Automatic identification of fungi in microscopic leucorrhea images.

Identifying fungi in microscopic leucorrhea images provides important information for evaluating gynecological diseases. Subjective judgment and fatigue can greatly affect recognition accuracy. This paper proposes an automatic identification system to detect fungi in leucorrhea images that incorporates a convolutional neural network, the histogram of oriented gradients algorithm, and a binary support vector machine. In experiments, the detection rate of the positive samples was as high as 99.8%. The experimental results demonstrate the effectiveness of the proposed method and its potential as a primary software component of a completely automated system.

[Causation and treatment of infectious leucorrhoea at the Cocody University Hospital (Abidjan, Côte d'Ivoire)]. / Etiologie et prise en charge thérapeutique des leucorrhées infectieuses au CHU de Cocody (Abidjan, Côte d'Ivoire).

OBJECTIVES: to determine the frequency of different bacteria causing infectious leucorrhoea and to calculate the percentage of cures after standard treatment. PATIENTS AND METHODS: This 7-month prospective descriptive study took place from October 2003 through April 2004 in the gynaecology department of Cocody University Hospital and in the department of sexually-transmitted infections of the Pasteur Institute of Côte d'Ivoire. After identification of the organism causing each case of leucorrhoea, we prescribed treatment according to a standard protocol. Vaginal samples were taken after treatment and tested to assess its success. RESULTS: The most frequent bacteria discovered, in descending order, were: Gardnerella vaginalis (47%), Candida albicans (29.4%), Chlamydia trachomatis (13.7%), Trichomonas vaginalis (6.9%), and Neisseria gonorrhoeae (2.9%). The overall cure rate was 87%. Treatment failure was most common for C. trachomatis (8 of 14 cases, 57.1%), N. gonorrhoeae (1 of 3 cases) and T. vaginalis (2 of 7 cases, 28.6%). Treatment was 100% effective for G. vaginalis and C. albicans. CONCLUSION: The fight against sexually-transmitted infections should be intensified, and patients and physicians cautioned about use of doubtful generic drugs.

Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations.

Numerous previous studies of nonspecific vaginitis have yielded contradictory results regarding its cause and clinical manifestations, due to a lack of uniform case definition and laboratory methods. We studied 397 consecutive unselected female university students and applied sets of well defined criteria to distinguish nonspecific vaginitis from other forms of vaginitis and from normal findings. Using such criteria, we diagnosed nonspecific vaginitis in up to 25 percent of our study population; asymptomatic disease was recognized in more than 50 percent of those with nonspecific vaginitis. A clinical diagnosis of nonspecific vaginitis, based on simple office procedures, was correlated with both the presence and the concentration of Gardnerella vaginalis (Hemophilus vaginalis) in vaginal discharge, and with characteristic biochemical findings in vaginal discharge. Nonspecific vaginitis was also correlated with a history of sexual activity, a history of previous trichomoniasis, current use of nonbarrier contraceptive methods, and, particularly, use of an intrauterine device. G. vaginalis was isolated from 51.3 percent of the total population using a highly selective medium that detected the organism in lower concentration in vaginal discharge than did previously used media. Practical diagnostic criteria for standard clinical use are proposed. Application of such criteria should assist in clinical management of nonspecific vaginitis and in further study of the microbiologic and biochemical correlates and the pathogenesis of this mild but quite prevalent disease.

Microbial flora of the vagina and cervix.

The microbial flora of the vagina and cervix was assessed qualitatively and semiquantitatively in 40 women attending an intrauterine contraceptive device clinic. Both sites harboured many types of macroorganism, the mean number of microbial types isolated being five from the vagina and four from the cervix. Typical lactobacilli were detected in 61% of vaginal and in 53% of cervical specimens; faecal bacteria, including anaerobes, were even more frequently found at both sites. No differences in the microbial populations at either the vagina or the cervix were detected after fitting of the devices, in the different weeks of the menstrual cycle, or with various previously used contraceptive methods.

Endotoxin in vaginal fluid of women with bacterial vaginosis.

The concentration of endotoxin in vaginal fluid was measured in 19 women with bacterial vaginosis and in nine controls with normal vaginal flora. The vaginal fluid of the women with bacterial vaginosis contained significantly greater amounts of endotoxin: 0.308 +/- 0.396 versus 0.008 +/- 0.002 endotoxin units/mg vaginal fluid. Endotoxin in vaginal fluid may contribute to the activation of the prostaglandin system, which could provoke premature labor.

Chlamydia trachomatis as a cause of prepubertal vaginitis.

Chlamydia trachomatis was encountered in four cases during the evaluation of 29 premenarchal girls with gynecologic complaints during 1983. Only one of the patients had antecedent infection with Neisseria gonorrhoeae. The importance of using specific tests to actively establish a definite diagnosis of chlamydia is stressed. The susceptibility of the thin premenarchal vaginal mucosa to chlamydial infection is discussed as is the role of chlamydia as a marker for sexual abuse. Once a diagnosis of chlamydial rectogenital infection is established in a child, it is mandatory to investigate for child abuse and sexual molestation as the source of the infection.

Virulence of transparent and opaque colony types of Neisseria gonorrhoeae for the genital tract of mice.

The virulence of transparent (Tr) and opaque (Op) colony types of Neisseria gonorrhoeae in the genital tract of female mice was evaluated at two stages of oestrous. Isogenic pairs of Tr and Op variants were isolated from N. gonorrhoeae strain 57-120. Both variants exhibited a T2 morphology, but only the Op variant possessed protein II (P.II) in outer-membrane fractions. When administered by intravaginal inoculation Op gonococci were highly infective only for mice in late pro-oestrous, whereas Tr gonococci were virulent for mice at both late pro-oestrous and dioestrous. Gonococci recovered from the uterus were of both Tr and Op phenotypes in equal proportions when mice were infected at dioestrous with Tr cells. In contrast, greater than 90% of recovered colonies were of Op phenotype when mice were infected at late pro-oestrous with either Op or Tr cells. These results indicate that the virulence of gonococci for the genital tract of female mice differs from that for the chicken embryo. Furthermore, gonococcal survival in the female genital tract might be attributable to phase variation from Tr to Op phenotypes.

Characteristics of motile curved rods in vaginal secretions.

Motile curved rods seen in vaginal secretions have been isolated on Columbia agar supplemented with 5% human blood and vitamin K. Growth occurred anaerobically and in 5% oxygen but not in more aerobic conditions. There were two distinct groups of these organisms, distinguishable by morphology, biochemical activity and susceptibility to metronidazole. All isolates were sensitive to a wide range of antimicrobial agents, with the exception of nalidixic acid and polymyxin, but one group was resistant to metronidazole. There was little difference between the results of tests of susceptibility to aminoglycosides or to metronidazole performed in anaerobic and microaerophilic conditions. Motile curved rods were isolated from 18 of 80 patients with a clinical diagnosis of non-specific vaginitis, but from only two of 39 without the disease.

Itraconazole versus placebo in the management of vaginal candidiasis.

A randomized double-blind trial was carried out with itraconazole versus placebo in the treatment of vaginal candidiasis, confirmed by clinical evaluation, direct microscopic examination and Sabouraud culture. Fifty patients were studied, 25 in the itraconazole group and 25 in the placebo group. Both groups received two capsules once daily (100 mg itraconazole/cap) for 3 days. One week after treatment patients were re-evaluated according to the same parameters as in selection. The scores for clinical symptoms, leukorrhea, vulvar pruritus, vaginitis and vulvitis, were compared in both groups before and after treatment. Statistically significant differences were found for the itraconazole group in pruritus and vaginitis (P less than 0.05) and vulvitis (P less than 0.001), with no significant difference for leukorrhea. As to the mycological evaluation, 7 days after treatment there were negative results for the itraconazole group in 92% of the patients in comparison to 52% in the placebo group (chi-square, P = 0.005).

Vaginal discharge in the adult: a practice guideline.

A practice guideline as a preformatted chart is presented. It is designed to be simple in concept and design, easy to use, parsimonious of data, easily scanned for quality assurance, and to provide clinical and cost-effectiveness prompts. It has supporting medical information for all recommendations that is literature- and experience-based. A patient aftercare instruction sheet is appended. An abbreviated "pocket practice guideline" is also provided. This format is clearly appropriate only for simple, not complex, clinical encounters.

Application of an enzyme-linked immunosorbent assay for detection of Brucella antigens in vaginal discharge of cows.

An enzyme-linked immunosorbent assay (ELISA) was developed for detecting Brucella abortus. Carbodiimide cyanamide was used as an antigen-coupling agent and NH4Cl was used to neutralize residual active charges present on the cuvette surface. Suitable ELISA reactions were observed in vaginal swabs placed in phosphate-buffered saline solution. The ELISA described may be useful under controlled laboratory conditions for detecting B abortus-infected cows shedding bacteria in vaginal secretions.

First isolation of Campylobacter jejuni from the vaginal discharge of three bitches after abortion in South Africa.

Campylobacter jejuni was isolated in pure culture from the vaginal discharge from three German Shepherd bitches after late-pregnancy abortions. The main clinical sign occurring in the bitches was a profuse and odourless haemorrhagic vaginal discharge.

Vulvovaginitis in the preadolescent girl.

Vaginal discharges in prepubertal girls can be categorized under two broad headings--those with specific microbiological causes and, in the absence of such, those that are nonspecific in origin. For specific vulvovaginitis, treatment should be tailored to the findings on cultures, wet mounts, KOH, or other slide preparations. For the sexually transmissible organisms resulting in a vaginal discharge, thorough social service investigation should be undertaken in addition to appropriate antibiotic therapy. When a microbiological cause cannot be found and a foreign body has been ruled out, one is left with a diagnosis of nonspecific vulvovaginitis; treatment goals should be aimed at reassuring and re-educating the patient and parents in good hygienic practices as well as the elimination of potential irritants.

[Characterisation of Corynebacterium vaginale by the fluorescent antibody technic (author's transl)]. / Apport de l'immunofluorescence à la caractérisation de Corynebacterium vaginale.

When using the serum of rabbits immunized against the reference vaginal strain 594 of Gardner and Dukes, the authors tried to find an antigenic identity between this strain and the usual strains that can ordinarily be detected in vaginal samples. The immunizing process that has been used is indirect immunofluorescence. Through these studies, it is possible to conclude that, besides usual strains identical to the reference strain, some specific strains can be detected that have the same microscopic and cultural characteristics as Corynebacterium vaginale but that are deprived of its antigenic characteristics.

[Chlamydia trachomatis: detection using a direct test and culture in 100 genital specimens]. / Chlamydia trachomatis: recherche par test direct et par culture dans 100 prélèvements génitaux.

We have used in routine fluorescein labelled monoclonal antibodies to detect directly C. trachomatis in genital smears from 68 men with urethritis and 32 women with leukorrhoea or cervicitis. We have compared the results with those obtained by culture on cycloheximide treated McCoy cells stained by Giemsa. C. trachomatis was detected in men respectively from 31 per cent of urethral specimens by culture and 29 per cent by direct test and in women from 12 per cent of cervical specimens by culture and 9 per cent by direct test. There was agreement between the results in 92 per cent of the specimen tested. Discrepancies were observed in case of low number of inclusions in culture or low number of elementary bodies in direct test. The direct test seems a rapid and sensitive method and can be performed by many laboratories.

[Prevalence of 4 agents of sexually transmitted diseases in leukorrhea in Abidjan (Ivory Coast)]. / Prévalence de quatre agents des maladies transmises sexuellement au cours des leucorrhées à Abidjan (Côte-D'Ivoire).

6,603 women with vaginal discharges were investigated for genital infection with four sexually transmitted diseases. Germs of vaginitis were isolated with prevalence as following: C. albicans 25%, G. vaginalis 17.4%, T. vaginalis 8.2%. Cervicitis with N. gonorrhoeae represented 3.2% of cases.

[Gardnerella vaginalis. Frequency of its isolation from women complaining of leukorrhea]. / Gardnerella vaginalis. Fréquence de son isolement chez la femme se plaignant de leucorrhées.

A study was carried out on 131 vaginal swabs that were taken from 98 women who had a discharge and 33 women who were asymptomatic to determine the frequency in which Gardnerella vaginalis was discovered. This study shows that this bacteria is the only micro-organism that is found in a significantly higher number of women with nonspecific discharges (37%) than in those who have no discharge (9.1%). These results, while they do not show that Gardnerella vaginalis is the only aetiological factor in nonspecific vaginitis, do underline that it is a factor in thinking about such a syndrome and therefore it should be looked for by the laboratory and by the doctor treating patients.

[Aspects of sexually transmissible diseases in young children in Burundi: gonorrhea caused by sexual abuse]. / Un aspect des maladies sexuellement transmissibles chez le jeune enfant au Burundi: les gonococcies secondaires à des sévices sexuels.

The purpose of this study was to demonstrate the existence of sexually transmitted diseases secondary to sexual abuse inflicted on young infants in Black Africa. A total of 230 files involving infants presenting leucorrhea or urethral discharge were reviewed in Bujumbura (Burundi) to select only cases with bacteriologically documented gonorrhea. A total of 2 such cases were identified during the period from 1987 to 1992. There were 20 girls and 5 boys with a mean age of 6.4 years. In 4 cases, rape was proven. In 9 cases the contaminator could not be identified, but in 12 cases medical and legal evidence showed that the alleged authors of sexual abuse was a domestic employee at the child's home. These findings indicated that sexual abuse in children is not an uncommon occurrence in Black Africa and often leads to gonorrhea. The consequences of such abuse are aggravated by the epidemic of human immunodeficiency virus. The authors recommend a practical approach that should be taken whenever sexual abuse is suspected in these countries.

Primary isolation of curved rods from women with vaginal discharge.

The occurrence of motile anaerobic curved rods in vaginal discharge was studied in 94 samples from women attending an STD clinic. Almost all wet smear preparations of discharge contained motile rods. Anaerobic curved rods were isolated from 46% of the samples. Of 28 specimens studied by culture and immunofluorescence, 21 were confirmed to harbour motile anaerobic curved rods. Culture was performed with a dilution and sampling technique that is too time-consuming for diagnostic routines, but it enhanced the precision of information on motile anaerobic curved rods in vaginal secretion. More selective and rapid methods for identification of these bacteria are desirable.