To evaluate the prevalence of mood disorder symptoms and measure the quality of life in women with vulvar dermatoses attending a specialized vulvar clinic in southern Sweden. A questionnaire-based study among consecutive women attending the vulvar unit at the Department of Dermatology and Venereology at Skåne University Hospital. Sociodemographic factors were collected; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS) and health-related quality of life with the EQ-5D VAS. In all, 217 of 242 women participated (response rate 90%). Data was collected from March 2020 to January 2023. The largest diagnostic group was lichen sclerosus (62%), followed by lichen planus (9.2%) and pain disorders (5.5%). Symptoms of depression and anxiety were highest among women with pain disorders (n=12, anxiety symptoms 58.3%, depression symptoms 20%), followed by Candida vulvovaginitis (n=7, anxiety symptoms 57.2%, depression symptoms 0.0%) and pruritus vulvae (n=7, anxiety symptoms 42.9% and depression symptoms14.3%). Differences between these groups were not significant. The mean EQ-5D VAS score was 69.7±19.7. Women with pain disorders, Candida vulvovaginitis, and pruritus vulvae showed the highest levels of mood symptoms. These findings support the importance of assessing mood symptoms and quality of life in the management of women with vulvar disease.

Discovery of antibacterial active components from the root barks of Sophora flavescens and evaluation of their antibacterial in vitro and infected wound healing activity in vivo.

Genitourinary syndrome of menopause (GSM) is a chronic, progressive condition resulting from estrogen and androgen deficiency that affects 27-84% of postmenopausal individuals. Symptoms include vaginal dryness, dyspareunia, urinary urgency, dysuria, and recurrent urinary tract infections. Despite strong evidence supporting the safety and efficacy of local vaginal estrogen (VE) therapy, treatment remains underutilized due to clinician uncertainty, misconceptions regarding systemic risk, and regulatory warnings. Recent clinical guidelines emphasize vaginal hormones as first-line therapy for GSM. This review summarizes the pathophysiology of GSM, evidence supporting local hormone therapy, safety considerations, and practical prescribing strategies for clinicians. Pearls for clinical practice are discussed, including dosing regimens, formulation selection, patient counseling, and strategies to overcome barriers to treatment adherence.

Objective The aim of the study was to compare the effectiveness, complications, and treatment preference parameters of long-term pessary therapy versus vaginal obliteration (colpocleisis) in elderly, sexually inactive female patients with severe POP. Design Single-center, retrospective observational study. Participants/Materials In our study we included elderly, sexually inactive women treated for advanced POP between January 2015 and November 2023. Long-term pessary therapy was applied in 30 cases, while 46 patients underwent vaginal obliteration. The mean follow-up duration was 41.9 ± 31.9 vs. 61.9 ± 40.1 months, respectively. Setting The study was performed at the Department of Urology of our University (n = 76). Methods Data collection was carried out based on clinical patient documentation and telephone interviews. We used a standardized, non-validated questionnaire specifically designed for this study covering four domains: patient characteristics; POP-related symptoms; treatment effectiveness and complications; socioeconomic and health-related parameters, treatment preferences. Pre- and post-treatment parameters and intergroup differences were statistically analyzed. Results The mean age of the patients was 74 ± 5.6 years, and the mean BMI was 25.6 ± 4.4. Following both pessary therapy and surgery, high rates of symptom resolution were observed regarding vaginal foreign body sensation, discomfort and/or palpable bulge (93.5% vs. 95.5%) and obstructive voiding difficulty (100% vs. 96.4%). The rate of patient satisfaction was high in both groups (90% vs. 97.8%, p = 0.15); however, symptom improvement was significantly greater following vaginal obliteration (VAS: 8.9 ± 1.1 vs. 7.7 ± 1.7, p < 0.001). Pessary therapy was discontinued in 23.3% of cases, and 20% later required surgical POP intervention. No reoperations due to recurrence were required following obliterative surgery. Adverse events occurred in 26.6% of pessary patients and complications in 17.3% of surgically treated patients. The most frequent reason for choosing pessary therapy was fear of surgery (76.6%), while the most common reason for choosing surgery was refusal of pessary therapy (58.5%). Limitations The retrospective design and relatively small sample size limit the generalizability of the findings. Conclusions In elderly, sexually inactive women requiring treatment for advanced POP, both vaginal obliteration and long-term pessary therapy provide excellent therapeutic alternatives. The two modalities demonstrate comparable outcomes, high effectiveness, and an acceptable rate of non-severe complications, making both options suitable for appropriately selected patients.

The increasing prevalence of multidrug-resistant pathogens has intensified the search for alternative sources of bioactive compounds. This study evaluated the antimicrobial and antioxidant potential of Pteleopsis suberosa and Piliostigma thonningii, two medicinal plants traditionally used in Togo to treat vaginal, respiratory, gastrointestinal, and skin infections. Hydroethanolic extracts from different plant organs were prepared by cold maceration. Phytochemical screening was performed using standard qualitative tests, while total flavonoid content was determined spectrophotometrically. Antioxidant activity was assessed using the phosphomolybdate reduction and ferric reducing antioxidant power (FRAP) assays. Antimicrobial activity was evaluated by agar well diffusion and broth microdilution methods. The highest extraction yield was obtained from the stem bark of P. thonningii (22.67%). Phytochemical analysis revealed the presence of tannins, saponins, alkaloids, phenolic compounds, triterpenes, and reducing sugars. The leaves of P. thonningii exhibited the highest total flavonoid content (313.82 µg Eq R/mg DE), whereas the leaves of P. suberosa showed the strongest antioxidant activity, reaching 90.70 mg Eq AA/g DE and 430.50 µmol Eq FeSO₄/mg DE in the phosphomolybdate and FRAP assays, respectively. The largest inhibition zone (20 mm) was produced by the stem bark extract of P. thonningii against Candida albicans. In addition, the stem bark extract of P. suberosa and both leaf and stem bark extracts of P. thonningii exhibited a minimum inhibitory concentration (MIC) of 1.562 mg/mL against S. aureus n0689. These findings provide preliminary in vitro evidence supporting the traditional use of both species. Although their antioxidant and antimicrobial activities were low, further studies are needed to isolate the active constituents, elucidate their mechanisms of action, and evaluate their safety before therapeutic application.

Type 2 diabetes mellitus (T2DM) is associated with chronic hyperglycemia, leading to immune dysfunction, increased susceptibility to infections and metabolic stress- induced cellular alterations. These factors may influence cervical epithelial morphology and contribute to the persistence of Human papillomavirus infection and progression of cervical lesions. Cytomorphometric analysis offers an objective method to detect subtle cellular changes in cervical smears. Aims and objectives: To comprehensively evaluate the cytological and cellular morphometric features of cervicovaginal smears (Pap smears) in women with T2DM. 1. To determine the prevalence of epithelial cell abnormalities as per the Bethesda System (2014) in Pap smears of diabetic women. 2. To identify and compare the spectrum and frequency of specific vaginal infections (e.g., Candidiasis, Bacterial Vaginosis, Trichomoniasis) and inflammatory patterns in diabetic group. 3. To perform a quantitative cytomorphometric analysis of normal-appearing intermediate squamous cells in poorly controlled and well-controlled diabetic populations as per latest American diabetes association (ADA) 2026 a. Nuclear Diameter (ND) b. Cytoplasmic Diameter (CD) c. Nuclear-to-Cytoplasmic (N:C) Ratio 4. To correlate cytopathological findings (presence of epithelial cell abnormalities, inflammation, and infection) with the degree of glycemic control as measured by Glycated Hemoglobin (HbA1c) levels within the diabetic group. 5. To correlate the cytomorphometric parameters (ND, CD, N:C ratio) with the HbA1c levels within the diabetic group. 6. To investigate any association between the age of the patient, the diabetes, and the observed cytological changes. Materials and Methods: This cross-sectional study was conducted at a tertiary care center in CHRI,Tamilnadu and included women. Cervical- vaginal smears were collected using conventional Pap smear technique and reported according to Bethesda system (2014). Cytomorphometric parameters namely CD, ND and N:C ratio, were measured using Image J software. Glycemic indices including fasting blood sugar (FBS), Postprandial blood sugar (PPBS) and HbA1c were documented. Data analysis was carried out using SPSS version 25, with ANOVA and t-tests; p -value of less than 0.05 was considered statically significant. Results: The study population demonstrated poor glycemic control (mean HbA1C: 8.49%) as per ADA 2026. Even though majority of cases were tested negative for intraepithelial lesion, significant number of epithelial abnormalities were observed including ASCUS (4.3%), LSIL (0.7%) and HSIL (2.9%). Infective conditions were present in 16.7% of cases, with Candida being the most common. Cytomorphometric analysis revealed increased nuclear diameter and a higher N:C ratio in patients with poor glycemic control. A statistically significant association was found between elevated HbA1c levels and increased N:C ratio(p=0.002). Additionally, N:C ratio showed significant variation across cytological categories (p &lt;0.001), increasing with severity of epithelial abnormalities. Conclusion: Inadequate glycemic control in patients with Type 2 diabetes mellitus is significantly associated with cytomorphometric alterations in cervical squamous epithelial cells, characterised by nuclear enlargement, cytoplasmic reduction and increased N:C ratio. These changes may represent early indicators of epithelial atypia and increased susceptibility to cervical dysplasia. Increase in HbA1c is associated with squamous intraepithelial lesion. Incorporating cytomorphometric analysis into routine Pap smear screening may enhance early detection of epithelial abnormalities, particularly in high-risk diabetic patients. Strict glycemic control may play a role in maintaining cervical epithelial integrity and reducing disease progression.

Currently, live biotherapeutic products (LBP) have been widely used to improve gut microbiota, enhance immunity, and promote digestion. Engineering bacteria, as one form of LBP, have made breakthrough progress in the treatment of diseases, but their effectiveness and specific mechanisms in treating vaginal infections are not clear. Here, we innovatively constructed Escherichia coli Nissle 1917-attB-IFN-α2b (EcN-IFN-α2b) expressing antiviral interferon alpha-2b (IFN-α2b) using genome integration technology, and evaluated its ability to reduce human papillomavirus (HPV) viral load and the underlying mechanisms in an NSG mouse surrogate model of HPV. Our results showed that EcN-IFN-α2b had good growth performance, acid resistance, antioxidant ability, and antimicrobial activity in vitro. EcN-IFN-α2b also significantly reduced the HPV viral load (M vs. EcN-IFN-α2b = 1.003 vs. 0.643, p < 0.01), and effectively alleviated the levels of interleukin 1β (IL-1β) (M vs. EcN-IFN-α2b, p < 0.01), interleukin 6 (IL-6) (M vs. EcN-IFN-α2b, p < 0.01), and tumor necrosis factor α (TNF-α) (M vs. EcN-IFN-α2b, p < 0.05) in the vagina. Further mechanistic studies suggested that EcN-IFN-α2b may reduce HPV viral load by activating the JAK/STAT/cGAS/STING signaling pathway. Additionally, we found that EcN-IFN-α2b altered the composition of vaginal microbiota, especially the relative abundance of vaginal pathogens such as Vibrionaceae_Vibrio, Streptococcus, and Staphylococcaceae_Staphylococcus, and the relative abundance of beneficial Lactobacillus. This study systematically evaluated the effects of the novel engineered strain EcN-IFN-α2b in reducing HPV viral load, alleviating associated inflammation, and restoring vaginal microbiota in an NSG mouse surrogate model, providing a new strategy for the future clinical treatment of HPV infection.

Neisseria gonorrhoeae is a common Gram-negative pathogen with increasing resistance to all recommended antibiotics. There is a critical need to improve the efficiency of the antibiotic hit discovery process to replenish the drug development pipeline. Here, we show that deep learning models can augment high-throughput screens to identify readily available molecules with narrow-spectrum activity against difficult-to-treat strains of N. gonorrhoeae. We phenotypically tested 38,650 small molecules for N. gonorrhoeae growth inhibition to train a predictive graph neural network (GNN) model. We benchmarked the model's performance against other architectures, including a large language model, and found that GNNs more accurately identify active, drug-like molecules that are structurally distinct from the training set and known antibiotics. Using the model to virtually screen ~6 million compounds, we identified 213 compounds for experimental validation and found that 83 (39%) inhibited N. gonorrhoeae growth. Two of these compounds were structurally dissimilar to existing antibiotics, maintained potency against multidrug-resistant N. gonorrhoeae strains in vitro, exhibited promising selectivity indices, and were rapidly bactericidal with low frequencies of resistance. Proteomic studies revealed their distinct mechanisms of action, with one compound targeting alanine racemase, an enzyme involved in the essential process of peptidoglycan synthesis. Furthermore, the compounds showed early promise in reducing N. gonorrhoeae titers in a human vagina-on-a-chip infection model and a mouse vaginal infection model. Our work establishes the deep learning-enabled discovery of selective antibacterial compounds against N. gonorrhoeae as a much-needed hit discovery tool to address the growing crisis of antimicrobial resistance for this pathogen.

Sustained mucosal delivery of SAMT-247 via an intravaginal ring reduces the risk of SIVmac251 acquisition in vaccinated macaques.

Evaluation of molecular thresholds based quantification of Gardnerella vaginalis and Fannyhessea vaginae for improved diagnosis of Bacterial Vaginosis.

Vaginal polycyclic aromatic hydrocarbons (PAHs), HPV infection, and vaginal microbiome in firefighters: A cross-sectional study.

BackgroundTestosterone-associated vulvovaginitis is an under-recognised cause of genital symptoms in transmasculine patients receiving testosterone as gender-affirming hormone therapy, with 5-years prevalence 64-78%. BASHH's Gender and Sexual Minorities Special Interest Group convened sexual health, gender, gynaecological and primary care experts and patient representatives to formulate a first-in-world best practice statement.MethodWe searched Medline, Embase, CINAHL, UpToDate, Trip Medical Database and Cochrane, to April 2025, regarding testosterone's impact on transmasculine people's vaginal histology and microbiomes, symptoms, and management. Papers on cis- or transgender women, editorials, and study protocols were excluded. Included studies were assessed using the Critical Appraisal Skills Programme tool. Recommendations for best practice were graded using GRADE methodology where possible, and supplemented by expert group consensus where evidence was limited.Results14 papers were included, of which 11 were descriptive/non-management focused. Testosterone is associated with vaginal Lactobacilli depletion, increased speciation, pH changes, atrophy, inflammation, and epithelial cell differentiation shift. The diagnosis of testosterone-associated vulvovaginitis is clinical; symptom severity does not reliably correlate with any of the above, nor other markers such as hormone levels. Two small case series and one cohort study (total n = 12) discussed treatment; topical estrogen reduced vaginal symptoms and increased Lactobacilli, with some refractory inflammatory cases requiring topical clindamycin +/- topical steroids. Presumed efficacy and safety are extrapolated from topical estrogen use in cisgender menopausal women.ConclusionSpecific evidence for testosterone-associated vulvovaginitis management is lacking; we suggest a culturally competent approach, considering it as a differential in any transmasculine people on testosterone with genitourinary symptoms. Offer examination (if possible) to exclude infection or dermatoses; offer first-line treatment with topical vaginal estrogens. Adjunctive/alternative measures include emollients and lubricants; topical clindamycin +/- topical steroids for refractory cases or aerobic/desquamative vaginitis. Long-term maintenance therapy and review is advised. Robust trans-specific clinical trials are needed to strengthen the evidence and optimise long-term outcomes.

Bacterial vaginosis (BV) is common and characterized by heterogeneous presentations. We aimed to determine BV subtype prevalence among women attending a United States infectious diseases vaginitis specialty clinic at initial and follow-up visits and identify factors associated with BV subtypes. Medical records from adult patients were reviewed, including demographics, visit frequency, STI history, symptoms, and diagnoses. Chi-square, Fisher's exact, and Wilcoxon rank-sum tests compared women with and without BV. Modified Poisson models with generalized estimating equations assessed associations between characteristics and BV subtypes. Between June 2021-December 2024, 149 patients were evaluated; 49 (32.9%) had BV at the initial visit. Recurrent BV was most common (n=27, 55.1%), followed by uncomplicated symptomatic BV (n=18, 36.7%), asymptomatic BV (n=3, 6.1%), and refractory BV (n=1, 2.0%). Black women were more likely than White women to have BV (adjusted relative risk [aRR] 3.92, 95% CI: 1.66-9.27), as were women with a pregnancy history (aRR 2.37, 95% CI: 1.23-5.03). No predictors were identified for uncomplicated BV. Recurrent BV was associated with younger age (≤25 years; aRR 4.29, 95% CI: 1.06-17.29), higher BMI (aRR 3.48 for BMI 25-29.9; aRR 3.06 for BMI ≥30), STI history (aRR 2.19, 95% CI: 1.05-4.57), and a pregnancy history (aRR 3.14, 95% CI: 1.22-8.06). High BV prevalence and frequent recurrent BV were observed. Race, obesity, STI history, and a pregnancy history were associated with recurrent BV. Further research is needed to characterize factors influencing recurrent BV to optimize sexual health outcomes.

Extracellular vesicles (EVs), including exosomes (EXOs) and microvesicles, are small particles surrounded by lipid bilayers that almost all cell types produce. They are essential for cell signaling because they transport bioactive molecules, including DNA, RNA, proteins, and lipids. The amount and make-up of EXOs are linked to several illnesses, including inflammatory diseases, cancer, metabolic diseases, and the one we're communicating about here, female infertility. Bacteria, fungi, viruses, and parasites are just a few of the organisms known to affect the reproductive system in both men and women. EVs are very important for reproductive health, and they can be a cause of infections that make women unable to have children. EVs play a significant role in cell communication and can influence both healthy and pathological processes in the female reproductive system. We looked into the use of EVs as an alternative way to treat vaginal infections (VIs), like bacterial vaginosis, viral vaginitis, and vaginal yeast infections, because traditional treatments for these diseases have some problems. In this study, we also examined the role of EVs in infertility associated with VI. Then, the pros and cons of this method for treating this sickness in the future are discussed.

BackgroundVaginal dysbiosis is associated with HIV acquisition and preterm delivery. Our objective was to evaluate prevalent vaginal infections, and changes in microbiota and cytokines among pregnant and breastfeeding women from 4 African countries using dapivirine vaginal ring (DVR) or oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in 2 parallel nonoverlapping trials.MethodsMTN-042 (NCT03965923) was a randomized trial evaluating daily TDF/FTC or monthly DVR during pregnancy (n = 558), and MTN-043 (NCT04140266) was a randomized study evaluating TDF/FTC or DVR during breastfeeding (n = 197). Women were evaluated for vaginal infections at enrollment and follow-up using Nugent score and BD Max™ Vaginal Panel. Microbiota was evaluated by quantitative PCR for 12 bacterial targets; 5 cytokines and RANTES were evaluated by MAGPIX. Rates of change in vaginal microbiota and cytokines and prevalence of vaginal infections were evaluated using generalized linear mixed models and Benjamini–Hochberg (BH)-adjusted P values.ResultsVaginal infections, microbiota and cytokines did not differ between the 2 study arms at baseline. Lactobacillus crispatus was less frequently detected postpartum and during breastfeeding compared with pregnancy. Bacterial vaginosis (BV) and Candida were common during pregnancy and breastfeeding, but there was no significant difference in the rate of change in these infections by study arm. BV-associated microbiota and cytokines changed over pregnancy and postpartum, but the rate of change by study arm did not differ.ConclusionsVaginal infections, microbiota or cytokines/chemokines changes were similar in women using DVR or TDF/FTC. These data augment the robust safety profile for DVR to support its use during pregnancy and breastfeeding.

Investigating Candida species and associated bacteria from vaginal swabs and smears of symptomatic and asymptomatic adult women: A cross-sectional study.

Candida vulvovaginitis treatment: A comparative clinical trial of clotrimazole and prangos ferulacea (Jashir) vaginal creams.

Genitourinary syndrome of menopause in women with cancer - a narrative review.

Background/Objectives: Adolescent pregnancy, defined as pregnancy occurring between ages 10 and 19, remains a pressing global health concern with significant disparities in prevalence and outcomes across countries. Early and systematic diagnostic screening may allow timely risk stratification and adequate management. Methods: We conducted this retrospective cohort study at a tertiary referral center from January 2015 through December 2024, including all women who delivered live fetuses at our facility, analyzing adolescent pregnancy outcomes in our region and comparing them with adult pregnancy outcomes. Results: Younger adolescents have higher rates of vaginal infections (45.3% vs. 38.1%), chorioamnionitis, urinary tract infections (6% vs. 4.9%), preterm birth, higher cesarean section rates, SGA and FGR fetuses, with more frequent NICU admissions than older adolescents. Adolescent pregnancies more often resulted in vaginal births compared to adult pregnancies but also showed higher rates of operative vaginal delivery, episiotomy, perineal tears, vaginal tears, and cervical lacerations. Gestational diabetes and excessive gestational weight gain were overall less common in adolescents, but pre-pregnancy maternal obesity was significantly more prevalent in the older adolescent group than in the younger ones. Gestational hypertension was about twice as frequent in adult pregnancies, while HELLP syndrome was approximately six times more common in adults than in adolescents. Conclusions: In summary, adolescent pregnancy presents both potential biological advantages and notable disadvantages, with outcomes resulting from the complex interplay of biological immaturity and socioeconomic factors. These results highlight the critical importance of implementing comprehensive early diagnostic screening protocols and structured antenatal care to facilitate earlier identification and mitigation of modifiable risk factors to improve both maternal and fetal outcomes.

BackgroundThe vaginal microbiome significantly influences gynecological and obstetric health, yet the interrelationship between host vaginal gene expression and the microbiota during pregnancy is understudied—particularly in racioethnically diverse cohorts. Here, we leveraged metatranscriptomic data from 123 participants from the Multi-Omic Microbiome Study-Pregnancy Initiative (MOMS-PI) cohort to perform a novel integrated analysis of human host gene expression and vaginal microbiota composition during pregnancy. We hypothesized that host gene expression at the vaginal-mucosal interface would exhibit distinct transcriptional profiles when colonized by bacteria commonly present in bacterial vaginosis (BV), termed BV-associated vagitypes, compared toLactobacillus-dominated microbiomes. Such distinct host response would provide evidence linking vaginal inflammation to microbiome composition during pregnancy in a majority Black cohort. By profiling host expression with different BV-associated vagitypes, these host-microbiome signatures could inform clinically actionable biomarkers for microbiome-focused interventions during pregnancy in historically underrepresented populations.ResultsHost transcriptomic profiles differed significantly between BV-associated andLactobacillus-dominated vagitypes, with this association remaining significant when analyses were restricted to Black participants. We identified 13 consistently differentially expressed genes in women with BV-associated vagitypes—vaginal microbiomes comprised of high relative abundance of eitherGardnerellaspp.,CandidatusLachnocurva vaginae, or a mixture of multiple anaerobic taxa—compared to women withLactobacillus crispatusvagitypes. These differentially expressed genes are involved in host immune response (DKK1, H2BC21, ILRUN, S100A9), oxidative stress response and inflammasome activation (CSTB), transcription modulation (CLK1, PAX9), vesicle trafficking (EXPH5), ubiquitination (FBXO32), membrane integrity (PIEZO1), and ion transport (S100A16, SCNN1A, SLCO4A1).ConclusionBV-associated vagitypes are correlated with distinct host immunomodulatory gene expression profiles during pregnancy, independent of self-reported racioethnicity. We demonstrated novel molecular insights into microbiome-host interaction during pregnancy within the context of adverse cervicovaginal health.