Objective. To compare knowledge and attitudes of human papillomavirus (HPV) and the vaccine between different cultures of African descent. Methods. A cross-sectional survey of 555 African-Americans and Afro-Caribbeans residing in the US and the Bahamas (BHM) was conducted. Results. General knowledge about HPV and the HPV vaccine differed between the two countries significantly. Bahamian respondents were less likely to have higher numbers of correct knowledge answers when compared to Americans (Adjusted Odds Ratio [Adj. OR] 0.47, 95&#x25; Confidence Interval [CI] 0.30&#x2013;0.75). Older age, regardless of location, was also associated with answering fewer questions correctly (Adj. OR 0.61, 95&#x25; CI 0.40&#x2013;0.92). Attitudes related to HPV vaccination were similar between the US and BHM, but nearly 80&#x25; of BHM respondents felt that children should not be able to receive the vaccine without parental consent compared to 57&#x25; of American respondents. Conclusions. Grave lack of knowledge, safety and cost concerns, and influence of parental restrictions may negatively impact vaccine uptake among African-American and Afro-Caribbean persons. Interventions to increase the vaccine uptake in the Caribbean must include medical provider and parental involvement. Effective strategies for education and increasing vaccine uptake in BHM are crucial for decreasing cervical cancer burden in the Caribbean.

Elizabeth Blackman

Natalie Thurman

Darron Halliday

Raleigh Butler

Dorita Francis

Madeline Joseph

Jahzreel Thompson

Aletha Akers

Cecile Andraos-Selim

Cornelius Bondzi

Emanuela Taioli

Kourtney L. Hagan

Erin A. Jones

Jade Jones

Cierra M. Moss

Ar&#x2019;Lena C. Smith

Kimlin Tam Ashing

Camille C. Ragin

Multicenter Study of Human Papillomavirus and the Human Papillomavirus Vaccine: Knowledge and Attitudes among People of African Descent

To summarize the literature regarding susceptibility of pregnant women to infectious diseases and severity of resulting disease, we conducted a review using a PubMed search and other strategies. Studies were included if they reported information on infection risk or disease outcome in pregnant women. In all, 1454 abstracts were reviewed, and a total of 85 studies were included. Data were extracted regarding number of cases in pregnant women, rates of infection, risk factors for disease severity or complications, and maternal outcomes. The evidence indicates that pregnancy is associated with increased severity of some infectious diseases, such as influenza, malaria, hepatitis E, and herpes simplex virus (HSV) infection (risk for dissemination/hepatitis); there is also some evidence for increased severity of measles and smallpox. Disease severity seems higher with advanced pregnancy. Pregnant women may be more susceptible to acquisition of malaria, HIV infection, and listeriosis, although the evidence is limited. These results reinforce the importance of infection prevention as well as of early identification and treatment of suspected influenza, malaria, hepatitis E, and HSV disease during pregnancy.

Elisabeth Sappenfield

Denise J. Jamieson

Athena P. Kourtis

Pregnancy and Susceptibility to Infectious Diseases

Vaginal (61) and fecal (61) Escherichia coli
 isolates from pregnant and nonpregnant women (18&#x2013;45 years old) were surveyed for 
 papG alleles by PCR technique. papG allele II was the most prevalent 
 among both vaginal (32.7&#x25;) and fecal (3.2&#x25;) isolates, whereas other alleles were found only among vaginal isolates 
 (1.6&#x25; for alleles I and III and 3.2&#x25; for alleles II + III). papG+ pregnant women's isolates did 
 not differ significantly from those of nonpregnant in possession of papG allele II (90&#x25; versus 73.3&#x25;), 
 whereas both (32.7&#x25;) differed significantly 
 (<svg style="vertical-align:-0.546pt;width:58.712502px;" id="M1" height="11.85" version="1.1" viewBox="0 0 58.712502 11.85" width="58.712502" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.113)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z" /></g><g transform="matrix(.017,-0,0,-.017,15.582,11.113)"><path id="x2264" d="M531 71l-474 214v50l474 215v-56l-416 -184l416 -183v-56zM531 -40h-474v50h474v-50z" /></g><g transform="matrix(.017,-0,0,-.017,30.286,11.113)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z" /></g><g transform="matrix(.017,-0,0,-.017,38.446,11.113)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" /></g><g transform="matrix(.017,-0,0,-.017,42.321,11.113)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.113)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z" /></g>

		
	
</svg>) in comparison with fecal isolates (3.2&#x25;). The vast majority of papG allele II+ vaginal isolates were clustered in group B2 (81.8&#x25;) and much less in group D (18.1&#x25;). Also, most of them were positive for fimH (100&#x25;), papC (100&#x25;), iucC (90.9&#x25;), and hly (72.7&#x25;), and about half of them were positive for sfa/foc (45.4&#x25;). In addition, the mean of VFs' gene possession was 3.5 (range from 2 to 5). It can be concluded that vaginal colonization by papG allele II+ E. coli is possibly one of the predisposing factors of both pregnant and nonpregnant women to pyelonephritis, but its potential may be modified by other factors especially host factors.

Sareaa Maseer Gatya Al-Mayahie

Vaginal Colonization by papG Allele II+ Escherichia coli Isolates from Pregnant and Nonpregnant Women as Predisposing Factor to Pyelonephritis

Background. Infants born to mothers who are colonized with group B streptococcus (GBS) but received &#x3c;4 hours of intrapartum antibiotic prophylaxis (IAP) are at-risk for presenting later with sepsis. We assessed if &#x3c;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 &#x2265;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 (&#x3c; or &#x2265;4-hours duration) were determined. Results. More infants whose mothers received &#x3c;4 hours of IAP were diagnosed with clinical sepsis, 13 of 1,149 (1.1&#x25;) versus 15 of 3,633 (0.4&#x25;), <svg style="vertical-align:-0.1638pt;width:50.549999px;" id="M1" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z" /></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><path id="x3D" d="M535 323h-483v50h483v-50zM535 138h-483v50h483v-50z" /></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" /></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z" /></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><path id="x33" d="M285 378v-2q65 -13 102 -54.5t37 -97.5q0 -57 -30.5 -104.5t-74 -75t-85.5 -42t-72 -14.5q-31 0 -59.5 11t-40.5 23q-19 18 -16 36q1 16 23 33q13 10 24 0q58 -51 124 -51q55 0 88 40t33 112q0 64 -39 96.5t-88 32.5q-29 0 -64 -11l-6 29q77 25 118 57.5t41 84.5&#xA;q0 45 -26.5 69.5t-68.5 24.5q-67 0 -120 -79l-20 20l43 63q51 56 127 56h1q66 0 107 -37t41 -95q0 -42 -31 -71q-22 -23 -68 -54z" /></g>

		
	
</svg>. Multivariate logistic regression analysis showed that treatment with &#x2265;4 hours of IAP reduced the risk of infants being diagnosed with clinical sepsis by 65&#x25;, adjusted relative risk 0.35, CI 0.16&#x2013;0.79, and <svg style="vertical-align:-0.1638pt;width:50.549999px;" id="M2" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z" /></g>

		
	
</svg>. Conclusion. The rate of neonatal clinical sepsis is increased in newborns of GBS colonized mothers who receive &#x3c;4 hours compared to &#x2265;4 hours of IAP.

Mark A. Turrentine

Anthony J. Greisinger

Kimberly S. Brown


							Oscar A. Wehmanen

Melanie E. Mouzoon

Duration of Intrapartum Antibiotics for Group B Streptococcus on the Diagnosis of Clinical Neonatal Sepsis

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&#x25;) 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&#x2013;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&#x25; CI: 0.3&#x2013;1.1 and 1.8, 95&#x25; CI 0.9&#x2013;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

Taraz Samandari

Pregnancy Outcomes in HIV-Infected Women Receiving Long-Term Isoniazid Prophylaxis for Tuberculosis and Antiretroviral Therapy

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&#x25;). In-house culture provided a prevalence rate of 105/356 (29.5&#x25;). When the accelerated GBS test result was compared to the in-house GBS culture, it demonstrated a sensitivity of 97.1&#x25; and a specificity of 88.4&#x25;. Interobserver reliability for the novel GBS test was 88.2&#x25;. 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

Sebastian Faro

Accuracy of an Accelerated, Culture-Based Assay for Detection of Group B Streptococcus

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 &#x201c;appropriate&#x201d; antibiotic choice, which was determined using 2002 CDC guidelines, were analyzed. Results. Intrapartum antibiotic prophylaxis was administered in 97.8&#x25; (95&#x25; confidence interval [CI] 93.5&#x2013;99.5&#x25;) of patients, but it was considered appropriate in only 62.2&#x25; (95&#x25; CI&#x2009;53.8&#x2013;70.0&#x25;) of patients. Clindamycin was the most commonly used antibiotic, but 26.4&#x25; (95&#x25; CI&#x2009;16.3&#x2013;39.7&#x25;) 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&#x25; (95&#x25; CI&#x2009;56.2&#x2013;73.7&#x25;) 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

Harold C. Wiesenfeld

Guideline Adherence for Intrapartum Group B Streptococci Prophylaxis in Penicillin-Allergic Patients

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). <svg style="vertical-align:-0.23206pt;width:63.337502px;" id="M1" height="16.9375" version="1.1" viewBox="0 0 63.337502 16.9375" width="63.337502" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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			<g transform="matrix(.012,-0,0,-.012,43.788,8.425)"><path id="x2212" d="M535 230h-483v50h483v-50z" /></g><g transform="matrix(.012,-0,0,-.012,50.772,8.425)"><path id="x2F" d="M368 703l-264 -866h-60l265 866h59z" /></g><g transform="matrix(.012,-0,0,-.012,55.674,8.425)"><use xlink:href="#x2212"/></g>

		
	
</svg> 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 <svg style="vertical-align:-0.23206pt;width:63.337502px;" id="M2" height="16.9375" version="1.1" viewBox="0 0 63.337502 16.9375" width="63.337502" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,16.588)"><use xlink:href="#x1D436"/></g><g transform="matrix(.017,-0,0,-.017,12.047,16.588)"><use xlink:href="#x1D465"/></g><g transform="matrix(.017,-0,0,-.017,21.549,16.588)"><use xlink:href="#x1D450"/></g><g transform="matrix(.017,-0,0,-.017,28.45,16.588)"><use xlink:href="#x1D45F"/></g><g transform="matrix(.017,-0,0,-.017,35.624,16.588)"><use xlink:href="#x35"/></g>

			<g transform="matrix(.012,-0,0,-.012,43.788,8.425)"><use xlink:href="#x2212"/></g><g transform="matrix(.012,-0,0,-.012,50.772,8.425)"><use xlink:href="#x2F"/></g><g transform="matrix(.012,-0,0,-.012,55.674,8.425)"><use xlink:href="#x2212"/></g>

		
	
</svg> 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

Kathleen A. Kelly

CD8+CXCR5+ T Cells Regulate Pathology in the Genital Tract

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Infectious Diseases in Obstetrics and Gynecology publishes articles related to infectious diseases in women’s health. Topics include diagnosis and treatment of sexually transmitted diseases, urinary tract infections, and infections in pregnancy.

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Infectious Diseases in Obstetrics and Gynecology publishes articles related to infectious diseases in women’s health. Topics include diagnosis and treatment of sexually transmitted diseases, urinary tract infections, and infections in pregnancy.

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Infectious Diseases in Obstetrics and Gynecology

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