[Parametritis caused by an IUD].
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Adult↗
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Results for “Reproductive Tract Infections”
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Management of the patient with an intrauterine device and a unilateral adnexal mass.
Patients wearing the intrauterine contraceptive device (IUD) and presenting with an unilateral adnexal mass may have a pelvic abscess in the absence of the typical dramatic stigmata that usually accompany an acute pelvic infection. Three such patients are presented, each receiving a different surgical management. An elevated erythrocyte sedimentation rate helps make the diagnosis in these relatively asymptomatic patients. IUD removal and prompt hospitalization for intravenous antibiotics are the appropriate management.
Adult↗
Behavioural and social issues in contraception.
Approximately 77% of the world's population lives in developing countries, where poverty prevails, and leads to high mortality and morbidity rates. About 95% of the world's population growth occurs in these countries, which are least equipped to meet the problem. Proper use of contraception is vital for these nations. The percentage of sexually active teenagers around the world is rising. However, only a minority of them use effective barrier contraceptives that protect against sexually transmitted diseases, including HIV. Changes in contraceptive use could improve maternal and child health, reduce population growth, and ensure better provision of resources around the world.
Abortion, Induced↗
HIV-1 seropositivity in pulmonary tuberculosis (study of 340 cases from Marathwada).
An investigative study was carried out in 340 cases of established pulmonary and presumed pleural tuberculosis for co-occurrence of HIV-1 infection in them. Confirmatory screening for HIV-1 was carried out with both ELISA (Vironostika) and Serodia commercial kits in all reactive samples on first screening. In all, 16 cases proved to be having HIV-1 coexistent infection with pulmonary tuberculosis. Their preliminary vital clinical observations and roentogenic finding are summarized and literature reviewed briefly.
Adult↗
HIV infection among patients with acute pelvic inflammatory disease at the Kenyatta National Hospital, Nairobi, Kenya.
AIDS continues to exert considerable strain on the economy, as well as social aspects of our lives. Previous studies have identified the categories of people most at risk of contracting and developing HIV infection and AIDS. In this study, 20.9% of women with acute pelvic infection at the Kenyatta National Hospital, were found to be seropositive for HIV, much higher than the general population in Kenya. Though there was no direct correlation between one's age and serological status, most of the women with pelvic inflammatory disease (PID) were young, quite sexually active, and involved with several partners. 49.0% of the entire group and 53.7% of the women who were seropositive, were married. This underlines the fact that marital status does not appear to offer any protection against HIV infection. The fact that majority of these women had started coitus quite early, they were not using any protective measure against STDs or HIV infection, and that they were involved with several partners, indicate that we are very far from winning the fight against HIV infection and AIDS. There is need to revise the currently operative programmes with a view to making them more effective, in preventing transmission and spread of HIV infection.
Acute Disease↗
Actinomyces species associated with intrauterine contraceptive devices and pelvic inflammatory disease.
Swabs from 112 removed intrauterine contraceptive devices (IUCD), endocervical swabs from these women and from 65 women with pelvic inflammatory disease (PID) were studied for actinomyces, using direct fluorescent antibody test and culture. Endocervical swabs from 50 control subjects were also studied. Actinomyces species could be detected in 23 (20.5 percent) of IUCD wearers and 8 (12.3 percent) of patients with PID. In control cases, no actinomyces were detected. The isolation rate using a selective medium (Actino Blood Agar) was 71.4 percent. Actinomyces israelii, Actinomyces naeslundii and Actinomyces viscosus were isolated.
Actinomyces↗
Sexually transmitted disease services in Madras: could their role in AIDS prevention be strengthened?
A baseline evaluation of the quality of STD case management was conducted in five areas of Madras city in 1992, using HIV prevention indicators recommended by the World Health Organization. Eighty-four interviews and 108 observations of private and public clinic practitioners were conducted. Sixty-one percent of interviewed doctors reported making only specific "clinical" diagnoses and 17% reported making only the WHO recommended syndrome-based diagnoses while 22% reported making both types of diagnosis. The adequacy of treatment was compared against various standards, including the Indian National Guidelines for STD management. Almost half of the health care providers (HCP) reported using a treatment effective against the two main pathogens that may cause male urethritis, while 20% reported using a treatment that was not effective against either. For male ulcers only 12% of HCPs reported using treatment effective against both syphilis and chancroid. Seventy-nine percent of the HCP reported that they advised their patients to use condoms, but in 30% only of observed consultations, condoms were promoted for STD or HIV/AIDS prevention. As information concerning the relative prevalence of pathogens in different areas is unlikely to be available, there is an urgent need for the syndromic approach to STD treatment be adopted by health care providers.
Acquired Immunodeficiency Syndrome↗
Simple algorithms for the management of genital ulcers: evaluation in a primary health care centre in Kigali, Rwanda.
A cross-sectional study was conducted among 395 patients presenting with genital ulcers at a primary health care centre in Kigali, Rwanda. Using clinical data and the results of a rapid plasma reagin (RPR) test, we simulated the diagnostic outcome of two simple WHO flowcharts for the management of genital ulcers. These outcomes and a clinical diagnosis were then compared with the laboratory diagnosis based on culture for genital herpes and Haemophilus ducreyi and serology for syphilis. The prevalence of HIV infection was high (73%) but there was no difference between HIV-positive and HIV-negative patients in the clinical presentation and etiology of genital ulcer disease. The proportion of correctly managed chancroid and/or syphilis cases was 99% using a syndromic approach, 82.1% using a hierarchical algorithm including an RPR test, and 38.3% with a clinical diagnosis. In situations where no laboratory support is available, a simple syndromic approach is preferable to the clinical approach for the management of genital ulcer. If an RPR test can be included in the diagnostic strategy, patients with a reactive RPR test should be treated for both syphilis and chancroid infection.
Algorithms↗
STD/HIV prevention in Turkey: planning a sequence of interventions.
This study was initiated to assess which mix of early STD/HIV prevention interventions would potentially be effective, cost-effective and sustainable in Turkey; and to program an intervention sequence to maximize synergy among the interventions. During rapid assessment we: 1) reviewed past issues of 3 leading newspapers; 2) collected information on TV coverage; 3) interviewed key informants including taxicab drivers, hotel employees, grocery store owners, academicians in public health and law, investigators of STD/HIV and reproductive tract infections, and officials in the ministry of health; 4) reviewed available evidence on STD/HIV morbidity, sexual behavior patterns, migration patterns and same/opposite gender sex trade. We found: 1) discrepancies between decision makers' perceptions and social realities with respect to the epidemiology of sexual behavior and STDs, and the state of public health programs; 2) discrepancies between sexual practices and public expression regarding sexual practices; 3) economic, demographic, and political pressures in Turkey and in surrounding countries for the expansion of prostitution; 4) a sexual double standard and gender specific migration patterns which sustain a high demand for commercial sex; 5) patterns of health care seeking behaviors and provision of STD clinical services which indicate other STDs may play a very important role in spread of HIV infection; 6) an important mass media role in opinion formation; 7) consensual denial of risk for the majority based on beliefs embedded in machismo, nationalism and religion, and a resulting marginalization and externalization of STD/HIV risk; 8) high prevalence of syphilis among both Turkish and immigrant female prostitutes in Istanbul (early latent 8 and 13%; late latent 0 and 4%; previous history 9 and 22%) 9) and high rates of syphilis among male prostitutes (early latent 11%, late latent 21% and previous history 58%). We concluded that interventions should initially include, in the following order; 1) awareness raising for decision makers and opinion leaders including members of parliament and mass media; 2) awareness raising for members of the general population; 3) needs assessment and intervention development for sex workers; 4) training in HIV and other STDs for medical personnel; and 5) quality assurance and control for laboratory procedures for STDs/HIV.
Female↗
Summary of track C: epidemiology and public health.
AIM: To review Track C on epidemiology and public health. DESCRIPTIVE EPIDEMIOLOGY: Recent trends in the descriptive epidemiology are reported, for example, the rapid spread of HIV in certain Asian countries and the more precise insights in the spread thanks to subtyping of HIV-1 (and HIV-2). TRANSMISSION: There is now ample evidence that sexually transmitted diseases enhance the rate of transmission. Viral load in the plasma of the mother is highly predictive for perinatal transmission. PROGRESSION: Natural history studies have shown that true non-progressors are probably rare. Preliminary evidence indicates that the progression rate to AIDS and death does not differ by HIV-1 subtype. Some genetic factors are associated with the rate of disease progression and a few with susceptibility to HIV infection. INTERVENTIONS AND PREVENTION: Needle-exchange programmes as an intervention measure for injecting drug users were hotly debated and so were HIV (home) testing and counselling. Successes in prevention were reported from Thailand and Uganda, and also from small scale programmes.
Female↗
Factors determining the choice of contraceptive methods at the Family Planning Clinic, University College Hospital, Ibadan, Nigeria.
In a study of 2000 women volunteers seeking contraceptive services at the Family Planning Clinic (FPC), University College Hospital, Ibadan, Nigeria, 66.2 per cent chose the intrauterine device (IUD) making it the most common method of contraception. Factors influencing choice of contraceptive methods were advice from friends and family members, intended duration of use and information from the media. Ignorance, fear and unfounded cultural beliefs were factors responsible for the delay in seeking contraceptive advice. The mass media was an important source of information for most of the women. We conclude that the IUD is the contraceptive of choice in our clinic because of the highly selective nature of our clients. In order to provide a service with a broader clientele, we suggest the incorporation of other priority reproductive health services such as cervical and breast cancer screening, prevention and treatment of reproductive tract infections and sexually transmitted diseases including HIV/AIDS.
Adolescent↗
Infection of the reproductive tract and eggs with Salmonella enterica serovar pullorum in the chicken is associated with suppression of cellular immunity at sexual maturity.
Salmonella enterica serovar Pullorum causes persistent infections in laying hens. Splenic macrophages are the main site of persistence. At sexual maturity, numbers of bacteria increase and spread to the reproductive tract, which may result in vertical transmission to eggs or chicks. In this study we demonstrate that both male and female chickens may develop a carrier state following infection but that the increases in bacterial numbers and spread to the reproductive tract are phenomena restricted to hens, indicating that such changes are likely to be related to the onset of egg laying. The immunological responses during the carrier state and through the onset of laying in hens were determined. These indicate that chickens produce both humoral and T-cell responses to infection, but at the onset of laying both the T-cell response to Salmonella and nonspecific responses to mitogenic stimulation fall sharply in both infected and noninfected birds. The fall in T-cell responsiveness coincided with the increase in numbers of Salmonella serovar Pullorum and its spread to the reproductive tract. Three weeks after the onset of egg laying, T-cell responsiveness began to increase and bacterial numbers declined. Specific antibody levels changed little at the onset of laying but increased following the rise in bacterial numbers in a manner reminiscent of a secondary antibody response to rechallenge. These findings indicate that a nonspecific suppression of cellular responses occurs at the onset of laying and plays a major role the ability of Salmonella serovar Pullorum to infect the reproductive tract, leading to transmission to eggs. The loss of T-cell activity at the point of laying also has implications for Salmonella enterica serovar Enteritidis infection and transmission to eggs, along with its control by vaccination offering a "window of opportunity" in which infection may occur.
Animals↗
Failure to establish chronic infection of the reproductive tract of the male horse with a South African asinine strain of equine arteritis virus (EAV).
Eight sexually mature horse stallions were inoculated intranasally with a South African asinine strain of EAV, a strain that was isolated from the semen of a donkey carrier. All horses developed fever, with maximum rectal temperatures of 38.9-39.9 degrees C recorded 3-6 d post challenge. Six horses showed very mild clinical signs of equine viral arteritis and two were asymptomatic. The virus was recovered from the nasopharynxes of six horses 2-7 d after inoculation, and from buffy-coat samples of all horses, 2-11 d after inoculation. Seroconversion to EAV was detected on days 8 and 10 and peak serum-virus-neutralizing antibody titres ranging from log10 1.2-1.8, on days 14-20 after challenge. The titres varied from log10 0.9-1.2 after about 10 weeks, when the experiment was terminated. In three stallions euthanased on days 5, 7 and 9 after challenge, virus was detected inconsistently in different parts of the reproductive tract and urine. No virus was isolated from the tissues of the reproductive tract collected from stallions on days 16, 23 and 68 after challenge. Five stallions were bred to six seronegative mares between 13 and 34 d post challenge. No clinical signs of EAV were observed, and neither was seroconversion detected in any of the mares after mating. No virus was recovered from semen samples collected at the time of breeding. The results of this study demonstrated that the tissues of the reproductive tracts of the stallions did not become persistently infected with a South African asinine strain of EAV.
Animals↗
Failure to establish infection with Tetratrichomonas sp. in the reproductive tracts of heifers and bulls.
Experimental infection of the reproductive tracts of heifers and bulls with Tetratrichomonas sp. isolated from preputial smegma of virgin bulls was attempted. Nine heifers and four bulls were challenged by inoculation of 7 x 10(6) Tetratrichomonas sp. into the vaginal lumen and preputial cavity, respectively. Vaginal mucus and preputial smegma samples were collected and cultured for Tetratrichomonas sp. Heifers were slaughtered in groups of three at 2, 9 and 21 days after inoculation. Two heifers and two bulls infected with Tritrichomonas foetus and two uninfected heifers were used as controls for the model infection. Tetratrichomonas sp. were only isolated in vaginal mucus of 7/9 inoculated heifers at 6h post-inoculation, and genital secretions taken at slaughter time from vagina, uterus and oviduct were cultural negative. Bulls challenged with Tetratrichomonas sp. remained cultural negative. Since Tetratrichomonas sp. survived only a few hours in the female genitalia and did not survive in the male genitalia after experimental challenge, Tetratrichomonas sp. did not colonize the genital tract. These were likely trichomonads from the digestive tract. Collection of clean samples without fecal contamination from the reproductive tract is proposed as a measure to avoid Tetratrichomonas sp. transitory genital infection.
Animals↗
HIV-1 infection of the female reproductive tract.
The human immunodeficiency virus type 1 (HIV-1) infects cells within mucosal tissues, including those of the female reproductive tract (FRT). The mechanism of viral transmission within the FRT and the mode of viral spread to the periphery are not completely understood. We performed phenotypical analyses and infectivity studies of primary FRT cells to identify potential targets of infection within the FRT. Our findings indicate that expression of HIV-1 receptors and coreceptors in the FRT varies as a function of menstrual-cycle stage, suggesting that sex hormone levels may influence a woman's susceptibility to infection by HIV-1. Moreover, HIV-1 strains that utilize the CXCR4 chemokine receptor for infectivity are able to undergo reverse transcription, integration, viral DNA transcription, and viral release, whereas viral strains that utilize CCR5 do not undergo these early replicative events, and are only released unmodified from these cells. This indicates that several mechanisms for viral infection and transmission are present throughout the FRT.
Adolescent↗
Experimentally indeced mycoplasma meleagridis infection of turkey reproductive tracts.
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Animals↗
[Studies on post-puerperal infections of the reproductive tract and their influence on the span of the intergestation period].
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Animals↗