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This retrospective study aimed to investigate the efficacy and safety of focused ultrasound (FU) treatment for high-risk human papillomavirus (HR-HPV) infection-related cervical intraepithelial neoplasia grade 2 (CIN2) in nulligravidae under 35 y old, while also assessing pregnancy outcomes post-treatment. Nulligravid patients aged 18–35 y with histologically confirmed CIN2 and HR-HPV infection were included in the study. We collected demographics, pertinent medical history, HPV genotypes and cervical length at baseline. Follow-up evaluations were conducted at 6- and 12-mo intervals post-treatment to assess histopathological response, HPV infection clearance and adverse events related to treatment. A total of 31 eligible patients were recruited and underwent FU treatment. At the 6-mo follow-up, complete pathologic response was observed in 22 out of 31 patients (70.96%), while partial response was seen in eight out of 31 patients (25.80%). The average duration from pathological diagnosis to achieving either a complete response or partial response after treatment was 214.36 ± 24.31 (186–270) d. The baseline remission rate for HPV was 35.48% at 6 mo, increasing to 71.49% at 12 mo. Moderate lower abdominal pain and increased vaginal discharge were the most frequent adverse events. Among the patients desiring pregnancy, the successful pregnancy rate was 57.14%, resulting in eight deliveries. FU demonstrated a favorable safety profile and efficacy in nulliparous females under 35 y old with CIN2, and its benefits for fertility warrant further investigation. [ABSTRACT FROM AUTHOR]

Fertility‐preserving surgery (FPS) in advanced ovarian cancer (AOC) is extremely rare and consequently, information about the pregnancies of these patients is anecdotal. Therefore, management of the pregnancy after AOC is challenging, especially if an unexpected situation arises. A 31‐year‐old nulliparous woman was admitted to our tertiary hospital in the 18th week of twin pregnancy with sudden severe abdominal pain. Her medical history included a low‐grade AOC stage IIIc diagnosed 2 years before pregnancy and treated by debulking FPS and systemic therapy with carboplatin/paclitaxel and bevacizumab. Clinical examination described normal vital signs and peritoneal irritation without any vaginal discharge. Sonography revealed free fluid in the pouch of Douglas and intact twin pregnancy. Laboratory work showed elevated leukocytes with neutrophilia. To evaluate appendicitis magnetic resonance imaging of the abdomen was indicated. This revealed a uterine rupture with the now extra‐cavitary position of the twins. Simultaneously, the patient's symptoms deteriorated, and emergency surgery was necessary where hemoperitoneum with avital fetuses were present. Despite excessive blood loss the uterus could be repaired and preserved. Previous resection of the uterine serosa during her debulking FPS, administration of bevacizumab affecting smooth muscles, and overstretching the uterus in the twin pregnancy were considered as possible risk factors for the presenting uterine rupture. Pregnancy after AOC is possible but should be monitored closely, especially due to the hidden long‐term consequences of its therapy. In the differential diagnosis of sudden abdominal pain during pregnancy uterine rupture should be considered even in patients with an unscared uterus. Synopsis: We present a case report of a spontaneous uterine rupture in the second trimester in a patient with a history of advanced ovarian cancer and fertility‐preserving surgery. [ABSTRACT FROM AUTHOR]

Introduction: Fitz-Hugh-Curtis syndrome (FHCS) is a relatively common complication of pelvic inflammatory disease. However, this diagnosis is frequently overlooked due to its nonspecific symptomatology that often mimics hepatobiliary disorders. This report presents a case of FHCS and offers a review of pertinent clinical considerations. Case: We describe a case of a 33-year-old sexually active female previously treated for vaginal discharge syndrome, who presented to our facility with worsening right upper quadrant pain. Initial laboratory and imaging findings were inconclusive. However, diagnostic laparoscopy revealed perihepatic "violin string" adhesions consistent with FHCS. Conclusion: This case underscores the importance of considering FHCS in the differential diagnosis of right upper quadrant pain, especially in individuals with a history of pelvic inflammatory disease. Awareness of this syndrome and its clinical manifestations is crucial for prompt diagnosis and appropriate management. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of a probiotic plus antibiotic with antibiotic therapy alone for the prevention of the recurrence of bacterial vaginosis. Method: A Randomized control trial was conducted in the Gynecological Department of Nishtar Hospital, Multan, between July 2022 and June 2023. One hundred and twenty (N=120) women with bacterial vaginosis, all cured with metronidazole, were enrolled and randomized. In Group-A, Probiotics were administered once a day for 14 days following antibiotic treatment (Tab Metronidazole 400mg, three times a day for seven days). In Group-B, only oral antibiotics were given. The patients were followed up in four visits for five months for bacterial vaginosis recurrence (responders, partial responders, non-responders, and drop-outs) using Amsel criteria by vaginal swabs. All the data was collected on a structured Performa. Results: The mean age of enrolled 120 women was 32.28±2.58, and 111(92.5%) were married. Of 120 enrolled women, 8 (6.7%) were dropped out. Evaluating the recurrence rate, the probiotic group (n=57) had fewer recurrences than the placebo (n=55) (8.9% vs 21.4%, p-value <0.05). Group-A had a better responder rate at five months of follow-up than the placebo group (39.2% vs. 25.8%) (RR 0.31, 95%CI: 0.1450-0.7998, p-Value <0.05). Comparing the effect of probiotics on the components of the Amsel criteria, only vaginal discharge had a statistically significant reduction by using probiotics plus antibiotics (p-value ≤0.05). Conclusion: This trial showed that probiotics plus antibiotics significantly reduced bacterial vaginosis recurrences than antibiotics alone. [ABSTRACT FROM AUTHOR]

Dysuria, a feeling of pain or discomfort during urination, is often caused by urinary tract infection but can also be due to sexually transmitted infection, bladder irritants, skin lesions, and some chronic pain conditions. History is most often useful for finding signs of sexually transmitted infection, complicated infections, lower urinary symptoms in males, and noninfectious causes. Most patients presenting with dysuria should have a urinalysis performed. Urine culture should be performed for infection to guide appropriate antibiotic use, especially for recurrent or suspected complicated urinary tract infection. Vaginal discharge decreases the likelihood of urinary tract infection, and other causes of dysuria, including cervicitis, should be investigated. If a patient has persistent urethritis or cervicitis with negative initial testing, Mycoplasma genitalium testing is recommended. Clinical decision rules may increase the accuracy of diagnosis with and without laboratory analysis. Evaluation and treatment of dysuria through a virtual encounter without laboratory testing may increase recurrent symptoms and antibiotic courses. Persistent symptoms after initial evaluation and treatment require further workup for infectious and noninfectious causes. Dysuria, a feeling of pain or discomfort during urination, is often caused by urinary tract infection but can also be due to sexually transmitted infection, bladder irritants, skin lesions, and some chronic pain conditions. History is most often useful for finding signs of sexually transmitted infection, complicated infections, lower urinary symptoms in males, and noninfectious causes. Most patients presenting with dysuria should have a urinalysis performed. Urine culture should be performed for infection to guide appropriate antibiotic use, especially for recurrent or suspected complicated urinary tract infection. Vaginal discharge decreases the likelihood of urinary tract infection, and other causes of dysuria, including cervicitis, should be investigated. If a patient has persistent urethritis or cervicitis with negative initial testing, Mycoplasma genitalium testing is recommended. Clinical decision rules may increase the accuracy of diagnosis with and without laboratory analysis. Evaluation and treatment of dysuria through a virtual encounter without laboratory testing may increase recurrent symptoms and antibiotic courses. Persistent symptoms after initial evaluation and treatment require further workup for infectious and noninfectious causes. [ABSTRACT FROM AUTHOR]

Introduction: Clinical metritis (CM) has significant costs to dairy producers. Current treatment strategy involves systemic antibiotics; however, there is increasing concern about judicious antibiotic use. The study objective was to evaluate the effects of a non-antibiotic treatment vs. systemic antibiotic therapy on the vaginal discharge microbiome of dairy cows diagnosed with CM at 7 ± 3 DIM (days in milk). We hypothesize that both treatment methods will have a similar impact on the reproductive microbiome due to broad-spectrum bactericidal activity; therefore, there will not be significant differences amongst the microbiota after the completion of therapy. Methods: Cows from a central Pennsylvania dairy were screened for CM at 7 ± 3 days DIM using a Metricheck™ device (n = 351). Cows with red-brown watery discharge were diagnosed with CM and eligible for enrollment. Eligible cows (n = 77) were blocked by parity and randomly allocated to one of two treatments starting on the day of diagnosis: (1) Intrauterine dextrose (DEX, n = 38): 1 l of an intrauterine 50% dextrose solution for 3 days, and (2) Systemic ceftiofur (CONV, n = 39): two injections of ceftiofur (6.6 mg/Kg of BW; Excede, Zoetis Inc.) 72 h apart. Cows were evaluated for clinical cure rate at 7 ± 3 and 14 ± 3 days post-diagnosis. Vaginal discharge samples were collected using the Metricheck™ at enrollment day [study day (sd) 0, pre-treatment], sd 7, and sd 14 for a subset of enrolled cows (DEX = 13, CONV = 14). Vaginal discharge samples were analyzed with 16S rRNA sequencing to evaluate changes in the microbiome between treatments. Results: After treatment, there were only minor differences within the microbiome between the two treatments indicating the potential suitability of dextrose as an antibiotic-alternative treatment. Alpha diversity did not differ (Welch's t -test) between the treatments at any of the time points. Beta diversity based on PERMANOVA analysis did differ between treatments at sd 0 (P = 0.014) and again at sd 14 (P = 0.028), but not at sd 7 (P = 0.261). Discussion: While 16S rRNA analysis does not provide information on bacterial viability, the relative similarity of the microbiome between the two groups immediately following treatment might suggest that intrauterine dextrose could be utilized as an alternative treatment for CM. [ABSTRACT FROM AUTHOR]

Introduction: Ureaplasma urealyticum (U. urealyticum) and Ureaplasma parvum (U. parvum) are the two causative agents for Sexually Transmittable Diseases (STDs), they are often accompanied by Pelvic Inflammatory Disease (PID), vaginitis, endometriosis, etc. Aim: To detect the prevalent genotypes/biovars of Ureaplasma species by using Duplex Polymerase Chain Reaction (PCR) in symptomatic women attending the Obstetrics and Gynaecology clinic of a tertiary care hospital. Materials and Methods: This was a cross-sectional study, comprised of 200 symptomatic women aged from 18 to 45 years. This study was carried out in the Department of Microbiology, School of Allied Health Sciences, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, and Mahatma Gandhi Medical Advanced Research Institute, Sri Balaji Vidyapeeth, Puducherry, India for the period of January 2021 to January 2024. Duplex PCR was performed for the presence of U. urealyticum and U. parvum in endocervical samples. Amplified PCR products were analysed and the positive PCR products were sent for sequencing and the sequenced results were compared with GenBank and phylogenetic analysis was constructed. Data was analysed using Chi-square tests to test level of significance between the two groups (p-value≤0.05). Results: The overall results found that 48 (24%) of symptomatic women were positive for Ureaplasma species. In Duplex PCR, 24 (12.0%) were positive for both urease and upv genes; followed by 15 (7.5%) for urease and 9 (4.5%) for upv genes only. The phylogenetic tree concluded that the genetic sequences of Ureaplasma species are closely related to various isolates within a species. Conclusion: The study concludes that U. parvum is the most common pathogen in symptomatic women with predominant age of 26-35-year-old. The duplex PCR, increase the sensitivity and specificity by the application of two different genes in a single amplification reaction. Since the research will focus on different gene targets of Ureaplasma species by the application of multiplex in future study. [ABSTRACT FROM AUTHOR]

Prepubertal vaginal bleeding is a common presentation for pediatric adolescent gynecologists with a broad differential diagnosis that historically may not have included complex lymphatic anomalies. However, given recent consensus criteria and imaging capabilities, this may be a condition that pediatric adolescent gynecologists see more frequently in the future. We present a case of a 5-year-old pre-pubertal girl whose only presenting symptoms of a rare complex lymphatic anomaly was copious vaginal bleeding. After three vaginoscopies, two hysteroscopies, two pelvic MRIs, and a percutaneous ultrasound guided core needle biopsy, this patient was eventually diagnosed with Kaposiform lymphangiomatosis at age 9 years-old, and she is now being treated medically with sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, with improvement in her symptoms. Complex lymphatic anomalies should be considered after initial and secondary workups for pre-pubertal vaginal bleeding or copious vaginal discharge are negative. Furthermore, this case illustrates the value of pelvic MRI in the setting of unknown cause of vaginal bleeding when typical workup is negative. [ABSTRACT FROM AUTHOR]

Leukorrhea is one of the most common reasons for consultation in gynecology. A distinction must be made between physiological leukorrhea, the variations of which are linked to hormonal changes or specific conditions such as pregnancy or menopause, and pathological leukorrhea. Among the latter, infections are the most common, bacterial or candidal vaginosis accompanied by abnormal vaginal discharge, vulvar and vaginal pruritus and burning sensations. They are a source of discomfort for women with a risk of transmission to sexual partners. How can they be distinguished? What appropriate management is needed to preserve women's well-being and prevent complications? [ABSTRACT FROM AUTHOR]

Pregnancy and childbirth involve substantial physical, physiological and psychological changes. As such, postpartum rugby players should be supported and appropriately prepared to return to the demands of rugby alongside the additional demands of motherhood. This review aims to discuss specific perinatal considerations that inform a rugby player's readiness to return‐to‐sport postpartum and present an approach to rehabilitation. Before engaging in full rugby training and matchplay, postpartum players should have progressed through the initial phases of rehabilitation and graded sports‐specific training to prepare them for the loads they will be exposed to. Additional rehabilitation considerations include minimising deconditioning during pregnancy; medical concerns; the abdominal wall; the pelvic floor; perinatal breast changes, breastfeeding and risk of contact breast injury; body mass; nutritional requirements; hormonal considerations; athlete identity and psychological considerations; joining team training; return to contact and tackle training; evaluating player load tolerance and future research, policy and surveillance needs. A whole‐systems, biopsychosocial approach following an evidence informed return‐to‐sport framework is recommended when rehabilitating postpartum rugby players. Health and exercise professionals are encouraged to use the perinatal‐specific recommendations in this review to guide the development of postpartum rehabilitation protocols and resources. Highlights: Unlike an injury, the postpartum period is a transitional time with unique biopsychosocial considerations, many of which can be anticipated and prepared for during pregnancy.Player education should commence early before they likely transition into motherhood.Before engaging in rugby postpartum, players should progress through the initial phases of a postpartum return‐to‐sport framework to respect tissue healing and prepare for the progressive loads they may be exposed to.Welfare and long‐term player health should focus across the player lifespan and playing level (from girls and community to the elite women's game). It also serves to educate others involved in the women's game (match officials, coaches, fans and family members) regarding key aspects of women's physical and mental well‐being (e.g., pregnancy and postpartum). [ABSTRACT FROM AUTHOR]

Malignant peripheral nerve sheath tumors (MPNSTs) of the cervix are rare, particularly in patients with neurofibromatosis type 1 (NF1). This report describes a cervical MPNST in an 18‐year‐old patient with no history of sexual activity, abnormal vaginal discharge, and prolonged menstruation. She had more than six café‐au‐lait spots on her body since birth and was diagnosed with NF1 at 2 years of age. Positron emission tomography‐computed tomography revealed a large pelvic mass and lung and bone metastases. Biopsy confirmed MPNST. Immunohistochemical staining showed diffuse positivity for CD10, approximately 30% positivity for cyclin D1, partial positivity for α‐SMA, desmin, and MyoD1, and negativity for myogenin, S‐100, and SOX‐10. A cancer gene panel identified several genetic abnormalities, but none were actionable mutations. Despite systemic chemotherapy, the tumor progressed rapidly, and the patient died 8 weeks post‐admission. Early diagnosis of MPNST is crucial. In patients with NF1, even mild symptoms can indicate MPNST. [ABSTRACT FROM AUTHOR]

Uterine intussusception is defined as the uterus telescoping onto itself. This condition has been rarely described in animals, and when it occurs, is often associated with post‐partum or pregnant animals. This case report describes the diagnosis and treatment of a uterine horn intussusception in a 1‐year 7‐month‐old, female, entire nulliparous pet rat (Rattus norvegicus). The rat presented for a 1‐day history of sanguineous vaginal discharge. An exploratory laparotomy was performed, and the rat was diagnosed with a firm, off‐white approximately 1 cm cervical mass and a left uterine horn intussusception. An ovariohysterectomy was performed for therapeutic and diagnostic purposes, and the mass was diagnosed as a benign endometrial stromal polyp on histopathology. Ten days post‐operative, the surgical incision developed a bacterial infection, which resolved with a course of amoxicillin/clavulanic acid. No further post‐operative complications occurred. The rat continues to do well 10 months after surgery. [ABSTRACT FROM AUTHOR]

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Consider the following hypothetical scenario: A patient suffering constant abdominal pain is referred to State Hospital A from her local clinic after not responding to simple analgesics for chronic pelvic pain associated with irregular menstruation. The doctors at State Hospital A discover that she has a suspicion of adenomyosis. She gives written informed consent for a hysterectomy. During routine postoperative check-ups she reports no alleviation of the pelvic pain, urinary frequency along with burning on micturition and a persistent vaginal discharge. Preoperatively, she was not told that the surgeons had inserted a surgical mesh to prevent vault prolapse. She is given antibiotics and further simple analgesia. As her symptoms do not improve she self-refers to State Hospital B. She is informed that she needs a CAT scan. However, the hospital's scanner has been out of order for three years. She is advised to go to State Hospital C, where the scanner works, but is not given a referral note. She is told by Hospital C that the doctors are too busy to see her, and as she does not have an appointment, and is not an emergency case she should go back to Hospital A. She does not want to go back to Hospital A, as during her last visit there, nursing staff accused her of being a nuisance and escorted her off the premises. She approaches Private Hospital D, where her abdomen and pelvis are scanned. The scan shows the surgical mesh inside her pelvis which had disintegrated. She is told that it is too risky to remove all the fragments, but that some could be removed at a cost - which she could not afford. The surgeon refers her back to State Hospital A with a referral note and copy of the CAT scan report. [ABSTRACT FROM AUTHOR]

Introduction: Vaginal discharge or another name is flour albus or leukorrhea, which occurs in women who are teenagers or of childbearing age. 75% of women will experience vaginal discharge at least once in their lives. Abnormal vaginal discharge is caused by infection from various microorganisms. In Indonesia alone, 90% of women are at risk of experiencing pathological vaginal discharge due to the tropical climate. Women often do vaginal cleaning or vaginal douching. Usually, this activity uses vaginal cleansing fluid. Objective: This study aims to dig deeper into the relationship between the use of vaginal cleansing soaps and pathological vaginal discharge in women, hoping to provide better insight into the effects of using these products and provide appropriate health recommendations. Method: The research design uses a descriptive case study method which aims to describe the relationship between two things experienced by the patient, namely vaginal discharge and the habit of cleaning the vagina with vaginal cleansing soap. Results: A 30-year-old woman came to the clinic with complaints of vaginal discharge coming out of her vagina. The vaginal discharge also feels thick, smells fishy, ​​and feels very itchy in the vaginal area. On physical examination, mucopurulent vaginal discharge with a fishy odor was found. The labia majora looks swollen and red. By using a speculum, the cervix appears reddish. No abrasions or blood spots were found on the cervical neck. Conclusion: There is a relationship between the use of vaginal cleansing soap and the emergence of pathological vaginal discharge. Changes in the acidity of the vagina influence the emergence of pathological flora. There is a need to increase Knowledge of how to maintain vaginal cleanliness, not just using vaginal cleansing fluids. With this study, it is further proven that the use of vaginal cleansing soap can cause pathological vaginal discharge. It is necessary to have good education for women with pathological vaginal discharge so that there is no recurrence of similar cases. In the case study above, it is essential to carry out additional examinations to find out the cause of the vaginal discharge, whether it is fungus, bacteria, or protozoa so that it can speed up the healing of the patient. With this research, it is also hoped that it can be an example of health care about pathological vaginal discharge and increase women's Knowledge of what kind of good vaginal cleaning behavior.

Introduction: Women of childbearing age have a higher risk of vaginal discharge than adolescents because of the frequent occurrence of pelvic inflammatory disease (PID). One of the symptoms of reproductive organ infections in women is vaginal discharge. Objective: This study aims to apply midwifery care to cases of vaginal discharge (flour albus). Methods: A descriptive method with a case study approach is used. Data was collected through primary data, including assessment and observation of the patient's health status, interviews to obtain subjective data, and direct examination for objective data. Secondary data was obtained through patient records, registered books in the KIA room, and literature studies. Result: The results showed that the symptoms of vaginal discharge in patients included thick white mucus, unpleasant odor, and itching in the genital area. The care provided uses red betel leaf water decoction as a treatment effort. After obstetric care was carried out from July 16 to 20, 2024, the results were obtained that the patient's vaginal discharge improved without signs of genetic infection. Conclusion: The success of this care is also marked by an increase in patients' understanding of good personal hygiene, how to properly clean the feminine area from front to back, and the effective use of red betel leaf boiled water. Thus, the management of obstetric care applied to this case of vaginal discharge is quite successful and practical, with a decoction of red betel leaves providing a positive effect in reducing the incidence of pathological vaginal discharge.

BACKGROUND: A rapid and affordable point-of-care test is a priority for Neisseria gonorrhoeae control. WHO and Foundation for Innovative New Diagnostics (FIND) have a target product profile for a non-molecular N gonorrhoeae rapid point-of-care test that requires a clinical sensitivity of greater than 80% and a specificity over 95% to be considered useful in syndromic management; test turnaround time should be 30 min or under, and the test should cost less than US$3. A novel lateral flow assay (LFA) was developed to achieve that profile. METHODS: In this cross-sectional study we evaluated the performance of the novel N gonorrhoeae lateral flow assay (NG-LFA) at the primary health-care level in South Africa. Male patients with urethral discharge syndrome and female patients with vaginal discharge syndrome were recruited from five primary health-care facilities in the Buffalo City Metropolitan Municipality health district of South Africa. First-void urine specimens and nurse-collected vaginal swabs were tested in-facility with the NG-LFA and Xpert CT/NG PCR assay. N gonorrhoeae multi-antigen sequence typing (NG-MAST) was performed on all LFA positive specimens. FINDINGS: Between March 7, and Sept 19, 2022, we enrolled 200 male patients with urethral discharge and 200 female patients with vaginal discharge. The median age of male patients was 24 years (IQR 21-31 years), and the median age of female patients was 25 years (IQR 21-32 years). In addition, 23 male patients and 12 female patients who presented at the facility with a partner notification slip were enrolled of whom one (4%) and five (42%) were symptomatic, respectively. NG-LFA and Xpert results were available for all participants. In urine specimens, NG-LFA sensitivity was 96·1% (Wilson 95% CI 91·2-98·3; 123 LFA-positive among 128 PCR-positive specimens) and 91·7% in vaginal swab specimens (78·2-97·1; 33 LFA-positive among 36 PCR-positive). The specificity was 97·2% in urine specimens (90·4-99·2; 70 LFA-negative among 72 PCR-negative) and 96·3% in vaginal specimens (92·2-98·3; 158 LFA-negative among 164 PCR-negative). In 156 LFA-positive specimens, NG-MAST showed 93 different sequence types. INTERPRETATION: The novel NG-LFA had excellent clinical sensitivity and specificity in symptomatic male and female patients. The test met the optimal requirement for sensitivity and the minimal requirement for specificity specified in the target product profile. NG-LFA could provide an important tool to optimise clinical management and reduce excess antibiotic use in settings without direct access to laboratory testing. FUNDING: Global Antimicrobial Resistance Innovation Fund (GAMRIF) via FIND and National Institutes of Health.

Background & Aims: Introduction: Pre-labour rupture of membranes is a critical obstetric condition, presenting an important contribution to maternal and neonatal morbidity and mortality. This study aims to investigate the diagnostic value of vaginal fluid creatinine in the identification of PROM. Materials & Methods: In the present descriptive-analytical study, 150 pregnant women were recruited and randomly assigned to three groups: confirmed PROM (n=50), suspected PROM (n=50), and healthy controls (n=50). Vaginal fluid samples were collected and analyzed for creatinine concentration using the Jaffe technique. Data were analyzed with SPSS version 16, employing ANOVA and post hoc tests. Results: Mean creatinine level of vaginal fluid was significantly higher in the PROM group compared with the control group (p < 0.05). Tukey post hoc test showed significant creatinine level groupings between PROM cases and controls. Maternal age, gestational age, and fetal weight did not show a significant correlation with creatinine levels (p > 0.05). Creatinine testing demonstrated higher diagnostic accuracy compared to the Fern test with a moderate correlation rate of 54%. Conclusion: The measurement of creatinine in vaginal fluid is an inexpensive, quick, and dependable diagnostic test for PROM, which is superior to the Fern test. Vaginal creatinine testing may also enhance maternal and neonatal outcomes due to the timeliness and accuracy of early diagnosis of PROM.

Background: Vaginal discharge (VD) is a common symptom in women during the reproductive period, especially during pregnancy. Pathological VD during pregnancy is an important public health concern because it has a sociopsychological impact on women and influences fetomaternal outcomes. Aims and Objectives: The study aims to estimate the prevalence of pathological discharge in pregnant women. The study also focuses on the demographic profile and various risk factors associated with pathological VDs and their consequences on fetal and maternal health. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology in a tertiary care center in Northern India. A total of 150 pregnant women with complaints of VD in the second and third trimesters with confirmation on speculum examination were recruited and evaluated for the etiology of discharge. Patients were followed until delivery and data regarding fetomaternal outcomes was collected. Results: The prevalence of pathological VD among enrolled women was 39.33% and various etiologies were candidiasis (15.33%), bacterial vaginosis (10.66%), aerobic vaginitis (8.67%), and trichomoniasis (4.67%). These infections were significantly related to pre-term delivery and pre-term pre-labor rupture of membranes. Furthermore, the incidence of prematurity, and low birth weight neonates requiring neonatal intensive care unit care was significantly high in babies born to mothers with pathological VD. Conclusion: Vaginal infections affect both maternal and neonatal health, thus, increasing the likelihood of poor perinatal outcomes. Hence, we propose that routine screening for pathological VD for all pregnant women should be introduced into standard antenatal care.

Patients with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome sometimes present with distinct symptoms related to coexisting urogenital abnormalities. We present a case of refractory abscess formation in a blind‐ended remnant ureter associated with ipsilateral renal agenesis. A 15‐year‐old patient with OHVIRA syndrome, who had a blind‐ended remnant ureter, underwent obstructed hemivagina opening 18 months after menarche due to heavy genital bleeding and abdominal pain after the end of menstruation. Four years later, the patient presented with recurring fever and abdominal pain due to a refractory abscess in the ureter. Although the continuity between the ureter and the previously opened hemivagina was not identified, the same bacteria were detected in the abscess and vaginal discharge, indicating that an ascending bacterial infection of the vagina may cause refractory abscess formation in a blind‐ended remnant ureter. Open ureterectomy with partial bladder resection was needed to resolve the symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Intraamniotic infection is crucial in preterm prelabor rupture of membranes(PPROM), a clinical condition resulting from the invasion of vaginal opportunistic microbes into the amniotic cavity. Although previous studies have suggested potential associations between infection and PPROM, the role of vaginalopportunistic bacteria in PPROM has received limited attention. Methods: This study aimed to confirm the vaginal bacterial etiology of PPROM. We investigated vaginal microbiotas using automatic analysis of vaginal discharge, microbiological tests, and 16s rRNA genehigh-throughput sequencing. Results: The research findings revealed that the proportion of parabasal epitheliocytes, leukocytes, toxic leukocytes, and bacteria with diameters smaller than 1.5 um was significantly higher in the PPROM group than that in the normal full-term labor (TL) group. The top three vaginal opportunistic bacterial isolates in all participants were 9.47% Escherichia coli, 5.99% Streptococcus agalactiae, and 3.57% Enterococcus faecalis. The bacterial resistance differed, but all the isolates were sensitive to nitrofurantoin. Compared with the vaginal microbiota dysbiosis (VMD) TL (C) group, the VMD PPROM (P) group demonstrated more operational taxonomic units, a high richness of bacterial taxa, and a different beta-diversity index. Indicator species analysis revealed that Lactobacillus jensenii, Lactobacillus crispatus, and Veillonellaceae bacterium DNF00626 were strongly associated with the C group. Unlike the C group, the indicator bacteria in the P group were Enterococcus faecalis, Escherichia coli, and Streptococcus agalactiae. Discussion: These findings provide solidevidence that an abnormal vaginal microbiome is a very crucial risk factorclosely related to PPROM. There were no unique bacteria in the vaginalmicrobiota of the PPROM group; however, the relative abundance of bacteria inthe abnormal vaginal flora of PPROM pregnancies differed. Antibiotics should bereasonably selected based on drug sensitivity testing. The findings presented in this paper enhance our understanding of Streptococcus agalactiae, Enterococcus faecalis, and Escherichia coli vaginal bacterial etiology of PPROM in Western China. [ABSTRACT FROM AUTHOR]

Many species use chemical messengers to communicate a remarkable range of information. Mice appear to make particular use of chemical messengers, including effects on estrous cycling and initiation, pregnancy, aggression, stress and of course attraction. Behavioral studies have helped identify several candidate messengers, or pheromones, that mediate attraction in mice. One question is whether attractive chemical messengers induced a physical vaginal secretory response. The preparation hypothesis posits that increased vaginal secretion would lubricate and protect the vagina in response to the prospect of imminent coitus, but this has been difficult to assess experimentally, particularly in mice. We developed a rapid, sensitive, minimally invasive method of quantifying vaginal moisture in mice and used this model to test vaginal secretory responses to male bedding. We report that female mice experience an increase in vaginal moisture after exposure to male, but not female, bedding. This response is induced by either physical or airborne exposure to male urine, to preputial gland extract, and to the preputial gland-derived pheromone alpha/beta farnesenes. This vaginal response is diurnally regulated, seen only during their active phase. The response is sensitive to the estrous phase, with a clear response during estrus but not during metestrus. We conclude that mice may serve as a model for aspects of vaginal function and that this assay will be readily applicable to other small animals. The identification of a pheromone-mediated vaginal secretory response offers a window into the regulation of the vaginal environment and the neurobiology of sexual responses in mice. [ABSTRACT FROM AUTHOR]

The article in the Australasian Journal of Dermatology discusses cases of vulvovaginal lichen planus (VLP) that were initially misdiagnosed as desquamative inflammatory vulvovaginitis (DIV). VLP is a chronic inflammatory condition that can be challenging to diagnose due to its varied presentation. The study highlights the importance of considering VLP as an alternative diagnosis in patients with treatment-resistant DIV symptoms, especially in peri-/post-menopausal women. The article emphasizes the need for systemic treatments in most cases of VLP that mimic DIV. [Extracted from the article]

Vaginal candidiasis poses significant health concerns that affect approximately 75% of women globally and often leads to discomfort and a decrease in quality of life. Traditional treatments, despite their effectiveness, may cause discomfort and adverse effects, such as vaginal discharge, bleeding, and dryness, promoting the exploration of alternative formulations. In this study, we aimed to develop a novel therapeutic approach for the treatment of vaginal candidiasis utilizing oleic acid containing emulgels made from thermoresponsive poloxamer-based hydrogels. These emulgels were designed to provide a sustained release of clotrimazole, an antifungal agent. Incorporating oleic acid enhanced the drug's solubility and contributed to vaginal health. The formulations were characterized by their rheological properties, in vitro release, mucoadhesion, and spreadability. We conducted rheological measurements on the hydrogels that served as the base for the emulgels, as well as on the emulgels themselves. The emulgels exhibited continuous rheological behavior with changing temperatures, making them suitable for storage at room temperature. With an increasing HPMC content, we achieved enhanced mucoadhesion, which is beneficial for formulations used in body cavities. Moreover, in vitro release studies revealed sustained drug release profiles, which can be adjusted by varying the ratios of poloxamers and HPMC. These findings suggest that the developed emulgels offer a promising therapeutic option for vaginal candidiasis, addressing both the symptoms and the treatment of discomfort. [ABSTRACT FROM AUTHOR]

Objective: The primary goal of this study is to discern the optimal adjuvant treatment for patients diagnosed with bacterial vaginosis, focusing on reducing recurrence rates. Methods: This study is a double-blind clinical trial with no previous similar trials conducted to date. The study population consisted of non-pregnant, married women visiting teaching hospitals' clinics in Mashhad, complaining of vaginal discharge. After informed consent and questionnaire completion, samples were obtained from vaginal discharge surrounding the cervix of clinically diagnosed bacterial vaginosis patients. Using Gram staining, a gold standard method for bacterial vaginosis diagnosis, samples were examined under a microscope according to the Nugent score. After initial treatment with metronidazole, patients were divided into two groups receiving either vaginal or oral probiotics. Results: Of the 55 participating women, 20 were in the vaginal probiotic group and 35 were in the oral probiotic group. No significant demographic or clinical differences existed between groups at baseline. The Nugent score decreased from 8.5 to 3 in the vaginal group and from 9 to 3 in the oral group, suggesting the effectiveness of both treatments. While the difference between groups was not statistically significant, each group showed significant improvements from their initial states (p-value < 0.001). Conclusion: No significant difference was observed in the effectiveness of oral versus vaginal probiotics in reducing the recurrence of bacterial vaginosis after routine treatment. Therefore, the type of probiotic to be used could be chosen based on patient preference. [ABSTRACT FROM AUTHOR]

Objective: Bacterial vaginosis is a disease caused by vaginal microecology disorder, which seriously affects female health. At present, there are many drugs to treat BV, and this study aims to compare the efficacy and safety of multiple drugs for BV through a network meta-analysis (NMA). Methods: All studies were sourced from PubMed and Embase databases from the establishment date to April 13, 2023. We evaluated the clinical cure success rate and adverse effects (abnormal increase in vaginal discharge, external genital irritation, and vulvar itching) and performed subgroup analyses of the clinical cure success rate for different modes of administration. All statistical analyses were performed using R and STATA 14.0 software for network meta-analysis. Results: Weincluded42studies thatmetthecriteria, involving a total of8382patients. Network meta-analysis results showed that metronidazole and secnidazole had a higher rate of adverse reactions than placebo (RR 7.06; 95%-CI 2.61-19.10, RR 4.03; 95%-CI1.63-9.98), theadverse reaction rateofprobioticsgroupwaslowerthanthat of metronidazole group (RR 0.44; 95%-CI 0.21-0.93). The clinical cure rate of oral ornidazole was better than clindamycin (RR 16.08; 95%-CI 1.72-150.47), Secnidazole (RR 8.17; 95%-CI 1.66-40.25) and probiotics. Directmeta-analysis results showed that ornidazole had a better clinical cure rate than Secnidazole (RR1.22; 95%-CI 1.10-1.34), oral ornidazole had a better clinical cure rate than Secnidazole (RR 1.23; 95%-CI 1.11-1.36). The clinical cure rate of vaginal application of sucrose was better than metronidazole (RR 1.12; 95%-CI 1.03-1.21) and metronidazole had a lower clinical cure rate than probiotics (RR 0.68; 95%-CI 0.52-0.88). Conclusions: The results of this systematic review and network meta-analysis suggest that ornidazole may be an effective alternative for the treatment of BV, and that sucrose and probiotics are potential BV treatments that need to be validated by more high-quality clinical studies in the future. [ABSTRACT FROM AUTHOR]

Background: Liquid-based cytology (LBC) is a newer method of preparing cervical cell samples. This technique involves collecting cells in a liquid fixative and preparing and evaluating them. Aim: This study aims to investigate cervical smears prepared using the Ezi-Prep LBC method and analyze the positivity rate for cervical cancer and assess the diagnostic accuracy of LBC in detecting cervical abnormalities among females with abnormal vaginal conditions attending a tertiary care center. Materials and Methods: The present diagnostic study was performed in a tertiary care hospital over a period of 1 year (April 1, 2021–November 30, 2021). A total of 230 women, aged 21–70 years, presented at the gynecology outpatient department for either routine cervical screening or with complaints of vaginal bleeding, discharge, or pelvic pain. Cervical smears were prepared using the Ezi-Prep method and stained with ULTRA-PAP stain. Results: LBC smears are monolayer smears and are without nuclear overlapping with spread over a diameter of 16 mm. Minimum cellular overlapping and crowding were observed in LBC smears. The mean age of the participants was 35.5 ± 5.1 years. The smears were studied by using nine morphological parameters. Conclusion: The majority of the smears were inflammatory smears. A total of 16 cases and three cases were found to be bacterial vaginosis and candidiasis, respectively. In an 8-month study, HSIL was found in two cases, whereas LSIL was found in only one case. The positivity rate was observed to be 0.9% in HSIL cases and 0.4% in LSIL cases, 0.9% ASC-US case, and 0.4% invasive carcinoma case. [ABSTRACT FROM AUTHOR]

Introduction: Streptococcus porcinus is considered a zoonotic opportunistic pathogen for several animal species, including swine, and can cause systemic clinical conditions. There are morphological similarities between streptococcal species, leading to possible incorrect diagnosis and inappropriate treatment choice. Here, we describe the identification, and genotypic and genomic characterization of S. porcinus isolated from 5 adult sick pigs from Minas Gerais and São Paulo (Brazil) between 2010-2017. Methodology: Streptococcus spp. strains were isolated from vaginal discharge, joint abscess, and brain tissue received for routine diagnosis. They were identified as S. porcinus by mass spectrometry and partial sequencing of the groEL gene. Genotypic characterization by amplified fragment length polymorphism was performed. In addition, the genome of one of the S. porcinus invasive strains was sequenced and comparative analyses were performed. Results: Genotyping revealed that the nervous system and joint abscess invasive strains had higher genetic similarity and clustered separately from vaginal discharge strains. Genome sequencing of one of the invasive strains revealed the presence of genes conferring resistance to erythromycin, tetracycline, lincosamides, and macrolides. A high level of similarity of the Brazilian strain genome with British and American strains was found. However, these strains also presented higher variation in their accessory genomes. Conclusions: The circulation of S. porcinus invasive and resistant strains, and the lack of its identification demands attention, posing a risk for animals and workers in the swine industry. [ABSTRACT FROM AUTHOR]

Osseous metaplasia of the endometrium is a rare entity in which there is presence of mature or immature bone tissue in the endometrium. It is a rare disorder that usually leads to secondary infertility and is frequently associated with recurrent miscarriages and can be rarely asymptomatic. We present the case of a patient with endometrial ossification associated with secondary infertility. The patient presented with excessive vaginal discharge and was undergoing evaluation for secondary infertility. Transvaginal sonography showed a hyperechoic elongated lesion in the endometrium suggestive of endometrial calcification with posterior acoustic shadowing. Diagnostic hysteroscopy was done and the endometrial cavity showed multiple white‐colored, solid, fan‐shaped structures and bony spicules all over the endometrium, which were removed with a hysteroscopic grasper and sent for histopathological examination (HPE). The HPE confirmed the presence of bony trabeculae along with secretory endometrial glands. There have only been a few cases of endometrial osseous metaplasia reported in India and it is usually an overlooked cause of infertility. Although rare, we should consider this as a probable cause of secondary infertility when the characteristic ultrasound features are visualized and that hysteroscopic resection is the gold standard treatment. Synopsis: We present a case report of osseous metaplasia of the endometrium; the patient presented with secondary infertility and successful diagnosis and resection were done by hysteroscopy. [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. Our objectives were to compare the efficacy of ketoprofen or ceftiofur for treatment of metritis in dairy cows considering subsequent health, production, and reproduction. Cows from 2 commercial dairy farms in Ontario, Canada were examined with a Metricheck device 3 times per week from 2 to 14 DIM. Cows with metritis (fetid vaginal discharge; n = 193) were blocked by parity and fever (rectal temperature ≥39.5°C or <39.5°C) and within each block per farm, randomly assigned to receive 3 mg/kg BW of ketoprofen (KET) or 2.2 mg/kg of ceftiofur hydrochloride (CEF), once a day for 3 d. Day of enrollment was considered study d 0. Rectal temperature and attitude were evaluated in cows with metritis on study d 0, 3, 4, 7, 10, and 13, and vaginal discharge was evaluated on study d 4, 7, 10, and 13. Body condition was scored at enrollment and at 35 DIM, and serum concentration of haptoglobin was measured at d 0, 2, 4, and 7. Cows with rectal temperature ≥39.5°C or a depressed attitude on d 3 were classified as clinical failure and received treatment with ceftiofur for 3 d (KET), or 2 additional days (CEF), to a maximum of 5 d of treatment with ceftiofur. At 35 ± 3 DIM cows were examined for uterine involution via transrectal palpation, purulent vaginal discharge (PVD) via Metricheck, and endometritis via endometrial cytology. Time to onset of cyclicity was assessed by serum progesterone (P4) measurements at 28, 42, and 56 DIM. Contemporary cows from the same farms without metritis (NOMET; n = 1,043) were used for comparison. Data were analyzed with mixed linear or logistic regression or Cox's proportional hazard models, including herd as a random effect. The proportion of clinical resolution of metritis on d 3 (96% vs. 92%), of cows with fever (from d 3 to d 13 after enrollment) or fetid discharge (from d 4 to d 13 after enrollment), and the number of medical treatments (3.1 vs. 3.3) were not different between CEF and KET, respectively. Cows in KET received fewer antibiotic treatments than cows in CEF (0.3 vs. 3.1). Uterine involution, prevalence of PVD (50% vs. 47%) and subclinical endometritis (6.6% vs. 4.3%), and proportion of cyclic cows (82% vs. 86%) did not differ between CEF and KET. Cows in KET had greater serum haptoglobin concentration from d 2 to 7 after enrollment. The incidence of mastitis, lameness, or displaced abomasum to 60 DIM and subclinical ketosis to 21 DIM did not differ among CEF, KET, and NOMET. There were no differences in median time to first AI (CEF = 68 d, 95% CI: 65–70; KET = 69 d, 95% CI: 68–72; NOMET = 69 d, 95% CI: 68–70), median time to pregnancy (CEF = 118 d, 95% CI: 92–145; KET = 113 d, 95% CI: 90–135; NOMET = 105 d, 95% CI: 101–109), pregnancy at first AI at 33 d after insemination (CEF = 42%; KET = 41%; NOMET = 41%), pregnancy loss after first AI (CEF = 8%; KET = 11%; NOMET = 8%), hazard of pregnancy, or hazard of culling up to 300 DIM. Milk yield was not different between CEF and KET during the first 10 wk, but was lesser in KET at wk 2 and 4 and CEF at wk 2, 4, and 6 than in NOMET. In this pilot-scale study, given early detection, we did not detect differences in subsequent health, milk yield, or reproductive performance in cows with metritis initially treated for 3 d with CEF or KET. Additional, larger studies are warranted. [ABSTRACT FROM AUTHOR]

Introduction- In India the most frequent cause of vaginitis in women in the reproductive age range is bacterial vaginosis (BV). In bacterial vaginosis anaerobes and Gardnerella vaginalis replaces the lactobacillus which is the most common species in a healthy, normal vaginal flora. Aim -To study the prevalence of bacterial vaginosis in patients with white discharge at Gynaecology OPD. Material and Methods- This Study was conducted in the department of Obstetrics and Gynaecology of JNU Medical College and Hospital Jaipur from January 2022 till April 2024. A total of 200 consecutive women with symptoms of vaginitis or excessive vaginal discharge were enrolled for this study. Results- Prevalence of BV was 28%. Most common affected age group was between 20-29 years. Routinely a combination of various methods are used for the diagnosis of bacterial vaginosis (BV), although Nugent criterion is considered as the gold standard method. Conclusion: The high prevalence of BV in India may necessitate adequate screening of pregnant women with abnormal vaginal discharge in order to give appropriate treatment and avoid complications associated with it. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) are significant public health concerns with widespread implications for individuals and communities. This research article aims to evaluate the awareness and practices regarding STIs and RTIs among individuals attending an RTI/STI clinic in a tertiary care hospital. Methodology: It is a hospital-based observational study using a universal sampling technique. The study utilizes one-on-one interviews with patients visiting the district STI/RTI Clinic. Results: Out of 147 study participants, 94% were female, with a mean age of 32 years. Maximum patients were in the age group of 25–35 years. Most (82%) of the participants were aware of the symptom of abnormal vaginal discharge for STIs and RTIs but less aware of the other symptoms. Approximately 78% of the subjects were aware that unprotected sexual intercourse with an infected person causes STIs and RTIs. Health-seeking behavior was also good among the participants. Conclusion: In this study, it was found that a lot of patients were unaware of the different modes of transmission and various symptoms of STI/RTI due to which additional actions are required by policy makers as well as family physicians. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction: Menstruation is a normal physiological event that takes place in a rhythmic fashion during the reproductive period of a woman. Menstrual hygiene management (MHM) practices differ and depend on the individual's socioeconomic status, local traditions and beliefs, and access to water and sanitation resources. Insufficient and incorrect information regarding menstruation and lack of knowledge and awareness leads to poor personal hygienic practices, which further leads to many infections. Bacterial vaginosis, the most common RTI, is characterized by an alteration in the vaginal micro biome with a decline in hydrogen peroxide producing Lactobacillus colonization and an overgrowth of facultative anaerobic bacteria like Gardnerella spp., Mobiluncus spp., etc. Aims: The primary objective of the study was to find out the association of bacterial vaginosis with menstrual hygiene practices. The secondary objective was to determine the prevalence of bacterial vaginosis among patients presenting with vaginal discharge to the outpatient department of a tertiary care hospital. Methods: Women in the reproductive age group 18-45 years having regular menstrual cycles were included in the study. Participants were enquired for sociodemographic data, menstrual hygiene practices and symptoms of abnormal vaginal discharge. High vaginal swab was collected for the symptomatic patients and sent to investigate for presence of bacterial vaginosis. Results and observation: The prevalence of BV was found to be 13% among symptomatic patients presenting with abnormal vaginal discharge. Apart from abnormal discharge, itching and burning sensation was also seen to have a positive association with bacterial vaginosis (p < 0.001). The women who used clothes as absorbent were more prone to develop BV than women using sanitary pad. The other parameters to have positive association with BV were decreased frequency of taking body bath. Unsatisfactory sanitation of latrine was found to be strongly associated with BV after adjusting for confounders. Conclusion: In conclusion, the result of this study provided a strong association between poor MHM practices with BV. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Journal of Babylon is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Vaginal discharge (VD) is a common symptom in women during the reproductive period, especially during pregnancy. Pathological VD during pregnancy is an important public health concern because it has a sociopsychological impact on women and influences fetomaternal outcomes. Aims and Objectives: The study aims to estimate the prevalence of pathological discharge in pregnant women. The study also focuses on the demographic profile and various risk factors associated with pathological VDs and their consequences on fetal and maternal health. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology in a tertiary care center in Northern India. A total of 150 pregnant women with complaints of VD in the second and third trimesters with confirmation on speculum examination were recruited and evaluated for the etiology of discharge. Patients were followed until delivery and data regarding fetomaternal outcomes was collected. Results: The prevalence of pathological VD among enrolled women was 39.33% and various etiologies were candidiasis (15.33%), bacterial vaginosis (10.66%), aerobic vaginitis (8.67%), and trichomoniasis (4.67%). These infections were significantly related to pre-term delivery and pre-term pre-labor rupture of membranes. Furthermore, the incidence of prematurity, and low birth weight neonates requiring neonatal intensive care unit care was significantly high in babies born to mothers with pathological VD. Conclusion: Vaginal infections affect both maternal and neonatal health, thus, increasing the likelihood of poor perinatal outcomes. Hence, we propose that routine screening for pathological VD for all pregnant women should be introduced into standard antenatal care. [ABSTRACT FROM AUTHOR]

Background: Sexually transmitted infections (STIs) are illnesses that spread from person to person through sexual activity. In Indonesia, STI cases increased between 2016 and 2017. One of the high cases reported in North Sumatra with 1,183 STIs cases which ranked seventh in Indonesia and second on Sumatera Island. Purpose: This study aimed to analyze the risk factors related to women with STIs symptoms in North Sumatra. Methods: A cross-sectional study was conducted using the 2017 Indonesian Demographic Health Survey data which included a total sample of 2,440 women aged 15-49 years domicile in North Sumatera. Then, using IBM SPSS 25 to perform a multivariate analysis utilizing logistic regression. Results: This study showed that women with a genital ulcer were associated with living in rural areas (OR: 2.68, 95% CI: 1.67-4.31), poor economic status (OR: 1.47, 95% CI: 0.94-2.29), and the spouse having other sex partners (OR: 0.54, 95% CI: 0.31-0.94). Moreover, women who lived in rural areas (OR: 1.74, 95% CI: 1.38-2.20), had poor economic status (OR: 1.33, 95% CI: 1.05-1.68), and their spouse has STIs (OR: 0.51, 95% CI: 0.39-0.66) were associated with vaginal discharge. Conclusion: Findings indicated that STIs symptoms were higher among women who lived in rural areas with poor economic status and had negative attitudes toward negotiating safe sex with partners. It is advised that intervention programs focus more on conducting mass STIs testing and safe sex campaign in rural areas. [ABSTRACT FROM AUTHOR]

Study Objective Design Setting Participants Main Outcome Measures Results Conclusions To investigate the aetiology of vaginal bleeding and discharge in prepubescent girls, and the utility of vaginoscopy for making a diagnosis.Retrospective observational study over 14 years.Two major tertiary referral paediatric hospitals in Sydney, Australia.All prepubescent girls (n = 104) who presented with vaginal bleeding and/or discharge and subsequently underwent a vaginoscopy. A total of 120 procedures were performed.Surgical findings at vaginoscopy; number needed to investigate (NNI) to establish a diagnosis and to exclude malignancy.There were 52/120 (43.3%) vaginoscopies which provided a positive diagnosis, including 36/86 (41.8%) performed for bleeding and 16/34 (47.0%) for vaginal discharge. In the vaginal bleeding group, the causes found were a foreign body in 11/86 (12.7%), vulvovaginitis in 6/86 (6.9%), benign Mullerian papilloma in 5/86 (5.8%), trauma in 4/86 (4.6%), and malignant tumours in 2/86 (2.3%). To establish a diagnosis in girls presenting with vaginal bleeding, the NNI was 2.4; to detect a malignancy the NNI was 43.0. In girls presenting with vaginal discharge, vulvovaginitis was noted intraoperatively in 7/34 (20.6%) and a foreign body was found in 7/34 (20.6%). No malignant tumours were identified in the vaginal discharge group. To establish a diagnosis in girls presenting with vaginal discharge, the NNI was 2.1.Vaginoscopy is an important diagnostic tool in the setting of vaginal bleeding in prepubescent girls, allowing the ability to confirm a diagnosis, and importantly, to exclude malignancy. [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. The objective of this prospective cohort study was to determine if progesterone (P4) profiles differed between dairy cows with or without inflammatory disorders early postpartum. A total of 708 cows from 2 commercial herds were enrolled 3 wk before parturition and examined for clinical health disorders (difficult calving, retained placenta, metritis, displaced abomasum, mastitis, or lameness) until 5 wk postpartum. Serum haptoglobin (Hp) was measured in blood at 2 and 6 DIM (range ±2 d); metritis was assessed at 4, 8, 11, and 15 DIM; and purulent vaginal discharge and endometritis (≥6% PMN in endometrial cytology sampled by cytobrush) were assessed at 35 ± 3 DIM. As Hp ≥0.8 g/L or endometritis were associated with ovarian dysfunction in previous studies, cows with serum Hp ≥0.8 g/L at either time point and endometritis, regardless of clinical disease, were classified as the cohort with inflammatory disorders (INFLAM; n = 139). Clinically healthy cows without difficult calving, with singleton birth, with Hp <0.8 g/L at both sampling times, without endometritis or purulent vaginal discharge, and BCS ≥3.00 (1 to 5 scale) were classified as healthy (n = 133). Cows with only one of the 2 conditions (high Hp or endometritis) were excluded. Cohorts had serum P4 measured twice weekly from 35 to 70 DIM (±3 d), and the first detected luteal phase (LP) during the sampling period was defined as the period from onset of luteal activity (P4 increase to ≥1 ng/mL) until decline of P4 to <1 ng/mL. The odds of prolonged LP (≥21 d long), average LP length, peak P4, and time to P4 decline (hazard rate) were analyzed using multivariable mixed logistic, linear, or Cox proportional hazard regression models including INFLAM status, parity, sampling day (when applicable), and herd as a random effect considering the covariates of season, milk yield at first DHIA test, and DIM at onset of cyclicity or LP length (when applicable). Cows with INFLAM had greater odds of prolonged LP (LSM ± SEM; 67% vs. 37% ± 7%), greater average LP length (17 vs. 15 ± 2 d), lesser P4 at d 4 (4.6 vs. 5.5 ± 0.3 ng/mL) and d 7 (6.0 vs. 7.7 ± 0.3 ng/mL) of the LP, and lesser peak P4 (6.9 vs. 8.2 ± 0.3 ng/mL) during the LP than healthy cows. Status of INFLAM was associated with time to P4 decline in multiparous but not primiparous cows; the LP of INFLAM multiparous cows was less likely to have luteolysis (P4 decline) by d 14 (adjusted hazard ratio [AHR] and 95% CI: 0.54; 0.31 to 0.94) or by d 21 (AHR: 0.32; 0.12 to 0.84) than in healthy multiparous cows. In conclusion, postpartum cows with markers of systemic inflammation at wk 1 and uterine inflammation at wk 5 had altered luteal function (prolonged LP and lower P4 concentrations) before first breeding, which is a possible pathway linking postpartum health disorders and reduced fertility. [ABSTRACT FROM AUTHOR]

Approximately 95% of cervical squamous cell carcinomas are associated with high-risk HPV, with a small number of HPV-independent tumors. However, low-risk HPV types have also been detected in rare cervical squamous cell carcinomas. Low-grade squamous intraepithelial lesion-related changes are a rare morphologic finding in cervical squamous cell carcinoma. We present the case of a 30-yr-old woman who presented with pelvic pain and foul-smelling vaginal discharge showing an exophytic lesion protruding from the cervix. Repeated superficial biopsies showed a low-grade squamous intraepithelial lesion (LSIL) characterized by binucleation and koilocytosis. Chromogenic in-situ hybridization revealed the presence of HPV6/11. The absence of high-risk HPV was confirmed by PCR. After following the patient for nine months without intervention, type III hysterectomy and bilateral pelvic paraaortic lymphadenectomy were performed. Microscopic examination showed well-differentiated squamous cell carcinoma with solid epithelial islands and extensive eosinophilic cytoplasm without pleomorphism. HPV 6 and 11 were also detected with chromogenic in-situ hybridization. Neoplasm invaded the full-thickness of the cervical wall and infiltrated the vagina, parametrium, the proximal ureter and bladder. The patient who received chemoradiotherapy is disease-free at 36 months follow-up. Low-risk HPV-related well-differentiated invasive squamous lesions exist, and such lesions could be a diagnostic pitfall for gynecologists and pathologists; in these cases, radiologic-pathologic correlation and radiologic guided biopsy are mandatory. [ABSTRACT FROM AUTHOR]

Background: Genital tract is the portal of entry for numerous sexually and non-sexually transmitted diseases. A number of bacterial and non-bacterial infections exist that affect the female reproductive tract and cause vaginal discharge. Candida species are among important opportunistic pathogens causing candidiasis in human worldwide. These yeast species are of public health concern nowadays. Aim: This study aimed at comparing the prevalence of candidiasis among single and married women attending Rwanda Military Hospital. The study population comprises of single and married women. Methodology: This was a retrospective study where data was collected from Rwanda Military Hospital. Results: The results of this study showed that the incidence of candidiasis was higher in married women when compared with single women. The prevalence of candidiasis in married women was 128(74.4%), while in single women is 44(25.6%). It was observed in this study that the distribution of candidiasis among married and single is statistically significant (p<0.05). Results also show that out of 172 single and married women, more cases of candidiasis were observed within the age range of 21-30 years, 66 (44.2%) were infected with candida albicans, 31-40 years had a prevalence of 55(32%) and 11-20 years had a prevalence of 13(7.6%). The overall of cases of candida other than C. albicans observed was 15.1%. Conclusion: This study showed that married and single women are predisposed to candidiasis. It is therefore important to give opportunistic pathogens like Candida species attention in women especially among married ones as they are mostly affected by this candidiasis. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)