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Objectives: This study evaluated the efficacy of an ultra-low-dose 0.005 % estriol vaginal gel in the prevention of urinary tract infections in postmenopausal women with genitourinary syndrome of menopause., Study Design: Randomized, double-blind, placebo-controlled, multicenter clinical trial conducted across 28 Spanish sites involving specialists in gynecology, urology, and primary care. A total of 108 postmenopausal women were randomly assigned in a 1:1 ratio to receive 1 g of vaginal gel with 50 micrograms of estriol or an identical moisturizing vaginal gel without estriol., Main Outcome Measures: The primary outcome was the number of episodes of urinary tract infection by the end of the 24-week treatment. Secondary measures encompassed percentage of patients without recurrence, time to first recurrence, use of antibiotic treatment, vaginal pH, safety, and tolerability, among others., Results: The incidence rate of urinary tract infections (new cases per 100 women-year) was 26 % lower in the group that received estriol vs. the group that received placebo (32.34 vs. 43.76 (RR = 0.74) p < 0.001). The frequency of urinary tract infections fell during treatment in all patients in the estriol group. Favorable pH changes from baseline were observed in the estriol arm at all follow-up visits., Conclusions: Ultra-low-dose 0.005 % estriol vaginal gel is safe and effective in preventing recurrent urinary tract infections in postmenopausal women with genitourinary syndrome of menopause, reducing the incidence and potentially decreasing the susceptibility to urogenital infections by improving vaginal pH. Study registration N°: 2018-001481-42. Date of registration: 09-04-2018., Competing Interests: Declaration of competing interest Susana Duce Tello declares to have received payments or fees for lectures, presentations, manuscript writing or educational events from Novartis, Pfizer. Payment for expert testimony from Italfarmaco, and support for attending meetings and/or travel from Viatris. Milagros González has been sponsored in communications at conferences and training courses by Chiesi, Menarini, GSK, Pfizer, Daichi Sankio, Alter, Astra Zeneca and Zentivia. Javier Rosado declares to have received fees for lectures and as a consultant from Astra-Zéneca, Boehringer Ingelgheim, Chiesi, Italfármaco, Merck Sharp and Dohme, Novartis, Pfizer, Sanofi-Aventis, Recordati, Daichi-Sankyo, Almirall, Servier, Medtronic. Laura Noguera, Ana Doyle Sanchez, Amelia Rodríguez and Eva Aguilar are full time employees at ITF Research Pharma. All other authors declare that they have no competing of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

INTRODUCTION: As NASA and its international partners, as well as the commercial spaceflight industry, prepare for missions of increasing duration and venturing outside of low-Earth orbit, mitigation of medical risk is of high priority. Gynecologic considerations constitute one facet of medical risk for female astronauts. This manuscript will review the preflight, in-flight, and postflight clinical evaluation, management, and prevention considerations for reducing gynecologic and reproductive risks in female astronauts. METHODS: Relevant gynecological articles from databases including Ovid, Medline, Web of Science, various medical libraries, and NASA archives were evaluated for this review. In particular, articles addressing preventive measures or management of conditions in resource-limited environments were evaluated for applicability to future long-duration exploration spaceflight. RESULTS: Topics including abnormal uterine bleeding, anemia, bone mineral density, ovarian cysts, venous thromboembolism, contraception, fertility, and health maintenance were reviewed. Prevention and treatment strategies are discussed with a focus on management options that consider limitations of onboard medical capabilities. DISCUSSION: Long-duration exploration spaceflight will introduce new challenges for maintenance of gynecological and reproductive health. The impact of the space environment outside of low-Earth orbit on gynecological concerns remains unknown, with factors such as increased particle radiation exposure adding complexity and potential risk. While the most effective means of minimizing the impact of gynecologic or reproductive pathology for female astronauts is screening and prevention, gynecological concerns can arise unpredictably as they do on Earth. Careful consideration of gynecological risks and potential adverse events during spaceflight is a critical component to risk analysis and preventive medicine for future exploration missions. Steller JG, Blue RS, Burns R, Bayuse TM, Antonsen EL, Jain V, Blackwell MM, Jennings RT. Gynecologic risk mitigation considerations for long-duration spaceflight . Aerosp Med Hum Perform. 2020; 91(7):543-564.

Neisseria meningitidis is an obligate human commensal bacterium that frequently colonises the upper respiratory tract. Person-to-person transmission occurs via direct contact or through dispersion of respiratory droplets from a carrier of the bacteria, and can lead to invasive meningococcal disease. Rare sporadic cases of meningococcal urogenital and anorectal infections, including urethritis, proctitis, and cervicitis, have been reported, typically following orogenital contact with an oropharyngeal meningococcal carrier. The resulting infections were clinically indistinguishable from infections caused by Neisseria gonorrhoeae. Over the past two decades, there have also been multiple outbreaks across North America and Europe of invasive meningococcal disease among men who have sex with men (MSM). The responsible meningococci belong to a highly virulent and predominantly serogroup C lineage, including strains that are able to express nitrite reductase and grow in anaerobic environments, such as the urogenital and anorectal tracts. More recently, a distinct clade within this lineage has expanded to cause urethritis predominantly among men who have sex with women. Evolutionary events giving rise to this clade included the loss of the ability to express a capsule, and acquisition of several gonococcal alleles, including one allele encoding a highly efficient gonococcal nitrite reductase. Members of the clade continue to acquire gonococcal alleles, including one allele associated with decreased antibiotic susceptibility. This evolution has implications for the clinical and public health management of those who are infected and their close contacts, in terms of both antibiotic treatment, and prevention through vaccination., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Effective future control of female genital schistosomiasis (FGS) requires an integrated and multisectoral approach, bringing together HIV, sexual and reproductive health, and reproductive rights sectors. In this article, an underappreciated but important connection between FGS and menstrual hygiene initiatives in Africa is highlighted., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Much is made of the need to translate scientific research into improved care of people or other life forms. Grant applications invariably start with the extent of a problem and end by claiming that their work will or could result in making an impact. In truth, very few projects ever lead to translation at the level of the host, nor was that really their intent. For those who are focused on applied science, there are many ways to reach the desired goal, sometimes through serendipity or by logical stepwise progress. The following paper will provide personal insight into the stages, pitfalls, and ultimate assessment of relevance in the context of using probiotic lactobacilli for human health and other applications.

Bifidobacteria are predominant microorganisms in the intestinal flora, but at the same time represent a subdominant group of the vaginal microbiota. For this reason, oral administration of these probiotic bacteria can provide beneficial effect for both intestinal and urogenital ecosystems. The first aim of this study was to test the strain Bifidobacterium breve BC204, isolated from a vaginal swab of a healthy woman, for its capability to adhere to human cells, to survive to gastric acids and bile salts and to exert antimicrobial activities. The second aim of the work was to develop an oral formulation able to guarantee bacterial survival during storage and administration, thus favouring intestinal and vaginal colonization. B. breve BC204 was encapsulated by spray-drying and subsequently formulated in time-dependent erodible tablets. B. breve BC204 showed good ability to adhere to Caco-2 cells and moderate ability to resist to gastrointestinal stress. Moreover, it exerted a strong antimicrobial activity against urogenital and enteric pathogens. Microencapsulation followed by tablet production allowed high loading and survival of B. breve BC204, associated to a delayed release and mucoadhesive ability. These characteristics are required to achieve appropriate amount and persistence of viable microbial cells in the treatment site., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The objective of this study was to examine the proportion of missed infections and correlates of pharyngeal gonorrhea among young people attending public sexually transmitted disease (STD) clinics., Methods: We conducted a case-control study of 245 young men and women between April 2012 and May 2014. Participants were eligible for inclusion if they (1) were 15 to 29 years of age, (2) reported giving oral sex to a partner of the opposite sex in the past 90 days, and (3) attended 1 of 12 public STD clinics in Los Angeles County. Computer-assisted self-interviews were used to collect information on sexual behaviors and tests were conducted for pharyngeal and urogenital gonorrhea., Results: Most participants were younger than 25 years (69%) and more than half were female (56%). We identified a total of 64 cases (27%) of gonorrhea, of which 29 (45%) were a urogenital only infection, 18 (28%) were a pharyngeal only, and 17 (27%) were dually infected at both sites. Pharyngeal testing increased case finding by 39% from 46 to 64 cases. After adjusting for age, sex, and number of sex partners, those who reported consistent pharyngeal exposure to ejaculate/vaginal fluids were 3 times as likely to have pharyngeal gonorrhea as compared with those without this exposure (adjusted odds ratio, 3.1; 95% confidence interval, 1.3-7.5)., Conclusions: A large proportion of gonorrhea cases among young people would be missed in the absence of pharyngeal testing. These results have implications for those who provide medical care to clients at STD clinics and highlight the need for pharyngeal screening recommendations and counseling messages related to strategies to reduce exposure to infected fluids.

Objectives: Risk factors and infection rates of radical robotic procedures have yet to be described in gynecology. A practice improvement strategy using a solitary dose of vaginal metronidazole the night before surgery was initiated to determine if it decreased the risk of pelvic infection., Methods: A retrospective chart review of robotic radical hysterectomies for gynecologic malignancy at our institution from April 2010 through April 2016 was performed. Demographic data, operative data, and data on use of metronidazole before surgery were collected. χ Statistical analysis, Student t test, and multivariate analysis were performed to analyze the data., Results: Ninety-four patients met the inclusion criteria, and 46 patients received vaginal metronidazole. Demographic and clinical factors were similar between the 2 groups. The pelvic infection rate was significantly higher in nonusers at 13% (6/46) compared with users at 0% (0/42) (P ≤ 0.05). The genitourinary infection rate was also significantly higher in nonusers at 20% as compared with users at 2.2% (P = 0.02). Operative risk factors found to be associated with pelvic infection included hospital length of stay, blood loss, and metronidazole use. Multivariate regression analysis determined that only vaginal metronidazole had a clinically significant reduction of pelvic and genitourinary infection., Discussion: A single dose of preoperative vaginal metronidazole reduces the risk of pelvic and genitourinary infection after robotic radical hysterectomy.

Radiation therapy is a treatment modality that is often used in the uro-oncological setting. The common indication for the radiation therapy in the urological sphere is prostate cancer, whether it is used primarily as a radical approach, or postoperatively as adjuvant or salvage therapy. All urological organs are sensitive to radiation injury with the urinary bladder being the most susceptible with a typical cascade including acute and late changes, arising in the dose-dependent manner. The common indication for radiation therapy in urology is prostate cancer, which collaterally affects the urinary bladder and rarely urethra (especially the bulbo-membranous urethra). Ureteral damage and stricture formation is almost always restricted to the cases of intraoperative therapy and external beam radiation therapy for other urological malignancies (gynecological organs, rectum, retroperitoneal soft tissue tumors) and should not be underestimated. Postradiotherapeutic tissue changes, especially of the prostate, can cause difficulties for pathologists and urologists with regard to diagnosis of prostate cancer recurrence and salvage therapy.

The arterial ligation during elective laparoscopic sigmoidectomy for diverticular disease can affect genito-urinary function injuring the superior hypogastric plexus, and can weaken the distal colonic stump arterial perfusion. Ligation of the inferior mesenteric artery distal to the left colic artery or the complete preservation of the inferior mesenteric artery can therefore be compared in terms of preservation of the descending sympathetic fibres running along the aorta to the rectum resulting in a different post operative genito urinary function. From January 2015 to March 2016, 66 patients underwent elective laparoscopic sigmoidectomy for diverticular disease among two enrolling hospitals. In one centre 35 patients underwent laparoscopic sigmoidectomy with the ligation of the inferior mesenteric artery distal to the left colic artery (low ligation). In the other centre 31 patient were operated on the same procedure with complete inferior mesenteric artery preservation (IMA preservation). There was no difference in terms of major complication occurred, first passage of stool and length of hospital stay between the two groups. Time of surgery was significantly shorter in LL group compared to IMA preserving group and intra operative blood loss was significantly lower in the LL group. There were no differences in the genito urinary function between the two group pre operatively, at 1 and 9 months post operatively. Genito urinary function did not significantly change across surgery in each groups. The low ligation and the IMA preserving vascular approach are safe end feasible techniques in elective laparoscopic sigmoidectomy for diverticular disease. They both prevent from genito-urinary post-operative disfunction and allow good post operative quality of life. The low ligation approach is related to shorter operative time and slower intra operative blood loss., (Celsius.)

The aim of this study was to assess Chlamydia trachomatis (CT) infection prevalence and serovar distribution in a high-density urban area in the north of Italy, by comparing different groups of subjects divided on the basis of the type of care provider they referred to (STI Clinic, gynaecologists or general practitioners). From January 2011 to May 2014, all the specimens submitted to the Microbiology Laboratory of St Orsola Hospital in Bologna for CT detection were tested by PCR assay. For positive specimens, molecular genotyping based on RFLP analysis was performed. Total prevalence of CT infection was 8.1 %, with significant differences between subgroups (P<0.01) but stable during the study period. The STI Clinic was mainly responsible for CT diagnosis, whereas the lowest infection prevalence was detected in gynaecological clinics, despite the high number of tests performed. Extra-genital samples were almost exclusively collected from males at the STI Clinic. Interestingly, 13.3 % of patients providing extra-genital specimens were positive for CT on rectal and/or pharyngeal swabs, and 4.4 % of cases would have been missed if extra-genital sites had not been tested. The most common serovar was E, and serovar distribution was influenced by gender (P<0.01), age (P<0.01), care provider (P=0.01) and anatomical site (P<0.01). The L2 serovar was detected only in extra-genital samples from males at the STI Clinic. Knowledge about care providers' contributions in CT testing and diagnosis is essential for infection control. CT typing is crucial for appropriate management of specific infections, such as lymphogranuloma venereum in extra-genital samples of high-risk populations.

Aim: We report on outcomes and significant grade 3-4 late toxicities between January 1999 and October 2006 following introduction of multi-phase treatment and effect of shielding in treatment of cervical cancer with concurrent chemoradiation., Patients and Methods: Radiotherapy dose by phase, recurrence, survival and toxicity data was collated by a retrospective review of clinical notes. Shielding information was retrieved from original planning films., Results: 3-year survival for stages I, II and III disease were 89%,76% and 51% respectively. Local pelvic failure was 9%. Overall significant late toxicity (SLT) rate was 13%, with lower rates for post-operative treatment than primary chemoradiation (4% vs. 16%). SLT with single phase treatment was 29% versus 12% following multiphase EBRT and 16% when <2 areas were shielded versus 6% with ≥3 shielded areas (p=0.01)., Conclusion: Shielding and multi-phase treatment not only reduce dose to organs at-risk but can also reduce late toxicity without compromising local control or survival., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, are considered a valid and novel alternative for the prevention and treatment of female urogenital tract infections. Lactobacilli, the predominant microorganisms of the healthy human vaginal microbiome, can be included as active pharmaceutical ingredients in probiotics products. Several requirements must be considered or criteria fulfilled during the development of a probiotic product or formula for the female urogenital tract. This review deals with the main selection criteria for urogenital probiotic microorganisms: host specificity, potential beneficial properties, functional specifications, technological characteristics and clinical trials used to test their effect on certain physiological and pathological conditions. Further studies are required to complement the current knowledge and support the clinical applications of probiotics in the urogenital tract. This therapy will allow the restoration of the ecological equilibrium of the urogenital tract microbiome as well as the recovery of the sexual and reproductive health of women., (Copyright © 2015 Elsevier B.V. All rights reserved.)

According to the latest demographic forecast in Poland is observed the progressive aging of the population with growing population of perimenopausal women. This is a special time in woman's life, in which there are many metabolic changes, neurovegetative symptoms and mental changes. All of them are connected with decreased concentration of sex hormones. Very important in this period are health behaviors, including healthy lifestyle, regular exercises and proper diet. Highly effective in removing menopausal symptoms is hormone replacement therapy. It also prevents the effects of metabolic disorders. This therapy is primary prevention of cardiovascular diseases and osteoporosis, depression, Alzheimer's and Parkinson's disease and urogenital atrophy. It also has to delay the process of aging. Clinical studies of HERS, WHI and MWS caused extreme caution in the use of hormone replacement therapy and distrust for this therapy between doctors and their patients. It is therefore important to establish priorities for action and individualized therapy, depending on the indications and contraindications for its use., (© 2015 MEDPRESS.)

The vagina, vulva, vestibule, labia majora/minora, and bladder trigone have a high concentration of estrogen receptors; therefore, they are a sensitive biological indicator of serum levels of these hormones in women. The estrogen loss in postmenopausal women produces a dysfunction called genitourinary syndrome of menopause. The principal therapeutic goal in the genitourinary syndrome of menopause is to relieve symptoms. Treatment options, as well as local and systemic hormonal treatment are changes in lifestyle and non-hormonal treatments mainly based on the use of moisturizers and lubricants. New treatments that have recently appeared are ospemifeme, the first selective hormone receptor modulator for dyspareunia and vulvovaginal atrophy treatment, and the use of vaginal laser. This review has been written with the intention of giving recommendations on the prevention and treatment of genitourinary syndrome of menopause.

Deep sequence analysis of the vaginal microbiome is revealing an unexpected complexity that was not anticipated as recently as several years ago. The lack of clarity in the definition of a healthy vaginal microbiome, much less an unhealthy vaginal microbiome, underscores the need for more investigation of these phenomena. Some clarity may be gained by the careful analysis of the genomes of the specific bacteria in these women. Ongoing studies will clarify this process and offer relief for women with recurring vaginal maladies and hope for pregnant women to avoid the experience of preterm birth., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: The vaginal microbiota of healthy women consists typically of a diversity of anaerobic and aerobic microorganisms. Lactobacilli are the most prevalent and often numerically dominant microorganisms and are relevant as a barrier to infection. The capacity of lactobacilli to adhere and compete for adhesion sites in the vaginal epithelium and the capacity to produce antimicrobial compounds (hydrogen peroxide, lactic acid, bacteriocin-like substances), are important in the impairment of colonization by pathogens., Objective: This review summarizes the role of lactic acid bacteria in preventing illness of the host, including bacterial vaginosis, yeast vaginitis, urinary tract infection and sexually transmitted diseases., Conclusions: The administration of probiotics that colonize the vaginal tract can be important in maintaining a normal urogenital health and also to prevent or treat infections.

Probiotics are live microbial food supplements or their components, which have been shown to have beneficial effects on human health. Probiotics can be bacteria, molds, or yeasts, but most of them fall into the group known as lactic acid bacteria and are normally consumed in the form of yogurt, fermented milk, or other fermented foods. Data from clinical trials have shown contrasting effects and should be interpreted with caution. A large variety of potential beneficial effects have been reported including improvement of intestinal tract health, enhancing the immune system, reducing symptoms of lactose intolerance, decreasing the prevalence of allergy in susceptible individuals, reducing risk of certain cancers, treating colitis, lowering serum cholesterol concentrations, reducing blood pressure in hypertensives, and improving female urogenital infections and Helicobacter pylori infections. The aim of this article is to present a review of the current expanding knowledge of applications of utilizing probiotic microorganisms in the prevention and treatment of several diseases.

Objective: To gain a better understanding of genitourinary (GU) health during deployment in the context of a military culture., Design: An ethnographic study design was selected to understand how military women managed GU symptoms during deployment., Setting: The deployed experiences were recalled from various locations around the world., Participants: The final sample consisted of 43 military women from the U.S. Army, Air Force, and Navy who were either deployed or had been deployed within the past year., Methods: Audio recorded interviews ranged from 30 to 75 min in length. Semistructured interviews were used to gather women's stories about their illness behaviors in the deployed setting. Formal interviews, informal interviews, and field notes were included in the data analysis., Results: Three themes were identified: (a) life in the deployed setting described the location women were referring when they experienced GU symptoms; (b) the dynamics of trust described individuals or entities that were trusted sources of information, supplies, or support; and (c) the sphere of control described the activities utilized to maintain health or manage GU symptoms., Conclusion: This study is significant to nursing research because it exposes the influence of culture on GU symptom management. Recommendations from this investigation include the following: provide better incremental, predeployment, and in-theater education for women and medics; inform leaders about the need to ensure the supply of self-care treatments and women's feminine hygiene products are available; and promote the role of family support stateside as a resource for information, supplies, and emotional support., (© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Clinical guidelines for obstetrical practice were first published by the Japan Society of Obstetrics and Gynecology (JSOG) and the Japan Association of Obstetricians and Gynecologists (JAOG) in 2008, and a revised version was published in 2011. The aims of this publication include the determination of current standard care practices for pregnant women in Japan, the widespread use of standard care practices, the enhancement of safety in obstetrical practice, the reduction in burdens associated with medico-legal and medico-economical problems, and a better understanding between pregnant women and maternity-service providers. These guidelines include a total of 87 Clinical Questions followed by several Answers (CQ&A), a Discussion, a List of References, and some Tables and Figures covering common problems and questions encountered in obstetrical practice. Each answer with a recommendation level of A, B or C has been prepared based principally on 'evidence' or a consensus among Japanese obstetricians in situations where 'evidence' is weak or lacking. Answers with a recommendation level of A or B represent current standard care practices in Japan. All 87 CQ&A are presented herein to promote a better understanding of the current standard care practices for pregnant women in Japan., (© 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.)

Probiotics are microorganisms that provide a health benefit to the host and are promoted as alternatives for the treatment and prevention of infectious diseases and other conditions. One of the most rapidly developing areas of probiotic research is in the management of vaginally acquired infections. Several Lactobacillus species produce compounds that kill or inhibit the growth of vaginally acquired pathogens. Other lactobacilli reduce the adherence of pathogens to urogenital epithelial cells in culture. This article discusses the mechanisms by which vaginal lactobacilli prevent pathogen colonization of the urogenital tract, and potential mechanisms that warrant investigation. Animal models and clinical studies, while limited, are discussed with the idea that these are the next critical steps to advance the study of probiotics for the treatment and prevention of vaginally acquired infections.

Objective: To assess the safety of VivaGel® used vaginally twice daily for 14 days among healthy, sexually-abstinent women, aged 18-24 years in the USA and Kenya., Design: Randomized placebo controlled trial., Methods: Participants were randomized 2∶1, VivaGel to placebo. Safety was assessed by comparing genitourinary (GU) adverse events (AEs), colposcopy findings, vaginal lactobacilli and laboratory abnormalities by arm., Results: Fifty-four women were enrolled; 35 in the VivaGel arm and 19 in the placebo arm. Twenty-six (74%) and 10 (53%) women reported taking all doses of VivaGel and placebo, respectively. No grade 3 or 4 AEs, or serious AEs occurred. Twenty-five (71%) participants in the VivaGel arm compared to 10 (53%) participants in the placebo arm had at least one grade 1 or 2 GU AE associated with product use (RR = 1.4, 95% CI 0.8-2.2). All seven grade 2 GU AEs associated with product use occurred among four women in the VivaGel arm. Vulvar and cervical erythema, cervical lesions, symptomatic BV, urinary frequency and metrorrhagia were more common in the VivaGel arm than the placebo arm. Twenty-nine (83%) participants in the VivaGel arm had a colposcopic finding compared to 10 (53%) participants in the placebo arm (RR = 1.6, 95%CI = 1.0-2.5). Two women in the VivaGel arm prematurely discontinued product use themselves due to a reported GU AE. Persistence of H₂O₂-producing and non-producing lactobacilli did not differ by study arm., Conclusions: GU AEs and colposcopic findings consistent with mild epithelial irritation and inflammation occurred more commonly among women in the VivaGel arm., Trial Registration: ClinicalTrials.gov NCT003311032.

Uropathogenic strains of Escherichia coli (UPEC) can colonize the vagina and cause infections within the entire urogenital tract, including those associated with urinary tract devices. Lactobacilli typically dominate the vaginal microbiota in healthy women, and studies have shown that they can inhibit UPEC growth and vaginal colonization. However, little is known regarding the mechanisms behind these effects. Using a luciferase-based reporter construct, gradients of lactic acid, hydrogen peroxide and spent culture supernatants (SCS) from urogenital probiotic strains Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 were examined for their effects on growth and virulence factor expression in UPEC isolate C1212. In a dose- and pH- dependent manner, lactic acid, hydrogen peroxide and Lactobacillus SCS all strongly inhibited UPEC C1212 growth and increased the promoter activity of outer membrane proteins (OMPs) A and X, two porins normally upregulated in response to UPEC membrane stress. Lactic acid and the culture supernatants also downregulated the promoter activity of the major subunits of type 1 and P fimbriae, critical adherence factors within the urogenital tract. Our findings indicate that compounds secreted by lactobacilli likely protect the urogenital tract from UPEC colonization and infection by inhibiting growth, inducing stress and downregulating proteins critical for host attachment.

Objectives/goal: Chlamydia infections are increasing in California, with rates highest in young women aged 15 to 24. Juvenile detention facilities are important venues for screening high-risk youth who may not otherwise access care. We, therefore, sought to identify risk factors for urogenital chlamydia among young women in a county juvenile detention facility between 2002 and 2005., Study Design: With the state Chlamydia Screening Project (ClaSP), young women booked into the county detention facility were offered urine-based screening for urogenital chlamydia. Demographics, sexual history, and behavioral risk factors were self-reported through questionnaires completed during specimen collection., Results: Nine hundred and thirty-nine young women were screened for chlamydia. The 5% positivity rate remained steady over the 33-month study. Vaginal sex was reported by 82% of women, oral sex by 50%, and anal sex by 30%. Only 9% reporting anal sex always used condoms. In multivariate analysis, little distinguished those with urogenital chlamydia. Women from the southern region of the county (adjusted odds ratio, 3.5; 1.4-8.7) and surrounding urban centers (3.7; 1.2-11.4) had higher odds of infection, as did those with 2 to 3 lifetime partners (3.2; 1.2-8.2)-although there was no linear relationship between partner number and infection. Those who had been in drug/alcohol treatment had lower odds of infection (0.1; 0.01-0.6)., Conclusions: Our findings support universal chlamydia testing of young women detainees. The high prevalence of unprotected anal sex highlights an important modifiable HIV risk behavior in these adolescents. Risk factors reported here should inform the integration of prevention and treatment services in correctional settings and substance abuse treatment centers.

Immunosuppressed HIV-infected women are at risk of developing cervical cytological abnormalities and should have routine annual cervical cytology smears performed as recommended by the National Health Services Cervical Screening Programme (NHSCSP). In the Anglian Genitourinary Medicine Audit Group review of practice of cervical cytology smears, only 55.5% of clinics met the NHSCSP standards. The mean age of the 173 women in the cohort was 35.8 +/- 8.1, range 16-66 years. Seventy-eight percent of clinics performed cervical cytology screening in women under the age of 25 years. High-grade cervical cytological abnormality (moderate dyskariosis and above) was seen in 9.5% of the cohort and 39.5% had low-grade lesions (borderline and mild dyskariosis). One patient, a 41-year-old black African on highly active antiretroviral therapy with HIV-1 RNA level <50 copies/mL and a CD4 count of 240 cells/mm(3) had invasive cervical cancer requiring hysterectomy. The expected mean number of cervical cytology smears for the cohort was 3.29 and the calculated performed mean cervical cytology smear was 1.9 (P = 0.0001), a statistically significant difference. Asylum dispersal among 69.5% black Africans in the cohort contributed to some of the clinics not meeting the NHSCSP standards.

Urogenital infections of bacterial origin have a high incidence among the world female population at reproductive age. Lactobacilli, the predominant microorganisms of the healthy vaginal microbiota, have shown a protective effect against the colonization and overgrowth of urogenital pathogens that increased the interest for including them into probiotics products assigned to restore the urogenital balance. In the present work, we determined in a mouse animal model the capability of Lactobacillus paracasei CRL 1289, a human vaginal strain with probiotic properties, to prevent the vaginal colonization of a uropathogenic strain of Staphylococcus aureus. Six-week-old female BALB/c mice, synchronized in their estral cycle, were intravaginally inoculated with two doses of 10(9) lactobacilli before challenging them with a single dose of 10(5) or 10(7) CFU of S. aureus. The vaginal colonization of both microorganisms and the effect on the vaginal structure were determined at 2, 5, and 7 days after pathogen inoculation. Control mice and those challenged only with the pathogen showed an insignificant lactobacilli population, whereas 10(5) lactobacilli/mL of vaginal homogenate were recovered at 2 days after challenge from the L. paracasei CRL 1289 and the probiotic + pathogen groups, decreasing this number on the following days. The treatment with L. paracasei CRL 1289 decreased significantly the number of staphylococci recovered at 2 and 5 days when mice were challenged only with 10(5) CFU of pathogen. The inoculation of S. aureus produced a remarkable inflammatory response and structural alterations in the vaginal mucosa that decreases in a significant manner when the mice were protected with L. paracasei CRL 1289. The results obtained suggest that this particular Lactobacillus strain could prevent the onset of urogenital infections by interfering with the epithelial colonization by uropathogenic S. aureus.

There was a wide range of activity and chlamydial diagnoses between the 177 clinics that responded. Most (92%) clinics have nucleic acid tests for chlamydial diagnosis. Different practitioners largely share roles in providing advice to patients about partner notification, treatment adherence, safer sex advice and abstinence. Most (97%) clinics have information leaflets about chlamydia, although about 30% of clinics lack leaflets containing information about antibiotics and hormonal contraception. About two-third clinics follow the National Guideline recommended interval for providing a test of cure where this is indicated. Only 18% of clinics routinely ask patients to reattend, with 40% having a policy of no routine follow-up and 62% using telephone or text follow-up. These categories were not mutually exclusive. Most (86%) of the 146 English clinics had a local Chlamydia Screening Programme coordinator for their Primary Care Trust area, although cooperation varies, with cooperation over treatment of 70% and Programme policy of 62%.

Survivors of sexual assault can access treatment and care within genitourinary (GU) medicine services by attending walk-in, booked or a dedicated clinic. Haven Whitechapel the local Sexual Assault Referral Centre (SARC) provides a forensic and aftercare service. A team was set up to ensure efficient communication and clear referral pathways between the centres. This service was audited after eight months of joint working. A retrospective case note review of women attending between August and March 2007 was undertaken. Sixty-nine women were referred to the dedicated clinic. Vaginal rape was reported by 80% of the women. Offer of forensic medical examination documented in 71% presenting within the forensic timeframe. Emergency contraception was offered to 75% of the women. HIV-acquisition risk was documented in 70%. Seventy-eight percent had a sexually transmitted infection screen at their first visit. An HIV test was done to 41% of the women; all were found to be negative. Sixty-two percent women attended follow-up. GU medicine staff should receive specific training in sexual assault. We recommend that GU medicine services and SARC work in partnership to improve the care of victims of sexual assault who access general GU medicine services.

Verbal information-giving is good, but only half of cases were reportedly given written information on chlamydia. Follow-up by 'phoning or texting (43%) was as common as follow-up in clinics (39%). About one-fourth of cases did not have follow up, with no recall for around 60% of these cases. Advice about partner notification (PN) was provided by a health adviser or other suitably trained health professional to 91% of cases, and the method of PN was documented for 92% of these cases. PN outcome was not documented for about 25% of these cases. There was no information on the chlamydial status of sexual contacts of about half of cases, and no information about the treatment status of sexual contacts of about 40% of cases. The average number of contacts screened per index was 0.52 outside London and 0.29 for the London Regions, levels below those suggested in the National Guideline.

Background: Lactobacilli are the dominant bacteria of the vaginal flora and possess antimicrobial properties that regulate other urogenital microbiota. Incomplete cure and recurrence of genitourinary infections lead to a shift in the local flora from a predominance of lactobacilli to coliform uropathogens. Use of Lactobacillus-containing probiotics to restore commensal vaginal flora has been proposed for the treatment and prophylaxis of bacterial urogenital infections., Objective: This review summarizes randomized controlled trials that have assessed the therapeutic efficacy and tolerability of lactobacilli in bacterial vaginosis (BV) and urinary tract infection (UTI)., Methods: Relevant randomized controlled trials published in English were identified through a search of MEDLINE (through November 2007), ClinicalTrials.gov, and the Cochrane Database (second quarter 2007). The search terms included probiotics, Lactobacillus, lactobacilli, urinary, urogenic, bacterial vaginosis, vaginal, colonization, bacteremia, sepsis, pathogenic, taxonomy, diagnosis, and infections., Results: Eleven randomized controlled trials were identified that investigated the effects of lactobacilli in the treatment and prophylaxis of bacterial urogenital infections. In the 2 studies that reported a beneficial effect for probiotics in the treatment of BV, cure rates for lactobacilli at 30 days were 60% (P=0.004) and 88% (P<0.005), more than double the effect of controls. One trial reported a 35% reduction in recurrent episodes of BV compared with placebo (P=0.004). Among the 4 trials involving treatment of UTI, 1 reported a 73% reduction in episodes of recurrent UTI compared with the previous year (P=0.001). Seven studies found no therapeutic effect of lactobacilli in the treatment or prophylaxis of BV or UTI. Only 2 of the identified trials attempted to validate the probiotic dosing strategy by obtaining quantitative evidence of local colonization with lactobacilli and had sufficient power to detect treatment effects, and only 1 trial addressed the stability of the probiotic product at the end of the study., Conclusions: Despite enhanced cure rates in some studies, concerns about product stability and limited documentation of strain-specific effects prevent recommendations for the use of Lactobacillus-containing probiotics in the treatment of BV. The results of studies of lactobacilli for the prophylaxis of UTI remain inconclusive as a result of small sample sizes and use of unvalidated dosing strategies.

In 2004, the Newcastle genitourinary medicine clinic launched a new website. To assess its value to users and impact on service demand, we surveyed those attending the clinic with a new episode between September and December 2005 by a questionnaire. One hundred and fifteen of 601 respondents (19%) visited the website. Fifty-nine percent of users were men with those aged between 35 and 44 ranking the highest percentage (31.7%) among those who visited the website. Fourteen (12.5%) would not have attended if they had not visited the website. One hundred and two (88.7%) found it easy to use and 81 (70.4%) looked for specific information of whom 73 (89%) were successful. Web users were more likely to present with an episode not requiring treatment possibly indicating increased demand promoted by our prevention information but less likely to have bacterial vaginosis, anaerobic balanitis and anogenital candidosis (not statistically significant).

A 53-year-old woman suffering for 20 years from chronic genitourinary pain was seen in our urogynecological unit. Quality of life assessment by King's Health Questionnaire showed a highly negative impact on quality of life. Clinical examination revealed a painful and swollen distal urethra, and a small fistula was seen located 12 mm proximal to the meatus externus. Perineal ultrasound and magnetic resonance imaging showed multiple cystic formations bilaterally located in the suburethral and paraurethral regions. A diverticulectomy was performed using the vaginal approach. Twelve months after surgery the woman is completely satisfied and only complaining about slight alguria., ((c) 2008 S. Karger AG, Basel)

A summary of the cultural and geopolitical climate described in the companion article, "Mwatambudzeni's Short Life," is provided (Kanchense, 2007). The multiplicity and complexity of factors, as well as some of the governmental policies and attitudes that have contributed to the environment in which a young pregnant woman can so easily suffer death during childbirth are explained. Some of the root causes of poverty among Zimbabwean women are described, and the pathophysiological consequences of cultural practices, and health and social policies are explored. Recommendations for improving overall urologic health among Zimbabwean women are provided.

In elderly women with osteoporosis, raloxifene treatment with vitamin D supplementation improves vaginal maturation index and vaginal pH.

The incidence of diabetes continues to increase dramatically; this incidence is predominantly of the type-2 form which clusters together with other comorbidities of hypertension and lipid abnormalities, to form the metabolic syndrome. These conditions will have an increasing impact on urological practice, with erectile dysfunction, hypogonadism, voiding difficulties and urinary tract infections all more common in these patients. These symptoms might be the initial presentation of previously undiagnosed diabetes and it is important to recognise this condition early to avoid later complications including end-stage renal failure.

The objective of this study was to assess current and future contraceptive provision in genitourinary (GU) medicine clinics in the United Kingdom. Questionnaires were sent to 18 British Co-Operative Clinical Group regional representatives for distribution to clinical leads. Of 185 clinics, 124 (67%) responded. All clinics provided condoms, 116 (94%) the 'morning after' pill and 31 (25%) would fit an intrauterine contraceptive device (IUCD) for emergency contraception. Twenty-three (18.5%) regarded their clinic as already providing a comprehensive service and most of these could provide a wide range of contraceptive methods. Of all clinics, which included eight (34%) clinics already providing a comprehensive service, 69 (56%) anticipated developing their contraceptive provision within the next five years. In conclusion, contraceptive provision varies between clinics. A reduction in unwanted pregnancies and sexually transmitted infections (STIs) would most likely be achieved if clinics expanded their provision of contraceptive services.

Twenty mock cases were designed. Thirty-two doctors completed the study, assigning local and KC60 codes for service provision and diagnoses. They gave a wide range of responses, often missing codes or adding inappropriate ones. Where the diagnosis was clear, e.g. gonorrhoea, 97% assigned the correct KC60 code. However, the KC60 codes for service provision (S1, S2, P1A, P3, etc.) were frequently omitted, representing a significant underestimate of workload. Some local codes were given by only 6-28% of clinicians, and when they included them, doctors were more likely to omit KC60 codes. Low response rates for local codes renders these codes unhelpful. Simplification of coding procedures is needed so that diagnoses and workload are documented accurately. This is crucial at a time of modernization of genitourinary (GU) Medicine services and the introduction of Payment by Results.

Urinary incontinence currently affects 33 million American women. In the next 30 years the population over 60 years will increase by 80-90%. This will result in a tremendous increase in patients suffering this condition. It is therefore not feasible for evaluation and treatment to be limited to specialists. Primary care physicians must be comfortable performing basic evaluations which will enable them to formulate a diagnosis and conservative treatment plan. This article outlines a practical approach.

Matrix metalloproteinases (MMP) are a family of host-derived enzymes involved in the turnover of extracellular matrix molecules. We have previously reported enhanced expression of matrix metalloproteinases in Chlamydia muridarum urogenital tract infection of female mice. Kinetics and patterns of MMP expression as well as enhanced expression in susceptible strains of mice in the prior study implied a role for MMP in pathogenesis. To explore this further, we infected a susceptible strain of mice (C3H/HeN) with C. muridarum and treated two groups of mice with either one of two chemical inhibitors of MMP (MMPi; captopril and a chemically modified tetracycline) and reserved infected sham-treated mice as controls. Neither of the treatments affected shedding of viable chlamydiae from the lower urogenital tract, but the administration of either MMPi protected mice from the formation of hydrosalpinx-a surrogate marker of oviduct occlusion and infertility. Interestingly, the mechanism of protection for mice treated with chemically modified tetracycline 3, appeared to be related to prevention of ascending upper genital tract infection. These results imply that MMP are involved in pathogenesis of chlamydial infection in this model by mediating ascension of the infection into the upper genital tract.

Most sexually transmitted infections (STIs) are associated with increased risk of HIV transmission. The draft Scottish Sexual Health Strategy (2003) proposed that 'HIV testing [should be] offered to all GUM clinic attendees not known to be HIV infected who present with a new STI. ... Reasons for non-uptake should be recorded.' We performed a national audit comparing practice in Scottish genitourinary (GU) medicine services against these standards. The results show that practice is highly variable but overall in 2004 Scottish GU medicine clinics were failing to meet the strategy standard.

We audited the practice of offering, and the uptake of, an HIV antibody test in new genitourinary medicine clinic attenders. We aimed to determine if we have reached targets set in the National Strategy for Sexual Health and HIV for 2006. We also aimed to determine whether patients at higher risk of acquiring HIV infection reached these targets. We found that nearly all patients were offered an HIV test (94.7%) and uptake was 60.5%, demonstrating that we have already reached our target. However, in this audit, the 60% uptake targets were not met by patients at increased risk of HIV, with 52.9% uptake in men who have sex with men and 50% uptake in Black Africans.

Requests for hepatitis C antibodies (HCV Ab) made by the Oxford Department of Genito-urinary (GU) Medicine were audited against national guidelines to determine how the service performed and to develop locally applicable standards. This resulted in more effective screening and cost savings.

We sought to determine the extent to which attenders at a genitourinary (GU) medicine clinic would be willing to see their general practitioner (GP) for sexual health services, and the factors that were important to them in making this decision. Fifty-nine percent of 209 patients expressed a preference for the GU clinic, and 30% for seeing a GP. Sixty-two percent of patients would accept an appointment with a GP if this meant being seen more quickly. The two most important factors reported by patients in deciding where to be seen were confidentiality (81% rated this 'very important') and attitudes of staff (75%). Range of tests available and specialist knowledge were also highly valued (65%). The findings support the development of sexual health services in primary care settings.