bluuebunny/crossref_metadata_2025 huggingface dataset:
Significance of Gram′s Stain in Rapid Intrapartum Screening for Maternal Carriership ofGroup B Streptococcus
Authors: Adriaanse Albert H. , Muytjens Harry L. , Kollée Louis A. A. , Nijhuis Jan G. , Hoogkamp-Korstanje Jacomina A. A.
Published: March 2007

Objective: Group B streptococcus (GBS, Streptococcus agalactiae) is an important cause of neonatal sepsis. Prevention is possible by intrapartum screening for maternal GBS carriership and antimicrobial treatment of colonized women with risk factors during labor. The conflicting results of diagnostic performance are reported both for the newly developed rapid GBS antigen tests and Gram′s stain.

Methods: The value of Gram′s stain in GBS screening was investigated prospectively in 1,020 women. Intrapartum Gram′s stains of the cervix from these women and of the introitus from 510 of them were compared with cultures of the cervix, introitus, and anorectum in a semiquantitative way.

Results: The sensitivities of the cervical and introital Gram′s stains were 25% and 31%, respectively, and the specificities 99% and 98%, respectively. Higher sensitivities (52% and 44%, respectively) were found in heavily colonized parturients. No significant influence of rupture of the membranes was detected. There was a poor correlation between the number of gram‐positive cocci in the Gram′s stain and the growth density.

Conclusions: We do not recommend the routine use of the Gram′s stain for intrapartum GBS detection because of both the limited sensitivity and positive predictive value.
Pilot Study to Evaluate the Appropriate Management of Patients With Coexistent Bacterial Vaginosis and Cervicitis
Authors: Schwebke Jane R. , Schulien Mary Beth , Zajackowski Mark
Published: March 2007

A pilot study was performed to obtain preliminary data regarding the need for targeted therapy of bacterial vaginosis (BV) when it accompanies clinically defined cervicitis. Specifically, women attending a sexually transmitted disease (STD) clinic with clinically defined BV and cervicitis were treated in the first phase of the study with doxycycline alone. In phase II, the patients received doxycycline and concomitant intravaginal metronidazole gel. All patients were reexamined 3–4 weeks after therapy. Persistence of BV occurred in 18/19 (95%) of women in phase I vs. 1/7 (14%) of women in phase II (P < 0.001). We concluded that, in women with coexistent clinically defined cervicitis and BV, the treatment of cervicitis does not result in a normalization of the vaginal flora.
Pregnancy Complications Associated With BacterialVaginosis and Their Estimated Costs
Authors: Oleen-Burkey MerriKay A. , Hillier Sharon L.
Published: March 2007

Objective: This study was undertaken to estimate the annual direct costs of complications associated
with bacterial vaginosis (BV) in pregnant women in the United States.

Methods: An economic model was developed from evidence in the published literature linking perinatal complications to BV. The estimates of attributable risks were applied to the estimated population of pregnant women in the United States in 1993. The charge data from a database of hospital utilization information were then used to estimate the direct costs of each pregnancy complication and the total direct costs associated with BV.

Results: Under the assumptions of our model, the direct costs of preterm labor, preterm delivery, the attendant low birth weight (LBW), and other perinatal complications associated with BV were estimated at nearly $1.0 billion in 1993. Over 40% of the total cost was associated with preterm delivery and intensive care of LBW infants, while another 24.5% of the cost was related to preterm labor.

Conclusions: If the current frequency of BV among pregnant women persists and BV is not
detected and treated during pregnancy, the projected annual costs will reach $1.4 billion by the year
2000. Reducing the heavy economic burden associated with BV in pregnant women will require the
establishment of effective screening and treatment regimens.
Immune Pathogenesis of Asymptomatic Chlamydia trachomatis Infections in the Female Genital Tract
Authors: Witkin Steven S.
Published: March 2007

Chlamydia trachomatis (CT) infections of the female genital tract, although frequently asymptomatic, are a major cause of fallopian‐tube occlusion and infertility. Early stage pregnancy loss may also be due to an unsuspected and undetected CT infection. In vitro and in vivo studies have demonstrated that this organism can persist in the female genital tract in a form undetectable by culture. The mechanism of tubal damage as well as the rejection of an embryo may involve an initial immune sensitization to the CT 60 kD heat shock protein (HSP), followed by a reactivation of HSP‐sensitized lymphocytes in response to the human HSP and the subsequent release of inflammatory cytokines. The periodic induction of human HSP expression by various microorganisms or by noninfectious mechanisms in the fallopian tubes of women sensitized to the CT HSP may eventually result in tubal scarring and occlusion. Similarly, an immune response to human HSP
expression during the early stages of pregnancy may interfere with the immune regulatory mechanisms required for the maintenance of a semiallogeneic embryo.
Cervicitis as a Clinical Indicator of Gonococcal and Chlamydial Infections in Pregnancy
Authors: Jackson Susan L. , O′Connell Nan G. , Borzelleca Joseph F. , Dinsmoor Mara J. , Soper David E.
Published: March 2007

Objective: We undertook the present study to attempt to apply clinical indicators predictive of cervical infection in nongravid populations with either Neisseria gonorrhoeae or Chlamydia trachomatis to our pregnant population and to determine the significance of the clinical diagnosis of “cervicitis.”

Methods: A retrospective chart review of all pregnant women with a final diagnosis of cervicitis who were seen in the Medical College of Virginia obstetrical emergency room was performed during the period of September 1991 to December 1992.

Results: Given the diagnosis of cervicitis in our emergency department, we found that the clinical examination predicted cervical infection with N. gonorrhoeae or C. trachomatis in only 20% of the pregnant women. Gravidas with chlamydial infections were younger (20.1 ± 3.7 years) compared with gravidas not infected (23.2 ± 5.4 years) (P < 0.0001). They were also more likely to have a diagnosis of lower urinary‐tract infection [relative risk (RR) 2.89, 95% confidence interval (CI) 1.42–5.85].

Conclusions: The clinical indicators of cervical infection with C. trachomatis and N. gonorrhoeae were unreliable.
Medical Management of Vulvar Vestibulitis: Results of a Sequential Treatment Plan
Authors: Nyirjesy Paul , Halpern Meredith
Published: March 2007

Objective: The objectives of this study were to assess the efficacy of medical management for vulvar vestibulitis and to examine several historical variables and determine their predictive values as to which treatments will be most successful.

Methods: Seventy‐four patients diagnosed with vulvar vestibulitis were evaluated. Each patient was treated using a sequence of consecutive medical therapies for vulvar vestibulitis. These therapies were topical aqueous 4% lidocaine with intercourse, topical corticosteroid therapy, oral amitriptyline, topical low‐dose 5‐fluorouracil (5‐FU) cream, intralesional alpha‐interferon, and a low‐oxalate diet in combination with oral calcium citrate. The patients were followed over 3–30 months and their responses to therapy were assessed. In addition, a statistical analysis was performed to determine the positive predictive values of certain historical variables and specific treatment successes.

Results: Forty‐nine patients reported positive responses to one of the initiated therapies. More specifically, 18.1% of the patients who used lidocaine, 33.8% who used topical corticosteroids, 57.1% who used amitriptyline, 16.7% who used 5‐FU, none who received interferon, and 50% who tried a low‐oxalate diet had positive responses to therapy. No historical variables were predictive of which therapies would have the most successful outcome.

Conclusions: Medical management is effective in alleviating the symptoms of vulvar vestibulitis. Various aspects of a patient′s history are not helpful in selecting the therapy that will be most effective.
Pasteurella multocida Bacteremia in a Patient With Ovarian Cancer andChemotherapy‐induced Neutropenia
Authors: Casey A. Catherine , Greenspoon Jeffrey S. , Lagasse Leo D.
Published: March 2007

Background:Pasteurella multocida is a commensal organism found in the saliva and oropharynx of domestic animals. It causes a variety of human infections ranging from cellulitis to bacteremia and sepsis. The severity of infection is somewhat related to the immunocompetency of the infected host. An immunocompromised host is more likely to suffer a disseminated infection as a result of contact with this organism than an immunocompetent host. This case report and review of the literature are presented to further evaluate the types of infections caused by this organism in oncology patients.

Case: A 54‐year‐old woman with epithelial ovarian cancer and a chemotherapy‐induced nadir of her WBC count developed P. multocida bacteremia after she incurred a scratch from her pet cat. She was treated with ceftazidime and then penicillin G with prompt resolution of the bacteremia.

Conclusion: This paper summarizes an infectious complication that is likely to become more common as chemotherapy‐induced neutropenia and pet ownership in the elderly become common coincidences. As such, oncologists and infectious disease physicians should keep this organism in mind when selecting antibiotics to treat the febrile, nadiring cancer patient who has known pet contact.
Climatic Factors and the Incidence of Pyelonephritis During Pregnancy
Authors: Busowski John D. , Chez Ronald A.
Published: March 2007

Objective: Numerous published reports have linked various disease states and pregnancy‐related conditions with meteorologic factors such as weather, humidity, and temperature. The purpose of this study was to determine if temperature and dew point affect the incidence of pyelonephritis during pregnancy.

Methods: A retrospective chart review of a 4‐year period from 1989 to 1992 was performed. The records of women who were diagnosed with pyelonephritis during pregnancy were abstracted for the dates of admission. The climatic records of the Tampa Bay area of Florida were obtained from the National Weather Service.

Results: The average, minimum, or maximum daily temperature or average daily dew point during the month of admission had no significant effect on the rate of pyelonephritis during pregnancy in the Tampa Bay area.

Conclusions: The rate of pyelonephritis during pregnancy per number of deliveries in the Tampa Bay area was not affected by the average, minimum, or maximum daily temperature or average daily dew point.
In Vitro Susceptibility of Ureaplasma urealyticum and Mycoplasma hominis Isolates in Argentina
Authors: Smayevsky Jorgelina , Relloso Silvia , Pundik Mariela , Lanza Alejandra , Weltman Gabriela , Bantar Carlos , Bianchini Hebe
Published: March 2007

Objective: Our goal was to determine the in vitro susceptibility of Ureaplasma urealyticum and Mycoplasma hominis isolates to several antibiotics in Argentina.

Methods: Ninety‐four strains of U. urealyticum and 18 strains of M. hominis isolated from cervical and urethral specimens were studied. Broth microdilution and agar dilution tests for minocycline, tetracycline, erythromycin, ciprofloxacin, and ofloxacin were performed.

Results: Both methods proved to be reliable and reproducible for U. urealyticum and M. hominis, with no major differences in results. The U. urealyticurn strains were inhibited by erythromycin at MICs ranging from ≤0.5 to >8 μ/ml. Ofloxacin showed the highest activity against this latter organism. No differences between tetracycline and minocycline MICs were observed with U. urealyticum. Two M. hominis strains displaying high MICs both to tetracycline and to minocycline were detected.

Conclusions: The emerging resistance of mycoplasmas to certain antibiotics emphasizes the need to undertake further surveillance studies on the clinical isolates of such organisms.
Randomized Trial of Erythromycin and Azithromycin for Treatment of Chlamydial Infection in Pregnancy
Authors: Rosenn Marc F. , Macones George A. , Silverman Neil S.
Published: March 2007

Objective: The purpose of this study was to compare erythromycin and azithromycin in the treatment
of chlamydial cervicitis during pregnancy with regard to efficacy, side effects, and compliance.

Methods: In a prospective manner, 48 pregnant patients with cervical chlamydial infections diagnosed by routine screening tests were randomly assigned to receive either erythromycin, 500 mg q.i.d. for 7 days (N = 24), or azithromycin, 1 g as a one‐time dose (N = 24). All sexual partners were given prescriptions for doxycycline, 100 mg b.i.d. for 7 days. The treatment efficacy was assessed by follow‐up chlamydia testing 3 weeks after the therapy was completed. The side effects, intolerance to therapy, and overall compliance were evaluated by means of a standardized posttreatment questionnaire.

Results: There was no significant difference in cure rates noted between the erythromycin group and the azithromycin group (77% vs. 91%, respectively; P = 0.24). Gastrointestinal side effects were reported more frequently among patients treated with erythromycin compared with patients treated with azithromycin (45% vs. 17%, respectively; P = 0.004). The patients who received erythromycin reported intolerance to therapy secondary to side effects more frequently than patients who received azithromycin (23% vs. 4%, respectively; P = 0.07). Furthermore, the patients in the azithromycin group were more likely to complete their course of therapy as prescribed than the patients in the erythromycin group (100% vs. 61%, respectively; P = 0.002).

Conclusions: Azithromycin is efficacious and well tolerated for the treatment of chlamydial cervicitis in pregnancy. Erythromycin, though efficacious, is poorly tolerated, as demonstrated by the number of patients reporting significant side effects during the course of therapy. Since the cost of azithromycin is comparable to that of generic erythromycin, the present study supports the use of azithromycin as an alternative to erythromycin for the treatment of chlamydial cervicitis in pregnancy.
Filariasis of the Breast in a Pregnant Woman Diagnosed by Fine‐needle Aspiration Cytology: A Case Report
Authors: Lau Melanie , Tauchi Pamela , Kim Milton , Liu Francis , Namiki Thomas
Published: March 2007

Background: Despite increased immigration to the United States from endemic areas, the diagnosis
of microfilariasis in this country remains infrequent. This disease may occasionally present as a breast mass, in the absence of other clinical findings.

Case: We report an unusual case of Wuchereria bancrofti diagnosed in a pregnant woman by breast fine‐needle aspiration (FNA) and discuss the clinical implications of filariasis in pregnancy.

Conclusion: FNA is safe and reliable in pregnancy. Infants of mothers with breast filariasis should be monitored.
Hepatitis C Virus in Pregnancy: Case Reports and Literature Review
Authors: Joffe Gary M.
Published: March 2007

Background: Hepatitis C virus (HCV) is now recognized as the cause of 90% of non‐A, non‐B (NANB) hepatitis. This virus is responsible for a large percentage of chronic persistent and chronic active hepatitis in the United States. Parenteral and sexual transmission are well described, so a significant population of pregnant patients is at risk. Vertical transmission of the virus to the fetus is dependent upon the level of maternal viremia.

Case: The cases described in the following report demonstrate that fulminant disease may present in pregnancy. They also demonstrate the cofactors promoting the severity of illness, methods of diagnosis, potential treatment, and outcome of the infection.

Conclusion: HCV may be encountered in pregnancy. Although most acute‐phase illness will be self limiting, some patients will manifest liver failure during gestation. Because vertical transmission to the fetus is possible, the pediatrician should be informed of the maternal disease. Chronic hepatitis is almost the rule rather than the exception, so patients require close postpartum follow‐up. Interferon, which may alter the course of the chronic disease, has been used on rare occasions in pregnancy.
Lyme Disease and Pregnancy
Authors: Alexander James M. , Cox Susan M.
Published: March 2007

Lyme disease is the most commonly transmitted vector‐borne disease in the United States, with many regions of the country at risk. Like other spirochete‐borne infections, Lyme disease progresses in stages, making diagnosis in the early stages of the illness and prompt treatment important for cure. An early diagnosis is made difficult by the less‐than‐ideal serologic tests and the varied clinical presentations of the disease. Although Lyme disease has been reported in pregnancy, the transmission rate to the fetus and potential harmful effects are largely unknown. This review discusses the diagnosis, clinical course, and treatment of Lyme disease with an emphasis on the pregnant patient.
Randomized Clinical Trial of Intrapartum Clindamycin Cream for Reduction of Group B Streptococcal Maternal and Neonatal Colonization
Authors: Gibbs R. S. , McNabb F.
Published: March 2007

Objective: In a randomized trial, we sought to determine whether 2% clindamycin cream administered
intravaginally during labor to group B streptococcal‐colonized pregnant women without risk
factors would decrease maternal and neonatal colonization.

Methods: The eligible women were randomized to receive either cream or no treatment. Two
hours after treatment or admission, the patients were tested with rectal and vaginal cultures. The
neonates of the study patients were also tested.

Results: Of women randomized to cream, 5 of 5 remained positive and 2 (33%) of their 6 neonates
were positive. Of 4 randomized to no treatment, 3 (75%) remained positive and 1 (25%) of 4 neonates
was positive.

Conclusions: Intravaginal 2% clindamycin cream was ineffective in reducing colonization with
group B streptococci.
Intraperitoneal Enterobius vermicularis Infection: A Case Report
Authors: Gazvani Mehmet R. , Emery Simon J.
Published: March 2007

Background: Enterobius vermicularis in an ectopic location usually represents an incidental finding
in tissue specimens in a patient without symptoms. However, the parasite can lead to inflammation
and symptoms in rare cases.

Case: A 36‐year‐old woman had an abdominal hysterectomy for menorrhagia, dyspareunia, and
lower abdominal pain. Two small nodules from the posterior aspect of the left broad ligament as
well as the uterus were sent for histologic examination. The pathologic findings confirmed the
diagnosis of “granulomatous peritoneal nodules due to E. vermicularis.” Within the nodules were aggregates of ova of E. vermicularis.

Conclusion: This case reminds us that such granulomatous lesions can simulate leiomyoma,
fibroma, endometrioma, and tuberculous or malignant lesions. It is important to be aware of this
resemblance to avoid unnecessary surgical intervention.
Ampicillin Vs. Penicillin for In Utero Therapy
Authors: Glover Douglas D. , Lalka David , Monif Gilles R. G.
Published: March 2007

The pharmacokinetics of penicillin G and ampicillin are reviewed as they pertain to their potential
use in in vitro therapy.
Tubo‐Ovarian Abscess Formation in Users of Intrauterine Devices Remote From Insertion: A Report of Three Cases
Authors: Toglia Marc R. , Schaffer Joseph I.
Published: March 2007

Background: The association between tubo‐ovarian abscess formation and the presence of an intrauterine
device (IUD) is well recognized. It has been suggested that the risk of upper‐genital‐tract
infection is highest during the immediate period following the insertion of an IUD, returning to
baseline by 5 months postinsertion. We present 3 cases of women who, 10–21 years after insertion of
their IUDs, developed tubo‐ovarian abscesses that were not causally related to sexually transmitted
diseases (STDs) or actinomycetes.

Cases: Three women, ages 39–47 years, presented to our gynecology service for evaluation of
abdominal pain. One woman had bilateral tubo‐ovarian abscesses and the other 2 had unilateral
tubo‐ovarian abscesses. All 3 were IUD users, with an interval from IUD insertion to presentation
of 10–21 years. In each case, the cervical cultures for gonorrhea and chlamydia were negative at
presentation and the sexual history was not consistent with an STD mode of spread. All 3 women
initially received broad‐spectrum antibiotics, but 2 eventually required definitive surgical therapy.

Conclusion: Long‐term users of IUDs remain at risk for serious, indolent pelvic infections. These
women should be counseled by their gynecologists on an ongoing basis as to this persistent risk.
Tubo‐ovarian abscess should be strongly considered in the differential diagnosis of an IUD user
who presents with an adnexal mass, fever, or abdominal pain.
Treatment of Sporadic Acute Puerperal Mastitis
Authors: Hager W. David , Barton John R.
Published: March 2007

Objective: The purposes of this study were to compare the efficacy of amoxicillin and cephradine for the
treatment of sporadic acute puerperal mastitis (SAPM) and to evaluate the microbiology and clinical
parameters of this infection.

Methods: We conducted a prospective, randomized, single‐blinded study comparing amoxicillin, 500 mg
orally q 8 h for 7 days, and cephradine, 500 mg orally q 6 h for 7 days. The diagnostic criteria for SAPM
included a temperature of ≥37.56℃ (≥99.6℉) and erythema and tenderness of the breast(s).

Results: Twenty‐seven consecutive outpatients with SAPM were evaluated for admission to the study,
and 25 of these were enrolled. The mean temperature at enrollment was 38.17℃ (100.7℉), with a mean
WBC count of 11,440/μl. The most frequent bacterial isolates from expressed milk were
Staphylococcus aureus (7), staphylococcal species (coagulase negative) (8), and α‐hemolytic streptococci (4). There were
no significant differences between the 2 antibiotic regimens in cure rate, mean days to resolution of
symptoms, or recurrence within 30 days. Both of the treatment failures and 1 of the 3 recurrences within
30 days were amoxicillin‐treated patients whose cultures grew S. aureus.

Conclusions: Oral amoxicillin and cephradine appear equally effective in the treatment of SAPM. Staphylococci
were the most frequent isolates from the milk of women with mastitis.
Immune Protection Against Chlamydia trachomatis in Females
Authors: Morrison Richard P.
Published: March 2007

Despite significant advances in our understanding of the biology and antigenic structure of
Chlamydia trachomatis, and the epidemiology and clinical spectrum of chlamydial disease, the magnitude of
morbidity from human chlamydial infections remains an important public health concern. Control
of chlamydial disease will likely depend on a multidisciplinary approach, including the development
of immunoprophylactic or immunotherapeutic strategies. Reasonable progress has been made in
understanding specific immune mechanisms that contribute to host immunity in experimental models
of chlamydial infection. However, studies of human immunity have not been so successful. This
is particularly evident in that studies to address the development and role of mucosal immune
responses to urogenital chlamydial infections have not been forthcoming. The following review is
a brief summary of our current knowledge of protective immunity to chlamydial urogenital infections
of females. It is not meant to be exhaustive, but instead to touch upon aspects of protective immunity
that have been described in both human and experimental animal models of chlamydial
infection.
Azithromycin (Zithromax ®)
Authors: McCarty James M.
Published: March 2007

Azithromycin (Zithromax ®, Pfizer, Inc., New York, NY) is a 15‐membered‐ring macrolide and
the first azalide antibiotic. It is distinguished from other macrolides by its rapid and extensive
penetration into intracellular and interstitial tissue compartments, accompanied by prolonged
tissue and serum half‐lives. Azithromycin shares the gram‐positive activity of erythromycin but
is more potent against gram‐negative organisms. For urethritis and cervicitis caused by
Chlamydia trachomatis, azithromycin is effective and well tolerated in a single dose of 1 g, a regimen
recommended by the CDC. A 5‐day dosage regimen is available for the treatment of community‐acquired
respiratory‐tract and skin and skin‐structure infections caused by susceptible organisms.
Azithromycin provides short‐duration, high‐compliance, cost‐effective regimens that should improve
outcomes.
Impact of Anaerobic Growth Conditions on Toxic Shock Syndrome Toxin‐I Production by Staphylococcus aureus
Authors: Lungren Max , Chaisilwattana Pongsakdi , Knoop Floyd C. , Monif Gilles R. G.
Published: March 2007

Objective: The impact of anaerobic growth conditions on the Staphylococcus aureus toxic shock syndrome
toxin‐1 (TSST‐1) production was studied.

Methods: Ten strains of S. aureus derived from patients with toxic shock syndrome (TSS), 10
isolates of S. aureus, and documented TSST‐1‐producing strains recovered from patients with either
staphylococcal septicemia or staphylococcal nongenital abscesses were grown under aerobic and
anaerobic conditions. The bacterial growth was measured using optical density (OD) determinations
at 520 nm. The toxin production was assayed using the TS‐RPLA latex agglutination test.

Results: Both TSS and non‐TSS strains of S. aureus grown under aerobic and anaerobic conditions
exhibited comparable OD patterns of growth, and the levels of toxin production remained constant
during the logarithmic phase. Toxin titers developed during the logarithmic growth phase and
peaked after 24 h of incubation. When stationary‐phase isolates grown initially under aerobic
conditions were subjected to strict anaerobic conditions, subsequent toxin titers, compared with
isolates grown in the continued presence of oxygen, were depressed 2‐fold, peaking at a later time.

Conclusions: TSST‐1 production is diminished under continued anaerobic conditions.
Intra‐amniotic Infection Caused by Capnocytophaga Species
Authors: Mikamo Hiroshige , Kawazoe Kyoko , Sato Yasumasa , Izumi Koji , Tamaya Teruhiko
Published: March 2007

Background: Capnocytophaga species are common oral pathogens and infrequent causes of systemic
infection in patients with compromised host. The isolation of this organism suggests an oral source
of infection.

Case: A 32‐year‐old woman was admitted at 23 weeks gestation in preterm premature rupture
of the membranes. She subsequently developed signs of clinical intra‐amniotic infection, including
fever, fetal tachycardia, and uterine tenderness. Bacteriologic studies of the amniotic fluid by trans‐abdominal
amniocentesis and subchorionic placental cultures yielded Capnocytophaga species. On
review of the patient′s history, a temporal relation was noted between orogenital contact and onset
of clinical infection. Thorough evaluation of the patient, including dental examination with periodontal
cultures, did not reveal an obvious source of infection. However, significant periodontal
disease was identified in her partner and Capnocytophaga species were isolated from her partner.

Conclusion: This case suggests that intra‐amniotic infection may have been due to an ascending
infection after orogenital contact.
Effect of Butoconazole Nitrate 2% Vaginal Cream and Miconazole Nitrate 2% Vaginal Cream Treatments in Patients with Vulvovaginal Candidiasis
Authors: Lappin Myra A. , Brooker Doris C. , Francisco Carol A. , Dorfman Joan
Published: March 2007

In a multicenter, randomized, invesgtigator‐blind, parallel study, 398 patients were dispensed topical
butoconazole nitrate 2% cream for 3 days (n = 199) or miconazole nitrate 2% cream for 7 days (n =
199) for vaginal use. Efficacy analyses included 254 patients with culture‐confirmed Candida (119
butoconazole and 135 miconazole users). Of the 398 patients issued study medication, 9 were lost
to follow‐up. Therefore, safety analyses included 389 patients (197 butoconazole and 192 miconazole
users). Evaluations upon admission and approximately 8 and 30 days post‐treatment included
Candida cultures, potassium hydroxide (KOH) wet mounts, and vulvovaginal examinations, with
rating of vulvovaginal signs and symptoms using a 4‐point scale. Rates of clinical cure (based on
sign/symptom scores), microbiologic cure (based on cultures and wet mounts), and therapeutic cure
(both clinical and microbiologic cures) were assessed and were to be similar between the regimens.
Therapeutic cure rates were 57.8% and 61.4% for butoconazole and miconazole, respectively.
Three‐day butoconazole treatment was as safe and effective as 7‐day miconazole therapy in treating
vulvovaginal candidiasis.
Double‐Blind Placebo‐Controlled Treatment Trial of Chlamydia trachomatis Endocervical Infections in Pregnant Women
Authors: Martin David H. , Eschenbach David A. , Cotch Mary Frances , Nugent Robert P. , Rao A. Vijaya , Klebanoff Mark A. , Lou Yu , Rettig Philip J. , Gibbs Ronald S. , Pastorek Joseph G. , Regan Joan A. , Kaslow Richard A.
Published: March 2007

Objective: The purpose of this study was to determine if treatment of pregnant women with Chlamydia trachomatis infection would lower the incidence of preterm delivery and/or low birth weight.

Methods: Pregnant women between the 23rd and 29th weeks of gestation were randomized in double‐blind fashion to receive either erythromycin 333 mg three times daily or an identical placebo. The trial continued until the end of the 35th week of gestation.

Results: When the results were examined without regard to study site, erythromycin had little impact on reducing low birth weight (8% vs. 11%, P = 0.4) or preterm delivery (13% vs. 15%, P = 0.7). At the sites with high persistence of C. trachomatis in the placebo‐treated women, low birth weight infants occurred in 9 (8%) of 114 erythromycin‐treated and 18 (17%) of 105 placebo‐treated women (P = 0.04) and delivery <37 weeks occurred in 15 (13%) of 115 erythromycin‐treated and 18 (17%) of 105 placebo‐treated women (P = 0.4).

Conclusions: The results of this trial suggest that the risk of low birth weight can be decreased by giving erythromycin to some women with C. trachomatis. Due to the high clearance rate of C. trachomatis in the placebo group, these data do not provide unequivocal evidence that erythromycin use in all C. trachomatis‐infected women prevents low birth weight.
Evaluation of 3‐Day Course of Doxycycline for the Treatment of Uncomplicated Chlamydia trachomatis Cervicitis
Authors: Reedy Mark B. , Sulak Patricia J. , Miller Sally L. , Ortiz Miriam , Kasberg-Preece Cheryl , Kuehl Thomas J.
Published: March 2007

Objective: The purpose of this study was to compare the efficacy of a 3‐day course of doxycycline to a standard 7‐day course for treating uncomplicated chlamydia cervicitis.

Methods: During an 18‐month period, 77 women with uncomplicated chlamydia cervicitis were randomized to receive either a 3‐day or a 7‐day course of doxycycline (100 mg twice daily). Tests of cure were performed 3 weeks after completion of therapy with the Amplicor polymerase chain reaction (PCR) assay (Roche Molecular Systems, Branchburg, NJ). Demographics, therapeutic results, and side effects for the two groups were compared.

Results: Seventy‐three patients completed the study: 35 in the 3‐day group and 38 in the 7‐day group. There were no significant differences in age, gravidity, or parity between the groups. There was a 94% (33/35) cure rate in the 3‐day group and a 95% (36/38) cure rate in the 7‐day group (P = 1.0). Thirty‐four percent and 32% of the patients in the 3‐ and 7‐day groups reported side effects, respectively; there was no significant differences between the 3‐ and 7‐day groups in regard to population demographics, patient compliance, therapeutic outcome, or side effects.

Conclusions: A 3‐day course of doxycycline appears to be as effective as a 7‐day course of doxycycline for the treatment of uncomplicated chlamydia cervicitis.
Phage Infection in Vaginal Lactobacilli: An In Vitro Study
Authors: Pavlova Sylvia I. , Kiliç Ali O. , Mou Susan M. , Tao Lin
Published: March 2007

Objective: During bacterial vaginosis, an unexplained decrease of vaginal lactobacilli occurs. To identify whether these lactobacilli could be infected by phages, we isolated phages from vaginal lactobacilli and analyzed their potential virulence in attacking vaginal lactobacilli in vitro.

Methods: Vaginal samples were obtained from 39 reproductive‐aged women. The selective Rogosa SL agar was used to isolate lactobacilli, from which phages induced by mitomycin C or released spontaneoulsy were analyzed by the agar spot method.

Results: Of 20 samples from women with vaginal infections, 12 did not have lactobacilli. From the remaining 8 infection samples and the 19 samples from healthy women, 37 Lactobacillus strains were isolated, from which 7 temperate phages were identified. Upon analysis, all 7 phages infected vaginal lactobacilli from the same and/or different women in vitro. Two phages, Φkc005 and Φkc007, had a broad host range, infecting 7 of 8 species tested. A control intestinal Lactobacillus phage also lysed several vaginal strains. One vaginal phage, Φkc039, was apparently lytic against vaginal lactobacilli from 7 other women. This phage was characterized as follows: plaque morphology, small and clear; burst size, 300 phages per cell; spontaneous induction rate, 1 per 106 cells; DNA, double‐stranded and linear, 41 kb; and shape, a hexogonal head and a non‐contractile tail.

Conclusions: Bacteriophages were isolated from vaginal lactobacilli of some women and were shown in vitro to lyse vaginal Lactobacillus strains from the same and/or different women. It was suggested that vaginal lactobacilli might be suppressed by phages.
Chlamydia trachomatisInfection, Immunity, and Pregnancy Outcome
Authors: Witkin S. S. , Neuer A. , Giraldo P. , Jeremias J. , Tolbert V. , Korneeva I. L. , Kneissl D. , Bongiovanni A. M.
Published: March 2007

Chlamydia trachomatiscan ascend from the cervix to the fallopian tubes and survive for long periods of time without causing symptoms. The immune response to infection clears the extracellular organisms but leads to development of a persistent intracellular infection. Repeated cycles of productive infection and persistence eventually induce tubal occlusion and infertility. Persistently infected cells continue to synthesize the chlamydial 60 kD heat shock protein (hsp60). Immunity to conserved regions of hsp60 may result in autoimmunity to human hsp60. Expression of hsp60 by the embryo and decidua during early pregnancy may reactivate hsp60-sensitized lymphocytes, disturb pregnancy-induced immune regulatory mechanisms, and lead to immune rejection of the embryo. Due to this mechanism women with tubal infertility who are sensitized to the human hsp60 may have a decreased probability of successful outcome after undergoing in vitro fertilization and embryo transfer.
Biochemical Markers Predictive of Preterm Delivery
Authors: Inglis Steven R.
Published: March 2007

Preterm delivery is the leading cause of perinatal morbidity and mortality worldwide. Despite a great deal of research into this disease, we still do not understand its pathophysiology. Our treatments for this disease are only marginally effective. Biochemical markers were developed with the hope of giving us new tools to prevent preterm deliveries. Specifically the hope was that they could predict which patients were destined to have a preterm delivery. At the present time these markers perform only satisfactorily at predicting preterm labor. They are expensive and not convenient to use at present. Perhaps more importantly, though, these markers have given us insight into the complexities of preterm delivery. Preterm delivery can arise from many different etiologies. This will lead to research into new treatments as knowledge about preterm delivery is amassed. We know that any number of pathological processes may be involved in any given patient with preterm labor. Biochemical markers have the distinct advantage of being able to determine the specific pathophysiology in a given patient and may allow us to tailor therapy according to the specific problem. In the future it is likely that a careful search for specific pathophysiology will be the only way we can treat this disease effectively. For the present time the biochemical markers will be used only to predict preterm delivery. Ultrasound measurements of the cervix during the pregnancy are likely a faster and less expensive way to accomplish that goal.
Cell Damage at the Origin of Antiphospholipid Antibodies and Their Pathogenic Potential in Recurrent Pregnancy Loss
Authors: Piroux Véronique , Eschwège Valérie , Freyssinet Jean-Marie
Published: March 2007

Antiphospholipid antibodies (APA) are associated with thrombosis, thrombocytopenia and fetal loss but they occur in a variety of diseases. Despite many efforts, a correlation between the specificity of particular subgroups of APA and particular clinical situations remains to be established. The antigens at the origin of APA remain to be identified. We discuss here the possible links between cell apoptosis or necrosis, leading to plasma membrane alterations, and the occurrence of APA in response to sustained stimulation. The pathogenic potential of APA is also considered with respect to recurrent pregnancy loss.
Open Study of the Safety and Efficacy of a Single Oral Dose of Cefixime for the Treatment ofGonorrhea in Pregnancy
Authors: Miller Joseph M.
Published: March 2007

Objective: The intent of this study was to determine the efficacy and tolerance of single dose oral cefixime use in the treatment of pregnant women with endocervical gonococcal carriage.

Methods: A retrospective review of clinic records over a 3 year period identified patients treated with a single 400 mg dose of cefixime for gonorrhea during pregnancy. Side effects and subsequent gonococcal carriage were noted.

Results: Pregnant women (n = 102) treated with cefixime were reviewed. A cure rate of 95.2% was found. Side effects were reported in three patients: two had nausea and vomiting and one had diarrhea.

Conclusions: A single 400 mg oral dose of cefixime was effective for the treatment of gonorrhea and was well tolerated by the pregnant women.
Ultrasound Characteristics of In Utero Infection
Authors: Puder Karoline S. , Treadwell Marjorie C. , Gonik Bernard
Published: March 2007

In utero infection of the fetus has become recognized as an important cause of fetal and neonatal morbidity and mortality. Since both anatomic and functional abnormalities have been described in the fetus related to various infections, ultrasonography may be a valuable diagnostic tool in this regard. A complete review of the current literature was undertaken to report available information on this topic. Common pathogens or clinical conditions were selected. The identified data were confounded by the way in which each case originally presented for study. Although certain anomalies were frequently associated with individual organisms, their incidence could not be determined, nor were most specific to that infectious agent. Representative ultrasound images are presented for common and unusual cases.
Double‐Blind, Multicenter, Prospective Randomized Study of Trospectomycin Vs. Clindamycin, Both With Aztreonam, in Non‐Community Acquired Obstetric and Gynecologic Infections
Authors: Chatwani Ashwin , Martens Mark , Blanco Jorge , Gall Stanley , Przybylko Kira , Wajszczuk Charles P. , Nickens Dana
Published: March 2007

Objective: The purpose of this study was to compare the clinical efficacy and safety of trospectomycin sulfate with that of clindamycin phosphate, both with aztreonam, for the treatment of obstetric and gynecologic infections.

Methods: In a double‐blind, multicenter, prospective randomized study, 579 patients with either endometritis following cesarean delivery or pelvic cellulitis following hysterectomy were enrolled and received medication. Administered was either trospectomycin sulfate 500 mg IV every 8 h or clindamycin phosphate 900 mg IV every 8 h in a 1:1 randomization ratio. Both groups of patients received aztreonam 1 g IV every 8 h. The patients were followed for clinical responses and side effects.

Results: The cure rate for the trospectomycin sulfate arm was 91.8% and for clindamycin phosphate arm it was 88.4% (P = 0.218). The adverse events were similar in both groups.

Conclusions: Trospectomycin was as effective as clindamycin, when both were combined with aztreonam, in treatment of obstetric and gynecologic infections.
Maternal Death From Postpartum Necrotizing Fasciitis Arising in an Episiotomy: A Case Report
Authors: Lynch Catherine M. , Pinelli Donna M. , Cruse C. Wayne , Spellacy William N. , Sinnott John T. , Shashy Ron G.
Published: March 2007

Background: Necrotizing fasciitis is a rare condition. We report a fatal case arising from an episiotomy in a previously healthy woman.

Case: A healthy 23‐year‐old prima gravida white female underwent vaginal delivery with repair of a proctoepisiotomy. Eighty‐four hours postpartum, she developed increasing perineal swelling with severe pain. She presented on the 4th postpartum day with edema, erythema localized to the perineum, and vital signs significant only for tachycardia of 120/min. With a leukocytosis of 45,000/μl (87%) neutrophils, she was admitted to the hospital with an initial diagnosis of perineal cellulitis and empirically started on broad‐spectrum intravenous antibiotic therapy. The patient′s condition continued to deteriorate and she was then transferred to our facility on postpartum day 9 where a team performed two radical debridements of all necrotic tissue. Despite this and a broadened antibiotic coverage, the patient eventually experienced cardiopulmonary arrest and died on postpartum day 12.

Conclusion: Necrotizing fasciitis must be considered in the differential diagnosis of the postpartum patient presenting with severe vulvar pain and erythema. Our patient exemplifies the obscure presentation with seemingly minimal skin changes. Any delay in diagnosis and treatment, which must include expeditious aggressive surgical debridement, will likely result in severe morbidity or mortality.
Detection of Antibodies to Chlamydia trachomatis With Peptide‐Based Species‐SpecificEnzyme Immunoassay
Authors: Närvänen Ale , Puolakkainen Mirja , Hao Wu , Kino Kohsuke , Suni Jukka
Published: March 2007

Objective: We have evaluated the sensitivity and specificity of a new synthetic peptide‐based species‐specific enzyme immunoassay (EIA) for detection of Chlamydia trachomatis IgG and IgA antibodies.

Methods: Synthetic peptides derived from variable domain IV of major outer membrane protein (MOMP) were used as antigen in indirect EIA. IgG and IgA antibodies were measured in parallel with serum samples from C. trachomatis culture positive, culture negative, and antigen positive patients, and women with suspected C. trachomatis infection and blood donors. Sera from children under 15 years of age were used as controls.

Results: Culture positive women, culture positive men, and antigen positive women had positive peptide serology in 84.2%, 61.3%, and 93.1% of the cases, respectively. Among C. trachomatis suspected women, the antibody prevalence was 63.6%. Randomly collected blood donors showed a prevalence of 21.5%. Children with C. pneumoniae antibodies determined with the microimmuno‐fluorescence (MIF) method did not show any reactivity in the C. trachomatis peptide EIA.

Conclusions: The results suggest that the new EIA test is highly specific for C. trachomatis, and C. pneumoniae antibodies do not interfere. Both IgG and IgA antibodies appear within at least 2 weeks in acute phase of infection among both culture positive and culture negative patients.
Evaluation of Specific Symptoms of Bacterial Vaginosis Among Pregnant Women
Authors: Boris J. , Henriksen T. B. , Davidsen U. , Secher N. J.
Published: March 2007

Objective: Identification of the symptoms of bacterial vaginosis (BV) in pregnancy might be rational in order to identify a possible BV‐associated group at risk of preterm delivery.

Methods: Three hundred and five women early in the third trimester of pregnancy were interviewed about lifestyle factors and specific symptoms of BV and given a vaginal examination. A longitudinal three‐week follow‐up was conducted for 127 women.

Results: The prevalence of BV was 16%. Women with BV were significantly more often smokers than women without BV (52% vs. 34%). No difference in sexual activity or other behavioral characteristics between the two groups were seen. No differences were noted among women with and without BV according to specific symptoms: malodorous discharge (26% vs. 23%), increased discharge (76% vs. 68%), or itching or troublesome discharge. More than one third of women with BV at the first examination did not fulfill the criteria for BV at the three week follow‐up exam. None of the women without BV had developed BV by the follow‐up exam. The incidence of preterm delivery among women with BV was 4%, women without BV had an incidence of 2.4%. This difference was not statistically significant.

Conclusion: Asymptomatic BV in pregnancy is common. Specific questions about the character of the discharge do not identify women with BV during pregnancy. To identify a potential BV‐associated group at risk for preterm delivery, screening for BV must be conducted not only among symptomatic women but among all women. Women with BV are more often smokers than women without BV.
Grepafloxacin Versus Cefixime as Single‐Dose Therapy for Uncomplicated Gonorrhea in Women
Authors: Mroczkowski T. F. , Hook E. W. , Jones R. B. , McCormack W. M. , Martin D. H.
Published: March 2007

Objective: To compare the efficacy and tolerance of single‐dose grepafloxacin with cefixime for treatment of uncomplicated gonorrhea in women.

Methods: Women attending nine sexually‐transmitted‐disease clinics in the United States who had suspected uncomplicated gonorrhea were enrolled in an open study. Participants were randomized to receive single oral doses of grepafloxacin (400 mg) or cefixime (400 mg), and efficacy was evaluated in those who returned for follow‐up assessment 5 to 10 days later. The primary measure of efficacy was microbiological response to therapy as determined by pre‐ and posttreatment culture results for Neisseria gonorrhoeae.

Results: Of 380 patients enrolled, 124 in the grepafloxacin group and 131 in the cefixime group were evaluated for microbiological response. Cervical gonococcal infections were eradicated in 99% of patients in both treatment groups, with only one persistent infection in each group. All pharyngeal (n = 15) and rectal (n = 32) gonococcal infections treated with grepafloxacin were cured, whereas 5 of 16 (31%) pharyngeal and 1 of 38 (3%) rectal infections failed to respond to cefixime. Although a third (123 of 386) of N. gonorrhoeae pretreatment isolates were resistant to penicillin or tetracycline, this had no impact on cure rates. Both drugs were well tolerated, with vaginitis being the most common treatment‐related adverse event in each group.

Conclusions: This study shows that single‐dose grepafloxacin is at least as effective as cefixime for treating women with uncomplicated cervical gonorrhea. Grepafloxacin also appears to be highly effective against extragenital infections.
Expanding Disease Spectrum Associated With Puerperal Mastitis
Authors: McAdoo Gregg L. , Monif Gilles R. G.
Published: March 2007

Background: Staphylococcus aureus and the β‐hemolytic streptococci are the commonest causes of puerperal mastitis which tends to be a localized disease process. This report describes 2 cases attributable to these bacteria that resulted in extramammary involvement and augmented morbidity.

Cases: Two cases of postpartum mastitis are described, one leading to necrotizing fasciitis caused by group A streptococci and the other leading to toxic shock syndrome (TSS) caused by S. aureus.

Conclusion: The spectrum of disease commonly attributed to mastitis occurring in this setting should be expanded.