Treatment Of Urogenital Infections Research Articles

Reactive oxygen species and their role in the andrological factor of couple fertility.

Reactive oxygen species play a significant role in male fertility and infertility. They are essential for physiological processes, but when their concentration becomes excessive, they can be a cause of various sperm pathologies. Seminal leukocytes and pathologically abnormal sperm are the primary sources of oxygen radicals in ejaculate. They negatively affect sperm quality, including DNA fragmentation and sperm motility impairment. Addressing increased concentrations of reactive oxygen species involves various appropriate lifestyle modifications and measures, including the use of antioxidants, treatment of urogenital infections, management of varicocele, weight reduction, and others. In many cases, these interventions can lead to adjustments in the condition and improvement in sperm quality. Such improvements can subsequently lead to enhanced outcomes in assisted reproduction or even an increased likelihood of natural conception. In some instances, the need for donor sperm may be eliminated. However, a key factor is adhering to a sufficiently prolonged treatment, which requires patience on the part of both, the physician and the patient.

Lactobacillus Composed Urinary Microbiome of Healthy People and Urinary Tract Infection Patients

Lactobacillus has long been known to reconstruct the microbiome of the urogenital organs of healthy people. However, changes in lactobacillus abundance are known occurring in urogenital tract infections (UTI) patients. It is also known that there are Lactobacillus species that have specific genomic characteristics and nutritional requirements that cause them to turn into pathogens. Understanding population characteristics and taxa composition that reconstruct urine microbiome is very important for the diagnosis and treatment of urogenital infections. This review provides an update information of metagenomic sequencing to identify the urinary microbiome profile and the role of lactobacilli in healthy and UTI patients.

Doxycycline versus azithromycin for the treatment of anorectal Chlamydia trachomatis infection in women concurrent with vaginal infection (CHLAZIDOXY study): a multicentre, open-label, randomised, controlled, superiority trial

Anorectal infections with Chlamydia trachomatis are commonly found in women. Although the efficacy of doxycycline and azithromycin is comparable in the treatment of urogenital infection, their efficacies toward anorectal infection remain unclear. We therefore aimed to compare a single dose of azithromycin with a 7-day course of doxycycline for the treatment of anorectal C trachomatis infection in women with concurrent vaginal infection. We did a multicentre, open-label, randomised, controlled, superiority trial involving four sexually transmitted infection screening centres and three pregnancy termination centres in France. We included sexually active adult women (≥18 years) with a positive C trachomatis vaginal swab who agreed to provide self-collected anorectal swabs for C trachomatis detection. Participants were randomly assigned (1:1), using block sizes of six and eight and stratification by each investigating centre, to orally receive either azithromycin (a single 1-g dose, with or without food) or doxycycline (100 mg in the morning and evening at mealtimes for 7 days [ie, 100 mg of doxycycline twice per day for 7 days]). All laboratory staff who did the bacteriological analyses, but not the participants and the investigators, were masked to the treatment groups. The primary outcome was the microbiological anorectal cure rate defined as a C trachomatis-negative nucleic acid amplification test (NAAT) result in anorectal specimens 6 weeks after treatment initiation among women who had a baseline C trachomatis-positive anorectal NAAT result. The primary analysis was done in the modified intention-to-treat population, with multiple imputation, which included all women who underwent randomisation and had a C trachomatis-positive vaginal and anorectal NAAT result at baseline. Adverse events were reported in all women who underwent randomisation. This study is registered with ClinicalTrials.gov, number NCT03532464. Between Oct 19, 2018, and April 17, 2020, we randomly assigned a total of 460 participants to either the doxycycline group (n=230) or the azithromycin group (n=230). Four (1%) of 460 participants were excluded because they refused to take doxycycline or were found to be ineligible after randomisation. Among the 456 participants, 357 (78%) had a concurrent C trachomatis-positive anorectal NAAT result at baseline; 184 (52%) of 357 were in the doxycycline group and 173 (48%) were in the azithromycin group (ie, the modified intention-to-treat population). Microbiological anorectal cure occurred in 147 (94%) of 156 participants in the doxycycline group (28 missing values) versus 120 (85%) of 142 in the azithromycin group (31 missing values; adjusted odds ratio with imputation of missing values 0·43 [95% CI 0·21-0·91]; p=0·0274). Reported adverse events possibly related to treatment were notified in 53 (12%) of 456 women: 24 (11%) of 228 in the doxycycline group and 29 (13%) of 228 in the azithromycin group. Gastrointestinal disorders were the most frequently occurring, in 43 (9%) of 456 women: 17 (8%) of 228 in the doxycycline group and 26 (11%) of 228 in the azithromycin group. The microbiological anorectal cure rate was significantly lower among women who received a single dose of azithromycin than among those who received a 1-week course of doxycycline. This finding suggests that doxycycline should be the first-line therapy for C trachomatis infection in women. French Ministry of Health. For the French translation of the abstract see Supplementary Materials section.

Cervical diseases after subtotal hysterectomy (modern aspects of diagnosis and tactics of management)

Aim. To study the state of the cervical stump after subtotal hysterectomy (STGE) without uterine appendages with and without excision of the endocervix in patients with myoma to justify the choice of a rational volume of surgical operation.
 Materials and methods. Examination and treatment of 140 women was carried out with the formation of three groups: 1st 40 patients after laparoscopic STGE with excision of the endocervix; 2nd 38 patients after laparoscopic STGE without excision of the endocervix; 3rd (comparison group) 62 patients with uterine myoma that do not require surgical treatment.
 Results. The study of the state of the cervical stump was carried out 5.10.3 years after surgery. The number of patients with cervical pathology after STGE with excision of the endocervix (in group 1) was 1.8 times less in percentage terms than after STGE without excision of the endocervix (in group 2), and 3.2 times less than in patients with uterine fibroids who do not require surgical treatment (in the 3rd comparison group).
 Conclusion. Out of 3 (3.8%) patients after surgical treatment with diagnosed HPV type 16.1 (1.3%) in the STGE group without endocervical excision was diagnosed with grade II intraepithelial neoplasia (CIN II). In patients with uterine myoma, STGE can be performed only after a comprehensive preoperative examination, including: diagnosis and treatment of urogenital infections, DNA typing of HPV of high oncogenic types, cytological and colposcopic examination of the cervix, targeted biopsy of the cervix with histological examination of the material. If a subtotal hysterectomy is performed, it must be supplemented with excision of the endocervix. In the future, these women require careful follow-up to improve early diagnosis and treatment of underlying and precancerous diseases and reduce the risk of developing cervical stump cancer.

Experience of application of a new combined drug for treatment of urogenital infections

Experience of application of a new combined drug for treatment of urogenital infections

Premature rupture of the amniotic membrane: what’s new in its management and delivery tactics?

Background. Premature rupture of the amniotic membranes (PRAM) is a spontaneous rupture before the onset of labor at 22-37 weeks. The main complications of PRAM for mother and fetus include infection, premature birth, asphyxia of the fetus during labor, and the increased frequency of cesarean sections. Deformations of extremities, face and lungs are observed in case of a long oligohydramnion (>3 weeks).
 Objective. To describe the features of the management of pregnant women with PRAM.
 Materials and methods. Analysis of literature sources on this topic.
 Results and discussion. Gynecological and extragenital pathology of mother, genetic predisposition, adverse environmental factors and infections are risk factors for PRAM. Prevention of PRAM includes detection and treatment of urogenital infections, quitting of smoking and alcohol intake, screening for bacteriuria and bacteriological culture for β-hemolytic streptococcus (BHS) at 35-37 weeks of pregnancy. From 22 to 34 weeks of pregnancy, pregnant women with PRAM are hospitalized to the tertiary level hospitals, since 35 weeks care can be provided in secondary level hospitals. The management algorithm is the following: 1) history taking; 2) establishment of gestational age; 3) establishment of the approximate time of PRAM; 4) general physical examination; 5) external obstetric examination; 6) cardiotocogram (CTG), tests of fetal movements (TFM), ultrasonography (US); 7) blood test with leukocyte formula, determination of C-reactive protein; 8) bacterioscopic examination of vaginal discharge; 9) collection of amniotic fluid for microbiological examination, study of rectogenital smear for BHS; 10) sanitation of the vagina with a solution of antiseptic decamethoxine after collection of vaginal secretions and amniotic fluid. PRAM management involves active or waiting tactics. Waiting tactic includes monitoring of the fetus and mother (thermometry and pulsometry, the number of leukocytes and C-reactive protein, bacterioscopy of vaginal discharge, CTG, TFM, US). Antibiotic prophylaxis (semi-synthetic penicillins + macrolides, reserve – second-generation cephalosporins) in PRAM significantly prolongs the latent phase of delivery, reduces the incidence of infections in both mother and newborn, reduces the need for surfactant and oxygen therapy. In the presence of chorioamnionitis, delivery should be performed within <12 hours. In case of PRAM in the term of 24-34 weeks the course of corticosteroids is administered. Delivery delay for 48 h for steroid prophylaxis is the main indication for tocolysis in PRAM. In general, the tactics of pregnancy management in PRAM at 24-34 weeks include monitoring of the mother and fetus, steroid prophylaxis, tocolytic therapy and the use of magnesium sulfate. Waiting tactic should be followed until 34 weeks. In women with PRAM without contraindications to prolonging pregnancy, the waiting tactic is accompanied by better results for both mother and fetus. Signs of infection or other complications of pregnancy indicate the need for termination of the waiting tactic and delivery management according to the clinical situation. Within 34-37 weeks, the waiting tactic is followed for 24 hours. Antibiotic prophylaxis is prescribed after 18 hours of anhydrous interval, and in case of BHS – immediately after PRAM. In the absence of active labor process, an internal obstetric examination is performed to decide the tactics of delivery. Other procedures include cervix preparation, induction of labor and washing of the vagina with decamethoxine solution. Cesarean section is indicated for PRAM at 26-32 weeks and immaturity of the birth canal.
 Conclusions. 1. Hospitalization and delivery in women with PRAM is carried out in hospitals of secondary and tertiary level. 2. Routine use of antibiotics in PRAM prolongs the latent phase of delivery and reduces the incidence of neonatal sepsis. 3. Waiting tactic in pregnant women with PRAM in the period of 24-34 weeks is accompanied by good outcomes for both mother and child. 4. Pregnant women with PRAM in 24-34 weeks should be treated with corticosteroids to prevent acute respiratory distress syndrome in neonates.

Chlamydial infections in women

Chlamydia trachomatis (Ct) is a Gram-negative bacterium with an obligatory intracellular life cycle. Tropism manifests through columnar epithelia in the uterine cervix, rectum, lungs, and eyes. The literature review of the Medline database identified 3,458 papers. The WHO estimates that over 100 million new cases of infection by Ct occur worldwide annually, with an increase of 4.1% since the last global evaluation conducted in 2006. Chlamydia trachomatis is the most frequent sexually transmissible bacterium in the United States with a yearly incidence of more than one million reported cases. Approximately 50 to 75% of infected women show no symptoms of the infection or appear to be mucopurulent cervicitis. Pain caused by cervical motion or evaluation of the accessories in response to a bimanual exam suggests the infection has moved on to the upper genital tract leading to endometritis, salpingitis and peritonitis and its consequences: pelvic pain, infertility, ectopic pregnancy. Chlamydia trachomatis may also be the etiologic agent of bacterial urethritis, in which case, despite the patient’s report of dysuria, the urine culture is negative for the usual urinary pathogens. Since bacteria favor columnar epithelia, the Skene and the Bartholin vestibular glands may also be a site of infection and attendant symptoms. The nucleic acid amplification test is the most recommended for its higher sensitivity and specificity and is currently the gold standard for diagnosis. The antibiotics for the treatment should be chosen for their intracellular penetration ability and should have a half-life of 36 to 48 hours to cover the bacterium’s life cycle. Azithromycin is excellent at intracellular penetration, has a half-life of 5 to 7 days, and can be administered in a single dose; it may also be given to pregnant women. A recent meta-analysis showed a small increase (3%) of better outcome in the use of doxycycline against azithromycin in the treatment of urogenital infection.

Possibilities of using essential oils in obstetric and gynecological practice

The review discusses the prospects for the use of essential oils in medicine. It was found that drugs based on herbal remedies containing essential oils combine safety, a wide range of pharmacological activity, including anxiolytic, antiviral, immunomodulating, antioxidant, anti-inflammatory and antimicrobial properties. The above studies indicate their high demand in medicine, in particular in the treatment of urogenital infections in pregnant women, and the properties of essential oils and the physiological aspects of their effects on the body have not been fully studied; the range of their use in obstetric and gynecological practice can be significantly expanded.

Intravaginal administration of gelatine capsules containing freeze-dried autochthonous lactobacilli: a double-blind, randomised clinical trial of safety.

Vaginal lactobacilli (LAB) in probiotic formulas constitute a promising alternative for microbiome reconstitution and for the prevention and treatment of urogenital infections. A double-blind, randomised clinical trial was conducted to assess the safety of LAB-gelatine capsules vaginally administered to healthy sexually active women. Participants were randomised into three groups: intervention A: Lactobacillus reuteri CRL1324, Lactobacillus gasseri CRL1263 and CRL1307; intervention B: Lactobacillus rhamnosus CRL1332, L. gasseri CRL1256 and CRL1320; and intervention C: placebo. In a survey and clinical evaluation, participants received a blister with 7 capsules to be administered 1 per day. A second sampling and a new survey were conducted 3-10 days after completing application. Colposcopy was performed to assess adverse effects on vaginal-cervical mucosa. Vaginal swabs were taken for Gram staining to determine the Nugent score, and obtainment of viable-cell cultures to quantify cultivable lactic acid bacteria and pathogens. The main outcomes evaluated were overall satisfaction and secondary effects, including discomfort, urogenital infection, inflammatory response or other symptoms. No significant differences were found in Nugent score or in leukocyte numbers in vaginal samples either before or after the three interventions. However, a tendency to decrease in both the Nugent score and in leukocyte numbers was observed after interventions A and B, though not after C. A significant increase in cultivable lactobacilli was determined after LAB interventions. No severe adverse events were detected. LAB-containing capsules were well tolerated by subjects, so they could be proposed as an adequate alternative to restore vaginal lactobacilli in sexually active women.

Молекулярно-генетические механизмы лечения урогенитальной инфекции беременных

Молекулярно-генетические механизмы лечения урогенитальной инфекции беременных

Alternative to antibiotic-associated complications from the digestive tract after treatment of urological diseases (Review)

The use of a modern enterosorbent with a prebiotic component (a combination of lignin, lactulose and microcrystalline cellulose) in urological practice helps prevent the development of complications of antibiotic therapy in the treatment of urogenital infections.

Макролиды в лечении урогенитальной инфекции: доказанная эффективность или маркетинговая политика фармацевтических компаний?

Макролиды в лечении урогенитальной инфекции: доказанная эффективность или маркетинговая политика фармацевтических компаний?

Патогенетические, иммунологические и клинические цели лечения урогенитальных инфекций во время беременности

Патогенетические, иммунологические и клинические цели лечения урогенитальных инфекций во время беременности

Antibacterial activities and toxicological study of the aqueous extract from leaves of Alchornea cordifolia (Euphorbiaceae)

BackgroundA. cordifolia is a plant widely used in Africa to solve many health problems. In Cameroon, it is used in the treatment of urogenital infections. As a continuation of our search for pharmacologically active agents from natural sources, the antimicrobial activity of A. cordifolia leaf extracts against E. coli and the toxicity of this extract were investigated.MethodsThe antibacterial activity of the aqueous extract from leaves of Alchornea cordifolia was carried out in vitro on Escherichia coli, as well as in vivo on E. coli-infected rat model. Phytochemical screening was performed using standard methods. The acute toxicity was investigated in mice, while at the end of treatment of infected rats, some biochemical, hematological and histological markers of toxicity were evaluated.ResultsThe extract exhibited a bacteriostatic activity with MIC value of 1500 μg/ml. Phytochemical screening revealed the presence of phenols, tannins, triterpens, flavonoids, alkaloids, anthraquinones, anthocyanins, saponins and coumarins in the extract. The acute toxicity study showed LD50 values of 8.6 g/kg and 3.8 g/kg in male and female mice respectively. In vivo, the oral administration of the extract showed a dose-dependent decrease of the bacterial load as the extract at 232, 112 and 58 g/kg were able to eradicate the infection after 9, 11 and 13 days of treatment. The infected rats showed a significant (p < 0.05) increase in the level of serum creatinine, ALAT, white blood cells, and a significant (p < 0.05) decrease in the level of food and water intake, the relative weight of lungs, heart and spleen. In the treated rats, a significant (p < 0.05) increase in food and water intake and ALAT was observed at the doses of 116 and 232 mg/kg. A decrease in the red blood cells count and serum protein levels was also observed. These observations corroborate liver damages as revealed by the histopathological examination of the cross sections of this organ.ConclusionThe results of this assay thus showed that the extract of A. cordifolia is bacteriostatic, therapeutic at 58 g/kg bw and may be considered as slightly and almost non-toxic on females and males mice respectively.

Probiotics for Treatment and Prevention of Urogenital Infections in Women: A Systematic Review.

Probiotics are a complementary and integrative therapy useful in the treatment and prevention of urogenital infections in women. This study extends the work of researchers who systematically investigated the scientific literature on probiotics to prevent or treat urogenital infections. A systematic review was conducted to determine the efficacy of probiotics for prevention and/or treatment of urogenital infections in adult women from January 1, 2008, through June 30, 2015. We searched in CINAHL, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Dissertations and Theses, and Alt-HealthWatch. After removing duplicates and studies that did not meet inclusion criteria, 20 studies were reviewed. All included at least one species of Lactobacillus probiotic as an intervention for treatment or prevention of urogenital infections. Data extracted included samples, settings, study designs, intervention types, reported outcomes, follow-up periods, and results. We evaluated all randomized controlled trials for risk of bias and made quality appraisals on all studies. Fourteen of the studies focused on bacterial vaginosis (BV), 3 on urinary tract infections (UTIs), 2 on vulvovaginal candidiasis, and one on human papillomavirus (HPV) as identified on Papanicolaou test. Studies were heterogeneous in terms of design, intervention, and outcomes. Four studies were of good quality, 9 of fair, and 7 poor. Probiotic interventions were effective for treatment and prevention of BV, prevention of recurrences of candidiasis and UTIs, and clearing HPV lesions. No study reported significant adverse events related to the probiotic intervention. The quality of the studies in this systematic review varied. Although clinical practice recommendations were limited by the strength of evidence, probiotic interventions were effective in treatment and prevention of urogenital infections as alternatives or co-treatments. More good quality research is needed to strengthen the body of evidence needed for application by clinicians.

Azithromycin or Doxycycline for

For several years, the recommended treatment for urogenital infections from Chlamydia trachomatis has been either doxycycline or azithromycin, although

Do We Need PK/PD in the Treatment of Urogenital Infections?

Do We Need PK/PD in the Treatment of Urogenital Infections?

Comparison of antimicrobial activity of traditionally used herbal uroantiseptics against clinical isolates of uro-genital pathogens

In present study, we compared the antimicrobial activity of ethanolic extracts of four traditionally used drugs in the treatment of urogenital infections (Ericaceae flos, Myrtilli folium, Uvae ursi folium, Vitis ideae folium) [1] with arbutin, hydrochinone, and the commonly used uroantiseptic norfloxacin. The activity against clinical isolates of the most common urinary pathogens was evaluated against gram-negative (Escherichia coli p-fimbriae positive-strains, Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas aeruginosa) and gram-positive bacterial species (Enterococcus faecalis, Staphylococcus aureus), as well as against the yeast Candida albicans, using hole plate diffusion and broth dilution methods. In general, the activity of the extracts was species-dependent. In hole plate diffusion method, the extracts of Uvae ursi folium and Myrtilli folium showed stronger bactericidal activity than the rest of the extracts with average inhibition zones of 28.47 and 25.47mm, respectively. In the same method none of the extracts showed noticeable antifungal activity against Candida albicans. Using broth dilution method minimal inhibitory concentrations (MICs) were determined. All the investigated bacterial species were sensitive to the extracts with MICs below or equal to 10.42mg/mL while the MIC values for the isolates of C. albicans yeast were between 8.33 and 25mg/mL. The highest activity was demonstrated by Uvae ursi folium extract against E. faecalis (MIC 2.60mg/mL) and P. aeruginosa strains (3.13mg/mL). The antimicrobial activity of the extracts was lower than the activity of hydrochinone and norfloxacin, but higher than arbutin. Statistical analysis did not reveal clear correlation between content of arbutin, methylarbutin, polyphenols or tannin in extracts and in vitro MIC values. However, the extracts with higher amount of investigated substances tended to be more active in both methods. The results of the study confirm the justifiability of use of these drugs in treatment of urinary infections caused by investigated bacterial species.

Prevention and treatment of urogenital infections and complications: lactobacilli's multi-pronged effects

The association between depletion of vaginal lactobacilli and increased risk of various urogenital infections and complications such as preterm labor, has been known for some time. Restoration of depleted lactobacilli by administration of probiotic strains has been demonstrated in humans using Lactobacillus rhamnosus GR-1 and L. reuter i RC-14. These organisms also augment antibiotic efficacy, lessen the side effects of these drugs, and alleviate diarrhea in AIDS patients. The mechanisms appear to be multi-factorial, and include production of: (i) anti-microbial factors such as lactic acid, bacteriocins, hydrogen peroxide, (ii) biosurfactants or other components that affect pathogen colonization and biofilm formation, (iii) signalling compounds that influence pathogen virulence expression, and (iv) signalling compounds that modulate immunity. Recombinant strains have been produced that inhibit or kill HIV, offering hope for microbicide applications that can be self-used by women. As more information becomes available about the ‘normal’ versus ‘disease prone’ vaginal microbiota and strains that confer the most benefits, current and new probiotic remedies will potentially provide improved restorative and therapeutic options to lower the one billion urogenital infections currently afflicting women around the world. Key words: probiotics, lactobacillus, urogenital infections, mechanisms

Prevention and treatment of urogenital infections and complications: lactobacilli's multi-pronged effects

The association between depletion of vaginal lactobacilli and increased risk of various urogenital infections and complications such as preterm labor, has been known for some time. Restoration of depleted lactobacilli by administration of probiotic strains has been demonstrated in humans using Lactobacillus rhamnosus GR-1 and L. reuteri RC-14. These organisms also augment antibiotic efficacy, lessen the side effects of these drugs, and alleviate diarrhea in AIDS patients. The mechanisms appear to be multi-factorial, and include production of: (i) anti-microbial factors such as lactic acid, bacteriocins, hydrogen peroxide, (ii) biosurfactants or other components that affect pathogen colonization and biofilm formation, (iii) signalling compounds that influence pathogen virulence expression, and (iv) signalling compounds that modulate immunity. Recombinant strains have been produced that inhibit or kill HIV, offering hope for microbicide applications that can be self-used by women. As more information becomes available about the ‘normal’ versus ‘disease prone’ vaginal microbiota and strains that confer the most benefits, current and new probiotic remedies will potentially provide improved restorative and therapeutic options to lower the one billion urogenital infections currently afflicting women around the world.