Longitudinal Assessment of Systemic and Genital Tract Inflammatory Markers and Endogenous Genital Tract E. coli Inhibitory Activity in HIV-Infected and Uninfected Women.

PROBLEM: Stability over time of systemic and mucosal immunity and their associations with bacterial vaginosis (BV) and HIV-specific parameters were assessed. METHOD OF STUDY: Immune mediators and HIV viral load in plasma and cervicovaginal lavage (CVL), E. coli inhibition, and Nugent score were measured at three semiannual visits among 94 participants in the Women's Interagency HIV Study. Mixed models identified the factors associated with immune mediators. RESULTS: There was higher E. coli inhibition and lower inflammation over time in the genital tract and systemically. BV was consistently associated with higher CVL inflammatory mediators and lower CVL E. coli inhibition. HIV-infected women with higher CD4 counts had lower systemic and genital inflammatory mediators, and genital HIV shedding was associated with higher CVL inflammatory mediators. Use of antiretroviral therapy (ART) was associated with lower plasma and CVL mediators, but higher E. coli inhibition. CONCLUSION: HIV and BV are linked to inflammation, and ART may be associated with improved vaginal health.

Evaluation of CHROMagar Candida medium for the isolation and direct identification of yeast species from the female genital tract.

The performance and cost-effectiveness of CHROMagar Candida in the isolation and identification of Candida species from female genital tract specimens were investigated. Eight hundred and forty-three specimens were inoculated in parallel onto malt extract agar and CHROMagar Candida. Yeasts isolated on CHROMagar were provisionally identified by morphology and pigmentation. Those isolated on malt extract agar were further identified by a germ tube test, and negative isolates were identified biochemically. A cost comparison was performed, detailing labour and material costs. Of 119 yeast isolates, seven were detected only on CHROMagar. Mixed Candida spp. from three specimens were only differentiated on CHROMagar. There was a 100% correlation between the results of the germ tube test and provisional identity on CHROMagar. CHROMagar Candida facilitated the presumptive identification of yeast isolates from the female genital tract, and the detection of mixed populations. The cost of the media was higher than malt extract agar and germ tube testing, but the rapid identification of isolates to species level and ease of use may be of sufficient advantage to justify the extra cost.

Strategies for the prevention of neonatal infection with herpes simplex virus: a decision analysis.

Decision analysis was used in the evaluation of nine strategies for the prevention of neonatal infection with herpes simplex virus (HSV). These strategies involve physical examination at labor, weekly screening of pregnant women for shedding of HSV, use of serologic methods specific for HSV type 2, and performance of a rapid diagnostic test at labor. Rates of cesarean delivery and of neonatal infection with HSV were estimated for each strategy, and the estimates were compared with those for a strategy of no intervention. The effects of variations in the sensitivities and specificities of the diagnostic and serologic tests used were analyzed. Given the currently available data and technology, physical examination at labor is the optimal strategy if the primary goal is to minimize the ratio of excess cesarean sections to cases of neonatal HSV infection averted.

[The assessment of the clinical and microbiological status of the lower genital tract in women with sterility]. / Otsenka na klinichniia i mikrobiologichniia status na dolniia genitalen trakt pri zheni sus sterilitet.

The study was carried out on 40 randomly selected patients with sterility, in whom microbiological examination of the lower genital tract was performed. Pathogenic microorganisms were isolated in the vaginal secretion of 10 out of 26 patients with primary sterility, but in the cervical secretion in 8 out of 26 women. Similar finding was found in 5 patients out of 14 patients with secondary sterility. The obtained results were compared with the complaints of women and their gynecological examination. Attention is paid again to the necessity of complex evaluation on the character of microbiological flora in view of the frequent usage of invasive methods in diagnosis and treatment of sterility.

A 2-year quantitative assessment of Chlamydia trachomatis in a sexually transmitted diseases clinic population by the MicroTrak direct smear immunofluorescence test.

The MicroTrak direct smear immunofluorescence test was used to determine the prevalence of Chlamydia trachomatis elementary bodies (EBs) in groups of patients in various clinical categories, most of whom were seen in a clinic for sexually transmitted diseases (STD). Overall, 8138 adequate specimens were tested, of which 14.3% were found to contain chlamydial EBs. Of the samples from patients seen in the STD clinic, over 70% were from women and 14.9% of these were positive, as were 15.7% of those from men. EBs were detected in 27% of samples from infants and in 7.0% of those from adults with conjunctivitis. EBs were detected most often in men with nongonococcal urethritis (40.2%), infants with conjunctivitis (30%) and contacts of chlamydiae-positive patients (24.5%) and least often in 'prostatitis' (2.9%) and patients tested to determine the success of treatment (2.7%). Over 40% of samples from both the male urethra and the cervix contained 10 or fewer EBs, highlighting the importance of recognizing small numbers and the sensitivity required of other detection procedures.

Patient cost in the treatment of postsurgical female pelvic infection.

Soft tissue female pelvic infections, that is, postpartum endomyometritis, pelvic cellulitis, and salpingitis, are frequently polymicrobial, involving aerobic and anaerobic bacteria. The most common antibiotic regimen employed for the treatment of these patients is clindamycin and an aminoglycoside. Single-agent therapy, utilizing the newer beta-lactams, is more economical, potentially less toxic, and as effective.

The epidemiology of genital colonization with Staphylococcus aureus.

The prevalence of genital colonization with Staphylococcus aureus, including strains that have been associated with toxic shock syndrome, was studied in 600 women. Nine percent of these women were colonized with S. aureus, 5% of whom had positive vaginal cultures, and 1% were colonized with toxin-producing strains. Black women were colonized with S. aureus, including toxin-producing strains, as frequently or more frequently than white women. The highest colonization rates occurred in postpartum women. Trends toward increasing colonization occurred in relation to decreasing age and socioeconomic status. There were no statistically significant relationships between genital colonization with S. aureus and the use of tampons, oral contraceptives, or a variety of other personal habits and health problems. Genital cultures taken in consecutive menstrual cycles indicated that 35% of women with S. aureus were persistent carriers, and the rest either intermittent or transient carriers. Toxin-producing S. aureus was also identified in family members of women carrying the same organism. This report defines the prevalence of genital colonization in a large population of women, characterizes the women with S. aureus, and describes epidemiologic features of genital carriage.