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Female genital schistosomiasis and HIV/AIDS: Reversing the neglect of girls and women
Competing interests: PJH is a patentholder and investigator on a vaccine against schistosomiasis that is in clinical trials.
Since the 2000s, we have known that female genital schistosomiasis (FGS) is likely the most neglected gynecologic condition and HIV/AIDS cofactor across sub-Saharan Africa.
[...]multiple (and peer-reviewed) scientific papers have been written on this subject [13–21], but they have largely appealed to the community of scientists and public health experts committed to NTDs.
[...]although “preaching to the converted” has helped to unify the NTDs community, it has (so far) done little to stimulate the global HIV/AIDS community toward accepting the importance of praziquantel MDA as a key component of strategies to prevent new infections of HIV/AIDS.
Realizing that declines in new HIV/AIDS infections remain too slow, especially in younger women aged 15–24 years who are twice as likely to be living with HIV than men [39]—in 25 countries, of which 18 in sub-Saharan Africa—UNAIDS launched its Prevention 2020 Road Map [40] calling for innovative combination prevention packages, in addition to HIV screening, counseling, and treatment programs.
Since 2017, several parallel sessions have taken place at international AIDS and Women’s conferences—including the 22nd International AIDS Conference held in Amsterdam, the Netherlands in 2018—calling for a more holistic approach to women’s health and HIV.
According to the WHO, despite making impressive gains in 2017, we are still falling short of meeting the minimum target of treating at least 75% of the African children who require regular and periodic administration of praziquantel [43].
Journal Article
Spontaneous Resolution of Genital Chlamydia trachomatis Infection in Women and Protection from Reinfection
The natural history of chlamydia is variable and may include persisting asymptomatic infection, complications, or spontaneous resolution before treatment. Reinfection is common. We evaluated whether spontaneous resolution was associated with decreased reinfection in women returning for treatment of a positive chlamydia screening test. At enrollment, participants were tested for chlamydia, treated with azithromycin, and scheduled for a 6-month follow-up visit for repeat testing. Two hundred participants returned 1 to 12 months after treatment. Spontaneous resolution at enrollment was demonstrated in 44 (22.0%). Reinfection at follow-up occurred in 33 (16.5%), being more frequent in those with persisting infection at enrollment versus spontaneous resolution (31 of 156 [19.9%] vs 2 of 44 [4.5%]; P = .016). Adjusting for age, the odds of reinfection was 4 times higher for participants with persisting infection at enrollment (odds ratio 4.0, 95% confidence interval, 1.1—25.6; P = .034). Chlamydia treatment may attenuate protective immunity in some patients.
Journal Article
Duration of Untreated, Uncomplicated Chlamydia trachomatis Genital Infection and Factors Associated with Chlamydia Resolution: A Review of Human Studies
The majority of Chlamydia trachomatis genital infections in humans are asymptomatic and without clinical evidence of complications at the time of diagnosis. The natural history of chlamydial infection in humans, including the duration of infection and factors influencing resolution of infection, is not yet completely understood. This is in part attributable to the inherent challenges and ethical considerations in studying untreated chlamydia in humans. An improved understanding of the natural history of chlamydia in humans has implications for chlamydia screening and treatment recommendations. In April 2008, the Centers for Disease Control and Prevention convened an advisory group for the Chlamydia Immunology and Control Expert Advisory Meeting, in which studies related to chlamydia natural history, pathogenesis, and immunobiology were reviewed and gaps in our knowledge that would have implications for prevention and control of C. trachomatis infection were identified. This article summarizes the key questions posed and the evidence reviewed on the duration of untreated, uncomplicated genital chlamydial infection in humans and the factors associated with chlamydia resolution.
Journal Article
Genital graft versus host disease in women after allogeneic hematopoietic stem cell transplantation – a single center experience
Chronic Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (HSCT), affecting the female genital tract in 25–66% of the patients. This condition, referred to as Genital GVHD is an underdiagnosed gynecologic comorbidity, that can significantly impair quality of life. We aimed to describe the prevalence and management of genital GVHD following HSCT. This retrospective analysis included women who underwent allogeneic HSCT at a single Bone Marrow Transplantation Unit between 2015 and 2020 and were evaluated at a specialized Vulvo-Vaginal Clinic. Diagnosis and severity of genital GVHD were based on the recommendations by the National Institute of Health (NIH), therapeutic options included topical treatments and surgical interventions. Of the thirty-six patients evaluated, 19.4% were diagnosed with genital GVHD. Patients with genital GVHD were older than those with no-genital GVHD (58.42 vs 47.48 years,
p
= 0.02), and most of them had concurrent multi-organ chronic GVHD (85.71%). Genital GVHD was mostly symptomatic in our cohort (71.42%), clinical findings at the time of diagnosis corresponded with NIH grade 3 (severe disease) in 57.1% of cases. Topical treatments were initiated for all patients with genital GVHD, one required surgical intervention. Genitourinary syndrome of menopause (GSM) was diagnosed among 100% of patients with genital GVHD and among 58.62% of patients without genital GVHD (
p
= 0.08). In the genital GVHD group, adherence to clinical follow up was limited (43.85%). Genital GVHD should be considered as part of chronic GVHD evaluation after allogeneic HSCT. It is associated with advanced age and the presence of chronic systemic GVHD. Impaired quality of life and limited follow-up within this population emphasize the need for increased awareness and early evaluations.
Journal Article
Biological and Behavioral Factors Associated With Positive Chlamydia Retests
BACKGROUNDRepeat chlamydia detection after treatment is common, and there is concern that treatment failure may be a cause.
METHODSWithin a randomized trial, we established a prospective cohort of 600 participants with anogenital chlamydia diagnoses (200 each of women, heterosexual men, and men who have sex with men [MSM]). Participants were invited for repeat testing at 3 months and to complete a behavioral survey at 4 months. Positive samples were analyzed for organism DNA load and genovar. We estimated repeat chlamydia positivity, reinfection and treatment failure rates, and investigated the biological and behavioral factors associated with a repeat positive test.
RESULTSA total of 290 participants (100 women, 89 heterosexual men, 101 MSM) were retested at 1 to 4 months, with 43 repeat positives, including 26 classed as reinfection and 9 as treatment failures. Comparing MSM with heterosexual men and women combined, repeat positivity was higher (20.8% vs 11.6%, P = 0.04), and treatment failure was higher (6.9% vs 1.1%, P = 0.01), but there was no difference in reinfection rates (11.9% vs 7.4%, P = 0.21). Among MSM, the odds of repeat positivity increased by 90% with each additional log organism load in the original specimen (baseline) (adjusted odds ratio, 1.9; 95% confidence interval, 1.1–3.2). Among heterosexuals, the odds of repeat positivity decreased by 10% with each additional week delay in being retested for chlamydia (adjusted odds ratio, 0.9; 95% confidence interval, 0.8–0.9).
CONCLUSIONSPositive retests were more common among MSM than heterosexuals. Treatment failure was more common in MSM with rectal chlamydia, reinforcing concerns about azithromycin treatment failure.
Journal Article
Trichomonas vaginalis Genital Infections: Progress and Challenges
Trichomonas vaginalis (TV) infection is the most prevalent curable sexually transmitted infection in the United States and worldwide. Most TV infections are asymptomatic, and the accurate diagnosis of this infection has been limited by lack of sufficiently sensitive and specific diagnostic tests, particularly for men. To provide updates for the 2010 Centers for Disease Control and Prevention's Sexually Transmitted Diseases Treatment Guidelines, a PubMed search was conducted of all TV literature published from 9 January 2004 through 24 September 2008. Approximately 175 pertinent abstracts and articles were reviewed and discussed with national experts. This article describes advances in TV diagnostics which have led to an improved understanding of the epidemiology of this pathogen, as well as potential biologic and epidemiological interactions between TV and human immunodeficiency virus (HIV). New data on treatment outcomes, metronidazole-resistant TV, management of nitroimidazole-allergic patients, frequency of recurrent TV infection following treatment, and screening considerations for TV in certain populations are also presented.
Journal Article
Transdermal estrogen gel and oral aspirin combination therapy improves fertility prognosis via the promotion of endometrial receptivity in moderate to severe intrauterine adhesion
Intrauterine adhesion (IUA) is one of the most common gynecological diseases in women of reproductive age. IUA, particularlyin moderate to severe forms, accounts for a large percentage of infertility cases. Clinically, the first-line treatment strategy for IUA is transcervical resection of adhesion (TCRA), followed by adjuvant postoperative treatment. Estrogen is one of the classic chemotherapies used following TCRA and contributes to preventing re-adhesion following surgery. However, estrogen has limited effects in promoting pregnancy, which is the ultimate goal for IUA management. In the present study, a transdermal estrogen gel and oral aspirin combination therapy was used in patients with IUA following TCRA. Compared with in the control group (transdermal estrogen only therapy), the combination therapy significantly increased endometrial receptivity marker (αvβ٣ and laminin) expression in endometrium tissues. Additionally, ultrasonic examination revealed the pulsatility index and resistant index of the uterine artery were lower in the combination therapy group. Combination therapy promoted angiogenesis and prevented fibrosis following TCRA more effectively than estrogen-only therapy. Collectively, the evaluation indices, including American Fertility Society score, endometrial parameters and pregnancy rate, indicated that patients with combination therapy had better prognoses in endometrial repair and pregnancy. In conclusion, postoperative combination therapy with transdermal estrogen gel and oral aspirin may be more efficacious in enhancing endometrial receptivity by increasing uterine blood and angiogenesis, contributing to improved fertility prognosis. The findings of the present study may provide novel guidance to the clinical treatment of IUA.
Journal Article
A Randomized, Controlled, Molecular Study of Condylomata Acuminata Clearance during Treatment with Imiquimod
Imiquimod, an immune response modifier, has been demonstrated to be safe and effective in the treatment of external genital and perianal warts caused by human papillomavirus (HPV). To identify the molecular mechanism(s) by which condylomata acuminata clear during topical treatment with imiquimod, wart skin biopsies were taken from patients before treatment, at treatment week 6, and at the end of treatment. Tissues were analyzed for HPV DNA and for mRNA of several cytokines and HPV gene products. Wart clearance was associated with evidence of tissue production of interferon-α, -β, and -γ and tumor necrosis factor-α. Regression of warts was strongly associated with a decrease in HPV DNA and in mRNA expression for both early and late viral proteins. Thus, topical imiquimod treatment of anogenital warts led to significant increases in local production of multiple interferon mRNAs and a significant reduction in virus load as measured by decreases in HPV DNA and mRNA for early HPV proteins.
Journal Article