妊娠晚期HPV潜伏感染对妊娠结局的影响

目的:探讨妊娠晚期HPV潜伏感染是否改变了阴道内酸性环境及阴道菌群,进而对妊娠结局产生不良影响;了解妊娠晚期HPV潜伏感染的高危因素。方法:选取我院产检的孕妇312例,孕28～30周。进行问卷调查,取阴道分泌物及宫颈分泌物检测滴虫、念珠菌性阴道炎、细菌性阴道病及HPV;检测阴道pH值,按照HPV DNA是否阳性分研究组与对照组,追踪孕妇不良妊娠结局的发生情况。结果:妊娠晚期HPV DNA阳性发生率45.51%(142/312),感染高危型23.08%(72/312),低危型16.67%(52/312),高危型与低危型混合感染18例,发生率5.77%(18/312);妊娠合并念珠菌性阴道炎患病率15.06%(47/312);妊娠合并滴虫性阴道炎患病率1.28%(4/312);妊娠合并细菌性阴道病患病率29.81%(93/312)。研究组孕妇阴道pH值明显高于对照组,差异有显著性(P<0.05);研究组与对照组细菌性阴道病发生率有显著差异(P<0.05);而两组间念珠菌性阴道炎、滴虫性阴道炎的发生率无显著差异(P>0.05);妊娠晚期HPV潜伏感染与低文化水平、吸烟因素及首次性生活年龄小有关(P<0.05);研究组与对照组间分娩方式相似。结论:妊娠晚期HPV潜伏感染与阴道内酸性环境改变相关,增加了妊娠合并细菌性阴道病的发生率且可增加胎膜早破发生。对围生期妇女行生殖道感染筛查,尤其是HPV、BV检测很有必要。     

高危型人乳头状瘤病毒感染的自然清除状况分析

目的 研究宫颈病理结果正常而高危型人乳头状瘤病毒(HPV)检测阳性的妇女HPV感染的自然清除情况.方法 选取2006年8月至2008年8月于上海市长宁区妇幼保健院门诊行高危型HPV检测结果阳性、而宫颈病理检查结果为正常的妇女,随访HPV感染状态(随访时间中位数为11.6个月),分析HPV感染自然清除所需的时间及相关影响因素.结果 入选本研究的妇女共172例,平均年龄(34±10)岁(18～62岁);随访过程中有107例(62.2%,107/172)HPV感染自然清除,总体HPV感染自然清除时间的中位数为11.3个月(95%CI为10.6～16.6个月).不同年龄组中,<30岁、30～39岁、40～49岁、>49岁妇女HPV感染清除时间的中位数分别为11.3、12.0、10.9和8.5个月,4者比较,差异无统计学意义(P=0.384).HPV感染自然清除妇女的病毒相对拷贝数中位数为22.6,HPV持续阳性者为95.0,两者比较,差异无统计学意义(P=0.061).结论 宫颈病理结果正常且高危型HPV检测阳性的妇女在无临床干预的情况下,大部分的HPV感染能自然清除,年龄、病毒拷贝数对HPV感染自然清除无明显影响.     

人乳头状瘤病毒与妇科其他常见病原微生物感染关系的调查

Objective To Investigate correlation between screening assay of human papillomavirus (HPV) and microbial pathogens in gynecology. Methods Cervical samples were collected to search for HPV, bacteria and yeast infections in gynecologic outpatients. HPV typing was carried out by PCR and sequencing on cervical brush specimens. Chlamydia trachomatis was identified by strand displacement amplification (SDA) and the other microorganisms were detected by conventional methods. All data were analyzed to investigate the correlation among them. Results In this cross-sectional study, among 857 enrolled outpatients, there were 266 cases with positive HPV DNA, and the rate of infection was 31.0%(266/857). HPV genotype showed that thirty-five different HPV types were identified, of which HPV16 was the most prevalent ( 14.5%, 38/262), followed by HPV58 (9.2%, 24/262), HPV53 (8.0%, 21/262)and HPV42 (6.1%, 16/262); while other genotypes were present in less than 5% of HPV positive women.According to the reclassification, the aggregated percentage (high-risk and probably high-risk) of detected HPV was 58.8% ( 154/262), 27.9% (73/262) for low-risk and 13.4% (35/262) for unknown-risk HPV types. Among HPV positive women, cervical brush specimens results showed that more than 60% cases with normal cytology, 3.8% (10/266) with high-grade squamous intraepithelial lesions (HSIL), 29. 7% (79/266) with low-grade squamous intraepithelial lesions (LSIL) and 3.0% (8/266) with atypical squamous cells of undetermined significance (ASCUS), respectively. Statistical analyses revealed there was a significant association between the infected HPV and Chlamydia trachomatis or Ureaplasma urealyticum ( >10000 CCU/ml; all P <0.01), while no correlation was found between HPV infection and bacterial vaginosis, streptococcus agalactiae, candida, Trichomonas vaginalis or Ureaplasma urealyticum ( ≤ 10000CCU/ml; all P > 0.05 ). Among the cases with bacterial vaginosis, the positive rate of HPV infected was42.6%. Chlamydia trachomatis was one of the high-risk factors for the infection of HPV ( OR = 2.82, 95%CI: 1.74 -4.57). Mycoplasma hominis was isolated only in 2 cases, no patient was infected with Neisseria gonorrhocae. Conclusions Although bacterial vaginosis was not significantly associated with HPV, it was more common among the HPV positive women. There is the significant association between HPV and Chlamydia trachomatis or Ureaplasma urealyticum which may be increase the infection of HPV. These data suggest that it may be important to screen for the simultaneous presence of different microorganisms which may have synergistic pathological effects.     

人乳头状瘤病毒与妇科其他常见病原微生物感染关系的调查

Objective To Investigate correlation between screening assay of human papillomavirus (HPV) and microbial pathogens in gynecology. Methods Cervical samples were collected to search for HPV, bacteria and yeast infections in gynecologic outpatients. HPV typing was carried out by PCR and sequencing on cervical brush specimens. Chlamydia trachomatis was identified by strand displacement amplification (SDA) and the other microorganisms were detected by conventional methods. All data were analyzed to investigate the correlation among them. Results In this cross-sectional study, among 857 enrolled outpatients, there were 266 cases with positive HPV DNA, and the rate of infection was 31.0%(266/857). HPV genotype showed that thirty-five different HPV types were identified, of which HPV16 was the most prevalent ( 14.5%, 38/262), followed by HPV58 (9.2%, 24/262), HPV53 (8.0%, 21/262)and HPV42 (6.1%, 16/262); while other genotypes were present in less than 5% of HPV positive women.According to the reclassification, the aggregated percentage (high-risk and probably high-risk) of detected HPV was 58.8% ( 154/262), 27.9% (73/262) for low-risk and 13.4% (35/262) for unknown-risk HPV types. Among HPV positive women, cervical brush specimens results showed that more than 60% cases with normal cytology, 3.8% (10/266) with high-grade squamous intraepithelial lesions (HSIL), 29. 7% (79/266) with low-grade squamous intraepithelial lesions (LSIL) and 3.0% (8/266) with atypical squamous cells of undetermined significance (ASCUS), respectively. Statistical analyses revealed there was a significant association between the infected HPV and Chlamydia trachomatis or Ureaplasma urealyticum ( >10000 CCU/ml; all P <0.01), while no correlation was found between HPV infection and bacterial vaginosis, streptococcus agalactiae, candida, Trichomonas vaginalis or Ureaplasma urealyticum ( ≤ 10000CCU/ml; all P > 0.05 ). Among the cases with bacterial vaginosis, the positive rate of HPV infected was42.6%. Chlamydia trachomatis was one of the high-risk factors for the infection of HPV ( OR = 2.82, 95%CI: 1.74 -4.57). Mycoplasma hominis was isolated only in 2 cases, no patient was infected with Neisseria gonorrhocae. Conclusions Although bacterial vaginosis was not significantly associated with HPV, it was more common among the HPV positive women. There is the significant association between HPV and Chlamydia trachomatis or Ureaplasma urealyticum which may be increase the infection of HPV. These data suggest that it may be important to screen for the simultaneous presence of different microorganisms which may have synergistic pathological effects.     

高危型人乳头状瘤病毒DNA检测与细胞学联合检查对子宫颈癌前病变筛查的研究

目的评价高危型人乳头状瘤病毒(HPV)DNA检测联合宫颈细胞学检查对宫颈癌前病变筛查的效果。方法2003年1月至2004年6月,对广东省人民医院妇科门诊5210名妇女进行宫颈癌前病变筛查,采用第二代杂交捕获试验(HC-Ⅱ)检测高危型HPV DNA联合细胞学检查,同时进行阴道镜检查,并以宫颈活检的组织病理学结果为确诊标准。结果受检者平均年龄(34±9)岁,筛查并最后经病理诊断为HPV感染890例,宫颈上皮内瘤变(CIN)Ⅰ级83例,CINⅡ73例,CINⅢ80例,宫颈浸润癌54例,子宫内膜癌5例,阴道上皮内瘤样病变1例,宫颈结核1例。以组织病理学为确诊标准,高危型HPV DNA检测CINⅡ、Ⅲ的敏感度是92·22%,特异度是74·71%,阳性预测值5·19%,阴性预测值99·84%。宫颈细胞学筛查CINⅡ、Ⅲ,以未明确诊断意义的不典型鳞状上皮细胞(ASCUS)为分界点的敏感度、特异度、阳性预测值和阴性预测值分别是90·00%、80·34%、11·94%和99·63%;以低度鳞状上皮内病变(LSIL)为分界点的敏感度、特异度、阳性预测值和阴性预测值分别是70·13%、91·58%、11·11%和99·51%;以高度鳞状上皮内病变(HSIL)为分界点的敏感度、特异度、阳性预测值和阴性预测值分别是48·05%、98·46%、31·90%和99·21%。高危型HPV DNA检测联合细胞学检查筛查CINⅡ、Ⅲ的敏感度、特异度、阳性预测值和阴性预测值分别是98·70%、73·08%、5·21%和100·00%。高危型HPV DNA在不同宫颈病变中的阳性率分别是:宫颈癌85·2%(46/54),CINⅢ92·5%(74/80),CINⅡ86·3%(63/73)和CINⅠ45·8%(38/83)。结论高危型HPV DNA检测在宫颈癌前病变的筛查中有很高的敏感度和阴性预测值,高危型HPV DNA检测联合细胞学检查可使敏感度和阴性预测值有提高,但特异度未能提高。     

HR HPV感染与阴道微生态的相关性研究

目的:分析高危型人乳头瘤病毒(HR HPV)感染者的阴道微生态特征,探讨HR HPV感染与阴道微生态失调之间的相关性。方法:收集2015年5月至2017年4月于北京清华长庚医院妇产科同时行阴道微生态及HPV检测的4381例患者的资料,分析微生态检测结果与高危型HPV检测结果之间的相关性。结果:4381例患者中,微生态异常诊断为各种阴道炎者1346例,其中需氧菌性阴道炎(AV)单纯及混合感染839例(839/4381,19.14%),细菌性阴道病(BV)单纯及混合感染508例(508/4381,11.59%),外阴阴道假丝酵母菌病(VVC)单纯及混合感染448例(448/4381,10.23%),滴虫性阴道炎(TV)单纯及混合感染33例(33/4381,0.75%)。HR HPV感染470例,感染前五位为HPV16、58、52、53、39型。AV、BV感染增加HR HPV感染风险(P0.05);TV、VVC与HR-HPV感染之间无明显相关性。AV、BV与HR HPV16/18型感染之间有一定的相关性(P0.05)。结论:妇科微生态中AV、BV增加HR HPV感染的风险,尤其是HPV16/18型感染。     

沙眼衣原体感染与生殖道人乳头瘤病毒感染的关系及其与宫颈病变发生的相关性研究

目的研究女性生殖道人乳头瘤病毒(human papilloma virus,HPV)感染与沙眼衣原体(Chlamydia trachomatis,CT)感染的关系,及其与宫颈癌前病变和宫颈癌发生的相关性。方法以妇产科门诊患者540例为研究对象,所有患者均行HPV、CT和宫颈细胞学检查。对疑似宫颈病变的患者进一步行宫颈活检。根据HPV检测结果,将HPV检测阳性的患者140例设为观察组,HPV检测阴性的患者400例设为对照组,分析生殖道HPV感染与CT感染的相关性,以及其与宫颈病变发生的相关性。结果观察组宫颈病变发生率(21.4%)显著高于对照组(1.3%,P0.000 1)。按照HPV感染分型,进一步将观察组分为高危组(78例)、低危组(32例)和混合感染组(30例)。高危组(25.6%)和混合感染组(26.7%)宫颈病变发生率均显著高于低危组(6.3%,P=0.009;P=0.019)。同时,观察组CT感染率(27.1%)显著高于对照组(3.3%,P0.000 1)。HPV感染患者中,高危组(33.3%)和混合感染组(36.7%)的CT感染率均显著高于低危组(3.1%,P=0.021;P=0.019)。依据是否存在C T感染将观察组患者分为H P V单纯感染组和C T混合感染组。结果显示后者宫颈病变率(57.8%)显著高于前者(25.5%,P=0.046)。且CT混合感染组,高危HPV和混合HPV感染患者宫颈病变的发生率分别为39.3%和50.0%,均明显高于HPV单纯感染组中高危HPV和混合HPV感染患者,其发生率分别为16.0%和15.4%,差异均具有统计学意义(P=0.026和P=0.017)。Logistic回归分析显示高危型HPV感染(OR=2.180,P=0.018)、HPV和CT混合感染(OR=6.690,P=0.012)是宫颈病变发生的风险因素。结论女性生殖道CT感染与HPV感染密切相关,HPV和CT混合感染是宫颈癌前病变和癌变的独立风险因素。通过早期筛查女性生殖道HPV感染和CT感染,及时有效地治疗微生物混合感染,对进一步降低宫颈癌前病变和宫颈癌的发病率,提高临床治疗效果具有重要意义。     

宫颈上皮内瘤变LEEP术后人乳头瘤病毒感染的临床分析

目的：探讨影响宫颈环形电切术（LEEP）治疗宫颈上皮内瘤变（CIN）术后人乳头瘤病毒（HPV）感染和预后的相关因素。方法：回顾分析2013年1月-2015年12月在中国医科大学附属盛京医院妇科门诊行LEEP术并参与术后随访至少一次的CIN患者临床资料,共297例,分析其临床病理指标、术后HPV分型检测及病变残留或复发等情况。结果：LEEP术后HPV阳性率为14.5%（43/297）。LEEP术后HPV感染与切缘情况、病变累及外阴和/或阴道壁具有相关性（P＜0.05）。术后HPV阳性69.8%（30/43）在首次复查时发现,30.2%（13/43）为HPV首次复查转阴后再次感染。LEEP术后高危型HPV阳性与病变残留或复发具有相关性（r=0.401,P＝0.000）。手术前后HPV同一型别持续感染发生病变残留或复发的风险明显高于HPV不同型别感染（χ2=5.619,P＝0.046）,常见型别是HPV16、HPV58。结论：术前CIN合并阴道上皮内瘤变（VAIN）和/或外阴上皮内瘤变（VIN）及切缘阳性是术后HPV感染的高危因素,LEEP术后HPV分型检测对预测病变残留或复发具有重要作用。     

女性人乳头瘤病毒感染与细菌性阴道病、宫颈病变程度的相关性研究

目的 探讨人乳头瘤病毒（HR-HPV）感染分别与细菌性阴道病、不同宫颈病变程度的相关性。方法 回顾性分析2019年12月至2020年12月在合肥市第二人民医院确诊为细菌性阴道病821例及宫颈病变758例患者的临床资料,按照HR-HPV检测结果分别将其分为阴道HPV阳性组（n=279）与阴道HPV阴性组（n=542）、宫颈HPV阳性组（n=383）及宫颈HPV阴性组（n=375）,分析细菌性阴道病中不同年龄段妇女HPV阳性率及阴道微生态指标;观察不同宫颈病变中HR-HPV的阳性率细菌性阴道病、不同宫颈病变程度之间的相关性;ROC分别评估HR-HPV阳性率在细菌性阴道病与宫颈病变中的诊断价值。结果 细菌性阴道病患者共有279(33.98%)例检查出HR-HPV阳性;阴道微生态检测中HR-HPV阳性患者与阴性患者仅唾液酸苷酶阳性率差异有统计学意义（P <0.05）;宫颈病变患者中共有383例（50.53%）检查出HR-HPV阳性;Spearman显示HR-HPV阳性率与细菌性阴道病、宫颈病变程度之间均呈正相关（P <0.05）;ROC显示HR-HPV阳性在细菌性阴道病及宫颈病变中...     

西藏自治区妇女子宫颈人乳头状瘤病毒感染现状调查及相关因素分析

目的 了解我国西藏自治区妇女宫颈人乳头状瘤病毒(HPV)感染率和亚刑分布及与HPV感染相关的因素.方法 于2007年8月,采用整群抽样的方法对西藏自治区拉萨、日喀则和那曲3个地区的3036例妇女进行流行病学问卷调查和HPV DNA分型检测,并对与HPV感染相关的因素进行单因素及多因素分析.结果 3036例妇女中,HPV感染患者为279例,总感染率为9.19%(279/3036),其中高危型HPV、低危刑HPV和HPV复合感染率分别为7.05%(214/3036)、2.14%(65/3036)和1.32%(40/3036);不同年龄、民族、地区妇女间HPV感染率比较,差异均无统计学意义(P>0.05).HPV感染的亚型中,HPV16(1.52%)最常见,其次为HPV33(1.42%)、58(1.22%)、52(1.15%)和31(1.05%);不同年龄妇女巾,HPV感染的亚型分布也略有不同.单因素分析显示,婚姻状态、初次性生活年龄和妊娠次数为影响HPV感染的危险因素(P<0.05).多凶素分析表明,吸烟(P=0.027)、性伴侣数(P=0.198)和初次性生活年龄(P=0.237)为影响HPV感染的独立危险因素.结论 两藏自治区妇女官颈HPV感染率低于国内外平均水平,其最常见的亚型为HPV16.影响HPV感染的独立危险因素为吸烟、性伴俏数和初次性牛活年龄.     

HPV, Chlamydia trachomatis and genital mycoplasmas infections in women with low-grade squamous intraepithelial lesions (LSIL)

OBJECTIVES: The purpose of the study was to determine the correlation between Chlamydia trachomatis, urogenital mycoplasmas and Low Grade Squamous Intraepithelial Lesions (LSIL) in women with and without Human Papilloma Virus (HPV) infection. MATERIALS AND METHODS: The specimens were tested for: carcinogenic HPV by the Hybrid Capture I Assay, Chlamydia trachomatis antigen by direct immunofluorescence, urogenital mycoplasmas by Mycoplasma IS test. Cytological smears were classified according to the Bethesda system. RESULTS: High-oncogenic HPV types, Chlamydia trachomatis and mixed infections with Mycoplasma hominis and Ureaplasma urealyticum in patients with LSIL occur significantly more frequently comparing to women without dysplasia. Statistically significant correlation between C. trachomatis and presence of HPV was determined. In HPV negative women there was no correlation between C. trachomatis and LSIL. CONCLUSION: In women infected with HPV, especially high-oncogenic types, C. trachomatis test should be included in diagnostic-therapeutic routine scheme.     

Early postpartum endometritis: the role of bacteria, genital mycoplasmas, and Chlamydia trachomatis

To characterize the flora of early postpartum endometritis and the clinical features of women with specific organisms, endometrial cultures for facultative and anaerobic bacteria, genital mycoplasmas, and Chlamydia trachomatis were taken with a triple-lumen sampling device. More than one organism was recovered from 80% of the women. Over 60% of the women had Gardnerella vaginalis and/or anaerobes associated with bacterial vaginosis isolated from the endometrium; these women were more likely to have severe illness and to develop a wound infection than were other women. Genital mycoplasmas were isolated frequently, but specific antibiotic therapy was not required for clinical cure in the 10% of patients who had Ureaplasma urealyticum only. Chlamydia trachomatis was infrequently isolated, but C trachomatis commonly remained after therapy.     

宫颈高危型HPV感染程度与阴道菌群、宫颈局部调节性T细胞的关系分析

目的 探讨宫颈高危型人乳头瘤病毒(human papilloma viruses,HPV)感染感染是否转阴与阴道菌群及宫颈局部调节性T细胞关系.方法 选择2018年9月至2019年12月南通市妇幼保健院收治的230例高危HPV感染患者为研究对象,所有患者随访6个月,观察两组阴道菌群和宫颈局部CD4+CD25+Foxp3...     

Etiology of cervical inflammation

We studied the relationships of selected microbial, clinical, demographic, and behavioral variables to mucopurulent cervicitis in two clinical settings, a sexually transmitted disease clinic and a student health clinic. From each clinic, we studied a group of women referred for suspected mucopurulent cervicitis and a representative sample of other women attending the clinic. After the women were stratified by patient group and summary odds ratios for all groups were obtained, mucopurulent cervicitis was most strongly associated with the isolation of Chlamydia trachomatis; other variables associated with mucopurulent cervicitis included the isolation of Ureaplasma urealyticum, Gardnerella vaginalis, and Trichomonas vaginalis, the presence of serum antibody to C. trachomatis, the clinical diagnosis of bacterial vaginosis, and oral contraceptive use (positive associations) or isolation of yeast (negative association). After adjustment for cervical culture results for C. trachomatis, mucopurulent cervicitis was positively associated with oral contraceptive use (p = 0.02) and isolation of U. urealyticum (p = 0.02) and negatively associated with isolation of yeast (p = 0.03). Among women with a positive cervical culture for C. trachomatis, isolation of U. urealyticum was significantly associated with mucopurulent cervicitis, while among the subgroup of women with a negative cervical culture for C. trachomatis and positive serum antibody to C. trachomatis, oral contraceptive use was strongly associated with mucopurulent cervicitis. These results confirm that in both clinical settings C. trachomatis is the major cause of mucopurulent cervicitis. The roles of U. urealyticum, T. vaginalis, G. vaginalis, bacterial vaginosis, and oral contraceptive use in the etiology of mucopurulent cervicitis deserve further study.     

Possible role of bacterial and viral infections in miscarriages

OBJECTIVE: To determine the role of infections in miscarriages. Chorionic villi from aborted material were subjected to cytogenetic evaluation and analyzed for the presence of Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, human cytomegalovirus (HCMV), adeno-associated virus (AAV), and human papillomaviruses (HPV). DESIGN: Retrospective study. SETTING: University hospital and academic research institution. MAIN OUTCOME MEASURE(S): Karyotyping and detection of bacterial and viral DNA by means of polymerase chain reaction (PCR) in placenta specimens. RESULT(S): In 54 (50%) of 108 samples the karyotype was normal, in 38 (35%) samples it was abnormal, and in 16 (15%) samples karyotype was undetermined. No U. urealyticum, M. hominis, HCMV, or AAV-2 DNA was detected, while C. trachomatis DNA was detected in one (1%) and HPV DNA in eight (7%) samples. No significant correlation of HPV-positive findings with karyotype status was established. CONCLUSION(S): Our findings do not support a role of C. trachomatis, U. urealyticum, M. hominis, HCMV, or AAV infections in miscarriages during the first trimester of pregnancy. However, further investigation should be made to determine a possible involvement of HPVs in the development of genetic abnormalities of the fetus and in miscarriages.     

The etiology of infectious cervicitis in women

Infectious cervicitis is a common disease in women of reproductive age. A prospective study was carried out including 70 women with clinical manifestations of cervicitis during gynecological and colposcopic examination. In 19 women (27%), Chlamydia trachomatis was demonstrated by direct immunofluorescence in cervical smears. Neisseria gonorrhoeae was isolated in 2 women and 1 had a concomitant infection with Neisseria gonorrhoeae and Chlamydia trachomatis. Mycoplasma hominis and Ureaplasma urealyticum were isolated in 7 patients and 4 had cytological smears consistent with Human Papilloma Virus infection. In the rest 47 patients no etiological agent was found. The results of the present study indicate that the most common etiological cause for infectious cervicitis can be Chlamydia trachomatis and an examination for this organism should me mandatory in women with infectious cervicitis for guiding the correct diagnosis and treatment.     

Combination of bacterial vaginosis and leukorrhea as a predictor of cervical chlamydial or gonococcal infection

OBJECTIVE: To evaluate whether the combination of bacterial vaginosis and leukorrhea on microscopic evaluation of a saline wet preparation is associated with cervical infection with Chlamydia trachomatis (C. trachomatis) or Neisseria gonorrhea (N. gonorrhea). METHODS: A cross-sectional study of 598 patients was performed. Nonpregnant patients undergoing a saline wet preparation and microbiologic testing for C. trachomatis and N. gonorrhea were eligible. Providers prospectively collected data from saline microscopic analysis. Bacterial vaginosis was documented based on Amsel's criteria, and ligase chain reaction testing of the endocervix was performed for C. trachomatis and N. gonorrhea. RESULTS: On univariate analysis, young age (less than 25 years), unmarried marital status, black race, and the presence of leukorrhea were all associated with increased rates of testing positive for C. trachomatis and N. gonorrhea (P <.05). We stratified patients into three groups: 1) no evidence of bacterial vaginosis or leukorrhea; 2) evidence of either bacterial vaginosis or leukorrhea, but not both; and 3) evidence of both bacterial vaginosis and leukorrhea. Using logistic regression analysis to control for age, marital status, and race, we found an odds ratio of 3.8 (95% confidence interval 1.3, 11.6) for a positive microbiologic test for either C. trachomatis or N. gonorrhea in women with the combination of bacterial vaginosis and leukorrhea. CONCLUSION: In this group of high-risk women seen in an urgent care facility, the presence of both bacterial vaginosis and leukorrhea was associated with an increased risk of cervical infection. Future prospective studies should evaluate whether empiric treatment of high-risk women with these findings is justified and cost-effective.     

Increased frequency of bacterial vaginosis and Chlamydia trachomatis in pregnant women with human papillomavirus infection

The aim of this study was to verify the presence of bacterial vaginosis (BV), Candida sp, Chlamydia trachomatis, Neisseria gonorrhoeae, to determine the prevalence of tobacco use and measure vaginal pH (VpH) in pregnant women with (n = 26) and without (n = 26) human papillomavirus (HPV) infection, and make comparisons between these 2 groups. HPV, C. trachomatis and N. gonorrhoeae were diagnosed using hybrid capture, BV using clinical criteria, and Candida sp via cultures. A digital pH meter was used to measure VpH. The frequencies of Candida sp were 19.2 and 23.1% (p = 1), and VpH was 4.4 +/- 0.4 and 4.3 +/- 0.4 (p = 0.23), in the HPV-positive and HPV-negative groups, respectively. Compared to the group of pregnant women without HPV infection, those with HPV infection had a significantly higher prevalence of tobacco use (50 vs. 11.5%; p = 0.006), BV (53.8 vs. 15.4%; p = 0.007), and C. trachomatis (34.6 vs. 7.7%; p = 0.039). No case of N. gonorrhoeae was diagnosed. All cases of C. trachomatis and BV had high-grade HPV infection.     

Detection of Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum in pregnant Dutch women

A prospective study was performed to determine the prevalence of endocervical infection by Chlamydia trachomatis and vaginal colonization by Mycoplasma hominis and Ureaplasma urealyticum in pregnant women seeking routine obstetrical care in two clinics in the southern part of the Netherlands. C. trachomatis was detected using the direct immunofluorescence staining technique. For the genital mycoplasmata, generally accepted culture methods were used. Evaluable samples were obtained from 691 of 770 women in the first trimester of pregnancy. C. trachomatis was detected in 2.3%, M. hominis in 5.2% and U. urealyticum in 23.9% of the women. The isolation percentages of C. trachomatis and U. urealyticum were almost equally distributed in the different age groups. The prevalence of all three micro-organisms did not seem to be related to parity. Smoking and alcohol consumption seemed to influence the isolation rate of M. hominis and U. urealyticum.     

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections in women. Prevalence, risks and management at a South African infertility clinic

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections not only jeopardize fertility but also pose a risk for infertility treatment and resulting pregnancies. Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of these organisms. We studied the wives in 40 consecutive infertile couples. Monoclonal direct immunofluorescence (DIF) for C trachomatis was performed on fixed smears from endocervical swabs. M hominis and U urealyticum were isolated by inoculation of Hayflick (HF) medium, HF broth and Ureaplasma A7 agar with endocervical swabs. Using DIF, 11 (27.5%) specimens were positive, 25 (62.5%) were negative, and 4 (10.0%) were equivocal. DIF was repeated on smears from three of the last four patients; all three were positive for C trachomatis. One patient was lost to follow-up and excluded from the study. For the total 39 specimens the final results were 14 (35.9%) positive and 25 (64.1%) negative. M hominis was isolated from 3 (7.5%) endocervical swabs. None of the endocervical swabs yielded a culture positive for U urealyticum. Statistical analysis showed no correlation between the clinical history and presence of infection with any of the three organisms. The prevalence of 35.9% for C trachomatis was surprisingly high for an infertile population and, if supported by culture confirmation, justifies routine screening. The potential adverse effects of these organisms on the success rate of highly specialized infertility treatments are essentially unresolved. Since our analysis of cost effectiveness as applicable to our unit, all new infertile couples are treated empirically with lymecycline.