Lower Reproductive Tract Infections Research Articles

The pregnancy research on inflammation, nutrition, & city environment: systematic analyses study (PRINCESA) cohort, 2009-2015.

The Pregnancy Research on Inflammation, Nutrition, & City Environment: Systematic Analyses Study (PRINCESA) cohort was set up to evaluate associations between air pollution and birth outcomes among pregnant persons in Mexico City. Specifically, the study was designed to improve air pollution exposure assessment and elucidate biological mechanisms underlying associations between maternal exposures and adverse pregnancy outcomes. Pregnant persons (all women) (N = 935) between ages 18-45 who lived and/or worked in metropolitan Mexico City, Mexico, from 2009 to 2015 and liveborn singleton infants (N = 815) of participants who completed follow-up were enrolled in the cohort. We followed participants monthly from enrollment to delivery and the following categories of data were obtained: demographic, medical and obstetric history, geo-referenced data, repeated measures on daily activity patterns, reported food intake, anthropometric, clinical and obstetric data, 20 serum and 20 cervicovaginal cytokines, and lower reproductive tract infection. Repeated ultrasound measures of fetal parameters and infant birth data are also included in the study's database. In addition, PRINCESA investigators calculated air pollution exposure measures for six pollutants measured by the Mexico City Atmospheric Monitoring System (SIMAT). These estimates utilize participants' addresses to account for spatial variation in exposure (nearest monitor, inverse distance weighting, and kriging) and are available daily during pregnancy for participants. To date, associations between environmental and nutritional impacts on maternal and child health outcomes have been evaluated. PRINCESA has a comprehensive database of maternal and infant data and biological samples and offers collaboration opportunities to study associations between environmental and other factors, including nutrition and pregnancy outcomes.

Prevalence of Mycoplasma genitalium and Chlamydia trachomatis in Chinese female with lower reproductive tract infection: a multicenter epidemiological survey

BackgroundChlamydia trachomatis and Mycoplasma infections have been regarded as severe challenges to public health worldwide because their potential risk of leading to serious reproductive complications. C. trachomatis is the most common sexually transmitted bacterial infections and the prevalence has been increasing in recent years. As a newly discovered pathogen, Mycoplasma genitalium has gradually been recognized as important sexually transmitted infection and even been called a “new chlamydia”. There are no official epidemiological data of M. genitalium in China especially in women with lower reproductive tract infection. This work aims to understand the prevalence and risk factors of M. genitalium and C. trachomatis in women with lower reproductive tract infections and to provide reference for the formulation of health policy in China.MethodsThis study was conducted in the gynecological clinics of 12 hospitals geographically located in different regions in China. Women with purulent cervical secretions or abnormal vaginal microecology were included as the research group, and those with normal vaginal microecology and cervical secretions were included as the control group. A total of 2190 participants were recruited in this project including 1357 of research group and 833 of control group. All participants were required to complete questionnaires, whose vaginal discharge were collected for vaginal microecology test and cervical discharge for detection of M. genitalium and C. trachomatis.ResultsThe prevalence of C. trachomatis and M. genitalium were 7.1% (96/1357) and 3.8% (51/1357), respectively in research group. The prevalence of C. trachomatis and M. genitalium varied in different regions. Infection rates of C. trachomatis and M. genitalium were higher in women with abnormal vaginal microecology (C.t P = 0.038, M.g P = 0.043), especially in women with bacterial vaginosis and mixed vaginitis, of which C. trachomatis showed statistical differences (bacterial vaginosis, P = 0.035; mixed vaginitis, P = 0.0001) and M. genitalium was close to statistical differences (bacterial vaginosis, P = 0.057; mixed vaginitis, P = 0.081). Alcoholism and abnormal vaginal microecology were positively correlated with both C. trachomatis and M. genitalium infection. Increasing age, being married and multi-parity were negatively correlated with C. trachomatis infection. There is a positive correlation between multiple sexual partners, diversed styles of sex and C. trachomatis infection.ConclusionsWomen with lower genital dysbiosis have an increased risk of C. trachomatis and M. genitalium. The overall prevalence of M. genitalium is lower than that of C. trachomatis, while they have similarities in the characteristics of infection. Although M. genitalium is not routinely screened as C. trachomatis in young women, attention should be paid to M. genitalium infection in young women with abnormal vaginal microecology or having childbearing needs.

Relationship between Menstrual Hygiene Management and Lower Reproductive Tract Infections among Adolescent Girls in Informal Settlements in Nakuru County, Kenya

Infections of the lower reproductive tract are a public-health concern. However, in Sub-Saharan Africa, the link between menstrual hygiene, water, sanitation and hygiene variables and lower reproductive tract infection has not been appropriately explored. This study sought to determine the menstrual hygiene management practices associated with occurrence of lower reproductive tract infections among adolescent girls in Informal Settlements in Nakuru County. The study used a community-based cross-sectional design targeting adolescent girls in informal settlements in Nakuru County. Multi-stage and simple random sampling methods were used to obtain a sample size of 385 adolescent girls. The findings showed that the proportion of lower respiratory tract infections (LRTIs) among the participants was 59.71% Regarding the menstrual hygiene management practices, adolescents who changed absorbent material more than twice a day were 0.22 times less likely to report experiencing a LRTI compared to those who changed once a day, (p=0.005), those who dried their reusable absorbent material outside the house were 0.26 times less likely to be infected with LRTI compared to those who dried inside the house, (p=0.014), and those who reported bathing  3times during menstruation were 0.27 less likely to report occurrence of LRTI compared to those who bath once, (p=0.012). The study found significant association between type of absorbent material, frequency of changing absorbent material, frequency of bathing, presence of hand washing equipment and presence of anal cleansing material in toilets and lower reproductive tract infections. A study in this population that incorporate comprehensive microbiological and clinical assessments so as to get a better estimate of the prevalence of LRTI would be recommended, this will also support development of public health interventions. Keywords: Menstrual Hygiene Management, Lower Reproductive Tract Infections, Adolescent Girls

Vaginal Exposure to Candida albicans During Early Gestation Results in Adverse Pregnancy Outcomes via Inhibiting Placental Development.

Vulvovaginal candidiasis (VVC) is considered the second most common cause of vaginitis after bacterial vaginosis and the most common lower genital tract infection during pregnancy. Candida albicans (C. albicans), an opportunistic pathogen, is the major species causing VVC. Recently, increasing researches have shown that lower reproductive tract infection during pregnancy can lead to various adverse pregnancy outcomes. However, the underlying mechanisms are not fully understood. Hence, we successfully established a mouse model of vaginal C. albicans infection and characterized the adverse pregnancy outcomes. C. albicans infection strikingly increased abortion rate and decreased litter size. Further analysis of placental development demonstrated that placental structure was abnormal, including that the area of spongiotrophoblast (Spo) and labyrinth (Lab) was reduced, and the formation of placental vessel was decreased in Lab zone. Accordingly, the expression of marker genes during placental development was downregulated. Collectively, the above findings revealed that vaginal C. albicans infection during pregnancy can inhibit placental development and ultimately lead to adverse pregnancy outcomes. This study enhances our comprehension of the effect of VVC on pregnancy, and placental dysplasia as a feasible orientation to explore VVC during pregnancy.

Возможности применения молочной кислоты в акушерско-гинекологической практике

nflammatory diseases and dysbiosis provoked by opportunistic microbes currently rank first among lower reproductive tract infections in women. Lactobacilli are predominant in the vaginal microecosystem that is considered the first line of defense against infectious agents. Changes in hormonal profile, the pattern of intimate hygiene and sex life, and other factors impair the vaginal microecosystem. Diseases resulting from the activation of aerobic and anaerobic opportunistic microbes are particularly harmful during pregnancy, since they cause serious reproductive disorders and significantly increase the risks of perinatal complications. Frequent recurrences due to growing antibiotic resistance and the lack of potential antimicrobial treatment in the first trimester of pregnancy force to search for alternative therapeutic tools with good efficacy and safety. Topical agents containing lactic acid decrease vaginal pH and provide unfavorable conditions for the activity of opportunistic microbes, thereby maintaining the protective functions of Lactobacilli. Lactic acid is a natural chemical for this locus. As a result, agents containing this compound are virtually lacking side effects. They can be used along with antibiotics or as monotherapy. KEYWORDS: bacterial vaginosis, aerobic vaginitis, lactic acid, opportunistic microbes, vaginal microbiota, Lactobacilli, dysbiosis, pregnancy, normal flora. FOR CITATION: Savicheva A.M., Shadrova P.A. Potential use of lactic acid in obstetrics and gynecology. Russian Journal of Woman and Child Health. 2022;5(2):138–145 (in Russ.). DOI: 10.32364/2618-8430-2022-5-2-138-145.

Prevalence and Antimicrobial Susceptibility Profiles of Microorganisms Associated with Lower Reproductive Tract Infections in Women from Southern Poland-Retrospective Laboratory-Based Study.

Objective: Female infections affecting the genital tract include sexually transmitted diseases, endogenous infections such as vulvovaginal candidiasis, bacterial vaginosis (BV) or aerobic vaginitis (AV) and healthcare-associated infections. The aim of the study was to analyze the etiological factors of the vaginal dysbacteriosis, and the antimicrobial susceptibility of the dominant bacterial and fungal infections in different age groups of outpatient women from the Silesian Region. Materials and methods: A retrospective laboratory-based multi-center study encompassed 4994 women of different ages in Silesian Voivodeship, in the south of Poland; patients who had vaginal swabs collected as per physicians’ orders during the period from 1 January 2017 until 30 June 2018 were included in the study. The inclusion criteria were: non-hospitalized female, aged ≤80, with suspected vulvovaginal candidiasis or bacterial vaginosis and clinical sings of infections. Results: Gram-positive cocci were the ones most often isolated: Enterococcus faecalis (29.2%) and Streptoccoccus agalactiae (13.1%), followed by bacilli from the Enterobacteriaceae group, including Escherichia coli (26.3%). The presence of Streptococcus agalactiae was confirmed in 13.1%, slightly more often in the 45–80 age group, and Gardnerella vaginalis in 6.4%, most often in women aged 15–24. The prevalence of yeast-like infections was 24.3%, Candida albicans accounted for 78.3%, whereas among C. non-albicans spp.—C. glabrata dominated (14.9%) followed by C. parapsilosis (3.8%). The highest resistance was observed only in Streptococcus agalactiae as the MLSB mechanism (Macrolide-lincosamide-streptogramin B) was identified in 38.6% of strains. The prevalence of vulvovaginal candidiasis was 24.3%, the highest in women aged 15–44. Conclusions: Drug resistance in studied vulvovaginitis was associated only with Streptococcus agalactiae. A high proportion of yeast-like aetiology was found, probably associated with recurrent infections. In the analyzed cases only the Amsel criteria and culture methods were used for diagnosis without preparations and microbiological Nugent criteria.

Prevention control and syndromic management of reproductive tract infections (RTIs) and sexually transmitted infections (STIs) in women

Reproductive tract infections (RTIs) and sexually transmitted infections (STIs) are key public health problem in India with significant effect on sexual and reproductive health. Globally in the age group of 15-49 years, 499 million episodes of remediable sexually transmitted infections occur yearly, of which 80% occur in developing countries and 79 million cases occur in India alone. There is remarkable decrease of bacterial sexually transmitted infections (gonorrhea and syphillis) with chancroid virtually on edge of disappearance. Viral sexually transmitted infections; genital warts, hepatitis B and herpes simplex have an rising trend. There is notable burden of lower reproductive tract infections; Candidiasis, trichomoniasis and Bacterial vaginosis among women with no evidence to indicate decrease in prevalence. In specific populations, STIs prevalence increases the risk of transmitting and ac quiring HIV infection by 2 to 3 times. (RMNCH+A) and STI/RTI Control and Prevention Programme is useful in implementing a user friendly syndromic approach endorsed by WHO and NACO as an effective means to treat STI/RTI along with correct and consistent use of condom for every act of sex. Agenda for Sustainable Development Goal-3, 2030 aims at ending sexually transmitted infections epidemics as utmost health concerns with universal access to reproductive and sexual health for all. Keywords: Reproductive tract infections (RTIs), HIV, Sexually transmitted infections (STIs), Partner Management, Prevention.

Knowledge and Practice of Women with Lower Genital Tract Infections

Background: Reproductive tract infections (RTIs) are recognized as a major public health problem and rank second - after maternal morbidity and mortality - as the cause of healthy life loss among sexually- active women of reproductive age in developing countries. The aim: the study: The study aimed to assess to assess knowledge &practice of women regarding lower of reproductive tract infection. Setting: The study was conducted at the patient gynecological clinic at Benha University Hospital. Design: Descriptive study design. Sampling: A purposive sample included300 women were recruited in the current study. Tools: Three tools were used to collect data, Tool 1-Interviewing questionnaire to collect data include Part 1:-sociodemographic characteristics data, Part 2:- Reproductive history Part 3:- Related to characteristics of vaginal discharge Part 4:- Related to personal hygiene habits Tool II: - women's knowledge and Tool III-An observation check list: used to assess practice of studied sample of reproductive tract infections. Results: The present study revealed that most common of the studied group are mean age 25.67 ± 2.09 married, house wife, and are living in urban area. There is highly statistically significant differences women's total knowledge score and their marital status, age at marriage, and years of marriage. The total practice score in relation to their personnel characteristics, it reveals that there was a statistical significant difference between women total practice score and their residence, age at marriage, and years of marriage. Conclusion: There is highly statistically significant differences women's total knowledge score. And the total practice score in relation to their personnel characteristics, it reveals that there was a statistical significant difference between women total practice score and their residence, age at marriage, and years of marriage in addition to highly positive significant correlation that clarifies that increase knowledge will subsequently increase practice of women regarding lower reproductive tract infection. Recommendations: Periodic educational program for women to increase their knowledge and to improve their practice. Counseling women about the importance of periodic follow up.

Effects of medroxyprogesterone acetate and compound norethisterone enanthate on the susceptibility of BABL/ c mice to lower reproductive tract infection with Chlamydia trachomatis

Objective To compare the effects of medroxyprogesterone acetate (MPA) and compound norethisterone enanthate (CNE) on the susceptibility of BABL/c mice to lower reproductive tract infection withchlamydia trachomatis(Ct). Methods A total of 60 BALB/c mice were randomly and equally divided into 6 groups: MPA-pretreated control group and CNE-pretreated control group inoculated with MyCoy cell suspensions in the vagina on the 5th day after single treatment with MPA and CNE respectively, blank control group receiving no treatment, MPA-pretreated infected group and CNE-pretreated infected group inoculated with 1×107 inclusion-forming units (IFU) of Ct serovar E in the vagina on the 5th day after single treatment with MPA and CNE respectively, control infected group inoculated with the same quantity of IFU of Ct serovar E in the vagina but receiving no pretreatment. On day 4, 7 and 14 after inoculation, vaginal irrigation fluid was obtained from all the mice for cell culture of Ct. Three mice were randomly selected from each of these groups at the above three time points and sacrificed, and vaginal and uterine tissue specimens were obtained for hematoxylin-eosin (HE) staining and microscopic examination. Chi-square test and Fisher's exact test were conducted to compare infection rate among different groups. Results No growth of Ct was observed in the three control groups at the above time points. The culture-positive rate of Ct was 1/10 on day 4 but 0 on day 7 and 14 in both the CNE-pretreated infected group and control infected group, 7/10 on day 4, 2/7 on day 7 but 0 on day 14 in the MPA-pretreated infected group. Fisher's exact test revealed that the culture-positive rate of Ct was significantly higher in the MPA-pretreated infected group than in the control infected group and CNE-pretreated infected group on day 4(bothP=0.03), but similar among the three infected groups on day 7(P=0.23). Both the MPA-pretreated control group and infected group showed an increase in endovaginal mucus, thinning of vaginal stratified squamous epithelium, mucification of vaginal epithelium, presence of secretions in vaginal lumen and submucosal infiltration of a few inflammatory cells on day 4, 7 and 14, as well as appearance of pathological changes (including the presence of large quantities of purulent secretions in lumen, mild tissue edema and submucosal infiltration of a few inflammatory cells) in the vagina on day 4. Vaginal tissues were normal in both the CNE-pretreated infected group and control group at the above three time points, but mild tissue edema, lumen expansion, secretion retention and infiltration of scattered inflammatory cells were observed in the uterus on day 4 after inoculation. Conclusions MPA can arrest the estrous cycle of mice at diestrus with the mucification of vaginal epithelium, which may increase the susceptibility to Ct vaginal infection in mice. In contrast, CNE has no obvious effect on the estrous cycle and susceptibility to Ct vaginal infection despite of the appearance of pathological changes in the uterus. Key words: Medroxyprogesterone acetate; Norethindrone; Chlamydia trachomatis; Disease models, animal; Mice; Reproductive tract infections

FACTORS INFLUENCING LOWER REPRODUCTIVE TRACT INFECTIONS AMONG FEMALE WORKERS OF BA RIA RUBBER COMPANY

Objectives: This study defines the prevalence and factors relating to lower reproductive tract infections of female workers of Ba Ria Rubber Company. Subjects and Methods: Using the design of cross-sectional study from June 2009 to May 2010, a total number of 506 female workers of Ba Ria Rubber Company had been chosen to be interviewed, examined and tested for diagnosing of lower reproductive tract infections and related factors. Results and Discussion: It showed that the prevalence of lower reproductive tract infections (RTIs) was 43.1% in which 25.23% of Candida albicans, 1.83% of Trichomonas, 15.14% of Gardneralla and 57.80% of bacteria. Conclusion: Some related factors were work place, characteristics of job, economic conditions, the quality of water supply, female workers’ history of abortion, contraceptive methods, bathroom and environmental conditions at work place. Key words: Reproductive tract infections (RTIs), working environmental conditions.

Prevalence and determinants of lower reproductive tract infections among women aged 25 - 54 years in Beijing

To determine the prevalence and determinants of the most commonly seen lower reproductive tract infections among women aged 25 - 54 years in Beijing. The study population consisted of 6339 women aged 25 - 54 years in 137 communities of Beijing. Focus of this study was to understand the prevalence of the following diseases as:bacterial vaginosis, trichomoniasis and vulvovaginal candidiasis. In addition to their prevalence rates, a generalized equation for estimation was used to analyze those infection-associated factors. The overall infection prevalence in the lower reproductive tract was 11.4%, including bacterial vaginitis as 8.7%, trichomonads as 1.0% and vulvovaginal candidiasis as 1.7%. Factors which were found to be significantly associated with lower reproductive tract infections in women were age, profession, family income, number of sex partners and frequency of condom use during sexual contacts. In patients with bacterial vaginitis, both prevalence rates of cervical intraepithelial neoplasia and infection of human papillomavirus were high. The prevalence of the most commonly seen lower reproductive tract infections among women aged 25 - 54 years in Beijing was lower than other areas in China. Lower reproductive tract infections seemed to be related to 30 - 49 years of age, nongovernmental employee, poverty, higher number of sex partners and not using condoms during sexual contacts.

Investigation of the situation of vaginal microflora in healthy women population

To assess the distribution of vaginal microflora in healthy women and investigate their cognition of lower reproductive tract infection-related knowledge as well as personal hygiene habits and character of behavior in seeking medical treatment. Total of 1660 healthy women who had physical check-ups at the Medical Center of Renji Hospital were selected and received gynecologic examination, as well as routine examination, pH examination and bacterial culture of the vaginal discharge. In addition, 860 of them were randomly selected for questionnaire survey, in which reproductive tract infection -related knowledge and personal hygiene habits as well as behavior in seeking medical treatment were involved. Among the 1660 censused women, vaginal average pH was 4. 16 +/- 0.21. The positive rate of Candida in vaginal discharge routine examination was 3.86% (64/1660), which was lower than that in aerobes culture 7.71% (128/1660). Candida albicans was the most populous species 78.9% (101/128), followed by 7.8% (10/128) and 7.0% (9/128) for the Candida glabrata and Candida krusei respectively. The most populous species of vaginal microflora were hemolytic streptococcus A (63.80%, 1059/1660), Staphylococcus epidermidis (14.28%, 237/1660), and Enterococcus faecalis (D) group (11.44%, 190/1660). The questionnaire survey showed that 88.4% (760/860) of 860 women took active treatment when feeling unwell, 92.1% (792/860) of them had good hygiene practices, and only 21.2% (182/860) had the habit of vaginal douching. In addition, 50.0% (430/860) of them had the desire to obtain reproductive health knowledge through out-patient consultation. Vulvovaginal Candida disease ranks the first in all types of vaginitis, among which, Candida albicans is the most populous species followed by the Candida glabrata and Candida krusei. Hemolytic streptococcus A and Staphylococcus epidermidis are the most common species of vaginal microflora in healthy women. The censused women have high awareness of reproductive health care and pay much attention to common gynecologic diseases such as lower reproductive tract infection. Nevertheless, we should strengthen the public education of reproductive health-related knowledge.

Health-seeking behavior of Karachi women with reproductive tract infections

To explore the contextual factors influencing health-seeking behavior of women in Karachi regarding reproductive tract infections, 18 women with reproductive tract infections from different clinics and community settings were identified and in-depth interviews were conducted. Physicians in our study diagnosed a woman to have lower reproductive tract infection if she complained of malodorous vaginal discharge with or without perineal itching; and to have pelvic inflammatory disease or upper reproductive tract infection if she had any two of the following complaints: malodorous vaginal discharge, menstrual irregularities, lower abdominal pain or dyspareunia. Women consulted a variety of healthcare providers in their pursuit for treatment, mainly allopathic doctors and hakims. The different treatments prescribed to women ranged from oral and intravaginal medications to various home remedies including refraining from specific foods. Causes of reproductive tract infections reported were “melting bones”, consuming foods with perceived hot composition, poor personal hygiene and procedures like dilatation and curettage, delivery and induced abortions. None reported sexually transmitted diseases as the perceived cause of their problem. Interference with religious activities, sexual relationships or socializing was reported as consequences of reproductive tract infections, in addition to lower abdominal pain, menstrual irregularities, backache and kamzori (weakness). Pakistani women seek care for reproductive tract infections and visit a variety of providers, though causes and treatments offered are usually not related to sexually transmitted diseases. We therefore suggest training of healthcare providers for appropriate counseling and that treatment management protocols be advocated.

Levels of Vaginal Secretory Leukocyte Protease Inhibitor Are Decreased in Women with Lower Reproductive Tract Infections

The following abstracts are taken from journals of interest to our readers and are reviewed by Thomas M. Julian (TMJ), L Stewart Massad (LSM), Leo B. Twiggs (LBT), and Kenneth D. Hatch (KDH).

Levels of vaginal secretory leukocyte protease inhibitor are decreased in women with lower reproductive tract infections

Objective: Secretory leukocyte protease inhibitor contributes resistance to primary human immunodeficiency virus infection in the oral cavity. However, the levels of this inhibitor in the genital tract of women with sexually transmitted diseases or vaginitis are not well described. The objective was to determine vaginal inhibitor levels in women with symptomatic and asymptomatic genital infections. Study Design: We tested 207 nonpregnant women for Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, Candida species, and bacterial vaginosis by standard methods. A second group of symptom-free pregnant women (N = 231) was also studied. Secretory leukocyte protease inhibitor was measured by enzyme-linked immunosorbent assay, and results were compared by nonparametric methods. Results: Vaginal levels of secretory leukocyte protease inhibitor in both groups were significantly lower in women with any sexually transmitted disease than in those without infection (P <.0001). Patients with bacterial vaginosis and those with bacterial vaginosis with yeast vaginitis also had decreased levels (P <.025). Conclusions: Levels of secretory leukocyte protease inhibitor in vaginal fluid are decreased in women with lower genital tract infection. This may represent a common mechanism of increasing susceptibility to infection with human immunodeficiency virus. (Am J Obstet Gynecol 2000;183:1243-8.)

Gynecologic Problems Are Common Among Recent Mothers in Parts of India

In a survey of 3600 women from southern Indias Kamataka State 23% reported symptoms of anemia 17% reported lower reproductive tract infection 7% had menstruation-related problems and 5% described symptoms consistent with pelvic inflammatory disease. Those most likely to report such problems were women who had obstetric problems during their last birth women who had been sterilized rural residents and those who had delivered their last child at home or in a government institution. All respondents had at least one child under five years of age; 59% had obstetric problems such as excessive bleeding or postpartum lower abdominal pain associated with that birth. 58% were not using contraception and 35% were sterilized. 43-56% of respondents had sought medical treatment for their self-reported health problems generally from private sources of care. The causation of this high maternal morbidity is unclear. It is speculated however that women who are sterilized and those who receive obstetric care at a government hospital are often exposed to unsanitary conditions and thus the risk of infection.