Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears

Urinary tract infections are responsible for most human infections, these are caused by bacteria, fungi, protozoa and associated microorganisms. The goal of this study was to determine the rate of vaginal infection-causing agents in routine cytological exams and also to evaluate the characteristics of positive tested Pap smears. A retrospective documental with descriptive aspect research was performed in a Clinical Pathology laboratory from Maceió-AL. The results of the Pap smears exams for Trichomonas vaginalis, Gardnerella vaginalis, Candida spp and HPV were arranged in a database as well as other data such as bacterial, protozoan, fungal and viral coinfections. The sample was composed by 18.645 women who have undergone Pap smear exams from 2013 to 2017. Of these analyzed exams, 27.4% in 2013, 10.9% in 2014, 10.6% in 2015, 15.2% in 2016 and 13.67% in 2017 were within normal range, however more than half of these exams presented some infections caused by unspecific or microbiological agents. By analyzing all the reports, 4.073 (21.84%) presented inflammations caused by some species of infectious agent with the following rate order: G. vaginalis and T. vaginalis. Furthermore, it was possible to confirm high rates of coinfection by and Candida spp. The rate of genital infections in this study highlights that there is a public health matter that must be controlled, which points a greater need for monitoring, guidance and actions towards greater awareness in order to prevent these problems.

Pathway Analysis of Behavioral Determinants in Preventing Genital Infections of Santri Putri Pondok Pesantren : Application of The Integrated Behavior Model

Female students who live in Islamic boarding schools are a population at risk for genital infections. The practice of personal/vaginal hygiene or menstrual hygiene is a form of maintaining reproductive health by preventing genital infections. Some bad behavior related to vaginal hygiene is a trigger factor for female genital infections. This study aimed to examine the factors behind the behavior of preventing genital infection in female students in the Islamic boarding school environment. This study was a quantitative study with a cross-sectional design. The population in this study was all female students. Determination of the sample in this study was carried out randomly with the number of subjects determined based on the rule-of-thumb sample size for path analysis, namely a minimum of 100 subjects, a minimum of 5 subjects per parameter, and a minimum of 10 subjects per variable. So that a sample of 150 female students was determined. The independent variable in this study was the behavior of preventing genital infection, while the dependent variables was: (1) behavioral intentions, (2) correct knowledge about behavior, (3) perception of the meaning of behavior, (4) environmental barriers, (5) experiential attitudes, (6) instrumental attitudes, (7) injunctive norms, (8) descriptive norms, (9) perceived behavioral control, (10) self-efficacy. This study indicated that infection prevention behavior can be determined by the behavior of female students prevention of genital infection is not influenced by the behavior of environmental barriers. Good knowledge and skills did not affect female students in taking measures to prevent genital infections; therefore, it was necessary to develop a more heterogeneous number of respondents and a questionnaire that can be understood by respondents so that an integrated behavioral model can become a reference to change behavior, and use methods that can improve their behavior.

Complete Genome Sequence of Schaalia turicensis Strain CT001, Isolated from a Patient with Gonococcal Urethritis in Thailand

Schaalia turicensis , a Gram-positive bacillus, is a potential pathogen in genital infections. Here, we report the complete genome sequence of S. turicensis strain CT001, which was coisolated with Neisseria gonorrhoeae . Comprehensive analysis revealed the presence of a composite transposon carrying an imperfect class 1 integron in S. turicensis .

Endocrine Disorders and Genital Infections Impair Gynecological Health in APECED (APS-1)

ObjectiveIn autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) defects in the autoimmune regulator gene lead to impaired immunotolerance. We explored the effects of immunodeficiency and endocrinopathies on gynecologic health in patients with APECED.DesignCross-sectional cohort study combined with longitudinal follow-up data.MethodsWe carried out a gynecologic evaluation, pelvic ultrasound, and laboratory and microbiologic assessment in 19 women with APECED. Retrospective data were collected from previous study visits and hospital records.ResultsThe study subjects’ median age was 42.6 years (range, 16.7-65.5). Sixteen patients (84%) had premature ovarian insufficiency, diagnosed at the median age of 16.5 years; 75% of them used currently either combined contraception or hormonal replacement therapy. In 76% of women, the morphology and size of the uterus were determined normal for age, menopausal status, and current hormonal therapy. Fifteen patients (79%) had primary adrenal insufficiency; three of them used dehydroepiandrosterone substitution. All androgen concentrations were under the detection limit in 11 patients (58%). Genital infections were detected in nine patients (47%); most of them were asymptomatic. Gynecologic C. albicans infection was detected in four patients (21%); one of the strains was resistant to azoles. Five patients (26%) had human papillomavirus infection, three of which were high-risk subtypes. Cervical cell atypia was detected in one patient. No correlation between genital infections and anti-cytokine autoantibodies was found.ConclusionsOvarian and adrenal insufficiencies manifested with very low androgen levels in over half of the patients. Asymptomatic genital infections, but not cervical cell atypia, were common in female patients with APECED.

Multicenter comparison of nucleic acid amplification tests for the diagnosis of rectal and oropharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae infection.

Research using nucleic acid amplification tests (NAATs) have repeatedly found rectal and oropharyngeal infections with Chlamydia trachomatis and Neisseria gonorrhoeae to be common and potentially more difficult to treat than genital infections. Unfortunately, public health and patient care efforts have been hampered by the lack of FDA-cleared NAATs with claims for anorectal or oropharyngeal samples. At the time of the initiation of this study, no commercially available assays had these claims. We formed a novel partnership among academic institutions and diagnostic manufacturers to address this public health need. From May 2018 through August 2019 we recruited 1108 women, 1256 men and 26 transgender persons each of whom provided 3 anal and 3 oropharyngeal swab specimens. The 3 anal swabs were pooled into a single transport tube as were the 3 oropharyngeal swabs. The performance of each of three study assays was estimated by comparison to the composite result and relative to one another. Percent positivity for chlamydia was 5.9 and 1.2% from anal and oropharyngeal specimens, respectively compared to 4.2 and 4.1% for gonorrhea. Sensitivity for chlamydia detection ranged from 81.0-95.1% and 82.8-100% for anal and oropharyngeal specimens, respectively. Gonorrhea sensitivity ranged from 85.9-99.0% and 74.0-100% for anal and oropharyngeal samples, respectively. Specificity estimates were ≥ 98.9% for all assays, organisms and sample types. Although there was heterogeneity between sensitivity estimates, these assays offer better ability to detect extra genital infections than culture and potential solutions for providing appropriate sexual healthcare for populations in which these infections are of concern.

Comparative study of cervical-vaginal microbial flora changes in women using Cu-T380A contraceptive device and LNG-IUS in Ibadan: a two-centre clinical COHORT study

Background: Intrauterine devices cause various changes in the female genital tract which might result in altered microbial flora and risk of genital infections. The aim of this study was to determine the change in bacterial flora of women using Copper-bearing T380A and levonorgestrel intrauterine system and the risk of genital infections.Methods: This was a two-center clinical cohort study of women using Cu-T380A IUD and LNG-IUS in Ibadan, Nigeria. The study was conducted from March to August, 2016 and it involved 130 women (66 Cu-T380A and 64 LNG-IUS) at 2 family planning clinics in Ibadan, Nigeria. The clients were clinically assessed before admission into the study and high vaginal and endocervical swabs were taken before insertion of the devices, and at 3 and 6months after insertion.Results: Fifty-seven clients with LNG and 63 with copper T380A completed the study. The mean age in LNG-IUS was 34.4years (SD= 6.3) and Cu-T380A was 35.4 years (SD=5.6). All participants had one sexual partner. There was no previous or current STIs/PID at recruitment. The organisms isolated included coagulase negative Staphylococcus (CNS), Staphylococcus aureus, Streptococcus spp, Escherichia coli, Candida spp, Neisseria gonorrhoeae and Klebsiella spp. Cu-T380A women had an increase or persistence of CNS, Staphylococci, Klebsiella and Candida at 3 months while in the LNG-IUS group only CNS increased. The HVS revealed that participants with Cu-T380A had higher risks (33.3%) for asymptomatic genital infections than the LNG-IUS (5.3%) group at 6 months (p value <0.001).Conclusions: Cu-T380A has a higher likelihood of altering the microbial flora in the cervix and vagina and therefore encouraging the growth of a variety of other organisms compared to LNG-IUS.

Symptomatic Female Genital Tract Infections Due to Neisseria meningitidis in Athens, Greece

Neisseria meningitidis is considered as an obligate human pathogen and can cause life-threatening diseases like meningitis and/or septicaemia. Occasionally, it can be recovered from infections outside the bloodstream or central nervous system, like respiratory, ocular, joint, urogenital or other unusual sites. Herein, we present two rare cases of female genital infections due to N. meningitidis within a two-year period (2019–2020), identified as serogroup B (MenB) and Y (MenY), respectively. Genotypic analysis for PorA, FetA and MLST revealed the following characteristics: MenB: 7-12, 14, F5-36, 1572cc and MenY: 5-1,10-1, F4-5, 23cc, respectively. Such unusual presentations should alert the clinicians and microbiologists not to exclude N. meningitidis from routine diagnosis and the need of early detection. This is the first report in Greece, and, to our knowledge, in Europe since 2005 describing meningococcal female genital infections.

Diagnosis of Chlamydia trachomatis genital infections in the era of genomic medicine

Purpose Chlamydial genital infections constitute significant sexually transmitted infections worldwide. The often asymptomatic status of C. trachomatis (CT) infections leads to an increased burden on human reproductive health, especially in middle- and low-income settings. Early detection and management of these infections could play a decisive role in controlling this public health burden. The objective of this review is to provide an insight into the evolution of diagnostic methods for CT infections through the development of new molecular technologies, emphasizing on -omics’ technologies and their significance as diagnostic tools both for effective patient management and control of disease transmission. Methods Narrative review of the diagnostic methodologies of CT infections and the impact of the introduction of -omics’ technologies on their diagnosis by review of the literature. Results Various methodologies are discussed with respect to working principles, required specifications, advantages, and disadvantages. Implementing the most accurate methods in diagnosis is highlighted as the cornerstone in managing CT infections. Conclusion Diagnostics based on -omics’ technologies are considered to be the most pertinent modalities in CT testing when compared to other available methods. There is a need to modify these effective and accurate diagnostic tools in order to render them more available and feasible in all settings, especially aiming on turning them to rapid point-of-care tests for effective patient management and disease control.

Economic evaluation of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low- and middle-income countries: A systematic review

Background Sexually transmitted and genital infections in pregnancy are associated with adverse pregnancy and birth outcomes. Point-of-care tests for these infections facilitate testing and treatment in a single antenatal clinic visit and may reduce the risk of adverse outcomes. Successful implementation and scale-up depends on understanding comparative effectiveness of such programmes and their comparative costs and cost effectiveness. This systematic review synthesises and appraises evidence from economic evaluations of point-of-care testing and treatment for sexually transmitted and genital infections among pregnant women in low- and middle-income countries. Methods Medline, Embase and Web of Science databases were comprehensively searched using pre-determined criteria. Additional literature was identified by searching Google Scholar and the bibliographies of all included studies. Economic evaluations were eligible if they were set in low- and middle-income countries and assessed antenatal point-of-care testing and treatment for syphilis, chlamydia, gonorrhoea, trichomoniasis, and/or bacterial vaginosis. Studies were analysed using narrative synthesis. Methodological and reporting standards were assessed using two published checklists. Results Sixteen economic evaluations were included in this review; ten based in Africa, three in Latin and South America and three were cross-continent comparisons. Fifteen studies assessed point-of-care testing and treatment for syphilis, while one evaluated chlamydia. Key drivers of cost and cost-effectiveness included disease prevalence; test, treatment, and staff costs; test sensitivity and specificity; and screening and treatment coverage. All studies met 75% or more of the criteria of the Drummond Checklist and 60% of the Consolidated Health Economics Evaluation Reporting Standards. Conclusions Generally, point-of-care testing and treatment was cost-effective compared to no screening, syndromic management, and laboratory-based testing. Future economic evaluations should consider other common infections, and their lifetime impact on mothers and babies. Complementary affordability and equity analyses would strengthen the case for greater investment in antenatal point-of-care testing and treatment for sexually transmitted and genital infections.