bluuebunny/crossref_metadata_2025 huggingface dataset:
Virulence Attributes of Low‐Virulence Organisms
Authors: Larsen Bryan
Published: March 2007

The vast majority of infections involving female pelvic structures arise from organisms that are members of the normal
flora. In addition, exogenous organisms that invade through the lower genital tract must interact with organisms that
are part of the host′s flora. In contrast to the concept that the normal flora is entirely innocuous, recent research has
begun to identify what appear to be virulence attributes among these ordinarily low‐virulence organisms. Most of our
understanding of virulence has been derived from highly virulent organisms, of which Neisseria gonorrhoeae provides an
example of relevance to the female genital tract. A review of the virulence factors of the gonococcus is presented to serve
as an example of the variety of virulence properties associated with pathogenic bacteria. Molecular biology has begun to
clarify one of the important paradigms of pathogenic bacteriology—that bacteria change their expression of virulence
properties in response to their location within a host or to the stage of infection. Thus, infection involves not only the
possession of virulence factors, but also the carefully controlled use of those factors. Virulence is often controlled by the
coordinate expression of many virulence‐associated genes in response to one environmental signal. With regard to low‐
virulence organisms present in the female lower genital tract, we are beginning to identify some of their virulence attributes.
Examples from the work of our laboratory include the hemolysin of Gardnerella vaginalis and an immunosuppressive
mycotoxin produced by Candida albicans. Demonstrating the coordinate expression (or other control mechanisms) of
virulence factors in these sometimes innocuous and sometimes inimical organisms represents the next frontier in the
study of normal vaginal microbiology.
Infectious Morbidity After Radical Vulvectomy
Authors: Elg Steven A. , Carson Linda F. , Brooker Doris C. , Carter Jonathan R. , Twiggs Leo B.
Published: March 2007

Objective: This retrospective investigation describes the infectious morbidity of patients following
radical vulvectomy with or without inguinal lymph node dissection.

Methods: The charts of patients undergoing radical vulvectomy between January 1, 1986, and
September 1, 1989, were reviewed for age, weight, cancer type, tumor stage, operative procedure(s), prophylactic
antibiotic and its length of use, febrile morbidity, infection site, culture results, significant medical history, and length
of use and number of drains or catheters used.

Results: The study group was composed of 61 patients, 14 of whom underwent a radical vulvectomy
and 47 who also had inguinal lymph node dissection performed. Twenty‐nine patients (48%) had at least 1
postoperative infection. Five patients (8%) had 2 or more postoperative infections. The site and incidence of the
infections were as follows: urinary tract 23%, wound 23%, lymphocyst 3%, lymphatics (lymphangitis)
5%, and bowel (pseudomembranous colitis) 3%. The most common pathogens isolated from both urine and
wound sites were Pseudomonas aeruginosa, enterococcus, and Escherichia coli. A significant decrease in wound
infection was demonstrated when separate incisions were made for inguinal lymph node dissection (P <0.05).
The mean number of days to onset of postoperative infection for wound, urine, lymphatics, lymphocyst, and bowel were
11, 8, 57, 48, and 5, respectively.

Conclusions: We conclude that the clinical appearance of post‐radical vulvectomy infections is
delayed when compared with other post‐surgical wound infections. Second, utilizing separate inguinal surgical
incisions may reduce infectious morbidity. Finally, tumor stage and type do not necessarily increase the infectious
morbidity of radical vulvar surgery.
Propensity of Tampons and Barrier Contraceptives to Amplify Staphylococcus aureusToxic Shock Syndrome Toxin‐I
Authors: Tierno Philip M. , Hanna Bruce A.
Published: March 2007

Objective: Although the incidence of reported cases of toxic shock syndrome (TSS) has declined in
recent years, the disease continues to occur in menstruating women using the newer, less‐absorbent tampons or barrier
contraceptives. Extant tampons and other vaginal devices were tested for the ability to induce TSS toxin‐1 (TSST‐1)
by a TSS strain of Staphylococcus aureus MN8, a known high‐toxin producer. Tested for the first time were 20 varieties
of tampons, including 2 all‐cotton brands newly introduced in the United States, a polyurethane contraceptive sponge,
a latex diaphragm, and a polymer menstrual collection cup.

Methods: All products were washed in sterile distilled water prior to use to reduce the effect of
leachable chemicals. Duplicate experiments with unwashed products were also performed. Entire tampons and other
test products were immersed in brain heart infusion broth plus yeast extract (BHIY) and inoculated with S.
aureus MN8, a known TSST‐1 producer. After incubation, the culture supernatants were assayed for TSST‐1 by
gel immunodiffusion.

Results: Except for all‐cotton tampons, greater amounts of TSST‐1 were detected in the supernatant
fluid of washed tampons than detected in those which were not washed. While TSST‐1 levels in unwashed non‐cotton
tampons ranged from 0.5 to 8 μg/ml, when these products were washed, TSST‐1 levels increased to 2–32
μg/ml. In all‐cotton tampons, whether washed or not, there was no detectable TSST‐1.

Conclusions: The propensity for all‐cotton tampons not to amplify TSST‐1 in vitro suggests they
would lower the risk for tampon‐associated TSS.
Novel Family of Gynecologic Cancer Antigens Detected by Anti‐HIV Antibody
Authors: Rakowicz-Szulczynska Ewa M. , McIntosh David G. , Morris Peter , Smith McClure
Published: March 2007

Objective: The reactivity of gynecologic cancer proteins with monoclonal antibody (MAb) directed
against the human immunodeficiency virus I (HIV‐I) was tested.

Methods: Cytoplasmic and nuclear proteins, extracted from a broad range of gynecologic cancers
obtained during standard surgical procedures, were tested in Western blotting with MAb 5023
developed against the amino acid sequences 308–322 of the envelope protein gp120 of HIV‐I.

Results: Three cell membrane proteins, Mrl20,000 (p120), Mr41,000 (p41), and Mr24,000 (p24), and
one chromatin protein, Mr24,000 (p24), were detected by MAb 5023 in invasive, poorly differentiated
cervical squamous‐cell carcinoma; ovarian serous cystadenocarcinoma; poorly and well‐differentiated
endometrial carcinoma; vulvar squamous‐cell carcinoma; and malignant mixed müllerian tumor. The
same antigens were identified in cervical carcinoma cell line SiHa. Neither p120 nor p24 was recognized
by other MAbs directed against the variable loop of gp120. Antigens p120 and p41 were undetectable in
normal ovarian tissue and in biopsy samples of normal vaginal and rectal mucosa. Rectosigmoid cancer
as well as colon carcinoma, lung carcinoma, and melanoma cell lines all tested negative.

Conclusions: The identified antigens may represent either the products of human genes (proto‐onc‐ogenes)
or, more likely, the products of an unknown virus specifically expressed in female cancer.
Role of Bacterial Vaginosis in Peripartum Infections
Authors: Clark Penny , Kurtzer Traci , Duff Patrick
Published: March 2007

Objective: The purpose of this prospective investigation was to determine if the presence of bacterial
vaginosis (BV) at the time of delivery was associated with the development of maternal and neonatal
infection.

Methods: Vaginal fluid was collected from 390 laboring patients. Smears of the vaginal secretions
were gram stained, and slides were scored and interpreted as normal, intermediate, and BV based on
Gram′s stain criteria. Results of the Gram′s stains were correlated with the clinical diagnoses of
chorioamnionitis, endometritis, and neonatal sepsis.

Results: Eighty‐eight percent of patients were term and 12% were preterm. The overall prevalence of BV was 30%. The frequency of BV was similar in both term and preterm women. BV was
significantly more prevalent among nonwhites than whites (37% vs. 25%, P = 0.005). Maternal
characteristics such as mean age, parity, status of the membranes, mean duration of labor, mean
duration of ruptured membranes, mean length of fetal monitoring, mean number of vaginal examinations,
and mode of delivery were similar in patients with BV, intermediate, and normal Gram′s
stains. Forty‐seven (12%) women developed peripartum infection. The frequencies of chorioamnionitis
or endometritis in women with BV or intermediate Gram′s stains were 19/116 (16.4%) and
11/63 (17.5%), respectively. The frequency in each of the 2 groups was significantly increased
compared with the rate in women with normal Gram′s stains: 17/211 (8.1%), [P = 0.034, OR = 2.0
(95% CI, 1.07–3.73) for BV and P = 0.054, OR = 2.1 (95% CI, 1.12–3.94) for intermediate Gram′s
stain]. The incidence of suspected or confirmed neonatal infection was significantly higher in mothers
with intermediate Gram′s stains compared with mothers with normal Gram′s stains (P = 0.02,
OR = 2.18, 95% CI, 1.12–3.94), while no difference in incidence was observed between mothers
with BV and normal Gram′s stains (P > 0.05). The rate of neonatal infection directly correlated
with maternal group B streptococcal colonization rather than with BV.

Conclusions: In this population, patients with BV and intermediate Gram′s stains had an increased
frequency of peripartum infection.
Teratogenic and Embryocidal Effects of Zidovudine (AZT) in Sprague‐Dawley Rats
Authors: Christmas James T. , Little Bertis B. , Knoll Kraig A. , Bawdon Roger E. , Gilstrap Larry C.
Published: March 2007

Objective: The purpose of the present investigation was to analyze the effets of zidovudine on the
postimplantation embryo and fetus.

Methods: Pregnant Sprague‐Dawley rats were given various doses (10 mg/kg, 30 mg/kg, 150
mg/kg) of zidovudine or saline by an endotracheal tube during the period of embryogenesis (days
6–8, 9–11, 6–11 postconception). The animals were sacrificed on days 18–19 of pregnancy, and their
fetuses were removed by hysterotomy. Autopsies under low (15×) and high (40×) power light
microscopy were performed on all fetuses.

Results: There was no statistically significant difference among the groups with respect to maternal
weight gain. There were more pregnancy resorptions in the group receiving high‐dose zidovudine
(150 mg/kg/day) throughout embryogenesis than in the control group (P = 0.001, respectively).
Four major structural anomalies were noted among the 689 fetuses examined, but zidovudine was
not associated with an increased frequency of congenital anomalies in rats when it was administered
in doses similar to, 3‐, and 15‐fold higher than the regimen recommended for adult humans. The
drug, however, was embryocidal in the high‐dose group (P = 0.002).

Conclusions: These findings are consistent with previous studies of preimplantation mouse embryos
that demonstrated an embryocidal effect on preimplantation conceptuses. In summary, post‐implantation
embryonic zidovudine exposure was associated with significantly increased pregnancy
losses (resorptions and intrauterine deaths).
Perihepatic Adhesions: Another Look
Authors: Chatwani Ashwin , Mohammed Nina , Amin-Hanjani Soheil , Nyirjesy Paul
Published: March 2007

Objective: The objective of our study was to determine if pelvic inflammatory disease (PID) was the
only cause of perihepatic adhesions.

Methods: One hundred consecutive patients undergoing elective sterilization by laparoscopy were
enrolled in this study. The preoperative workup included a history, physical examination, cervical
culture for Neisseria gonorrhoeae and Chlamydia trachomatis, leukocyte count, C‐reactive protein,
and liver‐function tests. During the laparoscopic procedure, the pelvis and liver surface were inspected
for evidence of any adhesions. If perihepatic adhesions were discovered in a patient without
any evidence of prior PID, then cultures from the adhesion, peritoneal fluid, and tubal specimens
were obtained for N. gonorrhoeae, C. trachomatis, Mycoplasma hominis, Ureaplasma urealyticum,
anaerobes, and facultative aerobes. Tubal specimens were also obtained for histologic examination.

Results: Of 100 patients, 7 patients had perihepatic adhesions without any laparoscopic evidence
of prior PID. The preoperative cultures were negative. Three of these patients had no history of
sexually transmitted disease or PID. Their anti‐chlamydial antibody titers were also negative. Of the
remaining 4 patients with perihepatic adhesions, 2 had a history of gonococcal or chlamydial
infection and 2 had histological evidence of chronic salpingitis.

Conclusions: The study suggests that PID may not be the only cause of perihepatic adhesions.
Chronic Endometritis and Positive Mycoplasma Cultures: Is There a Correlation?
Authors: Chatwani Ashwin , Nyirjesy Paul , Amin-Hanjani Soheil
Published: March 2007

Objective: This study was undertaken to assess the impact of mycoplasma strains (Mycoplasma hominis or Ureaplasma urealyticum) on the development of chronic endometritis.

Methods: Fifty‐eight patients with acute pelvic infection were enrolled in this prospective cohort study. Endometrial cultures and biopsies were obtained on admission and 5–7 and 21–28 days after completion of treatment.

Results: Of 148 samples, 40 were positive for mycoplasma strains (group A) and 58 were positive for mycoplasma with other pathogens (group B). Twenty‐seven samples were positive for other pathogens only (group C). Chronic endometritis was seen in 7 (17.5%), 30 (51.7%), and 10 (37%) in group A, B, and C patients, respectively.

Conclusions: The presence of mycoplasma strains in the endometrial cavity was not found to be associated with an increased incidence of chronic endometritis.
Comparative Study of the Effectiveness of Oral Fluconazole and Intravaginal Clotrimazole in theTreatment of Vaginal Candidiasis
Authors: Mikamo Hiroshige , Izumi Koji , Ito Kunihiko , Tamaya Teruhiko
Published: March 2007

Objective: A study was carried out to compare 3 treatment regimens
for vaginal candidiasis.

Methods: A total of 150 women with clinical and mycological evidence of vaginal candidiasis were
randomized to receive 50 mg of oral fluconazole daily for 6 days (50 women), a single oral 150 mg dose of fluconazole (50 women), or 100 mg of intravaginal clotrimazole daily for 6 days (50 women). They were assessed at 5–15 days (short‐term assessment) and again at 30–60 days (long‐term assessment) after the completion of treatment.

Results:Candida species were completely eradicated from the vagina in 88% or 80% in the 6‐day oral fluconzaole group, 76% or 70% in the single oral fluconazole group, and 72% or 60% in the intravaginal clotrimazole group at short‐term or long‐term
assessment, respectively. The rates of clinical effectiveness were 92% or 88% in the 6‐day oral fluconzaole group, 80% or 76% in the single oral fluconazole group, and 72% or 58% in the intravaginal clotrimazole group at the short‐term or long‐term assessment, respectively. Treatment‐related side effects
were not found in any group.

Conclusions: This study suggests that the treatment of vaginal candidiasis with oral fluconazole is effective and that a single oral fluconazole dose might be one choice in the treatment of vaginal candidiasis.
Doxycycline or Ofloxacin for Outpatient Chlamydial Pelvic Inflammatory Disease? A Cost‐Benefit and Cost‐Effectiveness Analysis
Authors: Rosenberg Michael J. , Waugh Michael S.
Published: March 2007

Objective: The current Centers for Disease Control and Prevention
(CDC) guidelines include 2 drugs, doxycycline and ofloxacin, for
treatment of the chlamydial component of outpatient pelvic
inflammatory disease (PID). Although ofloxacin costs about $90
more than doxycycline, doxycycline is frequently associated with
side effects and patient compliance with this drug is probably
poor. Because clinicians have little information by which to judge
the tradeoffs between price and compliance for these 2
antibiotics, we examined the impact of patient compliance in the
evaluation of the costs and benefits of using each drug.

Methods: The incidence and direct costs of PID sequelae (infertility,
ectopic pregnancy, and chronic pelvic pain) resulting after
partially treated chlamydial PID were taken from previous
estimates. For differing levels of antibiotic compliance, the
probability of cure, probability of the occurrence of sequelae,
and the associated cost of each were calculated. Because the
relationship between partial antibiotic compliance and PID cure is
unknown, we included 3 plausible relationships in our analyses.
The sensitivity analysis was performed by varying key assumptions
and examining the effect of each on future costs.

Results: The average probability of future PID sequelae attributable to
chlamydia is slightly less than 2%, with an associated cost of $1,272. With an average compliance for doxycycline of 50%, an
improvement in compliance of as little as 1.8–3.5 percentage points (51.8–53.5%), depending on the
assumption used regarding partial compliance and cure, would make
the use of ofloxacin less costly than doxycycline in the long run.
Even with a cost difference of $90 between the 2 drugs, a
10‐percentage‐point increase in compliance (to 60% compliance) with the more expensive drug would save $2.63 for each $1.00 spent.

Conclusions: Since the long‐term costs of PID are likely to overshadow the immediate cost of providing treatment, physicians should carefully consider the
likelihood of patient compliance in selecting an antibiotic.
Single‐Blind, Prospective, Randomized Study of Cefmetazole and Cefoxitin in the Treatment ofPostcesarean Endometritis
Authors: Chatwani Ashwin , Martens Mark , Grimes David A. , Chatterjee Molly , Noah Melvin , Stamp-Cole Marion M. , Perry Kimberly T. , the Cefmetazole Study Group
Published: March 2007

Objective: The purpose of this study was to compare the clinical efficacy and safety of cefmetazole
given by IV push with that of parenterally administered cefoxitin for the treatment of endometritis following cesarean delivery.

Methods: In a single‐blind, multicenter, prospective, randomized study, 355 patients with endometritis after cesarean delivery were enrolled and received medication. Administered was either cefmetazole sodium, 2 g by IV push over 1 min q 8 h, or cefoxitin sodium, 2 g IV q 6 h in a 2:1 ratio. The patients were followed for clinical responses and side effects.

Results: The cure rate for cefmetazole was 89% and for cefoxitin it was 79% (P = 0.006). The adverse events were similar in both groups.

Conclusions: Cefmetazole was significantly more effective than cefoxitin in the treatment of endometritis following cesarean delivery.
Clinical Trial of the Outpatient Management of Pyelonephritis in Pregnancy
Authors: Brooks Allyson M. , Garite Thomas J.
Published: March 2007

Objective: This study was designed to determine whether outpatient treatment of pyelonephritis in pregnancy can reduce costs without compromising safety or efficacy.

Methods: Pregnant patients with uncomplicated initial episodes of acute pyelonephritis were considered for outpatient management. The outpatient treatment consisted of an initial dose of IV ceftriaxone (2 g), followed by daily outpatient IM ceftriaxone (2 g) until resolution of fever and flank tenderness, followed by a 10‐day course of oral antibiotics. The study group was compared with a group requiring inpatient treatment and a historical control group meeting the criteria for outpatient management but having been treated as inpatients in the previous year.

Results: Of the 34 treated as outpatients, only 4 (12%) required hospital admission and 1 developed an upper urinary tract recurrence. None of these patients had premature delivery or any other serious complication. The historical control group (N = 29) included 1 upper urinary tract recurrence, no preterm deliveries, and 1 case of acute respiratory disease syndrome. The outpatient group required an average of 3.4 daily outpatient visits compared with 3.9 days of hospitalization for the historical control group. The inpatient group (N = 39) was significantly more likely to require hospitalization >6 days (P = 0.0004), with a trend toward more frequent upper urinary tract recurrences (6/39 vs. 1/34, P = 0.08). The cost analysis revealed a 3‐fold difference between outpatient and inpatient therapy ($1,100 vs. $3,350, P < 0.001).

Conclusions: The outpatient treatment of selected patients with pyelonephritis in pregnancy as a promising approach to reducing costs warrants further investigation.
Endometrial Cultures in Acute Pelvic Inflammatory Disease
Authors: Amin-Hanjani Soheil , Chatwani Ashwin
Published: March 2007

Objective: The objective of this study was to investigate the correlation of endometrial culture results with the clinical diagnosis of acute pelvic inflammatory disease (PID).

Methods: A total of 130 patients admitted with the clinical diagnosis of acute PID were prospectively enrolled in this study. Endometrial cultures by transcervical aspirate currette were obtained from all patients.

Results: Of 130 patients, 114 were discharged with a clinical diagnosis of PID. Of these 114 patients, 112 had positive endometrial cultures for pathogenic organisms. The correlation between endometrial culture results and the clinical diagnosis of acute PID was 98.2%. When patients with only mycoplasmas in the endometrial cavity were excluded, the correlation between endometrial culture results and the clinical diagnosis of acute PID was 93.8%.

Conclusion: These data demonstrate the exceedingly high degree of correlation between endometrial culture results and the clinical diagnosis of acute PID. Therefore, endometrial cultures may serve as a useful adjunct in the evaluation of patients with a clinical diagnosis of acute PID.
Sexually Transmitted and Other Genital Infections in Women With Cervical Human Papillomavirus Infection
Authors: Sikström B. , Hellberg D. , Nilsson S. , Kallings I. , Mårdh P.-A.
Published: March 2007

Objective: We investigated possible correlations between latent cervical human papillomavirus infection (CHPI) and other sexually transmitted diseases (STDs).

Methods: Of 972 randomly selected women attending 2 family planning clinics and a youth clinic who had agreed to participate in a study concerning STDs, 66 (6.8%) had latent CHPI.

Results: An association was found between latent CHPI on one hand and a history of genital chlamydial infection, gonorrhea, recurrent vaginal candidiasis, cervicitis, or pelvic inflammatory disease (PID) on the other, while no correlation between latent CHPI and coexistent STDs was found. No correlation of latent CHPI to either current or past genital warts was noted. In multifactorial analyses, which included the lifetime number of sexual partners and age at first intercourse, we found that all significant associations except a history of gonorrhea vanished.

Conclusions: In this study population, screening for other current STDs in women with latent CHPI would be of limited value.
Antifungal Effect of Hydrogen Peroxide on Catalase‐Producing Strains of Candida spp.
Authors: Larsen Bryan , White Sandra
Published: March 2007

Objective: Clinical isolates of Candida were tested for the presence of catalase and susceptibility to hydrogen peroxide.

Methods: MIC was tested by broth dilution technique and catalase was determined by a spectrophotometric procedure.

Results: All 38 strains tested were inhibited by hydrogen peroxide in concentrations ranging from 4.4 to 88 mM/l, with non‐albicans isolates generally requiring higher concentrations of hydrogen peroxide for inhibition. Growth media consisting of glucose and protein diminished the antifungal effectiveness of hydrogen peroxide, as did the presence of hemoglobin, in incubation mixtures. However, hydrogen peroxide exerted greater inhibition at pH 4 than at pH 7. Although all Candida isolates tested possessed catalase, there was no apparent correlation between the catalase activity of individual isolates and the minimal antifungal concentration of hydrogen peroxide.

Conclusions: This study suggested that, despite the production of catalase by vaginal microorganisms, hydrogen peroxide may exert a regulating influence which may be further modified by the proteins found in the vaginal milieu.
In Vitro Bacterial Contamination of Amniotic Fluid: Effects on Fluorescence Polarization LungMaturity Testing
Authors: Heine R. Phillip , Harding Susan , Emmett Pegi , Ashwood Edward , Lenke Roger R.
Published: March 2007

Objective: We sought to determine the effect of bacteria on fluorescence polarization (FPOL) testing of amniotic fluid.

Methods: Fusobacterium necrophorum and Escherichia coli were inoculated at concentrations of
103 and
106/ml in amniotic‐fluid specimens from 4 patients with no clinical or laboratory evidence of infection. The FPOL results were obtained at inoculation and again at 24 h of incubation. The results were compared using analysis of variance (ANOVA).

Results: The FPOL results from inoculated specimens were all within 2% of the uninoculated controls. The specimens incubated with bacteria showed a < 1–19% variation when compared with the time‐zero uninoculated controls. However, uninoculated controls incubated for 24 h exhibited a 2–12% variation when compared with the time‐zero controls, suggesting that the variation present was not secondary to the bacterial co‐incubation.

Conclusions: In vitro, neither bacterial inoculation nor prolonged co‐incubation influences FPOL results beyond the effect of incubation alone. FPOL appears to be an appropriate test to assess fetal lung maturity in patients in whom intraamniotic infection is a concern.
Long, Uniform Lactobacilli (Döderlein′s Bacteria): A New Risk Factor for Postoperative Infection After First‐Trimester Abortion
Authors: Platz-Christensen Jens-Jörgen , Påhlson Carl , Larsson Per-Göran
Published: March 2007

Objective: The production of hydrogen peroxide (H2O2)
from different strains of lactobacilli in the
vagina has been proposed to play one of the most important protective roles in the vaginal defense
system. New data have, however, suggested that Döderlein′s bacteria, with the morphological
appearance of long lactobacilli, have a low production of H2O2
. The purpose of the present study was to correlate the morphology of lactobacilli with the incidence of infection following legal abortion.

Methods: Seven hundred sixty‐nine women with lactobacilli but without Chlamydia trachomatis or bacterial vaginosis in their vaginal wet smears who were to undergo legal abortions were divided into 6 different groups according to the morphological appearance of the lactobacilli. The postoperative infection rates in these different groups were compared. A phenotypic classification of some of the lactobacilli was performed.

Results: The presence of Döderlein′s bacteria compared with a mixed flora of lactobacilli increased
the risk of postoperative infection 3 times [relative risk (RR) = 3.0; 95% confidence interval (CI), 1.5‐6.3]. After a logistic regression analysis, the only independent risk factors were the presence of Döderlein′s bacteria and earlier gestational age.

Conclusions: We found that the lactobacilli regarded as commensal organisms and “normal, healthy lactobacilli” in the vagina were present in only 18% of these women and that their presence might be hazardous. Therefore, we must reconsider our concept of the “normal” lactobacilli in the vaginal wet smears of healthy women.
Granulocyte Colony‐Stimulating Factorin Amniotic Fluid
Authors: Raynor B. Denise , Clark Penny , Duff Patrick
Published: March 2007

Objective: The purpose of this study was to determine if granulocyte colony‐stimulating factor
(G‐CSF) is normally present in amniotic fluid and then to determine if amniotic‐fluid G‐CSF levels
are affected by labor and intrauterine infection.

Methods: Amniotic fluid was collected from 35 patients in 4 groups: no labor, early labor, late labor, and labor plus chorioamnionitis. G‐CSF levels were measured by enzyme‐linked immunosorbent
assay (ELISA).

Results: The mean amniotic‐fluid G‐CSF concentrations prior to labor were lower than during labor (0.49 ± 0.25 ng/ml for prior to labor vs. 1.83 ± 1.0 ng/ml for labor, P < 0.001). With chorioamnionitis, the mean levels were elevated compared with normal labor (25.0 ± 4.8 ng/ml for chorioamnionitis vs. 1.83 ± 1.0 ng/ml for normal labor, P < 0.0001). In early and late labor, G‐CSF was higher than prior to labor (0.49 ± 0.25 ng/ml for no labor vs. 1.48 ± 1.0 ng/ml for early labor, P < 0.02, vs. 2.2 ± 0.8 ng/ml for late labor, P < 0.0005). The mean concentrations in early and late labor were not different.

Conclusions: G‐CSF is present in amniotic fluid and increased with labor. When labor is complicated by chorioamnionitis, G‐CSF is significantly elevated.
Pelvic Inflammatory Disease and Involuntary Infertility: Prospective Pilot Observations
Authors: Soper David , Ness Roberta B.
Published: March 2007

Objective: We prospectively evaluated the rate of adverse reproductive outcomes following pelvic inflammatory disease (PID) in a small cohort of American women.

Methods: We enrolled 28 patients having either salpingitis confirmed by laparoscopy or endometritis confirmed by endometrial biopsy. The follow‐up was maintained by clinic visits and telephone contact.

Results: A median of 15.4 months of follow‐up was accomplished for 82.1% of these women. Fifty‐two percent (13/25) had unprotected sexual activity without conception for at least 6 months. Fully 55.6% (10/18) of the cohort were involuntarily infertile after at least 1 year of follow‐up.

Conclusion: In the first prospective cohort study of the reproductive outcomes of American women having had PID, high rates of infertility at 1 year of follow‐up were experienced by these women.
Efficacy and Tolerance of Single‐dose Azithromycin for Treatment of Chlamydial Cervicitis During Pregnancy
Authors: Miller Joseph M.
Published: March 2007

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

Methods: A retrospective review of clinic records over a two‐year period identified pregnant patients treated with a single 1‐g dose of azithromycin for chlamydial carriage. The side effects and subsequent chlamydial carriage (test of cure) were noted.

Results: A total of 146 pregnant women treated with azithromycin was reviewed. A cure rate of
96% was found. Side effects were reported in 5%.

Conclusions: A single 1‐g oral dose of azithromycin is effective for the treatment of chlamydia and is well tolerated in pregnant women.
Blindness in a Woman With Human Immunodeficiency Virus Infection and Syphilis
Authors: Luchi Michael , Beauregard Curtis , Ault Kevin , Hinthorn Daniel
Published: March 2007

Background: A concomitant infection with human immunodeficiency virus (HIV) may alter the natural history of other infections. Several reports indicate that syphilis may behave more aggressively when HIV infection is present.

Case: A woman presented with a rash involving her hands and feet and progressive loss of the vision in her right eye. Her serologic tests for syphilis and HIV infection were positive. A diagnosis of neurosyphilis was confirmed by an analysis of cerebrospinal fluid (CSF). She was treated with high‐dose intravenous (IV) penicillin. Her skin lesions resolved, but her vision did not improve.

Conclusion: The incidence of HIV infection among women is rising. A patient with HIV and syphilis may develop neurosyphilis in a much shorter time than a patient without HIV infection.
Human Immunodeficiency Virus Type 1 Counseling and Testing Program in the Prenatal Setting
Authors: Bardeguez Arlene D. , Denny Thomas , Palumbo Paul , Wesley Yvonne , Oleske James , Connor Edward , Weiss Gerson
Published: March 2007

Objective: The objectives of this study were to ascertain the acceptance rate of human immunodeficiency virus type 1 (HIV‐1) testing in a high‐prevalence area and to describe the sociodemographic
and clinical characteristics of seropositive women diagnosed in the prenatal setting.

Methods: A retrospective review was carried out of the prenatal HIV‐1 counseling and testing program at University Hospital, Newark, NJ (1989‐1990).

Results: Sixty‐seven percent (741/1,114) of the women offered HIV‐1 counseling services accepted testing and 40 (40/741:5.3%) new cases were identified. Heterosexual contact was the primary exposure (17:52%) of these women, of whom 13 (73%) had negative syphilis serologies. Sixty‐four percent were asymptomatic. The mean absolute CD4 lymphocyte count in seropositive women was 514 ± 305 cells/mm3
. Severe immunosuppression was seen in 7/32 (22%) patients. Seventy‐three percent (24/33) depended on public‐assistance programs for their health‐care services.

Conclusions: A voluntary HIV‐1 counseling and testing program is well accepted in the prenatal setting. It can provide early identification of asymptomatic seropositive women and infants at risk and lead to early intervention and therapy.
Septicemia due to Aeromonas hydrophila in aPregnant Woman: A Case Report and Review of the Literature
Authors: Damián Ricardo Figueroa , Zesati Roberto Villagrana , Fernáindez León Sáinchez , García Jose Luis Arredondo
Published: March 2007

Background: In the late 1960s, the first isolates of Aeromonas were recovered from human specimens. Presently, there is sufficient evidence to suggest that the different isolates of the genus Aeromonas are human pathogens. The most frequent site of infection is the digestive tract, although extraintestinal infection also occurs. In those cases involving septicemia, most infections occur in individuals with underlying diseases. This report presents the case of a pregnant woman with no underlying disease or signs of immunodeficiency who developed A. hydrophila septicemia at 24 weeks gestation.

Case: A 20‐year‐old pregnant woman was admitted with a history of 10 days of fever, chills, and diaphoresis. Three days before her hospitalization, she noted jaundice and choluria. Her liver was enlarged and her liver function tests were abnormal, with a moderate elevation of serum aminotransferases and direct serum bilirubin and a high serum alkaline phosphatase. Her blood and bone‐marrow cultures revealed A. hydropkila. She was treated with parenteral ceftriaxone. She experienced a complete remission of her symptoms and laboratory abnormalities after therapy. The remainder of the pregnancy was normal. At 39.2 weeks gestation, she delivered a healthy male infant.

Conclusion: An association was noted between pregnancy and
A. hydrophila septicemia in a woman without immunodeficiency or underlying disease, possibly indicating another infectious complication in pregnancy.
Ethical Issues Associated With Routine Screening and Prophylaxis for Group B Streptococcus in Pregnancy
Authors: Yancey Michael K. , Schuchat Anne , Duff Patrick
Published: March 2007

An increased awareness of the impact of group B streptococcus (GBS) infection on neonatal outcome has prompted several seemingly discordant committee recommendations. Intrapartum antibiotics are effective in reducing the risk of neonatal morbidity when administered to a colonized woman who has a clinical condition that places her neonate at high risk for early-onset sepsis. However, less is known about the efficacy of prophylactic antibiotics in the colonized woman who does not have obvious risk factors. Some authorities have suggested that providers refrain from administering intrapartum antibiotics to colonized women who do not have any of these risk factors, primarily due to concerns about potential adverse reactions, selection of resistant pathogens, and cost-effectiveness. These recommendations may conflict with the desires of an informed woman who weighs the real, albeit low, risk for serious neonatal disease against the lower perceived risk of adverse maternal sequelae from allergic reactions to the antimicrobial agents. Selective prophylaxis for GBS disease that is limited to the colonized parturient with risk factors has the potential for creating conflict because maternal beneficence-based obligations of the physician may be at odds with maternal autonomy-based obligations. We believe that, given all currently available information, providers have a moral obligation to discuss GBS screening and treatment issues with patients. The potential for conflict between patient and physician at the time of delivery can be minimized through the use of preventive ethics, allowing patients to develop advance directives regarding intrapartum management within the confines of reasonable and cost-effective care. Until a consensus is reached among experts, the most prudent approach would be to address such issues proactively and individualize care based upon the overall estimation and anticipation of risk as well as the patient's specific desires.
Comparative Study of Intravaginal Metronidazole and Triple-Sulfa Therapy for Bacterial Vaginosis
Authors: Sobel Jack D. , Chaim Walter , Thomason Jessica , Livengood Charles , Sweet Richard , McGregor James A. , Eschenbach David , Hillier Sharon , Galask Rudolph , Faro Sebastian , Shangle Elizabeth , Baker David
Published: March 2007

Objective:We sought to compare the efficacy of metronidazole gel vs. triple-sulfa cream in the treatment of bacterial vaginosis (BV).

Methods:In a double-blinded study, 247 women with symptomatic BV were randomly assigned to receive either 5 g of 0.75% metronidazole gel twice daily for 5 days or triple-sulfa cream twice daily for 5 days. There were 205 (96 treated with metronidazole and 109 treated with triple-sulfa) evaluable patients to compare efficacy at the final visit. Approximately 60% of these patients had been previously treated for BV, reflecting the recurrent nature of the disease in this patient population.

Results:At the first (12–16 days) return visit, 81/103 (79%) patients in the metronidazole group were cured compared with 80/113 (71%) patients in the triple-sulfa cream group (P= 0.333). At the final (28–35 days) return visit, 63/96 (66%) in the 96 metronidazole group remained cured compared with only 51/109 (47%) in the triple-sulfa group (P= 0.02). An intent-to-treat analysis similarly showed that the cure rate with metronidazole was superior to triple-sulfa (P≤ 0.02). The clinical diagnosis demonstrated a high correlation (88%) with the diagnosis made by an independent assessment by Gram's stain. The side effects reported by the patients using metronidazole gel were infrequent and mild and were similar to those reported with triple-sulfa.

Conclusions:Metronidazole gel is a safe, effective, and well-tolerated treatment for BV.
Strategies for Prevention of Varicella Pneumonia: A Cost‐Effectiveness Analysis
Authors: Macones George A. , Ewing Stephanie , Silverman Neil S.
Published: March 2007

Objective: The objective of this study was to compare the cost‐effectiveness of 3 strategies of serologic
enzyme‐linked immunosorbent assay (ELISA) testing and post‐exposure varicella zoster immune globulin
(VZIG) prophylaxis for the prevention of maternal varicella pneumonia during pregnancy in patients with
negative or uncertain histories of varicella infection.

Methods: A decision tree was constructed to compare the following strategies: 1) routine serologic testing
for varicella immunity followed by targeted post‐exposure VZIG prophylaxis, 2) post‐exposure serologic
testing followed by targeted VZIG prophylaxis, and 3) untargeted post‐exposure VZIG administration. The
probabilities for the model were obtained from the medical literature and supplemented by expert opinion.
The costs were obtained by a review of inpatient hospitalizations for varicella pneumonia. All costs were
converted to 1995 dollars.

Results: Routine serologic testing followed by targeted post‐exposure VZIG prophylaxis was the most
costly strategy ($37.22/person), with no demonstrable increase in benefit compared with the other 2 strategies.
The disutility of this strategy compared with the others was stable across a wide range of values for
the probabilities and costs utilized in the sensitivity analysis. We were unable to differentiate between the
cost‐effectiveness of the other 2 strategies.

Conclusions: Routine serologic testing for varicella immunity in patients with negative or uncertain
histories of varicella infection should not be performed. The remaining options of screening and prophylaxis
appear to be reasonable alternatives for dealing with varicella exposures.
Human Immunodeficiency Virus‐Associated Nephropathy in Pregnancy
Authors: Eriksen Nancy L. , Mastrobattista Joan M.
Published: March 2007

Background: Human immunodeficiency virus (HIV)‐associated nephropathy typically leads to endstage
renal disease requiring dialysis within 3–4 months. This report describes the prenatal course
of a patient with HIV‐associated nephropathy requiring dialysis during pregnancy.

Case: A 23‐year‐old nulliparous, black female presented at 13 weeks gestation with a history of
HIV‐associated nephropathy and anemia. She had a CD4 count of 350/mm3, a total urinary protein
of 1.7 g/day, and a serum creatinine of 4.8 mg/dl. The patient was begun on zidovudine, 500
mg daily, and erythropoietin, 4,000 units weekly. At 23 weeks gestation, when she developed
hypertension, a total urinary protein of 3.4 g/day, and a serum creatinine of 4.4 mg/dl, she was
hospitalized. Her renal function continued to deteriorate, requiring hemodialysis. At 29‐4/7 weeks,
she developed preterm labor, for which she was placed on indomethacin. Four days later, at 30
weeks gestation, she delivered a viable male infant.

Conclusion: HIV‐associated nephropathy during pregnancy can be successfully managed with
hemodialysis.
Fusobacterium Chorioamnionitis: Report of Two Cases in Preterm Labor With Intact Amniotic Membranes
Authors: Jazayeri Allahyar , Lantz Michael E. , O′Brien William F.
Published: March 2007

Background: Preterm labor (PTL) in women with intact membranes may be caused by developing
chorioamnionitis. Fusobacterium displays the ability to cause chorioamnionitis in the presence of
intact amniotic membrane.

Case: We report 2 patients with severe Fusobacterium chorioamnionitis which resulted in premature
termination of pregnancy. Both patients presented with PTL and intact membranes. Neither
initially appeared acutely ill. Despite the benign appearance, one woman rapidly deteriorated,
requiring ventilation, pressor support, and surgical evacuation of the uterus.

Conclusion: We feel that a Gram′s Stain and proper collection of anaerobic cultures at the time
of amniocentesis should be part of the evaluation of every patient with suspected chorioamnionitis.
Polymerase Chain Reaction Assay With Urine Specimens in the Diagnosis of Acute Chlamydia trachomatis Infection in Women
Authors: Pasternack R. , Mustila A. , Vuorinen P. , Heinonen P. K. , Miettinen A.
Published: March 2007

Objective: The purpose of this study was to evaluate the benefits achievable by Amplicor polymerase chain reaction (PCR) (F. Hoffmann‐LaRoche Ltd., Basel, Switzerland) with urine specimens in addition to PACE 2 (Gen‐Probe, Inc., San Diego, California) assay with cervical swab specimens in the diagnosis of Chlamydia trachomatis in women.

Methods: Cervical and urine specimens from 286 women were tested for C. trachomatis by PACE 2 and Amplicor PCR, respectively. All urine specimens were analyzed undiluted and diluted 1:10 to detect and eliminate possible PCR inhibition. A confirmatory PCR assay using major outer membrane protein‐based primers (MOMP‐PCR) was used on urine specimens that were positive by PCR from women who were negative by PACE 2 with cervical swab specimens.

Results: Of the endocervical specimens, 26 were positive by the PACE 2 assay. The PCR with urine was positive in 21 of these patients. When the urine specimens were analyzed diluted 1:10, 4 of the 5 PCR‐negative specimens from PACE 2‐positive patients turned positive by the PCR. Additionally, 4 urine specimens from PACE 2‐negative women were positive by the PCR with
urine, and 3 of them could be confirmed by MOMP‐PCR. Altogether, 29 women were found to be positive for C. trachomatis by either of the two assays.

Conclusions: By using the PCR with urine specimens, an 11% increase in sensitivity could be achieved in addition to that obtained by PACE 2 assay with cervical swab specimens. In the present material, however, the increased sensitivity was reversed by the presence of PCR inhibitors in 14% of the female urine specimens. Amplicor PCR with urine specimens can undoubtedly be recommended
for the diagnosis of chlamydial infections in women. However, constant monitoring of the PCR inhibition seems highly advisable to obtain full benefit of the sensitivity of the PCR.
Ultrasound‐guided Transvaginal Aspiration in the Management of Actinomyces Pelvic Abscess
Authors: Anteby Eyal Y. , Rahav Galiya , Hanoch Josef , Shimonovitz Shlomo , Yagel Simcha , Laufer Neri
Published: March 2007

Background: Increasing reports of intrauterine device (IUD)‐related abdominopelvic actinomycosis
have been described recently. Surgical therapy has been the usual treatment when tubo‐ovarian
abscess is identified.

Case: A 38‐year‐old woman suffering from Actinomyces pelvic abscess unresponsive to medical
treatment underwent transvaginal ultrasound‐guided needle aspiration. It resulted in marked improvement
and avoided surgical treatment.

Conclusion: Transvaginal needle aspiration of Actinomyces pelvic abscess may be an alternative to
surgical therapy, thereby allowing the preservation of pelvic organs.
Famciclovir (FAMVIR®)
Authors: Sacks Stephen L.
Published: March 2007

Famciclovir is an antiviral with efficacy and safety comparable to aciclovir, but famciclovir's more favorable pharmacokinetic profile enables a less frequent dosing regimen. Future trials will likely determine famciclovir's role in the suppression of HBV.
Materno‐Fetal Transmission of Human Immune Deficiency Virus
Authors: Schäfer Axel
Published: March 2007

Mother‐to‐child transmission of human immune deficiency virus (HIV) is a multifactorial event highly associated with advanced maternal HIV disease and obstetric incidents taking place during parturition. Thus, various approaches to prevention may be beneficial. Although the time and the route of materno‐fetal HIV transmission are still not sufficiently clear, much speaks in favor of a late HIV transmission, most probably taking place during parturition or the phase before the delivery. The fetus is remarkably protected by the placenta and the intact fetal membranes against many viral infections during gestation. These conditions change at parturition and the chance for a transition of HIV‐infected carrier cells or virus into the fetal compartment increases. Proinflammatory cytokines secreted at the materno‐fetal interface accumulate in amniotic fluid and may chemoattract and stimulate potentially HIV‐infected immunocytes. After rupture of membranes, maternal cells of the decidua are directly exposed to the amniotic fluid. Aside from the contamination of the fetal skin at vaginal delivery as a debatable route of infection, blood‐to‐blood contacts and the fetal swallowing of contaminated amniotic fluid may be the major path of fetal HIV infection. For the fetal prophylaxis of an intrauterine infection, the application of zidovudine is recommended. However, cesarian section before the onset of labor leads also to a diminution of the transmission rate. As the transmission seems to have both systemic and local causes, it makes sense to combine different intervention strategies. Whether a combination of zidovudine and elective cesarean section can lower the transmission risk further has to be evaluated.