Genital chlamydial infections: Epidemiology and reproductive sequelae

Citations from the Literature vaginal microflora is significantly associated with onset of PTL. Design - A comprehensive prospective study of the vaginal microflora of women in early labour comparing women in PTL with term controls. Microbiological assessment included cultures for aerobic and anaerobic bacteria, yeasts, genital mycoplasmas and Trichomonas vaginalis. Multiple logistic regression analysis was used to adjust for confounding obstetric and demographic variables. Setting - The Queen Victoria Hospital, Adelaide. Patients - 428 Women in PTL compared to 568 women in labour at term. Main outcome measure - PTL and preterm prelabour rupture of membranes (PPROM) in relation to specific vaginal microflora. Results - After multiple logistic regression analysis, two distinct bacteriological groupings were associated with PTL < 37 weeks gestation, namely, the bacterial vaginosis group of organisms, Gardnerella vaginalis and Bacteroides spp., and a group of enteropharyngeal organisms, E. coli, Klebsiella spp., Haemophilus spp. and S. aureus. G. vaginalis was found in 12% of women in PTL compared to 6% at term [regression odds ratio (RGR) l&95% confidence intervals (CI) I. l-3. I] whereas Bacteroides spp. were detected in 45% of women in PTL compared with 35% at term (ROR 1.6, CI 1.2-2.1). The prevalence of G. vaginalis (17%) and Bacteroides spp. (50%) was even higher in women in PTL <34 weeks gestation. The enteropharyngeal group of organisms were more commonly present in women in PTL < 37 weeks (E. coli 10% vs. 6%, ROR 1.4, CI 0.8-2-4; Klebsiella spp. 3% vs
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Streptococcus was less common among women with more education. Increased risk was seen only with extreme increases in sexual activity including both frequent intercourse and multiple partners during the previous year. The risk of colonization was greater when there was concurrent colonization with Candida sp, but group B Streptococcus was not associated with carriage of Chlamydia trachomatis, Ureaplasma vaginalis, and Mycoplasma urealyticum, Trichomonas hominis. External genital erythema and scaling, purulent vaginal discharge, and pH greater than 5 were associated with increased colonization. Although these associations can raise the clinical index of suspicion for group B streptococcal colonization in a given patient, the study data did not enable us to select a small group of women with a very high probability of colonization. We conclude that selective screening is not useful in detecting group B streptococcal colonization in pregnancy. Comparative eftkacy of short-term versus long-term cefoxitin prophylaxis against postoperative infection after radical hysterectomy: A prospective study Sevin B-U; Ramos R; Gerhardt RT; Guerra L; Hilsenbeck S; Averette HE Division ofGynecologic Oncology. Department of Obstetrics and Gynecology, University of Miami School of Medicine, P. 0. Box 016960 (D-52). Miami, FL 33101, USA OBSTET GYNECOL 1991 7715 (729-734) We report the results of a randomized, double-blind comparison of short-term versus long-term cefoxitin prophylaxis against infections after radical abdominal hysterectomy with pelvic and para-aortic lymphadenectomy. Of I I3 evaluable patients, 54 (47.8%) received short-term (three doses) and 59 (52.2%) long-term (12 doses) prophylaxis with intravenous cefoxitin (2 g per dose). No significant differences in demographics, preoperative risk factors, or clinical course were detected between the two groups; nor did we detect significant differences in the incidence of surgical-site-related infections (7.4 versus 5.1%, respectively, P = .61), postoperative urinary tract infection, or other febrile morbidity. We conclude that short-term and long-term cefoxitin prophylaxis are equally effective for the prevention of postoperative surgical-site-related infections after radical hysterectomy. Genital chhunydial infections: Epidemiology aad reproductive sequelae Cates W Jr; Wasserheit JN Division of STD/HIV Prevention, Technical Information Services (EOb). Centers for Disease Control, Atlanta, GA 30333, USA AMJOBSTETGYNECOL 1991 164/6IISUPPL(1771-1781) Genital chlamydial infection is increasing and is now more common than gonorrhea. A sizable percentage of chlamydial infections of the lower genital tract in women progress to endometritis and salpingitis. Tubal infertility and ectopic pregnancy are important sequelae. Failure to control chlamydial infections reflects the following four factors: (I) Many cases are mild or asymptomatic; (2) diagnostic tests are expensive and technically demanding; (3) at least 7 days of multiple-dose Int J Gynecol Obstet 38

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Citations from the Literature

therapy are currently required; (4) partner notification is not routinely performed. Thus early identification of infected persons and compliance with curative therapy are less likely than with other sexually transmitted bacterial diseases. The role of azalide antibiotics in the treatment of cblamydia Johnson RB Department of Clinical Research, Pfizer Central Research, Eastern Point Road, Groton. CT 06340. USA AM J OBSTET GYNECOL 1991 l64/6 II SUPPL (1794-1796) Chlamydia trachomatis causes an estimated 4 million infections each year in the United States. Sequelae in women include infertility and ectopic pregnancy. Doxycycline, the current standard therapy, must be taken twice daily for at least 7 days. Patient compliance is often poor, Azithromycin, a new antibiotic high and sustained intracellular cellent in vitro activity against C.

leading to recurrent disease. of the azalide class, achieves levels and demonstrates extrachomatis. Reported herein

are the results of three comparative clinical trials, which demonstrate that single-dose oral therapy with azithromycin is as effective as a standard 7-day twice-daily course of doxycycline in the treatment of uncomplicated genital infections caused

by C. trachomatis.

New treatments for Chlamydia trachomatis Jones RB Department of Medicine, EM 435, 545 Barnhill Drive, Indianapolis, IN 46202-5124, USA AM J OBSTET GYNECOL 1991 l64/6 II SUPPL (1789-1793) Standard regimens of tetracycline, doxycycline, or erthyromycin, if complied with, appear to be effective against Chlamydia trachomatis infections under most circumstances. However, the organism may sometimes persist despite what would seem to be adequate therapy. How often this occurs, to what extent noncompliance is the issue, and the role antibiotic resistance plays remain to be determined. Among newer antibiotics, azithromycin appears to be effective in the treatment of uncomplicated urogenital C. trachomatis infections. Singledose therapy with azithromycin overcoming compliance problems of sexually transmitted disease. Chlamydia McGregor Department do Health

may be especially useful in associated with the treatment

trachomatis infection during pregnancy JA; French JI of Obstetrics and Gynecology, University of ColoraSciences Center, 4200 E. 9th Avenue, Box BI98,

Denver, CO 80262, USA AM J OBSTETGYNECOL 1991 16416 II SUPPL (1782-1789) Although transmission of Chlamydia trachomatis to infants during vaginal birth can result in conjunctivitis and pneumonitis, there is uncertainty about other adverse effects of chlamydial infection during pregnancy. There is some evidence that it may contribute to adverse complications such as premature rupture of membranes, preterm labor and birth, low birth weight, and still birth. Infection with C.. trachomatis is also implicated in postabortal, postcesarean section, and postpartum maternal infections. Treatment of chlamydial in-

Int J Gynecol Obstet 38

fection during pregnancy has proved beneficial in the prevention of neonatal morbidity and is now recommended by the Centers for Disease Control.

FERTILITY, STERILITY Poor oocyte quality rather than implantation failure as a cause of age-related decline in female fertility Navot D; Bergh PA; Williams MA; Garrisi GJ; Guzman I; Sandier B; Grunfeld L Department of Obstetrics, Gynecology, and Reproductive Science, Division of Reproductive Endocrinology, Mount Sinai Medical Center, New York, NY 10029, USA LANCET 1991 337/8754 (1375-1377) Female fertility declines with advancing age. To establish whether this age-related reproductive failure results from diminished oocyte quality or uterine/endometrial inadequacy we investigated ovum donation in 35 infertile women, aged 40 years or older (mean 42.7 (SE 0.3)) who had failed at attempts at conception with their own (self) oocytes. Oocytes were donated by 29 young individuals (mean age 33.4 (0.7)) undergoing in-vitro fertilisation (IVF). 8 (5.3”/) pregnancies were achieved in I50 cycles of ovulation induction with self-oocytes and 2 (3.3%) in 60 such cycles by in-vitro fertilisation (IVF), but none attained viability. By contrast in 50 cycles with donated oocytes 28 (56%) pregnancies and I5 (30%) deliveries were realised (P < 0.005). The rate of implantation per embryo transferred was higher (14.7%) with donated oocytes than with self-oocytes (3.3%) (P < 0.01). To further elucidate the contribution of age to reproductive outcome, pregnancy results were compared between the young donors and older recipients. Both donors and recipients shared oocytes from the same induced cohort. Rates for clinical pregnancy and delivery did not differ between donors (33% and 23%) and recipients (4O”h and 30%). Our data suggest that the age-related decline in female fertility is attributable to oocyte quality and is correctable by ovum donation. The uterus can adequately sustain pregnancies even when reproductive potential is artificially prolonged into the late 40s. Effect of bromocriptine on sperm function in vitro and in vivo Chenette PE; Siegel MS; Vermesh M; Kletzky OA Division of Reproductive Endocrinology, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90509, USA OBSTET GYNECOL 1991 7716 (935-938) Vaginal bromocriptine is an effective method for the treatment of hyperprolactinemia, but it is unknown whether bromocriptine applied vaginally can interfere with sperm function. Thus, we sought to determine the effects in vitro and in vivo on sperm directly exposed to bromocriptine. Ten semen specimens from normal donors were diluted with Ham’s F-IO medium and incubated with 0, 0.01, 0.1, and 1.0 mmol/L bromocriptine solution or diluent without bromocriptine. Computerized semen analysis revealed a 3 I% decrease in sperm motility, a 24”/u decrease in sperm average path velocity, and a 33% decrease in sperm average straight line velocity only using