Mucopurulent Vaginal Discharge Research Articles

A CRITICAL REVIEW ON KAPHAJ YONIVYAPADA W.S.R CHRONIC CERVICITIS

In Ayurvedic classics, almost all gynecological disorders come under the big heading of Yonivyapada. This also includes menstrual disorders, abortions or stillbirths and diseases of uterus, cervix and vagina. Chronic cervicitis is judged by the presence of a heavy mixed chronic inflammatory cell infiltrate. This condition causes congestion and fibrosis of cervix and is characterized by mucopurulent vaginal discharge with foul smelling, pruritus vulvae, dyspareunia, failure of conception etc. The disease chronic cervicitis can be put parallel to kaphaj yoni vyapada on the basis of signs and symptoms. Here an attempt has been made to correlate chronic cervicitis with kaphaj yoni vyapada describes in Ayurvedic classics.

Approach to dysmenorrhoea in primary care.

Approach to dysmenorrhoea in primary care.

BILATERAL DYSGERMINOMA IN A SENILE BITCH ASSOCIATED WITH NODULAR LYMPHOID HYPERPLASIA IN SPLEEN AND PYOMETRA: A CASE REPORT

Ovarian neoplasms affect a low percentage of female dogs, and these tumors are classified according to their cellular origin and are considered rare. Dysgerminoma is a tumor derived from undifferentiated primordial ovarian germinal epithelium cells. In the male, this neoplasm is diagnosed as seminoma. Thus, dysgerminoma is not linked to the production of ovarian hormones such as estrogen and progesterone, which play a fundamental role in the establishment of pyometra. At Araujo Veterinary Hospital (HVA), a 15-year-old female Pinscher was admitted with mucopurulent vaginal discharge, abdominal enlargement, anorexia, polydipsia, and prostration clinical signs indicative of pyometra, radiographic and ultrasound examinations were requested, as well as a blood collection for hemogram and serum biochemistry. Ultrasound examination revealed uterine enlargement and hypoechoic content, in addition to bilateral ovarian cysts, measuring 7 cm in the right ovary and 3 cm in the left. The blood count revealed normal values in the erythrogram and the leukogram showed monocytosis and lymphopenia, in addition to macroplatelets. Biochemical examination revealed increased GGT values of 10 U/L. Ovariohysterectomy was performed and, in the trans-surgical period, nodules in the spleen were observed. So, the ovaries and a fragment of the lymphoid organ, were fixed and sent to the histopathology laboratory after surgical resection. Histopathology revealed ovarian dysgerminoma and lymphoid nodular hyperplasia. Ten days after the surgical procedure, the dog returned to the HVA for clinical evaluation and suture removal. However, three days after the return, the patient presented a convulsive condition evolving to death.

Prevalence of subclinical endometritis in dairy cows that recovered after treatment of clinical endometritis with cephapirin and PGF2α

The aims of our study were to evaluate (1) the prevalence of subclinical endometritis (SE) in clinically cured cows after treatment of clinical endometritis (CE) with uterine cephapirin infusion or with systemic application of PGF2α and after self-healing, (2) the prevalence of SE in clinically cured cows in relation to the type of vaginal discharge. The study was conducted on 222 Polish Holstein Friesian cows with CE diagnosed by vaginoscopy and ultrasound. The animals were randomly allocated to one of three groups: Group 1 (n = 72): intrauterine cephapirin infusion; Group 2 (n = 73): single intramuscular injection of dinoprost; and Group 3 (n = 77): left untreated as a control. All cows were reexamined two weeks later (Exam 1). If there was still CE at this examination, these cows were treated using the same method as previously and were examined 2 weeks later (Exam 2). Cows still having CE at the second examination were examined two weeks later (Exam 3). Cows without signs of CE at Exams 1, 2 and 3 were considered cured, and endometrial samples from the uteri were collected by cytobrush to diagnose SE using cytological evaluation of PMN percentage. The threshold for SE was set at ≥ 5% PMNs. Two cows each from Groups 1 and 3 and three cows from Group 2 were not clinically recovered at Exam 3 and were excluded from the analysis. In total, SE was diagnosed in an average of 40.9% of clinically cured cows. The prevalence of SE in Group 1, 2 and 3 was 35.0%, 47.1% and 40.0%, respectively (p > 0.05). There were significantly higher (p < 0.05) SE cases after treatment of CE associated with purulent vaginal discharge than with mucopurulent discharge. In relation to the method of treatment, the prevalence of SE was significantly higher (p < 0.05) in cows treated with cephapirin with purulent vaginal discharge than with mucopurulent vaginal discharge. In conclusion, the study showed a high prevalence of SE in cows clinically cured after treatment of clinical endometritis with cephapirin or PGF2α and after self-healing. The prevalence of SE was significantly higher in cows with purulent vaginal discharge than with mucopurulent vaginal discharge. Therefore, in cows clinically recovered from clinical endometritis, the prevalence of SE should always be considered a negative consequence, and the resulting management of this uterine disease should be implemented at the herd level.

Evaluation of antimicrobial resistance and risk factors for recovery of intrauterine Escherichia coli from cows with metritis on California commercial dairy farms

The goals of this study were to evaluate factors affecting recovery and antimicrobial resistance (AMR) in intrauterine E. coli in post-partum dairy cows with and without metritis from commercial California dairy farms. Using a cross-sectional study design, a total of 307 cows were sampled from 25 farms throughout California, from which a total of 162 intrauterine E. coli isolates were recovered. During farm visits, cows within 21 days post-partum were categorized in one of three clinical presentation groups before enrollment: metritis (MET, n = 86), defined as a cow with watery, red or brown colored, and fetid vaginal discharge; cows with purulent discharge (PUS, n = 106), defined as a non-fetid purulent or mucopurulent vaginal discharge; and control cows, (CTL, n = 115) defined as cows with either no vaginal discharge or a clear, non-purulent mucus vaginal discharge. Cows diagnosed as MET had significantly higher odds for recovery of E. coli compared to cows diagnosed as CTL (OR = 2.16, 95% CI: 1.17–3.96), with no significant difference observed between PUS and CTL, and PUS and MET. An increase in days in milk (DIM) at the time of sampling was significantly associated with a decrease in the odds ratio for E. coli recovery from intrauterine swabs (OR = 0.94, 95% CI: 0.89–0.98). All intrauterine E. coli were resistant to ampicillin (AMP), with an AMR prevalence of 30.2% and 33.9% observed for chlortetracycline and oxytetracycline, respectively. Only 8.6% of isolates were resistant to ceftiofur (CEFT), one of the most common drugs used to treat cows on farms sampled. No significant difference in the prevalence of AMR was observed among clinical groups at the individual cow level. At the farm level, a significantly higher odds for isolating intrauterine E. coli resistant to chlortetracycline (OR: 2.6; 95% CI: 3.7–58.0) or oxytetracycline (OR: 1.9; 95% CI: 1.4–33.8) was observed at farms that used an intrauterine infusion of oxytetracycline as a treatment for metritis when compared to those farms that did not use this practice. Findings from this study indicate the need for further research supporting a broader understanding of farm practices driving AMR in cows with metritis, as well as data to increase the accuracy of breakpoints for AMR classification of intrauterine E. coli from cattle.

​Genital Changes, Haemato-biochemical Profile and Therapeutic Management of Endometritis in Crossbred Dairy Cows

Background: Reproductive performance is one of the major determinants for the economic improvement of a dairy farm. Endometritis and other uterine complications cause decrease the pregnancy rate. In this study, the genital changes and haemato-biochemical profile of crossbred dairy cows affected with endometritis was studied to evolve a suitable treatment protocol in order to improve reproductive efficiency. Methods: Crossbred cow affected with endometritis were selected based on mucopurulent vaginal discharge at estrus and tested positive for white side test. Animals were divided randomly into 8 groups with 24 animals in each group. Different therapeutic regimens fortified with supportive treatment were opted. The therapeutic regimens were supportive therapy having bypass fat, vitamins and minerals, Lugol’s iodine, Lugol’s iodine with supportive therapy, intrauterine (IU) antibiotic, IU antibiotic with supportive therapy, E. coli. LPS, E. coli. LPS with supportive therapy and control group respectively. Efficacy of each treatment regimen was based on first service conception rate (FSCR). Result: Of all the therapeutic regimens, fortification of Lugol’s iodine with supportive therapy resulted in higher FSCR (83.33%) indicating better applicability as a treatment tool for endometritis in crossbred cows.

Case studies on clinico-pathological aspects of concurrent occurrence of mammary tumors and pyometra in female dogs

The present study describes the clinico-pathological aspects of concurrent occurrence of mammary tumors and pyometra in female dogs. Three bitches with growth in mammary gland are brought to the Veterinary Clinical Complex, Veterinary College and Research Institute, TANUVAS, Namakkal, Tamil Nadu with the history abdominal distension, vomiting, polyuria, polydipsia and mucopurulent vaginal discharge. On clinical examinations animals revealed distended abdomen with pain on palpation. Haematological parameters revealed anaemia. Serum biochemical parameters showed decreased protein and electrolyte levels and increased blood urea nitrogen and creatinine values. Serum hormones such as estradiol and progesterone levels were increased. Radiography revealed moderately distended uterus. The mammary masses and infected uterus from affected bitches were removed by aseptic surgical procedures under general anaesthesia. Cytology of mammary masses showed neoplastic cells characterised by anisocytosis, anisokaryosis and hyperchromasia. Grossly, the infected uterus was edematous, turgid and the lumen was filled with about 200 ml of yellowish creamy pus. Histopathology and immunohistochemistry profile of mammary masses confirmed the cases as mixed mammary carcinoma. Clinical profile and gross pathology of uterus revealed pyometra. Hence, the pathological features of concurrent occurrence of mixed mammary tumor and pyometra in bitches were reported.

Simultaneous Occurrence of Ovarian Teratoma and Endometrial Cystic Hyperplasia with Pyometra in a Labrador Retriever Bitch

Background: Ovarian teratoma is a rare tumor that occurs in dogs. Its origin comes from embryonic cells of the notochord and it is a unipotent tumor. Pyometra is the accumulation of purulent content in the uterine lumen. Cystic endometrial hyperplasia is one of the factors predisposing a dog to the development of pyometra. The safest and most efficient treatment for pyometra is ovariohysterectomy. The purpose of this report was to describe a case of ovarian teratoma and cystic endometrial hyperplasia with concomitant pyometra in a Labrador Retriever Bitch.Case: A 10-year-old bitch Labrador Retriever, weighing 42 kg, was evaluated at Animal Care Barueri Veterinary Clinic, in Barueri, São Paulo. The patient was referred from another veterinary service to our clinic for an ovariohysterectomy and removal of an intestinal foreign body as previous ultrasonography (US) had indicated the presence of pyometra and a foreign body in the descending colon (she had ingested cloth according to the owner’s report). Laboratory tests, complete blood count, alanine aminotransferase, alkaline phosphatase, urea, and creatinine levels did not show any significant changes. Upon examination, the clinical signs were mucopurulent vaginal discharge, 5% dehydration, rectal temperature 39.1°C, mild abdominal pain on palpation, normophagy, normodipsia, and normal defecation and urinatination. Laboratory tests a new US were requested on which the uterus was observed with the presence of luminal anechoic content and increased uterine diameter (uterine horns 3.97 cm), an acoustic intestinal shadow supposedly from a foreign body,and on the leukogram, leukocytosis (23,600/mm3) due to neutrophilia with a right shift (20,532/mm3) was observed. Therapeutic ovariohysterectomy and exploratory celiotomy were chosen as therapeutic options. Celiotomy with caudoumbilical mid ventral access was performed. When the left uterine horn was identified, an attempt was made to pull it in order to expose the left ovary, but this maneuver was not successful. For this reason, the abdominal incision was enlarged cranially. At that point, a huge mass was observed in the ovary (which was supposedly the acoustic shadow of the foreign body in the descending colon/left ovary). The intestines appeared normal. Macroscopically, the mass had an irregular surface, round shape, firm consistency, and was 15 cm long x 10 cm wide. Once removed, the mass was incised in the transversal direction, purulent content, hair, and mineralized areas inside it were observed. Histopathological examination showed neoplastic proliferation, consisting of cells with elongated epithelioid shape that were arranged in long irregular bundles among well-differentiated adipose tissue. An exuberant eosinophilic matrix with extensive cystic areas filled with lamellar keratin and hairy stems covered by squamous epithelium was also observed. Extensive areas exhibiting nervous tissue. The morphological picture was compatible with teratoma.Discussion: The present report describes the concomitant presence of ovarian teratoma and pyometra in a dog. The diagnosis of pyometra requires complementary tests (laboratory and imaging). The intestinal acoustic shadow observed on the two US images obtained by two different professionals was suggestive of intestinal foreign body but was also a wrong diagnosis, which was confirmed after an exploratory celiotomy when the mass in the left ovary was identified. On the histopathological examination of this presente case, epithelial, nervous, and cartilaginous tissues were observed. This differentiation of tissues corroborated the teratoma diagnosis. Thus, the importance of an accurate diagnosis contributes to the resolution of a surgical conditions that may have had a poor prognosis when the procedure took a longer time to perform. Keywords: ovarian neoplasia, ultrasonography, OSH, pyometra.Descritores: neoplasia ovariana, ultrassonografia, OSH, piometra.Título: Ocorrência simultânea de teratoma ovariano e hiperplasia endometrial cística com piometra em cadela Labrador Retriever

Metabolic markers for purulent vaginal discharge and subclinical endometritis in dairy cows

This study compares serum markers for systemic inflammation, and liver, mineral, and energy status in samples obtained −7, 1, 3, 5, 7, 14 ± 1, 21 ± 1, and 35 d relative to calving from healthy dairy cows and those diagnosed with purulent vaginal discharge (PVD) or subclinical endometritis (SCE). Metabolites and markers measured in serum were total calcium, total protein, albumin, globulin, cholesterol, urea, glucose, gamma-glutamyl transferase, aspartate aminotransferase, glutamate dehydrogenase, β-hydroxybutyrate (BHB), non-esterified fatty acids (NEFA), haptoglobin (Hp), and insulin-like growth factor-1 (IGF-1). Holstein cows with no recorded clinical disease were classified healthy (neither PVD nor SCE; n = 38), PVD (n = 10) or SCE (n = 10) at 35 d postpartum. The cut-point for PVD was mucopurulent vaginal discharge or worse, measured with Metricheck, and for SCE > 5% endometrial polymorphonuclear cells (PMN). Purulent vaginal discharge and SCE were mutually exclusive categories. The association of each serum marker with reproductive tract health classification was fitted in mixed linear regression models, accounting for repeated measures, sampling day, parity, BCS, and interactions of reproductive tract status and day. Serum Hp concentrations were greater at 3, 5, 7, and 14 ± 1 d postpartum for SCE and at 7 and 35 d postpartum for PVD than in healthy cows. Albumin concentrations were lesser for PVD than healthy at 14 ± 1 d postpartum and lesser for SCE than healthy at 35 d postpartum. The week before calving, SCE had lesser total calcium than healthy cows, and at 7 and 14 ± 1 d postpartum PVD had lesser total calcium than healthy cows. At 14 ± 1 d postpartum, serum NEFA, BHB, and globulin were greater, and IGF-1 lower for SCE than PVD or healthy cows. For all other metabolites, no differences were found. Before diagnosis, PVD or SCE had more indication of postpartum systemic inflammation (high Hp and low albumin) than healthy cows, and markers of energy status were more compromised in SCE than in PVD or healthy cows. This supports the hypothesis that SCE is associated with maladaptation to postpartum metabolic demands and with metabolic inflammation.

Identification and clinico-gynaecological characterization of reproductive disorders in crossbred cows under field conditions

The present study was conducted on a total of 909 crossbred cows maintained in various private farms from Kamrup, Darrang and Lakhimpur districts of Assam. Breeding records provided by the farmers and characteristic genital changes detected on per rectum examination of 133 reported infertile cows were analyzed. The study revealed that the incidence of infertility due to different types of reproductive disorders was 14.63 per cent in cross bred cow under field conditions. Common clinically detectable reproductive disorders were repeat breeding with uterine infection, repeat breeding without uterine infection, true anoestrus and silent oestrus with the percentage frequencies of 36.09, 23.30, 20.30 and 17.29 respectively when estimated out of total number of infertile cows. Less frequent reproductive disorders were pyometra, ovarian cyst, infantile genitalia and ovario-bursal adhesion occurring in the frequencies of 36.09, 23.30, 20.30 and 17.29 per cent respectively. Irrespective of type the incidence of anoestrus and repeat breeding was 37.59 and 59.39 per cent respectively. Palpable corpus luteum was present in the ovary of silent oestrous cows but totally absent in cows affected with true anoestrus. Mucopurulent vaginal discharge was a distinct clinically detectable genital characteristic observed in 62.50 per cent repeat breeder cows with uterine infection. Of the infertile cows 53.38 per cent had body condition score between 2.5 and 3.5 and 46.61 per cent had the score less than 2.5. Out of repeat breeder cows with uterine infection 43.66 per cent had good body condition and 27.41 per cent poor body condition. Level of serum calcium, zinc, leptin, ghrelin and IGF-1 did not vary significantly between types of infertility. Level of phosphorus and iron was lower in cows affected with repeat breeding due to infection. Serum oestrogen level remained low in cows affected with silent oestrus and true anoestrus while level of progesterone was higher in cows affected with silent oestrus.

Review on canine pyometra, oxidative stress and current trends in diagnostics

Pyometra is one of the most important and common disorders in canine. The disease results in life threatening condition associated with septicemia and toxemia. The condition commonly occurs during luteal phase of estrous cycle, generally 4 weeks to 4 months of estrous cycle. The age, parity, breeds, administration of hormones are some predisposing factors of the condition. However, interaction between potentially pathogenic bacteria and hormonally primed uterus is believed to result in pyometra. The disease is initiated in the form of cystic endometrial hyperplasia, which later progresses into purulent uterine content following bacterial infection resulting in pyometra. The disturbance in antioxidant and pro-oxidant balance succeeding bacterial infection results in oxidative stress. The resultant stress further induces endometrial degeneration, immunosuppression and additionally aggravates the condition. An important clinical sign is malodorous, sanguineous or mucopurulent vaginal discharge with general symptoms such as vomiting, polyuria, polydipsia, depression, anorexia and occasionally fever. Till date, ultrasonography is the best diagnostic method while radiology and serological test are also helpful. Recently, the estimation of inflammatory mediators (acute phase proteins and prostaglandin metabolites) has appeared as marker for diagnosis of the pyometra. Determination of levels of inflammatory mediators has emerged as an important diagnostic method because it can be helpful in prognosis of the condition. The pyometra can be best treated by surgical manipulation (ovariohysterectomy); however, hormonal treatment can be given in less severe cases which aimed at reducing the effect of progesterone on the reproductive tract. Together, provision of antioxidants could be helpful in disease recovery along with the determined treatment. In this review, incidence, predisposing factors, etio-pathogenesis, oxidative stress associated with condition, diagnostic methods and treatment are discussed.

Short communication: Meta-analysis on therapy of bovine endometritis with prostaglandin F2α—An update

The objective of the study was to update a prior meta-analysis on the efficacy of the treatment of bovine endometritis with PGF2α. Clinical endometritis in cattle is defined as the presence of a purulent or mucopurulent vaginal discharge after 20 or 26 d, respectively, postpartum. Although the prevalence and impact of this disease are well known, the questions of whether and how to treat endometritis are still controversially discussed. Hence, to ensure timeliness of scientific results, we updated an existing meta-analysis published in 2013 that showed no treatment effect of PGF2α in cases of bovine endometritis. As in the prior meta-analysis, a comprehensive literature search was conducted. After applying specific inclusion and exclusion criteria, 3 trials remained that could be added to the 6 trials in the initial meta-analysis. Data for each trial were analyzed using the meta-analysis software Review Manager (version 5.3; The Nordic Cochrane Centre, Copenhagen, Denmark). Estimated effect sizes of PGF2α were calculated on calving to first service interval (CFSI) and calving to conception interval (CCI). As revealed by the initial meta-analysis, PGF2α treatment still had no effect on both reproductive parameters. Heterogeneity remained substantial for CFSI and CCI and even increased for CCI compared with the initial meta-analysis. Subgroup analysis, however, did not reveal a source of heterogeneity. In updating the meta-analysis, publication bias for trials reporting CCI became even more pronounced, suggesting that studies with higher standard error (i.e., usually smaller studies) that reported a prolonging effect on CCI after a PGF2α treatment were less likely to be published. Finally, although the number of trials published on the chosen topic and their comparability are still limited, this update of our meta-analysis now provides results that are based on approximately twice the number of included cows. The overall outcome, however, has not substantially changed and a positive effect of a PGF2α treatment in case of clinical endometritis could not be shown. Therefore, we do not recommend a treatment of bovine endometritis with PGF2α as a means to improve reproductive performance.

Pyosalpinges after hysterosalpingography in a patient with lower genital tract infection and managed by laparoscopic surgery in a resource low tertiary hospital case report and literature review

BackgroundPyosalpinges (a complication of pelvic inflammatory disease) is infection of the fallopian tubes and the morbidity associated with it has major health implications. We are reporting a case of pyosalpinges diagnosed after hysterosalpingography and managed by laparoscopic surgery at the Douala General Hospital, Cameroon.Case presentationA 29-year-old single woman, an assistant nurse of the Douala tribe in Cameroon. She is G1P0010 and came to our attention because of secondary infertility of three years duration. She has a history consistent with four lifetime sexual partners, self-medication for chlamydia trachomatis infection and induced abortion by dilatation and aspiration. Furthermore, she is HIV positive and had an ultrasound scan suggestive of bilateral hydrosalpinges. After a hysterosalpingography examination she developed painless muco-purulent vaginal discharge and bilateral adnexal tenderness on bimanual examination suggestive of pyosalpinges. Vaginal and cervical cultures isolated Ureaplasma urealyticum and Gardnerella vaginalis sensitive to ofloxacin and metronidazole, respectively.At laparoscopy, bilateral pyosalpinges, pelvic adhesions and peri-hepatic adhesions were found. Bilateral salpingectomy with adhesiolysis including lysis of perihepatic adhesions and peritoneal toileting was done. She was discharged from hospital 72 h later and her hospital stay was uneventful. She was counseled for in-vitro fertilization and to register in the national HIV treatment programme. Her husband was prescribed ofloxacin empirically.ConclusionAntimicrobial prophylaxis should be given to patients prior to HSG, especially those with a history of chlamydia or evidence of hydrosalpinges. There should also be universal STI testing in high risk and HIV positive patients or the danger for suboptimal antibiotic usage in areas where self-medication is common.In resource-low tertiary hospitals where computed tomography or magnetic resonance imaging is not readily available and/or affordable, clinical examination and pelvic ultrasound remains the key diagnostic tool. Surgical treatment is the best option for pyosalpinges and when plausible, laparoscopic surgery is the treatment of choice. Laparotomy is the mainstay in most hospitals in Cameroon. The parent of the patient did not consent to histo-pathologic examination.

Categorization of endometritis and its association with ovarian follicular growth and ovulation, reproductive performance, dry matter intake, and milk yield in dairy cattle

The objectives were to evaluate the effect of different categories of endometritis on follicular growth and ovulation, reproductive performance, dry matter intake (DMI), and milk yield (MY) in dairy cows. Lactating Holstein cows (n = 126) were examined for endometritis on 25 ± 1 day postpartum (DPP) using vaginoscopy, transrectal ultrasonography, and endometrial cytology to determine the presence and type of vaginal discharge, uterine fluid, and proportion of polymorphonuclear (PMN) cells, respectively. Cows that had mucopurulent vaginal discharge and/or presence of uterine fluid, no mucopurulent vaginal discharge or uterine fluid but 8% or more PMN, and mucopurulent vaginal discharge and/or uterine fluid and 8% or more of PMN were defined as having clinical (CLIN; n = 45), cytological (CYTO; n = 15), and clinical and cytological (CLINCYTO; n = 30) endometritis, respectively. Cows that had none of the above pathological conditions were classified as unaffected (UNAF; n = 36). The diameter of the largest follicle at first examination, intervals from calving to first dominant (diameter = 10 mm) follicle, preovulatory size (diameter = 16 mm) follicle, ovulation, presence of follicular cyst, and proportion of ovular cows at 35 and 65 DPP were recorded as the measures of follicular growth and ovulation. None of the ovarian follicular parameters analyzed was affected by categories of endometritis. The first service conception rate tended (P = 0.06) to differ among categories of endometritis; cows that had CLIN and CLINCYTO endometritis were four times less likely to conceive to the first insemination compared to UNAF cows. Cows that had CLIN (hazard ratio: 0.52) and CLINCYTO (hazard ratio: 0.40) endometritis had decreased likelihood of pregnancy at 150 DPP compared to UNAF cows. Similarly, cows diagnosed as having CLINCYTO endometritis had decreased likelihood (hazard ratio: 0.48) of pregnancy at 250 DPP compared to UNAF cows. The DMI and MY up to 5 weeks postpartum were not affected by categories of endometritis. In summary, categories of endometritis as determined at 25 DPP did not affect follicular growth and ovulation, DMI, or MY. However, the combined (CLINCYTO endometritis) category had a negative impact on first service conception rate and subsequent services.

The effect of intrauterine infusion of dextrose on clinical endometritis cure rate and reproductive performance of dairy cows

The main objective of this study was to evaluate the intrauterine administration use of 200mL of 50% dextrose solution as a treatment against clinical endometritis (CE); CE cure rate and reproductive performance were evaluated. Additionally, the association of several relevant risk factors, such as retained placenta (RP), metritis, CE, anovulation, hyperketonemia, and body condition score with reproductive performance, early embryonic mortality, and CE were evaluated. A total of 1,313 Holstein cows housed on 4 commercial dairy farms were enrolled in the study. At 7±3 DIM cows were examined for metritis and had blood collected to determine serum β-hydroxybutyrate concentration. To determine if cows had ovulated at least once before 44±3 DIM, the presence of a corpus luteum was evaluated by ovarian ultrasonography at 30±3 DIM and at 44±3 DIM. At 30±3 DIM, CE was diagnosed using the Metricheck device (SimcroTech, Hamilton, New Zealand); cows with purulent or mucopurulent vaginal discharge were diagnosed as having CE. Cows diagnosed with CE (n=175) were randomly allocated into 2 treatment groups: treatment (intrauterine infusion of 200mL of 50% dextrose) or control (no infusion). Clinical endometritis cows were re-evaluated as described above at 44±3 DIM, and cows that were free of purulent or mucopurulent vaginal discharge were considered cured. Intrauterine infusion of dextrose tended to have a detrimental effect on CE cure rate, and treatment did not have an effect on first-service conception rate and early embryonic mortality. A multivariable Cox’s proportional hazard model was performed to evaluate the effect of several variables on reproductive performance; the variables RP, CE, parity, anovulation, and the interaction term between parity and anovulation were associated with hazard of pregnancy. Cows that did not have RP or CE were more likely to conceive than cows that were diagnosed with RP or CE. Cows that had RP were at 3.36 times higher odds of losing their pregnancy than cows that did not have RP. In addition, cows diagnosed with CE were at 2.16 higher odds of losing their pregnancy than cows without CE. In conclusion, intrauterine infusion of 200mL of 50% dextrose solution as a treatment for CE had a strong statistical tendency to decrease CE cure rate, did not improve first-service conception rate and early embryonic mortality, and did not decrease calving-to-conception interval.

Survival of taylorellae in the environmental amoeba Acanthamoeba castellanii

BackgroundTaylorella equigenitalis is the causative agent of contagious equine metritis, a sexually-transmitted infection of Equidae characterised in infected mares by abundant mucopurulent vaginal discharge and a variable degree of vaginitis, cervicitis or endometritis, usually resulting in temporary infertility. The second species of the Taylorella genus, Taylorella asinigenitalis, is considered non-pathogenic, although mares experimentally infected with this bacterium can develop clinical signs of endometritis. To date, little is understood about the basic molecular virulence and persistence mechanisms employed by the Taylorella species. To clarify these points, we investigated whether the host-pathogen interaction model Acanthamoeba castellanii was a suitable model for studying taylorellae.ResultsWe herein demonstrate that both species of the Taylorella genus are internalised by a mechanism involving the phagocytic capacity of the amoeba and are able to survive for at least one week inside the amoeba. During this one-week incubation period, taylorellae concentrations remain strikingly constant and no overt toxicity to amoeba cells was observed.ConclusionsThis study provides the first evidence of the capacity of taylorellae to survive in a natural environment other than the mammalian genital tract, and shows that the alternative infection model, A. castellanii, constitutes a relevant alternative system to assess host-pathogen interactions of taylorellae. The survival of taylorellae inside the potential environmental reservoir A. castellanii brings new insight, fostering a broader understanding of taylorellae biology and its potential natural ecological niche.

Clinical Characteristics Associated With Mycoplasma genitalium Infection Among Women at High Risk of HIV and Other STI in Uganda

Mycoplasma genitalium is a common infection of the genitourinary tract, but its pathogenic effects have not been well described, especially in women. The increasing evidence that M. genitalium is associated with HIV infection calls for an urgent consensus on how best to control this infection. The aim of this study was to describe symptoms and signs associated with M. genitalium infection among high-risk women in Uganda. A cohort of 1027 female sex workers was recruited in Kampala in 2008. At enrollment, HIV testing was performed, genital specimens were tested for other sexually transmitted infection, and urogenital symptoms and signs were recorded. Endocervical swabs were tested for M. genitalium using a commercial Real-TM PCR assay (Sacace Biotechnologies, Como, Italy). The associations of clinical signs and symptoms with prevalent M. genitalium were investigated using multivariable logistic regression models. Reported dysuria and presence of mucopurulent vaginal discharge were significantly associated with M. genitalium infection (OR: 1.85, 95% confidence interval: 1.13-3.03 and OR: 1.55, 95% confidence interval: 1.06-2.29, respectively). There was little evidence for an association with cervicitis or with pelvic inflammatory disease. In this specific population, we found evidence that symptoms of urethritis and mucopurulent vaginal discharge were associated with M. genitalium infection. This supports earlier studies showing that M. genitalium may lead to clinically relevant genitourinary disorders and should be treated. In the absence of sensitive screening tests, further work is needed to validate clinical findings as possible indicators of M. genitalium infection to guide a possible syndromic approach for its control.

Risk Factors, Impacts, and Therapy for Endometritis in Dairy Cows

Endometritis is diagnosed cytologically, as endometrial inflammation, or clinically as purulent or mucopurulent vaginal discharge. Cytological endometritis (CYTO) is based on an increased proportion of polymorphonuclear cells in endometrial cytology. Purulent vaginal discharge (PVD) has only moderate diagnostic agreement with CYTO. The prevalence of CYTO and PVD have been reported to be as high as 53 and 40%, respectively. Reported risk factors for PVD include dystocia, retained placenta (RP), and metritis. Little information is available on the risk factors for CYTO. Cytological endometritis and PVD were shown independently to have detrimental effects on subsequent reproductive performance. Conflicting results have been reported regarding the effect of prostaglandin F2alpha (PGF) on uterine health and reproduction. The hypotheses were that CYTO and PVD would have different risk factors because they represent different reproductive diseases, and that treatment with PGF would mitigate the impact of CYTO and PVD. The objectives of this study were to investigate risk factors and impacts of CYTO and PVD in postpartum dairy cows, and to determine the efficacy of PGF for treating CYTO and PVD and for improving reproductive performance.

Characterisation of mycoplasmas isolated from genital tract infections of sheep in Nigeria

Four mycoplasma-like organisms isolated from ewes with mucopurulent vaginal discharge and swollen vulva were characterised. Biochemical tests showed three of the isolates to be negative for glucose fermentation and arginine hydrolysis, while the remaining isolate was negative for glucose fermentation but hydrolysed arginine. Serological identification using the growth inhibition, growth precipitation and indirect immunofluorescence tests indicated the three similar isolates as Mycoplasma bovigenitalium and the other isolate as Mycoplasma arginini. There are apparently no previous reports of the isolation of these organisms from the genital tract of sheep in Nigeria.

"SAFETY PIN IN VAGINA OF CHILD"

To the Editor: —InThe Journal, April 15, appears an interesting account of a safety pin in the vagina of a 4 year old child whose hymen was imperforate. The author, Dr. Nixon, supplements his communication with a list of similar cases culled from the literature. May I add another? In the case of a child, aged 2½ years, seen by me about ten years ago, a mucopurulent vaginal discharge had persisted for six months in spite of treatment with antiseptic and astringent douches and instillations by a well known pediatrician, who had regarded the condition as a benign vulvovaginitis, as the smears were negative. Under this therapeutic regimen the condition would ameliorate and increase, and during one of these remissions the child was brought to Atlantic City. After arrival here a sharp exacerbation occurred. When I saw the patient, examination disclosed the hymen imperforate except for a small opening