, it can be argued that the drug has established itself as a drug with proven effectiveness and a known safety profile.

(021) STEALTHING IS ASSOCIATED WITH NEGATIVE SEXUAL HEALTH OUTCOMES AMONG COLLEGE WOMEN, REGARDLESS OF WOMEN’S SEXUAL COMMUNICATION

Abstract Introduction Non-consensual condom removal (“stealthing”) occurs when a perpetrator either says that they will put on a condom but begins intercourse before doing so, or removes a condom before or during intercourse without their partner’s consent. Up to one third of women report experiencing stealthing (Latimer et al., 2018). Stealthing is associated with greater lifetime recreational drug use and sexual shame, as well as positive sexual outcomes like pleasure, desire, arousal, lubrication, and feelings of pleasure deservingness (blinded for review). Preliminary research on the gynecological and reproductive health outcomes of stealthing reveals that experiences of stealthing significantly predict gynecological infections, lifetime pregnancy, and condom use barriers (blinded for review). Intervention research highlights the necessity of prevention programming enhancing women’s sexual communication skills to increase agency in condom use and to prevent SV. However, stealthing is a deliberate choice of non-communication by a perpetrator, and thus it is unclear if women’s sexual communication can play a role in preventing negative health sequelae. Objective The present study examined if sexual communication comfort explains associations between stealthing experiences and a series of sexual outcomes (vaginal infection, ever pregnant, times pregnant, age pregnant, contraceptive use, condom use barriers and motivators, genital self-image, pleasure deservingness, pleasure assertiveness self-efficacy, and female sexual functioning) among a sample of college women. Methods A sample of 440 women (Mage = 20.3, SD = 2.24) from an online pool at a large Midwestern US university completed an online survey regarding sexual violence and sexual health. Measures included single items regarding lifetime history of vaginal infections, number of lifetime pregnancies (including parity and gravidity), age at first pregnancy, and current contraceptive use. Participants completed well-validated measures of condom use barriers and motivators, genital self-image, pleasure deservingness and assertiveness, and overall sexual functioning. We tested associations between stealthing and outcome of interest via linear regressions controlling for other forms of SV (force, coercion, intoxication) as well as lifetime number of sexual partners. We ran mediation models using the Hayes PROCESS Macro (Model 4). All analyses were completed in R version 4.2. Results Approximately one-third of participants (30.2%, n = 133) reported stealthing experiences. Stealthing was independently associated with a history of vaginal infection, ever having been pregnant, and condom use barriers related to partner pressure. Sexual communication skills did not significantly mediate associations between stealthing and any outcome variables of interest. Conclusions Despite SV prevention work emphasizing the utility of sexual communication skills in protecting women against both SV and negative sexual health outcomes, we found that sexual communication comfort did not mediate associations between stealthing and sexual wellbeing outcomes. Findings indicate that intervention resources would be better spent on preventing stealthing perpetration. Given findings relevant to pregnancy, addressing stealthing perpetration is particularly important following the repeal of Roe vs. Wade and new restrictions to abortion access in the United States. Disclosure No.

Hydrogel- and Nanocomposite-Based Drug-Delivery Strategies in the Treatment of Vaginal Infections.

The reproductive health of women is governed by an optimal balance in the host-microbiota interaction. Depletion of the beneficial vaginal microflora caused by depletion of Lactobacillus species and increased proliferation of pathogens results in gynaecological infections. Among women of reproductive age, vaginal infections are increasingly prevalent. Attaining therapeutic efficacy using conventional formulations remains a challenge as vaginal fluids quickly remove or dilute the therapeutic formulations. Hydrogels have been widely exploited for targeted delivery of therapeutics directly into the vaginal mucus. With a careful choice of polymers (natural, synthetic, or semisynthetic), hydrogels with specific properties, such as stimuli responsiveness, antimicrobial, and muco-adhesiveness, can be tailored for higher therapeutic efficacy. In this review, the advances in hydrogel strategies for the treatment of vaginal infections are presented with emphasis on the types and properties that play a significant role in vaginal drug delivery systems.

Factors associated with late diagnosis of cervical cancer at two national referral hospitals, Kenya 2017: A case control study

BackgroundCervical cancer is the leading cause of cancer mortality among women in Kenya. Two thirds of cervical cancer cases in Kenya are diagnosed in advanced stages. We aimed to identify factors associated with late diagnosis of cervical cancer, to guide policy interventions. MethodsAn unmatched case control study (ratio 1:2) was conducted among women aged ≥ 18 years with cervical cancer at Kenyatta National and Moi Teaching and Referral Hospitals. We defined a case as patients with International Federation of Gynecology and Obstetrics (FIGO) stage ≥ 2A and controls as those with stage ≤ 1B. A structured questionnaire was used to document exposure variables. We calculated adjusted odds ratio (aOR) to identify any associations. ResultsWe enrolled 192 participants (64 cases, 128 controls). Mean age 39.2 (±9.3) years, 145 (76 %) were married, 77 (40 %) had primary level education, 168 (88 %) had their first pregnancy ≤ 24 years of age, 85 (44 %) were > para 3 and 150 (78 %) used contraceptives. Late diagnosis of cervical cancer was associated with cost of travel to cancer centres > USD 6.1 (aOR 6.43 95% CI [1.30, 31.72]), age > 50 years (aOR 4.71; 95% CI [1.18, 18.80]), anxiety over cost of cancer care (aOR 5.6; 95% CI [1.05, 32.72]) and ultrasound examination during evaluation of symptoms (aOR 4.89; 95% CI [1.07–22.42]). Previous treatment for gynecological infections (aOR 0.10; 95% CI [0.02, 0.47]) was protective against late diagnosis. ConclusionCost of seeking care and the quality of the diagnostic process were important factors in this study. Decentralization of care, innovative health financing solutions and clear diagnostic and referral algorithms for women presenting with gynecological symptoms could reduce late-stage diagnosis in Kenya.

Mycoplasma and Neisseria Prevalence in Asymptomatic Women and Investigation of their Susceptibility to Tamarindus indica and Syzygium aromaticum Aqueous Extracts

Neisseria and Mycoplasma are two prevalent bacteria in the female urogenital tract leading to gynecological infections and infertility. The aim of this study was to assess the antibacterial activity of Tamarindus indica and Syzygium aromaticum extracts against Neisseria and Mycoplasma isolates. It was a cross cectional study on 60 asymptomatic women at the Protestant and Regional Hospital of Ngaoundere. For this reason, a large consecutive sample of patients with several well-defined characteristics was assembled and urine and cervical-vaginal swab were collected using standard procedures. After being isolated on a specific medium, several strains of Neisseria and Mycoplasma were identified based on their morphological and biochemical characteristics. The antibacterial activity of the plant extracts was tested using the agar-well diffusion method. It was discovered that 70% of asymptomatic women had overall infection, with varying prevalence rates. The prevalence rates of Neisseria and Mycoplasma were 14.29% and 85.71% respectively. The aqueous extracts of Syzygium aromaticum against Neisseria produced inhibitory diameters of 43 mm, 40 mm and 32 mm at doses of 20 mg/mL, 10 mg/mL, and 5 mg/mL, respectively while, at the same doses, the aqueous extract of Tamarindus indica produced inhibitory diameters of 16 mm, 14 mm and 13 mm, respectively. The combined extract of Syzygium aromaticum and Tamarindus indica exhibits inhibitory diameters of 25, 23, and 30 mm at 20 mg/mL, 10 mg/mL, and 5 mg/mL, respectively. Syzygium aromaticum extract alone showed efficacy against Mycoplasma, with diameters of 16.5 mm, 13 mm and 10.5 mm at concentrations of 20 mg/mL, 10 mg/mL, and 5 mg/mL respectively. Inhibition diameters of 18 mm (for fosfomycin and ofloxacin), 22 mm (for chloramphenicol and ceftriaxone) and 26 mm (for levofloxacin) were found using Neisseria isolates. The only drugs that demonstrated efficacy against Mycoplasma were Minocycline and Josamycin. Given these findings, extracts of Syzygium aromaticum and Tamarindus indica can be investigated and used to treat infections caused by Niesseria and Mycoplasma.

A case of bacteremia caused by Dialister micraerophilus with Enterocloster clostridioformis and Eggerthella lenta in a patient with pyometra

BackgroundInfection by Dialister micraerophilus, an obligate anaerobic gram-negative bacillus, has rarely been described, and its clinical characteristics remain unclear.Case presentationWe report a case of bacteremia caused by D. micraerophilus, Enterocloster clostridioformis, and Eggerthella lenta in a 47-year-old woman, associated with pyometra. D. micraerophilus was identified using 16S rRNA gene sequencing and matrix-assisted laser desorption ionization time-of-flight mass spectrometry. D. micraerophilus was detected by polymerase chain reaction using D. micraerophilus-specific primers and E. clostridioformis and E. lenta was isolated from the drainage pus sample obtained from the pyometra uterus. The patient achieved a cure after abscess drainage and 2-week antibiotic treatment.ConclusionsTo the best of our knowledge, this is the first report of D. micraerophilus bacteremia. D. micraerophilus may be associated with gynecological infections. Clinicians should consider both oral and gynecological sites when searching to identify the focus of D. micraerophilus infection.

Haitian women in New York City use global food plants for women’s health

BackgroundDespite the availability of mainstream biomedical healthcare in New York City (NYC), community-based ethnomedicine practices remain a low-cost, culturally relevant treatment for many immigrants. Previous urban ethnobotany research in NYC has established that several Caribbean communities continue using medicinal plants for women’s health after immigration. This study sought to address to what extent: (1) NYC Haitian women continue using medicinal plants for women’s health after migration; (2) their plants and the conditions treated were similar to those identified in an earlier survey with NYC immigrants from the Dominican Republic.MethodsThrough an ethnobotanical survey, 100 Haitian women living in NYC and born in Haiti were interviewed about their knowledge of medicinal plants for women’s health conditions. Reported species were purchased based on local names in NYC Haitian stores and markets, vouchered, and identified.ResultsNearly all Haitian women (97%) reported using medicinal plants while living in Haiti. Most Haitian women continued using medicinal plants after coming to the USA (83%). The 14% decrease, although significant (z = 3.3; p = 0.001), was mainly due to logistical difficulties with sourcing plants after recent immigration. Popular medicinal plant species reported were primarily global food plants, re-emphasizing the intertwined food-medicine relationship in Caribbean diasporas. Comparison with data from NYC Dominicans identified childbirth and puerperium, gynecological infections, and vaginal cleansing as priority Haitian women’s health concerns treated with plants.ConclusionOur findings support the global nature of Caribbean migrant plant pharmacopeia, predominantly centered around food plants and adapted to transnational urban settings. They underscore cultural diversity, dispelling the notion of one uniform traditional knowledge system labeled “Caribbean.” The importance of preventative medicine for women’s health, particularly the regular consumption of “healthy” foods or teas highlights the role food plants play in maintaining health without seeking treatment for a particular condition. Cross-cultural comparisons with other NYC Caribbean immigrants emphasize the importance of conducting ethnobotanical surveys to ground-truth plant use in the community. Such surveys can also identify culture-specific health priorities treated with these plants. Healthcare providers can leverage these insights to formulate culturally relevant and community-tailored healthcare strategies aligned with Haitian women’s health beliefs and needs.

A Review on the Use of Third-Generation Cephalosporins on Gram-Positive and Gram-Negative Bacteria Based on its Spectrum of Activity

This review explores the clinical usage of third-generation cephalosporins, a class of broad-spectrum antibiotics that are essential for treating gram-positive and gram-negative bacterial infections in a variety of infectious conditions. These antibiotics have bactericidal action by inhibiting the synthesis of bacterial cell walls. Among the well-known members of this class are cefoperazone, cefpodoxime proxetil, ceftibuten, ceftriaxone, cefotaxime, and ceftazidime. Inhibiting transpeptidase is the mechanism of action, which, in the case of gram-negative bacteria, results in cell lysis and death. Third-generation cephalosporins are used to treat a wide range of conditions, including meningitis, genitourinary tract infections, pneumonia, infections of the skin and soft tissues, and bone and joint infections. Each cephalosporin within this generation exhibits a distinct spectrum of activity. For instance, cefpodoxime proxetil acts against Staphylococcus aureus and Klebsiella pneumoniae, whereas cefixime acts against Streptococcus pneumoniae and Escherichia coli. Neisseria gonorrhoea and Pseudomonas aeruginosa are only two examples of the many gram-positive and gram-negative bacteria that ceftriaxone is active against. This review also highlights the synergistic effects of combining third-generation cephalosporins with other antibiotics, demonstrating their versatility in managing complex infections. Despite their effectiveness, third-generation cephalosporins may not be effective against Chlamydia trachomatis. Furthermore, careful consideration of each antibiotic's spectrum guides their specific use in treating conditions such as urinary tract infections, otitis media, bronchitis, and gynecologic infections. In conclusion, the comprehensive spectrum of action of third-generation cephalosporins makes them valuable in addressing a diverse array of bacterial infections. However, their use should be judicious, considering the evolving landscape of antibiotic resistance and the specific bacterial targets for optimal therapeutic outcomes.

Culturally Inclusive and Gender Sensitive Menstrual Health Education: Nursing and Immigrant and Refugee Community Organizational Partnership

Background Worldwide period poverty results in gynecological infections and poor outcomes increased menorrhagia, or infections (candidiasis, bacterial vaginosis). Immigrants and refugees have minimal menstrual health education due to cultural taboos, inability to afford feminine hygiene products, and inappropriate use of menstrual reusable products or previous sanitization teachings. The Immigrant &amp; Refugee Community Organization (IRCO) needed evidence-based interventions to reduce period poverty via a culturally sensitive, and gender-affirming menstrual health hygiene program. The purpose of the menstrual health dignity scholarly project intervention was to increase knowledge, comfort, and confidence of community health staff educators (CHSEs) to provide effective client teaching Methods The Rogers’ Diffusion of Innovation Theory, Plan-Do-Study-Act (PDSA) Model, and popular education interactive strategies guided the academic-community scholarly project partnership. Developed a cross-sectoral academic-community team partnership with CHSEs buy in; modified teaching in 2 PDSA cycles (100% attendance of at least 2 sessions); and used Power Points for lesson content, case studies, and technology to reinforce learning and menstrual cup and health brochure to increase CHSEs’ knowledge. Results Questionnaire scores showed increases of: knowledge (96% in at least 3 categories), confidence (100%) with increased capacity to provide appropriate menstrual health hygiene teaching, products, handouts, and guidance based on appropriate assessments. The results showed 92.3% overall positive comments about the menstrual health education provided including expressing enthusiasm for teaching menstrual health to all genders. Overall, 85.7% of people agreed they would use the information learned in this project for future work and found the education valuable. Conclusion The addition of menstrual health trainings with interactive popular education increased CHSEs’ knowledge, comfort, and confidence. Sustainability efforts included recorded lesson content education and encouragement to provide the menstrual cup and health brochure to refugee families upon agency admission.

Analysis of the Effectiveness of Microbiological Testing Methods in Gynecological Inflammatory Infections

Analysis of the Effectiveness of Microbiological Testing Methods in Gynecological Inflammatory Infections

Blood Transfusion Service Challenges and Patterns at Kampala International University Teaching Hospital, Ishaka-Bushenyi, Western Uganda: Insights from a Comprehensive Prospective Study

Uganda, a developing East African nation with nearly 20% of its populace living below the poverty line, faces significant constraints in its national blood transfusion service. Despite serving over 3 million individuals in Regional Referral Hospitals, a chronic scarcity of blood persists, impacting critical healthcare provisions, notably at Mulago, Uganda’s National Referral Hospital. This study conducted a meticulous assessment of the indications and influential factors shaping blood transfusion services at Kampala International University Teaching Hospital, Ishaka-Bushenyi, adopting a prospective descriptive cross-sectional design encompassing a 100% review of the target patient population receiving blood transfusions. Employing a pretested questionnaire as the data collection instrument, the gathered information underwent meticulous coding, sorting, entry, and analysis utilizing statistical software. Results were systematically presented through tables and charts. The findings revealed that a considerable proportion (42.3%) of transfused individuals fell within the age range of 20-39 years, with infants and young children (&lt;5 years) comprising 22.4% of the recipients. Males accounted for 58.7% of the transfused population. Predominant indications for blood transfusions included anemia (30.4%), obstetric and gynecological conditions (23.4%), surgical operations (19.0%), infections (14.2%), and incidents involving road traffic accidents or assault (13.0%). The study identified the availability of a blood storage facility as a significant factor motivating the utilization of blood transfusion services, with an 87.4% availability rate reported. Notably, the demand for transfusions was notably high among females (56.1%) compared to males (43.9%), with anemia (53.3%) and blood group O (48.6%) constituting the majority of cases. Blood group distributions varied across different indications, with group O being predominant in most categories. Additionally, the Rh factor played a role, with Rh+ constituting 90.5% of cases and Rh- comprising 9.5%. Blood Group O had the highest occurrence of Rh+, while Blood Group A had the highest occurrence of Rh-. In summary, the study outlined several prominent factors influencing blood transfusion indications at KIUTH, notably anemia, obstetric and gynecological conditions such as postpartum hemorrhage and cesarean sections, surgical procedures (e.g., abdominal obstructions), infections (e.g., malaria), and incidents involving road traffic accidents or assault. These indicators are influenced by factors such as blood availability, age, gender, medical conditions, and blood type, with Blood Group O Rh+ being the most prevalent. Keywords: Blood transfusion, Gynaecology, Anaemia, Blood Group O.

Contribution of medico-administrative databases to health vigilance: example of post-oocyte retrieval infections.

Can we monitor post-oocyte retrieval infections in the French national health data system to complement the French ART vigilance system? Medico-administrative databases provide a more comprehensive view of post-oocyte retrieval infections and can be used to detect abnormal increases in frequency and outlier ART centers as a complementary tool to the ART vigilance system. The various studies of ART complications are reassuring, showing relatively low overall complication rates. Nonetheless, the European Union has set up a vigilance system to monitor these complications. However, this system is not an exhaustive source of information and does not provide a complete overview of post-ART complications. The study population was identified from the comprehensive French national hospital discharge database. It included women under 46 years of age undergoing an oocyte retrieval in 2019, classified into three population subgroups according to the indication of oocyte retrieval: infertility (IF) , fertility preservation (FP), and oocyte donation (OD) . The study population included 52 098 women who had undergone 65 948 oocyte retrievals in 2019. Hospital stays and delivery of antibiotics within 31 days after oocyte retrieval were analyzed. Women and infections were characterized according to various characteristics (age, comorbidities, indication of oocyte retrieval, type of hospital stay, length of hospital stay, type of antibiotherapy, etc.). Multivariate analysis was performed to determine the relation between the occurrence of infection and women's characteristics, and results are expressed as odds ratios (ORs) and 95% CI. A funnel plot and a box plot were used to compare the infection rate per center with the national average and to detect outliers. Infections in the month following the oocyte retrieval represented 6.9% of the procedures in 2019 (n = 4522). Of these infections, 112 were hospitalized (0.2% of oocyte retrievals), and 4410 were non-hospitalized (6.7% of oocyte retrievals). The hospitalized infections were essentially gynecological infections (40.9%) and urinary tract infections (23.5%). In 87.9% of non-hospitalized infections, a single antibiotic therapy was prescribed. Mixed-effect model analysis showed that the risk of infection was significantly higher in women under 30 years of age, in the FP population, in supplementary universal health coverage (CMU-C) beneficiaries, and women with endometriosis. Funnel plot and box plot analysis showed that three ART centers have an infection rate significantly higher than the national average. In the three centers that stand out from all the others, the objective is to return to these centers to understand the possible reasons for this observed rate and to implement corrective measures. Despite all its advantages, the French national health data system presents some limitations, such as the risk of inappropriate coding. Another limitation of this study is that we cannot confirm an attributable relation between the infection and the ART procedure, even if the delay of 31 days after oocyte retrieval is consistent with the occurrence of a post-retrieval complication. In addition, antibiotics may be prescribed as a 'precautionary' measure in certain situations (women with a susceptibility to infection, complicated procedures), or as antibiotic prophylaxis for embryo transfer. Despite the limits in identifying post-ART infections in medico-administrative databases, this approach is a promising way to complement the ART vigilance reporting system. This concept developed for infections will also be generalized to other complications with regular feedback to professionals. No specific funding was sought for the study. The study was supported by the Agence de la biomédecine, France. The authors declare that they have no conflict of interest. N/A.

From Prevention to Management: Understanding Postoperative Infections in Gynaecology.

This narrative review examines the multifaceted realm of postoperative infections in gynaecology, addressing their significance, types, risk factors, prevention, management, and emerging trends. Postoperative infections, encompassing surgical site infections, urinary tract infections, and pelvic inflammatory disease, pose considerable challenges in patient care, warranting comprehensive exploration. Strategies for prevention include preoperative patient assessment, antimicrobial prophylaxis, and aseptic techniques. Intraoperative measures encompass infection control and instrument sterilization, while postoperative care involves wound management and early infection detection. Diagnostic tools, including blood tests, imaging, and microbiological cultures, aid in timely identification. Management strategies encompass antibiotic therapy, surgical interventions, supportive care, and addressing complications. The review underscores the necessity of personalized approaches, multidisciplinary collaboration, and innovative technologies in future infection management. It calls for ongoing research, heightened awareness, and meticulous care to minimize the impact of postoperative infections and optimize patient outcomes.

Analysis of Racial Disparity among U.S. Patients with Gynecologic Cancers and COVID-19 Infection

Gynecologic cancer care has been affected by the COVID-19 pandemic. We studied the association of racial disparity and COVID infection in the care of patients with gynecologic cancers. To assess the association of racial disparity and COVID infection in gynecologic cancers the National Cancer Database (NCDB) was queried for the year 2020 for patients with histologically confirmed diagnosis of cervical, endometrial and ovarian cancers. Patients were divided into two cohorts based on COVID test result status and subsequently stratified based on race. Race/ethnicity was categorized as 1) non-Hispanic White (NHW), 2) non-Hispanic Black (NHB), and 3) Hispanic. Subjects with missing race/ethnicity information were excluded. Outcome variables were time from diagnosis to initiation of treatment (surgery, radiation therapy versus chemotherapy). Continuous and categorical variables were reported as median [interquartile range] and number [rate] and were compared using Mann-Whitney U test and Chi-Square test, respectively. Statistical software was used and the level of significance was set at 0.05. A total of 36,863 subjects with newly diagnosed gynecologic cancers in 2020 underwent had available COVID testing information (4,827 with cervical, 23,935 with endometrial, and 8,101 with ovarian cancer). 31,516 (85.5%), 4,735 (12.8%), and 612 (1.7%) of the population were NHW, NHB, and Hispanic, respectively. The overall rate of COVID infection was the highest in NHB (6.9%), followed by Hispanic (5.6%) and NHW (5.4%), p < 0.001. Patients with cervical cancer had the highest rate of COVID infection (7.3%), followed by ovarian (5.6%) and endometrial (5.2%), p < 0.001. Non-Hispanic Black women with cervical cancer had the highest rate of infection (8.6%). Median time from diagnosis to first surgical procedure was highest in COVID positive NHB subjects (52 [IQR 20-91] in NHB, 41 [IQR 12-67] in NHW, and 40 [IQR 9-58] in Hispanics, p = 0.02). Median time from diagnosis to first radiation treatment was also highest in COVID positive NHB subjects (83 [IQR 29-107] in NHB, 52 [IQR 17-67] in NHW, and 39 [IQR 9-51] in Hispanics, p = 0.04). There was not racial or ethnic disparity in time from diagnosis to the first systemic therapy. COVID pandemic has substantially impacted gynecologic cancer care in the United States and exacerbated existing healthcare disparities. Members of African American community with gynecologic cancers have been affected the most compared to other racial groups, both in terms of COVID infection rates and delays in receiving care. Further study is warranted to understand impact on long-term cancer related outcomes.

Bacterial Vaginosis Treatment Patterns, Associated Complications, and Health Care Economic Burden of Women With Medicaid Coverage in the United States.

Bacterial vaginosis (BV) is a highly prevalent vaginal infection. Primary objectives of this study were to examine treatment patterns among female patients with Medicaid coverage who were diagnosed with incident BV, the frequency of BV-associated complications, and health care resource utilization (HCRU) and associated costs of incident BV and its recurrence. Secondary objectives were to identify predictors of total all-cause health care costs and number of treatment courses. Female patients aged 12-49 years with an incident vaginitis diagnosis and ≥1 pharmacy claim for a BV medication were selected from the Merative MarketScan Medicaid database (2017-2020). Additional treatment courses were evaluated during a ≥12-month follow-up period, in which new cases of BV-associated complications and HCRU and the associated costs were also measured. Generalized linear models were used to identify baseline predictors of total all-cause health care costs and number of treatment courses. An incident vaginitis diagnosis and ≥1 BV medication claim were present in 114 313 patients (mean age: 28.4 years; 48.6% black). During the follow-up, 56.6% had 1 treatment course, 24.9% had 2, 10.2% had 3, and 8.3% had ≥4; 43.4% had BV recurrence. Oral metronidazole (88.5%) was the most frequently prescribed medication. Nearly 1 in 5 had a new occurrence of a BV-associated complication; most (76.6%) were sexually transmitted infections (STIs). Total all-cause and BV-related costs averaged $5794 and $300, respectively, per patient; both increased among those with more treatment courses. Older age, pregnancy, comorbidity, any STIs, postprocedural gynecological infection (PGI), and infertility were predictive of higher total all-cause health care costs, while race/ethnicity other than white was predictive of lower costs. Older age, black race, any STIs, pelvic inflammatory disease, and PGI were predictive of >1 treatment courses. The high recurrence of BV represents an unmet need in women's health care and better treatments are necessary.

Fournier's gangrene in Patients Operated for Hemorrhoidal Prolapse in the Surgical Emergency Department.

Fournier's gangrene (FG) is a well known often fatal fasziitis of the pelvic floor following ano-rectal, urologic and gynecologic infections. Although rarely it is described as a complication of operative anal procedures and predisposing factors such as diabetes, alcoholism, immune-defects and consumptive diseases.&#x0D; Current literature only briefly mentions the potential risk of FG after such a common surgical procedure. However, devastating complications occur more often than expected. This catastrophic complication without a predisposing factor is discussed along with a review of the literature.&#x0D; The objective of this article is to provide updated and relevant information regarding the recognition, diagnosis and management of FG, from the general surgeon to the emergency department.&#x0D; This article refers to two complicated cases of Fournier's gangrene. The patients underwent emergency surgical intervention with the diagnosis of hemorrhoidal prolapse with rectal bleeding and accompanying anemia…&#x0D; Conclusion; The gold standard for treatment was found to be a combination of surgical debridement, broad-spectrum antibiotics, and the administration of intravenous fluids. Further, patient survival was found to be directly related to the time from diagnosis to treatment when they underwent surgical debridement. &#x0D; The General surgeon must be vigilant for this condition and be aware of risk factors, prognostic indicators, and proper treatment protocols to recognize FG early and initiate appropriate management.