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At least 19 recordsLinked to original sources
PubMed1991

Abnormal bleeding associated with reproductive tract infection.

Reproductive tract infection is an often unrecognized, but relatively common, cause of abnormal reproductive tract bleeding. Postcoital bleeding, menorrhagia, metrorrhagia, and oral contraceptive break-through bleeding are potentially infection-related complaints. The microorganisms most often associated with abnormal reproductive tract bleeding include: Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus type 2, and microorganisms associated with bacterial vaginosis. The clinical conditions cervicitis, endometritis, and pelvic inflammatory disease and the related microorganisms are discussed, as are strategies for clinical management and counseling.

Clinical Protocols↗
PubMed1991

Phospholipase C activity in microorganisms associated with reproductive tract infection.

Phospholipase C (lecithinase or phosphatidylcholine phosphorylase) catalyzes the hydrolysis of lecithin into phosphorylcholine and 1,2-diglyceride. Bacterial production of phospholipase C may damage reproductive tract tissues by both direct and indirect mechanisms. Use of the synthetic substrate p-nitrophenylphosphorylcholine phospholipase C activity was determined in 204 isolates representative of those found in female genital tract. Multiple aerobic (28%) and anaerobic (28%) reproductive tract microorganisms showed phospholipase C activity. Phospholipase C-producing isolates included strains of Bacteroides fragilis, B. bivius, B. thetaiotaomicron, Gardnerella vaginalis, and group B streptococcus. Phospholipase C activity was heterogenous; not all isolates that belong to a particular species showed activity. Phospholipase C production may be a possible virulence factor produced by a number of microflora commonly implicated in various reproductive tract infections or conditions, as well as in some instances of preterm birth.

Bacteria, Aerobic↗
PubMed1991

Intramuscular imipenem/cilastatin treatment of upper reproductive tract infection in women: efficacy and use characteristics.

We evaluated the efficacy, patient and medical staff acceptance, and costs of intramuscular therapy with imipenem/cilastatin for mild to moderate upper reproductive tract infection in hospitalized women in an open study. Thirty-five patients were enrolled, and 29 successfully completed the protocol. Of these, 90% were satisfactorily treated with imipenem/cilastatin given intramuscularly. Twenty-eight of 29 subjects tolerated the intramuscular injections well, although 7 women noted mild to moderate discomfort during injection. All patients who had previously received intravenous therapy (24/29) stated that they preferred the intramuscular injections to continuation or reinitiation of intravenous treatment. Therapy with intramuscular imipenem/cilastatin (assuming a marketed price per gram of approximately $30) was associated with cost savings in comparison with other regimens offering similar antibacterial coverage. Initial care provider resistance to treatment with intramuscular imipenem/cilastatin was overcome due to patient satisfaction. Intramuscularly administered imipenem/cilastatin was effective, generally well tolerated, and resulted in cost saving. Intramuscular administration of imipenem/cilastatin may be a preferred antibiotic treatment in patients with mild to moderate infection due to susceptible microorganisms.

Cesarean Section↗
PubMed1992

[The role of Candida kefyr (C. pseudotropicalis) in reproductive tract infections].

Frequency of appearance of C. kefyr strains, their diagnosis, susceptibility to drugs and importance in pathogenesis of reproductive tract mycoses were investigated. The investigated material consisted of 2717 strains, and there were 67 strains of C. kefyr isolated from vaginal mucous membrane. C. kefyr strains constituted 2.5% of total number of 2717 isolated strains and 8.2% within fungi other than C. albicans species. Vaginal mycosis caused by C. kefyr occurs in presence of Lactobacillus sp. and correct values of pH in vaginal contents, however changing leukocyte number was observed. Clinical symptoms and complaints regarding reproductive tract were present in 47.8% of patients with C. kefyr infections. Investigating susceptibility to antimycotic drugs, regardless of appointed method, low susceptibility of C. kefyr strains to amphotericin B was noted (79% resistant strains). Strain of C. kefyr were sensitive to all remaining drugs.

Candida↗
PubMedDate not supplied

Women's reproductive health--challenges for the 1990s.

Health policy makers, program planners and donor agencies have paid little attention to issues surrounding women's reproductive health. This paper will look at reproductive health issues surrounding pregnancy and childbirth, the accessibility and safety of contraception, and reproductive tract infections. The gross social injustice caused by high maternal mortality can no longer be ignored. Nor can we ignore the much larger numbers of women who suffer life-long health impairment resulting directly from the health hazards associated with pregnancy and childbirth. The challenge is to reduce maternal mortality by at least 50% by the year 2000. If these challenges are not faced, the 1990s may very well be remembered as the decade that saw the largest numbers of women dying in childbirth and pregnancy. The 1990s will see the addition of some 300 million couples to the reproductive age group. These couples will need access to good sexual health care, including safe and effective contraception, and prevention of reproductive tract infections and sexually transmitted disease. The biomedical consequences of reproductive tract infections are, among others, fetal wastage, low birth weight, carcinoma of the cervix, infertility and ectopic pregnancy. In addition to these consequences, there are the psychological, social and economic costs of these diseases. Some suggestions for meeting these challenges are put forward. These include building on existing programs and expanding available resources to help women to attain health, dignity, and their basic human rights.

Female↗
PubMed1992

Preterm birth is associated with increased risk of maternal and neonatal infection.

Much information suggests that maternal reproductive tract infections, both recognized and unrecognized, account for an important and possibly preventable portion of preterm births. If such infections do mediate instances of preterm labor and premature rupture of the membranes (PROM), then associated risks of subsequent maternal and neonatal infections would be increased, even after controlling for confounding variables. To evaluate possible associations between preterm birth and maternal and neonatal infections, we conducted a retrospective study of 9642 births at the University of Colorado Health Sciences Center between July 1980 and June 1985. Clinical chorioamnionitis occurred more frequently among women delivering before term with intact membranes at the onset of labor (5.8% preterm versus 1.7% term) and among women with PROM (26.5% preterm versus 6.7% term). Among the women delivered by cesarean, the incidence of postpartum endometritis was higher in those with preterm PROM than in those with term rupture of membranes. The incidence of neonatal infection increased significantly as the gestational age of the neonates decreased (P less than .01). The rate of culture-proven neonatal infection was significantly higher following PROM (P less than .01) than after birth without PROM. Both neonatal infection and perinatal mortality were increased in association with chorioamnionitis in both preterm and term pregnancies. These consistent observations complement and support suggestions that reproductive tract infection plays a possibly preventable role in the pathogenesis of preterm birth.

Adolescent↗
PubMed1992

Pharmacologic considerations in the management of peripartum conditions in the cow.

As is true with the use of drugs in veterinary medicine in general, there are many controversial issues in the management of peripartum conditions in the cow. For example, the use of PG versus antibacterial drugs in the management of postpartum uterine infections has advocates for the use of either approach. Intrauterine versus systemic administration of antibacterial drugs for the prophylaxis or treatment of postpartum metritis is another area of debate. Clearly, more research is needed in this area. Equally clearly, however, the research results that are available are being disregarded on a daily basis. In considering this discussion of the use of drugs in the peripartum period, one is struck by the frequency that optimum drug therapy of a condition relies on the extralabel use of nonapproved preparations. What guidelines are available to the practitioner in this regard? One example is lack of availability of appropriate dosage regimens or withdrawal times for food derived from treated animals. Unfortunately, pharmacokinetic and residue studies that would aid in establishing guidelines generally are not available and, in most instances, are not forthcoming. Extrapolation of data from other species to the ruminant or extrapolation of information from one drug to a related compound (such as prediction of residue and withdrawal data from an approved aminoglycoside, dihydrostreptomycin, to another unapproved drug, gentamicin) is fraught with difficulties. The need for research in this area is obvious, and lack of such information is one of the major dilemmas in trying to establish rational drug therapy in the food-producing animal. Recent developments in drug therapy have led to innovative approaches for the management of peripartum and other diseases in cattle. The use of PG in the treatment of reproductive disorders, so commonplace and widely accepted in contemporary veterinary practice, is a relatively recent approach that continues to be refined with the development of new, more potent, more specific PG analogs. What will be the role of ceftiofur, a potent, third-generation cephalosporin that currently is approved only for the treatment of respiratory infections in cattle, in the management of reproductive tract infections? The fluoroquinolones, which represent a novel approach to the control of infectious diseases, are being increasingly used in veterinary and human medicine, and one may predict that these powerful antimicrobial drugs will find application in bovine practice, including for the treatment of peripartum infections. Pharmacologic manipulation of immune and defense mechanisms also is an approach with some promise.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1990

Antenatal microbiologic and maternal risk factors associated with prematurity.

In a prospective study of 202 women (gestational age 24 +/- 4 weeks), we evaluated possible influences of lower genital tract infection or bacterial conditions on obstetric outcomes, including preterm labor, preterm premature rupture of membranes, and preterm birth. The presence of bacterial vaginosis (18.7%) was associated with an increased risk of preterm labor (relative risk, 2.6; 95% confidence interval, 1.08 to 6.46). For women with bacterial vaginosis who also had Mobiluncus species morphotypes identified on Gram stain, the relative risk of preterm labor was 3.8 (95% confidence interval, 1.32 to 11.5). Presence of vaginal Mycoplasma hominis (10.8% of patients) was associated with both preterm labor (relative risk, 1.8; 95% confidence interval, 0.77 to 4.4) and preterm birth (relative risk, 5.1; 95% confidence interval, 1.45 to 17.9). Recovery of Staphylococcus aureus (3.0%) was associated with preterm labor (relative risk, 3.1; 95% confidence interval 1.12 to 8.7). Identification of two or more bacterial-linked abnormalities was also associated with preterm labor (relative risk, 3.3; 95% confidence interval, 1.44 to 7.58). An increased level of vaginal wash protease (greater than or equal to 10 trypsin units) (16%) was associated with preterm labor and was noted in 50% of women with preterm premature rupture of membranes. A history of prior preterm birth was the single best historical predictor of both preterm labor (relative risk, 3.6; 95% confidence interval, 1.92 to 6.83) and preterm birth (relative risk, 6.7; 95% confidence interval, 2.2 to 20.4). History of three or more abortions, antenatal urinary tract infection, and occurrence of medical complications during pregnancy also correlated with increased risk of preterm labor. These findings affirm and refine associations of various maternal reproductive tract infections with preterm labor, premature rupture of membranes, and birth, allowing for controlled treatment trials aimed at prevention of preterm birth.

Adult↗
PubMed1992

Fetal gender differences in preterm birth: findings in a North American cohort.

A higher incidence of preterm birth (PTB) and premature rupture of membranes (PROM) has been observed among women delivering male newborns compared with female newborns in different populations. Some authors have speculated that this higher incidence of PTB may be related to the relatively greater weight at lower gestational age of male newborns compared with female newborns. Others have suggested that the greater incidence of PTB and PROM is caused by an increased vulnerability to infection in women carrying males. To understand possible pathogenic factors leading to PTB further, we examined the association between PTB and infant gender in a cohort of North American women. In addition, incidences of PROM, chorioamnionitis, and postpartum endometritis were analyzed for women delivering males versus females. Overall, males were more likely than females to deliver at 33 to 36 weeks' gestation (OR = 1.21; 95% CI: 1.02-1.42). This increase in PTB among males was not accompanied by an increased number of males with low birthweight; rather, males were less likely than females to weigh between 2000 and 2499 gm (OR = 0.71; 95% CI: 0.60-0.84). The difference in PTB by gender could not be explained by an increased occurrence of PROM, chorioamnionitis, endometritis, or other infection-linked processes. Our findings suggest that shorter gestation in males in this population may be related to their relatively increased size and birthweight. Male gender-associated factors that predispose to infection-mediated preterm birth may play greater roles in populations at higher risk for reproductive tract infection during pregnancy.

Adolescent↗
PubMed1991

Variation in the pathogenic potential and molecular characteristics of bovid herpesvirus-4 isolates.

Seven bovid herpesvirus-4 (BHV-4) isolates recovered from various clinical conditions of cattle were studied for their pathogenic potential in pregnant rabbits. These viruses were originally recovered from respiratory and reproductive tract infections of cattle. A virus dose of 4 x 10(6.8)TCID50 per fetus was inoculated via the intrauterine route in 10- and 17-day pregnant rabbits. Clinical, virologic, and pathologic data were collected to compare the effect of each isolate on does and fetuses/kits. Three isolates (LVR-140, QVR-3140 and 86-068) caused abortion, fetal reabsorption and/or mummification in inoculated rabbits. Virus was recovered from tissues of inoculated rabbits (especially the spleen, ovaries and uterus) by organ explanation and/or co-cultivation. Intravenous inoculation of isolate 86-068 did not produce any clinical signs in either 10- or 17-day pregnant rabbits. All seven isolates of BHV-4 showed a predilection for the reproductive tract of pregnant rabbits but varied in the severity of disease signs produced. Variation was also observed in the genome of various isolates on the basis of restriction endonuclease (RE) analysis. Relationship of RE patterns to the variation in the pathogenic potential of seven BHV-4 isolates is discussed.

Animals↗
PubMedDate not supplied

Family planning, sexually transmitted diseases and contraceptive choice: a literature update--Part I.

Couples who use contraceptives not only protect themselves against unwanted pregnancies, but also may reduce their risk of becoming infected with a sexually transmitted disease (STD). No currently available method, however, is highly effective in protecting simultaneously against pregnancy and infection. Thus, couples who place high priority on minimizing both risks may have to use two methods. The need for contraceptive methods that provide effective protection against both pregnancy and STDs has been intensified by the HIV epidemic, but progress has been slowed by the lack of integration between the STD and family planning fields. The first part of this two-part article discusses the similarities and differences between the two fields, examines the impact of STDs on contraceptive use and services, and reviews the scientific literature dealing with the effects of condoms, spermicides and barrier-and-spermicide methods on the risk of STD transmission. Part II (which will appear in the next issue) examines what is known about the effects of oral contraceptives, the IUD, tubal sterilization and abortion on reproductive tract infections. The second part also includes a discussion of the trade-offs involved in choosing a contraceptive and presents estimates of the first-year rates of unplanned pregnancy and gonorrhea infection (given an infected partner) that would occur among women using various contraceptive methods.

Contraceptive Devices, Female↗
PubMed1992

Use of antibiotics for preterm premature rupture of membranes. Rationales and results.

PPROM is directly associated with 30% to 40% of preterm births. Reproductive tract infection, inflammation, or both may be primary causes or occur secondarily after PPROM and hasten the onset of labor. Recent carefully controlled trials demonstrate that antibiotic treatment (erythromycin, ampicillin) can significantly lengthen the "beneficial latency period" and reduce perinatal and maternal morbidity, as well as the costs.

Anti-Bacterial Agents↗
PubMed1977

[Infection hazards and complications following the use of IUDs].

Own experiences on IUD-complications especially irregular bleedings and infections underline that modern plastic intrauterine devices are second-rate contraceptives. Compared to hormonal contraceptive drugs intrauterine devices have a higher pregnancy risk and increased rates of infections. Therefore the IUD is in our opinion not suited primary contraceptive method used without indication. Because of the relatively often occurring ascendant genital infections the application of intrauterine devices should not be carried out in nulliparae.

Adult↗