Signs Of Genital Infection Research Articles

The study of efficacy and safety of expectant management of incomplete abortion

Expectant management of incomplete abortion is a watch full waiting without intervention for certain period of time so that the retained product of conception will be expelled spontaneously. This study was carried out to see feasibility and safety of expectant management of incomplete abortion. It was observational descriptive study which was carried out in Nepal Medical College Teaching Hospital from July to December 2020 in 60 patients of spontaneous incomplete abortion. The patients which fulfill the inclusion criteria were sent home after bleeding has settled and ultrasound was carried after two weeks to see the success of the treatment. The success of the expectant management was found in 86.7%. There were heavy bleeding in 6.7% cases, unscheduled surgical evacuation was done in 13.3% cases. Blood transfusion was carried out in 5.0% of cases. The number of cases complained of severe low abdomen pain were 8.3% and limitation of activity were present in 10.0% of cases. There was one (1.7%) patient who showed the sign of genital infection. With the success of 86.7% of expectant management of incomplete abortion in our study we can consider expectant management of incomplete abortion as a safe option. However, small percentage of complications such as heavy bleeding, emergency surgical evacuation and severe pain are seen.

Empagliflozin Use and Fournier’s Gangrene: Case Report and Systematic Literature Review

Background: Fournier’s gangrene (FG) is a rare necrotising soft tissue infection localised in the genital areas with possible dramatic outcomes. Recently, sodium glucose co-transporter-2 (SGLT2) inhibitors were identified as a risk factor. Methods: We present a case report of a 57-year-old female patient with type 2 diabetes mellitus (T2DM) in treatment with empagliflozin which led to the development of FG. Moreover, we performed a systematic review assessing the association between empagliflozin use and FG. Results: The female patient with 15-years treated diabetes presented a massive FG after 6 months from starting empagliflozin. Over the period of two months, she was successfully treated in a low-income setting. The systematic review included two studies with a total of 9915 participants. Although no participant had FG, there was an increased rate of urinary and genital infection in patients treated with empagliflozin compared to those treated with other antidiabetics or placebo. Conclusions: FG should be considered as a possible complication in patients using SGLT2. Patients should be educated to report early signs of genital infection and healthy behaviours as well as a balanced diet should be promoted to aid in the prevention of FG.

Laboratory diagnosis of genital herpes – direct immunofluorescence method

Aim of the study was to determine clinical usefulness of direct immunofluorescence method in the laboratory diagnosis of genital herpes in women. Overall 187 anogenital swabs were collected from 120 women. Using a dacron-tipped applicator 83 swabs were collected from women suspected of genital herpes and 104 from patients with no signs of genital infection. All samples were tested using cell culture (Vero cell line) and then direct immunofluorescence method (DIF) for the identification of antigens of herpes simplex viruses: HSV-1 and HSV-2. Characteristic cytopathic effect (CPE), indicative of alphaherpesvirus infection, was observed in 43.4% of cultures with clinical specimens collected from women with suspected genital herpes and in 29.8% of cultures of clinical specimens taken from patients with no clinical symptoms of genital herpes. Herpes simplex viruses were determined in 73 samples by direct immunofluorescence method after amplification of the virus in cell culture. The DIF test confirmed the diagnosis based on the microscopic CPE observation in 85%. In 15% of samples (taken from pregnant women without clinical signs of infection) we reported positive immunofluorescence in the absence of CPE. The frequency of antigen detection was statistically significantly higher in samples that were positive by culture study (chi-square test with Yates's correction, p < 0.01). This method proved to be highly sensitive (97%) in women with clinically suspected infection. High negative predictive value (99%) proves the clinical utility of the DIF in these group of patients. In asymptomatic infections, viral antigens were detected most frequently in the swabs from the cervical canal, and in cases of suspected genital herpes in swabs taken from the vestibule of the vagina and the vulva. However, there was no statistically significant difference in the frequency of detection of Herpes Simplex Virus antigens in specimens from different parts of the genital tract in both groups of women (chi-square test, p > 0.05). In our study HHV-1 was the main causative agent of genital herpes. The growing worldwide prevalence of genital herpes, challenges with the clinical diagnosis, and availability of effective antiviral therapy are the main reasons for a growing interest in rapid, proper laboratory diagnosis of infected patients. Optimal testing diagnostic algorithm depends on patient population, clinical circumstances and availability. Our results indicated that combination of laboratory tests may help to establish the diagnosis if genital herpes is suspected but there are no typical signs.

Hospital-Diagnosed Late Sequelae after Female Chlamydia trachomatis Infections in 1990–2006 in Turku, Finland

Background: Rather little is known about the late sequelae of previously detected female Chlamydia infections. Methods: The late sequelae of previous female Chlamydia infections detected during a 15-year period in a south-western Finnish university hospital were surveyed. Hospital records of women with positive laboratory diagnoses of Chlamydia trachomatis as a sign of genital infection were collected from the years 1990–2006 and subsequently linked to known or suspected in-hospital-treated late Chlamydia complications. Results: The annual number of late complications has increased in proportion to the increasing trend of detected Chlamydia cases. 239 late complications of the total of 4,920 previously detected Chlamydia-positive infections were observed. The most frequent in-hospital-treated complications were disturbances in early pregnancy (n = 72) and low abdominal pain (n = 67). The others were 45 genital tract or pelvic infections, 34 cases of tubal or unknown infertility and 21 complications of late pregnancy and delivery. Conclusion: The late sequelae of Chlamydia infections need increasing attention in hospitals.

Severity of Genital Cutting is Linked to Complications Experienced Later in Life

This paper reports the results of two studies that linked the severity of genital cutting to complications experienced later in life among women in Africa. About 1920 women in Burkina Faso and 5337 women in Mali were surveyed. In Burkina Faso information on signs of genital infection and experiences of stillbirths was gathered while data on immediate complications of genital cutting were collected from women in Mali. Findings revealed that 93% of the women surveyed in Burkina Faso and 94% of those surveyed in Mali experienced some type of genital cutting. Clitoridectomy the most common form of genital cutting was found in 56% of women in Burkina Faso as compared to 21% in Mali. Excision--the removal of the clitoris and all or part of the labia minora--was found in 74% of women in Mali and in 39% in Burkina Faso. In both countries only 5% experienced infibulation. Most common complications related to genital cutting among women in Burkina Faso include keloid scars (62%) and vaginal narrowing (20%); among women in Mali hemorrhage (52%) and vaginal narrowing (13%). Difficulties in giving birth were also experienced such as obstructed labor and perineal tears; required interventions during childbirth were episiotomy and cesarean section.

Prevalence of chlamydial antibody in pregnancy

In this matched-pair study 139 pregnant women were matched on the basis of age to an equal number of non-pregnant women with no signs of genital infection. The mean age was 28.7 years (range 20-41). The cut-offs used for detection of chlamydial antibody were 1:64 and 1:128 for IgG and 1:16 for IgA. IgG antibody at 64 was detected in 37.4% of pregnant women, compared to 46% of controls (p = 0.145). There was, however, a statistically significant difference between the groups for IgG at 128 (gravidae = 15.8%; controls = 28%; p = 0.014). IgA were detected in 8.6% and 16.5% of subjects, respectively (p = 0.047). IgG levels did not vary with increasing age among the pregnant women, but rose significantly with age in non-pregnant controls (logistic regression p-values = 0.011 and 0.006, for IgG at 64 and 128, respectively). IgG-positive women in the control group tended to be older than pregnant IgG-positive women (p = 0.06). These differences could not be explained by marital status, parity or use of oral contraceptives. In view of the lack of epidemiological differences, biological explanations might be invoked.

Antichlamydial activity of cervical secretion

SummarySummaryCervical secretion from women with and without symptoms and signs of genital infection were analysed for their ability to inhibit inclusion formation of Chlamydia trachomatis in McCoy cell cultures. Of 173 cervical samples, 115 (66 per cent) had antichlamydial activity. The inhibition was concentration-dependent and the inhibitory factor had a molecular weight of < 10 000 Da and was heat labile. C. trachomatis was isolated by culture from six (3 per cent) of the 173 women. Those who were culture-positive for C. trachomatis had higher levels of antichlamydial activity than other age matched women. There was no relation between the antichlamydial activity and the antichlamydial antibody titre either in cervical secretion or in sera, as measured by micro-immunofluorescence tests and an enzyme-linked immunosorbent assay.

Bacterial vaginosis Diagnosis, treatment and significance in gynecological practice

Bacterial vaginosis (BV) is a syndrome which is characterized of a disagreeable vaginal discharge but not necessarily an increase in discharge and is present in nearly 20-30% of women attending gynaecological out-patient clinics. Some women have BV unknowingly but others suffer the disagreeable discharge as a lifelong nuisance and areconstantly visiting physicians without relief. This problem has even been regarded as an aesthetic problem and has received little attention, especially from gynaecologists. The diagnosis of BV is based on the fulfilment of three out of four clinical criteria as introduced by Amsel in 1983. Few studies have been carried out investigating whether BV is a risk factor for other gynaecological diseases such as bleeding disturbances or postoperative infections. The aim of this thesis was to investigate the role of BV in gyrtaecological diseases and to evaluate whether it is possible to make a reliable diagnosis of BV using saved smears, such as air-dried or Papanicolaou (PAP)-stained smears. This would make it possible to investigate a large material and enable retrospective investigations. Since vaginal leucocytosis has been regarded as a sign of genital infection, women with BY and leucocytosis have often been withdrawn from clinical studies. The presence of leucocytosis among women without BV was therefore also investigated to evaluate if this practice is justifiable. The diagnosis of BV using Amsel's criteria was compared with the detection of clue cells in air-dried vaginal smears or with the detection of clue cells in PAP-stained smears. Detection of clue cells in air-dried smears had a sensitivity of 96% and a specificity of 98% in diagnosing BY, and detection of clue cells in PAP-stained smears had a sensitivity of 90% and a specificity of 95%. Leucocytosis cannot be used to exelude BV as nearly 30 OJo of all women have leucocytosis regardless of whether BV is present or not and that healthy women can normally have transient leucocytosis during a menstrual cycle. The significance of BV in postoperative infections after gynaecological surgery and bleeding disorders was studied. BV was found to be a risk factor for pelvic inflammatory disease after first-trimester abortion, and postoperative infection following abdominal hysterectomy. A common complaint with a multifactorial etiology at a gynaecological out-patient department is bleeding disorder. Women with BV and with Mobiluncus were treated in a double-blind study with either metronidazole or with placebo. BV was successfully treated in 76% of the women. The bleeding disorder was regularized in all successfully treated women. Women with BV are at risk of developing a post-operative infection after first trimester abortion. One-hundred and seventy-four women with BV were treated in a doubleblind study with either metronidazole or placebo the week before the abortion. There were 12.2% post-operative infections in the placebo group compared to 3.6% in the group treated with metronidazole. The treatment thus reduced the incidence of infection by more than 3 times. Using simple clinical criteria it is possible to identify a risk group which if treated will reduce the incidence of postoperative infections after legal abortion. In Sweden with 36 000 abortions each year preoperative treatment of 10 000 women with BV will prevent 860 post-abortion PID's per year.

Evaluation of a Direct Fluorescence Assay as a Screening Method in Asymptomatic Young Women

The purpose of the study was to evaluate one rapid antigen test (DFA), in comparison to culture, for the detection ofChlamydia trachomatisin young, asymptomatic women.C. trachomatiswas isolated from specimens of 8.6% of the patients studied, and 11.3% had 10 or more elementary bodies (EBs) in their specimens. A lowered cut-off point of the DFA did not affect the sensitivity of the method, but the predictive value of a positive test decreased markedly when the cut-off point was lowered. Patients with symptoms of genital infection, signs of genital infection, or both had a higher DFA sensitivity than those who were asymptomatic. Patients whose specimens yielded 1-9 EBs were reexamined three times, once every fourth week. We found little evidence that those patients should be regarded as falsely negative in culture, since most of them remained negative. In order to minimize the social consequences of a false positive test, the DFA method should not be substituted for culture as a diagnostic tool, especially for screening of asymptomatic groups with a low prevalence ofC. trachomatis.

Evaluation of a Direct Fluorescence Assay as a Screening Method in Asymptomatic Young Women

The purpose of the study was to evaluate one rapid antigen test (DFA), in comparison to culture, for the detection of Chlamydia trachomatis in young, asymptomatic women. C. trachomatis was isolated from specimens of 8.6% of the patients studied, and 11.3% had 10 or more elementary bodies (EBs) in their specimens. A lowered cut-off point of the DFA did not affect the sensitivity of the method, but the predictive value of a positive test decreased markedly when the cut-off point was lowered. Patients with symptoms of genital infection, signs of genital infection, or both had a higher DFA sensitivity than those who were asymptomatic. Patients whose specimens yielded 1-9 EBs were reexamined three times, once every fourth week. We found little evidence that those patients should be regarded as falsely negative in culture, since most of them remained negative. In order to minimize the social consequences of a false positive test, the DFA method should not be substituted for culture as a diagnostic tool, especially for screening of asymptomatic groups with a low prevalence of C. trachomatis.

Bacterial vaginosis and the vaginal leucocyte/epithelial cell ratio in women attending an outpatient gynaecology clinic

In order to investigate the usefulness of vaginal leucocytosis as a sign of genital infection, vaginal wet smears were obtained from 230 consecutive non-pregnant women attending an outpatient gynaecology clinic. Although 52 (22.6%) of the women were diagnosed as having bacterial vaginosis, none had symptoms of cervicitis or genital infection. Of the patients with bacterial vaginosis 19 (36.5%) had vaginal leucocytosis compared to 37.1% of the women without bacterial vaginosis. In a further study, bacterial vaginosis was also diagnosed in 104 of 384 women (33.3%) attending for first trimester legal abortions. Of the women with bacterial vaginosis 37.5% had vaginal leucocytosis compared to 31.8% for those without bacterial vaginosis ( P > 0.05). There was no correlation between vaginal leucocytosis and the presence of cervical Chlamydia trachomatis; however, the presence of C. trachomatis did correlate with bacterial vaginosis. Vaginal leucocytes varies with factors unrelated to genital infection. This fact must be taken into consideration when wet smears from patients with suspected genital tract infection are evaluated.

Bacterial vaginosis in women attending STD clinic: diagnostic criteria and prevalence of Mobiluncus spp.

The diagnostic criteria of bacterial vaginosis (BV) and the prevalence of Mobiluncus spp as detected by monoclonal antibodies were investigated in all new women patients attending the sexually transmitted disease (STD) clinic in Uppsala during a four month period. Of 455 patients, 164 fulfilled the generally accepted criteria for BV, but in 57 of them simultaneous infection with a recognised pathogen was diagnosed. BV was thus the only clinical diagnosis in 107 (24%) of the women. The sniff test and clue cells in the wet smear were the two criteria most relevant for the diagnosis of BV. The sniff test was positive in 95% (156) of the 164 patients with BV and negative in all other cases. The corresponding figure for the clue cells was 98% (160 of 164), but clue cells were also detected in 19 patients without BV. Though 99% (162) of women with BV had a vaginal pH of more than 4.5, so did 83 women without BV. Only 59% (96) of women fulfilling the criteria of BV had a characteristic discharge. Mobiluncus spp were present in 20% (90) of the 455 women and in 50% (53) of the 107 women with BV only. Of the 90 Mobiluncus spp isolates, M curtisii comprised 44% (40), M mulieris 34% (31), and both strains together 21% (19). Mobiluncus spp were detected with monoclonal antibodies in 35 women who had no motile curved rods on wet smear microscopy. Furthermore, Mobiluncus spp were often detected in women infected with recognised pathogens, as well as in a few women without signs of genital infection.

Chlamydia trachomatis infection in patients with acute salpingitis.

We examined the prevalence of Chlamydia trachomatis in the cervix and the fallopian tubes of patients with acute salpingitis. Cycloheximide-treated McCoy cells were used as the growth medium. For purposes of comparison, women with infections confined to the lower genital tract and women without signs of genital infections were also studied. C. trachomatis was isolated from the cervix in 19 of 53 patients with acute salpingitis, in one of 18 lower-genital-tract infections and in none of 12 without signs of genital infection. C. trachomatis was recovered from six of the 20 valid specimens from the fallopian tubes of the patients with acute salpingitis. Our results indicate that chlamydia is a common etiologic agent in acute salpingitis.