[Proceedings: A rare utero-vaginal double abnormality].
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Abnormalities, Multiple↗
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Mycoplasma hominis in nonspecific vaginitis.
The prevalence of nonspecific vaginitis was 24% among 98 randomly selected women examined at a clinic for sexually transmitted diseases and 32% among 135 women with suspected cervicitis at the same clinic. Mycoplasma hominis was isolated more often and serum antibody levels to M. hominis were higher in women with nonspecific vaginitis than in women without nonspecific vaginitis. Similarly, the rate of isolation of Gardnerella vaginalis and the quantitative growth of G. vaginalis were higher for women with nonspecific vaginitis. Abnormal results of gasliquid chromatographic analysis of vaginal fluid and the presence of abnormal diamines in the vaginal fluid also were associated with nonspecific vaginitis and with the isolation of M. hominis, whether or not G. vaginalis was isolated. Further studies of the ecologic interactions among M. hominis, G. vaginalis, and anaerobes in nonspecific vaginitis are needed for a better understanding of the pathogenesis of this syndrome.
Adolescent↗
Antibiotic treatment for threatened abortion during the early first trimester in women with previous spontaneous abortion.
BACKGROUND: We retrospectively examined the usefulness of antibiotic therapy for management of first-trimester threatened abortion in women with previous spontaneous abortion. METHODS: From 1993 through 1999, women with first-trimester threatened abortion received antibiotic therapy. Only those with gestational age less than 9 weeks and previous spontaneous abortion were included in this analysis. Women with mild abdominal cramping received amoxicillin plus erythromycin for 1 week; those with severe abdominal pain received amoxicillin plus clindamycin for 1 week. Recurrence was documented on the basis of either lower abdominal pain or vaginal bleeding. RESULTS: Of the 23 women included, 15 (65%) had abnormal vaginal flora (a score above 4, Nugent's criteria). Seven of 16 women who received amoxicillin plus clindamycin and three of seven who received amoxicillin plus erythromycin had complete resolution of lower abdominal pain and vaginal bleeding without recurrence (p=1). The recurrence rate was higher, though not significantly, in women with abnormal bacterial vaginal flora (8/15 vs. 2/8, p=0.379). Twenty-two (96%) of the 23 pregnancies were carried to term, with no identifiable neonatal anomalies. CONCLUSIONS: These results suggest the usefulness of early antibiotic therapy in preventing pregnancy loss in women with threatened abortion early in the first trimester, and warrant further clinical trials.
Abortion, Spontaneous↗
Oestrogen producing adrenocortical adenoma: clinical, biochemical and immunohistochemical studies.
Oestrogen producing adrenocortical tumours are extremely rare. We report a 65-year-old woman who presented with abnormal vaginal bleeding, with no significant abnormalities in her uterus or ovaries, who was found to have a right adrenal mass by radiological examination. Excessive secretion of oestrogens from the tumour was demonstrated by adrenal venous sampling. Basal levels of corticosteroids were within normal limits. Adrenalectomy was performed and pathological examination revealed an adrenocortical adenoma measuring 5.5 cm in its greatest dimension, in which both clear and compact tumour cells were observed. Oestrogen levels normalized following the removal of the adrenal mass. Tissue concentrations of oestrone and oestradiol in the tumour were 6.9 (69.5 pmol/g wet tissue weight) and 34.6 (93.6 pmol/g wet tissue weight)-fold greater respectively than those of adjacent non-neoplastic adrenal cortex. Aromatase activity in the tumour tissue determined by the 3H-water method was 118.6 pmol/h/mg protein, equivalent to that of a full-term human placenta. Immunohistochemical analysis of aromatase demonstrated immunoreactivity in the tumour cells, especially in compact cells, but not in adjacent non-neoplastic adrenal cells. This is the first reported case of an oestrogen producing adrenocortical adenoma in which aromatase in the tumour cells was documented.
Adenoma↗
Risk factors for infection with herpes simplex virus type 2: role of smoking, douching, uncircumcised males, and vaginal flora.
BACKGROUND: Herpes simplex virus type 2 (HSV-2), the primary cause of genital herpes, is one of the most prevalent sexually transmitted diseases worldwide. Epidemiologic serosurveys suggest that infections occur more frequently in women than in men. GOAL: The goal of the study was to identify unique correlates of HSV-2 infection in women that might contribute to their increased susceptibility of infection or suggest opportunities for decreasing the incidence of disease. STUDY DESIGN: We enrolled 1207 women aged 18 to 30 years from three Pittsburgh health clinics in a cross-sectional study. Each woman provided demographic and behavioral information, vaginal swab specimens for bacterial culture, a vaginal smear for Gram stain diagnosis of bacterial vaginosis, and blood for HSV-1 and HSV-2 serology. RESULTS: Black race, older age, cigarette smoking, douching, a greater number of lifetime sex partners, a history of intercourse with an uncircumcised partner, the presence of vaginal group B Streptococcus, and abnormal vaginal flora were among the independent predictors of HSV-2 infection. CONCLUSION: HSV-2 infection may be occur more often in women who douche, smoke, have sex with uncircumcised partners, or have bacterial vaginosis; these represent alterable risk factors.
Adolescent↗
Prevalence of bacteria in the vagina of normal young women.
We report on factors related to the prevalence of bacteria in the vagina of 1498 women who were attending a family planning clinic. Anaerobes were significantly commoner in women with an abnormal vaginal discharge on clinical examination, in women with a history of a troublesome vaginal discharge and in women who used an intrauterine contraceptive device (IUCD) than in others. The association between anaerobes and abnormalities of vaginal discharge was found both in women who used the IUCD and in women who did not. We found no significant associations between symptoms and other bacterial species or combinations of species. Coliforms were significantly commoner in women who did not use tampons, in women who used the diaphragm and in women who had received recent antibacterial or antifungal treatment than in others. Lactobacilli were significantly commoner in women who used the contraceptive pill, and were significantly less common in women who harboured Candida albicans, anaerobes, coliforms or enterococci and in women who had been treated with antibacterial drugs, than in others. We found no important associations between the presence of bacteria and the patients' age, parity or social class.
Bacteria↗
Predictors of the vaginal microflora.
OBJECTIVE: Our purpose was to define influences on the patterns of the vaginal microflora. STUDY DESIGN: We enrolled 617 African American and Mexican American women in a 1-year longitudinal study of sexual behaviors and the vaginal microflora on the basis of the presence of gonorrhea, chlamydial infection, trichomoniasis, or syphilis at the initial visit. The patients were assigned randomly to a behavioral intervention or standard counseling regarding sexually transmitted disease. We reevaluated 508 (82%) and 549 (89%) women at 6 and 12 months, respectively. A comprehensive survey of lower genital tract organisms was conducted at baseline and at 6 and 12 months. Behavioral and microbiologic associations were screened by bivariate analysis. All variables associated with an organism at P < or = .15 were included in a multivariate analysis. Associations between behavior and the genital tract microflora were identified by logistic regression coefficients with P <.05. RESULTS: African American race had a consistent association with vaginal microflora, specifically, Mycoplasma hominis, Trichomonas vaginalis, bacterial vaginosis, group B streptococci, Neisseria gonorrhoeae, and Chlamydia trachomatis. Various behaviors had a less consistent effect, including multiple partners, douching, frequency of coitus >3 times a week, and cunnilingus, fellatio, and anal intercourse at the last sexual encounter. M hominis (but not Ureaplasma urealyticum ), Gardnerella vaginalis, and Lactobacillus species were associated with bacterial vaginosis. Lactobacillus species appeared to protect against bacterial vaginosis and infection with G vaginalis. Sexually transmitted diseases (caused by M hominis, N gonorrhoeae, C trachomatis, and T vaginalis ) were associated with each other. In contrast, hormonal status, vaginal blood, and foreign bodies had little effect. CONCLUSION: The presence of other microorganisms and race have a more consistent association with the presence or absence of a cervical-vaginal organism than sexual behavior, hormonal status, vaginal devices, or the presence of abnormal vaginal bleeding.
Adolescent↗
Vaginal nitric oxide in pregnant women with bacterial vaginosis.
PROBLEM: To evaluate vaginal nitric oxide (NO) production in response to alterations in the vaginal microbial flora. METHOD OF STUDY: Cervicovaginal lavage samples from 206 women at 18-22 weeks of gestation were tested for NO, interleukin-1beta (IL-1beta), IL-1 receptor antagonist (IL-1ra), tumor necrosis factor-alpha and the inducible 70 kDa heat shock protein (hsp70). Bacterial vaginosis (BV) was diagnosed based on gram staining of vaginal smears. RESULTS AND CONCLUSIONS: Elevated NO (>2.14 mmol/L) was associated with a diagnosis of BV (38% versus 11%, P < 0.008) as well as an increased median vaginal IL-1ra concentration (72.5 ng/ml versus 36.6 ng/ml, P = 0.041). Elevated vaginal NO was also associated with vaginal hsp70 and this relationship was independent of BV status or IL-1ra concentrations (P < 0.026). We conclude that vaginal hsp70 release in response to abnormal vaginal microflora may trigger NO production in an attempt to minimize the pathological consequences of this altered milieu.
Adult↗
Lack of correlation of vaginal impedance measurements with hormone levels in the rat.
Hormone levels vary in female rats depending on estrous cycle stage. Vaginal cytology is a reliable method of staging female rats, but vaginal impedance offers an alternative depending on application. We sought to correlate vaginal impedance in cycling female rats with hormone levels. Vaginal cytology was the standard for comparison and verification of estrous cycle stage. Female rats (n = 41) were evaluated twice daily for 15 days via vaginal cytology and impedance to evaluate two or three estrous cycles per rat. During the last 5 days of the study, selected anesthetized sampling groups (n = 3 or 4 rats per group) were bled terminally at each time point to allow hormone determinations concurrently with vaginal cytology and impedance. Rats with abnormal vaginal smears or discharges (n = 5) were evaluated for reproductive tract histology. Rats classified in estrus by vaginal cytology had significantly higher vaginal impedance values than did nonestrus rats, but vaginal impedance and estrous cycle stage as determined by vaginal cytology did not correlate. Because of small sampling size in nonproestrus groups, correlation between vaginal impedance and hormone levels was evaluated only in proestrus rats (n = 22) and was nonsignificant. No correlation occurred between vaginal impedance and hormone levels in unstaged rats (n = 41). Two animals evaluated for reproductive tract histology showed evidence of pseudopregnancy. Vaginal impedance may be useful in distinguishing estrus from nonestrus rats but may be limited for chronic estrous cycle monitoring because of the possible risk of inducing pseudopregnancy.
Animals↗
Endocervical Chlamydia trachomatis infection in Canadian adolescents.
The highest prevalence rate of sexually transmitted chlamydial infection is among adolescent girls. To determine the rate among predominantly asymptomatic girls who were seen at a pediatric gynecology unit and to identify those at high risk we screened 541 such patients from Jan. 1 to Dec. 31, 1986, by means of direct fluorescent antibody testing; 422 (78.0%) were asymptomatic. The most common reason for presentation was a request for contraceptive advice (the reason for 59.2% of the patients). Of the 446 patients (82.4%) who were sexually active 66 (14.7%) had evidence of chlamydial infection; none of the 93 sexually inactive patients were infected. Neisseria gonorrhoeae was isolated from eight (1.5%) of the patients. The risk factors that correlated with chlamydial infection were abnormal vaginal discharge, abdominopelvic pain and an abnormal Papanicolaou test result. Because of the high morbidity rate associated with genital chlamydial infection and the high prevalence rate among adolescent girls, most of whom are asymptomatic, all sexually active teenagers should be screened.
Adolescent↗
Abnormal uterine bleeding. Accuracy of vaginal probe ultrasound in predicting abnormal hysteroscopic findings.
OBJECTIVE: To determine the accuracy of vaginosonography in predicting the presence of abnormal intrauterine findings at hysteroscopy in women presenting with abnormal uterine bleeding. STUDY DESIGN: Two hundred thirty-eight women between the ages of 25 and 75 were evaluated for abnormal uterine bleeding by a combination of vaginal probe ultrasound, hysteroscopy and suction curettage. Ultrasound findings were classified as normal, abnormal or equivocal, and hysteroscopic findings as normal or abnormal. The ability of findings on ultrasound to predict a normal or abnormal hysteroscopic examination was evaluated. RESULTS: Ultrasound examination was normal, equivocal and abnormal in 57 (24%), 78 (33%) and 103 (43%) patients, respectively. If equivocal scans are excluded, ultrasound had a positive predictive value of 87%, negative predictive value of 89%, sensitivity of 94% and specificity of 89%. If equivocal scans are considered abnormal, the positive predictive value of an abnormal ultrasound examination was 75%, negative predictive value was 89%, sensitivity 96% and specificity 53%. Vaginosonography detected 99% of submucous myomas and 89% of endometrial polyps. CONCLUSION: Normal and abnormal vaginal probe ultrasound examination of the uterus is effective in predicting the presence or absence of endometrial pathology as determined by hysteroscopy and suction curettage. Vaginal probe ultrasound is an excellent screening examination for the presence of intrauterine pathology and can assist in planning further evaluation and treatment.
Adult↗
Uterus didelphys with unilateral imperforate vagina: spontaneous rupture of the vaginal septum.
A 13-year-old girl with abnormal vaginal bleeding was found to have uterus didelphys with unilateral imperforate vagina. A brief discussion of this rare anomaly and its treatment accompanies the case report.
Adolescent↗
Probiotics for women's health.
GOALS: The goals of this research were 2-fold: (1) to determine whether a commercially available probiotic mixture (VSL-3) could survive and grow in a continuous culture system simulating the vaginal environment and (2) to determine whether the probiotic mixture was capable of suppressing the growth of a known vaginal vault pathogen, Gardnerella vaginalis. BACKGROUND: An abnormal vaginal microflora, such as that associated with bacterial vaginosis (BV) is an important health issue for women. In addition, the association of this condition with preterm labor and delivery suggests that control of BV may impact the number of preterm births. Interventional trials with antibiotics have received mixed reviews and other interventional options, including the use of probiotics, are being considered. STUDY: A well-documented continuous culture system has been used to determine whether VSL-3 can survive and grow in conditions simulating a vaginal environment. In addition, the ability of VSL-3 to inhibit the growth of a known vaginal vault pathogen, G. vaginalis, has been determined. RESULTS: The probiotic mixture was shown to survive and maintain itself within the fermentation vessel of the continuous culture system over an extended period of time. This mixture, when challenged with a known pathogen, was also shown to suppress the growth of G. vaginalis. CONCLUSIONS: It may be feasible to use probiotics as interventional therapy to suppress the growth of pathogens within the vaginal vault associated with BV.
Culture Techniques↗
Higher-risk behavioral practices associated with bacterial vaginosis compared with vaginal candidiasis.
OBJECTIVE: Bacterial vaginosis has been associated with hormonal factors and sexual practices; however, the cause is unclear, and the notion that bacterial vaginosis is a sexually transmitted infection is still debated. To investigate whether bacterial vaginosis is associated with specific sexual practices or instead has features in common with a sexually transmitted infection, we compared behavioral associations in women with bacterial vaginosis to women with vaginal candidiasis. METHODS: Women with symptoms of abnormal vaginal discharge or odor who attended Melbourne Sexual Health Centre between July 2003 and August 2004 were eligible for enrollment in the study. Information on demographics and behavioral and contraceptive practices were collected by self-completed questionnaire. Participants were tested for bacterial vaginosis, Candida spp (microscopy and culture), and sexually transmitted infections. Statistical comparisons were made between women with and without bacterial vaginosis and women with and without candidiasis, using univariate and multivariate analysis. RESULTS: A total of 342 women were enrolled in the study; 157 were diagnosed with bacterial vaginosis, 51 had candidiasis by microscopy, and 95 had candidiasis by culture. Bacterial vaginosis was associated with indicators of high-risk sexual behavior such as a new sexual partner and greater number of male partners in the last year, increased number of lifetime sexual partners, less than 13 years of education, a past history of pregnancy, and smoking (P < .05). Candidiasis was not associated with these risk behaviors and was instead related to practices such as receptive anal and oral sex and douching. CONCLUSION: The association between bacterial vaginosis and practices that are associated with sexually transmitted infections, in contrast to those observed with candidiasis, suggests a possible sexually transmitted cause. LEVEL OF EVIDENCE: II-2.
Adult↗
Single dose of tinidazole in the treatment of vaginal discharge.
Seventy-nine unselected women whose main symptom was abnormal vaginal discharge were seen at the Department of Obstetrics and Gynecology at Helsinki University Central Hospital between October 1980 and September 1981. All patients and their current sex partners were randomly treated either with a 2-gram single dose of tinidazole or with identical placebos. Those excluded were 9 patients who did not attend the follow-up examination, 15 who had specific cervicovaginal infections (6 with chlamydial infection, 4 with trichomoniasis and 5 with yeast infection), and 22 with normal Döderlein flora seen on vaginal Pap smear. Response to the treatment was analysed among the remaining 33 women, of whom 17 received tinidazole and 16 placebo. The symptoms and signs that best discriminated between those who had normal Döderlein flora and those who had non-Döderlein flora were malodour, other than white colour of the discharge, and the presence of clue cells on Pap smear. When these findings were used to evaluate the response to treatment, tinidazole proved to be more effective than placebo. Disappearance of clue cells best (p less than 0.01) discriminated between tinidazole and placebo.
Adult↗
Vaginal microbial flora as a cofactor in the pathogenesis of uterine cervical intraepithelial neoplasia.
The vaginal microbial flora of 106 women with histopathologically confirmed cervical intraepithelial neoplasia and 79 women without disease, was evaluated for Gardnerella vaginalis, Trichomonas vaginalis, Candida albicans and other yeasts. Flora morphology was assessed by gram staining of secretions. Cervical cultures were examined for Herpes Simplex virus, Cytomegalovirus and Neisseria gonorrhoeae. Chlamydia trachomatis antigens in cervical secretions were detected by enzyme immunoassay. Human Papillomavirus was identified by koilocytosis in cytologic or histopathologic specimens. Human Papillomavirus infection (P less than 0.00001), vaginal infection with Mycoplasma hominis (P = 0.012) and abnormal vaginal flora (P = 0.006) were significantly associated with CIN, suggesting that CIN may be promoted by vaginal microorganisms in conjunction with human papillomavirus cervical infection.
Adolescent↗
Population-based genetic epidemiologic analysis of Chlamydia trachomatis serotypes and lack of association between ompA polymorphisms and clinical phenotypes.
Chlamydia trachomatis is the leading cause of bacterial sexually transmitted diseases worldwide. Urogenital strains are classified into serotypes and genotypes based on the major outer membrane protein and its gene, ompA, respectively. Studies of the association of serotypes with clinical signs and symptoms have produced conflicting results while no studies have evaluated associations with ompA polymorphisms. We designed a population-based cross-sectional study of 344 men and women with urogenital chlamydial infections (excluding co-pathogen infections) presenting to clinics serving five U.S. cities from 1995 to 1997. Signs, symptoms and sequelae of chlamydial infection (mucopurulent cervicitis, vaginal or urethral discharge; dysuria; lower abdominal pain; abnormal vaginal bleeding; and pelvic inflammatory disease) were analyzed for associations with serotype and ompA polymorphisms. One hundred and fifty-three (44.5%) of 344 patients had symptoms consistent with urogenital chlamydial infection. Gender, reason for visit and city were significant independent predictors of symptom status. Men were 2.2 times more likely than women to report any symptoms (P=0.03) and 2.8 times more likely to report a urethral discharge than women were to report a vaginal discharge in adjusted analyses (P=0.007). Differences in serotype or ompA were not predictive except for an association between serotype F and pelvic inflammatory disease (P=0.046); however, the number of these cases was small. While there was no clinically prognostic value associated with serotype or ompA polymorphism for urogenital chlamydial infections except for serotype F, future studies might utilize multilocus genomic typing to identify chlamydial strains associated with clinical phenotypes.
Adolescent↗
Interrelationships among human immunodeficiency virus type 1 infection, bacterial vaginosis, trichomoniasis, and the presence of yeasts.
Vaginal discharge of mixed etiology occurs frequently, with abnormal vaginal flora being the most common condition. The interrelationships among the disturbance of the vaginal ecology, the presence of yeasts, and infection with Trichomonas vaginalis and human immunodeficiency virus type 1 (HIV-1) were investigated among women presenting to a sexually transmitted diseases service. Analysis was done for 598 women. Although the prevalence of HIV-1 infection increased linearly with increasing Nugent's score (bacterial vaginosis score of Gram stain), the prevalence of T. vaginalis increased suddenly, from 12% in patients with a Nugent's score of < or =3 to 33% in patients with a score of 4, and remained at this level at higher scores. Yeast colonization and vulvovaginal candidiasis were inversely related to Nugent's scores. T. vaginalis might be responsible for the change in normal vaginal flora and may, therefore, be one of the causes of bacterial vaginosis. This could lead to more effective HIV-1 acquisition.
Adolescent↗