Simple and inexpensive point-of-care tests improve diagnosis of vaginal infections in resource constrained settings

Objective  Bacterial vaginosis (BV) and Trichomonas vaginalis infection (TV) have been associated with adverse birth outcomes and increased risk for HIV. We compare the performance of simple inexpensive point-of-care (POC) tests to laboratory diagnosis and syndromic management of BV and TV in poor settings.
Methods  Between November 2005 and March 2006, 898 sexually active women attending two reproductive health clinics in Mysore, India were recruited into a cohort study investigating the relationship between vaginal flora and HSV-2 infection. Participants were interviewed and screened for reproductive tract infections. Laboratory tests included serology for HSV-2; cultures for TV, Candida sp., and Neisseria gonorrhoeae ; Gram stains; and two POC tests: vaginal pH; and Whiff test.
Results  Of the 898 participants, 411 [45.7%, 95% confidence interval (95% CI): 42.4–49.0%] had any laboratory diagnosed vaginal infection. BV was detected in 165 women (19.1%, 95%CI: 16.5–21.9%) using Nugent score. TV was detected in 76 women (8.5%, 95%CI: 6.7–10.4%) using culture. Among the entire study population, POC correctly detected 82% of laboratory diagnosed BV cases, and 83% of laboratory diagnosed TV infections. Among women with complaints of vulval itching, burning, abnormal vaginal discharge, and/or sores (445/898), POC correctly detected 83% (60 of 72 cases) of laboratory diagnosed BV cases vs. 40% (29 of 72 cases) correctly managed using the syndromic approach ( P  <   0.001). Similarly, POC would have detected 82% (37 of 45 cases) of TV cases vs. 51% (23 of 45 cases) correctly managed using the syndromic approach ( P  =   0.001).
Conclusions  In the absence of laboratory diagnostics, POC is not only inexpensive and practical, but also significantly more sensitive than the syndromic management approach, resulting in less overtreatment.     

长治地区妇女阴道滴虫病流行病学调查

１９９８年６月－１９９９年６月，选择长治市两所医院妇科门诊病人进行阴道滴虫病调查。检查妇女白带１６８６份，阴道滴虫感染率２６．８％；乡村妇女的感染率明显高于城市妇女；各年龄组以３０岁－４０岁组感染率最高；一年四季之间感染率无显著差异。     

睾丸鞘膜补片非管状化尿道成形术治疗前尿道长段狭窄的探讨

目的：探讨前尿道长段狭窄的治疗方法。方法：对9例前尿道长段狭窄患者行睾丸鞘膜补片非管状化尿道成形术。结果：本组9例均一次成功,术后3周拔除尿管,平均随访28个月,排尿通畅,阴茎无畸形。结论：睾丸鞘膜可作为良好的尿道替代物,手术创伤小,取材方便,组织修复快,以补片形式非管状化覆盖尿道缺损,可避免鞘膜瓣形成管状而减少成形尿道再狭窄,而且游离鞘膜与带蒂鞘膜移植效果均良好,可减少成形尿道再狭窄,值得推广。     

Malignant mesothelioma of the tunica vaginalis and epididymis

Malignant mesothelioma of the para-testis is a rare cancer which may be clinically undiagnosed for several years and found incidentally at cut up for presumed benign disease. It has a number of histological presentations to be aware of and pitfalls to avoid. It is important to be able to reliably distinguish para-testicular MM from various other less aggressive entities which have significantly different management strategies. We present a case of epididymis and tunica vaginalis MM that was incidentally diagnosed on histological examination following a hydrocelectomy.     

Innate Immunity and Inflammatory Response to Trichomonas vaginalis and Bacterial Vaginosis: Relationship to HIV Acquisition

Citation Thurman AR, Doncel GF. Innate immunity and inflammatory response to Trichomonas vaginalis and bacterial vaginosis: relationship to HIV acquisition. Am J Reprod Immunol 2011; 65: 89–98 Most women contract HIV‐1 through sexual intercourse with an infected partner. Highly prevalent, unreported and often asymptomatic lower genital tract infections, including bacterial vaginosis (BV) and trichomoniasis (Trichomonas vaginalis– TV), increase a woman’s susceptibility to HIV‐1 genital infection, given an exposure. A review of the literature from 1989 to the present was conducted. This article will review potential mechanisms by which BV and TV serve as HIV‐1‐enhancing cofactors including (i) initiation of a clinical or subclinical mucosal inflammatory response, (ii) alteration of innate mucosal immunity, (iii) alteration of normal vaginal microflora and pH, and (iv) weakening or breach of intact cervico‐vaginal mucosa. The transmission of HIV‐1, in the absence of cofactors, is poorly efficient. Understanding the mechanisms by which these infections enhance HIV‐1 acquisition is important to designing effective, safe and evidence‐based prevention modalities.     

武陵源区已婚妇女阴道滴虫感染状况及其影响因素研究

目的探讨武陵源区已婚妇女阴道滴虫感染状况,为已婚妇女阴道滴虫感染的防治提供科学依据。方法采用现况研究的方法对2 854例武陵源区已婚妇女进行调查,用涂片法对其阴道分泌物进行滴虫检测。应用SPSS16.0对阴道滴虫的感染情况资料进行统计学处理和描述,假设检验采用χ2检验、Logistic回归。结果 2 854例已婚妇女阴道分泌物检查结果中,滴虫感染207例,感染率为9.32%;不同乡镇(χ2=151.898,P0.05)、不同年龄(χ2=30.596,P0.05)、不同结婚年限(χ2=32.689,P0.05)、不同避孕方式(χ2=18.293,P0.05)的已婚妇女阴道滴虫的感染率不同。多因素Logistic回归分析显示年龄差异有统计学意义。结论武陵源区已婚妇女阴道滴虫感染率较高,不同乡镇阴道滴虫感染率不同,50岁组妇女阴道滴虫感染率最高。     

Migration of Abdominal Catheter of Ventriculoperitoneal Shunt into the Scrotum

Summary Four cases of migration of the ventriculoperitoneal (V-P) shunt tip through patent processes vaginalis resulting in scrotal hydrocele are presented. These cases are considered a rare complication of V-P shunts and causal mechanisms are discussed with a review of the literature.     

阴道加德纳菌配偶传播的研究

目的:了解阴道加德纳菌(GV)在配偶之间的传播,探讨细菌性阴道病(BV)患者、配偶双方同时治疗的意义。方法:首先应用免疫荧光法对401例BV患者进行GV感染调查,对其中122例GV阳性者的配偶取尿道拭子进行GV检测,对BV患者、配偶同时进行治疗,并观察疗效。结果:BV患者GV检出率为42.9%,配偶双方同时检出率为63.1%;配偶同时治疗组与对照组比较,BV治愈率及治疗有效率差异均无统计学意义,P>0.05;但BV复发率却明显降低,P<0.01。结论:GV在配偶之间有较高的传播率,BV患者、配偶同时治疗可降低BV复发率。     

Urethritis in Men and Women

Urethritis is usually caused by sexually transmissible organisms. Sexually transmitted diseases (STDs) increase the risk of acquiring other STDs, which is why patients presenting with urethritis should generally be examined for other STDs as well, and examination and treatment of sexual partners are necessary. Standard diagnosis is made via stains of urethral swabs or urine, but modern microbiological diagnostic methods such as nucleic acid amplification techniques achieve higher diagnostic accuracy. In non-gonococcal urethritis, a causative organism can often not be isolated. Antibiotic treatment is usually based on current epidemiologic data.