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Estimates of Trichomonas vaginalis prevalence in pregnant women are variable with few studies in Iraq. T. vaginalis is a worldwide prevalent sexually transmitted infection, but fortunately, it is very treatable. Researchers believed that pregnancy is one of the effective factors for T. vaginalis infection in women. A cross-sectional study performed in Obstetrics and Gynecology Department at Maternity and Children Hospital in Al-Diwaniya city on two hundred female pregnant patients between the ages of 16–45 years. These females had no intercourse for 2–3 days, not using drugs (antibiotics, antiprotozoal or steroids) for the last 15 days. Vaginal discharges of any type with or without itching, burning sensation or both were their main complaints. Vaginal swabs were taken from all participating patients for direct wet mount microscopy and culture for the detection of Trichomonas vaginalis infection. The study showed that twelve out of two hundred examined pregnant women (6%) presented with T. vaginalis infection. The infection was more in those with mothers’ age (26–35) years, housewives, low education, higher parity, and of rural residents. Other maternal variables were not significantly associated with T. vaginalis infection. The study showed a prevalence of (6%) of T. vaginalis infection in pregnant female attendees. Infection was more in those with mothers ’age (26–35) years, housewives, low educational level, higher parity, and living in rural areas.

Maternal group B Streptococcus (GBS) colonization is a major risk factor for neonatal GBS infection. However, data on GBS are scarce in low- and middle-income countries. Using sociodemographic data and vaginal swabs collected from an international cohort of mothers and newborns, this study aimed to estimate the prevalence of GBS colonization among pregnant women in Madagascar (n = 1,603) and Senegal (n = 616). The prevalence was 5.0% (95% CI, 3.9–6.1) and 16.1% (95% CI, 13.1–19.0) in Madagascar and Senegal, respectively. No factors among sociodemographic characteristics, living conditions, and obstetric history were found to be associated independently with GBS colonization in both countries. This community-based study provides one of the first estimates of maternal GBS colonization among pregnant women from Madagascar and Senegal.

Vaginal swabs were obtained from 300 females and examined by the wet preparation and culture methods. Trichomonas vaginalis was identified in 34 female subjects [11.3%] with vaginal discharge. Pregnant women showed the highest rate [15.0%]. The next highest infection rate [12.9%] was noticed during the menstrual years. Women aged over 40 years showed a rate of 3.8%. A total of 235 males were also investigated;150 [63.8%] presented with urethral discharge and 85 [36.2%] were apparently healthy and asymptomatic. Among those with discharge, infection was identified in 11 subjects [7.3%], against 2 [2.4%] among the asymptomatic subjects. The majority of positive cases were in the age group 21-40 years

BACKGROUND Evidence suggests that intravaginal practices (IVPs) women use to cleanse their vagina or enhance sexual pleasure may be associated with unhealthy changes in the vaginal microbiome (VM). However, the effects of these practices in postmenopausal women are unknown. OBJECTIVES The objective of this pilot study was to characterize the VM communities of postmenopausal women, identify types and frequency of IVPs, and explore associations between the VM and IVPs in postmenopausal women. METHODS We analyzed the VM data of 21 postmenopausal women in Atlanta, Georgia, from vaginal swabs collected at a routine gynecological visit. 16S rRNA gene sequencing in the V3-V4 region was used to characterize the VM. In addition, we described the IVPs of these women, identified by using our newly developed instrument: the Vaginal Cleansing Practices Questionnaire. The associations between the VM and IVPs were explored by comparing the alpha diversities, beta diversities, and the relative abundances at both the community level and individual genus level. RESULTS The most abundant known bacterial genus found in the VM samples was Lactobacillus (35.7%), followed by Prevotella (21.4%). Eleven women (52%) reported using at least one type of IVP since menopause. The most common type of IVP was soap and water to clean inside the vagina. The use of IVPs was not associated with any alpha diversity metric, including Shannon index, inverse Simpson index, and Chao1 index; beta diversity metric, including Bray-Curtis and Jaccard distances; nor relative abundances at the community and individual genus level. Sociodemographic factors were also not associated with any alpha diversity metric. DISCUSSION Clinicians must assess IVPs and other vaginal and sexual hygiene practices of women of all ages to educate and promote healthy behaviors. More than half of the postmenopausal women in this pilot study use IVPs. Understanding the reasoning behind participants' use of IVPs and their perceptions of the possible effects of these practices will require further research. Although the small sample did not show associations with the VM, more extensive studies are warranted.

Background Chronic infection with high-risk human papillomavirus is a necessary cause for cervical carcinogenesis. This study examined prevalence of nonavalent vaccine preventable HPV types over four months among sexually active women in the United States. Methods This sub-study obtained meta-data for 80 of the 1,365 women (18–25 years), enrolled in the BRAVO study, a randomized, open-label trial of home screening and treatment of asymptomatic bacterial vaginosis at high-risk for sexually transmitted infections conducted between 2008 and 2013. Participants were randomized to treatment or standard-of-care, and followed every 2-months for 12 months. Stored vaginal swabs from the first three visits were tested for the nine vaccine preventable HPV types using quantitative PCR. Prevalence and associated 95% confidence intervals for the HPV types were assessed using R (version 3.6.1). Results The average age of the participants was 21.5 (SD ± 2.11) years, with 60% having ever been pregnant and all were African-American. Majority (71%) reported ≥ two sex partners in the prior year with 89% having unprotected vaginal sex and 45% having a new sex partner in the prior year. About 30% had ≥ one of the nine nonavalent vaccine HPV types at all three time points over a period of four months, 15% at two of any three visits, 19% at one of the three visits and 36% were negative for all nine vaccine HPV types at all time points. The most frequently detected HPV vaccine types were 52, 58, 16, and 18. The prevalence of any vaccine HPV types, and high-risk HPV types was 63.8% and 58.8%, respectively. Conclusions Our findings suggest that HPV vaccination which is currently recommended for all unvaccinated persons through age 26 years, is likely to be more beneficial than previously thought as nonavalent HPV vaccine was not available during the time these data were collected.

Many women with pelvic organ prolapse opt for a pessary, and some of these women develop erosions of the vaginal mucosa. Ongoing erosions might lead to the discontinuation of this otherwise effective, non-invasive, and inexpensive treatment. The objectives of this study were to investigate the differences in vaginal pH and variations of the vaginal microbiota among pessary and non-pessary users.For this descriptive observational study, 30 women, followed in our urogynecology clinic, were recruited to form 3 equal groups: 2 groups of women using a pessary (with and without erosions) and 1 control group of women not using a pessary. Vaginal pH was measured distally and next to the erosion. Vaginal swabs were used to investigate the vaginal microbiota by sequencing the V4 region of the 16S ribosomal RNA gene and analyzing the data with Qiime2. Descriptive statistics were reported using the median values. Vaginal pH comparisons between groups were made using a Kruskal-Wallis test with Dunn's correction for multiple comparisons.The pH of the vagina was more alkaline in women with erosions compared with women in the other 2 groups (P 0.01). Also, the pH of the distal vagina was not different from the pH next to the erosion (P = 0.25). Patients with erosions displayed significant differences in their vaginal microbiota, which contained a much greater bacterial diversity with an increase in gram-negative bacteria (e.g., Bacteroidetes, Actinobacteria) and a decrease in lactobacilli.In our study, women with vaginal erosions had significantly higher vaginal pH and more complex vaginal microbiota than women in the control groups. Treatments focusing on lowering the vaginal pH and/or re-establishing the vaginal microbiota should be considered.

Brucellosis is a zoonotic disease primarily affecting animals and accidentally exposed humans. In Eritrea, brucellosis endemicity is proven by several sero-prevalence studies in domestic animals and occupationally exposed humans. However, there is a gap of information on the commonly occurring brucella species and cause of human/animal brucellosis. The objective of this study is to identify brucella species in sheep and goats which possibly pose risk to human brucellosis. Out of a total 71 serum and 71 vaginal swab samples collected from sheep and goats, eight serum samples by Rose Bengal plate test (RBPT) and 4 vaginal swabs by polymerase chain reaction (PCR) were found positive for brucellosis. Combinatorial PCR detected Br. melitensis from the four PCR positive samples. Questionnaire interviews collected from 68 confirmed brucellosis patients showed that habits of drinking unpasteurized yoghurt and raw milk and handling of aborted materials were common. This investigation study suggests, Br. melitensis could be the major cause of brucellosis in humans and animals in Maekel region Eritrea. Therefore, a large-scale epidemiological study is recommended to confirm the true extent of the problem in animals and humans.

Background The Chlamydia trachomatis bacterial load could have impact on transmission and sequelae. This is the first study providing comparison of C. trachomatis load at 3 anatomic sites estimated by cycle quantification (Cq) values. Methods Data from 7900 C. trachomatis-positive samples were included (2012–2018). Cq value was used as an inversely proportional measure for C. trachomatis load. Multivariable linear regression analyses assessed differences in mean Cq values. Results Vaginal swabs had the lowest Cq values (31.0) followed by urine (32.5), anorectal swabs (34.0), and oropharyngeal swabs (36.8) (P < .001). Men and women had similar oropharyngeal (36.4 vs 37.3; P = .13) and anorectal (34.2 vs 33.9; P = .19) Cq values. Men (32.2) and women (30.7) aged Conclusions Men and women have a similar C. trachomatis load at extragenital locations arguing for similar transmission potential and clinical relevance. Older patients and HIV-coinfected patients had lower C. trachomatis load, suggesting exposure to previous C. trachomatis infections potentially leading to partial immunity reducing load.

Background: Vaginal microbiota considered as a complex microbial population consisting of a multitude of microbial species and causes many vaginal infections including bacterial vaginosis. Objective: The study is investigating the antibiotic sensitivity of predominant vaginal microbiota. Patients and Methods: 250 pregnant women in Erbil city in the North of Iraq, from October 2018 to March 2019. Samples were collected from pregnant women who visited Maternity, Rizgary and Raparin Hospitals’ laboratory department under medical precautions. The samples were cultures to investigate to identify the bacteria types and sensitivity for common antibiotics. Results: About 72% of samples showed positive microbial growth and the higher distribution percentage of isolated microorganisms was 27.2%, 23.8%, 21.6 and 11.6% for Candida sp., Staphylococcus aureus, Escherichia coli and Streptococcus pyogenes respectively. Moreover, antibiotic sensitivity tests declared that ciprofloxacin was effectively inhibited the growth of both Staphylococcus aureus and Streptococcus pyogenes while Norfloxacin was 95% which inhibited the growth of E. coli. Conclusion: Candida albicans, Staphylococcus aureus, Escherichia coli and Streptococcus pyogenes are among the most predominant microorganisms in pregnant women. Keywords: Antibiotic sensitivity profile, Bacterial culture, High vaginal swab

Background: Q fever is a worldwide zoonosis caused by Coxiella burnetii. This study was carried out to investigate the occurrence of C. burnetii among apparently healthy pregnant, parturient, and postparturient dogs and cats to highlight their role in the transmission of such disease to humans. Materials and Methods: A total of 88 apparently healthy pet animals (48 dogs and 40 cats) were enrolled in this study, vaginal swabs were obtained from pregnant and postparturient animals while birth fluids were collected from parturient ones. All samples were subjected to DNA extraction followed by nested PCR for molecular detection of C. burnetii. Results: Out of 40 cats, 3 were positive for C. burnetii with an overall prevalence of 7.5%, all positive samples were birth fluids of parturient queens with a prevalence of 15.8% (3/19) while all pregnant and postparturient animals were negative. In contrast, none of 48 dogs yielded positive result. Moreover, the phylogenetic analysis and sequence identity matrix of the obtained sequence from a parturient cat showed high genetic relatedness to strains derived from human cases rather than those of ruminants to indicate the public health burden of such strain. Conclusion: This study underscores the occurrence of C. burnetii among parturient cats to point out the possible zoonotic transmission to human contacts.

Background and objective: Vaginal candidiasis is a common infection among pregnant women. The current study aimed to investigate the etiologic species of vaginal candidiasis and the genotypes of C. albicans isolated from vaginal samples among pregnant women in the Kurdistan region of Iraq. Methods: Vaginal swabs were collected from pregnant women admitted to the Maternity hospital in Sulaymaniyah and Erbil cities from March 2016 to December 2018. Candida isolates were identified on CHROMagar medium, then confirmed with PCR depending on ITS region. All C. albicans isolates were confirmed using chitin synthase gene (CHS1) and subjected to genotypic analysis based on the transposable intron in 25S rDNA with using CA25S and CA-INT primers. DNA sequencing of 25S rDNA region was done by using CA and CA-INT primers. Results: Among 340 women tested, 114 (33.53%) were positive for vaginal candidiasis. Five Candida species were identified, where they are C. albicans (56.14%), C. glabrata (24.56%), C. kefyr (11.40%), C. tropicalis (5.27%) and C. krusei (2.63%). It has been found that C. albicans significantly (P

Objective The aim of the study was to evaluate the performance of nucleic acid amplification testing (NAAT) for the diagnosis of vulvovaginal candidiasis (VVC), bacterial vaginosis, and Trichomonas vaginalis. Methods A cross-sectional analysis of women with (n = 200) and without (n = 100) vulvovaginal symptoms was enrolled from outpatient gynecology offices and a vulvovaginal referral clinic. Vaginal swabs were analyzed by wet mount microscopy, yeast culture, Gram stain, T. vaginalis culture, and NAAT. Sensitivity and specificity analyses were performed. Results Among symptomatic women, the sensitivity of microscopy was 48.5% for VVC and 75% for T. vaginalis. Sensitivities of NAAT and culture for diagnosing VVC were 92.4% and 83.3%, respectively, whereas these methods were 100% and 93.8% for T. vaginalis. The sensitivity for bacterial vaginosis diagnosis by clinical criteria ("Amsel criteria"), Gram stain, and NAAT were 98.7%, 82.7%, and 78.7%, respectively. Test concordance rates were high between culture and NAAT for Candida species (91%) and between Gram stain and NAAT for the detection of bacterial vaginosis (88%). Among asymptomatic women, 20%-21% tested positive for bacterial vaginosis by Gram stain or NAAT, and 8%-13% were colonized with Candida species based on culture or NAAT. Conclusions Given the limitations of wet mount sensitivity for VVC and T. vaginalis, culture or NAAT testing should be considered when evaluating women with symptoms of vaginitis who test negative by microscopy. Although Amsel criteria accurately diagnosed bacterial vaginosis, NAAT is preferred for detection of T. vaginalis and performed similarly to culture for the diagnosis of VVC.

In this work 68 S. aureus isolated frommastitic cows (n=48), camel milk (n=5) and human samples (urine n = 4, abscesses aspiration n = 3, sputum n = 2, nasal swabs n = 2, vaginal swabs n = 1 and wound swabs n = 3) were investigated using phenotypic and molecular identification to detect the occurrence of enterotoxins. Eighteen out of 48 S. aureus isolated from mastitic cows and 5 out of 15 S. aureus isolated from human samples were enterotoxin producers. All toxigenic S. aureus isolated from clinical mastitic cows (13) were toxin type D producer while seb and sed were detected from subclinical mastitic cows. Among human isolates, 2 isolates produced mixed toxins A and E, 2 isolates produced mixed toxins C and D and one isolate produced type C toxin. No toxin was detected from camel isolates. All toxigenic S. aureus isolated from cows (13) were toxin type D producer. Among human isolates 2 isolates produced mixed toxins A and E, 2 isolates produced mixed toxins C & D and one isolate produced type C toxin. Five S. aureuscrude enterotoxin type D were investigated by protein SDS-PAGE. It was clear that all isolates had from 9 to 7 bands. All the isolates had a band at 148-159 kDa, 35-42 kDa, 28-30 kDa, 23-26 kDa, 20-22 kDa and 18-19 kDa. 4 isolates had a band at 48-55 kDa, 3 isolates had a band at 39-42 kDa, 3 isolates had a band at 31-34 kDa and one isolate had a band at 17 kDa.

The incidence of diabetes mellitus has increased in Saudi Arabia, which has raised the risk of vulvovaginal candidiasis (VVC). This study highlights the prevalence and antifungal susceptibility of Candida species among postmenopausal women with diabetes with symptoms of VVC in Taif, a city in Saudi Arabia. Several diagnostic tools were used to differentiate the yeast isolates, including microscopic examination, culture morphology on CHROM agar, further confirmation with the VITEK 2 system, and ITS1 and ITS4 region sequencing. Antifungal susceptibility of the selected Candida species was determined using the VITEK 2 system (bioMérieux Inc., USA). Out of the 550 high vaginal swabs investigated, 86 specimens were Candida species positive (15.6%) with a significant difference according to age; the positivity in the 45–50 years’ age group (12%) was higher than that in the 51–55 years’ age group (3.6%). Candida albicans was the most common causative agent in 51 samples (59.3%), followed by C. glabrata in 21 samples (24.41%) and C. krusei in 14 samples (16.27%), with no significant differences between the age groups. Three isolates, including two C. albicans and one C. krusei, exhibited resistance against all the tested antifungal agents. CHROM agar and VITEK 2 were accurate phenotypic tools to identify Candida species with 100% sensitivity and specificity and were consistent with the phylogenetic characterization. The data emphasized the importance of identifying Candida species and their antifungal susceptibility among postmenopausal women with diabetes, highlighting the potential risk posed by diabetes in this age group.

There is an increase in non-albicans Candida (NAC) vulvovaginal candidiasis which is attributed to overuse of antifungal therapy and this has led to antifungal resistance. This study was aimed at determining the antifungal resistance pattern of some clinical isolates of Candida species. Eighty-eight (88) isolates were used which included Candida tropicalis (34), Candida Parapsilosis (21), Candida albicans (20), Candida krusei (7) and Candida glabrata (6). The drugs used were Fluconazole (25µg), Ketoconazole (10µg), Voriconazole (1µg), Nystatin (100Units), Amphotericin B (20µg), Flucytosine (1µg), Clotrimazole (10µg) and Itraconazole (50µg). The susceptibility testing was carried out using the M44-A standard method for yeast disk diffusion testing. Results showed that the percentages of Candida species resistant to Fluconazole, Ketoconazole, Voriconazole, Amphotericin B, Flucytosine, Clotrimazole and Itraconazole and Nystatin were 52.3%, 61.9%, 35.2%, 19.3%, 86.4%, 34.1%, 45.5% and 44.3%, with inhibition zone diameters ≤14mm, ≤20mm, ≤13mm

Background: The objective was to compare commercial assays on clinical specimens for Mycoplasma genitalium (MG) detection and macrolide resistance mutation (MRM) frequency. Methods: Three self-collected vaginal swabs (VS) and a first-void urine (FVU) from 300 consented women were tested by Aptima MG (AMG), ResistancePlus MG (RPMG) and Seeplex STD6 ACE (STD6) for detection of MG. Aptima MG and STD6 MG positives were tested for MRM using MG 23S rRNA polymerase chain reaction with Sanger sequencing (23SMGSS) compared with MRM determination in the RPMG assay. Unique AMG positives were tested with confirmatory Aptima assays. Results: M. genitalium prevalence ranged from 7.1% to 19.7%, influenced by the assay used and the specimen tested. Overall agreements for MG detection were 96.3% (κ = 0.91) for VS and 93.3% (κ = 0.72) for FVU between AMG and RPMG with lower agreements with STD6. Using a rotating reference standard, sensitivities on VS and FVU were 100% and 100% for AMG, 100% and 83.3% for RPMG, and 54.2% and 48.4% for STD6. Specificities were high for RPMG and STD6 and AMG detected extra positives, most of which were confirmed. Macrolide resistance mutation frequency rates testing VS and FVU were 50% (24/48) and 58.1% (18/31) by RPMG compared with 52.5% (31/59) and 23.5% (12/51) by 23SMGSS. MRM overall agreements between RPMG and 23SMGSS were 73.2% (κ = 0.41) for VS and 76.0% (κ = 0.52) for FVU. Conclusions: Aptima MG detected more cases of MG infections. ResistancePlus MG detection was more effective on VS than on FVU. Seeplex STD6 ACE performance was inferior. The MRM detection component of RPMG agreed with results from 23SMGSS most of the time.

Thirty postpartum (>70 days) anestrus crossbred cows were treated with three standard hormonal protocols (CIDR TRIU-B, and P4 Sponge n=10 each) for induction of estrus and the findings were compared with a group of untreated anestrus cows (Blank Sponge n=10). 80 vaginal swabs were collected aseptically from each group just before insertion of Implants/Blank Sponge and at the time of Implant/Blank Sponge withdrawal for microbiological evaluation of vaginal mucosa. Total number of isolates obtained from all the swabs were 180. Out of 180 isolates, 72 (40.00%) isolates were Gram positive and 108 isolates were (60.00%) Gram-negative bacteria, indicating dominance of Gram- negative bacteria. Overall ratio of number of isolates per vaginal sample obtained in the present study was 2.25. The highest rate of isolation of bacteria per sample was recorded in the placebo group at the time of removal of placebo i.e. 2.6, followed by 2.5 by same group at the time of insertion, 2.3 at the time of TRIU-B removal, 2.2 at the time of TRIU-B insertion and P4 Sponge removal, 2.1 in CIDR at the time of removal and P4 Sponge insertion and lowest i.e. 2.0 in CIDR group at the time of insertion of implant. The frequency of single and mixed isolates observed in different groups of anestrus animals at the time of insertion and removal of implants showed predominance of mixed isolates over single isolates 63 (78.75%) vs 17 (21.25%), indicating dominance of mixed isolates over single isolates. E. coli, Staphylococcus, Proteus and Bacillus were the commonest isolates obtained before and after insertion of implants and Blank Sponge in post-partum anestrus cattle. The implant used and time/period of isolation did not alter the types of bacteria isolated.

Introduction: The identification of semen stain is one of the most common human stains that can provide crucial information for crime scene reconstruction and forensic investigation. In sexual assault cases semen identification helps to support or refute victim’s allegations, it also provides a material for DNA analysis. The rapid Stain Identification of Human Semen (RSIDTM -Semen) bioassay is designed to detect specifically the presence of human semenogelin. It does not cross‐ react with other human or nonhuman tissues. Aim: To assess the efficacy of RSIDTM – Semen strip test for the detection of human semen under some different variables (different fabrics, different time intervals and mixed with vaginal secretions). Methodology: Semen samples were collected from four male participants; each sample was divided into two portions; one used for semen only test group and the other mixed with vaginal secretions for the mixed test group. Vaginal swabs were carried out from the four female participants using cotton, linen or nylon-tipped plastic rods (2 swabs from each female). One of the fabrics tipped vaginal swab was mixed with semen for the mixed test group and the other used as a positive control group to test the sensitivity and specificity of the RSIDTM – Semen strip. The semen samples were deposited over different fabrics at the same time. All the samples were left to dry for 15 minutes at room temperature (summer) then extracted and analyzed. Each of the previous groups, was categorized into 5 subgroups (a, b, c, d and e) according to the time interval of semen extraction (zero (on the spot), 2, 4, 6 and 10 days respectively). Results: Semen could be identified in 100% of tested samples of the semen only group as well as of the combined semen and vaginal secretions group over cotton and linen fabrics at all the different tested time intervals. However, semen extracted from nylon fabric was identified in tested samples of the semen only group and of the combined semen and vaginal secretions group only at zero time only and couldn’t be identified at the rest of tested time intervals. Conclusion: The current study evidenced that the new RSIDTM -semen kit is a reliable method for semen identification over different types of fabrics even in the presence of vaginal secretions. It also persists up to 10 days except on nylon fabric.

Vulvovaginal candidiasis (VVC) is a major cause of lower genital infections in women, especially in developing countries and cause significant morbidity and financial burden on the already weak economy. The objective was to isolate and identify Candida spp responsible for Vulvovaginitis. Two hundred (200) vaginal swabs were collected from female patients 15years and above, attending Yusuf Dantsoho Memorial Hospital (YDMH) and Barau Dikko Specialist Hospital (BDSH) all within Kaduna metropolis. The samples were analysed for the presence of Candida spp using standard procedures of microscopy, culture and biochemical identification. The overall incidence of VVC was 79.5% (159/200), with higher incidence among patients attending Yusuf Dantsoho Memorial Hospital 84.8% (117/138), than Barau Dikko Memorial Hospital 67.7% (42/62). Four (4) yeast species were isolated and identified which include Candida krusie, Candida parapsilosis and Candida glabrata. C. krusie had the highest percentage occurrence of 42.5% (39/159), while C. parapsilosis had the least percentage occurrence of 11.3% (18/159). Higher incidence was recorded among age group 40 and above 92.8% (13/14) and lowest among age group 31-40 76.5% (39/51). Highest incidence was also recorded among widow 100% (18/18) and lowest among married 76.8% (109/142). The high percentage of positive samples is an indication that there is a high incidence of candidiasis among the study population. There is need for regular screening of women for VVC and other sexually transmitted infections. Key words: Incidence, Vulvovaginal Candidiasis, Isolation, Kaduna.

The vaginal microbiota may be important for pregnancy prognosis because vaginal dysbiosis during pregnancy appears to be related to preterm birth (PTB) or pregnancy loss. Previous reports have indicated that a Lactobacillus-poor microbial flora in the vagina and intrauterine infection by diverse anaerobes ascending from the vagina are associated with undesirable delivery outcomes. However, no research has involved the use of pyrosequencing analysis to examine vaginal microbiota profiles or their potential associations with high-risk pregnancy in Korean women. Vaginal swabs were collected from 500 Korean women for the identification of community state types (CSTs). Of these, 137 samples were further analyzed using a Roche/454 GS Junior pyrosequencer. Three distinct CSTs were identified based on the dominant vaginal microbes: CST I (Lactobacillus crispatus dominated), CST III (Lactobacillus iners dominated), and CST IV (with diverse species of anaerobes). Twelve of the 67 pregnant women had undesirable pregnancy outcomes (four miscarriages and eight PTBs). The dominant microbe in the vaginal microbiota of women who gave birth at full-term was L. crispatus. In contrast, L. iners was the dominant vaginal microbe in women who miscarried. Most (n = 6/8) vaginal microbiota profiles of women who experienced PTB could be classified as CST IV, with diverse bacteria, including anaerobic vaginal species. The present study provides valuable information regarding the characteristics of the vaginal microbiota of Korean women related to high-risk pregnancy. Investigation of the vaginal microbiotic structure in pregnant Korean women is necessary to enable better prediction of adverse pregnancy outcomes.

Trichomonas vaginalis is one of the most common curable sexually transmitted pathogens infecting both men and women worldwide. Unlike traditional methods such as microscopy and culture, nucleic acid amplification tests rapidly detect this agent, assisting in treatment. Conventional polymerase chain reaction (PCR), the loop-mediated isothermal amplification (LAMP), and the Xpert TV assay were evaluated using 28 microscopy positive T. vaginalis samples and 125 microscopy negative samples from symptomatic females of reproductive age. The sensitivity of all tests was 100% and the specificity was 100%, 100%, and 99·2% for PCR, Xpert TV, and LAMP, respectively. The inter-rater reliability was excellent for PCR: Xpert TV (kappa-coefficient = 1) and good for LAMP assay: Xpert TV/PCR (kappa-coefficient = 0·98) and conventional PCR: LAMP (kappa-coefficient = 0·98). The study highlights the importance of PCR for screening T. vaginalis in women, particularly in laboratories where the Xpert-TV assay is not available or not affordable. The LAMP assay showed a lower positive predictive value which merits further evaluation. SIGNIFICANCE AND IMPACT OF THE STUDY: Trichomonas vaginalis is a common sexually transmitted pathogen associated with considerable morbidity and risk of complications. Due to the limitations of traditional diagnostic modalities, three molecular assays were compared: conventional polymerase chain reaction (PCR), Xpert TV assay, and loop mediated isothermal amplification (LAMP) assay for detecting T. vaginalis in symptomatic females. All tests had a sensitivity of 100% and the inter-rater reliability was excellent for PCR: Xpert TV, and good for LAMP assay: Xpert TV/PCR. The translational impact of this study lies in the possible use of conventional PCR and LAMP in laboratories where the Xpert TV assay is not available or not affordable.

Group B Streptococcus (GBS) infection in newborns during childbirth can result in death. We described a method to detect GBS from vaginal swabs in pregnant women, without prior enrichment, using real-time polymerase chain reaction (qPCR), and compared its results to the culture method. The qPCR outperforms culture method.

Objectives: No previous studies had been performed on asymptomatic sexually transmitted infections (STIs) in Spanish university students. Therefore, the aim of the study was to determine the prevalence of Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and Mycoplasma genitalium (MG) in this group. Material and Methods: All medical students were invited to participate in the study between September 2017 and June 2019. First-void urine specimens were collected from men and vaginal swabs from women. Results: Four females had positive results. The prevalence of CT and MG in women was 4.0% and 2.4%. All individuals with positive results had stable partners. CT infection was associated with having stable and sporadic sexual partner in the previous year. The frequency of positive results was higher in those women who had sought an app-based sexual partner. Conclusion: The prevalence of asymptomatic STI in medical students was similar (rather than lower) to that in same age individuals in the area. Medical knowledge might not protect from STI acquisition.

This study intends to explore the prevalence of pathogenic bacteria infected the vaginal cavity of sheep and goats, in addition to determine the normal vaginal bacterial flora in pregnant and non pregnant local breed goat and sheep. Vaginal swabs were collected from 80 cases comprised of 54 sheep and 26 goats that involve 20 and 6 pregnant ewes and goats from Baghdad city during May 2019 to July 2019. These samples were cultivated onto different bacteriological media. The isolated bacteria were identified by different biochemical tests. Mixed bacterial isolates were determined in 65 out of 80 (81.3%) samples. Totally, 9 various microorganisms were isolated from animal’s vagina. E. coli, Streptococcus Spp, KlebsiellaSpp and Staphylococcus aureus were the most common isolated microorganism from vaginal swabs in a percentage of 36, 20, 17.5 and 16.3%respectively. While Bacillus Spp, Proteus Spp, Staphylococcus Spp, Corynebacterium Spp and Salmonella Spp.were the less common isolated microorganisms in a percentages of 10, 10, 7.5, 6.3 and %2.5 respectively. Moreover, the enteric bacteria especially E. coli was isolated in the higher incidence rate (44.4%) in pregnant ewes compared to pregnant goats 15.4%. However, in non-pregnant animals, the percentages were 50 and 15% in sheep and goats respectively. Nonetheless, Proteus Spp were isolated only from newly birth animals. Meanwhile, Staphylococcus aureus were relatively isolated at the same level of incidence at 15%-17% in either pregnant or non-pregnant sheep or goats, while Streptococcus Spp were mostly found in pregnant goats and ewes at 50 and 25% respectively. In conclusion, this study approved the isolation of different bacterial spp in various incidence rates from vaginal cavity of pregnant and non-pregnant sheep and goats.

ObjectivesTo assess risk and protective factors associated with bacterial vaginosis (BV) chronicity ascertained by Nugent score criteria.MethodsA longitudinal cohort study included 255 sexually experienced, postmenarcheal women who provided weekly self-collected vaginal swabs for up to 2 years. Vaginal swabs were scored using Nugent criteria and classified as normal (≤3), intermediate (4–6) and Nugent-BV (≥7). Detailed behavioural/health information were assessed every 6 months. A per-woman longitudinal summary measure of BV chronicity was defined as the percentage of each woman’s weekly vaginal assessments scored as Nugent-BV over a 6-month interval. Risk and protective factors associated with BV chronicity were assessed using multiple linear regression with generalised estimating equations.ResultsAverage BV chronicity was 39% across all follow-up periods. After adjustment, factors associated with BV chronicity included baseline Nugent-BV (β=35.3, 95% CI 28.6 to 42.0) compared with normal baseline Nugent scores and use of unprotected water for bathing (ie, rainwater, pond, lake/stream) (β=12.0, 95% CI 3.4 to 20.5) compared with protected water sources (ie, well, tap, borehole). Women had fewer BV occurrences if they were currently pregnant (β=−6.6, 95% CI −12.1 to 1.1), reported consistent condom use (β=−7.7, 95% CI −14.2 to 1.3) or their partner was circumcised (β=−5.8, 95% CI −11.3 to 0.3).ConclusionsFactors associated with higher and lower values of BV chronicity were multifactorial. Notably, higher values of BV chronicity were associated with potentially contaminated bathing water. Future studies should examine the role of waterborne microbial agents in the pathogenesis of BV.

International audience; Vaginal self-sampling and human papillomavirus (HPV) DNA testing can be useful tools for women with limited access to health care living in sub-Saharan Africa. To assess the feasibility and acceptability of vaginal self-sampling and high-risk HPV prevalence in two villages of central Senegal, women were asked to self-sample vaginal swabs for HPV detection in May, 2016. Vaginal swabs were collected from 133 women and were tested for HPV genotyping. The acceptability rate of vaginal self-sampling was 98.5%, and 99.2% of the women (133/134) used the device correctly. The quality of self-sampling was satisfactory in 100% of the samples; 10.5% of the samples were positive for HPV, including 6% with high-risk HPV types and 4% with low-risk HPV types. This preliminary study indicates that vaginal self-sampling is a valuable strategy for high-risk HPV detection and cervical cancer screening in a population of women not attending gynecologic screening in rural areas of Senegal.

Background Measurements of HIV exposure could help identify subpopulations at highest risk of acquisition and improve the design of HIV prevention efficacy trials and public health interventions. The HVTN 915 study evaluated the feasibility of self-administered vaginal swabs for detection of HIV virions to assess exposure. Methods Fifty 18- to 25-year-old sexually active HIV-seronegative women using contraception were enrolled in Soweto, South Africa. Participants self-administered daily vaginal swabs and answered sexual behavior questions through mobile phone for 90 days. Clinician-administered vaginal swabs, behavioral questionnaires, HIV diagnostic testing, and counseling were performed at 8 clinic visits. Glycogen concentrations assessed adherence to swabbing. Y-chromosome DNA (Yc-DNA) assessed the accuracy of reported condom use. HIV exposure was measured by virion polymerase chain reaction in swabs from 41 women who reported unprotected vaginal sex during follow-up. Results Glycogen was detected in 315/336 (93.8%) participant-collected and in all clinician-collected swabs. Approximately 20/39 daily swabs (51.3%) linked to mobile reports of unprotected sex tested positive for Yc-DNA, whereas 10/187 swabs collected after 3 days of abstinence or protected sex (5.3%) had detectable Yc-DNA. No participant became HIV infected during the study; yet, exposure to HIV was detected by nucleic acids in 2 vaginal swabs from 1 participant, collected less than 1 hour after coitus. Conclusion There was high adherence to daily vaginal swabbing. Daily mobile surveys had accurate reporting of unprotected sex. Detection of HIV in self-collected vaginal swabs from an uninfected participant demonstrated it was possible to measure HIV exposure, but the detection rate was lower than expected.

In the current study, a total of 50 sheep, 23 goat and 60 human blood serum samples were collected for serological tests. A total of 30 (22 ewes and 8 does) milk samples, 43(25 ewes and 18 does) vaginal swabs, 14 preputial swabs from rams and 60 human citrated plasma were collected for bacteriological and molecular studies. All examined sheep and goat were non-vaccinated. Ewes and does had history of abortion, while rams had no clinical signs. Samples were collected from different localities at Minia governorate. Serological results using buffered acidified plate antigen test (BAPAT), rose Bengal test (RBT), rivanol test (RT), tube agglutination test (TAT), and indirect enzyme linked immunosorbent assay (iELISA) gave 32(64%), 30(60%), 26(52%), 31 (62%), and 28 (56%) in sheep respectively, where in goat revealed 23(100%), 23(100%), 22(95.7%), 23(100%), and 22(95.7%) respectively. While human serum samples were 33(55%), 29(48.3%), 33(55%), 27(45%), and 23(38.3%) respectively. The bacteriological results revealed 35 isolates [10(45.5%), 4(50%), 4(16%), 10(55.6%), 2(14.3%), and 5(8.3%)] from ewes' milk samples, does' milk samples, ewes' vaginal swabs, does' vaginal swabs, rams' preputial swabs and human citrated plasma respectively. All 35 isolates were molecularly identified using polymerase chain reaction (PCR) as B. melitensis biovar3. Conclusively, brucellosis was endemic at Minia governorate with a high level especially in goat. Rams act as chronic carriers leading to public health hazards. B. melitensis is the prevalent serotype in Egypt. More effective preventive and control measures should be applied

Forty female patients experiencing symptoms suggestive of trichomoniasis were included into the present investigation. Patients` self-obtained vaginal swabs were gathered and examined for T. vaginalis by wet mount, Giemsa stain, Gram stain and culture techniques. T. vaginalis was recognized in 11 out of 40 specimens by culture (27.5 %), 10 by wet mount (25 %), 8 by Gram stain (20 %) and 7 by Giemsa stain (17.5 %). Contrasted with culture as the standard technique, Giemsa staining method indicated 63.6 % sensitivity compared with 54.5% for wet mount or Gram staining. Giemsa staining specificity was 100 % contrasted with 86.2 % for wet mount and 93.1 % for Gram stain. In addition, a considerable agreement was found amongst culture and Giemsa staining (Kappa= 0.717) while moderate agreement of Gram stain (Kappa= 0.52) and wet mount (Kappa = 0.419) with culture was found.

ObjectivesPathogen load has been linked to disease severity in patients infected with HIV, resulting in international standards to adequately and reproducibly quantify load.Chlamydia trachomatis(CT) load has been inconsistently linked to disease severity since extensive differences exist in quantification methods (14 methods in 28 articles). Differences include normalisation for human cell load due to CT’s intracellular nature, despite the inability to distinguish inflammatory cells from epithelial cells with molecular techniques. We compared the human cell load in CT-positive men and women at the genital and anal site to a CT-negative control group to estimate the impact of inflammatory cells in these samples.Methods188 women (tested at genital and anal site) and 519 men (207 tested at the anal site and 312 tested at the urogenital site) were included from our STI-clinic in the Netherlands. Specimens were self-collected vaginal swabs, anal swabs and urine samples. Quantitative-PCR targeting the HLA-gene quantified human cell load. Mann-Whitney-U-test was used for statistical analyses.ResultsThe genital cell load had a similar range and median (6.5 log10) between CT-negative and CT-positive women . The urogenital cell load was significantly higher than the anal cell load (median 3.6 log10). The anal cell load was significantly higher in men with- than without anal CT infection (median 4.5 versus 3.9 respectively). The anal cell load is significantly higher in CT-positive men than in women. Both Neisseria gonorrhoeae-co-infections and reported anal intercourse significantly increased the human cell load in anal samples.ConclusionStandardisation in CT load studies is necessary as current studies show 14 different quantification methods in 28 studies . In this study we demonstrate the inappropriateness of normalising the CT load for the human cell load using molecular techniques, as the presence of inflammatory cells cannot be excluded.

Bacterial vaginosis (BV) is an inflammatory disease, caused by polymicrobial infection, including pathogenic bacteria which replace the vaginal normal flora and finally this replacement causes manifestations of several physiological and clinical symptoms among women within different ages. BV has become one of the main problems that make woman patients visit gynecological and obstetric consultant hospitals in most country. The present study is designed to determine the causative pathogen and the prevalence of bacterial vaginosis among married women patients in Kalar district. This cross-sectional study was performed from the beginning of March to the mid April-2021 among women who attended Obstetrics and Gynecological governmental hospital and out-patient clinics in Kalar City. Intra vaginal swabs have been collected in sterile Amies transport medium sticks and processed for isolation and identification of bacterial species depending on colony morphology, Gram’s stain and microbiological analysis protocols. Then socio-demographic and gynaecologic data were collected by questionnaire. Out of the 108 participant women who suffered from Gynecological diseases, 67(62.03%) of them exhibited bacterial vaginosis. From the 73 different isolated colonies, 18 bacterial species were identified; coagulase-negative staphylococci (CoNS) were the predominant cause of BV (32.84%), followed by E. coli (14.93%), Staphylococcus aureus (13.43%), Klebsiella pneumonia (8.96) and Micrococcus luteus (7.46%), while Proteus spp. and some uncommon bacteria display (1.49%) for each of them. The socio-demographic analysis between positive and negative woman patients revealed that the association between all studied risk factors and BV were statistically significant (P value < 0.05) except the age factor which was statistically non-significant meaning that the age was not associated with BV. In addition, the clinical symptom analysis showed that abnormal vaginal discharge, lower back pain, dysmenorrhea and strawberry were significantly associated with BV (P value < 0.05), while the rest of other factor did not exhibit statistically significant association.

Background Chlamydia trachomatis (CT) is one of the most prevalent bacterial sexually transmitted infections (STIs) globally but has been inadequately detected for intervention. Introduction of point-of-care tests (POCTs) for CT is critical for filling the intervention gaps. We conducted a systematical review and meta-analysis on diagnostic performance of POCTs for CT to assist in guiding the application of these assays in CT screening and detection. Methods We searched PubMed/Medline and Embase databases, from January 2004 to May 2021, for studies reporting the performance of POCTs for identifying CT using specimens collected from urethral, vaginal, cervical, anorectal, or pharyngeal site or of urine. Two investigators independently screened and extracted data for controlling the quality of data extraction. Any discrepancies in study selection and data extraction were resolved through consensus. We only included studies with sufficient data to estimate sensitivity and specificity, and used laboratory-based nucleic acid amplification test (NAAT) as the reference standard. The main outcomes were pooled sensitivity, specificity, and diagnostic odds ratio (DOR) and their corresponding 95% confidence intervals (CIs). Summary estimates were calculated using a random-effects model and summary receiver operator curves (SROCs) were generated using the Moses-Littenberg method. STATA 14.0 and Meta-DiSc 1.4 were used for statistical analysis. The study protocol is registered with PROSPERO, number CRD42019140544. Findings Of 3,038 records identified, 39 studies (42,336 specimens) were included in the study, including 14 studies on evaluation of antigen detection (AD)-based and 25 on NAAT-based POCTs. The overall pooled sensitivity, specificity and DOR were 56% (95% CI 45%–67%), 99% (95% CI 98%–99%) and 86 (95% CI 46–163), respectively, for AD-based POCTs and corresponding values for NAAT-based POCTs were 94% (95% CI 91%–96%), 99% (95% CI 99%–99%) and 1,933(95% CI 1,018–3,669), respectively. The pooled sensitivity of AD-based POCTs varied across the types of specimens, indicating 46% for cervical swabs (95% CI 37%–56%; range 22.7%–71.4%), 52% for vaginal swabs (95% CI 34%–70%; range 17.1%–86.8%) and 57% for male urine (95% CI 36%–75%; range 20.0%–82.6%). For NAAT-based POCTs, the pooled sensitivity was 94% (95% CI 90%–96%) for cervical swabs, 94% (95% CI 86%–98%) for vaginal swabs, 95% (95% CI 91%–97%) for urine specimens and 93% (95% CI 87%–96%) for anorectal swabs. Interpretation NAAT-based POCTs for CT have a significantly better performance particularly in sensitivity for diagnosing the infection with CT than the AD-based POCTs. Screening strategy with AD-based POCTs may potentially result in a substantial under-detection of the infections.

Chlamydia trachomatis (CT) increases its plasmid numbers when stressed, as occurs in clinical trachoma samples. Most CT tests target the plasmid to increase the test sensitivity, but some only target the chromosome. We investigated clinical urogenital samples for total plasmid copy numbers to assess its diagnostic value and intra-bacterial plasmid copy numbers to assess its natural variation. Both plasmid and chromosome copies were quantified using qPCR, and the plasmid:chromosome ratio (PCr) calculated in two cohorts: (1) 383 urogenital samples for the total PCR (tPCr), and (2) 42 vaginal swabs, with one half treated with propium-monoazide (PMA) to prevent the quantification of extracellular DNA and the other half untreated to allow for both tPCr and intra-bacterial PCr (iPCr) quantification. Mann–Whitney U tests compared PCr between samples, in relation to age and gender. Cohort 1: tPCr varied greatly (1–677, median 16). Median tPCr was significantly higher in urines than vaginal swabs (32 vs. 11, p

Q fever caused by Coxiella burnetii is an important zoonosis and has great public health significance. A total of 905 clinical samples from 387 cattle [serum (n = 387); vaginal swabs (n = 387); milk (n = 131)] and 59 serum samples from humans were collected from gaushala (cattle shelter) and screened for anti-C. burnetii IgG antibodies in the sera using an indirect-ELISA kit. Further, the samples were tested for C. burnetii DNA employing TaqMan real-time and conventional PCR assays targeting the com1 gene. In ELISA, 9.56% and 6.78% of animal and human sera samples were positive for anti-C. burnetii antibodies, respectively. Upon pathogen detection, 3.87% sera, 1.81% vaginal swabs, and 6.87% milk samples from cattle tested positive in TaqMan real-time PCR and 1.55% sera, 0.52% vaginal swabs, and 3.05% milk samples were found positive in conventional PCR. In humans, one serum sample was positive in both the PCR assays. The PCR positive samples (n = 12) were partially sequenced and the phylogenetic tree was constructed using com1 gene sequences (n = 42) from a different host and geographical areas. The study highlights infection of cattle and their human contacts in gaushala and identifies relationships between strains identified in the gaushala and those in other parts of the globe.

OBJECTIVE The aim of the study was to determine whether the genitourinary microbiome differs between and within women with and without pubic hair. METHODS Premenopausal women who self-identified into 2 groups were recruited: in the "hair" group, women did not remove any pubic hair, and in the "bare" group, all pubic hair was removed routinely. Participants submitted a vaginal swab, a voided urine sample, and a catheterized urine sample, and then "crossed over." The "hair" group removed all hair for 1 month, and the "bare" group grew hair for 2 months. After crossover, participants again submitted a vaginal swab, a voided urine sample, and a catheterized urine sample. Ten participants acted as controls. DNA was extracted, and the V4 region of 16S rRNA gene was amplified and sequenced using the MiSeq platform. Paired-end sequences were imported into QIIME2-2018.6. Alpha diversity (the number and proportion of species in an individual sample) and beta diversity (differences in microbial composition between samples) were evaluated. RESULTS Forty-two participants were analyzed: 16 "bare to hair" crossovers, 16 "hair-to-bare" crossovers, and 10 controls. The microbiome varied by sample type: vaginal swabs had the lowest alpha diversity and catheterized urine had the highest (P < 0.001). At baseline, there were no differences in the alpha or beta diversity of urine or vaginal microbiomes between groups. Vaginal beta diversity at visit 2 was greater within crossovers than controls (P = 0.004), suggesting that altering hair status alters the microbiome composition. Urinary beta diversity was not different at visit 2 (P = 0.40). CONCLUSIONS Pubic hair status does not determine one's baseline genitourinary microbiome, but women who change their hair status may alter their vaginal microbiome.

Neisseria gonorrhoeae is a common bacterial sexually transmitted infection (STI). Currently, there are limited data on the bacterial load in both men and women and on both genital and extragenital sites. Therefore, we quantified N. gonorrhoeae bacterial loads in a large population of women, heterosexual men, and men who have sex with men (MSM) at three different anatomical sites. N. gonorrhoeae-positive samples (n = 1265) of STI clinic consultations (n = 944) were tested for N. gonorrhoeae with the Roche Cobas 4800 system, and quantification cycle (Cq) values were used as an inversely proportional measure for N. gonorrhoeae bacterial load after interpolation from a standard curve. Bacterial loads were compared between sample materials and sexes using t tests. The following mean N. gonorrhoeae loads were observed: urine, 4.5 +/- 1.0 log(10) CFU/ml; vaginal swabs, 4.3 +/- 1.1 log(10) CFU/ml; anorectal swabs (women), 4.0 +/- 1.2 logic, CFU/ml; anorectal swabs (men), 4.5 +/- 1.3 log(10) CFU/ml; oropharyngeal swabs (women), 2.8 +/- 0.9 log(10) CFU/ml; and oropharyngeal swabs (men), 3.2 +/- 1.0 log(10) CFU/ml. Oropharyngeal swabs had a significantly lower N. gonorrhoeae load (P

Never events (NEs) are serious clinical incidents that cause potentially avoidable harm and impose a significant financial burden on healthcare systems. The purpose of this study was to identify common never events. We analysed the NHS England NE data from 2012 to 2020 to identify common never events category and themes. We identified 51 common NE themes in 4 main categories out of a total of 3247 NE reported during this period. Wrong-site surgery was the most common category (n = 1307;40.25%) followed by retained foreign objects (n = 901;27.75%); wrong implant or prosthesis (n = 425;13.09%); and non-surgical/infrequent ones (n = 614; 18.9%). Wrong-side (laterality) and wrong tooth removal were the most common wrong-site NE accounting for 300 (22.95%) and 263 (20.12%) incidents, respectively. There were 197 (15%) wrong-site blocks, 125 (9.56%) wrong procedures, and 96 (7.3%) wrong skin lesions excised. Vaginal swabs were the most commonly retained items (276;30.63%) followed by surgical swabs (164;18.20%) and guidewires (152;16.87%). There were 67 (7.44%) incidents of retained parts of instruments and 48 (5.33%) retained instruments. Wrong intraocular lenses (165; 38.82%) were the most common wrong implants followed by wrong hip prostheses (n = 94; 22.11%) and wrong knees (n = 91; 21.41%). Non-surgical events accounted for 18.9% (n = 614) of the total incidents. Misplaced naso-or oro-gastric tubes (n = 178;29%) and wrong-route administration of medications were the most common events in this category (n = 111;18%), followed by unintentional connection of a patient requiring oxygen to an air flow-meter (n = 93; 15%). This paper identifies common NE categories and themes. Awareness of these might help reduce their incidence.

Background We compared vaginal microbial communities in postmenopausal black and white women. Methods Shotgun sequencing of vaginal swabs from postmenopausal women self-identified as black or white was compared using MiRKAT. Results Vaginal community dominance by Lactobacillus crispatus or Lactobacillusgasseri was more common in 44 postmenopausal black women (n = 12, 27%) than among 44 matched white women (n = 2, 5%; P = .01). No individual taxa were significantly more abundant in either group. Conclusions We identified small overall differences in vaginal microbial communities of black and white postmenopausal women. L. crispatus dominance was more common in black women. Clinical Trials Registration NCT02516202 (MsFLASH05) and NCT01418209 (MsFLASH03).

A survey of clinical laboratories in the United States was conducted to compare 2013 Chlamydia trachomatis/Neisseria gonorrhoeae testing practices (before the release of the 2014 Centers for Disease Control and Prevention testing recommendations) with 2015 C. trachomatis/N. gonorrhoeae testing practices. Supplemental digital content is available in the text., Background Adherence to recommended laboratory testing practices is crucial for sexually transmitted infection prevention and control. The objective of this article is to compare Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing practices of US clinical laboratories in 2013 before the updated 2014 Centers for Disease Control and Prevention recommendations and in 2015 after the updated recommendations. Methods A total of 236 clinical laboratories participated in surveys about their 2013 and 2015 CT and NG testing practices, including questions on specimen types collected and assays used. Results There was an increase of 5 laboratories offering CT nucleic acid amplification testing (NAAT) from 2013 to 2015 and an increase of 5 laboratories offering NG NAAT. There was a net increase of 3 laboratories accepting urine for CT and NG NAAT, the preferred specimen type for male individuals. There was not a net increase in the total number of laboratories accepting vaginal swabs for CT NAAT (n = 89 in 2013 and 2015), the preferred specimen type for female individuals, but there was an increase of 3 laboratories accepting vaginal swabs for NG NAAT. The number of laboratories performing NG susceptibility testing decreased from 100 in 2013 to 89 in 2015 (χ2 = 1.07, P > 0.10). Conclusions There were no major changes in testing practices in the 2-year period from 2013 to 2015. However, there were some small shifts, including increases in the use of NAATs, acceptance of Centers for Disease Control and Prevention–preferred specimen types for CT/NG, and changes in usage of assays by manufacturer.

Preterm birth is the leading cause of death worldwide in children under five years. Due to its complex multifactorial nature, prediction is a challenge. Current research is aiming to develop accurate predictive models using patient history, ultrasound and biochemical markers. Volatile organic compound (VOC) analysis is an approach, which has good diagnostic potential to predict many disease states. Analysis of VOCs can reflect both the microbiome and host response to a condition. We aimed to ascertain if VOC analysis of vaginal swabs, taken throughout pregnancy, could predict which women go on to deliver preterm. Our prospective observational cohort study demonstrates that VOC analysis of vaginal swabs, taken in the midtrimester, is a fair test (AUC 0.79) for preterm prediction, with a sensitivity of 0.66 (95%CI 0.56–0.75) and specificity 0.89 (95%CI 0.82–0.94). Using vaginal swabs taken closest to delivery, VOC analysis is a good test (AUC 0.84) for the prediction of preterm birth with a sensitivity of 0.73 (95%CI 0.64–0.81) and specificity of 0.90 (95%CI 0.82–0.95). Consequently, VOC analysis of vaginal swabs has potential to be used as a predictive tool. With further work it could be considered as an additional component in models for predicting preterm birth.

In 2017, two Thoroughbred stallions, A and B in Farms A and B, respectively, in Hokkaido in Japan showed clinical signs of equine coital exanthema (ECE). In 2020, stallion C in Farm B showed clinical signs of ECE. Eighteen mares were mated within five days before stallion A developed ECE. Ten mares that mated within 3 days before onset showed clinical signs of ECE on the external genitalia. Equine herpesvirus 3 (EHV-3) was isolated from vaginal swabs from three mares that mated within 2 days before onset. Swabs from 12 mares that mated within 4 days before onset were real-time PCR (rPCR)-positive and nine of those mares had an increased EHV-3 antibody titer. The three stallions were administered valaciclovir orally and topical acyclovir ointment was applied. Treatment started on the next day after onset in stallion A and on the day of onset in stallions B and C. EHV-3 was firstly isolated from penis swabs of stallions A and B before treatment and from penis swabs of stallion C 2 days after treatment. EHV-3 was not isolated after 8, 5 and 8 days from onset in stallions A, B and C, respectively. However, swabs were rPCR-positive for at least 12, 9 and 15 days after onset of stallions A, B and C, respectively. EHV-3 was excreted from the stallions at least within 4 days before the onset of ECE, and acyclovir treatment resulted in the termination of excretion within 8 days after onset.

Background In a recently published multicenter randomized controlled trial, we demonstrated that progestogens are not effective as maintenance tocolysis. Objective This study was aimed to evaluate if previous finding may be affected by positive urine culture and/or vaginal swab. Study Design We performed a secondary analysis of the PROTECT trial (NCT01178788). Women with singleton pregnancy between 22 and 31 6/7 weeks' gestation, admitted for threatened preterm labor were considered. At admission, we collected urine culture and vaginal swabs. At discharge, women with a cervical length ≤25 mm were randomized to vaginal progesterone or 17α-hydroxyprogesterone caproate or observation group. We used Chi-square statistics, considering 97.5% CI (confidence interval) and p-value less than 0.025 for significance. Results Urine culture and vaginal swabs were collected in 232 out of 235 patients included in the primary analysis. Overall, 31 out of 232 women (13.4%) had positive urine culture and 60 out of 232 (25.9%) had positive vaginal swab. In women with negative urine culture, a higher rate of preterm birth was found in vaginal progesterone group (27/69, 39.7%) respect with controls (14/68, 20.6%; relative risk [RR] = 1.90; 97.5% CI: 1.01–3.57; p = 0.018). Conclusion Among women with negative urine culture, the rate of preterm birth

The vaginal microbiome is a critical component of women’s sexual and reproductive health, with variations in microbial composition, particularly the loss of Lactobacillus species, being implicated in gynecologic and obstetric diseases. Given that the vaginal microbiome is so crucial, why do vaginal microbial profiles vary strikingly from person to person and even change over time within the same person? In the present study, which tracked the daily vaginal microbiomes of young healthy women through different lifestyles, we found that use of a locally released progestin contraceptive, a vegetarian diet, and intense exercise appear to lead to vaginal microbiome alterations and loss of Lactobacillus species. The impact of these vaginal microbiome changes on immediate and long-term health remain to be investigated., The microorganisms of the vaginal tract are critical for vaginal and reproductive health. However, the regulation of these microorganisms is not well understood. Therefore, we investigated whether different factors regulate the vaginal microbiota of healthy college-aged women (n = 26) with high temporal resolution by collecting daily self-administered vaginal swabs and using 16S rRNA sequencing for bacterial identification. As expected, vaginal microbiota clustered into five predefined community state types. Vaginal microbial diversity, stability, and Lactobacillus abundances were associated with the menstrual cycle and hormonal contraceptive use. Vaginal microbial diversity, as measured using the Shannon index, increased during menses (P < 0.001), while Lactobacillus abundances decreased (P = 0.01). The covariance of these microbial measures with previously established estradiol levels suggests that estrogens can regulate vaginal microbiota. Moreover, the use of hormonal contraceptives may alter the temporal dynamics of the vaginal microbiota and decrease Lactobacillus abundances, depending on hormonal content and release method. Interestingly, intrasample diversity was greater in participants on a vegetarian diet (P = 0.004) and among participants who exercised more (P = 0.04). These findings indicate that ovarian hormones, diet, and exercise can regulate vaginal microbial composition and stability and may impact vaginal and reproductive health. IMPORTANCE The vaginal microbiome is a critical component of women’s sexual and reproductive health, with variations in microbial composition, particularly the loss of Lactobacillus species, being implicated in gynecologic and obstetric diseases. Given that the vaginal microbiome is so crucial, why do vaginal microbial profiles vary strikingly from person to person and even change over time within the same person? In the present study, which tracked the daily vaginal microbiomes of young healthy women through different lifestyles, we found that use of a locally released progestin contraceptive, a vegetarian diet, and intense exercise appear to lead to vaginal microbiome alterations and loss of Lactobacillus species. The impact of these vaginal microbiome changes on immediate and long-term health remain to be investigated.

Summary Background Timely detection and treatment are important for the control of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. The objective of this study was to measure the performance of the Visby Medical Sexual Health Test, a single-use, point-of-care PCR device. Methods Women aged 14 years and older who presented consecutively to ten clinical sites across seven US states were enrolled for a cross-sectional, single-visit study. Patients who consented to participate, and who had not used any exclusionary products in the genital area in the previous 48 h, provided self-collected vaginal swabs for testing with the investigational device. Untrained operators received the specimens and ran the device using the guide provided. Specimens had to be run within 2 h of collection to be considered valid. For comparison, patient-infected status was derived by testing clinician-collected vaginal specimens with the Hologic Aptima Combo 2 Assay and Aptima Trichomonas vaginalis Assay, as well as the BD ProbeTec CT/GC Qx Amplified DNA Assay and BD ProbeTec Trichomonas vaginalis Qx Assay. If the results of those assays did not match, the BD MAX CT/GC/TV was used as a tiebreaker. The primary outcomes were the sensitivity and specificity of the investigational device for the detection of C trachomatis, N gonorrhoeae, and T vaginalis compared with patient-infected status. Findings Between Feb 25, 2019, and Jan 6, 2020, 1585 participants aged between 14 years and 80 years (mean 34·8 [SD 14·2]) were enrolled. 1555 participants had tests run with the investigational device, of whom 1532 (98·5%) had a valid result on either the first or repeat test. Among the patients with evaluable results (including a determinate patient-infected status), the device had a sensitivity of 97·6% (95% CI 93·2–99·2) and specificity of 98·3% (97·5–98·9) for C trachomatis (n=1457), sensitivity of 97·4% (86·5–99·5) and specificity of 99·4% (98·9–99·7) for N gonorrhoeae (n=1468), and sensitivity of 99·2% (95·5–99·9) and specificity of 96·9% (95·8–97·7) for T vaginalis (n=1449). Interpretation This innovative, rapid, easy-to-use, single-use, point-of-care device to detect C trachomatis, N gonorrhoeae, and T vaginalis infections showed excellent sensitivity and specificity, and could represent an important advance in the development of rapid diagnostics for sexually transmitted infections and other infectious diseases. Funding Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases.

Background The aim of this study was to identify vaginal Lactobacillus spp. and quantify vaginal inflammatory cytokines in primigravida vs. multigravida women and pregnant vs. non-pregnant women. Methods Vaginal swabs were obtained from four groups of patients. A real-time PCR was carried out to identify the Lactobacillus spp. Multiplex immunoassays were performed to quantify a total of 27 cytokines using the Bio-Plex MAGPIX multiplex reader and MesoQuick Plex SQ 120 (Meso Scale Diagnostics LLC, Rockville, MD, USA). Inferential statistics using hypothesis tests were applied to detect differences in cytokine levels. Results Significant differences in cytokines and chemokines exist among the four populations of women studied. IP-10 is significantly higher in multigravida women as compared to primigravida women. IFN-γ, MCP-1, MIP-1β, IL-2 and IL-10 are significantly higher in non-pregnant women compared to pregnant women. L. iners was the most abundant species in multigravida, pregnant and non-pregnant patients, while L. crispatus was the most abundant species in primigravida patients. Significant differences in the levels of MIP-1β, TNF-α, PDGF-BB, VEGF-A, IL-12, and IL-10 exist between women identified with Lactobacillus species and women not identified with Lactobacillus species. Conclusions There were significant differences regarding cytokines, chemokines, and Lactobacillus spp. among four groups of studied patients. With these results, we increase our understanding of the role that vaginal cytokines and Lactobacillus species have during pregnancy, with the goal that this novel research will be useful for examining vaginal biomarkers in obstetrical conditions.

Mycoplasma genitalium (MG) infections are a growing concern within the field of sexually transmitted infections. However, diagnostic assays for M. genitalium have been limited in the United States. As most infections are asymptomatic, individuals can unknowingly pass the infection on, and the prevalence is likely to be underestimated. Diagnosis of M. genitalium infection is recommended using a nucleic acid test. This multicenter study assessed the performance of the cobas Trichomonas vaginalis (TV)/MG assay (cobas) for the detection of M. genitalium, using 22,150 urogenital specimens from both symptomatic and asymptomatic men and women collected at geographically diverse sites across the United States., Mycoplasma genitalium (MG) infections are a growing concern within the field of sexually transmitted infections. However, diagnostic assays for M. genitalium have been limited in the United States. As most infections are asymptomatic, individuals can unknowingly pass the infection on, and the prevalence is likely to be underestimated. Diagnosis of M. genitalium infection is recommended using a nucleic acid test. This multicenter study assessed the performance of the cobas Trichomonas vaginalis (TV)/MG assay (cobas) for the detection of M. genitalium, using 22,150 urogenital specimens from both symptomatic and asymptomatic men and women collected at geographically diverse sites across the United States. The performance was compared to a reference standard of three laboratory-developed tests (LDTs). The specificity of the cobas assay for M. genitalium ranged from 96.0% to 99.8% across symptomatic and asymptomatic men and women. The sensitivities in female vaginal swabs and urine samples were 96.6% (95% confidence interval [CI], 88.5 to 99.1%) and 86.4% (95% CI, 75.5 to 93.0%), respectively. The sensitivities in male urine and meatal swab samples were 100% (95% CI, 94.0 to 100%) and 85.0% (95% CI, 73.9 to 91.9%), respectively. This study demonstrated that the cobas assay was highly sensitive and specific in all relevant clinical samples for the detection of M. genitalium.

Willingness to self-collect vaginal swabs at a pharmacy clinic is of interest as a venue to increase sexually transmissible infections (STIs) screening for chlamydia, gonorrhoea and trichomonas. Women self-collected vaginal swabs at the pharmacy, completed questionnaires and received STI results within 2 h. Women with STIs were offered free treatment. A total of 313 of 777 (40.3%) women consented and prevalence for any STI was 3.9%. Questionnaires demonstrated acceptability for self-collection at the pharmacy, with 63% (95% CI 57.3–68) and 32.3% (95% CI 27.4–37.8) indicating they ‘strongly agreed’ or ‘agreed’ that they felt comfortable with pharmacy collection, respectively. Self-collected vaginal swabs for STI testing for women who were at a pharmacy were feasible and acceptable to women.