bluuebunny/crossref_metadata_2025 huggingface dataset:
Human Papillomavirus Typing in HIV‐Positive Women
Authors: Hameed Meera , Fernandes Helen , Skurnick Joan , Moore Dorothy , Kloser Patricia , Heller Debra
Published: March 2007

Objective: Human papillomavirus (HPV) is the major cause of cervical carcinoma and cervical intraepithelial neoplasia worldwide. Certain HPV types have a strong association with and probably a causative role in the
pathogenesis of premalignant cervical lesions. Epidemiologic studies in women infected by the human immunodeficiency
virus (HIV) have shown an increased incidence of squamous intraepithelial lesions (SILs), whichwere predominantly
high‐grade. Six to 30 per cent of women diagnosed with atypical squamous cells of undetermined
significance (ASCUS) on a Papanicolaou (Pap) smear harbor SIL in normal screening populations. This study was
undertaken to determine the presence of low‐ and high‐risk HPV types in women infected by HIV and to correlate
the results to those of the Pap smear.

Study design: HPV DNA typing (low‐ and high‐risk) by Digene™ (Digene Corporation, Gathesburg, MD) hybrid capture methodology was performed on cervical swabs from 209 HIV‐positive women. The results of HPV typing
were correlated with those of the Pap smear in a retrospective analysis.

Results: One hundred and one women (48%) tested positive for HPV subtypes by DNA typing by the hybrid capture method. Of these, 64 patients (63%) had Pap smears whichwere read as being normal, having benign cellular
changes, or having ASCUS (favor reactive process). Of these, 19 patients tested positive for both high‐risk and
low‐risk subtypes, 32 patients tested positive only for high‐risk subtypes, and 13 patients tested positive only for
low‐risk subtypes.

Conclusion: HPV subtyping identifies a significant group of HIV‐positive women who are at risk for developing cervical intraepithelial neoplasia, although they may not show significant abnormalities on their Pap smears.
Production of Interferons and ß‐Chemokines by Placental Trophoblasts of HIV‐1‐Infected Women
Authors: Lee Bang-Ning , Hammill Hunter , Popek Edwina J. , Cron Stanley , Kozinetz Claudia , Paul Mary , Shearer William T. , Reuben James M.
Published: March 2007

Objective: The mechanism whereby the placental cells of a human immunodeficiency virus (HIV)‐1‐infected mother protect the fetus from HIV‐1 infection is unclear. Interferons (IFNs) inhibit the replication of viruses by
acting at various stages of the life cycle and may play a role in protecting against vertical transmission of HIV‐1. In
addition the ß‐chemokines RANTES (regulated on activation T cell expressed and secreted), macrophage inflammatory
protein‐1‐a (MIP‐1a), and MIP‐1ß can block HIV‐1 entry into cells by preventing the binding of the
macrophage‐trophic HIV‐1 strains to the coreceptorCCR5. In this study the production of IFNs and ß‐chemokines
by placental trophoblasts of HIV‐1‐infected women who were HIV‐1 non‐transmitters was examined.

Methods: Placental trophoblastic cells were isolated from 29 HIV‐1‐infected and 10 control subjects. Supernatants
of trophoblast cultures were tested for the production of IFNs and ß‐chemokines by enzyme
linked immunosorbent assay (ELISA). Additionally, HIV‐1‐gag and IFN‐ß transcripts were determined by a
semi‐quantitative reverse transcription polymerase chain reaction (RT‐PCR) assay.

Results: All placental trophoblasts of HIV‐1‐infected women contained HIV‐1‐gag transcripts. There were no
statistical differences in the median constitutive levels of IFN‐a and IFN‐? produced by trophoblasts of HIV‐1‐
infected and control subjects. In contrast, trophoblasts of HIV‐1‐infected women constitutively produced significantly
higher levels of IFN‐ß protein than trophoblasts of control subjects. Furthermore, the median levels of
ß‐chemokines produced by trophoblasts of HIV‐infected and control women were similar.

Conclusions: Since there was no correlation between the placental HIV load and the production of interferons or
ß‐chemokines, the role of trophoblast‐derived IFNs and ß‐chemokines in protecting the fetus from infection with
HIV‐1 is not clear.
The Classic Approach to Diagnosis of Vulvovaginitis: A Critical Analysis
Authors: Bornstein Jacob , Lakovsky Yaniv , Lavi Idit , Bar-Am Amiram , Abramovici Haim
Published: March 2007

Objective: To correlate the symptoms, signs and clinical diagnosis in women with vaginal discharge, based on the combined weight of the character of the vaginal discharge and bedside tests, with the laboratory diagnosis.

Methods: Women presenting consecutively to the women′s health center with vaginal discharge were interviewed and examined for assessment of the quantity and color of the discharge. One drop of the material was then examined for pH and the whiff test was done; a wet mount in saline and in 10% KOH was examined microscopically. The clinical diagnosis was based on the results of these assessments. Gram stain and cultures of the discharge were sent to the microbiology laboratory.

Results: One hundred and fifty‐threewomen with vaginal discharge with a clinical diagnosis of vulvovaginitis participated in the study. Fifty‐five (35.9%) had normal flora and the other 98 (64.1%) had true infectious vulvovaginitis (k agreement = 18%). According to the laboratory, the principal infectious micro‐organism causing the vulvovaginitis was Candida species. Candida infection was associated with pH levels of less than 4.5 (p < 0.0001, odds ratio = 4.74, 95% confidence interval: 2.35–9.5, positive predictive value 68.4%). The whiff test was positive in only a small percentage of bacterial vaginosis (BV) (p = not significant (NS)). Clue cells were documented in 53.3% of patients with a laboratory diagnosis of BV (p < 0.02, positive predictive value 26.7%).

Conclusions: The current approach to the diagnosis of vulvovaginitis should be further studied. The classical and time‐consuming assessments were shown not to be reliable diagnostic measures.
Differences in Innate Immunologic Response to Group BStreptococcus Between Colonized and Noncolonized Women
Authors: Smith Jennifer M. , Respess Rachel H. , Chaffin David G. , Larsen Bryan , Jackman Susan H.
Published: March 2007

Objective: To evaluate the functional capacity of granulocytes and monocytes from pregnant and nonpregnant
women in relation to group B streptococcus (GBS) colonization status.

Methods: Engulfment of fluorescent GBS by peripheral blood phagocytes from GBS‐colonized and noncolonized
women was measured by flow cytometry. Intracellular superoxiode generated in response to GBS challenge to
monocytes and granulocytes enriched from peripheral blood of these women was also measured by flow
cytometry, and extracellular superoxide was determined by colorimetric assay.

Results: Monocytes and granulocytes from pregnant, GBS‐colonized women engulfed significantly greater
numbers of GBS than phagocytes from pregnant, noncolonized women. No difference in intracellular superoxide
production was detected between any of the groups of women; however, monocytes from pregnant, colonized
women released significantly more superoxide into the extracellular milieu than did granulocytes from the same
women. No differences in extracellular release of superoxide were observed among noncolonized women
whether they were pregnant or not.

Conclusions: Monocytes from pregnant, colonized women engulf more GBS and release more of the superoxide
into the extracellular environment, where it is unlikely to be an effective defense mechanism against intracellular
bacteria. This suggests that components of the innate immune system that should serve in a protective role may
function suboptimally, thereby contributing to the colonization process by GBS.
Virulence Factors of Escherichia coli Isolated From FemaleReproductive Tract Infections and Neonatal Sepsis
Authors: Cook Susan W. , Hammill Hunter A. , Hull Richard A.
Published: March 2007

Objective: The presence of enterobacteria such as Escherichia coli in the vagina of normal women is not synonymous
with infection. However, vaginal E. coli may also cause symptomatic infections. We examined bacterial
virulenceproperties that may promote symptomatic female reproductive tract infections (RTI) and neonatal sepsis.

Methods: E. coli isolated as the causative agent from cases of vaginitis (n = 50), tubo‐ovarian abscess (n = 45) and
neonatal sepsis (n = 45) was examined for selected phenotypic and genetic virulence properties. Results were
compared with the frequency of the same properties among fecal E. coli not associated with disease.

Results: A significantly greater proportion of infection E. coli exhibited D‐mannose resistant hemagglutination
compared with fecal E. coli (p < 0.01). This adherence phenotype was associated with the presence of P fimbriae
(pap) genes which were also significantly more prevalent among isolates from all three infection sites (p < 0.01).
The majority of pap+
isolates contained the papG3 allele (Class II) regardless of infection type. Increased frequency
of Type 1C genes among vaginitis and abscess isolates was also noted. No significant differences in frequency of
other bacterial adherence genes, fim, sfa, uca (gaf) or dra were observed.
E. coli associated with vaginitis was significantly more likely to be hemolytic ( HIY +)
than were fecal isolates
(p < 0.05). The HIY + phenotype was also more prevalent among tubo‐ovarian abscess and neonatal sepsis isolates
(p < 0.08).

Conclusions:E. coli isolated from female RTI and neonatal sepses possess unique properties that may enhance
their virulence. These properties are similar to those associated with other E. coli extra‐intestinal infections,
indicating that strategies such as vaccination or bacterial interference that may be developed against urinary tract
infections (UTI) and other E. coli extra‐intestinal infections may also prevent selected female RTI.
Performance Characteristics of Putative Tests for Subclinical Chorioamnionitis
Authors: Edwards Rodney K. , Clark Penny , Locksmith Gregory J. , Duff Patrick
Published: March 2007

Objective: To evaluate amniotic fluid glucose, matrix metalloproteinase (MMP)‐9, interleukin (IL)‐6, and IL‐12 for
diagnosing subclinical chorioamnionitis in women with preterm labor.

Methods: Forty‐four women in preterm labor at 22–35 weeks gestation with suspected subclinical
chorioamnionitis underwentamniocentesis.Amniotic fluid analysis included Gram stain, culture, and determination
of glucose, MMP‐9, IL‐6, and IL‐12 concentrations. Median values of these analytes were compared using the
Mann‐Whitney U test. Sensitivity, specificity, and positive and negative predictive values were calculated for tests
using a positive amniotic fluid culture or delivery within 24 hours as the key outcome variables

Results: Amniotic fluid concentrations of glucose, MMP‐9, and IL‐6 correlated closely with positive culture or
delivery within 24 hours. IL‐12 concentrations did not correlate with either a positive culture or delivery within
24 hours.

Conclusions: Amniotic fluid glucose, MMP‐9, and IL‐6 reliably predict microbial invasion of the amniotic cavity or
imminent delivery. IL‐12 values did not correlate with amniotic fluid culture results or imminent delivery.
Prevalence of Human Immunodeficiency Virus, Hepatitis B andHepatitis C Virus Antibodies and Hepatitis B Antigen AmongCommercial Sex Workers in Japan
Authors: Ishi Kazuhisa , Suzuku Fujihiko , Saito Akira , Yoshimoto Shinsaku , Kubota Takeyoshi
Published: March 2007

Objective: To investigate the prevalence of antibodies to human immunodeficiency virus (HIV), hepatitis B virus
(HBV) and hepatitis C virus (HCV), and of hepatitis B surface (HBs) antigen in commercial sex workers (CSW) who
attended a sexually transmitted disease (STD) clinic in Tokyo.

Methods: Surveys were conducted on 308 CSW and 384 control subjects for HIV antibody or 241 control subjects
for HBs antibody and antigen and HCV antibody.

Results: HIV antibodywas not detected in either CSW or control subjects. The positive rates for HBs antigen and
antibody were 0.6 and 23.4%, respectively, in the CSW group, and 0.4 and 71.8% in the control group. The HCV
antibody positive rate was 3.2% in the CSW group and 0.4% in the control group.

Conclusion: A statistically significant difference between the two groups was observed only in HCV antibody
positive rate. STD checkup for CSW alone is inadequate – STD health education and screening for the general
public are also required.
Impaired Whole‐Blood Polymorphonuclear Leukocyte Migration as a Possible Predictive Marker for Infections in Preterm Premature Rupture of Membranes
Authors: Glasner Andreas , Egger Gerd , Winter Raimund
Published: March 2007

Objectives: Steroids, used in pretermpremature rupture of membranes (pPROM), to reduce the risk of morbidity and mortality of the preterm neonate, impair the maternal polymorphonuclear leukocyte (PMN)‐based immune system. In spite of combination with antibiotics, prenatal and postnatal bacterial infections of mother and child are frequent. This pilot study focuses on the influence of steroids in pPROM on maternal PMN functional capacity and subsequent infections.

Methods: After opting for expectant management, eight women with pPROM and no signs of infection were treated by steroids (betamethasone 5.7 mg, i.m. every 24 hours, for three days) and antibiotic therapy with either amoxicillin and clavulanic acid, piperacillin or ampicillin i.v. up to delivery. The conventional inflammation parameters of PMN blood count and C‐reactive protein (CRP) were measured daily in parallel with PMN migratory capacity towards N‐formyl‐methionyl‐leucyI‐phenylalanine stimulation and under blank conditions, estimated by a whole blood membrane filter assay.

Results: In all patients PMN migration decreased during the application of steroids. Three patients showed a decrease in PMN migration below critical values and in spite of antibiotic prophylaxis acute pyelonephritis developed 2–6 days later. PMN count and CRP were not predictive of maternal infection.

Conclusion: Reduced PMN function, caused by steroid treatment in pPROM, is suggested to be a reason for serious bacterial infections in spite of antibiotic prophylaxis. PMN migration reflects individual PMN defensive capacity.
A Randomized Controlled Trial of Interleukin‐1 ReceptorAntagonist in a Rabbit Model of Ascending Infection in Pregnancy
Authors: McDuffie Robert S. , Davies Jill K. , Leslie Kimberly K. , Lee Scott , Sherman Michael P. , Gibbs Ronald S.
Published: March 2007

Objective: To determinewhether treatment with interleukin‐1 receptor antagonist (IL1‐ra) would affect amniotic
fluid concentrations of tumor necrosis factor alpha (TNF‐α) and prostaglandins or clinical or microbiological outcomes
in a model of ascending bacterial infection in pregnancy.

Methods: Timed pregnant New Zealand white rabbits at 70% of gestation underwent endoscopic inoculation of
the cervices with 106
– 107cfu Escherichia coli . Animals were randomly assigned in a blinded manner to a 5‐h intravenous
infusion of human IL1‐ra (10 mg/kg) or placebo beginning 1 – 2 h after inoculation. Blood was drawn fromthe
does for assay of serum IL1‐ra concentration before inoculation, at mid‐infusion, after the infusion ended and at
necropsy. At necropsy, temperature and cultures were taken, and aspirated amniotic fluid was pooled for assays of
TNF‐α, prostaglandin E 2
( PGE 2) and IL1‐ra.

Results: Serum IL1‐ra concentrations rose to a mean of 2 mg/ml at mid‐infusion and fell markedly after the infusion
to concentrations barely detectable at necropsy. Between the two groups, there were no significant differences in
the rates of fever or positive cultures or in amniotic fluid concentrations of PGE 2 or TNF‐α.One unique finding was
the demonstration that administration of human IL1‐ra to the does resulted inmeasurable concentrationsof human
IL1‐ra in the amniotic fluid.

Conclusions: Treatment with an intravenous infusion of human IL1‐ra after cervical inoculation with E. coli did not
affect clinical or microbiological outcomes or amniotic fluid concentrations of TNF‐α or PGE 2. This experiment
provides the first demonstration of passageof human IL1‐ra from the maternal bloodstreamto the amniotic fluid.
Acyclovir Suppression to Prevent Recurrent Genital Herpesat Delivery
Authors: Scott L. L. , Hollier L. M. , McIntire D. , Sanchez P. J. , Jackson G. L. , Wendel G. D.
Published: March 2007

Objective: To determine if suppressive acyclovir near term decreased the frequency of clinical recurrences at
delivery in women with recurrent genital herpes simplex virus (HSV) infection.

Methods: We conducted a prospective, double‐blind, randomized trial in 234 women with recurrent genital
herpes. Women with genital infection of any frequency were enrolled. Patients received either suppressive oral
acyclovir 400 mg three times daily or an identical placebo after 36 weeks’ gestation.Clinical lesions were identified,
and HSV cultures were obtained at delivery. The frequencies of clinical and subclinical HSV recurrences at delivery
were evaluated.

Results: Six percent of patients treated with acyclovir, and 14% of patients treated with placebo had clinicalHSV at
delivery (p = 0.046). No patients in the acyclovir group had positive HSV cultures, compared with 6% of
placebo‐treated patients (p = 0.029). There was no significant difference in subclinical HSV shedding in the
acyclovir group (0%) compared with the placebo‐treated group (3%) (p = 0.102).

Conclusions: Suppressive acyclovir therapy significantly decreased the incidence of clinical genital herpes and the
overall incidence of HSV excretion at delivery in patients with previous herpes infection. Conclusions: Suppressive acyclovir therapy significantly decreased the incidence of clinical genital herpes and the
overall incidence of HSV excretion at delivery in patients with previous herpes infection.
Risk of Perinatal Transmission of Hepatitis B Virus in Jordan
Authors: Batayneh Naji , Bdour Salwa
Published: March 2007

Objectives: To determine the risk of perinatal transmission of hepatitis B virus (HBV) in Jordan.

Methods: Plasma samples from 1000 pregnant Jordanian women were screened by ELISA for HBV markers
(HBsAg, HBeAg, anti‐HBe, anti‐HBc and anti‐HBs).

Results: HBsAg and HBeAg were detected in 4.3% and 0.1% of the pregnant women, respectively. The overall
prevalence of antibodies was 6%, 11.1% and 7.5% for anti‐HBe, anti‐HBc and anti‐HBs, respectively. Women
were assignedto four groups according to the serological patternsofHBV markers: susceptible (85.9%), with acute
infection (2.9%), with chronic infection (1.4%) and previously infected (9.8%). Most women were at the third
trimester of pregnancy, therefore women with acute and chronic hepatitis at this gestational age were at risk of
transmitting HBV infection to their newborns. Women who belonged to the low socio‐economic class were
at higher risk of HBV infection.

Conclusions: Based on the results, we recommend screening women for HBV during pregnancy in order to
identify HBV carriers. All newborns born to carriers should be vaccinated immediately after birth, both passively
and actively. Also vaccination of HBV seronegative pregnant women is recommended.
Vulvar Myiasis During Pregnancy
Authors: Passos Mauro R. L. , Varella Renata Q. , Tavares Rogério R. , Barreto Nero A. , Santos Cláudio C. C. , Pinheiro Vandira M. S. , Bravo Renato S. , Morelhi Maurício H. L.
Published: March 2007

Myiasis is a parasitic infestation caused by the larvae of several fly species. Diagnosis and treatment are simple. The
location of this infestation at the vulvar area is, however, an extremely rare occurrence. The authors present two
cases of vulvar myiasis affecting pregnantwomen. The first case is a 19‐year‐old pregnant girl with vulvar myiasis and
concomitant syphilis, vaginal trichomoniasis and genital candidiasis. The patient was also HIV‐positive. The second
case is a 17‐year‐old pregnant girl with vulvar myiasis associated with extensive vulvar condyloma acuminatum
lesions.
Haemophilus influenzae Septic Abortion
Authors: Cherpes Thomas L. , Kusne Shimon , Hillier Sharon L.
Published: March 2007

Background: Haemophilus influenzae septic abortion is typically caused by nontypeable strains of the organism.
Furthermore, nontypeable species with a special affinity for the genital tract are the most frequent isolates encountered,
and an ascending vaginal or cervical infection is often the suspected route of transmission.

Case: A 39‐year‐old woman at 8 weeks gestation who underwent dilation, evacuation, and curettage for embryonic
demise had clinical evidence for sepsis and isolation of a nontypeable, ampicillin resistant H. influenzae
from blood cultures. Although an ascending vaginal infection was suspected, the route of transmission was not
determined.

Conclusion: Nontypeable strains of. H. influenzae have demonstrated increased beta‐lactamase activity, and
ampicillin, formerly the treatment of choice, should be used only if isolate susceptibility is known.
Compliance With a Protocol for Intrapartum AntibioticProphylaxis Against Neonatal Group B Streptococcal Sepsis in Women With Clinical Risk Factors
Authors: Sanders Toni R. , Roberts Christine L. , Gilbert Gwendolyn L.
Published: March 2007

Objective: The aim of this study was to determine the prevalence of clinical risk factors (CRF) for neonatal sepsis
in laboring women and to evaluate clinician compliance with a CRF‐based protocol for intrapartum antibiotic
prophylaxis (IAP).

Methods: A retrospective chart audit was undertaken at a district hospital (A) and a tertiary obstetric hospital (B)
in Sydney, Australia between 1996 and 1998, to determine compliance with IAP in women with defined CRF.

Results: Eighty‐five (12%) women at Hospital A and 117 (19%) at Hospital B had one or more CRF. Overall
compliance rates with the IAP protocols were 65 and 50%at Hospitals A and B respectively, but varied according to
maternal, obstetric and sepsis‐related risk factors. We postulate that differences between the hospitals were
related to protocol implementation.

Conclusions: Compliance with a CRF‐based protocol was lower than previously reported. Improvements in
protocol development, implementation and maintenance are required to enhance compliance with IAP based
on CRF.
Intravenous Penicillin for Antenatal Syphilotherapy
Authors: Galan Henry L. , Yandell Paul M. , Knight Alfred B.
Published: March 2007

A 21 year old woman (G2 P0101)
of 24 weeks gestation presented with syphilis of unknown duration.
Sonography revealed fetal hydrops and placental thickening. Weekly intramuscular injections of 2.4
million U Bicillin for 3 weeks was initiated as recommended by the Centers for Disease Control.
Repeat sonogram 1 week after starting treatment revealed increased ascites and a new pericardial
effusion. Due to the worsening fetal condition, therapy was altered and the patient was admitted for
IV penicillin. She received a continuous infusion of 18 million U penicillin G daily for 10 days. Serial
sonograms showed improvement offetal ascites and pericardial effusion with 10 days of IV therapy,
and complete resolution of hydrops was noted within 3 weeks. The fetus was born at term with no
stigmata of congenital syphilis on newborn exam, and laboratory tests suggested adequate treatment
in utero.
Abdominal Wound Problems After Hysterectomy WithElectrocautery vs. Scalpel Subcutaneous Incision
Authors: Hemsell David L. , Hemsell Patricia G. , Nobles Brenda , Johnson Edward R. , Little Bertis B. , Heard Molly
Published: March 2007

The purpose of this study was to evaluate the relationship between postoperative abdominal incision
problems and opening subcutaneous tissues with electrocautery or scalpel. Women scheduled for
elective abdominal hysterectomy who gave informed consent were randomly assigned to subcutaneous
abdominal wall tissue incision by electrocautery or scalpel. Postoperative abdominal wound
problem diagnoses included seroma, hematoma, infection, or dehiscence without identifiable etiology.
Fifteen of 380 women (3.9%) developed a wound problem; six had scalpel and nine had
electrosurgical subcutaneous incisions (P = 0.4). Thicker subcutaneous tissues (P = 0.04) and concurrent
pelvic infection (P < 0.001) were significant risk factors for postoperative wound problems.
Only two women (0.5%) developed an infection. We conclude that the method of subcutaneous
tissue incision was unrelated to the development of postoperative abdominal incision problems in
380 women undergoing elective abdominal hysterectomy.
In Vitro Susceptibility Testing of Clinical Isolates of Chlamydia trachomatis
Authors: Martens Mark G. , Faro Sebastian , Maccato Maurizio , Riddle Gerald , Hammill Hunter , Wang Y.
Published: March 2007

Penicillin class antibiotics have demonstrated varying degrees of in vivo and in vitro success when
tested against Chlamydia trachomatis. The activity of ampicillin‐sulbactam, an agent commonly
utilized in the treatment of pelvic infections, was tested to ascertain if any antichlamydial activity is
present. Up to six endocervical isolates of C. trachomatis were tested against each of five antibiotics
including doxycycline, erythromycin, clindamycin, ampicillin/sulbactam, and sulbactam alone. McCoy cell monolayers were inoculated with high inclusion counts of 10,000–30,000 inclusion‐forming
units (IFU) per coverslip, and exposed to each antibiotic. Up to nine subsequent antibiotic free
culture passes were performed to assess the viability of abnormal inclusions. Doxycycline, erythromycin,
and clindamycin achieved 100% eradication of inclusions at concentrations of 4.0, 2.0, and
1.0 µg/mL. Exposure to ampicillin/sulbactam resulted in a greater than 99% reduction in the inclusion
count at 32.0 µg/mL, while sulbactam by itself demonstrated considerably less activity. Abnormal
inclusions were noted only in the ampicillin/sulbactam exposed cells, and these, plus all inclusions
remaining following sublethal exposure to the other antibiotics, resulted in regrowth to control
levels in subsequent passes. Doxycycline and erythromycin demonstrated excellent activity. Clindamycin
and ampicillin/sulbactam also significantly reduced inclusion formation, and therefore may
provide adequate C. trachomatis coverage in patients receiving these antibiotics for pelvic infections.
Intrauterine Pressure Catheter in Labor: Associated Microbiology
Authors: Pinell Phillip , Faro Sebastian , Roberts Scott , Le Sy , Maccato Maurizio , Hammill Hunter
Published: March 2007

Objective: The purpose of this study was to determine if bacterial growth occurred in the amniotic
fluid of laboring women. Twenty patients who required an intrauterine pressure catheter (IUPC)
during labor were studied. Amniotic fluid samples were aspirated during labor and at the time of
delivery.
Methods: IUPCs were placed in laboring patients for a variety of reasons. Cervical cultures were
taken prior to insertion of an IUPC. After the IUPC was placed, amniotic fluid cultures were taken
both at the time of placement and 30 minutes prior to delivery. These cultures were sent for aerobic,
anaerobic, Mycoplasma, and Ureaplasma cultures.
Results: The increase in bacterial concentration from the initial sample to the final sample was
statistically significant (P < 0.01) for both aerobes and anaerobes. Amniotic fluid samples demonstrated
a median of 0 bacterial species per patient on initial collection and 2 bacterial species per
patient in final collection. The mean count of cfu for erobes in the initial amniotic samples was
3.5 × 104, compared to that of the second samples, which was 1.4 × 105. The mean count of cfu for
anaerobes in the initial amniotic fluid samples,.was 4.1 × 102, compared to that of the second
samples, which was 8.0 × 103. Only 3 of 20 patients developed chorioamnionitis, with only 1 patient
having an increased number ofbacterial species significantly higher than the median. Although 80%
of patients had a colony count ≥ 102 cfu/cc, only 19% of this group developed chorioamnionitis.
Conclusions: The number of bacterial species and colony counts increased significantly during
labor, but this factor alone was not enough to cause chorioamnionitis in a significant number of
patients.
Effectiveness of Repeated Gonorrhea Cultures in the Third Trimester
Authors: Torres Juan G. , Mattox T. Fleming , Pastorek Joseph G.
Published: March 2007

Objective: With the high cost of health care today, the universal
prophylactic measures recommended, and the availability of effective treatment should
infection occur, the practice of routinely repeating the endocervical gonorrhea (GC) culture
in the third trimester of pregnancy may be unwarranted.

Methods: To test this hypothesis, we reviewed charts from patients
who had received routine prenatal care during a 2‐year period at the Lafayette and Opelousas
parish health units. Those charts, which had documented results of both the initial and repeat
GC cultures, were then used for retrospective review. The results ofthe initial GC culture were
compared with that taken in the third trimester. Other data recorded included age, gravidity,
race, and history of gonorrhea, syphilis, or multiple sexual partners.

Results: Two hundred fifty charts were available for extraction; 130
of these had documentation of both GC cultures. Of the 130 cultures obtained during
the initial prenatal visit, only 6 (4.6%) were positive. Of the repeat cultures taken during the
third trimester, none were positive. Thirteen patients (10.0%) had a documented history of
GC infection; none of them had positive cultures during the study period.

Conclusions: Screening for GC during pregnancy is important and appropriate.
This is commonly accomplished by taking a GC culture during the initial prenatal visit.
Based upon the present study, we found that repeating this culture in the third trimester,
even in a relatively high‐risk population, seems unnecessary, whether the initial culture is
negative or not.
Acute Obstructive Hydrocephalus Due to Cysticercosis During Pregnancy
Authors: Ramus Ronald M. , Girson Mark , Twickler Diane M. , Wendel George D.
Published: March 2007

Conclusion: This case describes an uncommon presentation of
neurocysticercosis that should be considered in gravidas with acute mental status
changes.
Epidemiology of Sexually Transmitted Diseases Among Pregnant Adolescents
Authors: Gittens Lisa N. , Nichols Rhonda R. , Apuzzio Joseph J.
Published: March 2007

Objective: The purpose of this study was to determine the
epidemiology of sexually transmitted diseases (STDs) among pregnant adolescents.

Methods: Charts of all patients (n = 735) who attended the Maternal and
Infant Care Clinic at University Hospital, Newark, NJ, between July 1, 1991, and June 30,
1992, were reviewed for STDs which included gonorrhea, chlamydia, syphilis, and human
immunodeficiency virus (HIV). At the first prenatal visit, each registrant had endocervical
specimens obtained to detect gonorrhea and chlamydia. A serum sample was obtained
for syphilis screening. HIV testing was made available to all patients and testing was
done on a voluntary basis. The same STD screening that was done at the initial visit was
repeated at 28 and 36 weeks.

Results: Twenty‐five percent of patients tested positive for one or
more STDs. The mean patient age was 17.3 years. The mean gestational age at first visit
was 19.5 weeks. The mean number of visits was 7.3. The following STDs were identified:
4.8% of patients tested positive for gonorrhea, 20.9% tested positive for chlamydia,
and 1.7% tested positive for syphilis. Twenty‐one percent of patients had a positive
STD diagnosed at the initial visit. Another 4.8% of patients had an STD diagnosed at some
time after the initial visit when the initial screen was negative for STDs. An additional
1% of patients who initially tested positive for an STD had subsequent screening which
revealed another STD (different organism). Seven patients tested HIV positive.
Sixty‐one percent of patients with STDs agreed to HIV testing. One patient had
HIV coexistent with another STD.

Conclusions: Pregnant adolescents are at risk for multiple
STDs. HIV testing should be offered. STD screening should be repeated in the third
trimester in adolescent patients.
Trichomonas vaginalis: Diagnosis and Clinical Characteristics in Pregnancy
Authors: Heine R. Phillip , McGregor James A. , Patterson Elisa , Draper Deborah , French Janice , Jones Ward
Published: March 2007

Objective: The objectives of this study were to 1) determine the
prevalance and characterize the symptomatology of Trichomonas vaginalis (TV)
infection in pregnant women on entry into prenatal care in an inner‐city population; 2)
compare conventional microscopic methods vs. culture techniques in diagnosing
TV in both symptomatic and asymptomatic pregnant patients; and 3) correlate
wet mount microscopic and microbiologic characteristics of varying manifestations of
trichomoniasis.

Methods: One thousand two hundred sixty patients in an inner‐city
population were tested at entry into prenatal care for TV by saline wet mount and culture
techniques. Other tests for lower genital tract infection were also performed.
Vaginal symptoms were ascertained through standardized questioning prior to examination.
Standard microscopic and microbiologic data were also obtained for analysis. Wet
mounts were systematically examined and considered negative if no TV was identified in
10 high powerfields (HPFs). Cultures were inspected from days 4 to 7 or until positive
results were obtained. Results were analyzed using McNemar′s test for correlated proportions,
chi‐squared test, or Fisher exact test where appropriate.

Results: Culture and wet mount results were available in 1,175
patients. TV infection was documented by one or both techniques in 110/1,175 (9.4%).
Culture methods detected 105/110 (94.5%) of all patients while wet mount detected
90/110 (73%) (P <0.001). Vaginal symptoms were present in only 20/110 patents
(18.2%). Among asymptomatic patients, culture detected 94% while wet mount
detected 70% (P < 0.001). Among symptomatic patients, wet mount and culture were
both effective and diagnosed 85% and 95% of infections, respectively (P = not significant).
Patients with TV were more likely to have increased vaginal fluid wlaite blood cells (WBCs)
and more severe vaginal flora disruption than uninfected controls. Subgroup analysis
revealed wet mount‐positive/culture‐positive patients were more likely to have vaginal
flora disruption, as evidenced by decreased lactobacilli and elevated vaginal pH, than
wet mount‐negative/culture‐positive subjects. Coexistent infection rates were similar
regardless of wet mount status. Elevated vaginal fluid WBCs were more
common among patients with symptoms.

Conclusions: 1) Screening pregnant women for TV based solely
on symptomatology is ineffective in this population; 2) culture techniques detected
more infections than conventional microscopic evaluation; and 3) significant increases
in vaginal fluid WBCs and altered vaginal flora are found in both symptomatic and
asymptomatic TV, suggesting that both infestations have the potential to adversely
affect pregnancy outcome. Studies on the influence of TV on pregnancy outcomes are
ongoing.
Human Papillomaviruses and Papillomatosis Lesions of the Female Lower Genital Tract
Authors: Fu Yu-Liang , Hu Yao-Xiong , Ling Han-Liang , Ye Zhen-Zhong , Liang Tian , Zhang Mei-Gui , Liu Yun-Ke , Kang Biao , Luo Yuan-Ji , He Shu-Ying , Lian Yong-Jian
Published: March 2007

Objective: The objective of this study was to determine whether human
papillomavirus (HPV) infections are involved in the development of papillomatosis lesions
of the lower female genital tract.

Methods: A total of 616 biopsy specimens of genital papillomatous
lesions (307 nodular and 309 papular types) from 598 patients were anaylyzed for the
presence of HPV DNA sequences by polymerase chain reaction (PCR). These specimens
were also examined by histopathological assessment for characteristic HPV‐associated
cytological changes, by immunohistochemical staining for HPV‐associated antigen,
and by electron microscopy for the presence of virions.

Results: HPV DNA sequences were found in 97.9% (140 of 143 cases)
and 1.1% (1 of 91 cases) of the nodular and papular papillomatosis cases tested,
respectively. In 18 patients who had both types of papillomatosis lesions, HPV DNA was
invariably found only in nodular tissues. HPV‐associated antigen, koilocytosis, and
virions were found in 53.6% (98 of 183 cases), 70.5% (129 of 183 cases),
and 5.9% (5 of 85 cases) of nodular papillomatosis lesions tested, respectively.

Conclusions: These data suggest that nodular papillomatosis was
closely associated with HPV infection, but that papular papillomatosis of the lower
female genital tract may have an etiology other than HPV infection,
Pregnancy Outcome in Swiss‐Webster Mice Infected With Chlamydia trachomatis
Authors: Oshiro Bryan T. , Graham Jack M. , Blanco Jorge D. , Seraj Ibrahim M. , Bishop Karen D.
Published: March 2007

Objective: The objective of this study was to observe pregnancy
outcomes in mice infected transvaginally with Chlamydia trachomatis.
Methods: Pregnant mice were inoculated transvaginally with either C. trachomatis
(CT) or sterile calf serum (CON) on pregnancy day 4. Pregnancy outcomes as
well as genital tract histology and culture were compared. Statistical analysis was
performed using Fisher′s exact test and Student′s t‐test.
Results: Twenty‐four of 26 CT mice had positive uterine cultures for
C. trachomatis. Inflammation occurred in 9 (34.6%) (P = 0.002, 95% confidence interval = 1.7–3.5)
and intrauterine fetal demise occurred in 5 (19.2%) (P = 0.05, 95% confidence interval = 1.6–2.9)
of CT mice. No mice in the CON group (0/24) had positive uterine cultures, developed
inflammation, or experienced intrauterine fetal demise.
Conclusions: Lower genital tract chlamydial infection is associated
with intrauterine fetal demise in Swiss‐Webster mice.
Fatal Herpetic Hepatitis in Pregnancy
Authors: Chatelain Stephen , Neumann D. Edward , Alexander Samuel M.
Published: March 2007

Background: Disseminated herpetic infections during pregnancy have
been reported in the literature.

Case: This case presentation describes a pregnant patient who
presented with fever, elevated liver enzymes, and upper abdominal tenderness and
succumbed from fulminant herpetic hepatitis.

Conclusion: Early diagnosis and treatment are essential because of the
high mortality rate.
Group A Streptococcal Puerperal Sepsis: Historical Review and 1990s Resurgence
Authors: Nathan Lawrence , Leveno Kenneth J.
Published: March 2007

There appears to be a resurgence of puerperal sepsis due to a historically important
pathogen, group A β‐hemolytic streptococcus.
Microbiology of Bartholin′s Duct Abscess
Authors: Mattila Anu , Miettinen Ari , Heinonen Pentti K.
Published: March 2007

Objective: The aim of the study was to determine the currently most
frequent microbial findings in Bartholin′s duct abscess.

Methods: Computerized records of microbial findings of 249 cases
of Bartholin′s duct abscess were retrospectively studied.

Results: In 129 cases, only 1 microbe and, in 117 cases, >1 microbe
were recovered. In 3 cases, the flora was recorded as normal for the
lower genital tract. Of all bacteria isolated, 252 were aerobic or facultative and 108 were
anaerobic or microaerophilic. Aerobic or facultative bacteria alone caused 142 (57%) of the
249 cases, Escherichia coli being the most frequent isolate in this group. Anaerobic or
microaerophilic bacteria alone caused 33 cases (13%), Bacteroides species and Prevotella
species being most frequently identified. Both aerobic or facultative and anaerobic or
microaerophilic bacteria were isolated in 70 cases (28%). Candida albicans alone caused
1 case of Bartholin′s duct abscess. The sexually transmitted pathogens Neisseria gonorrhoeae
and Chlamydia trachomatis were both involved in only 2 cases.

Conclusions: Bartholin′s duct abscess was mainly caused by
opportunistic bacteria, and sexually transmitted pathogens were only rarely involved in its
pathogenesis. Since potentially pathogenic bacterial species were also frequently isolated,
the use of antibiotics to complement the surgical treatment of Bartholin′s duct abscess
seems advisable, especially in patients with systemic symptoms.
Neurobrucellosis Complicating Pregnancy: A Case Report
Authors: Gloeb D. Jay , Lupi Carla , O′Sullivan Mary Jo
Published: March 2007

Background: Brucellosis in humans is an infectious disease which may
occur following contact with infected domestic animals or the ingestion of unpasteurized
dairy products. It has rarely been described in pregnancy. The diagnosis, neuropsychiatric
manifestations, and management of brucellosis in a 3rd‐trimester pregnant woman are
discussed.

Case: A 24‐year‐old Mexican female, G3P2002,
at 30 weeks gestation
presented with fever, shaking chills, night sweats, a non‐productive cough, weakness,
nausea, vomiting, anorexia, and vague, dull, upper abdominal pain as well as neuropsychiatric
findings. Extensive evaluation revealed serologic and culture evidence of Brucella infection.
Her worsening neuropsychiatric condition necessitated preterm delivery with
satisfactory neonatal and improved maternal outcomes.

Conclusion: Bacteriologic infection of pregnant women with
neuropsychiatric manifestations should prompt a careful investigation, and brucellosis
should be considered if there is a travel history possibly compatible with contact with
domestic animals or the ingestion of unpasteurized dairy products.
Chlamydia trachomatis Infections: Implications for Pregnant Adolescents and Their Infants
Authors: Melzer-Lange Marlene , Good Laurie , Hennes Halim
Published: March 2007

Objective: Chlamydia trachomatis infections are common in pregnant adolescents. Previous studies
have shown that treating pregnant women of all ages with erythromycin prevents transmission of this infection to their
infants. However, there are no published studies on the efficacy of aggressive screening and treatment of C.
trachomatis in pregnant adolescents. This study was undertaken to determine if aggressive screening for C. trachomatis in pregnant adolescents and early treatment with erythromycin can prevent complications in their newborn
infants.

Methods: A group of pregnant adolescents enrolled at Teen Pregnancy Service of Milwaukee was
evaluated prospectively for the presence of C. trachomatis infection. Screening was performed during
the 1st and 3rd trimesters by enzyme immunoassay. Adolescents with positive enzyme immunoassays for Chlamydia
were treated with erythromycin for 10 days. Those with negative enzyme immunoassays were enrolled as controls.
All infants born to adolescents in both groups were followed for episodes of conjunctivitis, pneumonia, and wheezing
during their 1st year of life.

Results: Ninety mother/infant pairs were followed during the study period. Twenty‐eight mothers
(31%) had positive enzyme assay tests and all received erythromycin therapy. Nasopharyngeal cultures were obtained
from 60 (67%) infants; all were negative. There were no significant differences in general characteristics, development of
conjunctivitis (relative risk 1.27), wheezing (relative risk 0.91), or pneumonia (relative risk 1.12) between infants born to adolescents in either group.

Conclusions: We conclude that aggressive screening and treatment of C. trachomatis infection in pregnant adolescents may prevent complications in their offspring.
Penetration of Piperacillin/Tazobactam Into Gynecologic Tissues Following a Single Loading Dose Prior toHysterectomy
Authors: O′Brien William F. , George Shelley
Published: March 2007

Objective: This study was undertaken to determine plasma and pelvic tissue concentrations of
piperacillin/tazobactam following a single intravenous administration.

Methods: Plasma and tissue samples were obtained following administration of 3 g of piperacillin
and 0.375 g of tazobactam. Concentrations of these agents were determined by chromatography.

Results: Plasma concentrations (mean ±SD) for piperacillin/tazobactam were 208 ± 87/27 ± 8
and 95 ± 53/14 ± 2, respectively, at 30 and 60 min after the start of the infusion. The 8:1 ratio
between piperacillin and tazobactam in plasma remained constant for up to 96 min. Tissue concentrations
yielded a broader range, but each agent achieved significant penetration in each of the
tissues studied.

Conclusions: Piperacillin/tazobactam demonstrates favorable penetration in female genital tract
tissues and Should be considered a potentially effective agent for female pelvic infections.
Prenatal Human Immunodeficiency Virus Testing and Patient Management by Obstetricians in a HighSeroprevalence Community
Authors: Robinson William R. , Fleischer Michael
Published: March 2007

Objective: In order to determine the practice habits of obstetricians concerning frequency of prenatal
human immunodeficiency virus (HIV) testing and management strategies for HIV‐seropositive obstetric patients, we
conducted a telephone survey of practicing obstetricians over a 3‐month period.

Methods: In the New Orleans metropolitan area, 71/104 (68%) obstetricians participated and
completed the survey.

Results: Of these obstetricians, 43/71 (60.6%) test all new obstetric patients for HIV; 64/71
(84.5%) routinely ask the patients about risk factors for infection; and 28/71 (39.4%) have actually cared for
an HIV‐positive patient in their practice. Those obstetricians who routinely tested for HIV
were more likely to have personally managed an infected patient and more likely to ask about risk
factors. The number of obstetricians who would manage infected patients without consultative
assistance was 8/71 (11%).

Conclusions: We concluded that obstetricians in this community have largely accepted routinely
offered prenatal testing and risk assessment, but they have assumed a relatively small role in risk
reduction counseling and treatment.
Ability of History Taking Alone to Identify Early Pregnancies Among Potential Measles Vaccinees
Authors: Mead Philip B.
Published: March 2007

Objective: This study was undertaken to determine the ability of history taking alone, compared with
pregnancy testing, to identify early pregnancies among potential female measles vaccinees.

Methods: As part of an institution‐wide measles immunization program, 326 female health care
workers (HCWs) who denied being pregnant underwent a urine pregnancy test prior to vaccination.

Results: Of the 326 women, 3 had positive pregnancy tests and were ultimately confirmed to be
pregnant. Although all 3 women denied the possibility of pregnancy prior to testing, 2 had been
unable to give an exact date for their last menstrual period (LMP).

Conclusions: In this group of 326 northern New England HCWs being immunized against measles
during an outbreak, history taking alone failed to identify 3 pregnancies. If the inability to give an
exact date of the LMP had been included as a discriminator, 2 additional pregnancies could have
been suspected, but 1 pregnancy still would have gone undetected.
Depoliticize Human Immunodeficiency Virus Infection: A Commentary
Authors: Amstey Marvin S.
Published: March 2007

Public‐health policy is inconsistent in its approach to the sexually transmitted disease human immunodeficiency
virus (HIV). Nearly every health agency has politicized the reporting, finding, and contacting of HIV cases. There is also
no consistency among the various state health departments and the various federal health agencies. Until we have
a uniform health policy that treats HIV infection as every other reportable sexually transmitted disease, we will make
little progress toward controlling its inevitable increase in both cases and costs.