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Tsang HF, Cheung YS, Yu CSA, Chan CSS, Wong CBT, Yim KYA, Pei X, Wong SCC. Menstrual Blood as a Diagnostic Specimen for Human Papillomavirus Genotyping and Genital Tract Infection Using Next-Generation Sequencing as a Novel Diagnostic Tool. Diagnostics (Basel) 2024; 14:686. [PMID: 38611599 PMCID: PMC11012019 DOI: 10.3390/diagnostics14070686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/04/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Menstrual blood (MB) is a convenient specimen type that can be self-collected easily and non-invasively by women. This study assessed the potential application of MB as a diagnostic specimen to detect genital tract infections (GTIs) and human papillomavirus (HPV) infections in women. METHOD Genomic DNA was extracted from MB samples. Pacific Bioscience (Pacbio) 16S ribosomal DNA (rDNA) high-fidelity (HiFi) long-read sequencing and HPV PCR were performed. RESULTS MB samples were collected from women with a pathological diagnosis of CIN1, CIN2, CIN3 or HPV infection. The sensitivity and positive predictive value (PPV) of high-risk HPV detection using MB were found to be 66.7%. A shift in vaginal flora and a significant depletion in Lactobacillus spp. in the vaginal microbiota communities were observed in the MB samples using 16S rDNA sequencing. CONCLUSIONS In this study, we demonstrated that MB is a proper diagnostic specimen of consideration for non-invasive detection of HPV DNA and genotyping using PCR and the diagnosis of GTIs using metagenomic next-generation sequencing (mNGS). MB testing is suitable for all women who menstruate and this study has opened up the possibility of the use of MB as a diagnostic specimen to maintain women's health.
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Affiliation(s)
- Hin-Fung Tsang
- Department of Clinical Laboratory and Pathology, Hong Kong Adventist Hospital, Hong Kong SAR, China
| | - Yui-Shing Cheung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China; (Y.-S.C.); (C.-S.S.C.)
| | - Chi-Shing Allen Yu
- Codex Genetics Limited, Hong Kong SAR, China; (C.-S.A.Y.); (C.-B.T.W.); (K.-Y.A.Y.)
| | - Chung-Sum Sammy Chan
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China; (Y.-S.C.); (C.-S.S.C.)
| | - Chi-Bun Thomas Wong
- Codex Genetics Limited, Hong Kong SAR, China; (C.-S.A.Y.); (C.-B.T.W.); (K.-Y.A.Y.)
| | - Kay-Yuen Aldrin Yim
- Codex Genetics Limited, Hong Kong SAR, China; (C.-S.A.Y.); (C.-B.T.W.); (K.-Y.A.Y.)
| | - Xiaomeng Pei
- Department of Applied Biology & Chemical Technology, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Sze-Chuen Cesar Wong
- Department of Applied Biology & Chemical Technology, The Hong Kong Polytechnic University, Hong Kong SAR, China;
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Qian Y, Qian G, Ni H, Zhu D, Gu W, Cai X. Exploratory study on the mechanism of necrotic effect of nourishing cells in the context of genital tract infection in premature rupture of membranes. Medicine (Baltimore) 2023; 102:e36148. [PMID: 38115314 PMCID: PMC10727640 DOI: 10.1097/md.0000000000036148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 12/21/2023] Open
Abstract
To explore the mechanism of necrotic effect of nourishing cells in the context of genital tract infection in premature rupture of membranes (PROM). One hundred eight patients with PROM treated at our hospital from June 2020 to June 2022 were selected as the PROM group. Simultaneously, 108 cases of normal full-term pregnant women were chosen as the control group. Western blot analysis was performed to measure the relative expression levels of cysteinyl aspartate specific proteinase-1 (Caspase-1), cysteinyl aspartate specific proteinase-3 (Caspase-3), nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3), and interleukin (IL)-1β proteins, which are associated with necrosis of placental nourishing cells, in the placenta of both groups. TUNEL staining was used to detect the number of apoptotic placental nourishing cells. The differences in necrotic factors of placental nourishing cells were analyzed between full-term and preterm cases in the PROM group, as well as among patients with different genital tract infections. The apoptotic count of placental nourishing cells in the PROM group was 58.46 ± 11.26 cells/field, which was markedly higher than that of the control group (P < .05). The relative expression levels of the necrotic factors Caspase-1, Caspase-3, NLRP3, and IL-1β proteins in placental nourishing cells of the PROM group were 1.32 ± 0.26, 1.19 ± 0.30, 1.29 ± 0.28, and 1.23 ± 0.24, respectively. These values were significantly higher than those of the control group (P < .05). The relative expression levels of the necrotic factors Caspase-1, Caspase-3, NLRP3, and IL-1β proteins in placental nourishing cells were compared between full-term and preterm patients in the PROM group (P > .05). The relative expression levels of the necrotic factors Caspase-1, Caspase-3, NLRP3, and IL-1β proteins in placental nourishing cells were higher in patients with multiple genital tract infections compared to those with single infections or no infections in the PROM group (P < .05). PROM is associated with a significant upregulation of placental nourishing cell apoptosis and necrotic factors, including Caspase-1, Caspase-3, NLRP3, and IL-1β proteins. This upregulation is correlated with the presence of genital tract infections.
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Affiliation(s)
- Yunying Qian
- Department of Obstetrics and Gynecology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Guiying Qian
- Department of Pharmacy, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Haiyan Ni
- Department of Obstetrics and Gynecology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Danying Zhu
- Department of Obstetrics and Gynecology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Weiqun Gu
- Department of Obstetrics and Gynecology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Ximei Cai
- Department of Obstetrics and Gynecology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
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Li T, Liu Z, Zhang D, Liao Q, Fan S, Hao M, Hong Y, Huang X, Wang H, Xiong Z, Xu H, Xue F, Xue M, Yang X, Zhang J. Prevalence of and risk factors for chlamydia in female outpatients with genital tract infections: a nationwide multi-center, cross-sectional study in China. Front Public Health 2023; 11:1182108. [PMID: 37397732 PMCID: PMC10311204 DOI: 10.3389/fpubh.2023.1182108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Chlamydia trachomatis is the etiological agent of the commonest sexually transmitted bacterial infection. This study aimed to examine the prevalence of genital chlamydia and associated risk factors in Chinese female outpatients with genital tract infections. Methods A prospective, multicenter epidemiological study of genital chlamydia prevalence in 3008 patients with genital tract infections in 13 hospitals in 12 provinces of China was performed between May 2017 and November 2018. Vaginal secretion specimens were collected for the clinical diagnosis of vaginitis, whereas cervical secretion specimens were tested for Chlamydia trachomatis and Neisseria gonorrhoeae. All patients participated in a one-on-one cross-sectional questionnaire interview. Results Totally 2,908 participants were included. The prevalence rates of chlamydia and gonococcal infections in women with genital tract infections were 6.33% (184/2908) and 0.01% (20/2908), respectively. Multivariate analysis showed high risk factors for chlamydia were premarital sex behavior, first sexual intercourse before the age of 20 and bacterial vaginosis. Discussion Given that most chlamydia cases are asymptomatic and no vaccine is currently available, chlamydia prevention strategies should include behavioral interventions as well as early screening programs to identify and treat individuals with genital tract infections, especially those with the above identified risk factors.
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Affiliation(s)
- Ting Li
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Liu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Dai Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Qinping Liao
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Shangrong Fan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Min Hao
- Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ying Hong
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Xiufeng Huang
- Department of Obstetrics and Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huilan Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhengai Xiong
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fengxia Xue
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin, China
| | - Min Xue
- Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xingsheng Yang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Jianqing Zhang
- Department of Obstetrics and Gynecology, Qinghai Red Cross Hospital, Xining, China
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Wang Y, He R, Winner H, Gauduin MC, Zhang N, He C, Zhong G. Induction of Transmucosal Protection by Oral Vaccination with an Attenuated Chlamydia. Infect Immun 2023; 91:e0004323. [PMID: 37036335 PMCID: PMC10187116 DOI: 10.1128/iai.00043-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/14/2023] [Indexed: 04/11/2023] Open
Abstract
Chlamydia muridarum has been used to study chlamydial pathogenesis because it induces mice to develop hydrosalpinx, a pathology observed in C. trachomatis-infected women. We identified a C. muridarum mutant that is no longer able to induce hydrosalpinx. In the current study, we evaluated the mutant as an attenuated vaccine. Following an intravaginal immunization with the mutant, mice were protected from hydrosalpinx induced by wild-type C. muridarum. However, the mutant itself productively colonized the mouse genital tract and produced infectious organisms in vaginal swabs. Nevertheless, the mutant failed to produce infectious shedding in the rectal swabs following an oral inoculation. Importantly, mice orally inoculated with the mutant mounted transmucosal immunity against challenge infection of wild-type C. muridarum in the genital tract. The protection was detected as early as day 3 following the genital challenge infection and the orally immunized mice were protected from any significant pathology in the upper genital tract. However, the same orally immunized mice failed to prevent the colonization of wild-type C. muridarum in the gastrointestinal tract. The transmucosal immunity induced by the oral mutant was further validated in the airway. The orally vaccinated mice were protected from both lung infection and systemic toxicity caused by intranasally inoculated wild-type C. muridarum although the same mice still permitted the gastrointestinal colonization by the wild-type C. muridarum. These observations suggest that the mutant C. muridarum may be developed into an intracellular oral vaccine vector (or IntrOv) for selectively inducing transmucosal immunity in extra-gut tissues.
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Affiliation(s)
- Yihui Wang
- Key Laboratory of Animal Epidemiology and Zoonosis, Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, People’s Republic of China
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Rongze He
- Key Laboratory of Animal Epidemiology and Zoonosis, Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, People’s Republic of China
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Halah Winner
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Marie-Claire Gauduin
- Department of Virology, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Nu Zhang
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Cheng He
- Key Laboratory of Animal Epidemiology and Zoonosis, Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, People’s Republic of China
| | - Guangming Zhong
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, Texas, USA
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Zhao Y, Huo Z, Zhou Z, Cervantes C, Chen J, Xu Z, Zhong G. Interleukin-27 (IL-27) Promotes Chlamydial Infection in the Female Genital Tract. Infect Immun 2022;:e0065121. [PMID: 35258318 DOI: 10.1128/iai.00651-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Intravaginal infection of mice with Chlamydia muridarum has been used for investigating the mechanisms of Chlamydia trachomatis-induced pathogenicity and immune responses. In the current study, the mouse model was used to evaluate the impact of interleukin-27 (IL-27) and its receptor signaling on the susceptibility of the female genital tract to chlamydial infection. Mice deficient in IL-27 developed significantly shortened courses of chlamydial infection in the female genital tract. The titers of live Chlamydia recovered from the genital tract of IL-27-deficient mice declined significantly by day 7 following intravaginal inoculation. These observations suggest that IL-27 may promote chlamydial infection in the female mouse genital tract. This conclusion was validated using IL-27 receptor (R)-deficient mice. Further, the reduction in chlamydial burden corelated with the increase in gamma interferon (IFN-γ) and IL-17 in the genital tract tissues of the IL-27R-deificent mice. However, depletion of IFN-γ but not IL-17 from the IL-27R-deificent mice significantly increased the chlamydial burden, indicating that IL-27 may mainly suppress IFN-γ-mediated immunity for promoting chlamydial infection. Finally, knockout of IL-27R from T cells alone was sufficient for significantly shortening the infectious shedding courses of Chlamydia in the mouse genital tract. The above-described results have demonstrated that Chlamydia can activate IL-27R signaling in Th1-like cells for promoting its infection in the female genital tract, suggesting that attenuating IL-27 signaling in T cells may be used for enhancing genital tract immunity against chlamydial infection.
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Abstract
Objective: To systematically review the available literature on the long-term effects of sexually transmitted diseases (STIs) on male reproductive functions. Methods: A PubMed search was conducted on 3 January 2021, and as a result, 952 articles were retrieved. Exclusion of irrelevant articles resulted in 36 articles, dating from 1998 to 2020, which were analysed. Results: Only 52.8% of these articles described original research, while the rest were reviews. The majority (26) of the articles dealt with bacterial infections, of which 20 described Chlamydia trachomatis. There were 11 articles that described research on viruses, with five on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The analysis of the articles showed further that not much new knowledge on the long-term effects on male reproductive functions has been added. The existing knowledge that ascending infections can cause epididymo-orchitis, prostatitis or urethritis was confirmed. Due to epithelial inflammatory responses these infections can result in scarring with resulting infertility due to obstruction. These effects were described for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium or Treponema pallidum, as well as for the Zika and SARS-CoV-2 viruses. Even trichomoniasis can lead to long-term compromised male fertility if not treated. Conclusion: In conclusion, problem awareness needs to be raised and more research on this important topic needs to be conducted.
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Affiliation(s)
- Ralf Henkel
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.,Department of Urology, LogixX Pharma, Theale, Reading, UK.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
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Ko S, Kim H, Shinn J, Byeon SJ, Choi JH, Kim HS. Estimation of sodium-glucose cotransporter 2 inhibitor-related genital and urinary tract infections via electronic medical record-based common data model. J Clin Pharm Ther 2021; 46:975-983. [PMID: 33565150 DOI: 10.1111/jcpt.13381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES In Korea, the side effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) have not been clearly reported, aside from voluntary reporting. We aimed to develop detection algorithms for SGLT2i-related genital tract infections (GTIs) and urinary tract infections (UTIs) via a common data model (CDM), an electronic medical record-based database for supporting multi-hospital clinical research. We estimated the occurrence of GTIs and UTIs and-by assessing the status of each step of the algorithm-we also aimed to determine how clinicians responded to the SGLT2i-related GTIs and UTIs. METHODS We targeted all patients who were prescribed SGLT2i at Catholic University Seoul St. Mary's Hospital and Hallym University Dongtan Sacred Heart Hospital from January 2014 to August 2018. We developed algorithms for detection of SGLT2i-related GTIs or UTIs that divided patients into "most likely," "possibly" or "less likely" categories of GTIs or UTIs. The numbers of patients at each step were extracted. RESULTS AND DISCUSSION A total of 4253 patients received their first prescription of SGLT2i. According to the algorithm used in this study, the proportions of "most likely GTI" and "possibly GTI" were 0.9% (37 out of 4253) and 19.4% (826 out of 4253 patients), respectively. Similarly, the proportions of "most likely UTI" and "possibly UTI" were 0.9% (38 out of 4253) and 20.2% (858 out of 4253 patients), respectively. Compared to the various existing prospective studies, both GTIs and UTIs showed lower occurrence among patients who met "most likely" criteria and higher occurrence among those who met "possibly" criteria. When a GTI or UTI occurred or was suspected, the overall rate of discontinuing SGLT2i was 51.8% (1721 out of 3323). Despite a confirmed or suspected GTI and an UTI, 62.8% (1460 out of 2323) and 14.2% (142 out of 1000) of patients continued to take SGLT2i, respectively. The discontinuation rate for suspected GTIs was significantly lower than that for suspected UTIs (37.2% vs. 85.8%, p < 0.001). WHAT IS NEW AND CONCLUSION In this study, although the GTIs appeared to have a similar occurrence as UTIs, however, the discontinuation rate of SGLT2i for suspected GTIs was relatively lower. Our study is novel in that we identified how the physicians approached SGLT2i-related GTIs or UTIs at each step in a real-world clinical practice setting. Although we could estimate SGLT2i-related GTIs and UTIs via CDM, we were limited in our ability to accurately detect mild drug side effects via CDM, which lacked data for operational definition.
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Affiliation(s)
- SooJeong Ko
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - HyungMin Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jiwon Shinn
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun-Ju Byeon
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Hun-Sung Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Goodfellow L, Care A, Alfirevic Z. Controversies in the prevention of spontaneous preterm birth in asymptomatic women: an evidence summary and expert opinion. BJOG 2020; 128:177-194. [PMID: 32981206 DOI: 10.1111/1471-0528.16544] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 01/11/2023]
Abstract
Preterm birth prevention is multifaceted and produces many nuanced questions. This review addresses six important clinical questions about preterm birth prevention as voted for by members of the UK Preterm Clinical Network. The questions cover the following areas: preterm birth prevention in 'low-risk' populations; screening for asymptomatic genital tract infection in women at high risk of preterm birth; cervical length screening with cerclage or vaginal pessary in situ; cervical shortening whilst using progesterone; use of vaginal progesterone in combination with cervical cerclage; and optimal advice about intercourse for women at high risk of preterm birth.
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Affiliation(s)
- Laura Goodfellow
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Angharad Care
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Zarko Alfirevic
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
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Liu KS, Mao XD, Pan F, Chen YJ. Application of leukocyte subsets and sperm DNA fragment rate in infertile men with asymptomatic infection of genital tract. Ann Palliat Med 2020; 10:1021. [PMID: 32921103 DOI: 10.21037/apm-19-597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 08/04/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND About 15% of male infertility is due to genital tract infection and inflammation, some of them have no clinical symptoms, but manifested as leukocytospermia (LCS). Leukopenia will lead to functional impairment of male sperm and integrity damage of sperm morphology. A large amount of reactive oxygen species (ROS) produced by leukocytes can damage sperm nuclear DNA. The aim of this study was to investigate the correlation between leukocyte subsets and sperm DNA fragmentation rate in semen of infertile men with asymptomatic infection of genital tract. METHODS One hundred and eight cases of infertile men were enrolled, who were admitted to our hospital from May 2016 to September 2018, and all had genital tract infections. After routine sperm analysis, realtime PCR was performed for detecting the infection of chlamydia trachoma (CT) and Ureaplasma urealyticum (UU). Furthermore, total leukocyte count in semen was evaluated by detection of CD45 molecules using immunocytochemistry. Flow cytometry was used for subset analysis, monocyte/macrophages were evaluated by CD14, and activated macrophages were evaluated by HLA-DR antigen. Sperm DNA fragmentation index (DFI) were evaluated by SCD method and 8-hydroxydeoxyguanosine (8-OHdG) expression were evaluated by chromatin diffusion method and TUNEL method; the correlation analysis was conducted between semen leukocyte subsets, sperm DNA fragment rate and conventional semen parameters. RESULTS There was a significant correlation among the concentrations of cells expressing HLA-DR antigen and those expressing CD14 (P<0.01), but the concentrations of differential leukocyte subsets all had no significant correlation with sperm DFI, the percentage of 8-OHdG-expressing cells and routine semen parameters. The percentage of 8-OHdG-expressing sperm was positively correlated with the percentage of sperm fragments (r=0.42, P<0.01), and negatively correlated with sperm concentration (r=-0.32, P<0.01). After adjustment for possible confounders including age, abstinence time and smoking, the percentage of 8-OHdG-expressing sperms independently associated with sperm concentration (β=-0.30; P=0.006) and DFI (β=0.180, P=0.06). CONCLUSIONS Among infertile men with genital tract infection, the sperm DFI is associated with decreased semen quality and not the concentration of differential leukocyte subsets.
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Affiliation(s)
- Kang-Sheng Liu
- Department of Clinical Laboratory, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xiao-Dong Mao
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Feng Pan
- Department of Andrology, State Key Laboratory of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Ya-Jun Chen
- Department of Clinical Laboratory, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.
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Taylor-Robinson D. Thoughts about Mycoplasma hominis. Sex Transm Infect 2020; 96:492. [PMID: 32366603 DOI: 10.1136/sextrans-2020-054479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/25/2020] [Accepted: 04/14/2020] [Indexed: 11/04/2022] Open
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Cowley G, Milne G, Teixeira da Silva E, Nakutum J, Rodrigues A, Vasileva H, Mabey D, Versteeg B, Last A. Prevalence of and risk factors for curable sexually transmitted infections on Bubaque Island, Guinea Bissau. Sex Transm Infect 2020; 97:51-55. [PMID: 32345631 PMCID: PMC7841470 DOI: 10.1136/sextrans-2019-054351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/05/2020] [Accepted: 03/17/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives Complications from sexually transmitted infections (STIs) can result in severe morbidity and mortality. To date, no STI population studies have been conducted on the Bijagos Islands, Guinea Bissau. Our objective was to estimate the prevalence of and identify risk factors for Chlamydia trachomatis (Ct), Neisseria gonorrhoea (Ng), Mycoplasma genitalium (Mg), Trichomonas vaginalis (Tv) and Treponema pallidum (Tp) on Bubaque, the most populated island. Methods A cross-sectional survey was conducted on the island of Bubaque among people aged 16–49 years. Participants were asked to answer a questionnaire on STI risk factors, to provide urine samples (men and women) and vaginal swabs (women) for PCR testing for Ct, Ng, Mg and Tv, and to provide dry blood spots for Tp particle agglutination assays. Data were analysed to estimate the prevalence of STIs and logistic regression was used to identify risk factors. Results In total, 14.9% of participants were found to have a curable STI, with the highest prevalence being observed for Tv (5.9%) followed by Ct (3.8%), Ng (3.8%), Mg (1.9%) and Tp (0.8%). Significant risk factors for having any STI included being female, younger age and concurrent partnership. Having had a previous STI that was optimally treated was a protective factor. Conclusions This study demonstrates that there is a considerable burden of STI on the Bijagos Islands, stressing the need for diagnostic testing to facilitate early detection and treatment of these pathogens to stop ongoing transmission. Moreover, these results indicate the need to conduct further research into the STI burden on the Bijagos Islands to help inform and develop a national STI control strategy.
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Affiliation(s)
| | - Gregory Milne
- Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | | | - Jose Nakutum
- Hospital Regional de Bubaque Marcelino Banca, Bubaque, Guinea-Bissau
| | - Amabelia Rodrigues
- National Institute of Public Health, Guinea Bissau, Bissau, Guinea-Bissau
| | | | - David Mabey
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Bart Versteeg
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Last
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Le MT, Nguyen TLN, Le DD, Ngo TVQ, Nguyen ATC, Nguyen BH, Nguyen HVQ, Cao TN, Salumets A, Mändar R. Is genital tract infection related to tubal diseases in infertile Vietnamese women? J Infect Dev Ctries 2019; 13:906-913. [PMID: 32084021 DOI: 10.3855/jidc.11632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/15/2019] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION The goal of this study was to identify the profile of genital tract infections and their relationship with clinical and demographic parameters as well as tubal diseases among infertile women in Vietnam. METHODOLOGY In this cross-sectional descriptive study, we enrolled 597 women undergoing infertility treatment at the Center for Reproductive Endocrinology and Infertility, Hue University Hospital, Vietnam. All of the study participants were interviewed and examined by a gynecologist. Consecutive tests were then conducted including direct microscopy examination (wet mount and Gram stain), vaginal culture, polymerase chain reaction (PCR) for chlamydia diagnosis from a cervical canal swab, and a blood test for syphilis detection. A hysterosalpingogram (HSG) was carried out to examine the uterine cavity and Fallopian tubes. RESULTS A gynecologic infection was diagnosed in 43.4% (259/597) of the infertile women. Bacterial vaginosis was the most common condition at 19.6%of the cases. Candida spp., Chlamydia trachomatis, and Trichomonas vaginalis infections accounted for 17.4%, 3.7%, and 0.3%, respectively. Normal HSG results accounted for 87.4% of the women while 5.5% had 2-sided tubal occlusions, 5.4% had 1-sided tubal occlusions, 1.0% had 1-sided hydrosalpinx, and 0.7% had 2-sided hydrosalpinx. There was no significant association between tubal diseases and current infections; however, aerobic vaginitis increased the risk of tubal diseases by 2.4 times. CONCLUSIONS A marked proportion of infertile Vietnamese women have genital tract infections that can significantly influence their reproductive function and performance. These infections should be routinely screened and treated properly to prevent their consequences, such as infertility, which is especially important in developing countries.
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Affiliation(s)
- Minh Tam Le
- Department of OBGYN, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
| | - Thi Le Na Nguyen
- Department of OBGYN, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
| | - Duong Dinh Le
- Department of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
| | - Tram Viet Quynh Ngo
- Department of Microbiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
| | - Anh Thi Chau Nguyen
- Department of Microbiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
| | - Bach Hoang Nguyen
- Department of Microbiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
| | - Huy Vu Quoc Nguyen
- Department of OBGYN, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
| | - Thanh Ngoc Cao
- Department of OBGYN, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
| | - Andres Salumets
- Institute of Clinical Medicine, Department of Obstetrics and Gynecology, University of Tartu, Tartu, Estonia.
| | - Reet Mändar
- Competence Centre on Health Technologies, Tartu, Estonia.
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Tao X, Ge SQ, Chen L, Cai LS, Hwang MF, Wang CL. Relationships between female infertility and female genital infections and pelvic inflammatory disease: a population-based nested controlled study. Clinics (Sao Paulo) 2018; 73:e364. [PMID: 30110069 PMCID: PMC6077933 DOI: 10.6061/clinics/2018/e364] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 04/09/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Our purpose was to examine the associations of female genital infections and certain comorbidities with infertility. METHODS The Taiwan National Health Research Database was searched for women with a new diagnosis of infertility between 2000 and 2013. Women without a diagnosis of infertility served as a control group and were matched with the infertility cases by age (±3 years) and index year. They were divided into two groups: ≤40 years old and >40 years old. Univariate and multivariate conditional logistic regression models were employed to identify the risk factors associated with infertility. RESULTS A total of 18,276 women with a new diagnosis of infertility and 73,104 matched controls (mean cohort age, 31±6.2 years) were included. According to the adjusted multivariate analysis, pelvic inflammatory disease involving the ovary, fallopian tube, pelvic cellular tissue, peritoneum (odds ratio (OR)=4.823), and uterus (OR=3.050) and cervical, vaginal, and vulvar inflammation (OR=7.788) were associated with an increased risk of infertility in women aged ≤40 years. In women aged >40 years, pelvic inflammatory disease of the ovary, fallopian tube, pelvic cellular tissue, and peritoneum (OR=6.028) and cervical, vaginal, and vulvar inflammation (OR=6.648) were associated with infertility. Obesity, lipid metabolism disorders, dysthyroidism, abortion (spontaneous or induced), bacterial vaginosis, endometritis, and tubo-ovarian abscess were associated with an increased risk of infertility according to the univariate analysis but not the multivariate analysis. CONCLUSIONS Female genital tract infections, but not the comorbidities studied here, are associated with an increased risk of infertility.
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Affiliation(s)
- Xin Tao
- Center for Reproductive Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China, 510630
- *Corresponding author. E-mail:
| | - Shu-qi Ge
- Department of Infertility and Sexual Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China, 510630
- *Corresponding author. E-mail:
| | - Lei Chen
- Center for Reproductive Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China, 510630
| | - Li-si Cai
- Center for Reproductive Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China, 510630
| | - Muh-fa Hwang
- Department of Obstetrics and Gynecology, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chiung-lang Wang
- Department of Obstetrics and Gynecology, Min-Sheng General Hospital, Taoyuan, Taiwan
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Yang Y, Chen S, Pan H, Zou Y, Wang B, Wang G, Zhu H. Safety and efficiency of SGLT2 inhibitor combining with insulin in subjects with diabetes: Systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017; 96:e6944. [PMID: 28538386 PMCID: PMC5457866 DOI: 10.1097/md.0000000000006944] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/06/2017] [Accepted: 04/21/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We aimed to assess the safety and efficiency of the novel sodium glucose co-transporter 2 (SGLT2) inhibitor in combinations with insulin for type 1 and type 2 diabetes mellitus (T1DM and T2DM). METHODS We searched Medline, Pubmed, Embase, and the Cochrane Collaboration Library from January 2010 to December 2016 without restriction of language. FDA data and Clinical Trials (http://www.clinicaltrials.gov) were also searched. Study selection, data extraction, and evaluation of risk of bias were performed by 2 persons independently. The risk of bias was assessed by Cochrance System Evaluate Method and Q test was used to evaluate the heterogeneity between studies. We used random effect model to analyze the results by Revman 5.3. This meta-analysis has been registered at online public registry PROSPERO (registration number is: CRD42017054718). RESULTS Nine trials including 3069 patients were analyzed. Compared with control group, SGLT2 inhibitor produced absolute reduction in glycosylated hemoglobin A1c (HbA1c) (MD -1.35%, 95% confidence interval [CI] [-2.36 to -0.34], P = .009), fasting plasma glucose (FPG) (MD -1.01 mmol/L, 95%CI [-1.98 to 0.04], P = .04), insulin dosage (MD -4.85 U/24 hours, 95%CI [-7.42 to -2.29], P = .002), and body weight (MD -2.30 kg, 95%CI [-3.09 to -1.50], P < .00001). But the risk of hypoglycemia (OR 1.18, 95%CI [0.86, 1.61], P = . 30) and urinary tract infection (UTI) (OR 1.34, 95%CI [0.79, 2.27], P = .28) were proved as no difference and genital tract infection (GTI) with SGLT2 inhibitors was higher than control group (OR 2.96, 95%CI [1.05, 8.37], P = .04), in which cases were mild and responded to the therapy. According to the subgroup analysis, SGLT2 inhibitors had a similar effect in effective factors of both T1DM and T2DM, but the risk of GTI mainly increased in T2DM versus T1DM (T1DM OR 0.27 [0.01, 7.19], P = .43 vs T2DM OR 4.28 [2.00, 9.16], P = .0002). CONCLUSION SGLT2 inhibitors have improved the HbA1c, FPG, and body weight when combined with insulin and decreased the dose of insulin without increasing the risk of hypoglycemia. However, SGLT2 inhibitor was proved to be related to the events of GTI, despite SGLT2 inhibitors appeared to be well tolerated. We suggest that more monitoring should be done to prevent the events of GTI, and more randomized controlled trials should be planned next step.
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Affiliation(s)
- Yingying Yang
- Department of Endocrinology, Endocrine Key Laboratory of Ministry of Health, Peking Union Medical College Hospital, China Academy of Medical Sciences Peking Union Medical College and Peking Union Medical College, Beijing
| | - Shi Chen
- Department of Endocrinology, Endocrine Key Laboratory of Ministry of Health, Peking Union Medical College Hospital, China Academy of Medical Sciences Peking Union Medical College and Peking Union Medical College, Beijing
| | - Hui Pan
- Department of Endocrinology, Endocrine Key Laboratory of Ministry of Health, Peking Union Medical College Hospital, China Academy of Medical Sciences Peking Union Medical College and Peking Union Medical College, Beijing
| | - Yun Zou
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin
| | - Bo Wang
- Health Science Popularization Research Center, Chinese Academy of Medical Sciences, Beijing
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Huijuan Zhu
- Department of Endocrinology, Endocrine Key Laboratory of Ministry of Health, Peking Union Medical College Hospital, China Academy of Medical Sciences Peking Union Medical College and Peking Union Medical College, Beijing
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Vasilevsky S, Gyger J, Piersigilli A, Pilloux L, Greub G, Stojanov M, Baud D. Waddlia chondrophila induces systemic infection, organ pathology, and elicits Th1-associated humoral immunity in a murine model of genital infection. Front Cell Infect Microbiol 2015; 5:76. [PMID: 26583077 PMCID: PMC4631992 DOI: 10.3389/fcimb.2015.00076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/19/2015] [Indexed: 12/29/2022] Open
Abstract
Waddlia chondrophila is a known bovine abortigenic Chlamydia-related bacterium that has been associated with adverse pregnancy outcomes in human. However, there is a lack of knowledge regarding how W. chondrophila infection spreads, its ability to elicit an immune response and induce pathology. A murine model of genital infection was developed to investigate the pathogenicity and immune response associated with a W. chondrophila infection. Genital inoculation of the bacterial agent resulted in a dose-dependent infection that spread to lumbar lymph nodes and successively to spleen and liver. Bacterial-induced pathology peaked on day 14, characterized by leukocyte infiltration (uterine horn, liver, and spleen), necrosis (liver) and extramedullary hematopoiesis (spleen). Immunohistochemistry demonstrated the presence of a large number of W. chondrophila in the spleen on day 14. Robust IgG titers were detected by day 14 and remained high until day 52. IgG isotypes consisted of high IgG2a, moderate IgG3 and no detectable IgG1, indicating a Th1-associated immune response. This study provides the first evidence that W. chondrophila genital infection is capable of inducing a systemic infection that spreads to major organs, induces uterus, spleen, and liver pathology and elicits a Th1-skewed humoral response. This new animal model will help our understanding of the mechanisms related to intracellular bacteria-induced miscarriages, the most frequent complication of pregnancy that affects one in four women.
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Affiliation(s)
- Sam Vasilevsky
- Materno-fetal and Obstetrics Research Unit, Department of Obstetrics and Gynecology, Maternity, University Hospital Lausanne, Switzerland
| | - Joel Gyger
- Materno-fetal and Obstetrics Research Unit, Department of Obstetrics and Gynecology, Maternity, University Hospital Lausanne, Switzerland
| | - Alessandra Piersigilli
- School of Life Sciences, École Polytechnique Fédérale Lausanne Lausanne, Switzerland ; Institute of Animal Pathology, University of Bern Bern, Switzerland
| | - Ludovic Pilloux
- Centre Hospitalier Universitaire Vaudois, Institute of Microbiology, University Hospital Lausanne, Switzerland
| | - Gilbert Greub
- Centre Hospitalier Universitaire Vaudois, Institute of Microbiology, University Hospital Lausanne, Switzerland
| | - Milos Stojanov
- Materno-fetal and Obstetrics Research Unit, Department of Obstetrics and Gynecology, Maternity, University Hospital Lausanne, Switzerland
| | - David Baud
- Materno-fetal and Obstetrics Research Unit, Department of Obstetrics and Gynecology, Maternity, University Hospital Lausanne, Switzerland
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Abstract
Puerperal genital tract infections, although less common in the 21st century, continue to affect maternal mortality and morbidity rates in the United States. Puerperal genital tract infections include endometritis as well as abdominal and perineal wound infections. These infections interrupt postpartum restoration, increase the potential for readmission to a health care facility, and can interfere with maternal-infant bonding. In addition, unrecognized or improperly treated genital tract infection could extend to other sites via venous circulation or the lymphatic system and increase the risk of severe complications or sepsis. Midwives are leaders in education, low rates of intervention, and prompt recognition of deviation from normal. Because puerperal genital tract infection usually begins after discharge, detailed education for women will encourage preventative health care, prompt recognition, and treatment.
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Abstract
Waddlia chondrophila is an intracellular bacterium suspected to cause human and bovine abortion. We confirmed an association between antibodies against W. chondrophila and human miscarriage and identified this organism in placenta or genital tract of women who had had miscarriages. These results suggest a possible role of W. chondrophila infection in miscarriage.
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Hornung S, Thuong BC, Gyger J, Kebbi-Beghdadi C, Vasilevsky S, Greub G, Baud D. Role of Chlamydia trachomatis and emerging Chlamydia-related bacteria in ectopic pregnancy in Vietnam. Epidemiol Infect 2015; 143:2635-8. [PMID: 25543825 DOI: 10.1017/S0950268814003616] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In this case-control study, we investigated the seroprevalence and molecular evidence of Chlamydia trachomatis and Waddlia chondrophila in ectopic pregnancies (EP) and uneventful control pregnancies in 343 women from Vietnam. Whereas presence of C. trachomatis IgG was strongly associated with EP [adjusted odds ratio (aOR) 5·41, 95% confidence interval (CI) 2·58-11·32], its DNA remained undetected in all tubal lesions. We confirmed an independent association between antibodies against Waddlia and previous miscarriage (aOR 1·87, 95% CI 1·02-3·42). Further investigations are needed to understand the clinical significance of Waddlia's high seroprevalence (25·9% in control pregnancies) in this urban population.
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19
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Baud D, Goy G, Vasilevsky S, Osterheld MC, Roth-Kleiner M, Croxatto A, Greub G. Roles of bovine Waddlia chondrophila and Chlamydia trachomatis in human preterm birth. New Microbes New Infect 2015; 3:41-5. [PMID: 25755892 DOI: 10.1016/j.nmni.2014.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/13/2014] [Accepted: 11/11/2014] [Indexed: 11/22/2022] Open
Abstract
Waddlia chondrophila and Chlamydia trachomatis are intracellular bacteria associated with human miscarriage. We investigated their role in human preterm birth. Whereas presence of Chlamydia trachomatis DNA in genital tract was associated with human preterm birth, Waddlia was not, despite being present in women's genital tracts.
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Foxman B, Wen A, Srinivasan U, Goldberg D, Marrs CF, Owen J, Wing DA, Misra D. Mycoplasma, bacterial vaginosis-associated bacteria BVAB3, race, and risk of preterm birth in a high-risk cohort. Am J Obstet Gynecol 2014; 210:226.e1-7. [PMID: 24096128 PMCID: PMC3943817 DOI: 10.1016/j.ajog.2013.10.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/11/2013] [Accepted: 10/02/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Genital tract infection accounts for approximately 25-40% of all preterm births. We sought to assess the relationship between preterm birth and selected vaginal bacterial taxa associated with preterm birth either directly or through their association with bacterial vaginosis (BV). STUDY DESIGN Vaginal fluid for Gram stain was collected between 17 and 22 weeks' gestation as part of a randomized trial of ultrasound-indicated cerclage for preterm birth prevention in women at high risk for recurrent spontaneous preterm birth. Bacterial deoxyribonucleic acid was extracted from the Gram stain slides and analyzed using quantitative polymerase chain reaction. RESULTS Among the 499 participants, Mycoplasma was positively correlated with increased risk of preterm (risk ratio [RR], 1.83; 95% confidence interval [CI], 1.52-2.22) as was Mobiluncus (RR, 1.36; 95% CI, 1.07-1.73) and Atopobium (RR, 1.44; 95% CI, 1.1-1.87). However, there were strong interactions between the race/ethnic group and the presence of these and other individual taxa on risk of preterm birth. By contrast, bacterial vaginosis-associated bacteria (BVAB)-3 was consistently associated with a reduction in the risk of preterm birth for all racial/ethnic groups (0.55; 95% CI, 0.39-0.78). CONCLUSION BV is characterized by a reduction of Lactobacillus, and lactic acid-producing bacteria and the presence of Mobiluncus; we found these factors and the presence of Mycoplasma to be associated with an increased risk of preterm birth. By contrast, the presence of a recently identified organism sufficient to cause BV, BVAB3, decreased the risk of preterm birth. These findings give insight into why treating BV has mixed impact on risk of preterm birth.
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MESH Headings
- Adult
- Black or African American
- DNA, Bacterial/isolation & purification
- Female
- Hispanic or Latino
- Humans
- Infant, Newborn
- Mobiluncus/genetics
- Mobiluncus/isolation & purification
- Mycoplasma/genetics
- Mycoplasma/isolation & purification
- Obstetric Labor, Premature/etiology
- Obstetric Labor, Premature/microbiology
- Obstetric Labor, Premature/prevention & control
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/microbiology
- Premature Birth/etiology
- Premature Birth/microbiology
- Premature Birth/prevention & control
- Risk Factors
- Vagina/microbiology
- Vaginosis, Bacterial/complications
- Vaginosis, Bacterial/diagnosis
- Vaginosis, Bacterial/microbiology
- White People
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Affiliation(s)
- Betsy Foxman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
| | - Ai Wen
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Usha Srinivasan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Deborah Goldberg
- Department of Ecology and Evolutionary Biology, University of Michigan Medical School, Ann Arbor, MI
| | - Carl F Marrs
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - John Owen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL
| | - Deborah A Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California at Irvine School of Medicine, Irvine, CA
| | - Dawn Misra
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI
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Almobarak AO, Elhoweris MH, Nour HM, Ahmed MAAM, Omer AFA, Ahmed MH. Frequency and patterns of abnormal Pap smears in Sudanese women with infertility: What are the perspectives? J Cytol 2013; 30:100-3. [PMID: 23833398 PMCID: PMC3701332 DOI: 10.4103/0970-9371.112651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Pelvic inflammatory disease is one of the major causes of infertility in females. Also, women with infertility are at high-risk of developing cervical intraepithelial lesions or even carcinoma. Aim: To assess the prevalence and patterns of epithelial cell abnormalities in cervical smears in Sudanese infertile and fertile women. Materials and Methods: The present study included 200 cases (women with infertility) of age group 20-60 years who had routine pap smear. A total of 700 fertile women constituted the control group. Results: Among the 200 infertile women, 93.5% reported as negative for intraepithelial lesion or malignancy (NILM), and 6.5% were epithelial cell abnormalities (atypical squamous cells of undetermined significance and above). In the control group 96.6% of the smears reported as NILM and 3.4% as epithelial cell abnormalities. The percentage of abnormal pap smears in the infertile women was significantly higher when compared with the control group. Conclusions: Epithelial cell abnormalities are significantly higher in women with infertility as compared with fertile women. Importantly, inflammatory smears were reported two times more than in the controls. We recommend pap smear as a routine practice for all women assessed for infertility problems. Further studies are necessary to evaluate the incidence of human papilloma virus infections in infertile women with abnormal cervical cytology.
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Affiliation(s)
- Ahmed O Almobarak
- Department of Pathology, Faculty of Medicine, Faculty of Medical Laboratory Sciences, University of Medical Sciences and Technology, Khartoum, Sudan
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Abstract
Lactoferrin, an iron-binding protein, has been proposed to act as an anti-infective agent and has been used as a diagnostic marker in several inflammatory disorders. A sensitive enzyme-linked immunosorbent assay developed earlier was used for lactoferrin estimation in cervical mucus. A brief study was undertaken to observe if lactoferrin is detectable in cervical mucus and to correlate its level with reproductive tract infection, if present. One hundred and twelve cervical mucus samples were collected from healthy as well as infected females. Some of these females were using CuT-200 intrauterine copper devices for contraception. Women were at different phases of their menstrual cycle. The presence of detectable amount of lactoferrin in cervical mucus was confirmed. The average level of lactoferrin in cases either with clinical symptoms of cervicitis or with proven infection by PAP smear was significantly (t=7.6, P<0.01) higher than the normal controls. CuT users have higher (P<0.01) mean level of lactoferrin than corresponding non-users.
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Affiliation(s)
- J Mania-Pramanik
- Institute for Research in Reproduction, (Indian Council of Medical Research), Jehangir Merwanji Street, Parel, 400012 Mumbai
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