1 240例女性生殖道支原体感染分析

目的 为了解生殖道支原体在晚期孕妇、育龄妇女、念珠菌性阴道炎和淋球菌性阴道炎患者中的感染状况。方法 采用套式聚合酶链反应技术，对962例晚期孕妇、85例育龄妇女、90例念珠菌性阴道炎和103例淋球菌性阴道炎患者的宫颈拭子标本进行了生殖道支原体检测。结果 在晚期孕妇、育龄妇女、念珠菌性阴道炎和淋球菌性阴道炎患者中生殖道支原体的检出率分别为4．16％、3．52％、11．1l％和13．59％。结论 生殖道支原体在晚期孕妇、育龄妇女、念珠菌性阴道炎和淋球菌性阴道炎妇女中均有一定的检出率。     

1 657例阴道分泌物检查结果的初步研究

目的　了解长沙市阴道炎的患病情况 ,探讨简便有效的细菌性阴道病 (BV)的实验室诊断方法。　方法　采用常规方法对 16 5 7份阴道分泌物进行滴虫、霉菌及细菌性阴道病的检查 ,并对阴道分泌物涂片进行革兰染色及细菌评分。　结果　 16 5 7份阴道分泌物中 ,检出 BV5 73例 (34.6 4 %) ,滴虫性阴道炎及霉菌性阴道炎检出率分别为 4 .76 %及10 .0 8%,BV合并滴虫和 /或霉菌感染比率为 2 .96 %。细菌评分与 BV呈明显的相关 (P<0 .0 0 0 1)。　结论　长沙市区妇女中 BV患病率远远高于滴虫性和霉菌性阴道炎 ,且 BV常伴有滴虫和 /或霉菌的感染。提示临床工作中应常规开展 BV的检查 ,以提供及时准确的诊疗信息。     

Vaginal contraception with gossypol: A clinical study

A clinical study concerning the vaginal contraceptive efficacy of gossypol acetic acid was performed. Fifteen women who had undergone tubal sterilization volunteered for the study. The effect of vaginal gossypol-containing gel on spermatozoa was determined by postcoital tests performed in subjects without and after using gossypol gel. After gossypol application, the number of spermatozoa found in cervical mucus was greatly decreased and, in eleven of the fifteen women, all spermatozoa seen were immobilized. In four cases a few poorly motile spermatozoa were seen but they showed no forward progression. We have previously reported that gossypol has an inhibitory effect on herpes simplex virus type 2 $\text{in vitro}$. This antiviral property of gossypol makes it particularly attractive as a topical barrier contraceptive. The present study shows that gossypol is also promising as a vaginal contraceptive agent in human $\text{in vivo}$ experiments.     

育龄妇女生殖道感染综合干预效果的Meta分析

目的:综合评价生殖道感染的综合干预对控制我国育龄妇女内源性生殖道感染的效果。方法:检索近10年国内发表的关于育龄妇女细菌性阴道病和念珠菌性阴道炎的干预效果的研究。筛选文献、提取数据资料和进行质量评价后,采用RevMan5.0软件进行Meta分析。结果:共纳入13个研究,包括5个群组随机对照研究和8个干预前后对照研究,结果显示:①群组随机对照研究:细菌性阴道病患病率合并OR值为0.56(95%CI:0.37,0.84),念珠菌性阴道炎患病率合并OR值为0.50(95%CI:0.40,0.64);干预组患病率比对照组低。②干预前后对照研究:干预后细菌性阴道病患病率比干预前低(RD=-0.04,95%CI:-0.05,-0.02),干预后念珠菌性阴道炎患病率比干预前低(RD=-0.06,95%CI:-0.08,-0.03)。结论:在育龄妇女中进行生殖道感染的综合干预对降低生殖道感染的患病率有一定积极的作用。     

念珠菌性阴道炎病理变化与机体免疫反应的关系

目的:构建白色念珠菌性阴道炎动物模型,对阴道粘膜组织进行病理检测及机体免疫功能测定,探讨念珠菌性阴道炎时,机体Th细胞免疫反应的变化。方法:用5×104/ml白色念珠菌注入雌激素化的BALB/C小鼠阴道,构建阴道炎感染模型,然后观察阴道黏膜组织病理变化,用酶联免疫法(ELISA)检测Th细胞因子。结果:注入白色念珠菌后,随着感染时间的延长阴道黏膜组织真菌载量增加,念珠菌菌丝相明显,大量菌丝黏附于阴道黏膜,感染7天后可观察到菌丝向黏膜下层侵袭,局部出现炎性细胞浸润。随感染时间延长建模鼠脾细胞诱生的IFN-γ呈下降趋势,IL-4升高,第7天达到峰值,血清IL-6表达呈上升趋势。结论:在阴道黏膜组织念珠菌荷菌量增加时,机体呈现以Th2细胞为主的免疫反应,Th1细胞因子在抗念珠菌中发挥重要作用,炎性因子IL-6与阴道组织病理变化相关。     

A clinical and metabolic study of norethisterone oenanthate in Thai women

Norethisterone oenanthate was given as an injectable contraceptive to 126 Thai women. Only healthy informed volunteers aged 18–35 years were admitted to the study. One ml of oily solution containing 200 mg of steroid was administered into the gluteal muscles. The first injection was given during days 1–5 of a normal menstrual period. The second, third and fourth injections were given at eight-week intervals and were followed by subsequent injections at 12-week intervals. All injections were given within seven days of the scheduled date. Volunteers were instructed to record any vaginal bleeding in diary cards. At each visit, weight, blood pressure and menstrual bleeding were recorded. Complaints and adverse effects were also noted.Prior to admission for study, an oral glucose tolerance test (OGTT), serum transaminase, cholesterol and triglycerides were simultaneously studied in 21 women and then repeated at three, six and twelve months.The 12-month continuation rate was $\text{63}\text{100}$ women-years with 5 accidental pregnancies. Two pregnancies occurred during the second injection intervals and the other three pregnancies occurred during the third, fourth and fifth injection intervals. The 12-month study revealed $\text{11}\text{100}$ and $\text{25}\text{100}$ women-years of amenorrhea and heavy bleeding, respectively.There was a statistically significant increase in the serum glucose tolerance test (P < 0.05) at the 30-minute time intervals after 12 months of use, but the areas under the curves were within normal limits. The total cholesterol and triglycerides showed a significant transient decrease (P < 0.01) at the third month of study and returned to normal after 6 months.     

The effect of a contraceptive vaginal ring and oral contraceptives on the vaginal flora

Premenopausal women seeking a steroid contraceptive method were allowed to choose between a contraceptive vaginal ring (CVR) containing levonorgestrel and estradiol used in a 3-week in, 1-week out regimen (n = 20) and an oral contraceptive (OC) containing levonorgestrel and ethinyl estradiol in a 28-day regimen (n = 10). Cultures from the posterior vaginal fornix were obtained before therapy in both groups and monthly for 6 months for the CVR group and after 1,3, and 6 months for the OC group. These cultures were streaked on specific media to provide quantitative aerobic and anaerobic, lactobacillus, Candida sp., $\text{Gardnerella vaginalis}$ and $\text{Neisseria gohorrhoeae}$ counts in micro-organisms per milliliter. A comparison of the number and types of organisms isolated from vaginal cultures obtained initially and at 6 months demonstrated no statistically significant differences in colony counts between CVR and OC users. The results of this study suggest that the use of the CVR is not associated with a greater growth of pathogens than is oral administration of a progestin and estrogen combination.     

Reproductive tract immune cells from pregnant women or those using depot medroxyprogesterone acetate show no excess susceptibility to HIV-1: Results of an ex vivo fusion assay

IntroductionEx vivo fusion assays offer an efficient method for studying HIV-1 entry associated with contraceptive use and pregnancy outside of cohort studies of HIV-1 incidence.MethodsWe measured ex vivo HIV-1 fusion to cervical or endometrial immune cells from three groups of women: pregnant, non-pregnant not using hormonal or intrauterine contraception, and using depot medroxyprogesterone acetate (DMPA).Results and conclusionsThere was no excess susceptibility to HIV-1 fusion of cells from pregnant women or DMPA users compared to controls. Although the number of target cells in endometrium was higher in DMPA users compared to controls, HIV-1 fusion was lower.ImplicationsIn ex vivo assays, HIV-1 showed no enhanced fusion to cervical immune cells from pregnant women or DMPA users compared to controls, and lower fusion to endometrial immune cells from DMPA users. This assay is useful for studying hormonal and contraceptive effects on HIV-1 entry into reproductive tract immune cells.     

507例女性生殖道感染性疾病调查结果分析

目的:了解性病门诊女性患者生殖道感染性疾病的患病状况。方法:选择507例患者进行滴虫性阴道炎、霉菌性阴道炎、细菌性阴道病、尖锐湿疣、淋病、沙眼衣原体、梅毒、盆腔炎的临床及实验室检查。结果:生殖道一种病原体感染者330例,占65.09%;两种感染者147例,占28.99%;3种以上感染者30例,占5.92%。以21~40岁患病最多。结论:普及生殖道感染的防治知识,做到早发现、早诊断、早治疗,降低生殖道感染对妇女健康的危害。     

Vaginal colonization of escherichia coli and its relation to contraceptive methods

The prevalence rate of vaginal colonization with $\text{E. coli}$ was studied prospectively among 495 healthy premenopausal women, and factors associated with vaginal carriage of $\text{E. coli}$ were examined. Vaginal colonization with $\text{E. coli}$ was found in 12% of women, and was significantly correlated with phase of the menstrual cycle (p < 0.05), prior use of antibiotics (p < 0.05), current genital complaints (p < 0.05), history of previous urinary tract infection (p < 0.001), and use of diaphragm or cervical cap for contraception (p < 0.005). The high prevalence rate among diaphragm or cervical cap users remained significant when other confounding factors were kept constant (p < 0.05). This observation may explain the association of diaphragm use and urinary tract infection demonstrated in previous epidemiologic studies and confirmed in the present study (p < 0.05).     

In vitro immobilization of human spermatozoa with hydroxypropylmethylcellulose

Hydroxypropylmethylcellulose (MC) in one to three per cent $\text{w}\text{v}$ aqueous solution caused immediate and permanent immobilization of human spermatozoa $\text{in vitro}$. This spermicidal effect may open new ways of improving human vaginal contraception. It also accounts for the spermatotoxic effects of vaginal lubricants and other compounds containing MC as base vehicle.     

Depo Now: Preventing Unintended Pregnancies among Adolescents and Young Adults

PurposeWe compared the immediate administration of DMPA (Depo Now) to the immediate use of short-term hormonal methods that served as a “bridge method” until later DMPA initiation. We examined whether Depo Now, as compared to initiating with a bridge method (pills, transdermal patch, or vaginal ring), resulted in greater DMPA continuation at six months.MethodsYoung women aged 14 to 26 years seeking to use DMPA were randomized (nonblinded) after meeting eligibility criteria to either the Depo Now (n = 101) or bridge method (n = 232) group. Depo Now subjects received their first injection of DMPA at the conclusion of their first visit provided each was medically suitable and had a negative urine pregnancy test regardless of menstrual cycle day. Those assigned to the bridge method group were allowed to choose their starting contraceptive method and it was provided at the first visit. All subjects were told to return to the clinic in 21 days to repeat the urine pregnancy test, and among those who were assigned to use a bridge method, to receive their first injection of DMPA. All subjects were followed to their third injection, or about 6 months later.ResultsThose randomized to a bridge method were 1.8 (1.1, 2.9) times more likely than Depo Now subjects to return for their 21-day repeat pregnancy test, but only 55% (n = 125) of these young women actually received their first DMPA injection. Continuation rates at the third injection were 29.7% (n = 30) for those in the Depo Now group and 21.1% (n = 49) for those assigned to the bridge method (p = .09). Three factors were significantly associated with adherence to the third injection: randomized to Depo Now group, knowing more women who use DMPA, and returning to clinic for the 21-day repeat pregnancy test visit. Finally, 28 pregnancies were diagnosed during the study period, and those in the bridge method group were almost 4.0 (1.2, 13.4) times more likely to be diagnosed with a pregnancy than those in the Depo Now group.ConclusionsImmediate administration of DMPA is associated with improved adherence to DMPA continuation and fewer pregnancies.     

The effect of filters on the incidence of lung cancer in cigarette smokers

A follow-up was carried out on 2393 nonfilter and 3045 filter cigarette smokers from a sample of male mass radiography volunteers aged 40 or more. The follow-up period, which was a minimum of 69 months and a maximum of 81 months, revealed 104 cases of lung cancer identified by cross-checking records with the registers of regional cancer registration bureaus. The incidence of lung cancer of nonfilter cigarette smokers ($\text{24.2}\text{1000}$) was more than 50% higher than that of filter cigarette smokers ($\text{15.1}\text{1000}$). This relationship was maintained irrespective of age and amount smoked and, because of the fact that most filter smokers smoked nonfilter cigarettes for many years before changing to filters, probably underrates the protective effect of filters. The mechanism of the protection is likely to lie not only in the filter itself but also in the reduction of tobacco available for smoking compared with nonfilter cigarettes of comparable length and the impossibility of smoking filter cigarettes to a short butt.     

Implanon as a contraceptive choice for teenage mothers: a comparison of contraceptive choices, acceptability and repeat pregnancy

Background

This study was conducted to compare the incidence of repeat teenage pregnancy over a 24-month period postpartum among users of Implanon, the combined oral contraceptive pill (COCP) or depot medroxyprogesterone acetate (DMPA) and barrier methods or nothing (barrier/none). Contraceptive continuation rates 24 months postpartum for Implanon and COCP/DMPA were also compared.

Study Design

A prospective cohort study was conducted. Comparison groups were postpartum teenagers (12-18 years old) who self-selected Implanon (n=73), COCP/DMPA (n=40) and barrier/none (n=24). Questionnaires were used to gather data at recruitment and postpartum at 6 weeks and then 3 monthly intervals for 2 years.

Results

At 24 months postpartum, 48 (35%) teenagers had conceived. Implanon users became pregnant later than other contraceptive groups (p=.022), with mean time to first repeat pregnancy of 23.8 months [95% confidence interval (CI), 22.2-25.5], compared to 18.1 months (95% CI, 15.1-20.7) for COCP/DMPA and 17.6 months (95% CI, 14.0-21.3) for barrier/none. Implanon users were more likely to continue their use at 24 months than COCP/DMPA (p<.001) users. The mean duration for Implanon users was 18.7 months (95% CI, 17.0-20.3) compared to 11.9 months (95% CI, 9.5-14.3) for COCP/DMPA.

Conclusion

Teenagers who choose Implanon are significantly less likely to become pregnant and were found to continue with this method of contraception 24 months postpartum compared to those who choose COCP or DMPA and barrier methods or nothing.     

Fibrinolytic response and oral contraceptive associated thromboembolism

A case-control study of fibrinolytic activity was conducted comparing 12 women with a recent history of thromboembolism while taking oral contraceptives and 28 matched female controls without a history of thromboembolism. All subjects had stopped using oral contraceptives at least 12 months prior to study. A new assay, recently developed in this laboratory, was used to evaluate the mean fibrinolytic response to venous occlusion in both cases and controls. The fibrinolytic response of all subjects was stratified into quartiles as previously described. While the controls segregated as expected, all 12 cases occurred in subjects whose fibrinolytic response fell in the first two quartiles with 8 of the 12 subjects having first quartile responses. The mean fibrinolytic response for all controls was 12.3 units while cases showed a mean response of only 3.9 units. The above data supports and extends our recent suggestion that low fibrinolytic response may signal a natural predisposition to venous thromboembolism which could be triggered by use of synthetic estrogens. However, these data do not support the use of this assay as a screening test for oral contraceptive related risk to thromboembolism since at least 50% of the control population also $\text{segregate}$ in the first two quarters.     

Influence of oral contraceptives on the incidence of premalignant and malignant lesions of the cervix

The effect of oral contraceptive use on the development of severe dysplasia, carcinoma $\text{in situ}$ and invasive carcinoma of the cervix was studied by a prospective longitudinal survey of 32,000 women. They were enrolled into the study between the ages of 15 and 39. Some had started oral contraceptive use before enrollment, others started after enrollment and some remained non-users throughout the study period. They were followed-up to $\text{6-}\text{1}\text{2}$ years. Analyses were performed on data from 24,784 women who met our criteria for incidence. Data were adjusted for years of follow-up, age at enrollment, age at first pregnancy, number of pregnancies, number of smears, and duration of use.Although the overall incidence of carcinoma $\text{in situ}$ and severe dysplasia in oral contraceptive users is not statistically significantly different from the non-users, there is an age-specific increase in the incidence of carcinoma $\text{in situ}$ in a restricted oral-contraceptive-use group. An unexpected finding of 6 cases of invasive carcinoma was noted among oral contraceptive users.     

Discontinuation of oral contraceptives and depot medroxyprogesterone acetate among women with and without HIV in Uganda, Zimbabwe and Thailand

BackgroundWe examined hormonal contraceptive (HC) discontinuation and factors associated with discontinuation among HIV-uninfected women and the effect of HIV diagnosis on subsequent contraceptive use.Study DesignWe analyzed 4461 HIV-uninfected women from a prospective study of HC and HIV acquisition in Uganda, Zimbabwe and Thailand. Participants were ages 18–35 years, not pregnant, and using oral contraceptives (OCs) or injectable depot medroxyprogesterone acetate (DMPA) for at least 3 months before enrollment (median duration of OC and DMPA use before enrollment was 11.7 and 8.9 months, respectively). We compared the probability of OC and DMPA discontinuation using survival analysis and factors related to discontinuation using Cox regression. We also analyzed contraceptive patterns among 194 women who became infected with HIV.ResultsMedian duration of use after study enrollment was 15.6 months for OCs and 18.5 months for DMPA. Continuation rates for both methods were highest in Thailand. Factors associated with OC discontinuation included, nausea, breast tenderness, condom use, and no sex. Factors associated with DMPA discontinuation included young age, breast tenderness, nausea, irregular bleeding, high-risk sexual behaviors, partner risk, condom use, and no sex. Following an HIV diagnosis, 135 (98.5%) of 137 hormonal users continued HC and 14 (25%) of 57 nonusers began using HC.ConclusionsContraceptive continuation for OCs and DMPA was relatively high over 2 years. Young women, those reporting side effects, and those using condoms are more likely to discontinue and need ongoing contraceptive counseling. Many women receiving HIV-positive diagnoses desire effective contraception.     

Intrauterine device and ectopic pregnancy

In Turku, Finland, 345 ectopic pregnancies were diagnosed in the period 1966 – 1975. Calculated from the number of deliveries, the incidence of ectopic pregnancy was 0.60 % in 1966 – 70, and 1.08 % in 1971 – 75. This difference is significant (p < 0.001). During the period studied, 59 cases of ectopic pregnancy presented with an intrauterine device $\text{in situ}$, thus accounting for 17 % of the total number seen. The use of intrauterine devices increased considerably after 1972. From that year, 29 % of all ectopic pregnancies occurred with an intrauterine device $\text{in situ.}$ Our findings accord well with other investigations, which emphasize the major role of intrauterine devices in raising the incidence of ectopic pregnancy.     

Isaptent — A new cervical dilator

A new cervical dilator, Isaptent, was prepared from granulated $\text{Plantago ovata}$ (Isapgol) seed husk. It was evaluated in a multicentric clinical trial for dilatation of the cervix in subjects opting for medical termination of pregnancy. The trial covered 804 women in over 21 centres in different parts of the country. The cases were between 15 to 45 years of age, 0 to 10 parity with a gestation period of 8 to 24 weeks. A single tent was used in 750 subjects and satisfactory dilatation was achieved in 94 % of the cases. The cervical dilatation bore no relationship to age, parity and gestation period of the subjects. The tent provided self-lubrication, caused no apparent damage to the cervix and the vaginal flora remained unchanged in the randomly selected subjects in whom bacteriologic studies were performed. The outcome of the clinical trial and advantages of Isaptent over the other procedures used for cervical dilatation are discussed.     

Pharmacokinetic and pharmacodynamic effects of small doses of norethisterone released from vaginal rings continuously during 90 days

The pharmacokinetic and pharmacodynamic effects of norethisterone (NET) released continuously from vaginal devices at a rate of $\text{50 μ}\text{g}\text{24}\text{h}$ and $\text{200 μ}\text{g}\text{24}\text{h}$, respectively, were investigated during a 90-day period in two groups of 7 women each with regular menstrual periods. Blood samples were taken three times weekly (Mondays, Wednesdays and Fridays) during a control cycle and during the entire study period for the estimation of estradiol, progesterone and NET levels, and hourly blood samples were collected throughout a 24-hour period after 6 weeks of exposure to assess the short-term variation in NET levels. In addition, an endometrial biopsy was taken on days 21–23 of the control cycle and after 6 and 10 weeks with the device $\text{in situ}$.There was little, if any, initial “burst” effect on the plasma levels of NET following the insertion of the devices, and a statistically significant linear relationship was found in each case when the NET levels were plotted against the 90 days of exposure. However, the average slope of the regression lines with the 50 μg-releasing devices (?0.44) was significantly flatter than that with the 200 μg-releasing devices (?1.63). Also the mean plasma level in the former group (283 pg/ml) was significantly lower than that (666 pg/ml) observed in the latter group. The average daily decline in plasma NET levels was 0.16% and 0.24%, respectively, and the 95% confidence limits of the hour-to-hour variation in NET levels were at 92 and 106%.All control cycles were of normal length (26–35 days) and exhibited a normal luteal activity. There were a total of 16 cycles with normal luteal function among the 7 subjects with 50 μg-releasing devices; each of them had a minimum of 2 such cycles. However, 11 of these 16 cycles were of abnormal length, indicating a significant effect of norethisterone on the follicular phase. Only 9 cycles were found with a normal luteal activity in the group with the devices releasing $\text{200 μ}\text{g}\text{24}\text{h}$; 3 of the subjects in this group had anovulation throughout the entire study, and 2 of them had prolonged anovulatory periods alternating with normal cycles.Thirteen of the 14 biopsies taken with the 50 μg-releasing devices $\text{in situ}$ after 6 and 10 weeks of exposure showed normal cyclic changes, whereas 11 of the 14 biopsies taken in the group exposed to a release rate of $\text{200 μ}\text{g}\text{24}\text{h}$ indicated predecidual and atrophic changes. These were associated with a significantly diminished number of endometrial glands per microscopic field and with a significant increase in the number of days with bleeding and spotting. Hence, the increased frequency of intermenstrual bleeding may be associated with the predecidual and atrophie changes induced by the administration of NET.No correlation was found between the individual plasma levels of NET and the following parameters: weight, height and ponderal index of the subjects, individual release rate of NET from the devices, effects on ovarian function, the appearance of the endometrium and the number of days with bleeding and spotting.It is concluded that the vaginal rings studied provide a near zero order release of norethisterone and represent an ideal experimental model for the study of the effects of constant blood levels of contraceptive steroids.