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Results for “Reproductive Tract Infections”

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PubMed1997

First antenatal visits and metronidazole.

OBJECTIVE: We evaluated the timing of initial antenatal visits to better characterize possible use of metronidazole or other antimicrobials for common reproductive tract infections in early pregnancy. STUDY DESIGN: We determined timing of initial antenatal evaluation in five busy and representative Denver, Colorado, practice settings (most recent 50 patients). RESULTS: Most women were evaluated after completion of 9 weeks of pregnancy. Women seen in private settings received the initial visit earlier than did women in publicly supported clinics. CONCLUSION: Pregnant women with a common reproductive tract infection and bacterial vaginosis can be "screened and treated" at the initial antenatal examination.

Female↗

PubMed2004

Vaginal discharge: perceptions and health seeking behavior among Nepalese women.

OBJECTIVES: To understand women's perceptions and health seeking behavior and the association between vaginal discharge, clinical signs and laboratory findings as a presentation of sexually transmitted diseases (STD). METHODS: We conducted five focus group discussions with women attending the outpatient department in a large public hospital in Katmandu, Nepal, during May-June 1997. We also interviewed seventy women presenting with vaginal discharge to the same hospital, through structured questionnaire. Women presenting with discharge were also examined and investigated for six common sexually transmitted diseases and reproductive tract infections. RESULTS: In the focus groups vaginal discharge was identified as a common disease distinct from STDs, for which women can seek treatment. STDs were considered as social diseases transmitted to women through multiple sexual partners and not from husband. Patients with vaginal discharge preferred traditional healers and pharmacist. Clinical signs were inconclusive for type of infection. Simple laboratory tests identified etiologic agent in 64 (91%) patients and the three commonest infections were Moniliasis (78%), Bacterial Vaginosis (25%) and Trichomoniasis (17%). CONCLUSION: Vaginal discharge may be used as a risk marker for identification of STDs by Primary Health Workers. Low cost investigations should be made available at the secondary care level for identification of most common Reproductive Tract Infections. Communication campaigns should target the misconceptions that exist in the communities local context related to the prevention, treatment and control of vaginal discharge and STDs.

Adult↗

PubMed2004

Burden of gynaecological disease in a tertiary hospital: two years audit of outpatient department at PIMS.

OBJECTIVE: To estimate the pattern of gynaecological morbidity in women seeking services. METHODS: All women seeking advice for gynaecological problems in the outpatients department of Obstetrics and Gynaecology, Pakistan Institute of Medical Sciences Islamabad, from January 1997 to December 1998 were included. RESULTS: The total reproductive morbidity presenting at the outpatients department was 29,196. Of these 18,289 (62.7%) presented with obstetric morbidity and 10,851 (37.2%) with gynaecological morbidity. Menstrual irregularity was the commonest gynaecological problem encountered (41.1%). The rest included reproductive tract infections (27.8%), subfertility (18.2%), urogynaecological problems (5.3%), menopausal symptoms (4%), benign genital tract tumors (2. 8%), gynaecological malignancies (0.7%) and others (0.1%, including sexual dysfunction, congenital malformations and genital tract injuries) CONCLUSION: A number of women are seeking help for the varying severity of gynaecological morbidity, ranging from mild discomfort to overt disability. The major gnaecological morbidities identified are menstrual irregularities and reproductive tract infections. This study highlights the need for addressing and prioritising resources towards these women health issues which affect women's ability to fulfill a wide range of diverse roles.

Female↗

PubMed2005

An overview of reproductive health of women in Bajhang district.

Reproductive health is not merely an absence of disease or disorder, rather it is a condition in which reproductive process is accomplished in a state of complete physical, mental and social well being according to WHO. Reproductive morbidity encompasses obstetric morbidity including conditions during pregnancy, delivery and the post-partum period; and gynecological morbidity including conditions of the reproductive tract such as reproductive-tract infections, cervical cell changes, genital prolapse, malignancies and infertility. The first step towards achieving the needs of women as consumers and providers is to do baseline research so that the nature and magnitude of the problem is assessed. Bajhang is one of the poorest, most deprived and remotest districts in the Far Western development region of Nepal. The status of all women is very low and their situation is very difficult. This study was conducted during a gynecological camp for a period of six days from 10th-15th March, 2003, in the district hospital of Bajhang at Chainpur. All women who attended the gynecological camp were included in the study. The 6 days period, total 530 women had attended the camp. Among them 273 (51.5%) had gynecological problems. Uterovaginal prolapse was the leading morbidity found in 97 women (18.3%) followed by subfertility (14.2%) and reproductive tract infections(13.9%). Only 22.0% women were using family planning methods. This study shows that a large number of women are seeking help for gynecological problems, hence emphasizing the importance of research in this area. Such studies have a pronounced impact in settings where no information on gynaecological morbidities exists and where there is an absence of consensus on the extent of such morbidity. This study not only gives us a baseline data about the most prevalent gynaecological problems in the remote area, it may help us in planning future reproductive health programs also.

Adolescent↗

PubMed2000

Vaginal infections in pregnant women in Jamaica: prevalence and risk factors.

Trichomoniasis, bacterial vaginosis (BV) and candidiasis are reproductive tract infections (RTIs) of the vagina. We conducted a cross-sectional study in 4 prenatal clinics in Kingston, Jamaica, to estimate the prevalence of these infections and the risk factors that may facilitate their transmission among pregnant women. Of the 269 women studied, 18.0% had culture-positive trichomoniasis, 44.1% had BV (Nugent score > or = 7) and 30.7% were positive for candidiasis by wet mount. A multiple logistic regression analysis showed that having a malodorous discharge was associated with trichomoniasis (odd ratios [OR]=3.9, confidence intervals [CI]=1.04-14.7) and BV (OR=3.4, CI=1.3-8.7). Women who took action to prevent HIV infection had lower BV prevalence (OR=0.34, CI=0.12-0.98). Women who were employed were less likely to have any of the infections (OR=0.61, CI=0.36-1.03). The strong association of a symptomatic presentation with trichomoniasis and BV suggests the merit of considering syndromic management of vaginitis in this population.

Adolescent↗

PubMed2002

Nonoxynol-9 for preventing vaginal acquisition of sexually transmitted infections by women from men.

BACKGROUND: The incidence and prevalence of sexually transmitted infections (STI) and other reproductive tract infections (RTI) is high in much of the developing and parts of the developed worlds. STIs and RTIs are associated with the vaginal transmission of HIV. Additional strategies to improve STI control are needed, and vaginal microbicides are a possible strategy. One potential vaginal microbicide is the widely used spermicide, nonoxynol-9 (N-9). OBJECTIVES: To determine the safety and effectiveness of N-9 in preventing vaginal acquisition of sexual transmitted infections (exclusive of HIV) by women from men. SEARCH STRATEGY: Systematic search of electronic databases, conference abstracts, reference lists of relevant studies and contact with experts and funders. SELECTION CRITERIA: Randomised controlled trials meeting pre-determined quality criteria with STI as the outcome. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and checked by another. MAIN RESULTS: Ten of 12 identified randomised controlled trials were included and findings among them were broadly consistent. In meta-analysis, the risks of gonorrhoea (relative risk [RR] 0.91, 95%CI 0.67-1.24), cervical infection (RR 1.01, 0.84-1.22), trichomoniasis (RR 0.84, 0.69-1.02), bacterial vaginosis (0.88, 0.74-1.04), chlamydia (RR 0.88, 0.77-1.01) and candidiasis (RR 0.97, 0.84-1.12) were not statistically significantly different in women receiving N-9 compared with placebo. Genital lesions were more common in the N-9 users (RR 1.17, 95%CI 1.02-1.35). REVIEWER'S CONCLUSIONS: There is good evidence that nonoxynol-9 does not protect against sexually transmitted infections, and there is some evidence that it may be harmful by increasing the rate of genital ulceration. As such, this product cannot be recommended for STI prevention.

Female↗

PubMed2005

Correlates of HIV vaccine trial participation: an Indian perspective.

Successful conduct of HIV vaccine trials in a population of great cultural diversity like India could be a challenge. Concerns, knowledge gaps and willingness to participate in future HIV vaccine trials were studied among 349 patients attending three sexually transmitted infections clinics and one reproductive tract infections clinic. Overall willingness to volunteer for HIV vaccine trials was 48%. Women and men at risk of HIV infection were willing to participate in the HIV vaccine trials. Factors associated with increased willingness to participate in these trials were awareness of current HIV vaccine efforts, realization of importance of vaccine for self, concern about adverse events and altruism.

AIDS Vaccines↗

PubMed1999

The intrauterine device and its dynamics.

In the past decade, attention has shifted from family planning (often made available through population programs) to reproductive health--a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and its function and processes. Reproductive health has three components: the ability to procreate, regulate fertility and enjoy sex; the successful outcome of pregnancy through infant and child survival and growth; and the safety of the reproductive process. According to Mitchell et al., the following are key elements in a reproductive health program: (a) Family planning services that offer complete and accurate information about all contraceptive methods and that make contraceptive services, supplies and counseling accessible. (b) Antenatal care, which research suggests lowers rates of maternal mortality. (c) Safe delivery services, so that all women deliver under some type of supervised care and so that referral systems are established to provide emergency treatment of life-threatening complications of delivery. (d) Postnatal care that contributes to a woman's ability to have a speedy and complete recovery from the stress of pregnancy and childbirth, to enjoy sexual relations without pain and to have safe pregnancies and deliveries in the future. (e) Management of the complications of abortion where safe abortions are not available. (f) Infertility services that enable women to achieve their reproductive goals; and effective screening for or control of reproductive tract infections (RTIs), because RTIs are the most common preventable cause of involuntary infertility and ectopic pregnancy, as well as of chronic pelvic pain and recurrent infection. (g) Management and treatment of systemic sexually transmitted diseases (STDs), such as HIV and hepatitis B. (h) Symptomatic treatment of urinary tract infections. (i) Detection and treatment of breast and reproductive tract cancers, such as cervical cancer. (j) Attention to and treatment of dysmenorhea, which in some cases is the first sign of other problems, such as pelvic inflammatory disease, endometriosis, fibroids, endometrial cancer and ectopic pregnancy. (k) Nutritional supplementation to meet the special needs of adolescents, pregnant or lactating women, and women older than 50 years. (1) Services for menopause and other health problems that women encounter as they grow older. (m) Services for adolescents, including family planning and STD prevention and treatment. It shall be clear that many institutions delivering reproductive health services operate significantly below their physical capacity to see clients, and that much of the equipment required for expanding reproductive health services may already be available for use in family planning and other health services. In this context, we would therefore like to discuss the dynamics of IUDs.

Contraindications↗

PubMed2003

Recent herpes simplex virus type 2 infection and the risk of human immunodeficiency virus type 1 acquisition in India.

To estimate the impact of prevalent and incident herpes simplex virus type 2 (HSV-2) infection on the acquisition of human immunodeficiency virus type 1 (HIV-1), stored serum samples from a cohort of 2732 HIV-1-seronegative patients attending 3 sexually transmitted infection clinics and 1 reproductive tract infection clinic in Pune, India, were screened for HSV-2-specific antibodies. Incident HSV-2 infection was defined serologically as "recent" if a negative result of testing for HSV-2 could be documented within the previous 6 months or "remote" if >6 months had elapsed since the last negative test result. The prevalence of HSV-2 at enrollment was 43%. The HSV-2 incidence was 11.4 cases/100 person-years, and the HIV-1 incidence was 5.8 cases/100 person-years. The adjusted hazard ratios of HIV-1 acquisition from exposure to HSV-2 infection were 1.67 for prevalent HSV-2, 1.92 for remote incident HSV-2, and 3.81 for recent incident HSV-2. Recent incident HSV-2 infection was associated with the highest risk of HIV-1 in this study, which suggests that prevention of HSV-2 infection may reduce the risk of HIV-1 acquisition.

Antibodies, Viral↗

PubMed2003

Baseline survey of sexually transmitted infections in a cohort of female bar workers in Mbeya Region, Tanzania.

OBJECTIVES: To determine baseline prevalence of sexually transmitted infections (STI) and other reproductive tract infections (RTI) and their association with HIV as well as sociodemographic and behavioural characteristics in a newly recruited cohort of female bar workers in Mbeya Region, Tanzania. METHODS: 600 female bar workers were recruited from 17 different communities during September to November 2000 and underwent gynaecological examination, laboratory testing for HIV/STI, and interviews using structured questionnaires. RESULTS: HIV-1 seroprevalence was 68%. Prevalences of STI/RTI were high titre syphilis (TPPA/RPR >/=1/8), 9%; herpes simplex virus 2 antibodies, 87%; chlamydia, 12%; gonorrhoea, 22%; trichomoniasis, 24%; and bacterial vaginosis, 40%. HIV infection was associated with TPPA and HSV-2 seropositivity, bacterial vaginosis and clinically diagnosed genital ulcers, blisters, and warts. Reported high risk sexual behaviour during the past year (having multiple casual partners) was associated with prevalent STI. CONCLUSION: Female bar workers in Mbeya are at high risk of STI and HIV infection. Targeted STI/HIV prevention interventions for these women and their sexual partners need to be reinforced. Methods should be sought to improve healthcare seeking and to provide easily accessible and affordable STI care services.

Adult↗

PubMed1994

Pathology and localization of simian immunodeficiency virus in the reproductive tract of chronically infected male rhesus macaques.

BACKGROUND: Despite the fact that human immunodeficiency virus (HIV) is transmitted by sexual contact, the biology of this mode of transmission remains largely undefined. HIV is present in semen in both cell-free and cell-associated forms and can be isolated from asymptomatic individuals and AIDS patients. The source of HIV in semen and the target cells for HIV transmission to men are unknown. Epidemiologic studies have shown that in men, the presence of an intact foreskin is associated with increased risk of HIV infection. EXPERIMENTAL DESIGN: The reproductive tracts from 13 chronically simian immunodeficiency virus (SIV)-infected adult male rhesus macaques were examined for this study. Routine histologic examination was undertaken to characterize the reproductive tract pathology. In situ hybridization and immunohistochemistry were used to localize SIV-infected cells and determine the immunophenotype of inflammatory infiltrates. RESULTS: SIV-infected cells (macrophages, T cells) were found at all levels of the reproductive tract and were commonly associated with inflammatory lesions. Infected cells were found most consistently in the epididymis. In one animal, SIV-infected cells (presumably Langerhans cells) were present in the stratified squamous epithelium of the foreskin. Testicular atrophy and degeneration were relatively common findings. The most common lesion in the accessory glands was mild lymphocytic inflammation. In addition, atrophy of the glandular elements and interstitial fibrosis in the prostate gland were found. One animal had a granulomatous epididymitis with multinucleate giant cells that may have been a primary SIV lesion. CONCLUSIONS: The reproductive tract pathology in chronically SIV-infected male rhesus macaques and AIDS patients is similar. SIV-infected cells can be found at all levels of the male rhesus macaque reproductive tract and SIV can infect cells in the mucosal epithelium of the foreskin. This latter finding indicates that target cells for HIV transmission may be present in the foreskin epithelium of uncircumcised men.

Animals↗

PubMed1994

Relationship between AIDS and family planning programmes: a rationale for developing integrated reproductive health services.

This paper examines the potential links between family planning and maternal and child health programmes and the emerging needs of the global AIDS epidemic; and assesses the feasibility of organizing comprehensive reproductive health programmes in developing countries to include the prevention and control of reproductive tract infections including sexually transmitted infections as well as HIV/AIDS. The paper discusses arguments opposing the integration of programmes against sexually transmitted infections within family planning and MCH programmes, as well as the programmatic and epidemiological reasons for considering such integration. It is important to determine what elements can be realistically integrated within programmes of varying organizational capacity without compromising their effectiveness.

Communicable Disease Control↗

PubMed1996

Localization of chronic Chlamydia psittaci infection in the reproductive tract of sheep.

Twelve sheep experimentally infected with Chlamydia psittaci during pregnancy either aborted or gave birth to weak, low-birth-weight lambs as a result of uteroplacental infection. Subsequently, these ewes excreted chlamydial antigen from their reproductive tracts during estrus. About 1 year after pregnancy failure, immunohistochemistry and polymerase chain reaction were used to examine sections of vagina, uterus, and oviduct for evidence of C. psittaci. Four noninfected control ewes were similarly examined. C. psittaci antigen or DNA was detected in vagina, uterus, and oviduct samples from chronically infected ewes. Endometrial cells in the basal stroma were the predominant site of infection. There was no obvious evidence of pathology associated with persistent infection, but increased numbers of plasma cells and intraepithelial lymphocytes were detected in the uterus. C. psittaci is a naturally occurring reproductive infection in sheep that persists following primary infection. Therefore, sheep provide an excellent model to study the host-parasite interactions that occur during natural infection and subsequent persistence.

Abortion, Veterinary↗

PubMed2001

Sexually transmitted infections among married women in Dhaka, Bangladesh: unexpected high prevalence of herpes simplex type 2 infection.

OBJECTIVES: To document the prevalence of reproductive tract infections (RTI) and sexually transmitted infections (STI) among women attending a basic healthcare clinic in Dhaka, Bangladesh, to identify risk factors associated with the diseases and to estimate the incidence of syphilis, hepatitis C (HCV), hepatitis B (HBV), and herpes simplex type 2 (HSV-2) infection. METHODS: A cross sectional sample of 2335 consecutive women was examined during 1996-8. Women were interviewed about risk factors for RTI/STI and tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Treponema pallidum, HIV, HCV, HBV, HSV-1 and HSV-2 infection as well as vaginal candidosis and bacterial vaginosis. Women with antibodies to T pallidum were retested at regular intervals. One year after ending the study seroconversion for syphilis, HBV, HCV, and HSV-2 infection was detected among women initially negative for the respective diseases. RESULTS: The overall prevalence rate of N gonorrhoeae, C trachomatis, T vaginalis, and T pallidum infection was 0.5%, 1.9%, 2.0%, and 2.9% respectively. Overall, 35% of the women had antibodies to hepatitis B core antigen, 0.9% had HCV, and 12% HSV-2 infection. Risk factors for gonorrhoea/C trachomatis infection were a husband not living at home or suspected of being unfaithful. HSV-2 infection was associated with the same risk factors and with a polygamous marriage. The prevalence of HSV-2 infection among women "at risk" was 23%. HIV infection was not diagnosed. Repeated serological examination indicated that only 32% of women with serological evidence of syphilis had active disease. The seroincidences of HBV, HCV, and HSV-2 were 0.03, 0.007, and 0.009 per person year. Seroconversion for syphilis was not observed.

Adolescent↗

PubMed2000

Screening and syndromic approaches to identify gonorrhea and chlamydial infection among women.

The standard diagnostic tools to identify sexually transmitted infections are often expensive and have laboratory and infrastructure requirements that make them unavailable to family planning and primary health-care clinics in developing countries. Therefore, inexpensive, accessible tools that rely on symptoms, signs, and/or risk factors have been developed to identify and treat reproductive tract infections without the need for laboratory diagnostics. Studies were reviewed that used standard diagnostic tests to identify gonorrhea and cervical chlamydial infection among women and that provided adequate information about the usefulness of the tools for screening. Aggregation of the studies' results suggest that risk factors, algorithms, and risk scoring for syndromic management are poor indicators of gonorrhea and chlamydial infection in samples of both low and high prevalence and, consequently, are not effective mechanisms with which to identify or manage these conditions. The development and evaluation of other approaches to identify gonorrhea and chlamydial infections, including inexpensive and simple laboratory screening tools, periodic universal treatment, and other alternatives must be given priority.

Algorithms↗

PubMed2004

Tritrichomonas foetus induces apoptotic cell death in bovine vaginal epithelial cells.

Tritrichomonas foetus is a serious veterinary pathogen, causing bovine trichomoniasis, a sexually transmitted disease leading to infertility and abortion. T. foetus infects the mucosal surfaces of the reproductive tract. Infection with T. foetus leads to apoptotic cell death of bovine vaginal epithelial cells (BVECs) in culture. An affinity-purified cysteine protease (CP) fraction yielding on sodium dodecyl sulfate-polyacrylamide gel electrophoresis a single band with an apparent molecular mass of 30 kDa (CP30) also induces BVEC apoptosis. Treatment of CP30 with the protease inhibitors TLCK (Nalpha-p-tosyl-l-lysine chloromethyl ketone) and E-64 [l-trans-epoxysuccinyl-leucylamide-(4-guanido)-butane] greatly reduces induction of BVEC apoptosis. Matrix-assisted laser desorption ionization-time-of-flight MALDI-TOF mass spectrometry analysis of CP30 reveals a single peak with a molecular mass of 23.7 kDa. Mass spectral peptide sequence analysis of proteolytically digested CP30 reveals homologies to a previously reported cDNA clone, CP8 (D. J. Mallinson, J. Livingstone, K. M. Appleton, S. J. Lees, G. H. Coombs, and M. J. North, Microbiology 141:3077-3085, 1995). Induction of apoptosis is highly species specific, since the related human parasite Trichomonas vaginalis and associated purified CPs did not induce BVEC death. Fluorescence microscopy along with the Cell Death Detection ELISA(PLUS) assay and flow cytometry analyses were used to detect apoptotic nuclear condensation, DNA fragmentation, and changes in plasma membrane asymmetry in host cells undergoing apoptosis in response to T. foetus infection or incubation with CP30. Additionally, the activation of caspase-3 and inhibition of cell death by caspase inhibitors indicates that caspases are involved in BVEC apoptosis. These results imply that apoptosis is involved in the pathogenesis of T. foetus infection in vivo, which may have important implications for therapeutic interference with host cell death that could alter the course of the pathology in vivo.

Animals↗

PubMed1981

Combination antimicrobial therapy for serious gynecological and obstetrical infections--obsolete?

The normal flora of the lower reproductive tract are the pathogens isolated from upper reproductive tract infections after cesarean section and hysterectomy and from intraperitoneal cultures taken from women treated for acute pelvic inflammatory disease. Because these infections are usually polymicrobial, traditional antimicrobial therapy has included various combinations of agents. During the last six years we used five different antimicrobial combinations to treat more than 600 women with one of the above infections. From 15% to 50% of cases required the addition of a third (anaerobic-specific) antimicrobial. Original therapy with clindamycin/gentamicin was unsuccessful in only 5% of the infections treated. Single-agent therapy with third-generation cephalosporins avoids most problems associated with combination therapy. Over the past 18 months we treated 237 women with cefotaxime; 94% required no further therapy.

Anaerobiosis↗

PubMedDate not supplied

Self-reported symptoms of gynecological morbidity and their treatment in south India.

This article presents an analysis of self-reported symptoms of gynecological problems among 3,600 recent mothers in Karnataka State, India. Approximately one-third of all women reported at least one current symptom; the most common were a feeling of weakness and tiredness (suggestive of anemia); menstrual disorders; white or colored vaginal discharge (suggestive of lower reproductive tract infection); and lower abdominal pain and discharge with fever (suggestive of acute pelvic inflammatory disease). Obstetric morbidity, associated with the last live birth, was strongly predictive of current gynecological symptoms. Women who delivered their last child in a private institution were significantly less likely to report symptoms than were those who delivered at home or in a government hospital. Nonusers or users of reversible contraceptive methods were also less likely to report symptoms of morbid conditions than were sterilized women. These associations persisted in analyses controlling for potentially confounding economic and demographic characteristics, and have far-reaching policy implications.

Adult↗