bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Chlamydia trachomatis Infection Among WomenAttending Rural Midwest Family Planning Clinics
Authors: Hilger Tami M. , Smith Elaine M. , Ault Kevin
Published: March 2007

Objective: To determine predictors of Chlamydia trachomatis infection among women 14–24 years of age
attending family planning clinics throughout a rural Midwestern state.

Methods: The study population included 16 756 women between the ages of 14 and 24 years attending family
planning clinics for annual examinations throughout the state of Iowa in 1997. All women under 25 years of age
having annual exams were tested for C. trachomatis during the visit. At the time of exam, both behavioral and
demographic data were collected on all women participating in the study.

Results: The majority of women in the study (96%) reported no symptoms of chlamydia. Only 2.5% of all women
had a positive test result. In the multivariate model, the odds ratios were significantly increased among the youngest
age (14–17 years; OR = 2.2), those with mucopurulent cervicitis (OR = 3.4), cervical friability (OR = 2.2),
symptomatic for infection (OR = 1.8), risk history (OR = 1.6), and black race (OR = 1.2) and predictive of a
C. trachomatis infection.

Conclusions: Risk factors predictive of C. trachomatis infection among younger aged women attending family
planning clinics in a Midwest rural population are consistent with predictors of infection among women attending
family planning clinics across theUnited States. The overall findings suggest the importance of developing screening
guidelines as a means of lowering chlamydia rates. This may be a particularly difficult task in light of the low rate of
symptoms that would lead a woman to seek medical care, even in younger age women who are at higher risk. In
addition, screening guidelines would be more difficult to implement in a rural setting.
Efficacy of Clindamycin Vaginal Ovule (3‐Day Treatment) vs.Clindamycin Vaginal Cream (7‐Day Treatment) in Bacterial Vaginosis
Authors: Sobel Jack , Peipert Jeffrey F. , McGregor James A. , Livengood Charles , Martin Maureen , Robbins Jill , Wajszczuk Charles P.
Published: March 2007

Objective: To compare the efficacy and safety of a 3‐day regimen of clindamycin vaginal ovules with a 7‐day
regimen of clindamycin vaginal cream for the treatment of bacterial vaginosis (BV)

Methods: Women with a clinical diagnosis of BV were treated with a 3‐day course of clindamycin ovules or a 7‐day
course of clindamycin cream administered intravaginally. Three hundred and eighty‐four patients received study
drug and were included in the evaluable patient population (ovule group, n = 204; cream group, n = 180).
Assessments included pelvic examination and diagnostic testing. Primary efficacy endpoints were a resolution of
two of three diagnostic criteria at the first follow‐up visit and three of three diagnostic criteria at the second.

Results: Cure rates in the evaluable patient population were similar between treatment groups: 53.7% (109/204)
for the ovule group and 47.8% (85/180) for the cream group (p = 0.2471, 95% CI– 4.1–16.0%). The most
commonly reported medical event, vulvovaginal pruritus, had similar incidence in both treatment groups.

Conclusions: A 3‐day course of clindamycin vaginal ovules is as effective and well‐tolerated as a 7‐day course of
clindamycin vaginal cream in the treatment of BV.
Vaginal Microflora Associated With Bacterial Vaginosis inNonpregnant Women: Reliability of Sialidase Detection
Authors: Smayevsky Jorgelina , Canigia Liliana Fernández , Lanza Alejandra , Bianchini Hebe
Published: March 2007

Objective: To determine the prevalence of Gardnerella vaginalis, anaerobic bacteria and Mycoplasma hominis in vaginal specimens of women with and without bacterial vaginosis (BV) as well as to determine the sensitivity and specificity of the direct sialidase assay of vaginal fluid as a rapid test for diagnosing this syndrome.

Methods: Vaginal cultures were obtained from 109 nonpregnant women (mean age 33 ± 7.1 years), 47 of them with clinical signs of BV (BV+) and 62 of them without BV (BV‐ ). In addition, we determined the vaginal sialidase
activity in both groups, which may serve as a feature of this syndrome.

Results: Anaerobic bacteria were isolated in 91% and 18% of the BV+and BV‐ groups, respectively (p < 0.001).
Peptostreptococcus spp., Prevotella bivia and Porphyromonas spp. were strongly associated with BV. P. bivia and
Prevotella spp. represented 44% of all the anaerobes isolated in the BV+ group. All the isolated P. bivia strains presented sialidase activity. G. vaginalis and M. hominis were isolated in 76% and 42% of the BV+ and 1% and 0%
of the BV‐ women, respectively (p < 0.001). Mobiluncus morphotypeswere observed in 34% of the BV+and 0%
of BV‐ women. Sensitivity, specificity, positive predictive value and negative predictive value of sialidase activity
were 81%, 94%, 90% and 86%, respectively.

Conclusions: Our data demonstrate a strong association between G. vaginalis, M. hominis, and P. bivia and BV.
Sialidase activity and Gram stain of vaginal fluid represent accurate methods for diagnosing BV.
Antimicrobial Protein Produced by Vaginal Lactobacillusacidophilus that inhibits Gardnerella vaginalis
Authors: Aroutcheva Alla A. , Simoes Jose A. , Faro Sebastian
Published: March 2007

Objective: To isolate bacteriocin from a vaginal strain of Lactobacillus acidophilus.

Methods: L. acidophilus 160 was grown on two media. The first was MRS broth for 18 hours; the cells were
harvested, washed, and placed into a chemically defined medium. The second medium resembled vaginal fluid minus protein. Bacteriocin was precipitated from both media using ammonium sulfate. The growth‐inhibiting
activity of bacteriocin was determined by a bioassay using nine different isolates of Gardnerella vaginalis.

Results: MRS broth is not a suitable medium for extracting bacteriocin, because it binds with Tween 80.
Bacteriocin was isolated, without contaminating constituents, from chemically defined medium and identified as a single band by electrophoresis. Bacteriocin has a molecular weight of 3.8 kDa. All nine isolates of Gardnerella were inhibited by the bacteriocin isolated from L. acidophilus 160.

Conclusions: Bacteriocin produced by L. acidophilus 160 was isolated from the chemically defined medium
(starvation medium) in a partially pure form. L. acidophilus 160 bacteriocin inhibited growth of all nine isolates of Gardnerella vaginalis.
Septic Shock Resulting in Death After Operative Delivery
Authors: Kavak Zehra Neşe , Başgül Alin
Published: March 2007

Background: We report a youngwoman who developed septic shock after operative delivery in the 32nd week of
pregnancy.Clinical features, treatment modalities and prognosis of this high‐mortality‐rate disorder are presented
and discussed.

Case: A 24‐year‐old woman, gravida 1, para 1, was referred to our clinic in a confused state and immediately
admitted to our emergency unit. She apparently had eclampsia antenatally. Termination of pregnancy with
induction of labor and vacuum extraction had been employed in gestational week 32 of pregnancy. One day after
delivery, her clinical and laboratory parameters worsened, so she was referred to our clinic. After a thorough
physical examination and laboratory evaluation, the patient was diagnosed as having sepsis and disseminated
intravascular coagulation. After blood and urine cultures were taken, aggressive management included volume
repletion, antibiotics and positive inotropic therapy. Because she had persistent fever and unimproved laboratory
values despite these therapies, the uterus and ovaries were thought to be the source of sepsis, and total abdominal
hysterectomy and bilateral salpingo‐oophorectomy were performed. Neither clinical nor laboratory parameters
improved, and the patient died 28 days after delivery as a result of respiratory failure.

Conclusion: It is our purpose to emphasize that a rapid and appropriate decision for surgery may prevent the
maternal mortality in obstetric septic shock patients. Successful management depends on early identification and
aggressive treatment.
Adhesion Development and the Expression of Endothelial Nitric Oxide Synthase
Authors: Svinarich David M. , Zaher Fadi M. , Holmdahl Lena , Chegini Nasser , Gonik Bernard , Diamond Michael P.
Published: March 2007

Objective: This study was conducted to determine whether nitric oxide (NO), a potent vasodilator and inhibitor of thrombus formation, is involved in the formation and maintenance of adhesions.

Methods: Skin, subcutaneous tissues, peritoneum and adhesions were collected from surgical patients and total RNA was isolated. Quantitative reverse transcription polymerase chain reaction (QRT‐PCR) was performed to quantitate endothelial nitric oxide synthase (eNOS) and β‐actin mRNA levels.

Results: eNOS mRNA levels for skin, subcutaneous tissue, peritoneum and adhesions were ≤ 3.12 × 10-4, ≤ 3.12 × 10-4, 6.24 × 10-4 and 2.5 × 10-3 attomoles/μl, respectively. β‐actin mRNA levels for all tissues were between 1.25 × 10-1 and 6.25 × 10-2 attomoles/μl.

Conclusion: eNOS mRNA can be identified in tissue adhesions, and may therefore play a role in adhesion formation and maintenance.
Vaginal Mucormycosis: A Case Report
Authors: Sobel Jack D.
Published: March 2007

Although Zygomycetes cause life‐threatening, opportunistic infections in immunocompromised hosts, the first case
of vaginitis caused by Mucor species in a healthy woman is reported. Mucor vaginitis, which caused mild symptoms only, was refractory to conventional azole therapy and resistant to flucytosine. Cure was achieved with topical
amphotericin B.
A Multicenter Study of Bacterial Vaginosis in Women With orat Risk for Human Immunodeficiency Virus Infection
Authors: Warren Dora , Klein Robert S. , Sobel Jack , Kieke Burney , Brown William , Schuman Paula , Anderson Jean , Cu-Uvin Susan , Mayer Kenneth , Jamieson Denise J. , Holmberg Scott , Duerr Ann
Published: March 2007

Background: Bacterial vaginosis is a common gynecologic infection that has been associated with a variety of
gynecologic and obstetric complications, including pelvic inflammatory disease, postabortal infection and premature
delivery. Recent studies suggest that bacterial vaginosis may increase a woman’s risk for human immunodeficiency
virus (HIV). We undertook this study to assess whether the prevalence and characteristics of bacterial
vaginosis differed according to HIV status in high‐risk US women.

Methods: Prevalence of bacterial vaginosis was assessed by Gram’s stain and clinical criteria for 854 HIV‐infected
and 434 HIV‐uninfected women enrolled in the HIV Epidemiology Research (HER) Study.Multiple logistic regression
techniques were used to determine whether HIV infection independently predicted bacterial vaginosis.

Results: Almost half (46%) the women had bacterial vaginosis by Gram’s stain. The prevalence of bacterial
vaginosis was 47% in the HIV‐positive women compared with 44% in the HIV‐negativewomen; this difference was
not statistically significant (p = 0.36). After adjustment for other covariates, HIV‐positive women were more likely
than HIV‐negative women to have bacterial vaginosis (odds ratio (OR) 1.31; 95% confidence interval (CI)
1.01‐1.70) by Gram′s stain but not by clinical criteria (OR 1.16; CI 0.87‐1.55). Among HIV‐positive women, use of
antiretroviral drugs was associated with a lower prevalence of bacterial vaginosis (adjusted OR 0.54; Cl
0.38 ‐0.77).

Conclusions: In this cross‐sectional analysis of high‐risk US women, HIV infection was positively correlated with
bacterial vaginosis diagnosed by Gram’s stain.
Differentiation Between Women With Vulvovaginal SymptomsWho are Positive or Negative for Candida Species by Culture
Authors: Linhares Iara M. , Witkin Steven S. , Miranda Shirlei D. , Fonseca Angela M. , Pinotti Jose A. , Ledger William J.
Published: March 2007

Objective: To investigate whether clinical criteria could differentiate between women with vulvovaginitis who
were culture positive or negative for vaginal Candida species.

Methods: Vulvovaginal specimens were obtained from 501 women with a vaginal discharge and/or pruritis.
Clinical information and wet mount microscopy findings were obtained. All specimens were sent to a central
laboratory for species identification.

Results: A positive culture for Candida species was obtained from 364 (72.7%) of the specimens. C. albicans was
identified in 86.4% of the positive cultures, followed by C. glabrata in 4.5%, C. parapsilosis in 3.9%, C. tropicalis in
2.7% and other Candida species in 1.4%.Women with a positive Candida culture had an increased utilization of oral
contraceptives (26.1% vs. 16.8%, p = 0.02) and antibiotics (8.2% vs. 0.7%, p = 0.001), and were more likely to
be pregnant (9.1% vs. 3.6%, p = 0.04) than the culture‐negative women. Dyspareunia was more frequent in
women without Candida (38.0% vs. 28.3%, p = 0.03) while vaginal erythema (p = 0.01) was more common in
women with a positive Candida culture.

Conclusions: Although quantitative differences were observed, the presence of vaginal Candida vulvovaginitis
cannot be definitively identified by clinical criteria.
The Inhibitory Effect of Clindamycin on Lactobacillus in vitro
Authors: Aroutcheva Alla , Simoes Jose A. , Shott Susan , Faro Sebastian
Published: March 2007

Objective: To evaluate the in vitro effect of varying concentrations of clindamycin on Lactobacillus spp.

Methods: Concentrations of clindamycin ranging from 1.95–20 000 mg/ml were studied for their effect on the
growth of six strains of Lactobacillus .

Results: Clindamycin concentrations between 1.95–31.25 mg/ml had no statistically significant effect on growth of
lactobacilli (p > 0.05). Concentrations 125 and 250 mg/ml had a bacteriostatic effect. The mean minimum inhibitory
concentration (MIC) for studied Lactobacillus strains was determined as 1000 mg/ml.

Conclusion: High concentrations of clindamycin achieved in the vagina by intravaginal application might be
inhibitory for Lactobacillus .
Candida lusitaniae as an Unusual Cause of Recurrent Vaginitisand its Successful Treatment With Intravaginal Boric Acid
Authors: Silverman Neil S. , Morgan Margie , Nichols W. S.
Published: March 2007

Increasing use of short‐course antifungal therapies in patients with recurrent vulvovaginitis may enable the
emergence of less‐common, more resistant yeast strains as vaginal pathogens. We report the case of a patient with
chronically symptomatic and repeatedly treated vaginal candidiasis whose infection was attributable to Candidalusitaniae, a previously unreported cause of candidal vaginitis .
Urinalysis and Urinary Tract Infection: Update for Clinicians
Authors: Young Jennifer L. , Soper David E.
Published: March 2007

Dysuria is a common presenting complaint of women and urinalysis is a valuable tool in the initial evaluation of this presentation. Clinicians need to be aware that pyuria is the best determinate of bacteriuria requiring therapy and that values significant for infection differ depending on the method of analysis. A hemocytometer yields a value of ≥ 10 WBC/ mm 3 significant for bacteriuria, while manual microscopy studies show ≥ 8 WBC/high‐power field reliably predicts a positive urine culture. In cases of uncomplicated symptomatic urinary tract infection, a positive value for nitrites and leukocyte esterase by urine dipstick can be treated without the need for a urine culture. Automated urinalysis used widely in large volume laboratories provides more sensitive detection of leukocytes and bacteria in the urine.With automated microscopy, a value of > 2 WBC/hpf is significant pyuria indicative of inflammation of the urinary tract. In complicated cases such as pregnancy, recurrent infection or renal involvement, further evaluation is necessary including manual microscopy and urine culture with sensitivities.
Antimicrobial Susceptibility of Gram‐Negative UropathogensIsolated From Obstetric Patients
Authors: Jamie Whitney E. , Edwards Rodney K. , Duff Patrick
Published: March 2007

Objective: To evaluate the antimicrobial susceptibility of Gram‐negative uropathogens isolated from pregnant
women.

Methods: We performed a snapshot cohort study of women receiving care in the University of Florida prenatal
clinics duringMarch 2000. Subjects with asymptomatic bacteriuria or cystitis were identified and the antimicrobial
susceptibility of each pathogen was recorded. Data were analyzed using chi‐square, Fisher′s exact test and
ninety‐five percent confidence intervals, as appropriate.

Results: Ninety‐five positive cultures were identified. Isolates were more often susceptible to trimethoprimsulfamethoxazole
(TMP‐SMX) (87%) and nitrofurantoin (89%) than to ampicillin (72%) (p < 0.03). Escherichia coli
accounted for 71 (75%) cases and was more often susceptible to nitrofurantoin (100%) than to TMP‐SMX (87%)
(p < 0.01). Proteus isolates were all susceptible to TMP‐SMX and resistant to nitrofurantoin (p < 0.01).

Conclusions: Both TMP‐SMX and nitrofurantoin are superior to ampicillin for empiric treatment of lower urinary
tract infection in pregnant women. Nitrofurantoin is superior to TMP‐SMX for treatment of infections caused by
E. coli. For suspected or confirmed cases caused by Proteus organisms, TMP‐SMX is the preferred agent.
Does Pre‐ and Postoperative Metronidazole Treatment LowerVaginal Cuff Infection Rate After Abdominal HysterectomyAmong Women With Bacterial Vaginosis?
Authors: Larsson Per-Göran , Carlsson Bodil
Published: March 2007

Objective: Bacterial vaginosis (BV) is a known risk factor for postoperative infection following abdominal hysterectomy.
Vaginal bacterial flora scored as intermediate has been shown to have the same risk of postoperative
infection as BV.

Methods: Women undergoing total abdominal hysterectomy for benign diseases were open‐randomized according
to Zelen to either treatmentwith metronidazole rectally for at least 4 days or no treatment. At the preoperative
gynecological examination a vaginal smear was collected and Gram stained. Women with BV or intermediate flora
were merged to one group called abnormal vaginal flora.

Results: In total 213 women were randomized to treatment or no treatment. After exclusion of 71 women, 142
women were eligible for analysis. Among the 59 women diagnosed with abnormal vaginal flora there were no
vaginal cuff infections in the treated arm, comparedwith 27% in the ‘no treatment’ arm (p <0.01). Treatment also
reduced the vaginal cuff infection rate from 9.5 to 2% among the 83 women with lactobacilli flora. However,
this difference was not statistically significant. Treatment had no effect on the rate of wound infections.
Intention‐to‐treat analysis showed a significant reduction in vaginal cuff infections among women randomized
to treatment.

Conclusion: Pre‐ and postoperative treatment for at least 4 days with metronidazole rectally reduces
significantly vaginal cuff infection among women with abnormal vaginal flora.
Site‐Specific Prevalence and Cell Densities of Selected Microbesin the Lower Reproductive Tract of Menstruating Tampon Users
Authors: Hochwalt Anne E. , Berg Ronald W. , Meyer Sandy J. , Eusebio Rachelle
Published: March 2007

Objective: To assess differences in prevalence and cell densities of enterococci, Gram negative enterics (GNEs),
yeast and Staphylococcus aureus among four genital sites and to examine whether the presence of organisms at one
site affected the presence of organisms at other sites.

Methods: Swab samples from the perineum, below and above the hymen, and the posterior fornix obtained
from 52 tampon users on menstrual cycle day 3 were analyzed for site‐specific prevalence and cell densities of
microorganisms.

Results: Enterococci and GNEs were the most prevalent study organisms at all sites and decreased in prevalence
fromthe perineumto the posterior fornix.Cell densities similarly decreased frombelow the hymen to the posterior
fornix. Yeast were detected at the hymen only; S. aureus frequency was similarly low at all sites. Yeast and S. aureus
site‐specific cell densities were similar. The above‐ and below‐hymen sites were similar in prevalence and cell
density of organisms. An above‐chance association existed between the presence of any study organism below
the hymen and above the hymen and was strongest for GNEs.

Conclusions: The pattern of genital colonization with enterococci and GNEs reflects their likely gastrointestinal
source. The absence of significant differences in the prevalence and cell densities of study microflora above and
below the hymen combined with an above‐chance association of the presence of microorganisms at these regions
suggests that the regions above and below the hymen are not different with respect to the presence of the
organisms evaluated in this study.
Varicella Vaccination During Early Pregnancy: A Cause ofin utero Miliary Fetal Tissue Calcifications and Hydrops?
Authors: Apuzzio Joseph , Ganesh Vijaya , Iffy Leslie , Al-Khan Anthony
Published: March 2007

Background: It is the purpose of this article to describe a suspected association of inadvertent vaccination with
varicella vaccine during early pregnancy with the subsequent development of in utero miliary fetal tissue
calcifications and fetal hydrops detected by sonogram at 15 weeks of gestation.

Case: This is a case presentation of a pregnant patient who received varicella vaccination during the same
menstrual cycle that she became pregnant, and is supplemented by a literary review. The fetus developed miliary
fetal tissue calcifications and fetal hydrops detected by a targeted sonogram at 15 weeks gestation.

Conclusion: Varicella vaccination during early pregnancy may be a cause of miliary fetal tissue calcifications and
fetal hydrops.
Serotyping Group B Streptococci in a Small CommunityHospital: An Analysis of Distribution and Site of Isolation
Authors: Smith Jennifer M. , Rexroth Jason A. , Chaffin David G. , Jackman Susan H.
Published: March 2007

Objective: To determine the prevalence and site of isolation of different serotypes of group B streptococcus
(GBS) colonization or infection at a small community hospital.

Methods: GBS isolates were obtained from a small community hospital and were then serotyped as la, Ib, II, III, IV,
V or nontypeable. Hospital records were reviewed for patient sex, age and pregnancy status as well as the site of
GBS isolation.

Results: GBS serotypes Ia, III and V were most common and accounted for over 60% of the total number of
isolates. Serotype Ia wasmost prevalent in reproductive‐agefemales, while serotypesV and IIIwere most prevalent
in non‐reproductive‐age females and males, respectively. Serotype la was most frequent in both pregnant and
nonpregnantfemales. Serotype IV was more common in this studypopulation than in those from other locations.

Conclusions: The GBS serotype distribution in this small community did not differ significantly from distributions
described in larger North American centers. A GBS vaccine designed against multiple serotypes would be
protective for most of this population.
Role of the Vaginal Microbiological Ecosystem and Cytokine Profile in the Promotion of Cervical Dysplasia: A Case–Control Study
Authors: Behbakht Kian , Friedman Jennifer , Heimler Ira , Aroutcheva Alla , Simoes Jose , Faro Sebastian
Published: March 2007

Objective: To identify alterations in the cytokine profile and microbial ecosystem of the vagina in association
with cervical dysplasia.

Methods: Demographics, lifestyle variables and Papanicolau (Pap) smear results of subjects presenting to the
same site for gynecologic complaints, obstetric visits or colposcopy were prospectively recorded. Vaginal smear
for Gram stain, aerobic and anaerobic culture, pH, and wet mount and KOH examination for Trichomonas vaginalis ,
Gardnerella vaginalis and yeast organisms were performed. Vaginal lavage specimens were centrifuged, and the
pellets and supernatants were assayed for human papillomavirus (HPV) by polymerase chain reaction and for
cytokines interleukin (IL)‐1ß IL‐6, IL‐10 and IL‐12 by enzyme‐linked immunosorbent assay (ELISA) respectively.
Subjects with abnormal Pap smears underwent colposcopy and biopsy as indicated.

Results: Of 51 patients, 32 were referred for colposcopy, 12 presented with gynecologic needs, and seven
presented for obstetric visits. Median age was 24 years. Demographics did not differ significantly between the
dysplasia and control groups except for a trend towards more sexual partners in the dysplasia group. Biopsies were
performed in 81% (26/32) of patients presenting for colposcopy and 17 revealed cervical intraepithelial neoplasia.
IL‐1ß, IL‐6, IL‐10, and IL‐12 levels were elevated in 63% (20/32), 38% (15/39), 4% (2/49), and 0% of samples
respectively. Elevated vaginal lavage IL‐1ß was associated with a 6.1 odds ratio (95% confidence interval 1.06–35)
of cervical dysplasia. Alterations in other variables studied were not associated with cervical dysplasia.

Conclusions: Elevated IL‐1ß, possibly representing a complex host inflammatory response to multiple pathogens,
was demonstrated in patients with cervical dysplasia.
Case–Control Study of Vulvar Vestibulitis Risk Associated WithGenital Infections
Authors: Smith Elaine M. , Ritchie Justine M. , Galask Rudolph , Pugh Erica E. , Jia Jian , Ricks-McGillan Joan
Published: March 2007

Objective: To evaluate the risk of vulvar vestibulitis syndrome (VVS) associated with genital infections in a
case–control study.

Methods:Diagnosed cases with VVS (n = 69) and age‐frequency‐matched healthy controls (n = 65) were
enrolled from gynecology clinics in a university medical hospital during 1999. They were compared for potential
risk factors and symptoms of disease.

Results: VVS cases had a significantly higher risk of physician‐reported bacterial vaginosis (BV) (odds ratio,
OR = 9.4), Candida albicans (OR = 5.7), pelvic inflammatory disease (PID) (OR = 11.2), trichomoniasis
(OR = 20.6), and vulvar dysplasia (OR = l5.7) but no risk associated with human papillomavirus (HPV), ASCUS,
cervical dysplasia, genital warts, chlamydia, genital herpes or gonorrhea. Genital symptoms reported significantly
more often with VVS included vulvar burning (91 vs. 12%), dyspareunia (81 vs. 15%), vulvar itching (68 vs. 23%)
and dysuria (54 vs. 19%) (p < 0.0001).

Conclusion: A history of genital infections is associated with an increased risk of VVS. Long‐term follow‐up
case–control studies are needed to elucidate etiologic mechanisms, methods for prevention and effective
treatment.
Comparison of Gram Stain and Pap Smear Procedures in theDiagnosis of Bacterial Vaginosis
Authors: Vardar Enver , Maral Izzet , Inal Murat , Özgüder Özgül , Tasli Funda , Postaci Hakan
Published: March 2007

Objective: The purpose of this study was to examine the characteristics of Gram stain versus Pap smear in
diagnosis of bacterial vaginosis (BV).

Methods: One‐thousand and sixty women were enrolled in this study. All cases with symptoms of BV were
determined by Amsel′s criteria, which were accepted as the gold standard for diagnosis of BV. Pap smear and
Gram stain evaluations were compared according to Amsel′s criteria, without viewing the clinical results of the
patients. Gram stain and Pap smear results were determined as negative or positive according to Amsel’s criteria.
Sensitivity, specifity and positive predictive values were calculated.

Results: After accepting the cases that were diagnosed as BV according to Amsel′s criteria as reference cases, the
sensitivity of the Gram stain method was calculated as 97% and the sensitivity of the Pap smear method as 93%.
Similar specificity rates were obtained with both methods in diagnosis of BV related to the clinical results. There
were no statistically significant differences in diagnosis of BV between these two groups.

Conclusion: If Amsel′s criteria are accepted as the gold standard for diagnosis of BV, Gram stain and Pap smear
methods will give similar results in diagnosis.
Group A Streptococcal Toxic Shock Syndrome Developing inthe Third Trimester of Pregnancy
Authors: Crum Nancy F. , Chun Helen M. , Gaylord Thomas G. , Hale Braden R.
Published: March 2007

Background: Group A streptococcal (GAS) toxic shock syndrome (TSS) is an uncommon, but life‐threatening
infection during pregnancy and should be considered in rapid onset of shock.Most cases described in the literature
have occurred in the puerperium.We report a case of GAS TSS occurring during the third trimester of pregnancy
in a previously healthy woman.

Case: A 31‐year‐old female, who was 34 weeks pregnant, presented with fevers and a prodromal ‘flu‐like’
illness. She rapidly developed shock and multiorgan failure. Blood cultures revealed GAS bacteremia and the
patientmet criteria for streptococcal TSS.Despite her eventual recovery, her infant died on postpartumday 15 as a
consequence of the mother′s TSS.

Conclusions: This case is unusual in that there were no identifiable initiating events or source of the streptococcal
infection, and the TSS developed during pregnancy rather than after delivery. Early recognition of GAS infections is
important given the rapid onset and high morbidity and mortality associated with these infections. This is the first
reported case utilizing intravenous immunoglobulin for GAS TSS in the puerperium.
Two Cases of Delayed Diagnosis of Postpartal StreptococcalToxic Shock Syndrome
Authors: Schummer Wolfram , Schummer Claudia
Published: March 2007

Background: Puerperal sepsis due to group A β‐hemolytic streptococcal (GAS) toxic shock syndrome is
associated with very high morbidity and mortality. Luckily it is now rare, but diagnosis is not always easy. This
report demonstrates the problem of recognizing this disease, and summarizes the current knowledge on the
pathomechanism and management of streptococcal toxic shock syndrome.

Case: Two cases of postpartum streptococcal toxic shock syndrome due to GAS are described. In both cases
the correct diagnosis was delayed for several days. The first patient was sent home with the diagnosis of German
measles; the second patient was transferred to our neurological intensive care unit with the diagnosis of meningitis.
Both patients were admitted to the intensive care unit in profound shock, both developed multiple organ failure,
and one patient died.

Conclusions: GAS may produce virulence factors that cause host tissue pathology. Besides aggressive modern
intensive care treatment, early diagnosis and correct choice of anti‐streptococcal antibiotics are crucial. A possible
adverse effect of non‐steroidal anti‐inflammatory agents requires confirmation in a multicenter study.
Ertapenem Once a Day Versus Piperacillin–Tazobactam Every6 Hours for Treatment of Acute Pelvic Infections:A Prospective, Multicenter, Randomized, Double‐Blind Study
Authors: Roy Subir , Higareda Iliana , Angel-Muller Edith , Ismail Mahmoud , Hague Caren , Adeyi Ben , Woods Gail L. , Teppler Hedy
Published: March 2007

Objective: To compare ertapenem therapy with piperacillin–tazobactam therapy for the management of acute
pelvic infections.

Methods: In a multicenter, double‐blind study, 412 women with acute pelvic infection were assigned to one of
two strata, namely obstetric/postpartum infection or gynecologic/postoperative infection, and were then
randomized to ertapenem, 1 g once a day, or piperacillin–tazobactam, 3.375 g every 6 hours, both administered
intravenously.

Results: In total, 163 patients in the ertapenem group and 153 patients in the piperacillin–tazobactam group were
clinically evaluable. The median duration of therapy was 4.0 days in both treatment groups. The most common
single pathogen was Escherichia coli . At the primary efficacy endpoint 2–4 weeks post therapy, 93.9% of patients
who received ertapenem and 91.5% of those who received piperacillin–tazobactam were cured (95%
confidence interval for the difference, adjusting for strata, –4% to 8.8%), indicating that cure rates for both
treatment groups were equivalent. Cure rates for both treatment groups were also similar when compared by
stratum and severity of infection. The frequency and severity of drug‐related adverse events were generally
similar in both groups.

Conclusions: In this study, ertapenem was as effective as piperacillin–tazobactam for the treatment of acute pelvic
infection, was generally well tolerated, and had an overall safety profile similar to that of piperacillin–tazobactam.
Abscess in Adenomyosis Mimicking a Malignancy in a54‐Year‐Old Woman
Authors: Erguvan Rezzan , Meydanli Mehmet M. , Alkan Alpay , Edali Mehmet N. , Gokce Hasan , Kafkasli Ayşe
Published: March 2007

Background: Although there are a few reports describing abscess formation in endometriotic foci no report of
abscess formation arising de novo within adenomyosis appears in the literature. Preoperative diagnosis
of adenomyosis is frequently difficult because of non‐specific signs and symptoms. Synchronous pelvic pathologies
such as leiomyoma, endometrial polyp, endometrial hyperplasia, as well as endometrial cancer may cause
differential diagnostic problems.

Case: A 54‐year‐old postmenopausal woman complaining of inguinal pain, nightsweats and hot flashes is
presented. Radiologic examinations of the pelvis revealed a 95 × 85 mm leiomyoma‐like lesion including a
53 × 43 mmcystic space and 9 × 6 mmpapillary formation within the uterus raising clinical suspicion of malignancy.
A total abdominal hysterectomy and bilateral salpingo‐oophorectomy were performed accompanied by a
frozen section diagnosis. The frozen section revealed an abscess formation arising in a focus of adenomyosis.
The postoperative period of the patient was uneventful.

Conclusion: The present case, to our knowledge, is the first report representing abscess formation in
adenomyosis. Abscess arising within adenomyosis can strongly raise the suspicion of endometrial cancer, particularly
if the patient is postmenopausal. If endometrial cancer cannot be ruled out with definitive
histopathological diagnosis in the preoperative period, a frozen section becomes mandatory during surgical
intervention.
Guidelines for the Diagnosis, Treatment and Preventionof Postoperative Infections
Authors: Larsen John W. , Hager W. David , Livengood Charles H. , Hoyme Udo
Published: March 2007

Bacterial contamination of the operative site is a common occurrence in obstetrics and gynecology. The widespread
use of antibiotic prophylaxis has reduced but not eliminated serious postoperative infections. For most
operations, a single dose of a limited‐spectrum drug has been as effective as a multidose regimen. In the differential
diagnosis it is important to consider cellulitis, abscess, necrotizing fasciitis and septic pelvic thrombophlebitis.
Abscess and necrotizing fasciitis are expected to require invasive therapy in addition to antibiotics, while cellulitis
and septic pelvic thrombophlebitis should respond to medical management alone. Although a postoperative fever is
a warning sign of possible infection, it may also be caused by the antibiotics that are given for treatment. The use of
prolonged courses of antibiotics once the patient is clinically well is discouraged.
While clinical guidelines are provided for use in the diagnosis and management of postoperative infections,
these recommendations are intended for general direction and not as an exclusive management plan.
Pregnancy Outcome Following Pelvic Infection
Authors: Toth Miklos , Chaudhry Anu , Ledger William J. , Witkin Steven S.
Published: March 2007

To determine whether a previous pelvic infection has an effect on the outcome of a subsequent
pregnancy, we identified women with a diagnosis of pelvic inflammatory disease (PID), amnionitis,
and postpartum or postabortal endometritis‐salpingitis by a retrospective chart review of all patients
admitted to the Department of Obstetrics and Gynecology at The New York Hospital‐Cornell
Medical Center between 1975 and 1977 and between 1985 and 1988. Antimicrobial regimens
effective against Chlamydia trachomatis were initiated in 1985. Controls were randomly selected
patients presenting during the same time period for routine examinations who had normal Pap
smears and no infections. Both groups were comparable for age, race, gravity, and parity. Differences
were evaluated by chi square analysis, using the Yates correction factor. We identified 183
women with a history of the above infections who subsequently conceived, and 82 controls. There
were no differences in outcome between the two index groups. Term vaginal deliveries occurred in
14.2% of the women with a prior pelvic infection and in 56% of the controls (P < 0.001). Among the
97 women who had had PID, 21 (21.6%) had a spontaneous abortion in the subsequent pregnancy,
as opposed to 6 (7.3%) of the controls (P = 0.013). In addition, eight of the women with PID (but no
controls) went into preterm labor (P = 0.021). An increased incidence of preterm labor (P = 0.001)
was also observed in women with a history of amnionitis. A history of endometritis was not
associated with an increased prevalence of abnormal outcome in subsequent pregnancies. PID and
amnionitis may adversely affect the outcome of subsequent pregnancies.
Necrotizing Fasciitis: A Review of ManagementGuidelines in a Large Obstetrics and Gynecology Teaching Hospital
Authors: Thompson C. D. , Brekken A. L. , Kutteh W. H.
Published: March 2007

Necrotizing fasciitis is a severe, life‐threatening soft tissue infection that results in rapid and progressive
destruction of the superficial fascia and subcutaneous tissue. Because of its varied clinical
presentation and bacteriological make‐up, it has been labelled with many other names such as acute
streptococcal gangrene, gangrenous erysipelas, necrotizing erysipelas, hospital gangrene, and acute
dermal gangrene. Although described by Hippocrates and Galen, it has received increasing attention
in obstetrical and gynecological literature only within the last 20 years. This review includes two
recent cases successfully managed at Parkland Memorial Hospital, Dallas, Texas. The first patient
was a 50 year old, morbidly obese, diabetic woman who presented with a small, painful lesion on the
vulva. After failing triple antibiotic therapy with ampicillin, clindamycin, and gentamicin, the diagnosis
of necrotizing fasciitis of the vulva was made, and she was taken to the operating room for
extensive excision. She was discharged home on hospital day 29. The second patient was a 65 year
old, obese, diabetic woman with risk factors for atherosclerosis who had a wound separation after an
abdominal hysterectomy. Two days later a loss of resistance to probing was noted in the subcutaneous
tissue. Necrotizing fasciitis was suspected, and she was taken to the operating room for resection.
The patient was discharged home on hospital day 27. The mortality rate after diagnosis of
necrotizing fasciitis has been reported to be 30% to 60%. We review the literature and outline the
guidelines used in a large Ob/Gyn teaching hospital to minimize the adverse outcome. Lectures on
soft‐tissue infections are included on a regular basis. The high‐risk factors of age over 50, diabetes,
and atherosclerosis are emphasized. The need for early diagnosis and surgical treatment within 48
hours is stressed, and any suspicious lesions or wound complications are reported to experienced
senior house officers and staff. We use two recent cases to highlight the diagnostic clues and
management strategies for this often fatal polymicrobial infection.
Clinical Significance of Credé′s Prophylaxis in Germany at Present
Authors: Hoyme Udo B.
Published: March 2007

The introduction of silver nitrate for prophylaxis of gonococcal ophthalmia neonatorum is one of the
milestones of preventive medicine. However, in our time an increasing necessity to review Credé′s
prophylaxis from both a human rights and a medical standpoint is required. The chairmen of the
obstetrics and gynecology departments of the German university hospitals were questioned to learn
about their policy and experience. Data were provided by 22 of 28 consulted institutions, representing
31,700 annual deliveries seen over a mean period of 5.5 years. Ocular prophylaxis was in use in
16 (73%) of the reporting hospitals (1% silver nitrate in 14 and gentamicin in 2). A nonspecific
conjunctival reaction occurred in 5–10% of the newborns, but no major side effects were seen.
Non‐gonococcal ophthalmia neonatorum was observed in less than 0.1%; however, institutions
without a preventive policy reported up to a 5% incidence of neonatal conjunctivitis, mostly due to
Staphylococcus aureus, as well as Neisseria gonorrhoeae in two newborns. Application of silver nitrate
is considered a necessary prophylactic measure and safe if it is properly administered. However,
major efforts should be directed toward its replacement by alternative antiseptic substances as well
as toward chlamydial screening and therapy in pregnancy.
Sheathing of the Endovaginal Ultrasound Probe:Is It Adequate?
Authors: Jimenez Ronald , Duff Patrick
Published: March 2007

The purpose of this prospective investigation was to compare two methods for sheathing of the
endovaginal ultrasound‐probe. The study was conducted over a 7‐month period in 1991–1992. In the
first half of the investigation, latex examination gloves were used to sheath the endovaginal probe;
during the second half of the investigation, latex condoms were used. Following the ultrasound
examination, the probes were inspected for gross contamination by the ultrasonographer. The
sheaths were then tested for perforations by filling them with water to twice their usual volume and
observing for leaks. Fifty unused gloves and condoms were similarly tested to determine the prevalence
of preexisting defects. One hundred twenty‐eight gloves and 102 condoms from patients were
tested. Four gloves (3.1%, 95% C.I. 1.6–4.6%) and seven condoms (6.9%, 95% C.I. 4.4–9.4%) had
perforations (NS). When the probe was covered by a glove, one instance of visible contamination
occurred (0.78%, 95% C.I. 0–1.6%) compared with eight instances when the probe was covered with
a condom (7.8%, 95% C.I. 5.2–10.4%, P < .007). The prevalance of preexisting defects in the 50
unused gloves was 2%, which is not significantly different from the prevalence in used gloves. There
were no defects in the 50 unused condoms compared with 7 in the used condoms (P = .057). Visible
contamination of the endovaginal probe with blood or genital tract secretions is more likely when
condoms are used as sheaths. However, even gloves provide imperfect coverage of the probe,
illustrating the need for thorough decontamination of the endovaginal instrument after each use.
Maternal and Neonatal Infection With Salmonella heidelberg : A Case Report
Authors: Ault Kevin A. , Kennedy Maureen , Seoud Muhieddine A.-F. , Reiss Rosemary
Published: March 2007

Maternal and neonatal infections with Salmonella typhi have been well documented. There are only
two previous case reports of intrauterine infection with non‐typhoidal species. This paper presents a
third case of maternal septicemia followed by neonatal sepsis with Salmonella heidelberg.
Development of Pelvic Abscess Following Water‐Skiing Injury
Authors: Pearlman Mark D. , Zoschnick Lauren
Published: March 2007

Several descriptions of hydrostatic injuries while water‐skilng have been described, including lacerations
of the perineum, vagina, and cervix. Salpingitis or pelvic abscess resulting from water‐skiing
injuries are rare but important complications. A case of a pelvic abscess following a fall while
water‐skiing is described. The abscess was drained laparoscopically, resulting in a good clinical
outcome. The mechanism of injury and recommendations for prevention are also presented. Upper
genital tract infection may result from water‐skiing injuries due to hydrostatic pressure forcing
bacteria and water through the vagina and cervix into the endometrium, fallopian tube, and peritoneal
cavity. While an uncommon complication, physicians and other practitioners caring for women
should be aware of this potential complication from water‐skiing.
Does Method of Placental Removal or Site of UterineIncision Repair Alter Endometritis After Cesarean Delivery?
Authors: Magann Everett F. , Dodson Mark K. , Harris Robert L. , Floyd Randall C. , Martin James N. , Morrison John C.
Published: March 2007

Objective: his investigation was undertaken to evaluate the relationship between postcesarean endometritis
and (1) method of placental removal and (2) site for uterine repair.

Methods: This prospective, randomized study included 120 patients who underwent primary or
repeat abdominal delivery for arrest of progress in labor, fetal distress, or breech presentation.
Parturients were divided into four groups: I—spontaneous placental detachment, in situ uterine
repair; II—spontaneous placental detachment, exteriorized uterine repair; III—manual placental
removal, in situ uterine repair; and IV—manual placental removal, exteriorized uterine repair.
Prophylactic antibiotics were not used.

Results: Endometritis was significantly increased in the manual removal/exteriorized uterine
repair group versus all the other groups including the spontaneous removal in situ (group I,
P = 0.012), the spontaneous removal/exteriorized repair group (group II, P = 0.034), and the manual
removal/in situ repair group (group III, P = 0.043). Comparison of group IV (manual removal/
exteriorized repair) with the combined groups I, II, and III (spontaneous removal/in situ repair,
spontaneous removal/exteriorized repair, and manual removal/in situ repair) was significantly different
(P = 0.005). Prior to delivery, use of an internal monitoring system, skill of the operating
surgeon, and type of anesthesia were similar among groups.

Conclusions: The findings of this investigation suggest that; when other known causes of infectious
morbidity are constant, manual placental remvol in association with exteriorization for
uterine repair significantly increases postcesarean endometritis.
Presence of Chlamydia, Mycoplasma, Ureaplasma, and Other Bacteriain the Upper and Lower Genital Tracts of Fertile and Infertile Populations
Authors: Martens Mark G. , Young Ronald L. , Uribe Marco , Buttram V. C. , Faro Sebastian
Published: March 2007

Objective: The genital mycoplasmas (Mycoplasma hominis and
Ureaplasma urealyticum) and Chlamydia trachomatis have been implicated as possible
etiologic factors in infertility. Their role in patients with infertility needs to be further defined.

Methods: Seventy‐nine infertile patients underwent laparoscopy with
cultures obtained for aerobic and anaerobic bacteria, Chlamydia, Mycoplasma, and
Ureaplasma from the peritoneal fluid, fallopian tube, endometrium, and endocervix.
Cultures for similar organisms were taken from the endocervix of 80 fertile women in their
first trimester. Culture results were also compared according to ovulatory status and
laparoscopic findings in the infertile group.

Results: There were no differences in the recovery of Ureaplasma
(29% vs. 28%) or Chlamydia (4% vs. 0%) positive cervical cultures in the fertile and
infertile groups, respectively. However, a significantly higher number of Mycoplasma
positive cervical cultures (14% vs. 5%, P = 0.05) were found in the fertile group. Only two upper
genital tract cultures were found to be positive (Ureaplasma).

Conclusions: Therefore, if these organisms play a role in infertility,
they are present and eradicated prior to infertility work‐up and thus do not supports the use
of a routine trial of antibiotics prior to laparoscopy.