bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between HIV in Pregnancy and Antiretroviral Therapy, Including Protease Inhibitors and Low Birth Weight Infants
Authors: Goldstein Phillip J. , Smit René , Stevens Monique , Sever John L.
Published: March 2007

Objective:To determine the inciden’ce of low birth weight infants born to HIV seropositive women and to demonstrate any effects of antiretroviral therapy on birth weight.

Methods:Retrospective review of all obstetrical medical records from January 1, 1995 through June 30, 1998 to identify HIV seropositive women. We evaluated their antiretroviral therapy, CD4 counts, and birth weights of their newborns. We conducted detailed review of the clinical and laboratory findings for the HIV-infected untreated patients, women who received ZDV antepartum alone, and those who received PIs as part of antiretroviral treatment.

Results:The frequency of low birth weight infants was significantly increased in HIV seropositive compared to HIV seronegative parturients. Low birth weight infants were more frequent among HIV infected women with lower CD4 counts but the association was not statistically significant. Women who received no antepartum treatment, antepartum only ZDV, and those treated with PIs had significantly more low birth weight infants than did comparison groups. HIV seropositive women also had high frequencies of several obstetrical risk factors for low birth weight infants.

Conclusion:The present study showed a significantly increased frequency of low birth weight infants among HIV infected women and especially the subgroups of infected women who received no antepartum treatment, antepartum ZDV only, and those treated with PIs. This association, however, may be related to the presence of many other preterm obstetrical risk factors noted in this study. Increasing numbers of HIV seropositive women are being treated with PIs according to the Centers for Disease Control (CDC) guidelines. If PIs are a cause of low birth weight infants, women taking these drugs may have incremental risk of low birth weight. Infect. Dis. Obstet. Gynecol. 8:94–98; 2000.
Effect of Intravaginal Clindamycin Cream on Pregnancy Outcome and on Abnormal Vaginal Microbial Flora of Pregnant Women
Authors: Rosenstein Isobel J. , Morgan D. John , Lamont Ronald F. , Sheehan Marie , Doré Caroline J. , Hay Phillip E. , Taylor-Robinson David
Published: March 2007

Objectives:To determine whether intravaginal clindamycin cream reduces the incidence of abnormal pregnancy outcome in women with abnormal vaginal microbial flora graded as intermediate or BV and to investigate the effect of the antibiotic on vaginal microbial flora.

Methods:A prospective cohort study of pregnant women in an antenatal clinic of a district general hospital. The subjects were 268 women who had abnormal vaginal microbial flora at first clinic visit by examination of a Gram-stained vaginal smear and 34 women with a normal vaginal flora. Two hundred and thirty-seven women were evaluable. Women with abnormal Gram-stained smears (graded as II or III) on clinic recall were randomised to receive treatment (intravaginal clindamycin cream) or placebo and followed to assess outcome of pregnancy, vaginal flora, and detection ofMycoplasma hominisandUreaplasma urealyticumafter treatment.

Results:Abnormal outcomes of pregnancy were not significantly different in treated and placebo groups by Chi square (P= 0.2). However, women with grade III flora responded better to clindamycin than women with grade II flora by numbers of abnormal outcomes (P= 0.03) and return to normal vaginal flora (P= 0.01) (logistic regression analysis model). This may be due to differences in vaginal bacterial species in these grades. Women whose abnormal vaginal flora had spontaneously returned to normal on follow-up and were therefore not treated (revertants) had as many abnormal outcomes as placebos suggesting that damage by abnormal bacterial species occurred early in pregnancy.

Conclusions:Gram-stain screening distinguishing grade II from grade III flora may be helpful in prescribing treatment other than clindamycin for women with grade II flora. Earlier diagnosis and treatment may be more effective in preventing an abnormal outcome, possibly as soon as pregnancy is diagnosed or even offered as a pre-conception screen. Infect. Dis. Obstet. Gynecol. 8:158–165, 2000.
Vaginal‐Rectal Colonization With Group AStreptococci in Late Pregnancy
Authors: Mead Philip B. , Winn Washington C.
Published: March 2007

Objective: To determine the vaginal‐rectal colonization rate with group A streptococci in late pregnancy.

Methods: All patients delivering at a northern New England hospital over a 38 month period had
35–37 week vaginal‐rectal swabs cultured for group A and group B streptococci, using selective
media and slide agglutination.

Results: Six thousand nine hundred forty‐four screening cultures were obtained. Among these
1,393 were positive for group B streptococci and 2 for group A streptococci, yielding colonization
rates of 20.1% and 0.03%, respectively.

Conclusions: Vaginal‐rectal colonization with group A streptococci is rare, arguing against the
need for establishing group A streptococcal screening programs in pregnancy. An approach for
managing this uncommon finding is presented. Infect. Dis. Obstet. Gynecol. 8:217–219, 2000.
Q Fever During Pregnancy: An Emerging Cause ofPrematurity and Abortion
Authors: Jover-Díaz Francisco , Robert-Gates Jaqueline , Andreu-Gimenez Lucio , Merino-Sanchez Jaime
Published: March 2007

Background: Although the pathogenic role of Coxiella burnetii infection during pregnancy is controversial, some cases of stillbirth and abortion occurring after an acute or chronic infection have been mentioned in the literature. Recently, Q fever has been advocated as a significant cause of morbidity and mortality in pregnancy

Case: We describe an 18‐year‐old primipara woman admitted to our hospital for high fever and pancytopenia
during an acute C. burnetii infection. She was successfully treated with clarithromycin, overcoming fever and
pancytopenia. Finally, she gave birth to a healthy infant, and 1 year later both remained well.

Conclusion: Q fever is a potentially serious disease in pregnancy owing to the possibility of placenta infection and fetal transmission affecting its outcome. Q fever infection should be suspected in unexplained febrile episodes or
abortion during pregnancy, when epidemiologic and clinical data are present.We believe that C. burnetii serology should be tested in cases of fever of known origin or unexplained abortions, as the TORCH infections are.
Candidiasis During Pregnancy May Result From Isogenic Commensal Strains
Authors: Daniels Wayne , Glover Douglas D. , Essmann Michael , Larsen Bryan
Published: March 2007

Objective: Our laboratory previously demonstrated that asymptomatic vaginal colonization during pregnancy is a factor predisposing patients to subsequent symptomatic vulvovaginal candidiasis. It is unknown whether symptoms result from strain replacement or a change in host relationship to the original colonizing strain. This study was
undertaken to determine whether Candida albicans isolates from asymptomatic women could be responsible for subsequent symptomatic vaginitis.

Methods: We retained isolates of C. albicans from women followed longitudinally through pregnancy, and identified
six pairs of cultures from women who were colonized without symptoms and who later became symptomatic
(average time 14 weeks). We used a random amplification of polymorphic DNA (RAPD) analysis to determine
whether isolates from our study patients were genetically similar or dissimilar.

Results: Analysis of these pairs of yeast strains by RAPD revealed that five of the six women had symptoms
apparently due to the same yeast strain that was found initially as a commensal strain. To increase the power of
these observations, we also performed RAPD analysis on six randomly selected yeast strains from other women in
this study who had not become symptomatic to determine whether any of these unrelated strains matched strains
from those women who became symptomatic.

Conclusion: Symptomatic yeast vaginitis is usually due to strains of C. albicans already carried in the lower genital
tract, underscoring the need to understand regulation of growth and virulence of the organism in vivo.
Molecular Diagnosis of Human Papillomavirus: Comparison Between Cervical and Vaginal Sampling
Authors: Finan Ramzi R. , Irani-Hakime Noha , Tamim Hala , Almawi Wassim Y.
Published: March 2007

Background: Human papillomavirus (HPV) is the most significant cause of cervical cancer. In view of the number
of drawbacks associated with endocervical sampling, the gold standard for HPV detection, this study examined the
utility and specificity of vaginal sampling as an alternative for endocervical sampling for the routine detection of HPV.

Case study: The study comprised 51 women who tested positive and 54 women who tested negative for
endocervical HPV by polymerase chain reaction (PCR), confirmed by histopathology. At the time of specimen
collection, both (speculum‐assisted) endocervical and vaginal (no speculum) scrapings were isolated from HPV positive
and negativewomen, and HPV DNA was assessed by PCR using the MY09/MY11 primer system;HPV type
was identified by hybridization of PCR products with type‐specific biotinylated DNA probes. Each participant
served as her own control. HPV was detected in vaginal and cervical scrapes from all HPV‐positive but not
HPV‐negative women. In HPV‐positive women the same HPV type was found in vaginal and endocervical scrapings
(positive predictive value = 1.0).

Conclusion: Correlation between vaginal and endocervical sampling methods was excellent in detecting the
presence of HPV DNA and for identifying distinct HPV genotypes. Utilization of vaginal testing for routine HPV
detection, and for the long‐term follow‐up of persistent HPV infection, is therefore recommended.
Prevalence of Sexually Transmitted Infections (Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonasvaginalis and Human Papillomavirus) in Female Attendees of aSexually Transmitted Diseases Clinic in Ulaanbaatar, Mongolia
Authors: Garland Suzanne M. , Tabrizi Sepehr N. , Chen Shujun , Byambaa Chultemsuren , Davaajav Khalzan
Published: March 2007

Background: Epidemiological data suggest that the prevalence of syphilis, gonorrhea and trichomoniasis has
increased in both urban and rural areas of Mongolia. These data are primarily substantiated by notifications of cases
of clinically apparent disease in both rural and urban areas, plus laboratory diagnoses from the AIDS/STD Reference
Center,Ulaanbaatar. In the past 5 years, however, there has been a marked decline in the total number of patients
being screened for sexually transmitted infections (STIs). An assessment of true prevalence of STIs in a female
population attending an urban sexually transmitted diseases (STD) clinic was therefore commenced.

Methods: Consecutivewomen attending an STD clinic in Ulaanbaatar had genital samples collected by the insertion
and immediate removal of a tampon, which was then tested for the presence of Neisseria gonorrhoeae ,
Chlamydia trachomatis, human papillomavirus (HPV) and Trichomonas vaginalis , using polymerase chain reaction
(PCR) amplification.

Results: A total of 110 women were studied (mean age 26.7 years). Overall, 58 (53%) patients had one or more
pathogens identified; 43 (39%) had a single pathogen, while 15 (14%) had mixed pathogens. C. trachomatis was
found in 15 (14%), N. gonorrhoeae in 12 (11%), T. vaginalis in nine (8%) and HPV in 39 (36%). Among the 39
HPV‐positive patients, oncogenic genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52) were found in 17 (44%) patients.

Conclusions: Sexually transmitted infections as defined by PCR were common, and found in 53%of female
attendees of an urban STD clinic in Mongolia. As infections with conventional STIs increase the risk of human
immunodeficiency virus (HIV) transmission, it is imperative that strategies be introduced to reduce the prevalence
of STIs. Furthermore, detection of oncogenic HPV was common, indicating that it is vital that a strategy to reduce
cervical cancer such as a pre‐cancer cervical cytology screening program also be introduced.
A Randomized Trial of Azithromycin Versus Amoxicillin for theTreatment of Chlamydia trachomatis in pregnancy
Authors: Kacmar Jennifer , Cheh Emily , Montagno Andrea , Peipert Jeffrey F.
Published: March 2007

Objective: To compare the compliance, side effects and efficacy of amoxicillin and azithromycin for the treatment
of Chlamydia trachomatis infection in pregnancy.

Methods: This is a randomized single‐blind trial of women diagnosed with C. trachomatis before 33 weeks
gestation.Women were randomly assigned either 500 mg amoxicillin orally three times per day for 7 days or a single
dose of 1 g azithromycin orally. Patientswere interviewed by telephone approximately 3–7 days following therapy
to assess compliance and side effects. Test of cure was performed at a follow‐up visit 4–6 weeks following completion
of therapy.

Results: Thirty‐nine patients were randomized with 19 receiving amoxicillin and 20 receiving azithromycin. There
were no differences in baseline data between the two groups, and there were no statistically significant differences
in side effects, compliance or efficacy. In the amoxicillin group 84% of women took all pills, while 100% completed
the single 1 g dose of azithromycin. Side effects were common in both groups (38% overall), with 40% of the
azithromycin group reporting moderate to severe gastrointestinal side effects compared to 17% in the amoxicillin
group (p = 0.11). Of patients who returned for follow‐up test of cure, 3 of 15 (20%) in the amoxicillin group were
positive compared with 1 of 19 (5%) in the azithromycin group (p = 0.3).

Conclusions: Side effects of therapy for C. trachomatis in pregnancy are common. Amoxicillin was slightly better
tolerated than azithromycin. Compliance and cure rates with both regimens was high.
Hydatid Cyst of the Uterus
Authors: Başgül A. , Kavak Z. N. , Gökaslan H. , Küllü S.
Published: March 2007

Background: Hydatidosis is a common zoonosis that affects a large number of humans and animals, especially in
poorly developed countries. The infesting parasite has four forms named Echinococcus granulosis, E. multilocularis ,
E. vogeli and E. oligarthrus (very rare in humans). The most frequently involved organs are liver followed by the lung.
The involvement of the genital tract is rare and the occurrence in the uterus is an extreme rarity.We report a case of
hydatid cyst in the uterus.

Case: A 70‐year‐old female with a history of hydatid cysts of the liver, was admitted to hospital after complaining of
low abdominal pains.On physical and gynecological examinations, no pathological finding was detected. However,
the uteruswas significantly large for a postmenopausal patient. Transvaginal sonography (TS) revealed a cystic mass
in the uterus with a size of 7× 6 cm. After further examinations a subtotal hysterectomy was performed. Microscopic
examination showed scolices of Echinococcus granulosis .

Conclusion: Hydatid cysts in the genital tract are rare and the occurrence in the uterus is an extreme rarity.Differentiation
between hydatid cyst and malignant disease of the related organ is difficult. To avoid misdiagnosis, a careful
examination of pelvic masses should be carried out in endemic areas for detection of hydatid cysts.
Effect of Adjuvant Imiquimod 5% Cream on SustainedClearance of Anogenital Warts Following Laser Treatment
Authors: Hoyme U. B. , Hagedorn M. , Schindler A.-E. , Schneede P. , Hopfenmüller W. , Schorn K. , Eul A.
Published: March 2007

Objectives: Imiquimod is an immune response modifier that has demonstrated a good efficacy and relatively low
recurrencerates in comparison to other genitalwart treatment modalities. The primary objective of this open‐label
study was to evaluate the effect on sustained clearance of treated lesions and the safety of patient‐applied topical
imiquimod after laser therapy of external anogenital warts.

Methods: After laser treatment of visible external anogenital warts the ablated region(s) were treated with
imiquimod 5% cream three times/week over 12 weeks beginningwhen the wound healing process was completed,
followed by a six‐month treatment‐free observation period for the assessment of sustained clearance of treated
lesions.

Results: A total of 211 male and female patients was enrolled in the study. After 12 weeks of treatment, 65.4% of
all patients showed sustained clearance. During the treatment period, 15 patients (7.1% of 211 patients) presented
with recurrent warts in the treated areas, and 58 (27.5%) patients were excluded for other reasons. During
the six‐month follow‐up period, ten additional patients (7.3% of 138 patients) developed wart recurrences. The
application of imiquimod 5% cream was well tolerated. The number of patients with adverse events related to
studymedication declined fromthe first month of treatment until the end of the third month.Most frequently, mild
to moderate itching, burning, pain and erythema were reported.

Conclusions: After laser therapy and sufficient wound healing, administration of imiquimod 5% cream three
times/week appears to be safe and to reduce the incidence of wart recurrences.
Can the Diagnosis of Recurrent Vulvovaginal Candidosis BeImproved by Use of Vaginal Lavage Samples and Cultures onChromogenic Agar?
Authors: Novikova N. , Rodrigues A. , Mårdh P.-A.
Published: March 2007

Objective: To investigate if introital and vaginal flushing samples inoculated on chromogenic agar could increase
the recovery rate and rapid identification of Candida and non‐albicans species, as compared to culture of posterior
vaginal fornix samples on Sabouraud agar and speciation of isolates by biochemical tests.

Methods: Samples from the introitus and the posterior vaginal fornix and vaginal lavage samples were collected
from 91 women with a history suggestive of recurrent vulvovaginal candidosis (RVVC), and with a suspected new
attack of the condition. The specimens were cultured on Sabouraud and CHROMagar®
. Speciation of yeast
isolates was made on the chromogenic agar by API 32C®kits and by an atomized system (Vitek®).

Results: Forty‐six (51%) women were positive for Candida fromone or more of the samples. The introital cultures
were positive in 43 (47%) women, both on Sabouraud and chromogenic agar. From the posterior vaginal fomix,
42 (46%) women were positive on the Sabouraud and 43 (47%) on chromogenic agar cultures, while the vaginal
lavage cultures yielded Candida on those two media in 40 (44%) and 4l (45%) cases, respectively. Candida albicans
was the most frequent species recovered, from 40 (87%) cases, followed by C. krusei in 4 (9%), C. glabrata in
2 (4%), and C. parapsilosis in one case. There was only onewoman who had a mixed yeast infection, by C. albicans
and C. krusei . There was only one discrepancy in the speciation as demonstrated by mean of chromogenic agar and
API 32C kit.

Conclusions: Neither cultures of introital nor of vaginal lavage samples increases the detection rate of Candida in
RVVC cases as compared to cultures of posterior vaginal fornix samples. Use of chromogenic agar is a convenient
and reliable means to detect colonization by Candida and differentiate between C. albicans and non‐albicans
species.
Apoptosis in the Chorion Laeve of Term Patients WithHistologic Chorioamnionitis
Authors: Murtha A. P. , Auten R. , Herbert W. N. P.
Published: March 2007

Objective: The balance between cell survival and cell death (apoptosis) is critical during development and may
affect organ function. Apoptosis is accelerated in the presence of infection and inflammation in a variety of organ
systems. The objective of this investigation was to determine if apoptosis was increased in the chorion laeve of
term patients with and without histologic chorioamnionitis.

Methods: Records of placental pathology were reviewed with respect to the presence/absence of histologic
chorioamnionitis. Sections from formalin‐fixed, paraffin‐embedded fetal membrane rolls were stained using the
TUNEL method. The proportion of apoptotic nuclei was calculated in seven high‐powered fields/section. Those
with and without histologic chorioamnionitis were compared. Datawere analyzed using the Mann—Whitney U test,
with significance defined as p < 0.05.

Results: There was no significant difference in demographic or clinical characteristics between the two groups.
The chorion laeve from subjects with histologic chorioamnionitis had significantly more apoptotic nuclei when
compared to those without chorioamnionitis (11.2% vs. 5%, p = 0.02).

Conclusion: Apoptosis ismore prevalent in the chorion laeve of fetal membranes with histologic chorioamnionitis.
This finding suggests that infection/inflammation may impact cell survivalwithin fetal membranes. The implications
of these findings warrant further investigation.
Accuracy of Five Different Diagnostic Techniques inMild‐to‐Moderate Pelvic Inflammatory Disease
Authors: Gaitán Hernando , Angel Edith , Diaz Rodrigo , Parada Arturo , Sanchez Lilia , Vargas Cara
Published: March 2007

Objective: To evaluate the clinical diagnosis of pelvic inflammatory disease (PID) compared with the diagnosis of
PID made by laparoscopy, endometrial biopsy, transvaginal ultrasound, and cervical and endometrial cultures.

Study design: A diagnostic performance test study was carried out by cross‐sectional analysis in 61 women. A
group presenting PID (n = 31) was compared with a group (n = 30) presenting another cause for non‐specific
lower abdominal pain (NSLAP). Diagnosis provided by an evaluated method was compared with a standard
diagnosis (by surgical findings, histopathology, and microbiology). The pathologist was unaware of the visual
findings and presumptive diagnoses given by other methods.

Results: All clinical and laboratory PID criteria showed low discrimination capacity. Adnexal tenderness showed
the greatest sensitivity. Clinical diagnosis had 87% sensitivity, while laparoscopy had 81% sensitivity and 100%
specificity; transvaginal ultrasound had 30% sensitivity and 67% specificity; and endometrial culture had 83%
sensitivity and 26% specificity.

Conclusions: Clinical criteria represent the best diagnostic method for discriminating PID. Laparoscopy showed
the best specificity and is thus useful in those cases having an atypical clinical course for discarding abdominal
pain when caused by another factor. The other diagnostic methods might have limited use.
Lack of an Effect of Protease Inhibitor Use on GlucoseTolerance During Pregnancy
Authors: Dinsmoor Mara J. , Forrest Scott T.
Published: March 2007

Objective: We hypothesized that HIV‐positivewomen on protease inhibitors (PIs) would be more likely to have an
elevated glucola test result than those not on PIs.

Methods: We reviewed our database of all HIV‐positive pregnant women seen at our hospital. Serum glucose
was measured 1 hour following a 50‐g glucola load, at approximately 26–28 weeks of gestation. Statistical
analysis was performed using Student′s t‐test, Fisher′s exact test, and the Mann–Whitney rank sum test.

Results: Forty‐one HIV‐infected pregnant women with glucola testing were seen between January 1, 1997 and
March 1, 2000. Fourteen patients were on PIs at the time of glucola. One patient in each group had an abnormal
glucola test result (glucose ≥140 mg/dl); both had normal 3‐hour glucose tolerance tests. The glucola test results
were similar between the PI‐exposed and unexposed, with a mean difference of 5.8 mg/dl (95% confidence
interval 9.2–20.8 mg/dl). Two neonates (both exposed to PI) had hypoglycemia (glucose < 40 mg/dl).

Conclusions: The use of PIs does not significantly increase the risk of an elevated glucola result, nor is the
mean glucola result increased in the women on PIs. The finding of hypoglycemia in neonates exposed to PIs
merits further investigation.
Compliance With Protocols for Prevention of Neonatal Group B Streptococcal Sepsis: Practicalities and Limitations
Authors: Gilbert Gwendolyn L. , Hewitt Moira C. , Turner Catherine M. , Leeder Stephen R.
Published: March 2007

Objective: To compare two protocols for intrapartum antibiotic prophylaxis (IAP) against neonatal group B streptococcal (GBS) sepsis, with respect to staff compliance, in a prospective cohort study in the obstetric units of a community hospital (A) and a university teaching hospital (B).

Methods: Cohorts comprised about 500 women attending antenatal clinics at each hospital (total 1096). Women identified as GBS carriers at 26–32 weeks′gestation and those who had intrapartum clinical risk factors (CRF) were eligible for IAP. Compliance was defined as the proportion of women eligible for IAP who received it according to protocol–as determined by audit of case records–and compared between hospitals and according to indication.

Results: Overall, 39% of women were eligible for IAP. Indications were GBS carriage alone (21%), CRF alone (13% ) and both (5% ). Compliance was similar for GBS carriers at both hospitals: 78% at Hospital A and 76% at Hospital B. However, because of the poor predictive value of screening before 32 weeks, only 65%of intrapartum GBS carriers actually received IAP. For women with CRF only, compliance was significantly lower at Hospital B than Hospital A (56 vs. 75%; p= 0.03).

Conclusions: According to currently recommended protocols, about one‐third of healthy women are eligible for intrapartum antibiotics to prevent neonatal GBS sepsis. In practice, antibiotics are often used inefficiently because of poor compliance with protocols and poor predictive values of selection criteria. Better implementation strategies should improve compliance, but GBS vaccines are needed to replace prophylactic antibiotic use, with its associated disadvantages.
Leukocyte Esterase Activity in Vaginal Fluid of Pregnant andNon‐Pregnant Women With Vaginitis/Vaginosis and in Controls
Authors: Mårdh Per-Anders , Novikova Natalia , Niklasson Ola , Bekassy Zoltan , Skude Lennart
Published: March 2007

Objectives: To determine the leukocyte esterase (LE) activity in vaginal lavage fluid of women with acute and
recurrent vulvovaginal candidosis (VVC and RVVC respectively), bacterial vaginosis (BV), and in pregnant and
non‐pregnant women without evidence of the three conditions. Also to compare the result of LE tests in women
consulting at different weeks in the cycle and trimesters of pregnancy.The LE activity was correlated to vaginal pH,
number of inflammatory cells in stained vaginal smears, type of predominating vaginal bacteria and presence of
yeast morphotypes.

Methods: One hundred and thirteen women with a history of RVVC, i.e. with at least four attacks of the
condition during the previous year and who had consulted with an assumed new attack of the condition, were
studied. Furthermore, we studied 16 women with VVC, 15 women with BV, and 27 women attending for control
of cytological abnormalities, who all presented without evidence of either vaginitis or vaginosis. Finally, 73
pregnant women were investigated. The LE activity in vaginal fluid during different weeks in the cycle of 53 of
the women was measured.

Results: In the non‐pregnant women, an increased LE activity was found in 96, 88, 73 and 56% of those
with RVVC, VVC and BV and in the non‐VVC/BV cases, respectively. In 73% of pregnant women in the second
trimester, and 76% of those in the third, the LE test was positive. In all groups of non‐pregnant women tested,
the LE activity correlated with the number of leukocytes in vaginal smears, but it did not in those who were
pregnant. There was no correlation between LE activity and week in cycle. The vaginal pH showed no correlation
to LE activity in any of the groups studied.

Conclusions: The use of commercial LE dipsticks has a limited value in the differential diagnosis of RVVC, VVCand
BV. There is no correlation between the LE activity in vaginal secretion on one hand and vaginal pH, week in
the menstrual cycle and trimester in pregnancy on the other. Women with BV often have signs of inflammation
as evidenced by a positive LE test and inflammatory cells in genital smears.
Etiology of Persistent Tubo‐Ovarian Abscess in Nairobi, Kenya
Authors: Cohen Craig R. , Gravelle Lisa , Symekher Samwel , Waiyaki Peter , Stamm Walter E. , Kiehlbauch Julia A.
Published: March 2007

Objective To study the microbial etiology of tubo‐ovarian abscess (TOA).

Methods We recruited 11 women in Nairobi, Kenya who failed antibiotic therapy alone and required
surgical drainage of a presumptive TOA. Pus from the nine abscesses and two pyosalpinges were collected and
cultured for aerobic, facultative and anaerobic microorganisms.

Results Eleven women suspected of having a TOA were hospitalized and treated for a median of 6 days (range
3–14 days) prior to surgical drainage of the abscess. Nine (82%) specimens were culture positive. Aerobes
were present in all nine specimens. Seven of the nine positive cultures (78%) were polymicrobial and five of
the polymicrobial cultures contained both anaerobes and aerobes. Anaerobic Gram‐negative bacilli (Prevotella sp.,
Porphyromonas sp. and Bacteroides sp., Escherichia coli ) and Streptococcus sp. ( S. viridans and S. agalactiae) were the
most common microorganisms isolated. Neisseria gonorrhoeae and Chlamydia trachomatis were not isolated by
culture or detected by polymerase chain reaction.

Conclusions In Kenya, persistent TOAs are associated with endogenous flora similar to that normally found
in the gastrointestinal tract.
Pregnancy‐Associated Pyogenic Sacroiliitis: Case Report and Review
Authors: Almoujahed Mohammad O. , Khatib Riad , Baran Joseph
Published: March 2007

Background: Pyogenic sacroiliitis occurs infrequently during the peripartum period.

Case: A case at our institution and a review of the literature were analyzed. A total of 15 cases were discovered.
The onset of illness was during pregnancy (40% of cases), within 3 weeks postpartum (40%) or post‐abortion
(20%), and the presentation was usually acute (< 7 days in 67% of cases). Frequent manifestations included
localized pain in the hips or buttock, sacroiliac joint tenderness and fever. Computed tomography or magnetic
resonance imaging revealed joint involvement in all cases tested. Microbiology was confirmed by blood (40%) or
joint aspirate (75%), and most patients were treated with antibiotics. Surgical intervention took place in five cases.
Pretermlabor was reported in only one case. All patients respondedwell to therapy without locomotive disability,
and persistent pain was uncommon.

Conclusion: Septic sacroiliitis should be considered in peripartum patients who present with fever and severe
localized pain. Medical management is usually curative, and without an adverse effect on pregnancy.
Performance of the Syva Direct Fluorescent AntibodyAssay for Chlamydia in a Low‐Prevalence Population
Authors: Reedy Mark B. , Sulak Patricia J. , McCombs William B. , Kuehl Thomas J.
Published: March 2007

Chlamydia trachomatis is the most common reportable sexually transmitted disease (STD) in the
United States. In the 1980s, rapid diagnostic tests for chlamydia began to replace more cumbersome
tissue culture methods. Current data on rapid antigen detection assays demonstrate acceptable
sensitivity, specificity, and predictive values in populations with a high prevalence of chlamydia.
Few studies report the performance of these assays in a low‐prevalence obstetric and gynecologic
(Ob/Gyn) population, This study compares the most commonly used direct fluorescent antibody
(DFA) assay (Syva Microtrak) with tissue culture (TC) in a low‐prevalence population. Endocervical
specimens (775) were tested from women at risk for chlamydia infection, and the prevalence
was found to be 7.7%. The DFA assay demonstrated a sensitivity of 80% and a specificity of 97%
compared with TC. The positive and negative predictive values were 72% and 98%, respectively.
The results of this study indicate that the Syva DFA assay lacks the sensitivity and positive
predictive value for routine use in Ob/Gyn populations with a lowprevalence of C. trachomatis.
Prematurity, Subclinical Intraamniotic Infection, and FetalBiophysical Parameters: Is There a Correlation?
Authors: Cox Susan M. , Roberts Scott , Roussis Percilis , Campbell Berry A. , Curry Thomas E.
Published: March 2007

Objective: This prospective study was undertaken to examine the effects of subclinical intraamniotic
infection on fetal behavioral patterns.

Methods: Amniotic fluid was obtained from four groups of patients (n = 99): group 1, patients
with preterm premature rupture of the fetal membranes (PPROM) without infection; group 2,
patients with PPROM and infection; group 3, patients with preterm labor (PTL) and without
infection; and group 4, patients with PTL and infection. Fetal biophysical profiles were obtained on
admission to the labor suite. Amniotic fluid was analyzed for the presence of microorganisms and
endotoxin to confirm intraamniotic infection; cytokines interleukin (IL)‐1β, IL‐6, and IL‐8 were
also assayed.

Results: We found no association between low scores for biophysical parameters and subclinical
infection in patients with PPROM or PTL.

Conclusions: We could not demonstrate that upon a patient′s admission to the labor hall absent
fetal breathing and absent fetal movement, as well as reactivity, correlate with subclinical intraamniotic
infection. Elevated cytokines, i.e. IL‐1β, IL‐6, and IL‐8 were associated with subclinical
chorioamnionitis.
Quinolones for the Treatment of Neisseria Gonorrhoeae and Chlamydia Trachomatis
Authors: Faro Sebastian
Published: March 2007

The most commonly sexually transmitted bacteria are Neisseria gonorrhoeae and
Chlamydia trachomatis. The quinolones ofloxacin and ciprofloxacin have been
shown to have activity against both of these bacteria in vitro and in vivo. Ofloxacin is
particularly well suited for the treatment of N. gonorrhoeae and C. trachomatis cervical
infection, which can be considered the earliest manifestation of pelvic inflammatory
disease (PID). Not only can ofloxacin be effectively used as a single agent, it is also useful
in treating urinary tract infections caused by Enterobacteriaceae. Although it has
moderate activity against anaerobes in general, ofloxacin does have activity against the
anaerobes commonly isolated from female patients with soft tissue pelvic infections.
Thus, ofloxacin has the potential for being utilized to treat early salpingitis.
Evaluation of Infectious Disease Knowledge in Obstetrics and Gynecology and the Effects of Varying Durations of Training
Authors: Martens Mark G.
Published: March 2007

Objective: The amount, origin, and resources of infectious disease
knowledge in the field ofobstetrics and gynecology were investigated. If this knowledge is
lacking, the exact length of the specific infectious disease training during residency should
be defined to meet the ever‐increasing knowledge required in training.

Methods: A 50‐question test was developed by one faculty member
utilizing questions that incorporated the basic sciences of microbiology and pharmacology
and clinical knowledge of infectious diseases in the area of obstetrics and gynecology.
Multiple choice and matching questions were structured so as to ascertain the source of the
knowledge, including medical school curriculum, recent journal articles, and clinical
experience.

Results: The test was given yearly to all students and residents on the
Obstetric and Gynecology Service over a period of 2 year′s. The questions were the same for
each group, but were reshuffled each exam period. Three hundred and seven tests were
properly administered and recorded. There was no statistical improvement in any successive
year’s scores unless specific infectious disease training occurred. Increasing improvement in
scores was noted, with an increasing duration of infectious disease training specific for
obstetrics and gynecology, beginning at 2 weeks (22% improvement), 4 weeks (30%
improvement), and 6 weeks (31% improvement) (P = .05–.001). Basic science questions were
most frequently answered correctly by medical students and early residents, while correctly
answered clinical questions correlated with increasing clinical experience except in
the area of ambulatory care.

Conclusions: The infectious disease knowledge of residents in
obstetrics and gynecology can be improved with 4 weeks of intensive training.
Re‐exposure to basic science knowledge and improved training in ambulatory care in this
resident group appear to be necessary. This test or similar tests can be helpful in defining
areas of deficiencies and their possible remedies.
Coccidioidal Placentitis With Normal Umbilical Artery Velocimetry
Authors: Nickisch Stephen A. , Izquierdo Luis , Vill Maggie A. , Curet Luis , Wolf Gordon C.
Published: March 2007

Background: Disseminated coccidiomycosis during pregnancy can lead
to both maternal and neonatal mortality. Placentitis is an uncommon sequelae and its effect
on placental function remains speculative. The present report describes our management of
such a case and describes serial umbilical artery velocimetry of an affected placenta.

Case: A pregnant woman with coccidioidal placentitis confirmed
histologically was treated with systemic and intrathecal amphotericin B starting at 28 weeks
gestation. Serial umbilical artery velocimetry revealed that all systolic/diastolic ratios
remained normal, and a normal infant was delivered at term.

Conclusion: Coccidioidal placentitis was successfully treated with
amphotericin B; serial umbilical artery velocimetry monitoring exhibited no abnormalities
and, along with other reassuring fetal parameters, allowed continuation of the pregnancy to
term.
Amniotic Fluid Glucose Concentration: A Marker for Infection in Preterm Labor and Preterm Premature Rupture of Membranes
Authors: Dildy Gary A. , Pearlman Mark D. , Smith Leon G. , Tortolero-Luna Guillermo , Faro Sebastian , Cotton David B.
Published: March 2007

Amniotic fluid Gram stain and culture have been utilized as laboratory tests of microbial
invasion of the amniotic cavity. The Gram stain of amniotic fluid has a low sensitivity in the
detection of clinical infection or microbial invasion of the amniotic cavity, and amniotic fluid
culture results are not immediately available for management decisions. Glucose
concentration is used to diagnose infection in other sites such as cerebrospinal fluid.

Objective: The purpose of this study was to evaluate the usefulness
of amniotic fluid glucose concentration in detecting microbial invasion of the amniotic
cavity associated with preterm labor and preterm premature rupture of membranes.

Methods: Amniocentesis was performed in 60 women with preterm labor
and/or preterm premature rupture of membranes. Gram stain and culture for Mycoplasma hominis,
Ureaplasma urealyticum, aerobic, and anaerobic bacteria were performed. Subjects
were studied prospectively for the development of positive amniotic fluid cultures and the
development of clinical chorioamnionitis.

Results: The diagnosis of clinical chorioamnionitis was made in
25% (15/60) of women entered into the study. Low amniotic fluid glucose concentration
Was considered < 15 mg/dl. The sensitivity, specificity, and positive predictive value
of low amniotic, fluid glucose concentration to predict clinical chorioamnionitis were 73.3%,
88.1%, and 68.8% respectively, while positive amniotic fluid culture, hada sensitivity of
43.8%, specificity of 79.5%, and positive predictive value of 43.8%.

Conclusions: Amniotic fluid glucose concentration was more sensitive
in predicting chorioamnionitis than either Gram stain or culture. Amniotic fluid glucose
concentration was better in predicting clinical chorioamnionitis than predicting positive
amniotic fluid culture results. Gestational age‐dependent normal ranges and pathologic
conditions that may alter amniotic fluid glucose concentrations should be considered
when interpreting amniotic fluid glucose values to diagnose microbial invasion of the
amniotic cavity.
Screening for Chlamydia trachomatis in Low‐Risk Obstetric Patients
Authors: Gribble Robert K. , Ricci-Goodman Jean M. , Berg Richard L.
Published: March 2007

Objective: The purpose of this study was to evaluate the prevalence of
Chlamydia trachomatis in our rural obstetric population and assess the appropriateness
of selective vs. universal prenatal screening.

Methods: Between April 1, 1991 and May 1, 1993, 1,587 patients were
screened at their first prenatal visit using a C. trachomatis antigen test. Patients who were
unmarried, younger than 20 years of age, or had a history of a previous sexually transmitted
disease (STD) were classified as being at high risk for C. trachomatis. All others were
considered low risk for C. trachomatis.

Results: The overall prevalence of C. trachomatis was 2.0%.
There was a significant difference (P < 0.001) in the 1,128 patients
considered low risk [0.5%, 95% confidence interval (CI) 0.2–1.2] compared to the 459 patients
with one or more identifiable risk factors (5.7%, 95% CI 3.7–8.2).

Conclusions: Routine prenatal screening for C. trachomatis in our
population is not appropriate for low‐risk patients.
Rapid Polymerase Chain Reaction–Based Test for the Detection of Female Urogenital Chlamydial Infections
Authors: Wiesenfeld Harold C. , Uhrin Michael , Dixon Bruce W. , Sweet Richard L.
Published: March 2007

Objective: The purpose of this study was to evaluate the Amplicor
Chlamydia trachomatis Test (Roche Molecular Systems, Branchburg, NJ),
a polymerase chain reaction (PCR)‐based technique, as a screening test for the detection
of female urogenital C. trachomatis infections, comparing it to an enzyme
immunoassay method.
Methods: Endocervical specimens for PCR and Chlamydiazyme
(Abbott Laboratories, North Chicago, IL) analysis were obtained from 328 unselected
patients at the outpatient Sexually Transmitted Diseases Clinic at the Allegheny County
Health Department, Pittsburgh, PA. In addition, urethral swabs for PCR analysis were
obtained from 256 of these patients.
Results: By PCR analysis, the prevalence of urogenital chlamydial
infections was 15.6% and that of cervical chlamydial infections was 10.7%. The
sensitivity of PCR in the detection of endocervical chlamydial infections was 89.7% and
the specificity was 100%. The positive and negative predictive values of PCR were
100% and 99%, respectively. The sensitivity of Chlamydiazyme in the detection of cervical
infections was 61.5% and the specificity was 99.7%, with a positive predictive value of
96.0%. Among all patients with urogenital chlamydial infections, concomitant infections in the
urethra and cervix occurred in 52.5%, whereas the urthra or cervix was solely infected in 35.0%
and 12.5%, respectively.
Conclusions: This PCR‐based technique is a rapid screening
tool for the diagnosis of urogenital chlamydial infections and is more sensitive
than Chlamydiazyme for endocervical infections in a sexually transmitted disease
clinic population.
Effect of Resident Physician Education Regarding Selective Chemoprophylaxis for the Prevention of Early Onset Group B Streptococcal Sepsis: An Outcome Study
Authors: Greenspoon Jeffrey S. , Rosen Doron J. D. , Sumen Anita P.
Published: March 2007

Objective: The aim of this study was to evaluate the effect of a voluntary
protocol for selective intrapartum chemoprophylaxis on the incidence of early onset group
B streptococcal sepsis (GBS EOS).

Methods: Cases of GBS EOS were defined as a positive GBS culture
from a normally sterile fluid obtained during the first 7 days of life. All cases of GBS EOS at an
urban, university‐affiliated community hospital were reviewed during 2 time periods.
The 2‐year period before instituting a resident education program to promote selective
chemoprophylaxis (1988–89) was retrospectively reviewed; the 2‐year period after the
education program was introduced (1990–91) was prospectively recorded. The outcome
measure was the incidence of GBS EOS.

Results: The rate of GBS EOS was 7/14,335 deliveries (0.05%) before
and 9/13,999 (0.064%) after the introduction of the education program (observed
difference between proportions 0.016%, 95% confidence interval [CI] for the difference
between the proportions –0.071% to 0.04%, P = not significant [NS]). The rate of GBS EOS
in preterm infants was 5/1,331 (0.376%) before and 3/1,297 (0.23%) afterward (observed
difference between proportions 0.14%, 95% CI –0.28% to 0.56%, P = NS). The incidence
of GBS EOS did not decrease during the latter period due to failure of antepartum
cultures to predict intrapartum GBS colonization (2 cases); non‐compliance with voluntary
recommendations to administer chemoprophylaxis (2 cases); failure of chemoprophylaxis or
therapy for intraamniotic infection to prevent neonatal infection (3 cases); and occurrence
of GBS EOS in infants without risk factors (2 cases).

Conclusions: An education program for resident physicians regarding
chemoprophylaxis for GBS EOS did not significantly reduce the absolute incidence
of disease. Alternative strategies are needed that redress the causes of failure inherent
in the current guidelines. Some cases of GBS EOS are not preventable because the parturient
does not have risk factors that indicate chemoprophylaxis.
Randomized Trial of Antibiotics in Addition to Tocolytic Therapy to Treat Preterm Labor
Authors: Watts D. Heather , Krohn Marijane A. , Hillier Sharon L. , Eschenbach David A.
Published: March 2007

Objective: The objective of this study was to assess whether antibiotic
therapy plus tocolysis given to women in preterm labor would prolong pregnancy
compared with tocolysis alone.

Methods: A randomized, double‐blind trial of intravenous
mezlocillin and oral erythromycin therapy vs. placebo was used in addition to
tocolysis among women in preterm labor ≤34 weeks gestation with intact
membranes. Amniocentesis was performed, and chorioamnionic membranes
were examined histologically and cultured for microorganisms after delivery.

Results: Clinical characteristics including gestational age at
enrollment, frequency of contractions, cervical Bishop′s score, and white blood
cell count on admission were similar in the 2 groups. Antibiotic therapy was well tolerated.
No significant differences in the interval to delivery, birth weight, and neonatal outcomes
were observed between the 2 groups. Women in the antibiotic group had a significantly
lower incidence of postpartum infections compared with women in the placebo group.
Patients with evidence of upper genital tract infection in either group had a significantly
shorter interval to delivery, lower gestational age at delivery, lower mean birth weight,
and increased neonatal hospitalization time.

Conclusions: Lack of an antibiotic effect on the gestational age
at delivery may be due to the low prevalence of upper genital tract infection among
unselected women in preterm labor, to advanced preterm labor unresponsive to antibiotic
therapy, or to an inability of antibiotics given alone to inhibit the cytokine response.
Further work is needed to identify markers of upper genital tract infection
among women in preterm labor and to evaluate other potential therapeutic interventions.
Ovarian Abscess Following Therapeutic Insemination
Authors: Kolb Bradford A. , Mercer Lane , Peters Albert J. , Kazer Ralph
Published: March 2007

Background: Artificial insemination is a commonly performed
procedure for the treatment of various forms of infertility. Infectious complications have only
rarely been noted as a complication of intrauterine insemination (IUI).

Case: In this presentation, we report the first case of an ovarian
abscess following IUI with the husband′s semen. Despite treatment with triple antibiotics,
an oophorectomy was required. Surgical as well as pathological evaluation confirmed the
diagnosis of an ovarian abscess. Following surgery, the patient responded well to antibiotic
therapy.

Conclusion: Since pelvic infections are ascending processes, the
violation of the natural cervical barrier with IUI can theoretically place the patient at
increased risk for this complication. While few advocate routine cultures of semen
samples, the clinician must be acutely alert to potential infectious morbidity following
this procedure. Early diagnosis and intervention are necessary to minimize
morbidity and optimize treatment.