http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Thu, 28 Mar 2013 18:03:14 +0000 http://www.hindawi.com/journals/idog/2013/525878/ Background. Infants born to mothers who are colonized with group B streptococcus (GBS) but received <4 hours of intrapartum antibiotic prophylaxis (IAP) are at-risk for presenting later with sepsis. We assessed if <4 hours of maternal IAP for GBS are associated with an increased incidence of clinical neonatal sepsis. Materials and Methods. A retrospective cohort study of women-infant dyads undergoing IAP for GBS at ≥37-week gestation who presented in labor from January 1, 2003 through December 31, 2007 was performed. Infants diagnosed with clinical sepsis by the duration of maternal IAP received (< or ≥4-hours duration) were determined. Results. More infants whose mothers received <4 hours of IAP were diagnosed with clinical sepsis, 13 of 1,149 (1.1%) versus 15 of 3,633 (0.4%), . Multivariate logistic regression analysis showed that treatment with ≥4 hours of IAP reduced the risk of infants being diagnosed with clinical sepsis by 65%, adjusted relative risk 0.35, CI 0.16–0.79, and . Conclusion. The rate of neonatal clinical sepsis is increased in newborns of GBS colonized mothers who receive <4 hours compared to ≥4 hours of IAP. Mark A. Turrentine, Anthony J. Greisinger, Kimberly S. Brown, Oscar A. Wehmanen, and Melanie E. Mouzoon Copyright © 2013 Mark A. Turrentine et al. All rights reserved. Thu, 07 Mar 2013 19:13:43 +0000 http://www.hindawi.com/journals/idog/2013/195637/ Objective. While 6- to 12-month courses of isoniazid for tuberculosis prevention are considered safe in pregnant women, the effects of longer-term isoniazid prophylaxis or isoniazid in combination with antiretroviral therapy (ART) are not established in human-immunodeficiency-virus-(HIV-) infected women who experience pregnancy during the course of therapy. Design. Nested study of pregnancy outcomes among HIV-infected women participating in a placebo-controlled, TB-prevention trial using 36 months daily isoniazid. Pregnancy outcomes were collected by interview and record review. Results. Among 196 pregnant women, 103 (52.6%) were exposed to isoniazid during pregnancy; all were exposed to antiretroviral drugs. Prior to pregnancy they had received a median of 341 days (range 1–1095) of isoniazid. We observed no isoniazid-associated hepatitis or other severe isoniazid-associated adverse events in the 103 women. Pregnancy outcomes were 132 term live births, 42 premature births, 11 stillbirths, 8 low birth weight, 6 spontaneous abortions, 4 neonatal deaths, and 1 congenital abnormality. In a multivariable model, neither isoniazid nor ART exposure during pregnancy was significantly associated with adverse pregnancy outcome (adjusted odds ratios 0.6, 95% CI: 0.3–1.1 and 1.8, 95% CI 0.9–3.6, resp.). Conclusions. Long-term isoniazid prophylaxis was not associated with adverse pregnancy outcomes, such as preterm delivery, even in the context of ART exposure. Allan W. Taylor, Barudi Mosimaneotsile, Unami Mathebula, Anikie Mathoma, Ritah Moathlodi, Irene Theebetsile, and Taraz Samandari Copyright © 2013 Allan W. Taylor et al. All rights reserved. Tue, 19 Feb 2013 13:49:01 +0000 http://www.hindawi.com/journals/idog/2013/367935/ Objective. To determine the validity of a novel Group B Streptococcus (GBS) diagnostic assay for the detection of GBS in antepartum patients. Study Design. Women were screened for GBS colonization at 35 to 37 weeks of gestation. Three vaginal-rectal swabs were collected per patient; two were processed by traditional culture (commercial laboratory versus in-house culture), and the third was processed by an immunoblot-based test, in which a sample is placed over an antibody-coated nitrocellulose membrane, and after a six-hour culture, bound GBS is detected with a secondary antibody. Results. 356 patients were evaluated. Commercial processing revealed a GBS prevalence rate of 85/356 (23.6%). In-house culture provided a prevalence rate of 105/356 (29.5%). When the accelerated GBS test result was compared to the in-house GBS culture, it demonstrated a sensitivity of 97.1% and a specificity of 88.4%. Interobserver reliability for the novel GBS test was 88.2%. Conclusions. The accelerated GBS test provides a high level of validity for the detection of GBS colonization in antepartum patients within 6.5 hours and demonstrates a substantial agreement between observers. Jonathan P. Faro, Karen Bishop, Gerald Riddle, Mildred M. Ramirez, Allan R. Katz, Mark A. Turrentine, and Sebastian Faro Copyright © 2013 Jonathan P. Faro et al. All rights reserved. Tue, 12 Feb 2013 09:04:35 +0000 http://www.hindawi.com/journals/idog/2013/917304/ Objective. To investigate adherence to the 2002 Centers for Disease Control and Prevention (CDC) guidelines for perinatal group B streptococci (GBS) prevention in penicillin-allergic obstetric patients. Methods. This is a retrospective cohort study of penicillin-allergic obstetric patients who tested positive for GBS and delivered at our institution in 2010. Electronic medical records were reviewed for the nature of the penicillin allergy, documentation of having previously tolerated cephalosporins, gestational age at delivery, type of delivery, antimicrobial sensitivity testing, and antibiotics administered. Antimicrobial sensitivity testing and “appropriate” antibiotic choice, which was determined using 2002 CDC guidelines, were analyzed. Results. Intrapartum antibiotic prophylaxis was administered in 97.8% (95% confidence interval [CI] 93.5–99.5%) of patients, but it was considered appropriate in only 62.2% (95% CI 53.8–70.0%) of patients. Clindamycin was the most commonly used antibiotic, but 26.4% (95% CI 16.3–39.7%) of patients who received clindamycin did not have confirmation of susceptibility via antimicrobial sensitivity testing. Overall, the sensitivity testing was performed in only 65.5% (95% CI 56.2–73.7%) of patients in whom it was indicated. Conclusion. Compliance with CDC guidelines for performing antimicrobial sensitivity testing and choosing an appropriate antibiotic in GBS-positive penicillin-allergic women continues to be suboptimal. Institution of measures to increase adherence is necessary. Kimberly A. Paccione and Harold C. Wiesenfeld Copyright © 2013 Kimberly A. Paccione and Harold C. Wiesenfeld. All rights reserved. Thu, 10 Jan 2013 15:40:25 +0000 http://www.hindawi.com/journals/idog/2013/813238/ We have identified a CD8+CXCR5+ T cell that prevents the development of oviduct dilation following C. muridarum genital infection. Phenotypic studies show that CD8+CXCR5+ cells express markers of T regulatory cells (FoxP3, CD25, and GITR) but do not express a necessary component of cytotoxic cells (perforin). mice have significantly lower numbers of CD8+ cells and lack the CD8+CXCR5+ population while the total number of CD4+ cells is equivalent between mouse strains. The transfer of CD8+ splenocytes from WT mice reduces the oviduct dilation seen in mice following C. muridarum infection. Future studies will investigate the mechanism by which this cell type regulates genital tract pathology. Janina Jiang, Cheryl I. Champion, Bo Wei, Guangchao Liu, and Kathleen A. Kelly Copyright © 2013 Janina Jiang et al. All rights reserved. Sun, 30 Dec 2012 14:55:20 +0000 http://www.hindawi.com/journals/idog/2012/736864/ Jean R. Anderson, Deborah Cohan, and Susan Cu-Uvin Copyright © 2012 Jean R. Anderson et al. All rights reserved. Sun, 23 Dec 2012 11:00:42 +0000 http://www.hindawi.com/journals/idog/2012/628362/ Objective. To examine practice patterns for diagnosis and treatment of chorioamnionitis among US obstetricians. Study Design. We distributed a mail-based survey to members of the American College of Obstetricians and Gynecologists, querying demographics, practice setting, and chorioamnionitis management strategies. We performed univariable and multivariable analyses. Results. Of 500 surveys distributed, 53.8% were returned, and 212 met study criteria and were analyzed. Most respondents work in group practice (66.0%), perform >100 deliveries per year (60.0%), have been in practice >10 years (77.3%), and work in a nonuniversity setting (85.1%). Temperature plus one additional criterion (61.3%) was the most common diagnostic strategy. Over 25 different primary antibiotic regimens were reported, including use of a single agent by 30.0% of respondents. A wide range of postpartum antibiotic duration was reported from no postpartum treatment (34.5% after vaginal delivery, 11.3% after cesarean delivery) to 48 hours of postpartum treatment (24.7% after vaginal delivery, 32.1% after cesarean delivery). No practitioner characteristic was independently associated with diagnostic or therapeutic strategies in multivariable analysis. Conclusion. There is a wide variation in contemporary clinical practices for the management of chorioamnionitis. This may represent a dearth of level I evidence. Future prospective clinical trials may provide more evidence-based practice recommendations for diagnosis and treatment of chorioamnionitis. Mara B. Greenberg, Britta L. Anderson, Jay Schulkin, Mary E. Norton, and Natali Aziz Copyright © 2012 Mara B. Greenberg et al. All rights reserved. Sat, 22 Dec 2012 10:10:11 +0000 http://www.hindawi.com/journals/idog/2012/490686/ Recent studies suggest that acquisition of HIV-1 infection during pregnancy and breastfeeding is associated with a high risk of HIV mother-to-child transmission. This study evaluates risk factors associated with HIV acquisition during pregnancy in women delivering at a large metropolitan medical facility located in the south of Brazil. From February to August 2009, our group conducted a cross-sectional study assessing women’s risk for HIV acquisition by administering an oral survey to peripartum women. Of 2465 participants, 42% () knew that partner had been tested for HIV. During pregnancy, 82% () of participants never used condoms; yet 97% () practiced vaginal sex. Multivariate logistic regression analysis showed that patients with more years of education, in a relationship for more than 1 year, and who knew their own HIV status were more likely to know their partners' HIV status (). Those who were in relationship for more than 1 year and were married/living together were more likely to be comfortable discussing HIV testing with partners (). In conclusion, women in Brazil are at risk of HIV-infection during pregnancy as they remain sexually active, often do not know their sexual partner’s HIV status, and have minimal condom use. Nava Yeganeh, Ivana Varella, Breno Riegel Santos, Marineide Gonçalves de Melo, Mariana Simon, Taui Melo, and Karin Nielsen-Saines Copyright © 2012 Nava Yeganeh et al. All rights reserved. Thu, 29 Nov 2012 15:27:52 +0000 http://www.hindawi.com/journals/idog/2012/543916/ In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999–2008 and 12/302 (4.0%) in 2009–2011 (), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003–2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed. Osvaldo Lorenzo, Consuelo M. Beck-Sagué, Claudia Bautista-Soriano, Mina Halpern, José Roman-Poueriet, Nora Henderson, Eddy Perez-Then, Rosa Abreu-Perez, Solange Soto, Luis Martínez, Sarah Rives-Gray, Bienvenido Veras, Maureen Connolly, Greer Brittany Callender, and Stephen W. Nicholas Copyright © 2012 Osvaldo Lorenzo et al. All rights reserved. Mon, 26 Nov 2012 15:14:42 +0000 http://www.hindawi.com/journals/idog/2012/926435/ Francesco De Seta, Secondo Guaschino, Bryan Larsen, Gilbert Donders, and Gonzaga Andabati Copyright © 2012 Francesco De Seta et al. All rights reserved. Wed, 24 Oct 2012 10:53:04 +0000 http://www.hindawi.com/journals/idog/2012/921519/ Background. Bacterial vaginosis (BV) has been linked to female HIV acquisition and transmission. We investigated the effect of providing a latex diaphragm with Replens and condoms compared to condom only on BV prevalence among participants enrolled in an HIV prevention trial. Methods. We enrolled HIV-seronegative women and obtained a vaginal swab for diagnosis of BV using Nugent’s criteria; women with BV (score 7–10) were compared to those with intermediate (score 4–6) and normal flora (score 0–3). During quarterly follow-up visits over 12–24 months a vaginal Gram stain was obtained. The primary outcome was serial point prevalence of BV during followup. Results. 528 participants were enrolled; 213 (40%) had BV at enrollment. Overall, BV prevalence declined after enrollment in women with BV at baseline (, 95% CI 0.29–.56) but did not differ by intervention group. In the intention-to-treat analysis BV prevalence did not differ between the intervention and control groups for women who had BV (, 95% CI 0.52–1.94) or for those who did not have BV (, 95% CI 0.65–2.27) at enrollment. Only 2.1% of participants were treated for symptomatic BV and few women (5–16%) were reported using anything else but water to cleanse the vagina over the course of the trial. Conclusions. Provision of the diaphragm, Replens, and condoms did not change the risk of BV in comparison to the provision of condoms alone. Craig R. Cohen, Su-Chun Cheng, Stephen Shiboski, Tsungai Chipato, Martin Matu, James Mwangi, Monalisa E. S. Mutimutema, Jennifer Tuveson, Mavis Kamba, Nancy Padian, and Ariane van der Straten Copyright © 2012 Craig R. Cohen et al. All rights reserved. Mon, 22 Oct 2012 09:27:11 +0000 http://www.hindawi.com/journals/idog/2012/378640/ Bacterial vaginosis, trichomoniasis, and genital candidiasis are considered the main etiologies of vulvovaginitis. Few studies estimate the prevalence of vulvovaginitis among adolescents, especially in Brazil. This study aimed to determine the prevalence and main risk factors associated with bacterial vaginosis and genital infection by C. albicans and Trichomonas vaginalis among a group of adolescents from Salvador, Bahia, Brazil. One hundred sexually active adolescents followed at an adolescent gynecology clinic were included. Endocervical and vaginal samples were obtained during gynecological examination. Nugent criteria were applied for the diagnosis of bacterial vaginosis. For Candida albicans and Trichomonas vaginalis detection, culture in Sabouraud agar plates and Papanicolaou cytology were used, respectively. The mean age of participants was years. The prevalence of bacterial vaginosis was 20% (95% CI 12–28) and of genital infection by Candida was 22% (95% CI 14–30). Vaginal cytology detected Trichomonas vaginalis in one patient. Alcohol, tobacco, and illegal drug use () and multiple lifetime partners were statistically related to bacterial vaginosis (). The prevalence of bacterial vaginosis and genital candidiasis was similar to other studies carried out among adolescents worldwide. Rita Elizabeth Moreira Mascarenhas, Márcia Sacramento Cunha Machado, Bruno Fernando Borges da Costa e Silva, Rodrigo Fernandes Weyll Pimentel, Tatiana Teixeira Ferreira, Fernanda Maria Silva Leoni, and Maria Fernanda Rios Grassi Copyright © 2012 Rita Elizabeth Moreira Mascarenhas et al. All rights reserved. Thu, 18 Oct 2012 12:21:29 +0000 http://www.hindawi.com/journals/idog/2012/540295/ Objective. To project the increased incidence of HIV and subsequent costs resulting from the expected decreased rate of circumcision due to Medicaid defunding in one southeastern state. Methods. Using 2009 South Carolina (SC) Medicaid birth cohort (), we calculated expected heterosexually acquired HIV cases at current circumcision rates. To calculate age/race/gender specific HIV incidence rates, we used 2009 South Carolina Department of Health and Environmental Control reported gender and race specific HIV cases, CDC reported age distribution of HIV cases, and 2009 S.C. population data. Accounting for current circumcision rates, we calculated the change in incidence of heterosexually acquired HIV assuming circumcision provides 60% protection against HIV transmission to males and 46% protection against male to female transmission. Published lifetime cost of HIV was used to calculate the cost of additional HIV cases. Results. Assuming Medicaid circumcision rates decrease from current nationally reported levels to zero secondary to defunding, we project an additional 55 male cases of HIV and 47 female cases of HIV among this birth cohort. The total cost discounted to time of infection of these additional HIV cases is $20,924,400 for male cases and $17,711,400 for female cases. The cost to circumcise males in this birth cohort at currently reported rates is $4,856,000. Conclusions. For every year of decreased circumcision rates due to Medicaid defunding, we project over 100 additional HIV cases and $30,000,000 in net medical costs. Annie L. Andrews, Gweneth B. Lazenby, Elizabeth Ramsey Unal, and Kit N. Simpson Copyright © 2012 Annie L. Andrews et al. All rights reserved. Mon, 15 Oct 2012 16:46:34 +0000 http://www.hindawi.com/journals/idog/2012/859071/ Background. Vulvovaginal candidiasis is characterized by curd-like vaginal discharge and itching, and is associated with considerable health and economic costs. Materials and Methods. We examined the incidence, prevalence, and risk factors for vulvovaginal candidiasis among a cohort of 898 women in south India. Participants completed three study visits over six months, comprised of a structured interview and a pelvic examination. Results. The positive predictive values for diagnosis of vulvovaginal candidiasis using individual signs or symptoms were low (<19%). We did not find strong evidence for associations between sociodemographic characteristics and the prevalence of vulvovaginal candidiasis. Women clinically diagnosed with bacterial vaginosis had a higher prevalence of vulvovaginal candidiasis (Prevalence 12%, 95% CI 8.2, 15.8) compared to women assessed to be negative for bacterial vaginosis (Prevalence 6.5%, 95% 5.3, 7.6); however, differences in the prevalence of vulvovaginal candidiasis were not observed by the presence or absence of laboratory-confirmed bacterial vaginosis. Conclusions. For correct diagnosis of vulvovaginal candidiasis, laboratory confirmation of infection with Candida is necessary as well as assessment of whether the discharge has been caused by bacterial vaginosis. Studies are needed of women infected with Candida yeast species to determine the risk factors for yeast’s overgrowth. Sujit D. Rathod, Jeffrey D. Klausner, Karl Krupp, Arthur L. Reingold, and Purnima Madhivanan Copyright © 2012 Sujit D. Rathod et al. All rights reserved. Thu, 11 Oct 2012 14:53:51 +0000 http://www.hindawi.com/journals/idog/2012/604183/ Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically plan to have and raise children to adulthood. Although HIV may have adverse effects on fertility, recent studies suggest that antiretroviral therapy may increase or restore fertility. Data indicate the increasing numbers of women living with HIV who are becoming pregnant, and that many pregnancies are unintended and contraception is underutilized, reflecting an unmet need for preconception care (PCC). In addition to the PCC appropriate for all women of reproductive age, women living with HIV require comprehensive, specialized care that addresses their unique needs. The goals of PCC for women living with HIV are to prevent unintended pregnancy, optimize maternal health prior to pregnancy, improve maternal and fetal outcomes in pregnancy, prevent perinatal HIV transmission, and prevent HIV transmission to an HIV-uninfected sexual partner when trying to conceive. This paper discusses the rationale for preconception counseling and care in the setting of HIV and reviews current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on well-resourced settings. Mary Jo Hoyt, Deborah S. Storm, Erika Aaron, and Jean Anderson Copyright © 2012 Mary Jo Hoyt et al. All rights reserved. Wed, 03 Oct 2012 09:17:53 +0000 http://www.hindawi.com/journals/idog/2012/340782/ Background. Preventing unintended pregnancies among women living with HIV is an important component of prevention of mother-to-child HIV transmission (PMTCT), yet few data exist on contraceptive use among women entering HIV care. Methods. This was a retrospective study of electronic medical records from the initial HIV clinic visits of 826 sexually active, nonpregnant, 18–49-year old women in southwestern Uganda in 2009. We examined whether contraceptive use was associated with HIV status disclosure to one’s spouse. Results. The proportion reporting use of contraception was 27.8%. The most common method used was injectable hormones (51.7%), followed by condoms (29.6%), and oral contraceptives (8.7%). In multivariable analysis, the odds of contraceptive use were significantly higher among women reporting secondary education, higher income, three or more children, and younger age. There were no significant independent associations between contraceptive use and HIV status disclosure to spouse. Discussion. Contraceptive use among HIV-positive females enrolling into HIV care in southwestern Uganda was low. Our results suggest that increased emphasis should be given to increase the contraception uptake for all women especially those with lower education and income. HIV clinics may be prime sites for contraception education and service delivery integration. Winnie Muyindike, Robin Fatch, Rachel Steinfield, Lynn T. Matthews, Nicholas Musinguzi, Nneka I. Emenyonu, Jeffrey N. Martin, and Judith A. Hahn Copyright © 2012 Winnie Muyindike et al. All rights reserved. Tue, 18 Sep 2012 16:44:27 +0000 http://www.hindawi.com/journals/idog/2012/769851/ Purpose. Families with children are frequently exposed to pinworm infection and treatment involves the whole family. Information on consequences of exposure during, pregnancy is limited. The aim of this study was to investigate the exposure to pyrvinium and mebendazole before, during, and after pregnancy in a Danish nationwide cohort. Methods. From nationwide administrative registers, we identified 718, 900 births in Denmark between January 1997 and December 2007 as well as maternal prescription data of anthelmintics and maternal characteristics. Redemption of a prescription for pyrvinium or mebendazole was used to identify exposure. Results. 4715 women redeemed a prescription for pyrvinium or mebendazole during pregnancy; 1606 for pyrvinium, 2575 for mebendazole, and 534 for both drugs. Having >2 children compared to having no previous children was associated with exposure to pyrvinium (OR: 7.1, 95% CI: 5.8–8.7) and mebendazole (OR: 20.8, 95% CI: 17.3–24.9). Conclusion. 4715 pregnant women redeemed a prescription for either mebendazole or pyrvinium. We believe the exposure to be even higher since pyrvinium is also sold over-the-counter. Limited information on birth outcomes is available at present time, and considering the number of exposed pregnancies, we recommend that studies are to be undertaken to assess the safety of pyrvinium and mebendazole during pregnancy. A. Torp-Pedersen, E. Jimenez-Solem, J. T. Andersen, K. Broedbaek, C. Torp-Pedersen, and H. E. Poulsen Copyright © 2012 A. Torp-Pedersen et al. All rights reserved. Mon, 17 Sep 2012 10:32:44 +0000 http://www.hindawi.com/journals/idog/2012/284762/ Bacterial vaginosis is a common vaginal infection associated with numerous gynecological and obstetric complications. This condition is characterized by the presence of thick adherent vaginal biofilms, composed mainly of Gardnerella vaginalis. This organism is thought to be the primary aetiological cause of the infection paving the way for various opportunists to colonize the niche. Previously, we reported that the natural antimicrobials subtilosin, ε-poly-L-lysine, and lauramide arginine ethyl ester selectively inhibit the growth of this pathogen. In this study, we used plate counts to evaluate the efficacy of these antimicrobials against established biofilms of G. vaginalis. Additionally, we validated and compared two rapid methods (ATP viability and resazurin assays) for the assessment of cell viability in the antimicrobial-treated G. vaginalis biofilms. Out of the tested antimicrobials, lauramide arginine ethyl ester had the strongest bactericidal effect, followed by subtilosin, with clindamycin and polylysine showing the weakest effect. In comparison to plate counts, ATP viability and resazurin assays considerably underestimated the bactericidal effect of some antimicrobials. Our results indicate that these assays should be validated for every new application. Yevgeniy Turovskiy, Thomson Cheryian, Ammar Algburi, Ruth E. Wirawan, Paul Takhistov, Patrick J. Sinko, and Michael L. Chikindas Copyright © 2012 Yevgeniy Turovskiy et al. All rights reserved. Thu, 13 Sep 2012 17:34:20 +0000 http://www.hindawi.com/journals/idog/2012/617234/ Objective. Vietnamese American women are at the greatest risk for cervical cancer but have the lowest cervical cancer screening rates. This study was to determine whether demographic and acculturation, healthcare access, and knowledge and beliefs are associated with a prior history of cervical cancer screening among Vietnamese women. Methods. Vietnamese women (𝑛=1450) from 30 Vietnamese community-based organizations located in Pennsylvania and New Jersey participated in the study and completed baseline assessments. Logistic regression analyses were performed. Results. Overall levels of knowledge about cervical cancer screening and human papillomavirus (HPV) are low. Factors in knowledge, attitude, and beliefs domains were significantly associated with Pap test behavior. In multivariate analyses, physician recommendation for screening and having health insurance were positively associated with prior screening. Conclusion. Understanding the factors that are associated with cervical cancer screening will inform the development of culturally appropriate intervention strategies that would potentially lead to increasing cervical cancer screening rates among Vietnamese women. Grace X. Ma, Carolyn Y. Fang, Ziding Feng, Yin Tan, Wanzhen Gao, Shaokui Ge, and Cuc Nguyen Copyright © 2012 Grace X. Ma et al. All rights reserved. Tue, 04 Sep 2012 08:16:00 +0000 http://www.hindawi.com/journals/idog/2012/536037/ Trichomonas vaginalis is a parasitic protozoan which infects the urogenital tract and requires iron as an essential nutrient. Iron is known to upregulate various adhesins required for cytoadherance and other factors involved in pathogenesis. At mucosal surfaces, iron is chelated by lactoferrin resulting in low levels of free iron. However, pathogens have evolved mechanisms for an increased uptake of iron. The present review highlights the role of iron in survival of Trichomonas during fluctuating concentrations of iron at mucosal surfaces during the menstrual cycle. Future prospects in terms of new drug and vaccine targets related to iron and its receptors have also been described. Rakesh Sehgal, Kapil Goyal, and Alka Sehgal Copyright © 2012 Rakesh Sehgal et al. All rights reserved. Wed, 29 Aug 2012 09:03:18 +0000 http://www.hindawi.com/journals/idog/2012/325108/ Background. Evidence suggests adherence to clinical guidelines for pelvic inflammatory disease (PID) diagnosis and management is suboptimal. We systematically reviewed the literature for studies describing strategies to improve the adherence to PID clinical guidelines. Methods. The databases MEDLINE and EMBASE, and reference lists of review articles were searched from January 2000 to April 2012. Only studies with a control group were included. Results. An interrupted time-series study and two randomised controlled trials (RCTs) were included. The interrupted time-series found that following a multifaceted patient and practitioner intervention (practice protocol, provision of antibiotics on-site, written instructions for patients, and active followup), more patients received the recommended antibiotics and attended for followup. One RCT found a patient video on PID self-care did not improve medication compliance and followup. Another RCT found an abbreviated PID treatment guideline for health-practitioners improved their management of PID in hypothetical case scenarios but not their diagnosis of PID. Conclusion. There is limited research on what strategies can improve practitioner and patient adherence to PID diagnosis and management guidelines. Interventions that make managing PID more convenient, such as summary guidelines and provision of treatment on-site, appear to lead to better adherence but further empirical evidence is necessary. Bette Liu, Basil Donovan, Jane S. Hocking, Janet Knox, Bronwyn Silver, and Rebecca Guy Copyright © 2012 Bette Liu et al. All rights reserved. Sun, 26 Aug 2012 09:08:41 +0000 http://www.hindawi.com/journals/idog/2012/293867/ Objective. To elucidate differences in the frequency and severity of acute chorioamnionitis (CAM) and chronic villitis in placentas from stillborns compared with liveborns at term and to evaluate other risk factors and placental findings. Design. Case-control study. Setting. All delivery wards in major Stockholm area. Population or Sample. Placentas from stillborn/case (𝑛=126) and liveborn/control (𝑛=273) neonates were prospectively collected between 2002 and 2005. Methods. CAM was assessed on a three-grade scale based on the presence and distribution of polymorphonuclear leucocytes in the chorion/amnion. The presence of vasculitis and funisitis was recorded separately. Chronic villitis was diagnosed by the presence of mononuclear cells in the villous stroma. Relevant clinical data were collected from a specially constructed, web-based database. The statistic analyses were performed using multivariable logistic regression. Results. CAM (especially severe, AOR: 7.39 CI: 3.05–17.95), villous immaturity (AOR: 7.17 CI: 2.66–19.33), villitis (<1 % AOR: 4.31 CI: 1.16–15.98; ≥1 %, AOR: 3.87 CI: 1.38–10.83), SGA (AOR: 7.52 CI: 3.06–18.48), and BMI >24.9 (AOR: 2.06 CI: 1.21–3.51) were all connected to an elevated risk of term stillbirth. Conclusions. We found that CAM, chronic villitis, villous immaturity, SGA, and maternal overweight, but not vasculitis or funisitis are independently associated with risk for stillbirth at term. Ingela Hulthén Varli, Karin Petersson, Marius Kublickas, and Nikos Papadogiannakis Copyright © 2012 Ingela Hulthén Varli et al. All rights reserved. Wed, 15 Aug 2012 15:41:59 +0000 http://www.hindawi.com/journals/idog/2012/146348/ Background. Understanding HIV-infected patient experiences and perceptions of reproductive counseling in the health care context is critical to inform design of effective pharmaco-behavioral interventions that minimize periconception HIV risk and support HIV-affected couples to realize their fertility goals. Methods. We conducted semistructured, in-depth interviews with 30 HIV-infected women (with pregnancy in prior year) and 20 HIV-infected men, all reporting serodiscordant partners and accessing care in Durban, South Africa. We investigated patient-reported experiences with safer conception counseling from health care workers (HCWs). Interview transcripts were reviewed and coded using content analysis for conceptual categories and emergent themes. Results. The study findings indicate that HIV-infected patients recognize HCWs as a resource for periconception-related information and are receptive to speaking to a HCW prior to becoming pregnant, but seldom seek or receive conception advice in the clinic setting. HIV nondisclosure and unplanned pregnancy are important intervening factors. When advice is shared, patients reported receiving a range of information. Male participants showed particular interest in accessing safer conception information. Conclusions. HIV-infected men and women with serodiscordant partners are receptive to the idea of safer conception counseling. HCWs need to be supported to routinely initiate accurate safer conception counseling with HIV-infected patients of reproductive age. L. T. Matthews, T. Crankshaw, J. Giddy, A. Kaida, C. Psaros, N. C. Ware, J. A. Smit, and D. R. Bangsberg Copyright © 2012 L. T. Matthews et al. All rights reserved. Tue, 14 Aug 2012 12:15:43 +0000 http://www.hindawi.com/journals/idog/2012/890160/ Background. Preventing unintended pregnancy in HIV-positive women can significantly reduce maternal-to-child HIV transmission as well as improve the woman’s overall health. Hormonal contraceptives are safe and effective means to avoid unintended pregnancy, but there is concern that coadministration of antiretroviral drugs may alter contraceptive efficacy. Materials and Methods. We performed a literature search of PubMed and Ovid databases of articles published between January 1980 and February 2012 to identify English-language reports of drug-drug interactions between hormonal contraceptives (HCs) and antiretroviral drugs (ARVs). We also reviewed the FDA prescribing information of contraceptive hormone preparations and antiretrovirals for additional data and recommendations. Results. Twenty peer-reviewed publications and 42 pharmaceutical package labels were reviewed. Several studies of combined oral contraceptive pills (COCs) identified decreased serum estrogen and progestin levels when coadministered with certain ARVs. The contraceptive efficacy of injectable depot medroxyprogesterone acetate (DMPA) and the levonorgestrel intrauterine system (LNG-IUS) were largely unaffected by ARVs, while data on the contraceptive patch, ring, and implant were lacking. Conclusions. HIV-positive women should be offered a full range of hormonal contraceptive options, with conscientious counseling about possible reduced efficacy of COCs and the contraceptive implant when taken with ARVs. DMPA and the LNG-IUS maintain their contraceptive efficacy when taken with ARVs. Jennifer A. Robinson, Roxanne Jamshidi, and Anne E. Burke Copyright © 2012 Jennifer A. Robinson et al. All rights reserved. Wed, 08 Aug 2012 13:44:18 +0000 http://www.hindawi.com/journals/idog/2012/587651/ HIV serodiscordant couples represent at least half of all HIV-affected couples worldwide. Many of these couples have childbearing desires. Safer methods of conception may allow for pregnancy while minimizing the risk of sexual transmission of HIV. In serodiscordant partnerships with an HIV-infected female and HIV-uninfected male, vaginal insemination of a partner's semen during the fertile period coupled with 100% condom use may be the safest method of conception. Okeoma Mmeje, Craig R. Cohen, and Deborah Cohan Copyright © 2012 Okeoma Mmeje et al. All rights reserved. Thu, 12 Jul 2012 11:03:24 +0000 http://www.hindawi.com/journals/idog/2012/809682/ Despite increasing efforts to address the reproductive health needs of people living with HIV, a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. This study explores the fertility intentions and family planning (FP) preferences of Kenyan women accessing HIV treatment. We conducted 30 semistructured interviews and qualitatively analyzed the data with a grounded theory approach. Fears of premature death, financial hardship, and perinatal HIV transmission emerged as reasons for participants’ desire to delay/cease childbearing. Participants strongly identified FP needs, yet two-thirds were using male condoms alone or no modern method of contraception. Women preferred the HIV clinic as the site of FP access for reasons of convenience, provider expertise, and a sense of belonging, though some had privacy concerns. Our findings support the acceptability of integrated FP and HIV services. Efforts to empower women living with HIV to prevent unintended pregnancies must expand access to contraceptive methods, provide confidential services, and take into account women's varied reproductive intentions. Elizabeth K. Harrington, Sara J. Newmann, Maricianah Onono, Katie D. Schwartz, Elizabeth A. Bukusi, Craig R. Cohen, and Daniel Grossman Copyright © 2012 Elizabeth K. Harrington et al. All rights reserved. Thu, 05 Jul 2012 10:49:10 +0000 http://www.hindawi.com/journals/idog/2012/430585/ Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early congenital syphilis and late congenital syphilis. Diagnosis of maternal infection is based on clinical findings, serological tests, and direct identification of treponemes in clinical specimens. Adequate treatment of maternal infection is effective for preventing maternal transmission to the fetus and for treating fetal infection. Prenatal diagnosis of congenital syphilis includes noninvasive and invasive diagnosis. Serological screening during pregnancy and during preconception period should be performed to reduce the incidence of congenital syphilis. Marco De Santis, Carmen De Luca, Ilenia Mappa, Terryann Spagnuolo, Angelo Licameli, Gianluca Straface, and Giovanni Scambia Copyright © 2012 Marco De Santis et al. All rights reserved. Mon, 02 Jul 2012 10:16:38 +0000 http://www.hindawi.com/journals/idog/2012/384758/ Introduction. Cervical cancer is the most common cancer among Mexican women. The goal of the present study was to determine the prevalence and distribution of HPV types in women from Mexico City. Methods. Our study was conducted in the Clinica de Especialidades de la Mujer de la Secretaría de la Defensa Nacional, Mexico. Random samples were taken from 929 healthy women requesting a cervical Papanicolaou examination. Detection and genotyping of HPV were performed by multiplex PCR, with the HPV4A ACE Screening kit (Seegene). Results. 85 of nine hundred twenty-nine women (9.1%) were infected with HPV. Of HPV-positive women, 99% and 1% had high- and low-risk HPV genotypes, respectively. The prevalence of the 16 high-risk (HR) HPV types that were screened was 43% : 42% (18) were HPV positive and 14% (16) were HPV positive, which includes coinfection. Multiple infections with different viral genotypes were detected in 10% of the positive cases. Abnormal cervical cytological results were found in only 15.3% of HPV-positive women, while 84.7% had normal cytological results. Conclusions. We found a similar prevalence of HPV to previous studies in Mexico. The heterogeneity of the HPV genotype distribution in Mexico is evident in this study, which found a high frequency of HPV HR genotypes, the majority of which were HPV 18. María Guadalupe López Rivera, Maria Olivia Medel Flores, José D’Artagnan Villalba Magdaleno, and Virginia Sánchez Monroy Copyright © 2012 María Guadalupe López Rivera et al. All rights reserved. Sun, 01 Jul 2012 15:45:49 +0000 http://www.hindawi.com/journals/idog/2012/636474/ Candida albicans is the most important Candida species causing vulvovaginal candidiasis (VVC). VVC has significant medical and economical impact on women’s health and wellbeing. While current antifungal treatment is reasonably effective, supportive and preventive measures such as application of probiotics are required to reduce the incidence of VVC. We investigated the potential of the probiotics Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 towards control of C. albicans. In vitro experiments demonstrated that lactic acid at low pH plays a major role in suppressing fungal growth. Viability staining following cocultures with lactobacilli revealed that C. albicans cells lost metabolic activity and eventually were killed. Transcriptome analyses showed increased expression of stress-related genes and lower expression of genes involved in fluconazole resistance, which might explain the increased eradication of Candida in a previous clinical study on conjoint probiotic therapy. Our results provide insights on the impact of probiotics on C. albicans survival. Gerwald A. Köhler, Senait Assefa, and Gregor Reid Copyright © 2012 Gerwald A. Köhler et al. All rights reserved. Thu, 28 Jun 2012 09:46:45 +0000 http://www.hindawi.com/journals/idog/2012/739624/ Sociodemographic and behavioral characteristics of 212 Peruvian female sex workers (FSWs) were analyzed. The association between genital tract infections (GTIs) and risk factors by multivariate analysis was evaluated. Eighty-eight percent of FSWs were diagnosed with at least one GTI (HSV-2 80.1%, BV 44.8%, candidiasis 9.9%, syphilis seropositivity 9.4%, Trichomonas vaginalis 2.4%, HIV seropositivity 2.4%). Reported condom use with clients was nearly universal (98.3%), but infrequent with husband/regular partners (7.3%). In multivariate analysis BV was negatively associated with more consistent condom use (PRR=0.63, 95% CI, 0.42–0.96). Many had not visited a Sexually Transmitted Infection (STI) clinic or been tested for HIV in the past year (40.6%, 47.1%, resp.). Nonclient contraceptive use was low (57%) and induced abortion was common (68%). High GTI burden and abortions suggest that a services-access gap persists among marginalized FSWs. Continued health outreach programs and integrating family planning and reproductive health services into existing STI clinic services are recommended. M. E. Perla, Annette E. Ghee, Sixto Sánchez, R. Scott McClelland, Annette L. Fitzpatrick, Luis Suárez-Ognio, Javier R. Lama, and Jorge Sánchez Copyright © 2012 M. E. Perla et al. All rights reserved.