Lower Genital Tract In Women Research Articles

Aggressive angiomyxoma of female pelvis and perineum: Retrospective study of 17 cases

ObjectiveAggressive angiomyxoma is an uncommon mesenchymal neoplasm characterized by a high recurrence rate, usually observed in the lower genital tract of women during their reproductive age. Study designSeventeen cases of aggressive angiomyxoma confirmed by pathology from January 2007 to December 2021 in Beijing Chao-yang Hospital were included. We collected clinical data and summarized the clinical and immunohistochemical features. ResultsAll seventeen included patients were females, aged between 23 and 57 years (mean, 37.7 years; median, 42 years). Fourteen patients were newly diagnosed and three were recurrent. The tumors were located in vulva (58.8 %), vagina (23.5 %), buttock (11.8 %), and cervix (5.9 %). The tumors size were 2 to 15 cm in greatest dimension (mean 8 ± 4.4 cm, median 6 cm). Follow-up data was available for nine patients, which ranged from 25 to 124 months (mean, 82 months; median, 80 months). At the end of follow-up, no other recurrence or metastasis was reported. Immunohistochemical analysis showed immunoreactive for estrogen (10/11) and progesterone (8/11) receptor, desmin (6/8), smooth muscle actin (4/10), and vimentin (4/4), S-100 (1/8) and CD34 (1/7). The Ki67 level was less than 5 % in five cases. ConclusionsAAM is a hormone-sensitive, distinct rare mesenchymal neoplasm with high incidence of local recurrence. Surgery is the preferred treatment, with complete resection being an essential prerequisite for minimizing the risk of recurrence.

Risks of microbial colonization in newborn born to mothers with chorioamnionitis

BACKGROUND: Chorioamnionitis, or intra-amniotic infection, is an infection of the membranes and amniotic cavity caused by polymicrobial associations, including Streptococcus agalactiae (SGB), predominantly localised to the lower genital tract of women. The colonization of a infant with GBS occurs as a result of ascending infection from the mother, in the intranatal period during passage through the natural birth canal of the mother. Colonization of the skin and mucous membranes of the infant in the vast majority of cases proceeds without the clinical implementation of the infectious process, only 2-5% of infected newborns develop an infection associated with GBS.
 AIM: The aim of the study is to investigate the vaginal and uterine microflora in women with chorioamnionitis and to determine the degree of neonatal colonization.
 MATERIALS AND METHODS: A microbiological examination was undertaken in 113 motherchild pairs. Main group (group I): pregnant women with full-term pregnancy (37 weeks gestation) who were diagnosed with clinical chorioamnionitis and prescribed antibacterial agents, and their newborns (n = 77). Comparison group (group II): 36 pregnant women without clinical chorioamnionitis with a gestational age of 37 weeks gestation and their newborns with a physiological course of the early neonatal period. Clinical specimens: secretions from the posterior vaginal fornix and the inner surface of the uterine wall at surgical delivery in women in labour with clinical signs of chorioamnionitis (group I) and without clinical manifestations of chorioamnionitis (group II). Material was obtained at the height of body temperature in group I and during the 1st period of labour in group II. The clinical materials were umbilical cord blood, skin surface of the occipital fold, discharge from the cavity, and discharge from the tracheobronchial tree (in case of respiratory therapy with ventilator therapy).
 RESULTS: At bacteriological examination in women of Group I the frequency of microorganism isolation from the vaginal discharge was: Enterococcus faecalis 31.8%, S. agalactiae (SGB) 30.3% and Escherichia coli 24.2%. The proportion of SGB at 106 CFU/ml was 70%. The proportion of E. coli at 106 CFU/ml was 75% and that of Candida albicans 72%. Among microorganisms isolated from the uterine cavity, the proportion of SGB at 106 CFU/ml was 60%, E. coli 100%. Bacteriological testing of the examined children showed that S. agalactiae (SGB), E. faecalis and E. coli were isolated from almost all neonatal loci studied. Comparative studies have shown that the colonisation of newborn infants was most frequently caused by S. agalactiae (SGB), E. faecalis and E. coli. The frequency of maternal transmission of these organisms to the foetus and the newborn is 100% for S. agalactiae (SGB) and 1850% for E. faecalis and E. coli. In all examined children of the main group and with the presence of S. agalactiae (SGB) in the uterine cavity of their mothers (n = 5), these microorganisms were isolated from different loci (in all cases from the skin surface of the auricular fold and from oral discharge, and in three cases from umbilical cord blood), but clinical manifestations of the infection process did not develop in any child.
 CONCLUSIONS: Despite antibiotic therapy for chorioamnionitis in women, the incidence of micro-organism isolation from both the vagina and the uterine cavity remains high. In most cases, newborns from mothers with chorioamnionitis colonised with micro-organisms, including S. agalactiae (SGB), do not develop a clinical picture of an infective process. Further research is needed to develop preventive measures in terms of perinatal and neonatal infections.

Presence of SARS-CoV-2 in the lower genital tract of women with active COVID-19 infection: A prospective study.

SARS‐CoV‐2 may present in the lower genital tract of women with active COVID‐19 infection and the probability is significantly higher with high viral load.

Angiomyofibroblastoma of the Lower Genital Tract of Women: Report of Two Cases

Superficial angiomyofibroblastoma of the lower genital tract of women is a very rare, benign neoplasm that most commonly arises in the vulvo-vaginal area. Our first case is a 45-year-old woman who presented with menometrorrhagia. On gynecological examination, a pedinculated polipoid mass 2.5 cm in size was found on the cervix. The second case is a 40-year-old woman presented with a nodular mass 5 cm in size on the vulva. She admitted to hospital with itching and cosmetic problems. Histologic examination revealed bland spindled and epithelioid cells arranged around blood vessels. Tumor cells have immunoreactivity for desmin, vimentin, estrogen and progesterone receptors but staining for cytokeratin was negative. In the lipomatous variant, the cells are dispersed into the adipose tissue. Differential diagnosis of lipomatous angiomyofibroblastoma includes; spindle cell lipoma, angiomyolipoma, and cellular angiofibroma. We will discuss the differential diagnosis of these cases with immunohistochemical and morphological findings.

Эффективность применения противовоспалительного вагинального раствора ибупрофена изобутиламмония для уменьшения выраженности воспаления нижних половых путей у женщин с хирургическими патологиями малого таза

Эффективность применения противовоспалительного вагинального раствора ибупрофена изобутиламмония для уменьшения выраженности воспаления нижних половых путей у женщин с хирургическими патологиями малого таза

Group B streptococcal disease in the mother and newborn—A review

Group B Streptococcus, a common commensal in the gut of humans and in the lower genital tract in women, remains an important cause of neonatal mortality and morbidity. The incidence of early onset disease has fallen markedly in countries that test women for carriage at 35–37 weeks of pregnancy and then offer intrapartum prophylaxis with penicillin during labour. Countries that do not test, but instead employ a risk factor approach, have not seen a similar fall. There are concerns about the effect on the neonatal microbiome of widespread use of antibiotic prophylaxis during labour, but so far the effects seem minor and temporary. Vaccination against GBS would be acceptable to most women and GBS vaccines are in the early stages of development.Tweetable abstract: Group B Strep is a key cause of infection, death and disability in young babies. Antibiotics given in labour remain the mainstay of prevention, until a vaccine is available.

Prevalence of Candida spp. and age-related disparities amongst women presenting with vaginitis at the Obstetrics and Gynaecology (O&G) Clinic in a Tertiary hospital in Port Harcourt, Nigeria.

Vaginitis, an infection of the lower genital tract in women, is known to be triggered by the overgrowth of the vagina's naturally occurring microorganisms. This study looked at the prevalence of Candida spp. and age-related disparities amongst women presenting with vaginitis at the Obstetrics and Gynaecology (O&G) clinic in a tertiary hospital in Port Harcourt, Nigeria. One hundred high vaginal swabs were collected from pregnant and non-pregnant women and examined microscopically and microbiologically. Age-group 20-29 years had the highest incidence of candidal vaginitis. There was a higher occurrence of yeast cells in pregnant than in non-pregnant participants while the non-pregnant women had a greater level of bacterial cells. Forty (40) of the samples contained yeasts of Candida species representing a 40% prevalence. Three species of Candida were identified with C. albicans dominating. Of the 40 samples positive for Candida spp., 30 (75.0%) were confirmed to be C. albicans. The remaining isolates were C. tropicalis (15.0%) and C. parapsilosis (10.0%). The findings in this study would play a role in the future management of Candida-induced vaginitis.

Vaginal colonisation of women in labour with potentially pathogenic bacteria: a cross sectional study at three primary health care facilities in Central Uganda

BackgroundPotentially pathogenic bacteria that colonise the lower genital tract of women in labour can be passed to the baby during birth. While many babies become colonised with these bacteria after delivery, a few develop neonatal infections. The lower genital tract is a reservoir for potential pathogens and a source of infection for neonates. We determined the prevalence of vaginal colonisation of potentially pathogenic bacteria among women in labour in Central Uganda and identified potential risk factors associated with this colonisation.MethodsWe conducted a cross sectional study at three primary health care facilities and collected vaginal swabs from HIV-1 negative women in labour. Specimens were cultured on different selective microbiological media, and biochemical tests were used to classify bacterial isolates on the species level. Multivariable logistic regression analyses were used to estimate the association between relevant exposures and colonisation with potentially pathogenic bacteria.ResultsWe recruited 1472 women in labour whose mean age was 24.6 years (standard deviation [SD] 4.9). Of these, 955 (64.9%; 95% Confidence Interval [CI] 62.4, 67%) were vaginally colonised with at least one potentially pathogenic bacterial species. The most commonly isolated species were Escherichia coli (n = 508; 34.5%), Klebsiella pneumoniae (n = 144; 9.8%) and Staphylococcus aureus (n = 121; 8.2%). Results from exploratory multivariable regression analyses indicated that having had ≥5 previous pregnancies (adjusted odds ratio [aOR] 0.59; 95% CI 0.35, 0.97) or being ≥30 years old (aOR 1.52; 95% CI 1.03, 2.23) could be associated with vaginal colonisation with any potentially pathogenic bacteria, as well as with vaginal colonisation with S. aureus (aOR 0.33; 95% CI 0.12, 0.88, and aOR 2.17; 95% CI 1.17, 4.00, respectively). Possession of domestic animals in a household (aOR 0.57; 95% CI 0.35, 0.92) could be associated with vaginal colonisation with E. coli.ConclusionsTwo-thirds of HIV-1 negative women in labour were vaginally colonised by potentially pathogenic bacteria, mainly E. coli, K. pneumoniae, and S. aureus.

Ectopic prostatic tissue in vagina - case report

During embryonic development, both glandular parenchyma of prostate in a male fetus and paraurethral Skene’s glands in a female fetus develop from pelvic urethra endoderm. This common embryological origin results in finding prostatic tissue even in the lower genital tract in women. Herein, the authors present a case of polypoid lesion in vagina consisting solely of glandular elements without squamous component, which stained negative for prostatic markers, but morphologically identical to normal prostatic tissue. A patient, 57-years-old came to the Clinic, with a cystic change in the petiole, which size being 30×17×15 mm, on the left vaginal wall adjacent to introitus. The cystic change was excised and a preparation was sent to a histopathological examination. The histopathological examination included serial Hematoxylin and Eosin stained sections, along with immunohistochemical panel. It was concluded that it was ectopic prostatic tissue or ectopic paraurethral gland tissue within vaginal mucosa. Partially, epithelium at the surface of our polypoid lesion showed immature squamous metaplasia, vaginal intraepithelial neoplasia - VaIN II/III, and transitional cell metaplasia. Gland formations having benign features were within base of the change, at the resection lines, while dysplastic epithelium was fully removed.

Mast cell chymase decreases the severity of group B Streptococcus infections

Group B Streptococcus (GBS) or Streptococcus agalactiae are β-hemolytic gram-positive bacteria that colonize the lower genital tracts of women and are frequently associated with infections during pregnancy. Innate immune defenses are critical for controlling GBS dissemination and systemic infection. Mast cells are resident sentinel cells that come into contact with pathogens early during colonization and infection. We aimed to investigate the contribution of chymase to systemic GBS infection and rates of preterm birth. Pharmacologic and genetic approaches using mice deficient in mast cell protease (MCPT) 4, the mouse functional homologue of human chymase, were used. Our studies show that mast cells release a protease with chymotrypsin-like cleavage specificity in response to GBS. Additionally, increased GBS systemic infection and preterm births were observed in MCPT4-deficient mice versus MCPT4-sufficient mice. Furthermore, we observed that proteolytic cleavage of the host extracellular matrix protein fibronectin by peritoneal cell-derived mast cell lysates diminished GBS adherence. Consistent with this observation, the increase in GBS dissemination and preterm births observed in MCPT4-deficient mice was abolished when GBS was deficient in expression of the fibronectin-binding protein SfbA. Taken together, our results suggest that the protective effect of MCPT4 against GBS dissemination and preterm labor can be attributed in part to MCPT4-mediated proteolysis of fibronectin. Our studies reveal a novel role of mast cells in defense against bacterial infections.

D-лактат как маркер дисбиотических и воспалительных заболеваний нижнего отдела половых путей у женщин

D-лактат как маркер дисбиотических и воспалительных заболеваний нижнего отдела половых путей у женщин

Influence of 120 kDa Pyruvate:Ferredoxin Oxidoreductase on Pathogenicity of Trichomonas vaginalis.

Trichomonas vaginalis is a flagellate protozoan parasite and commonly infected the lower genital tract in women and men. Iron is a known nutrient for growth of various pathogens, and also reported to be involved in establishment of trichomoniasis. However, the exact mechanism was not clarified. In this study, the author investigated whether the 120 kDa protein of T. vaginalis may be involved in pathogenicity of trichomonads. Antibodies against 120 kDa protein of T. vaginalis, which was identified as pyruvate:ferredoxin oxidoreductase (PFOR) by peptide analysis of MALDI-TOF-MS, were prepared in rabbits. Pretreatment of T. vaginalis with anti-120 kDa Ab decreased the proliferation and adherence to vaginal epithelial cells (MS74) of T. vaginalis. Subcutaneous tissue abscess in anti-120 kDa Ab-treated T. vaginalis-injected mice was smaller in size than that of untreated T. vaginalis-infected mice. Collectively, the 120 kDa protein expressed by iron may be involved in proliferation, adhesion to host cells, and abscess formation, thereby may influence on the pathogenicity of T. vaginalis.

The Gonococcal Transcriptome during Infection of the Lower Genital Tract in Women.

Gonorrhea is a highly prevalent disease resulting in significant morbidity worldwide, with an estimated 106 cases reported annually. Neisseria gonorrhoeae, the causative agent of gonorrhea, colonizes and infects the human genital tract and often evades host immune mechanisms until successful antibiotic treatment is used. The alarming increase in antibiotic-resistant strains of N. gonorrhoeae, the often asymptomatic nature of this disease in women and the lack of a vaccine directed at crucial virulence determinants have prompted us to perform transcriptome analysis to understand gonococcal gene expression patterns during natural infection. We sequenced RNA extracted from cervico-vaginal lavage samples collected from women recently exposed to infected male partners and determined the complete N. gonorrhoeae transcriptome during infection of the lower genital tract in women. On average, 3.19% of total RNA isolated from female samples aligned to the N. gonorrhoeae NCCP11945 genome and 1750 gonococcal ORFs (65% of all protein-coding genes) were transcribed. High expression in vivo was observed in genes encoding antimicrobial efflux pumps, iron response, phage production, pilin structure, outer membrane structures and hypothetical proteins. A parallel analysis was performed using the same strains grown in vitro in a chemically defined media (CDM). A total of 140 genes were increased in expression during natural infection compared to growth in CDM, and 165 genes were decreased in expression. Large differences were found in gene expression profiles under each condition, particularly with genes involved in DNA and RNA processing, iron, transposase, pilin and lipoproteins. We specifically interrogated genes encoding DNA binding regulators and iron-scavenging proteins, and identified increased expression of several iron-regulated genes, including tbpAB and fbpAB, during infection in women as compared to growth in vitro, suggesting that during infection of the genital tract in women, the gonococcus is exposed to an iron deplete environment. Collectively, we demonstrate that a large portion of the gonococcal genome is expressed and regulated during mucosal infection including genes involved in regulatory functions and iron scavenging.

The colposcopic atlas of schistosomiasis in the lower female genital tract based on studies in Malawi, Zimbabwe, Madagascar and South Africa.

Background Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women.Methodology/Principal findingsPhotocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes.SignificanceThis is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.

A cross-sectional analysis of lower genital tract intraepithelial neoplasia in immune-compromised women with an abnormal Pap

Persistent human papillomavirus (HPV) infections can cause intraepithelial neoplasia of the lower genital tract. Immune-compromised women have higher rates for all lower genital tract intraepithelial neoplasia. We wish to study the distribution of genital intraepithelial neoplasia in women with and without an immune system. The study consisted of 343 women with an abnormal genital lesion or cervical cytology who were referred to a gynecologic oncologist. All patients underwent vulva, vaginal, cervical and anal colposcopy. Any lesion detected was biopsied. Demographic and medical data were collected. The Chi-square test was used to determine the relationship between immunosuppression status and various variables, including sites of intraepithelial neoplasia. Immune-compromised women (N = 33) are more likely than immune-competent women (N = 310) to have intraepithelial neoplasia of the vulva (p < 0.05) and vagina (p < 0.05), but not more likely to have intraepithelial neoplasia of the anus or cervix. Immune-compromised women are more likely than immune-competent women to have multifocal intraepithelial neoplasia (p < 0.001). In addition, immune-compromised women are more likely to have higher grade disease of the vulva and vagina (p < 0.05), and no more likely to have higher grade disease on the cervix or anus than immune-competent women. Women with conditions suppressing the immune system are at higher risk for HPV-related disease outside of the cervix and for worse HPV-related diseases than immune-competent women. This study highlights the need for vigilant evaluation of the complete lower genital tract in women with immune-compromised systems.

Microbial ecology of the lower genital tract in women with sexually transmitted diseases

Sexually transmitted diseases (STDs) in women are of great concern to all health-care providers since many of them are preventable and/or treatable conditions which, if left untreated, could have serious sequelae such as pelvic inflammatory disease, infertility, cervical cancer, systemic disease, etc. They may also become a major public health problem when dealing with diseases such as hepatitis, etc., or in people with human immunodeficiency virus. We present here a comprehensive review of the common causes of STDs and their treatment.

Hair in the Vagina

: Lack of estrogen after menopause can cause many changes in the lower genital tract of women, including involution of the introitus and collapse of the vestibule into the genital cleft. : Six cases of hypoestrogenic women are described, with the unusual finding of entrapment of terminal hairs between agglutinated genital folds or in the vagina. In symptomatic cases, there were severe inflammatory changes accompanying these findings. The initial case prompted a lengthy and costly diagnostic process to no avail. A MEDLINE search yielded several cases of pilonidal disease of the clitoris in younger women, but no reports of hair in the vagina of postmenopausal women. : This report is noteworthy because pilonidal disease in the lower genital tract of postmenopausal women is a less-known clinical entity. A hypothesis is offered based on its clinical similarity to pilonidal disease in the presacral area.

Avaliação de citocinas em secreção endocervical de mulheres com candidíase, tricomoníase ou vaginite bacteriana

Infectious processes in the vagina due to infectious micro-organisms are very common. Vulvovaginitis is commonly caused by protozoa, yeasts, bacteria and/orviruses and their eradication or containment are usually mediated by cytokines ofthe vaginal mucosa. In this study, the intention was to measure the concentration of cytokines IL-2, IL-6, IL-10, IL-12, IFN-? and TNF-? and their relationship with some of the infections. One-hundred and seventy three women were included, with ages between 16 and 48 years (mean=31.4 ± 6.5 years). They were distributed into four groups: control, candidiasis, trichomoniasis and bacterial vaginitis group. The samples were subsequently submitted to culture and identification of micro-organism, followed by cytokine measurements. The data was submitted to statistical analysis. Median, interquartile range and the Mann-Whitney test was employed and considered significant when p&lt;0.05. The levels of cytokines in the lower genital-tract of women with candidiasis, trichomoniasis, bacterial vaginitis were higher than those with normal flora. Sixty (34.7%) women were in the control group, 19 (11.0%) presented only candidiasis, three (1.7%) presented trichomoniasis, and only ten presented (5.8%) bacterial vaginosis. The remaining participants had comorbidities such as HPV or bacterial vaginosis, although the study of these last two or association with other conditions was not performed. IL-2 and IL-12 were significantly elevated in the presence of candidiasis, compared with the control group p=0.01 and p=0.07, respectively. Patients with bacterial vaginitis also had statistically significant increased levels for IL-2 (p=0.03) and for IL-12 (p=0.04). TNF-? was elevated only in the presence of trichomoniasis p=0.04. We concluded that patients with vaginal infections had an increase in the concentrations of some cytokines.

A Comparison of Lower Genital Tract Glycogen and Lactic Acid Levels in Women and Macaques: Implications for HIV and SIV Susceptibility

Understanding factors that affect heterosexual transmission of HIV in women is of great importance. Lactobacilli in the lower genital tract of women utilize glycogen in vaginal epithelial cells as an energy source and produce lactic acid. The resultant vaginal acidity is believed to provide protection against HIV infection. Conversely, bacterial vaginosis (BV) is characterized by less lactic acid and a higher pH, and is associated with increased susceptibility to HIV infection. Because vaginal infection of macaques with simian immunodeficiency virus (SIV) or simian-human immunodeficiency virus (SHIV) is used as a model to study HIV sexual transmission, and because previous studies have shown a paucity of lactobacilli in rhesus macaques' lower genital tract, we compared lactic acid and glycogen levels in the genital fluid of rhesus and pigtail macaques with levels found in humans. The levels of lactic acid were lower in both rhesus (median=1.2 mol lactate/mg protein) and pigtail macaques (median=0.7 mol/mg) compared to women with healthy genital microbiota (median=4.2 mol/mg). Glycogen levels were significantly lower in both rhesus (median=0.004 μg glycogen/μg protein) and pigtail macaques (median=0 μg/μg) than in women (median=0.2 μg/μg). No significant differences in glycogen or lactate levels were observed comparing longitudinally collected samples from cycling pigtail macaques. These data show that the previously reported scarcity of lactobacilli in macaques correlates with low glycogen and lactic acid levels. These findings have important implications for studies of vaginal infection of macaques with SIV or SHIV and further our understanding of how the bacterial microbiota influences HIV infection.

HPV infection and cervical disease: A review

Cervical cancer remains a significant problem worldwide particularly in underdeveloped countries. The disease and its financial impact are significant. Infection with the human papilloma virus (HPV) is necessary for the development of cervical cancer and its precursors. HPV also causes precancer and cancer elsewhere in the lower genital tract in women and men, as well as cancers of the aerodigestive tract. Whilst non-sexual transmission has been reported, the usual method of transmission is by sexual intercourse with the virus deposited on the basement membrane of the cervical epithelium. It is then taken up by the basal cells, and viral amplification occurs with the maturation of the squamous epithelium. During this process, it remains hidden from the host immune system, thus not mounting an immune response in many instances. About half of the women infected with HPV do not develop clinically detected serum antibody levels and are thus at risk of re-infection with the same HPV type. HPV vaccination produces sustained levels of serum-neutralising antibodies and has been shown to be effective in reducing disease caused by the vaccine-associated HPV types. Vaccination is considered well tolerated and safe with syncope and venous thromboembolism reported more frequently that would be expected. Vaccination will not protect against pre-existing HPV infection and hence may not provide complete protection in all women, and as the duration of protection is not known, for the time being routine Pap testing screening according to the Australian guidelines should continue.