Beyond the reproductive tract: gut microbiome and its influence on gynecological health

PURPOSE OF REVIEW

The analysis of microbiome in association with female health is today a "hot topic" with the main focus on microbes in the female reproductive tract. Nevertheless, recent studies are providing novel information of the possible influence of the gut microbiome on gynecological health outcomes, especially as we start to understand that the gut microbiome is an extended endocrine organ influencing female hormonal levels. This review summarizes the current knowledge of the gut microbes in association with gynecological health.

RECENT FINDINGS

The gut microbiome has been associated with endometriosis, polycystic ovary syndrome, gynecological cancers, and infertility, although there is a lack of consistency and consensus among studies due to different study designs and protocols used, and the studies in general are underpowered.

SUMMARY

The interconnection between the gut microbiome and reproductive health is complex and further research is warranted. The current knowledge in the field emphasizes the link between the microbiome and gynecological health outcomes, with high potential for novel diagnostic and treatment tools via modulation of the microenvironment.

Analysis of the potential regulatory mechanisms of female and latent genital tuberculosis affecting ovarian reserve function using untargeted metabolomics

Female and latent genital tuberculosis (FGTB and LGTB) in young women may lead to infertility by damaging ovarian reserve function, but the regulatory mechanisms remain unclear. In this study, we investigated the effects of FGTB and LGTB on ovarian reserve function and potential regulatory mechanisms by untargeted metabolomics of follicular fluid, aiming to provide insights for the clinical management and treatment approaches for afflicted women. We recruited 19 patients with FGTB, 16 patients with LGTB, and 16 healthy women as a control group. Clinical data analysis revealed that both the FGTB and LGTB groups had significantly lower ovarian reserve marker levels compared to the control group, including lower anti-Müllerian hormone levels (FGTB: 0.82 [0.6, 1.1] μg/L; LGTB: 1.57 [1.3, 1.8] μg/L vs. control: 3.29 [2.9, 3.5] μg/L), reduced antral follicular counts (FGTB: 6 [5.5, 9.5]; LGTB: 10.5 [7, 12.3] vs. control: 17 [14.5, 18]), and fewer retrieved oocytes (FGTB: 3 [2, 5]; LGTB: 8 [4, 8.3] vs. control: 14.5 [11.5, 15.3]). Conversely, these groups exhibited higher ovarian response marker levels, such as longer gonadotropin treatment days (FGTB: 12 [10.5, 12.5]; LGTB: 11 [10.8, 11.3] vs. control: 10 [8.8, 10]) and increased gonadotropin dosage requirements (FGTB: 3300 [3075, 3637.5] U; LGTB: 3037.5 [2700, 3225] U vs. control: 2531.25 [2337.5, 2943.8] U). All comparisons were statistically significant at P < 0.05. The results suggested that FGTB and LGTB have adverse effects on ovarian reserve and response. Untargeted metabolomic analysis identified 92 and 80 differential metabolites in the control vs. FGTB and control vs. LGTB groups, respectively. Pathway enrichment analysis revealed significant alterations in metabolic pathways in the FGTB and LGTB groups compared to the control group (P < 0.05), with specific changes noted in galactose metabolism, biotin metabolism, steroid hormone biosynthesis, and nicotinate and nicotinamide metabolism in the FGTB group, and caffeine metabolism, primary bile acid biosynthesis, steroid hormone biosynthesis, and glycerophospholipid metabolism in the LGTB group. The analysis of metabolic levels has revealed the potential mechanisms by which FGTB and LGTB affect ovarian reserve function, namely through alterations in metabolic pathways. The study emphasizes the importance of comprehending the metabolic alterations associated with FGTB and LGTB, which is of considerable relevance for the clinical management and therapeutic approaches in afflicted women.

[Vaginal microbiota abnormalities in women with unexplained infertility and its treatment]

The vaginal microbiota is a complex and dynamic environment that plays an important role in the healthy reproduction of women. The mechanism of unexplained infertility is not yet clear, and the imbalance and low stability of vaginal microbiota may be related to unexplained infertility. Taking probiotic composite preparations to restore normal vaginal microbiota may be a safe and natural method for treating unexplained infertility. This article reviews the probiotic composite preparations used in the treatment of unexplained infertility both domestically and internationally, including the isolation site of the bacterial species, the use method of the composite preparation, the course of treatment, and the final therapeutic effect, aiming to provide a basis for the clinical application of probiotic composite preparations in the treatment of unexplained infertility.

Forty years of development of salpingitis animal modeling

This review summarizes and examines research in the area of salpingitis animal modeling in the last 40 years, focusing primarily on Chlamydia trachomatis animal models, which are the most numerous in the literature. Early animal models are examined, followed by a discussion of study parameters and their impact on modeling success, subsequent considerations of fertility measures in modeling, explorations of treatment options, and finally exploring recent directions with a brief discussion of models using other bacterial pathogens.

Fallopian tubal infertility: the result of Chlamydia trachomatis-induced fallopian tubal fibrosis

Chlamydia trachomatis is one of the most common pathogens of sexually transmitted diseases, and its incidence in genital tract infections is now 4.7% in south China. Infertility is the end result of C. trachomatis-induced fallopian tubal fibrosis and is receiving intense attention from scientists worldwide. To reduce the incidence of infertility, it is important to understand the pathology-related changes of the genital tract where C. trachomatis infection is significant, especially the mechanism of fibrosis formation. During fibrosis development, the fallopian tube becomes sticky and occluded, which will eventually lead to tubal infertility. At present, the mechanism of fallopian tubal fibrosis induced by C. trachomatis infection is unclear. Our study attempted to summarize the possible mechanisms of fibrosis caused by C. trachomatis infection in the fallopian tube by reviewing published studies and further providing potential therapeutic targets to reduce the occurrence of infertility. This study also provides ideas for future research. Factors leading to fallopian tube fibrosis include inflammatory factors, miRNA, ECT, cHSP, and host factors. We hypothesized that C. trachomatis mediates the transcription and translation of EMT and ECM via upregulating TGF signaling pathway, which leads to the formation of fallopian tube fibrosis and ultimately to tubal infertility.

Potential biomarkers of infertility associated with microbiome imbalances

PROBLEM

The aim of this study was to investigate the possible relationship between vaginal/rectal microbiome disbalances and miRNA expression with infertility.

METHOD OF STUDY

Observational, exploratory, preliminary study. A total of 287 multiple IVF failure infertile patients were recruited. Twenty fertile women, not IVF failure, were recruited as the control group. Swab samples were collected from the vagina and rectum. Microbial composition by NGS and miRNA expression by real-time PCR of vaginal and rectal samples was measured. Immunometabolic markers from blood (insulin, vitamin D, LDL-cholesterol, ANA, TPO, Tg, and ASCA antibodies) and saliva (sIgA) were analyzed.

RESULT(S)

Infertile patients showed a lower bacterial richness and increased Firmicutes/Bacteroidetes ratio at rectal level and an increased Lactobacillus brevis/Lactobacillus iners ratio in vaginal samples regarding the fertile group. In the same rectal swab samples, we found that miR-21-5p, which is associated with tight junction disruption and yeast overgrowth, is upregulated and that miR-155-5p, which is associated with inflammation, is overexpressed in the unexplained infertile group (*p < .05). These deregulated miRNAs were also upregulated in the vaginal samples from the same patients (*p < .05).

CONCLUSION

miRNAs could be potential biomarkers of the inflammatory impact of microbiome disbalances in unexplained infertile women.

Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease

Bacterial vaginosis, pelvic inflammatory disease, and endometritis are infections of the genital tract that can lead to many adverse health outcomes, including infertility. Bacterial vaginosis is characterized by a lower prevalence of lactobacilli and a higher prevalence of anaerobic bacteria, including Gardnerella vaginalis, Megasphaera spp., and Atopobium vaginae. Endometritis and pelvic inflammatory disease are caused by the ascension of pathogenic bacteria to the uterus, although the mechanisms by which they do so are unclear. Bacterial vaginosis, chronic endometritis, and pelvic inflammatory disease have been linked to infertility in retrospective and prospective trials. Similarly, the causes of bacterial vaginosis and endometritis-related infertility are likely multifactorial and stem from inflammation, immune targeting of sperm antigens, the presence of bacterial toxins, and increased risk of sexually transmitted infections. Diagnosis and treatment of bacterial vaginosis, chronic endometritis, and pelvic inflammatory disease before attempting conception may be important components of preconceptional care for symptomatic women to improve outcomes of natural and assisted reproduction.

The Impact of Selected Bacterial Sexually Transmitted Diseases on Pregnancy and Female Fertility

Sexually transmitted infections (STIs) caused by Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium are a common cause of pelvic inflammatory disease (PID) which can lead to tubal factor infertility (TFI). TFI is one of the most common causes of infertility, accounting for 30% of female fertility problems. STIs can also have an impact on pregnancy, leading to adverse pregnancy outcomes. Escalating antibiotic resistance in Neisseria gonorrhoeae and Mycoplasma genitalium represents a significant problem and can be therapeutically challenging. We present a comprehensive review of the current treatment options, as well as the molecular approach to this subject. We have given special attention to molecular epidemiology, molecular diagnostics, current and new treatments, and drug resistance.

Probiotics Dietary Supplementation for Modulating Endocrine and Fertility Microbiota Dysbiosis

Human microbiota seems to play a key role in endocrine and reproductive systems. Fortunately, microbiota reproductive dysbiosis start to be treated by probiotics using typical species from genus Lactobacillus. This work presents the compiled and analysed results from the most up-to-date information from clinical trials regarding microbiota, fertility, probiotics and oral route administration, reviewing open access scientific documents. These studies analyse the clinical impact of probiotics administered on several endocrine disorders' manifestations in women: mastitis; vaginal dysbiosis; pregnancy complication disorders; and polycystic ovary syndrome. In all cases, the clinical modulation achieved by probiotics was evaluated positively through the improvement of specific disease outcomes with the exception of the pregnancy disorders studies, where the sample sizes results were statistically insufficient. High amounts of studies were discarded because no data were provided on specific probiotic strains, doses, impact on the individual autochthon microbiota, or data regarding specific hormonal values modifications and endocrine regulation effects. However, most of the selected studies with probiotics contained no protocolised administration. Therefore, we consider that intervention studies with probiotics might allocate the focus, not only in obtaining a final outcome, but in how to personalise the administration according to the disorder to be palliated.

The Potential Role for Host Genetic Profiling in Screening for Chlamydia-Associated Tubal Factor Infertility (TFI)-New Perspectives

Host immunogenetic factors can affect late complications of urogenital infections with Chlamydia trachomatis. These findings are creating new avenues for updating existing risk prediction models for C. trachomatis-associated tubal factor infertility (TFI). Research into host factors and its utilization may therefore have future implications for diagnosing C. trachomatis-induced infertility. We outline the epidemiological situation regarding C. trachomatis and TFI in high-income countries. Thereupon, we review the main characteristics of the population undergoing fertility work-up and identify screening and diagnostic strategies for TFI currently in place. The Netherlands is an exemplary model for the state of the art in high-income countries. Within the framework of existing clinical approaches, we propose a scenario for the translation of relevant genome-based information into triage of infertile women, with the objective of implementing genetic profiling in the routine investigation of TFI. Furthermore, we describe the state of the art in relevant gene- and single nucleotide polymorphism (SNP) based clinical prediction models and place our perspectives in the context of these applications. We conclude that the introduction of a genetic test of proven validity into the assessment of TFI should help reduce patient burden from invasive and costly examinations by achieving a more precise risk stratification.

Use of the mtrR Gene for Rapid Molecular Diagnosis of Neisseria gonorrhoeae and Identification of the Reduction of Susceptibility to Antibiotics in Endocervical Swabs

BACKGROUND

Neisseria gonorrhoeae is one of the main etiological agents of sexually transmitted diseases. The asymptomatic course of the infection and its resistance to antibiotics can lead to pelvic inflammatory disease and infertility.

OBJECTIVES

We developed a polymerase chain reaction (PCR) test using the methyltetrahydrofolate homocysteine methyltransferase reductase (mtrR) gene to identify N. gonorrhoeae and detect reduced susceptibility to antibiotics.

MATERIAL AND METHODS

We analysed 250 samples of endocervical exudate from infertile women with a negative diagnosis of N. gonorrhoeae. We designed NGmtr primers to detect N. gonorrhoeae and identify the antibiotic-resistant strain.

RESULTS

Of the 250 samples, 60 (24%) tested positive for N. gonorrhoeae using real-time PCR. Our study was validated using the HO primers and the Seeplex STD6 ACE System, with a 100% correlation. Furthermore, the NGmtr primers are specific for N. gonorrhoeae and not for other species. Additionally, the curves generated by real-time PCR differed between wild and variant strains (10.93%). The dissociation temperatures for the wild and variant strains were 86.5 and 89 °C, respectively.

CONCLUSIONS

The NGmtr primers enabled us to identify N. gonorrhoeae strains with or without reduction of susceptibility to antibiotics. Therefore, this work constitutes a tool that will facilitate the diagnosis of this infection for a low cost and improve patient quality of life.

Isolation of Mycoplasma genitalium from endocervical swabs of infertile women

Objectives:

To determine the occurrence of Mycoplasma genitalium (M. genitalium) infection in infertile women attending infertility clinic and its association to infertility.

Methods:

Endocervical specimens were collected from women presenting with primary and secondary infertility and from fertile women as control group. Real-time polymerase chain reaction (PCR) assay was performed to detect the presence of M. genitalium from these endocervical specimens.

Results:

Mycoplasma genitalium was detected in 3% of infertile women. There was no statistically significant difference between infertility and control group as to signs and symptoms except for signs of cervicitis were presented only among infertile group. We found no significant differences among fertile and infertile women for M. genitalium infection.

Conclusion:

An association between M. genitalium infection and infertility may exist. Screening of women for M. genitalium infection is recommended as part of investigations for infertility.

Microbiota-based analysis reveals specific bacterial traits and a novel strategy for the diagnosis of infectious infertility

Tubal factor infertility (TFI) accounts for more than 30% of the cases of female infertility and mostly resides from an inflammatory process triggered by an infection. Clinical appearances largely differ, and very often infections are not recognized or remain completely asymptomatic over time. Here, we characterized the microbial pattern in females diagnosed with infectious infertility (ININF) in comparison to females with non-infectious infertility (nININF), female sex workers (FSW) and healthy controls (fertile). Females diagnosed with infectious infertility differed significantly in the seroprevalence of IgG antibodies against the C. trachomatis proteins MOMP, OMP2, CPAF and HSP60 when compared to fertile females. Microbiota analysis using 16S amplicon sequencing of cervical swabs revealed significant differences between ININF and fertile controls in the relative read count of Gardnerella (10.08% vs. 5.43%). Alpha diversity varies among groups, which are characterized by community state types including Lactobacillus-dominated communities in fertile females, an increase in diversity in all the other groups and Gardnerella-dominated communities occurring more often in ININF. While all single parameters did not allow predicting infections as the cause of infertility, including C. trachomatis IgG/IgA status together with 16S rRNA gene analysis of the ten most frequent taxa a total of 93.8% of the females were correctly classified. Further studies are needed to unravel the impact of the cervical microbiota in the pathogenesis of infectious infertility and its potential for identifying females at risk earlier in life.

Clonality and distribution of clinical Ureaplasma isolates recovered from male patients and infertile couples in China

Ureaplasma spp. have gained increasing recognition as pathogens in both adult and neonatal patients with multiple clinical presentations. However, the clonality of this organism in the male population and infertile couples in China is largely unknown. In this study, 96 (53 U. parvum and 43 U. urealyticum) of 103 Ureaplasma spp. strains recovered from genital specimens from male patients and 15 pairs of infertile couples were analyzed using multilocus sequence typing (MLST)/expanded multilocus sequence typing (eMLST) schemes. A total of 39 sequence types (STs) and 53 expanded sequence types (eSTs) were identified, with three predominant STs (ST1, ST9 and ST22) and eSTs (eST16, eST41 and eST82). Moreover, phylogenetic analysis revealed two distinct clusters that were highly congruent with the taxonomic differences between the two Ureaplasma species. We found significant differences in the distributions of both clusters and sub-groups between the male and female patients (P < 0.001). Moreover, 66.7% and 40.0% of the male and female partners of the infertile couples tested positive for Ureaplasma spp. The present study also attained excellent agreement of the identification of both Ureaplasma species between paired urine and semen specimens from the male partners (k > 0.80). However, this concordance was observed only for the detection of U. urealyticum within the infertile couples. In conclusion, the distributions of the clusters and sub-groups significantly differed between the male and female patients. U. urealyticum is more likely to transmit between infertile couples and be associated with clinical manifestations by the specific epidemic clonal lineages.

[THE STATE OF FALLOPIAN TUBES IN WOMEN WITH UROGENITAL CHLAMYDIA AND INFERTILITY]

The aim of this work was to assess the state of the fallopian tubes in women with urogenital chlamydia (UC) and infertility. 344 women 18-49 y.o with infertility have been investigated. UC was detected in 133 of them -38.7%, (main group), UC was absent in 211 (61.3%) patients (comparision group). In the main group prevailed the tubal or tubal peritoneal factor of infertility (51.9% versus 19.4% in the comparison group, p<0.001). UC in women in the main (62.4%) was in the form of mixed infection. Obstruction of the fallopian tubes and adhesions in the pelvic region were more often detected in patients of the main group (p<0.05). The most pronounced lesions of the fallopian tubes were observed in women with chlamydial mixed infection. Adhesive process in the small pelvis was established by laparascopy in 72.2% of women in the main group and in 27.8% in the comparison group (p<0.001). There was a correlation between the extent of the adhesion process in the small pelvis and the presence of chlamydial mixed infection. A histological study was carried out of the tissues of the fallopian tubes in 12 women diagnosed with an ectopic pregnancy, 5 of whom had UC. Women with UC have alternating areas with signs of acute inflammation and various stages of the reparative processand in 4 women with UC the above mentioned signs and sclerosis were detected also in the the submucosa, which can cause destruction of the functional activities of the fallopian tubes and obstruction as well. All this causes a violation of the transport of spermatozoa, the embryo and leads to a ectopic pregnancy and infertility. Obtained results explain the inefficiency of restoring reproductive function in women after elimination of UC with preserved patency of the fallopian tubes.

The prevalence of Chlamydia trachomatis infection among Saudi women attending the infertility clinic in Central Saudi Arabia

Objectives:

To determine the prevalence of Chlamydia trachomatis (C. trachomatis) infection among Saudi women, its clinical presentation, and its association to infertility.

Methods:

This study was conducted between October 2012 and July 2013 at King Khalid University Hospital and King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia. Female patients aged between 19 and 46 years old with infertility problems seen at both hospitals were recruited to join the study. A separate group of female patients without infertility problems was also recruited from both hospitals to serve as controls for the study. Endocervical swabs were collected from both groups of patients, and samples were analyzed using real time polymerase chain reaction.

Results:

There was a statistically significantly greater prevalence of C. trachomatis infection in infertile women (n=8, 8.0%) compared with the fertile group of women (n=1, 1.0%). The C. trachomatis infection was significantly correlated to infertility.

Conclusion:

A significant association between infertility and increased prevalence of C. trachomatis infection is shown in this study, thus, we suggest that screening for Chlamydial infection to be part of the routine investigation for infertility.

[GUT AND VAGINAL MICROBIOTA IN FEMALE WITH REPRODUCTIVE DISORDERS ASSOCIATED WITH GASTROINTESTINAL DISTURBANCE]

The aim of research - a comparative study of the microflora of the vagina and bowel in women with secondary infertility and gastrointestinal distress. Materials and methods. We examined gut and vaginal microbiota in 17 infertile women according to the presence or absence of gastrointestinal diseases. We used a standard procedure for microbiological examination. Results. Certain changes of bacterial load and composition in both reservoirs were established. They allowed us to conclude the same trends in characterizing of the developing dysbiosis. Conclusion. Thus, the simultaneous studying of vaginal and gut microflora seems to be rational during the examination of women with childbearing disorders. It could possibly increase the treatment efficacy and/or prevent the development of some pathology.

[Prevalence of infections (Chlamydia, Ureaplasma and Mycoplasma) in patients with altered tuboperitoneal factor]

OBJECTIVE

To determine the prevalence of Chlamydia, Ureaplasma and Mycoplasma in patients with peritoneal tubal factor infertility and altered.

MATERIAL AND METHODS

A descriptive, observational, retrospec- tive, transversal, infertility patients Juarez Hospital of Mexico 2013 to 2015. Study included patients with infertility diagnosis and detection of antibodies (IgG) by ELISA for Chlamydia and vaginal cultures for Mycoplasma and Ureaplasma, hysterosalpingography and histerolapa- roscopia with chromotubation

RESULTS

46 patients with a mean age of 32.5 years. It was found that 36% were positive for these infections (n = 17): Chlamydia in 8.7% (n = 4), Ureaplasma in 21.7% (n = 10) and Mycoplasma in 6.5% (n = 3). Chlamydia patients and bilateral tubal occlusion (OTB) in 5.8% (n = 1), Ureaplasma and OTB (n = 5) were identified in 29.4% of them with pelvic inflammatory disease (PID) and tubal obstruction Ureaplasma right (OTD) in 5.8% (n = 1), Ureaplasma and tubal patency but with loose adhesions in 5.8% (n = 1) and Mycoplasma with OTB in 11.1% (n = 2), p = 0.425. Hysterosalpingography showed a sensitivity of 59% and specificity of 79%.

CONCLUSIONS

Although there was no association of variables, Ureaplasma infection was more common in patients with infertility and tubal damage.

Prevalence of genital Chlamydia trachomatis in Iran: a systematic review and meta-analysis

OBJECTIVE

To determine the overall prevalence of Chlamydia trachomatis in Iranian males and females and to find out the effect of this bacterium on fertility potential and its association with urogenital symptoms.

METHODS

We searched both English and Persian electronic databases using keywords 'Chlamydia', 'Chlamydia trachomatis', 'prevalence', 'incidence', 'frequency', 'epidemiology' and 'Iran'. Finally, after some exclusion, 34 studies from different regions of Iran were included in our study, and a meta-analysis was performed to determine pooled prevalence estimates for each group.

RESULTS

C. trachomatis prevalence for women and men was high and ranged from 0 to 32.7% and 0 to 23.3%, respectively (95% CI). The pooled prevalence of the bacterium in the female population was 12.3% (95% CI: 10.6-14.2%) and in men was 10.9% (95% CI: 7.6-15.4%). A high level of heterogeneity was seen for both men (I(2)  = 77.4%; P < 0.001) and women (I(2)  = 77.5%; P < 0.001); but in men and not in women, some evidence for publication bias was observed [Egger's test (two-tailed P = 0.013); Begg's test (two-tailed P = 0.025)]. In females analysis of symptomatic/infertile group with asymptomatic/fertile group in females, the overall OR was above 1 and the overall P-value was below zero.

CONCLUSIONS

This bacterium may play a role in female infertility or be associated with clinical manifestations; thus, planning national programmes for adequate diagnosis of genital infections caused by this pathogen is necessary. Furthermore, screening strategies, particularly for asymptomatic individuals, and treatment of infected people can reduce consequent complications.

[Implication of laparoscopy in diagnostics of genital tb among women through cytohistological testing of bioptic specimen]

Diagnostics of genital TB among women is a serious challenge because of the absence of specific clinical manifestation and difficulty to obtain material for bacteriological verification of the pathogen. All the cases with ascites and masses in pelvic cavity must undergo thorough testing to exclude tuberculosis. The present article describes 14 suspect cases of genital TB, where along with the mandatory clinical diagnostic studies (including PCR of ascites and bacteriological testing for TB, also on carcinoma of CA-125 ovary) they have conducted laparoscopy, with further cytological and bacteriological testing of bioptic sample. This method allowed us to diagnose genital and abdominal tuberculosis among women in 85,7% of cases through cytologic and histologic testing and to exclude ovarian carcinoma. Effectiveness of laparoscopy has been confirmed in diagnostics of genital and abdominal TB.

ATYPICAL TUBERCULOSIS PRESENTING WITH PRIMARY INFERTILITY AND ENDOMETRIAL CALCIFICATION

Tuberculosis (TB) is caused by mycobacterium tuberculosis. It remains a public health concern especially in developing country. Pulmonary infection is the main presentation. However, genitourinary TB is common especially with the increase in Human Immunodeficiency virus (HIV) infection. Genitourinary TB is one of the most common causes of extrapulmonary tuberculosis which affects 12% patients with pulmonary tuberculosis. It is common in women less than 40 years of age and rarely occurs in post-menopausal. Therefore it is more likely to affect women in reproductive years leading to infertility. Fallopian tube involvement in genital TB is at least 95-100% of cases and is mainly from haematological spread and this leads to infertility. This is a case of a woman who presented a diagnosis of primary infertility and tuberculous endometritis with endometrial calcification.

Can Helicobacter pylori infection influence human reproduction?

Helicobacter pylori (H. pylori) infection could be associated with extra-digestive diseases. Here, we report the evidences concerning the decrease in reproductive potential occurring in individuals infected by H. pylori, especially by strains expressing CagA. This infection is more prevalent in individuals with fertility disorders. Infected women have anti-H. pylori antibodies in cervical mucus and follicular fluid that may decrease sperm motility and cross react immunologically with spermatozoa, conceivably hampering the oocyte/sperm fusion. Infection by CagA positive organisms enhances the risk of preeclampsia, which is a main cause of foetus death. These findings are supported by the results of experimental infections of pregnant mice, which may cause reabsorption of a high number of foetuses and alter the balance between Th1 and Th2 cell response. Infected men have decreased sperm motility, viability and numbers of normally shaped sperm and augmented systemic levels of inflammatory cytokines, such as tumor necrosis factor-α, which may damage spermatozoa. In countries where parasitic infestation is endemic, detrimental effects of infection upon spermatozoa may not occur, because the immune response to parasites could determine a switch from a predominant Th1 type to Th2 type lymphocytes, with production of anti-inflammatory cytokines. In conclusion, the evidences gathered until now should be taken into consideration for future studies aiming to explore the possible role of H. pylori infection on human reproduction.

[Tuberculous endometritis: about a case and review of the literature]

La tuberculose constitue encore un problème de santé préoccupant, aussi bien dans les pays en voie de développement que dans les pays développés, en partie du fait de l’éclosion de l’épidémie mondiale de l’infection par le virus de l’immunodéficience humaine. Dans sa localisation génitale assez rare (6-10% des localisations tuberculeuses), la tuberculose pose des problèmes diagnostiques. Les symptômes communément rencontrés sont non spécifiques, ce qui contribue au retard thérapeutique et majore le risque d’infertilité qui reste la séquelle quasi inéluctable. A travers une observation d’endométrite tuberculeuse et une revue de la littérature nous étudions les aspects épidémio-cliniques, thérapeutiques et pronostiques de cette localisation tuberculeuse.

Transcriptional regulation of Culex pipiens mosquitoes by Wolbachia influences cytoplasmic incompatibility

Cytoplasmic incompatibility (CI) induced by the endosymbiont Wolbachia pipientis causes complex patterns of crossing sterility between populations of the Culex pipiens group of mosquitoes. The molecular basis of the phenotype is yet to be defined. In order to investigate what host changes may underlie CI at the molecular level, we examined the transcription of a homolog of the Drosophila melanogaster gene grauzone that encodes a zinc finger protein and acts as a regulator of female meiosis, in which mutations can cause sterility. Upregulation was observed in Wolbachia-infected C. pipiens group individuals relative to Wolbachia-cured lines and the level of upregulation differed between lines that were reproductively incompatible. Knockdown analysis of this gene using RNAi showed an effect on hatch rates in a Wolbachia infected Culex molestus line. Furthermore, in later stages of development an effect on developmental progression in CI embryos occurs in bidirectionally incompatible crosses. The genome of a wPip Wolbachia strain variant from Culex molestus was sequenced and compared with the genome of a wPip variant with which it was incompatible. Three genes in inserted or deleted regions were newly identified in the C. molestus wPip genome, one of which is a transcriptional regulator labelled wtrM. When this gene was transfected into adult Culex mosquitoes, upregulation of the grauzone homolog was observed. These data suggest that Wolbachia-mediated regulation of host gene expression is a component of the mechanism of cytoplasmic incompatibility.

Wolbachia are maternally inherited bacteria that manipulate invertebrate reproduction. Cytoplasmic incompatibility is embryo death that occurs when males carrying Wolbachia mate with females that do not, or that carry a different Wolbachia variant; its mechanism is poorly understood. In Culex mosquitoes, in the presence of Wolbachia a gene related to a Drosophila melanogaster gene, grauzone, which has been shown to act as a regulator of the meiotic cell cycle, showed an elevated level of expression. When lower levels of expression were achieved through RNA interference, embryo hatch rates were affected and the stage of development at which embryo death occurs was altered. To find Wolbachia genes that influence cytoplasmic incompatibility, we compared the genomes of two variants of Wolbachia from Culex that produce cytoplasmic incompatibility with one another. Although most segments of these genomes were very similar, one newly identified gene is predicted to be a regulator of gene transcription. We cloned this gene into a plasmid, expressed it in adult mosquitoes and found higher levels of expression of the Culex grauzone homolog. This suggests that the Wolbachia transcriptional regulator may play an important role in manipulating the host in order to induce cytoplasmic incompatibility.

TUNEL analysis of DNA fragmentation in mouse unfertilized oocytes: the effect of microorganisms within human follicular fluid collected during IVF cycles

Recently we reported the presence of bacteria within follicular fluid. Previous studies have reported that DNA fragmentation in human spermatozoa after in vivo or in vitro incubation with bacteria results in early embryo demise and a reduced rate of ongoing pregnancy, but the effect of bacteria on oocytes is unknown. This study examined the DNA within mouse oocytes after 12 hours' incubation within human follicular fluids (n=5), which were collected from women undergoing in vitro fertilization (IVF) treatment. Each follicular fluid sample was cultured to detect the presence of bacteria. Terminal deoxynucleotidyl transferase mediated dUTP nick-end labeling (TUNEL) was used to label DNA fragmentation in ovulated, non-fertilized mouse oocytes following in vitro incubation in human follicular fluid. The bacteria Streptococcus anginosus and Peptoniphilus spp., Lactobacillus gasseri (low-dose), L. gasseri (high-dose), Enterococcus faecalis, or Propionibacterium acnes were detected within the follicular fluids. The most severe DNA fragmentation was observed in oocytes incubated in the follicular fluids containing P. acnes or L. gasseri (high-dose). No DNA fragmentation was observed in the mouse oocytes incubated in the follicular fluid containing low-dose L. gasseri or E. faecalis. Low human oocyte fertilization rates (<29%) were associated with extensive fragmentation in mouse oocytes (80-100%). Bacteria colonizing human follicular fluid in vivo may cause DNA fragmentation in mouse oocytes following 12h of in vitro incubation. Follicular fluid bacteria may result in poor quality oocytes and/or embryos, leading to poor IVF outcomes.

Bacteriological agents which play a role in the development of infertility

This study was carried out to determine the prevalence of the bacterial agents Chlamydia trachomatis (C. trachomatis), Neisseria gonorrhoeae (N. gonorrhoeae), Mycoplasma hominis (M. hominis) and Ureaplasma urealyticum (U. urealyticum) and the conditions which may play a role in the development of female infertility, in the county of Iaşi in North-Eastern Romania. Cervical and blood samples were collected from 176 infertile women and 45 pregnant women in the third trimester. Classical methods and real time PCR were applied to each cervical sample to detect the presence of these sexually transmitted microorganisms; the ELISA method was applied to blood samples to detect C. trachomatis antibodies (IgA, IgM and IgG). The proportion of C. trachomatis IgG was significantly higher in the infertile group (23.8%) than in the pregnant group (4.4%), p < 0.05. For C. trachomatis antigen (Ag) and N. gonorrhoeae Ag no differences were observed between the two groups. The prevalence of mycoplasma genital infections was higher in the pregnant group (U. urealyticum - 53.3% and M. hominis - 20%) than in the infertile group (U. urealyticum - 39.7% and M. hominis - 7.3%). Higher rate of co-infection with C. trachomatis and mycoplasma were observed among the infertile women (25.7%) than among the pregnant women (7.7%). This combination could be involved in the appearance of pelvic inflammatory disease (PID) and its sequela, including infertility. C. trachomatis IgG determination still remains the gold standard for the diagnosis of PID and should be used as a screening test for the prediction of tubal damage in infertile women. In view of the large number of cases involving the co-existence of genital infections with C. trachomatis, M. hominis and U. urealyticum, it is clearly necessary to perform screening for all three microorganisms among all women of reproductive age but especially those who are infertile.

[No firm evidence for screening for Chlamydia in connection with spontaneous abortion]

Infection with genital Chlamydia while undergoing a vaginal instrumentation increases the risk of pelvic inflammatory disease with pain and sterility as sequelae. A literature study was performed in order to find out if screening and treatment for Chlamydia trachomatis should be offered to all women with miscarriages. This article reviews the available literature on the topic. The results show that there is a need for larger clinical trials before an evidence-based answer can be given.

The value of negative Chlamydia trachomatis antibody in prediction of normal tubes in infertile women

OBJECTIVE

To evaluate the value of Chlamydia trachomatis antibody testing in prediction of at least one normal tube in infertile women.

MATERIALS AND METHODS

Eighty infertile women without any history of abdominal or pelvic surgery, pelvic inflammatory disease, and endometriosis were recruited in this cross-sectional study from 2009 to 2010. The patients underwent hysterosalpingography, laparoscopy, and anti Chlamydia trachomatis IgG antibody (CAT) testing. We compared laparoscopy findings and CAT regarding sensitivity, specificity, accuracy, and predicting value of tubal conditions.

RESULTS

The CAT was positive in 50 patients (62.5%) and laparoscopy was positive in 32 patients (40%). The CAT was significantly higher in women with tubal disease (1.88 +/- 0.34) versus in women with normal tubes (1.21 +/- 0.28) (p = 0.003). Five out of 30 sero-negative women had unilateral tubal abnormality and none of them had bilateral tubal obstruction or severe pelvic adhesion. The sensitivity, specificity, positive and negative predictive value, and accuracy of the CAT in prediction of one normal tube were 100%, 42.25%, 18%, 100%, and 48.75%, respectively.

CONCLUSION

The negative predictive value of CAT to predict at least one normal tube in infertile women without history of abdominal or pelvic surgery, pelvic inflammatory disease, and endometriosis was 100%.

[Persistence of Chlamydia trachomatis in endometrium and peritoneal fluid of infertile patients with negative cervical culture]

BACKGROUND

Chlamydia trachomatis infection is considered a public health problem due to its high prevalence, and because is asymptomatic in 70% of women and provokes reproductive sequelae when it is not detected and treated timely.

OBJECTIVE

To search for C. trachomatis in endometrium and peritoneal fluid of infertile women without detection of this pathogen in cervical secretions.

PATIENTS AND METHOD

A retrospective and cross-sectional study was done in 38 patients with infertility only 18 showed peritoneal fluid infection and/or endometrial infection, eight of them were negative for the amplificated product of 129-bp from CT ompA gene in cervical secretions. Laparoscopic data showed that five of them had pelvic inflammatory disease.

CONCLUSION

The non-detection of Chlamydia trachomatis in endocervix does not reflect what happens in the upper genital tract, that's why we need to do a deliberate search of infection by this pathogen in endometrium of suspected women with infertility.

Chlamydia trachomatis infections: screening, diagnosis, and management

Chlamydia trachomatis is a gram-negative bacterium that infects the columnar epithelium of the cervix, urethra, and rectum, as well as nongenital sites such as the lungs and eyes. The bacterium is the cause of the most frequently reported sexually transmitted disease in the United States, which is responsible for more than 1 million infections annually. Most persons with this infection are asymptomatic. Untreated infection can result in serious complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy in women, and epididymitis and orchitis in men. Men and women can experience chlamydia-induced reactive arthritis. Treatment of uncomplicated cases should include azithromycin or doxycycline. Screening is recommended in all women younger than 25 years, in all pregnant women, and in women who are at increased risk of infection. Screening is not currently recommended in men. In neonates and infants, the bacterium can cause conjunctivitis and pneumonia. Adults may also experience conjunctivitis caused by chlamydia. Trachoma is a recurrent ocular infection caused by chlamydia and is endemic in the developing world.

[Prevalence of Chlamydia trachomatis infection in patients treated for infertility]

AIM OF THE STUDY

To determine the prevalence of Chlamydia trachomatis infection in patients treated for infertility.

STUDY TYPE

A retrospective analysis.

SETTING

Fertimed, infertility treatment center, Olomouc.

METHOD

At Fertimed, we used DNA detection of Chlamydia trachomatis by the PCR method of the company GeneProof to examine, between 2009-2011, 785 women undergoing one of the infertility treatment methods and their 113 partners. In the second group, we examined 121 oocyte donors and 30 men before sperm donation. We appraised the frequency of Chlamydia trachomatis detection in the specific groups and the clinical impact of the infection on the female reproductive organs.

RESULTS

In the group of women treated for infertility, we detected 20 (2.5%) women with an active infection. After treatment, 9 of them underwent an examination of Fallopian tube patency using the UTHL (ultrasonographically guided transvaginal hydrolaparoscopy) method. In 7 cases, we indicated a bilateral salpingectomy due to a sactosalpinx and in one case severe pelvic adhesions were found (88.9%), and in one patient, the result was normal. In the control group of 43 PCR-negative women who were examined for Fallopian tube patency, 9.3% rate of tubal pathology was found (p<0.001). In the oocyte donor group, we detected the presence of Chlamydia trachomatis in 12 (9.9%) women, and in the sperm donor group, in 7.6% men. Treatment with 500 mg of Sumamed (azithromycin), given in 3 doses, was successful in all of the positive patients.

CONCLUSION

We found that Chlamydia trachomatis detection was lower in the women treated for infertility than in the female donor group. Women with a confirmed infection had a high prevalence of inflammatory changes in the Fallopian tubes compared with women devoid of a confirmed infection. The treatment with azithromycin is effective.

How much tubal factor infertility is caused by Chlamydia? Estimates based on serological evidence corrected for sensitivity and specificity

OBJECTIVES

To estimate the proportion of tubal factor infertility (TFI) caused by Chlamydia trachomatis (CT), the etiologic fraction, from a retrospective study of CT antibody prevalence in TFI cases and controls, adjusted for sensitivity and specificity.

METHODS

We use published data on sensitivity and specificity to estimate the performance of assays in (a) women with a previous CT infection without sequelae and (b) women with TFI caused by CT. A model was developed and applied to antibody prevalence in TFI cases and controls from 1 published case-control study to estimate the proportion of TFI caused by CT.

RESULTS

The proportion of TFI episodes that were due to CT infection was estimated to be 45% (credible intervals: 28%, 62%). Models which assume that test sensitivity is higher in women with CT-related TFI than women with previous infection and no sequelae fit the data significantly better than models that assume the same sensitivity in all those previously infected.

CONCLUSIONS

Greater attention needs to be paid to methods for characterizing the performance of CT antibody tests. Serological studies could be given a greater role both in CT etiology and in monitoring the effects of prevention and control programmes.

Prevalence of Mycoplasma hominis and Ureaplasma urealiticum in pregnant and women with reproductive problems

The aim of the research was to explore women with reproductive problems and pregnant women on Mycoplasma and Ureaplasma as well as to investigate spread of these microbes in the women of reproductive age. There were investigated 100 women with reproductive problem and 96 pregnant women. It was found that 64% of women with reproductive problem and 60% of pregnant women had Ureaplasma urealyticum with high titer (more then 1000 cells in ml), but Mycoplasma hominis was detected approximately in equal % of non-pregnant and pregnant women (12% - non-pregnant women; 16% - pregnant women). It is recommended to investigate women before planning pregnancy.

Mycoplasmateceae species are not found in Fallopian tubes of women with tubo-peritoneal infertility

BACKGROUND

The role of mycoplasmas on the development and sequelae of pelvic inflammatory disease remains controversial. The objective of the present study is to correlate directly the presence of Mycoplasmateceae through polimerase chain reaction (PCR) determinations in cervix and Fallopian tubes of infertile patients with tubo-peritoneal factor diagnosed through laparoscopy.

METHODS

Thirty patients with tubo-peritoneal infertility and 30 normal fertile patients were included in the study; cervical samples and tubal flushings were obtained during laparoscopy. PCR determinations for the detection of genetic material of Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealiticum, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis in cervix and tubal flushings were performed.

RESULTS

No Mycoplasmataceae species as "only" microorganisms were found in tubal flushings of tubo-peritoneal infertility patients, whereas three (10%) fertile patients with normal tubes were positive for mycoplasma presence. This difference was not significant (p = 0.237). Among the 30 patients suffering from tubal infertility diagnosed through laparoscopy, Mycoplasmatecae species were not detected in the Fallopian tubes by PCR determinations, while in normal tubes from fertile patients these and other microorganisms could be found without distorting tubal anatomy.

CONCLUSION

Mycoplasmateceae species were not detected in Fallopian tubes of women with tubo-peritoneal infertility.

Seroprevalence of Chlamydia trachomatis infection in women with bad obstetric history and infertility

Chlamydia trachomatis has currently emerged as the most common sexually transmitted pathogen. It is usually asymptomatic and is difficult to diagnose clinically. It is one of the causes for bad Obstetric History (BOH) and infertility. Women at highest risk often have the least access to health care facilities. Therefore there is a need for a rapid, simple, inexpensive and non-invasive test to detect C. trachomatis infection. Serological testing forms the mainstay of diagnosing the disease and to treat BOH and infertility. Hence the present study was conducted. Enzyme linked immunosorbent Assay (ELISA) was used for detection of IgG antibodies against C. trachomatis. Out of 260 cases, 130 had history of BOH, 80 had history of infertility and 50 healthy pregnant women (HPW) were used as controls. The seropositivity of C. trachomatis in the study was 25.4% (66). Out of 130 cases of BOH, seropositivity was 27.7% (36). Out of 80 cases of infertility, seropositivity was 35% (28) and out of 50 cases of HPW seropositivity was 4% (2). In BOH cases, women with history of two abortions showed seropositivity of 7.3% and women with history of three or more abortions showed seropositivity of 62.5%. Hence, seropositivity of C. trachomatis infection was found to be significant among women with BOH and infertility as compared to HPW.

[Detection and the antibiotic susceptibility analysis of mycoplasma and chlamydia in urogenital tract infections of 327 cases patients with tubal infertility]

OBJECTIVE

To explore the effects of mycoplasma and chlamydia infections on tubal infertilityand to assess the antibiotic susceptibility and resistance of female urogenital, and consequently to guide clinical rational drug use.

METHODS

327 tubal infertility women as infertility group and 286 healthy pregnant women as control group were randomly selected, detected chlamydia trachomatis (CT), ureaplasma urealyticum (UU) and mycoplasma hominis (MH) in cervical secretions and drug resistance of UU and MH.

RESULTS

CT infection rates (14.99%), UU infection rates (23.24%), UU + MH infection rates (29.05%),CT + UU + MH infection rates (9.17%) and total infection rates (88.99%) in infertility group is higher than those (order: 2.80%, 6.99%, 8.39%, 4.55%, 29.02%) in the control group, comparisons of two groups are statistically significant differences (P < 0.05), the susceptibility of UU to roxithromycin (sensitivity is 96.05%), josamycin (sensitivity is 96.05%), tetracycline (sensitivity is 82.89%), vibramycin( sensitivity is 92.11%) and clarithromycin (sensitivity is 96.05%) were relatively high and low to ciprofloxacin and acetyl spiramycin. The susceptibility of MH to josamycin (sensitivity is 95.83%), vibramycin (sensitivity is 91.67%), minocin (sensitivity is 83.33%) and actinospectacin (sensitivity is 75.00%) were relatively high and low to erythromycin, azithromycin, roxithromycin and clarithromycin. UU + MH was only sensitive to josamycin (sensitivity is 90.52%), high resistance (77.89% -91.58%) to erythromycin, azithromycin, acetyl spiramycin, ciprofloxacin, ofloxacin, azithromycin and clarithromycin.

CONCLUSION

Infection of CT, UU, MH and tubal infertility have certain relevance,the rates of CT, UU and MH infection in tubal infertility patients higher than fertile people. For many commonantibacterial drugs, UU, MH and UU + MH has strong resistance, the etiology detection and using adapted antibios should be taken seriously in clinical treatment.

Mycoplasma genitalium: an emerging cause of sexually transmitted disease in women

Mycoplasma genitalium is an emerging sexually transmitted pathogen implicated in urethritis in men and several inflammatory reproductive tract syndromes in women including cervicitis, pelvic inflammatory disease (PID), and infertility. This comprehensive review critically examines epidemiologic studies of M. genitalium infections in women with the goal of assessing the associations with reproductive tract disease and enhancing awareness of this emerging pathogen. Over 27,000 women from 48 published reports have been screened for M. genitalium urogenital infection in high- or low-risk populations worldwide with an overall prevalence of 7.3% and 2.0%, respectively. M. genitalium was present in the general population at rates between those of Chlamydia trachomatis and Neisseria gonorrhoeae. Considering more than 20 studies of lower tract inflammation, M. genitalium has been positively associated with urethritis, vaginal discharge, and microscopic signs of cervicitis and/or mucopurulent cervical discharge in seven of 14 studies. A consistent case definition of cervicitis is lacking and will be required for comprehensive understanding of these associations. Importantly, evidence for M. genitalium PID and infertility are quite convincing and indicate that a significant proportion of upper tract inflammation may be attributed to this elusive pathogen. Collectively, M. genitalium is highly prevalent in high- and low-risk populations, and should be considered an etiologic agent of select reproductive tract disease syndromes in women.

Association of tubal factor infertility with elevated antibodies to Chlamydia trachomatis caseinolytic protease P

OBJECTIVE

The objective of the study was to assess antibodies against Chlamydia trachomatis heat shock proteins (HSP) in patients with tubal factor infertility (TFI), infertility controls (IFC), and fertile controls (FC). HSPs assist organisms in surviving caustic environments such as heat.

STUDY DESIGN

Twenty-one TFI, 15 IFC, and 29 FC patients were enrolled after laparoscopic tubal assessment. The titers of antibodies against C trachomatis organisms and 14 chlamydial HSPs were compared among the 3 groups.

RESULTS

TFI patients developed significantly higher levels of antibodies against C trachomatis and specifically recognizing chlamydial HSP60 and caseinolytic protease (Clp) P, a subunit of the ATP-dependent Clp protease complex involved in the degradation of abnormal proteins.

CONCLUSION

In addition to confirming high titers of antibodies against C trachomatis organisms and HSP60 in TFI patients, we identified a novel link of TFI with anti-ClpP antibodies. These findings may provide useful information for developing a noninvasive screening test for TFI and constructing subunit anti-C trachomatis vaccines.

[Relationship between mycoplasma and chlamydia infection and lesions in the cervical tissue in high-risk HPV-positive patients]

OBJECTIVE

Discussion of the relationship between Mycoplasma and chlamydia infection and lesions in the cervical tissue in high-risk HPV-positive infertile patients with cervical.

METHODS

HPV-negative patients with cervical as the control, retrospective analysis the relationship of Mycoplasma hominis and chlamydia infection, cervical histological graded, and inflammation graded.

RESULTS

The rate of HPV infection in mycoplasma-positive and those with negative mycoplasma has significant difference (P < 0.01), The rate of HPV infection in chlamydia-positive and those with negative chlamydia has no significant difference (P > 0.05). CIN and the incidence of cervical erosion and CIN grade were higher in HPV-positive than HPV-negative group (P < 0.01). The cervical erosion of HPV-positive was no difference in the degree (P > 0.05). Compared with the simple HPV-positive group, CIN and the incidence of severe cervical erosion in mixed infection of Mycoplasma was no difference (P > 0.05).

CONCLUSION

Mycoplasma infection increases the rate of high risk HPV infection, high-risk HPV infection increased cervical pathological damage, Mycoplasma infection might be the factor of persistent infection with high risk HPV, the degree of cervical pathological is the factor of cervical infertility which can not be ignored.

Results of bacteriological and cytological examinations of the endometrium of subfertile mares in stud farms in Serbia

Uterine microbiology, antimicrobial susceptibility and endometrial cytology were investigated in a total of 51 mares with fertility problems from 16 different stud farms in Serbia. Uterine cultures were performed after collection with a double guarded uterine swab, and endometrial cytology was evaluated after collection of endometrial cells with a special device (cytology brush). In 21 of 51 mares, at least one bacterial species was isolated from the uterus; the most frequent were Streptococcus equi subsp. zooepidemicus (13 isolates) and E. coli (four isolates). All isolates of Streptococcus equi subsp. zooepidemicus were susceptible to penicillin. Results from endometrial cytology were inconsistent; in 17 animals with positive bacteriological culture, cytology was not altered. It can be concluded that in Serbia, as in many other contries, Streptococcus equi subsp. zooepidemicus is the main cause for equine endometritis. It can be easily diagnosed by uterine culture but endometrial cytology does not always prove the existence of an endometrial infection with this agent.

Pelvic tuberculosis mimicking ovarian malignancy: a case report

BACKGROUND

Tuberculosis is quite prevalent in developing countries, including India. In the female genital tract, the fallopian tube is the most common site involved by the disease.

CASE

A woman presented with infertility, menstrual irregularities, an abdominal mass, abdominal pain and weight loss. She was previously operated on for left ovarian germ cell tumor. The clinical, radiologic and histopathologic examination helped to reach the correct diagnosis.

CONCLUSION

In a woman with a history of infertility, menstrual irregularities, an abdominal mass and weight loss, differentiation between malignancy and tuberculosis becomes difficult. These two possibilities should always be part of the differential diagnosis.

[Lack of evidence to support chlamydia infection screening]

Every year one fourth of the young Danish population is tested for urogenital Chlamydia trachomatis--mostly as part of opportunistic testing. The rationale is that asymptomatic infections may reduce reproductive capacity in women and that screening may reduce the burden of disease in the population. Systematic reviews documented lack of conclusive evidence for reproductive complications after asymptomatic infections and lack of evidence concerning the effect of screening on long-term sequelae. Routine opportunistic testing should be replaced by research protocols aiming to evaluate the effect of such interventions.

[Uterine eosinophils and infertility in the rat]

Uterine horn and adnexa structure have been studied with morphologic and morphometric methods in rats on the 10th day after infection of Staphylococcus aureus culture and in rats who became sterile after inflammatory survival. The even-aged intact female rats were used as control. The study demonstrates that nonbearing rats served the fertilization ability, but in genitals the signs of different degree indolent chronic inflammatory process have been observed. Endometrial inability to incorporate the embryonated egg may be determined by complex disturbances, the main of them being the dense eosinophilic infiltration of uterine wall and pathological cell interrelations in endometrium. The insufficient tissue drainage impaired the situation and caused the accumulation of toxic and antigenic substances.

[Tubo-peritoneal factor of infertility: diagnosis and treatment]

Infertility, defined as the inability to conceive despite regular unprotected sexual intercourse over 12 years, affects approximately 10% of the fertile population. The commonest cause of tubal damage is pelvic inflammatory disease (PID), which in the developed world is caused mainly by Chlamydia trachomatis infection. The incidence of tubal damage after one episode of pelvic infection is approximately 12%, 23% after two episodes and 54% after three episodes. Other causes of tubal damage include postsurgical adhesions or endometriosis. Tubal patency can be diagnosed by hysterosalpingography (HSG) or laparoscopy with chromopertubation. Surgery represents the best therapeutic approach for tubal pathology, with a term pregnancy rate of 70% after surgery in selected patients, while the latest results in Italy of assisted reproductive technology (ART) report a live birth rate per cycle of 13.8%. In conclusion, tubal reconstructive surgery remains an important option for many couples and surgery should be the fi rst line approach for a correct diagnosis and treatment of tubal infertility.

Gardnerella, Trichomonas vaginalis, Candida, Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum in the genital discharge of symptomatic fertile and asymptomatic infertile women

This study aimed to establish the different prevalence of the microorganisms investigated in the two groups considered: fertile women with symptoms and asymptomatic women with infertility problems. The data from women (n= 952) investigated for two years for quality of genital discharge and the presence of Gardnerella vaginalis, Trichomonas vaginalis, Candida species, Streptococcus agalactiae, Mycoplasma hominis, Ureaplasma urealyiticum and Chlamydia trachomatis were retrospectively analyzed. In the population of fertile women with symptoms the microrganisms most frequently involved are Gardnerella vaginalis (26.6%), Candida species (12.1%) and Streptococcus agalactiae (9.2%). The genital discharges of asymptomatic women with infertility problems are characterized by a prevalence of Gardnerella vaginalis (19.7%), Enterobacteriaceae or Enterococci (12.1%) and Streptococcus agalactiae (8.6%). The reduction of vaginal lactobacilli flora and the presence of an elevated number of polymorphonucleates in the vaginal discharge are important parameters to consider for the evaluation of the health status of the human female urogenital tract. Our results indicate that is important to culture the vaginal discharge for Streptococcus agalactiae and for prevalence of Enterobacteriaceae and Enterococci. Lastly, the reasons for the prevalence of some microorganisms (Gardnerella vaginalis, Enterobacteriaceae and Enterococci, Streptococcus agalactiae) in the population of infertile asymptomatic women need to be better analyzed especially after the recent studies correlating idiopathic infertility with the presence of cervical cytokines in women with an abnormal vaginal flora.

The prevalence of some bacterial markers in female patients undergoing an initial infertility evaluation in north-east Romania

SCOPE

Genital infections represent one of the most important causes of infertility, affecting: fallopian tubes, endometrial mucosa, sperm parameters. The aim of this study is to evaluate the involvement of four sexually transmitted infections (STD) in the achievement of infertility and to establish the prevalence of each infectious agent in our patients.

METHODS

We analyzed the presence of Chlamydia trachomatis (CT) antigen, Ureaplasma urealyticum (UU), Mycoplasma hominis (MH) and Neisseria gonorrhoeae (NG) in the endocervical secretions and Chlamydia trachomatis antibodies IgA, IgG, IgM in the serum of 125 infertile women as well as in 30 pregnant women in the 3rd trimester of pregnancy, as a control group. RESULTS. In infertile women, the prevalence rate of the four bacterial markers was: CT antigen 1/125 (0.80%), CT IgG antibodies 19/125 (15.20%), MH 6/125 (4.80%), UU 51/125 (40.80%) and NG 1/125 (0.8%). From the control group, none was positive for CT antigen, but 1/30 (3.33% of patients) was positive for CT IgA while the prevalence rate for MH and UU were 16.66% and 43.33% respectively.

CONCLUSIONS

We couldn't prove any association between genital MH/UU and infertility as the prevalence was higher in the control group than in the cases, but the correlation of the CT infection with the infertility was clearly shown. However, it is necessary to perform routine tests to screen for CT, NG, UU and MH among infertile patients. The positivity for CT IgG is a marker better correlated with fallopian tube obstruction than the CT antigen.