Vaginal Washes Research Articles

The microbiota of the vulva and vagina: Ways of washing to optimise the protective function of the vulvo-vaginal microbiota during pregnancy

Background: The microbiota of the vulva and vagina has a crucial protective function, which is important for all women and has particular significance in pregnancy. Yet this microbiota is part of a delicately balanced ecosystem, susceptible to extrinsic factors which include the simple matter of how women wash themselves. Clinical observation and anecdotal evidence indicate that women in Aotearoa New Zealand have washing practices that may compromise the naturally acidic vulvo-vaginal environment crucial to optimising the protective function of the microbiota. Aims: The aims of this review are: to determine if there is dissonance between how women are washing their vulva and vagina and recommended washing practices; and to raise awareness of the emerging significance of the vulvo-vaginal microbiota to women’s health, particularly in pregnancy. Method: A literature review was undertaken to discover what is reported (in the published literature) about the ways women wash themselves, products used, and their effect on the vulvo-vaginal microbiota. The evidence behind the “wash with water” recommendation was investigated. Findings: There is a lack of primary research on ways of vaginal washing used by women in Aotearoa New Zealand. Globally, women are routinely using a variety of products that include soap, anti-bacterial wipes, gels and baby wipes, and invasive vaginal washing practices such as douching, flannel scrubs and internal soap cleansing. All washing products, including gentle soap but excluding lactic-acid based gels, alter pH levels when used on either the vulva or the vagina. Washing practices that alter vaginal pH levels can cause a microbial shift into a sub-optimal state that compromises the protective function of the vulvo-vaginal microbiota and is more susceptible to bacterial vaginosis and group B streptococcus vaginal colonisation. The frequency and duration within suboptimal states may be predictors of risk. Conclusion: There is dissonance between the ways women wash their vulva and vagina, and evidence-based advice to just wash with water. The back-to-basics message “just wash with water” promotes a way of washing that optimises the protective function of the vulvo-vaginal microbiota, while also protecting the integrity of vulval skin, and supporting physiological self-cleaning of the vagina.

Sexual Health Knowledge and Attitude among the Sexually Abused Adolescents: A Single Centre Study

Introduction: Sexual education is an important step to prevent unwanted pregnancy, abortions and sexual transmitted diseases (STDs) in adolescent. Assessment of the sexual health knowledge and the attitude towards premarital sexual activity are essential to fill in this gap of knowledge. Objective: The objective of this study was to examine the knowledge on the sexual health and attitude towards premarital sexual activity among the sexually abused adolescent. Methods: A cross-sectional study was conducted among 88 female teenagers who were admitted to Hospital Universiti Sains Malaysia for sexual abuse. Using a self-administered validated Malay questionnaire, participants were guided to answer the question on knowledge and attitude. The attitude was categorized to a permissive and non-permissive attitude. Simple and multiple binary logistic regression were used to analyze the associated factors with the attitude. Result: The lowest percentage of correct responses included: penile discharge during ejaculation contains sperm (5.7%), pregnancy may not occur if having sexual intercourse once only (26.1%), having vaginal washing after sexual intercourse prevents pregnancies (19.3%). Forty-one (48.0%) of participants had a permissive attitude whereas forty-seven (53.4%) had a non-permissive attitude toward premarital sexual activity. Simple and multiple logistic regressions did not reveal any significant associated factors. Conclusion: The sexual health knowledge among sexually abused children was inadequate and they were at risk of permissive attitude toward premarital sexual activity. We could not identify any factors related to the permissive attitude in our study.

Isolation, Characterization, and Molecular Identification of Mycoplasma hominis in Females With Bacterial Vaginosis and its Association With Epidemiological Factors: A Cross-sectional Study From Isfahan Province, Iran

Background: Mycoplasma strains are frequently found in the human urogenital tract and are mainly associated with bacterial vaginosis (BV) which has several adverse outcomes including infertility, preterm delivery, and abortion. The prevalence of BV caused by Mycoplasma species could be associated with different epidemiological factors such as ethnicity, socioeconomic status, sexual activity, and age. Objective: This study aimed to investigate the prevalence of BV caused by Mycoplasma hominis and to examine its association with several epidemiological factors. Materials and Methods: A total number of 110 married, non-pregnant women in the 18-45 age range and with BV referring to the healthcare centers of Falavarjan, Isfahan province, Iran were included in this study. BV was diagnosed based on the Amsel criteria, and the polymerase chain reaction (PCR) was used for detecting M. hominis. Then, the association of several epidemiologic factors with the presence of M. hominis was examined. Results: According to the study results, 15.4% of patients (group 1, n=17) were positive for M. hominis infection, while the remaining ones (group 2, n=93) were negative for this pathogen. Statistical analyses showed no significant difference between the two groups in terms of age range, job, education level of the subjects and their husbands, history of birth delivery and abortion, number of sexual intercourses per week, daily vaginal wash, body mass index (BMI), socioeconomic status, contraception method, and positive whiff test. However, a higher prevalence of M. hominis infection was observed among the women with previous deliveries ≥2, which was significantly different from the prevalence of non-M. hominis infection. Moreover, a significant association of M. hominis infection with the pH of vaginal discharge and presence of clue cells was detected. Conclusion: An association was found between M. hominis infection and previous deliveries among the studied women, while other epidemiological factors were discovered not to be important determinants in this regard.

A truncated glycoprotein G vaccine formulated with Advax-CpG adjuvant provides protection of mice against genital herpes simplex virus 2 infection

Herpes simplex virus type 2 (HSV-2) is a common sexually transmitted disease that affects approximately 500 million individuals globally. There is currently no approved vaccine to prevent HSV-2 infection. EXCT4 is a truncated form of the mature glycoprotein G-2 (mgG-2) that unlike full mature form is secreted by expressing cells enabling it to be rapidly scaled up for production. The current study examined whether EXCT4 immunity in mice could be further enhanced through use of adjuvants. EXCT4 formulated with Advax-CpG adjuvant induced a strong Th1-type immune response characterized by interferon gamma (IFN-γ) and protected animals against a lethal genital challenge with HSV-2. This response was associated with reduced viral load in vaginal washes, spinal cord, and dorsal root ganglia. Together the results provide proof of concept that EXCT4 formulated with Advax-CpG adjuvant is a promising HSV-2 vaccine candidate warranting further investigation.

Management of Kaphaja Yoni Vyapat by Panchavalkala Arka w.s.r to Vuvlovaginal Candidiasis- A Case Report

Vulvovaginal candidiasis is caused due to different candida species, most commonly C.albicans. It occurs in 1-14% of all women of reproductive age throughout the world and its prevalence in India is estimated to be 30% It may be physiological condition but when turns into pathological, produces associated symptoms such as pruritus, backache, white discharge with foul smell and alters the PH of the vaginal flora. This can be correlated to the Lakshanas of Kaphaja yoni vyapat, where there will be Kaphavrudhi all over the body. Management of this condition is by using Ruksha, Katu, Ushna dravyas. Sthanika Chikitsa such as Yoni Prakshalana (douching), Yoni Pichu (tamponing per vagina), Yoni Varti (local use of pessaries) and Yoni Dhoopana (fumigation) have been mentioned and these modalities are found effective in treating Kaphaja Yoni Vyapat. During the current era, many vaginal washes is available easily over the counter and women prefers using such preparation, when they come across vaginal itching and discomfort and abnormal vaginal discharge. Here is an effort to prepare a colorless, odorless solution, adopting the principals of Ayurveda which can be convenient for washing easily at home for women. Methodology: Here is a case report of a patient with complaints of Kaphaja Yoni Vyapat diagnosed vaginal candidiasis by swab smear test selected from outpatient department of SDM Ayurveda hospital Hassan. Panchavalkala Arka will be given to the pts and advised to wash it twice a day for 7 days. Results: Local therapies such as Sthanika Chikitsa have lot of potential in treating Yoni Vyapad and in Panchavalkala Arka the drugs with its Guna Karma helps in breaking the Samprapti of Kaphaja Yoni Vyapat. Discussion: PVQ Arka is a liquid preparation obtained using Arkayantra which contains the 5 Ksheeravrukshadravyas and indicated for Shotha. The Dravyas by its Guna Karma Vranashodana, Ropana, Yonidoshahara, Kandugna properties which helps to treatment of Kaphaja Yoni Vyapat. Hence here is an attempt to use Panchavalkala in Arka form and help the women kind as an easily available Ayurvedic vaginal wash in treating Vuvlo Vaginal Candidiasis.

Role of Vaginal Fluid Aspartate Aminotransferase and Alanine Aminotransferase in the Diagnosis of Pre-Labor Rupture of Membranes

Background: Pre-labor rupture of membrane is a common obstetric complication. Rapid and good diagnosis is needed to prevent bad obstetric complication and unneeded hospitalization. Aim of work: The aim of this study was to evaluate the reliability of aspartate aminotransferase [AST] and alanine aminotransferase [ALT] enzymes measurement in vaginal washing fluid for the diagnosis of pre-labour rupture of membranes. Patient and method: This case-control study was carried out in two departments of Obstetrics and Gynecology [Al-Azhar University Hospital, New Damietta and Senbellawein General Hospital], between March 2019 and December 2020. It included 90 pregnant women at gestational age 30-40 weeks. They were divided into two equal groups. Group І [case group, PROM group]: included women with diagnosis of rupture of membranes confirmed by visualization of amniotic fluid passing from the cervical canal, and Group ІІ [control group] included women without any complaint or complication. All were clinically evaluated and the vaginal fluid was aspirated for laboratory analysis. Results: Results revealed significant differences between the studied groups. The mean AST level in the PROM group was 18.84±5.74 and 3.33±1.29 in the control group [p 8 IU/L. The mean ALT levels were 5.09±2.1 in the PROM and 1.13±0.94 in the control group, with significant difference between groups [p 2.5 IU/L is optimal. Conclusion: Vaginal fluid Aspartate aminotransferase [AST] and Alanine aminotransferase [ALT] have high sensitivity and high negative predictive value. So, they are considered a good screening tests for detection of PROM. Also measuring vaginal fluid AST and ALT levels are cheaper, faster, available and reliable method for detection of pre-labor rupture of membranes.

Correlates of Adherence to the Dapivirine Vaginal Ring for HIV-1 Prevention.

Understanding characteristics associated with adherence to pre-exposure prophylaxis (PrEP) methods for HIV-1 prevention may assist with optimizing implementation efforts. The dapivirine vaginal ring is a novel topical PrEP delivery method. Using data from a randomized, double-blind, placebo-controlled, phase III trial of the dapivirine vaginal ring conducted in four African countries, generalized estimating equation models were used to evaluate correlates of ring adherence. Two levels of quarterly dapivirine blood plasma, and dapivirine released from returned rings defined measures of adherence for recent and cumulative use, respectively. Time on study, calendar time, primary partner knowledge that the participant was taking part in the study, and use of long-acting contraceptive methods were associated with ring adherence whereas younger age, ring worries, condom use, episodes of menstrual bleeding and vaginal washing were associated with non-adherence. These findings may be useful for recruitment into future clinical studies and dapivirine ring implementation efforts.

Squalene nanoemulsion reinforces mucosal and immunological fingerprints following intravaginal delivery

This study describes the assessment of mucosal adjuvant activity of a squalene-based nanoemulsion (SQ@NE) following intravaginal delivery in mice. After immunization, a high level of recruitment of CD11b/c+ granulocytes and F4/80+ macrophages was observed in the vaginal mucosal tissues of the mice immunized with a model protein ovalbumin (OVA) formulated with SQ@NE, and then downstream regulated the expression of MHC II and costimulatory molecules CD40 and CD86 on CD11c+ cells harvested from the associated draining lymph node. With respect to cytotoxic T lymphocyte immunity, the mice immunized with SQ@NE-formulated OVA elicited a high population of OVA-specific CD8+ cells in the spleen and increased the secretion of IFN-γ, IL-2 and IL-17 from OVA-restimulated splenocytes compared with those immunized with OVA alone. By studying in vivo fluorescence imaging and B-cell immunoassays, we discovered how SQ@NE prolongs the retention of antigen depots at the mucosal membrane of the immune inductive site and allows them to properly drive the production of antibodies. The data demonstrated that SQ@NE prolonged fluorescence-labeled OVA retention at the genital tract and augmented the production of OVA-specific IgG in sera and IgA in vaginal washes. These results indicate that SQ@NE is a promising vaginal adjuvant for the induction of both mucosal and systemic immune responses, a feature that provides implications for the development of a mucosal vaccine against genital infections and sexually transmitted diseases.

EVALUATION OF HUMAN CHORIONIC GONADOTROPIN IN VAGINAL WASHINGS FOR THE EARLY DIAGNOSIS OF PREMATURE RUPTURE OF FOETAL MEMBRANES: A CLINICAL STUDY

Aim: This study is aimed to evaluate and validate the qualitative human chorionic gonadotropin β subunit (β-hCG) test of the vaginal uid washings of pregnant women with premature rupture of fetal membranes (PROM). Materials & Methodology: A total of 60 pregnant women between 26- and 36-weeks' gestation had participated in this study. The patients with leaking from the vagina were designated Group A, the patients with no leaking from the vagina were Group B. After administering 5 cc of normal saline to posterior fornix by sterile injector, a total of 5 cc washing uid was collected. human chorionic gonadotropin were examined on the same day on collected uid and both groups were compared statistically. Result: In the current study 53.4% patients in group 1 and 60.0% patients from control group were between 19-25 years of age group. Majority of patients were unbooked in both groups. 46.6% patients in PROM group and 56.6% patients in control group presents before 34 weeks of gestation. There is no statistical signicance between two groups in terms of demographic data. Beta -HCG values in vaginal uid of Group 1 was signicantly higher than values in Group 2 with cut off value of Beta -HCG as 50mIU/dL. 83.4% patients from Group 1 (PROM Group) shows Beta -HCG value more than 50Miu/dL.

Evaluation of Vaginal Fluid Urea and Creatinine as Biomarkers of Preterm Premature Rupture of Membranes

Background: PROMs occurs in 10% of all term pregnancies and about 2- 4% of preterm pregnancies and is associated with complications such as infection and preterm birth. Vaginal fluid urea and creatinine levels may be helpful in the diagnosis of PROM. Objectives: To evaluate the reliability of vaginal washing fluid urea and creatinine as biomarkers for diagnosis of preterm PROM. Subjects and Methods:A prospective case control study was conducted at the Obstetrics and Gynecology Department; Benha University Hospital during the period from September 2018 to September 2019. The study included 100 cases: 50 inpatient cases with preterm PROM and 50 cases from those attending outpatient clinics for routine antenatal care. All patients underwent speculum examination, nitrazine paper test, and U/S. Results: The creatinine levels were 0.35 ±0.12 mg/dl and 0.16± 0.08 mg/dl in confirmed cases and controls, respectively. The urea levels were 6.5 ±2.48 mg/dl and 3.4 ±1.68 mg/dl in confirmed cases and controls, respectively. There was a highly significant difference regarding creatinine level and urea level (P < 0.001). Sensitivity, specificity, PPV and NPV for creatinine level were 100%, 84%, 86,2% and 100%, respectively. Sensitivity, specificity, PPV and NPV, for urea level was 100%, 80%, 83.3% and 100%, respectively, with a cut‑off value of 0.2 mg/dl for creatinine level and 3 mg/dl for urea level. Conclusions: Detection of vaginal fluid urea and creatinine to diagnose PROM is a simple, reliable and rapid test with high sensitivity, specificity, PPV, NPV.

Analysis of the association between vaginal washing and changes in vaginal microbiota using broad range polymerase chain reaction with 16S rRNA gene amplicon sequencing

To evaluate the association between vaginal washing and relative abundances of vaginal bacterial taxa, measured by broad range 16S ribosomal RNA (rRNA) gene polymerase chain reaction (PCR) with deep sequencing of amplicons (Illumina sequencing).

Chlamydia-Specific IgA Secretion in the Female Reproductive Tract Induced via Per-Oral Immunization Confers Protection against Primary Chlamydia Challenge.

Chlamydia trachomatis is an obligate intracellular pathogen that causes sexually transmitted disease. In women, chlamydial infections may cause pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. The role of antibodies in protection against a primary Chlamydia infection is unclear and was a focus of this work. Using the C. muridarum mouse infection model, we show that intestinal mucosa is infected via intranasal (i.n.) or per-oral (p.o.) Chlamydia inoculation and that unlike the female reproductive tract (FRT) mucosa, it halts systemic Chlamydia dissemination. Moreover, p.o. immunization or infection with Chlamydia confers protection against per-vaginal (p.v.) challenge, resulting in significantly decreased bacterial burden in the FRT, accelerated Chlamydia clearance, and reduced hydrosalpinx pathology. In contrast, subcutaneous (s.c.) immunization conferred no protection against the p.v. challenge. Both p.o. and s.c. immunizations induced Chlamydia-specific serum IgA. However, IgA was found only in the vaginal washes and fecal extracts of p.o.-immunized animals. Following a p.v. challenge, unimmunized control and s.c.-s.c.-immunized animals developed Chlamydia-specific intestinal IgA yet failed to develop IgA in the FRT, indicating that IgA response in the FRT relies on the FRT to gastrointestinal tract (GIT) antigen transport. Vaginal secretions of p.o.-immunized animals neutralize Chlamydia in vivo, resulting in significantly lower Chlamydia burden in the FRT and Chlamydia transport to the GIT. We also show that infection of the GIT is not necessary for induction of protective immunity in the FRT, a finding that is important for the development of p.o. subunit vaccines to target Chlamydia and possibly other sexually transmitted pathogens.

Intravaginal poly-(D, L-lactic-co-glycolic acid)-(polyethylene glycol) drug-delivery nanoparticles induce pro-inflammatory responses with Candida albicans infection in a mouse model.

In a recent study, using an in vitro model to study intravaginal nanoparticle exposure during yeast infections, we demonstrated that C. albicans exposure suppressed apoptotic gene expression and induced oxidative stress and pyroptosis in vaginal epithelial cells. The mucous-penetrating drug delivery nanoparticles made from poly-(D, L-lactic-co-glycolic acid)-(polyethylene glycol) induced cytotoxicity by activating apoptosis, endoplasmic reticulum (ER) stress, oxidative stress, and DNA damage repair responses alone and, in some cases with C. albicans. In the current study we evaluated the effects of fluorescently-labelled nanoparticles in CBA/J mice challenged intravaginally for two hours followed by intravaginal challenge with C. albicans for 18 hours. Nanoparticle treatment increased systemic translocation of C. albicans threefold in the heart. C. albicans also increased systemic distribution of the nanoparticles fivefold in the heart. Flow cytometric assays showed co-localization of the nanoparticles with epithelial cells, macrophages and dendritic cells. Nanoparticle-treated, C. albicans-infected mice exhibited induction of autophagy, ER stress, apoptosis, and inflammatory serum cytokines. C. albicans infection was associated with pyroptosis and suppressed expression of ER stress and apoptosis-related genes. Induction of apoptosis during nanoparticle treatment and in nanoparticle-treated-C. albicans infected mice was observed as DNA damage responses, mitochondrial depolarization and (Poly [ADP-Ribose] Polymerase) cleavage. C. albicans infection was associated with increased mRNA expression of anti-apoptotic genes. Both C. albicans infection and nanoparticle treatment showed enhanced chemoattraction of dendritic cells and polymorphonuclear cells to factors in vaginal washings in a chemotaxis assay. This study shows that both intravaginal treatment of mice with the nanoparticles and infection with C. albicans induce cytotoxic and inflammatory responses. C. albicans also suppressed cell apoptosis. These results clarify our understanding of how nanoparticles modulate host cellular responses during C. albicans infection and will be applicable for future research and development of intravaginal nanomedicines.

Brief Report: Incidence and Correlates of Pregnancy in HIV-Positive Kenyan Sex Workers.

The incidence of pregnancy in female sex workers (FSWs) living with HIV is not well characterized. Current and former FSWs living with HIV and enrolled in a prospective cohort study in Mombasa, Kenya, were followed monthly to ascertain sexual behavior and underwent quarterly pregnancy testing. Pregnancies were considered planned, mistimed, or unwanted according to fertility desires and pregnancy intentions. Cox proportional hazards models were used to estimate hazard ratios (HRs) of the association between characteristics and incident pregnancy. Two hundred seventy-nine FSWs were eligible (October 2012-April 2017). Most women had a nonpaying, regular partner (83.2%, 232/279), were not using modern nonbarrier contraception (69.5%, 194/279), and did not desire additional children (70.6%, 197/279). Of 34 first incident pregnancies [5.8/100 person-years (p-y); 95% confidence interval (CI): 4.1 to 8.0], 91.2% (n = 31) were unintended. The incidences of planned (5.7/100 p-y, n = 3), mistimed (10.4/100 p-y, n = 9), and unwanted pregnancies (4.9/100 p-y, n = 22) were similar (P = 0.15). In univariable analysis, oral contraceptive pill use (versus no contraception), having a nonpaying, regular partner, transactional sex, vaginal washing, condomless sex, and higher sex frequency were associated with an increased pregnancy risk. Older age was associated with a lower pregnancy risk. In multivariable analysis, having a nonpaying, regular partner (adjusted HR 4.0, 95% CI: 1.2 to 14.1) and age ≥40 years (aHR 0.2, 95% CI: 0.0 to 0.9) remained significantly associated with a higher and lower pregnancy risk, respectively. In this cohort of HIV-positive FSWs, most pregnancies were unintended. Identifying FSWs' fertility desires and pregnancy intentions could facilitate efforts to increase contraceptive use and implement safer conception strategies.

Contraceptive and molecular function of a novel recombinant vaccine based human leukemia inhibitory factor on Balb/c mice: An experimental in vivo study

The functional competence of leukemia inhibitory factor (LIF), as immunocontraceptive vaccine in mice, was investigated. Balb/c mice were divided into two groups of vaccinated and controls. The recombinant human LIF (rhLIF) protein and phosphate buffer saline was emulsified with Freund's adjuvant and injected into vaccinated and control groups, respectively. Theinhibition of implantation was evaluated in mice uterine. The concentration of secreted interferon-γ (IFN-γ) and interleukin (IL)-4 were measured in cultured splenocyte of mice stimulated by rhLIF. The expressions of immune responsive gene 1 (IRG-1), cochlin (COCH), amphiregulin(Ar), and heparin-binding EGF-like growth factor (HB-EGF) genes were determined. Mice were assessed for inhibition of fertility after delivery, reversibility of immune response against rhLIF, and survival rate. Active immunization of mice with rhLIF resulted in reduction of the implantation and fertility rate up to 80.49% and 75%, respectively. All mice produced a high titer of anti-rhLIF antibodies in serums and vaginal fluids washes after 16 weeks; however, these antibodies were cleared from vaginal fluid washes after six months. A significant down-regulation in mRNA levels of IRG-1, Ar and HB-EGF was observed in vaccinated group compared to controls; however, no significant change in the expression profile of cochlin gene was detected. The results showed that rhLIF prevented pregnancy in a high percentage of female mice. Although the immunization of female Balb/c mice with rhLIF inhibited fertility and expression of genes associated with this molecule, further studies are needed to support this protein as a suitable candidate for contraceptive vaccine in mammals.

Elevation of cervical C-X-C motif chemokine ligand 10 levels is associated with HIV-1 acquisition in pregnant and postpartum women.

To evaluate the relationship between cervical cytokine/chemokine concentrations and HIV-1 acquisition in peripartum Kenyan women. Nested case-control study. Women participating in a prospective study of peripartum HIV acquisition in Kenya (the Mama Salama Study), were tested for HIV-1 at 1-3 month intervals during pregnancy and through 9 months postpartum. Cases positive for HIV-1 RNA during follow-up (N = 14), were matched 3 : 1 with HIV-negative controls (N = 42) based on age, marital status, partner HIV-1 status, transactional sex, and timing of cervical swab collection. Concentrations of five cytokines (IL-1β, IL-6, IL-10, IFNγ, and TNFα) and four chemokines (IL-8, C-X-C motif chemokine ligand 10 (CXCL10), macrophage inflammatory protein-1 α, and macrophage inflammatory protein-1 β) were measured from cervical swabs collected at the visit prior to HIV-1 diagnosis (cases) or matched gestational/postpartum time (controls). Cytokine/chemokine concentrations were compared between cases and controls using Wilcoxon rank-sum tests. Principal component analysis was used to create a summary score for closely correlated cytokines/chemokines. Associations with HIV-1 acquisition were analyzed using conditional logistic regression. Path analysis was used to evaluate hypothesized relationships between CXCL10, vaginal washing, Nugent score, and HIV-1 acquisition. Conditional logistic regression analysis demonstrated an association between increased concentrations of CXCL10 and HIV-1 acquisition (odds ratio = 1.74, 95% confidence interval 1.04, 2.93; P = 0.034). Path analysis confirmed a positive independent association between higher concentrations of CXCL10 and HIV-1 acquisition (path coefficient = 0.37, 95% confidence interval 0.15, 0.59; P < 0.001). HIV-1 acquisition was associated with increased cervical concentrations of CXCL10 in pregnant and postpartum women.

A preliminary study on the immune responses of HPV16-E7 by combined intranasal immunization with lymphotoxin

Human papillomavirus (HPV) ranks the first cause of cervical cancer. Cervical cancer has high prevalence rates in women around the world. The HPV-E7 oncoprotein is expressed in cervical cancer and is a target of developing immunotherapies against HPV-associated tumors. However, the antigenicity of this protein is low. Due to this reason, potent adjuvants are required to enhance its therapeutic efficacy. This preliminary study aims to evaluate whether lymphotoxin (LT) could act as an effective immune adjuvant for HPV infection in mice models. Intranasal immunization was used to explore the effect of HPV-E7 and/or LT immune response. After the third intranasal immunization, the titer for the HPV-E7 antibody was detected in serum and vaginal washing fluid. Also, we assessed the expression of chemokine ligand 13 (CXCL13) and Peripheral Node Addressin (PNAd) in the lymph nodes after intranasal immunization with immunohistochemical analysis. compared to HPV-E7 immunization, intranasal immunization with HPV-E7 plus LT significantly increased HPV-E7-specific serum IgG and vaginal IgA titers. Furthermore, the combined use of HPV-E7 and LT strongly induced E7-specific CTL responses. LT can be effective for intranasal immunized HPV-E7 to improve E7-specific immune responses to HPV infection. It is new approach to eradicate chronic HPV infection capable of inducing an effective anti-infection method.

Sensitivity and Resistance of the Microbiota of Reproductive Organs and Mammary Gland of Cows to Anti-microbial Agents in Cases of Inflammation

This paper contains the results of complex microbiological studies (culture method, real-time PCR) of biological material from cows affected by inflammatory diseases of reproductive organs and mammary gland. Milk microbiota with underlying subclinical mastitis was represented by pathogenic (S. aureus, enteropathogenic E. coli), opportunistic bacteria (Staphylococcus spp., E. coli, E. faecium, Streptococcus spp., S. agalactiae, P. aeruginosa) and yeast-like fungi of Candida spp. in association. Combined infectious and inflammatory diseases of genital tract and mammary gland in cows resulted in the same types of microorganisms in microflora composition, which confirms information obtained by other researchers on associated microbiota during inflammatory processes. S. aureus, P. aeruginosa, E. coli, E. faecium, E. faecalis, S. epidermidis, S. saprophyticus, Bacillus spp., and yeast-like fungi of Candida spp. were obtained from milk samples from cows with acute clinical mastitis and in vaginal washes from cows with acute postpartum endometritis. In the course of defining the sensitivity to antibiotics and identifying genes of antimicrobial resistance, multidrug resistance was established in most part of obtained strains, which should be taken into account when planning treatment measures.

Assessment of Urea and Creatinine in Vaginal Washing Fluid as a Method for Diagnosis of Premature Rupture of Membranes

Abstract Background: Premature rupture of membranes (PROM) refers to rupture of fetal membranes prior the onset of labor. If it occurs before 37 weeks of pregnancy, it is known as preterm premature rupture of membrane (PPROM). Prolonged duration from PROM till delivery is associated with increased maternal and neonatal morbidities, in term and preterm preg-nancies. This includes chorioamnionitis, fetal and neonatal sepsis, placental abruption, prematurity, umbilical cord pro-lapse, and increased rate of cesarean delivery. Pregnant women with history of vaginal leaking or ultra-sound evidence of diminished amniotic fluid should be care-fully evaluated to avoid adverse pregnancy outcomes. Accurate diagnosis helps obstetricians to optimize maternal and neonatal outcomes by early intervention to decrease morbidities. Diagnosis of PROM is may be easy by inspection of leaking through the cervix or fluid accumulation via speculum examination. However, with small rupture of membrane or rupture bag of hind-water, it is difficult to see amniotic fluid leakage clearly and diagnosis can't be easily made, which might lead to delay in diagnosis and management. Methods of PPROM diagnosis include fern and nitrazine which are two commonly used and traditional tests. They are rapid and easy tests but not completely reliable because of high false positive and negative results, which may be related to technical errors or contamination by blood, semen or cervical mucus. Ultrasound evaluation of amniotic fluid can't differentiate PROM from other causes of oligohydramnios. However, tampon or amnio-dye test is a test of accurate diagnosis through aspiration and dye injection into amniotic fluid under ultrasound guidance. It is an aggressive test with has a risk of bleeding, placental abruption infection, miscarriage, and iatrogenic uterine perforation. The Amnisure test for ROM is accurate but expensive and not available in many centers. Thus, a simple, non-invasive, and inexpensive method of detecting PROM is needed. Urea and creatinine are excreted by kidneys through glomerular filtration. Amniotic fluid also contains these markers and their determination in the vaginal can be used as a diagnostic test for PROM.Aim of Study: This study was conducted to evaluate the diagnostic value of urea and creatinine levels in vaginal wash in patients with suspected PROM. Patients and Method: The study was carried out at Ob-stetrics and Gynecology Department, Zagazig University Hospitals. A total of 228 pregnant women were included in study, between completed 24 weeks to completed 37 weeks' gestation. Divided into two equal groups: Group A with definite PROM, control Group is B. All pregnant women included in this study were subjected to: Full history taking, general, abdominal and speculum examination, fern test and nitrazine test. Vaginal wash urea measurement by enzymatic urease examination method and vaginal wash creatinine measurement by RATE JAFFE method. Results: The study showed that there is statistically significant difference between the two groups regarding vaginal wash urea and creatinine. The best cut-off value of vaginal wash urea in prediction of PROM is >!6.85mg/dl with AUC of 0.958, sensitivity of 98.2%, specificity of 70.2%, PPV of 76.7%, NPV of 97.6% and accuracy of 93%. The best cut-off value of vaginal wash creatinine in prediction of PROM is >!0.465mg/dl with AUC of 0.992, sensitivity of 100%, specificity of 80.7%, PPV of 83.8%, NPV of 100% and accuracy of 90.4%. Combined use of vaginal wash urea and creatinine in prediction of PROM had sensitivity of 98.3%, specificity of 91.2%, PPV of 91.8%, NPV of 98.1% and accuracy of 94.7%. Conclusion: This study concluded that urea and creatinine assay in vaginal fluid is cheaper, faster and more valid test, possible candidate for being a gold standard test for diagnosis of PROM.

Live-attenuated Salmonella enterica serotype Choleraesuis vaccine with regulated delayed fur mutation confer protection against Streptococcus suis in mice

BackgroundRecombinant Salmonella enterica serotype Choleraesuis (S. Choleraesuis) vaccine vector could be used to deliver heterologous antigens to prevent and control pig diseases. We have previously shown that a live-attenuated S. Choleraesuis vaccine candidate strain rSC0011 (ΔPcrp527::TT araC PBADcrp Δpmi-2426 ΔrelA199::araC PBADlacI TT ΔasdA33, Δ, deletion, TT, terminator) delivering SaoA, a conserved surface protein in most of S. suis serotypes, provided excellent protection against S. suis challenge, but occasionally lead to morbidity (enteritidis) in vaccinated mice (approximately 1 in every 10 mice). Thus, alternated attenuation method was sought to reduce the reactogenicity of strain rSC0011. Herein, we described another recombinant attenuated S. Choleraesuis vector, rSC0012 (ΔPfur88:: TT araC PBADfur Δpmi-2426 ΔrelA199:: araC PBADlacI TT ΔasdA33) with regulated delayed fur mutation to avoid inducing disease symptoms while exhibiting a high degree of immunogenicity.ResultsThe strain rSC0012 strain with the ΔPfur88::TT araC PBADfur mutation induced less production of inflammatory cytokines than strain rSC0011 with the ΔPcrp527::TT araC PBADcrp mutation in mice. When delivering the same pS-SaoA plasmid, the intraperitoneal LD50 of rSC0012 was 18.2 times higher than that of rSC0011 in 3-week-old BALB/C mice. rSC0012 with either pS-SaoA or pYA3493 was cleared from spleen and liver tissues 7 days earlier than rSC0011 with same vectors after oral inoculation. The strain rSC0012 synthesizing SaoA induced high titers of anti-SaoA antibodies in both systemic (IgG in serum) and mucosal (IgA in vaginal washes) sites, as well as increased level of IL-4, the facilitator of Th2-type T cell immune response in mice. The recombinant vaccine rSC0012(pS-SaoA) conferred high percentage of protection against S. suis or S. Choleraesuis challenge in BALB/C mice.ConclusionsThe live-attenuated Salmonella enterica serotype Choleraesuis vaccine rSC0012(pS-SaoA) with regulated delayed fur mutation provides a foundation for the development of a safe and effective vaccine against S. Choleraesuis and S. suis.