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PubMed2006

Human papillomavirus in the oral mucosa of women with genital human papillomavirus lesions.

OBJECTIVES: Human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases worldwide. We determined the frequency of HPV in the oral cavity of women with and without genital HPV lesions. MATERIAL AND METHODS: All patients were seen at the Department of Gynecology, Women's Health Center and the State University of Campinas, Sao Paulo, Brazil and submitted to a general physical and gynecological examination plus an evaluation of the oral cavity. Detailed histories investigated their sexual practices. HPV in the oral cavity was determined by polymerase chain reaction using consensus primers in 70 women presenting with histopathology-confirmed clinical HPV lesions in the genital region and 70 women negative by gynecological, colposcopic and cytological examination for clinical or subclinical HPV lesions. RESULTS: Oral HPV was detected in 29 (20.7%) of the subjects. Among the positive women, 26 (89.7%) were also positive for genital HPV as opposed to only 3 (2.7%) who were genital HPV-negative (p < 0.0001). The overall prevalence of HPV in the oral cavity of patients with and without genital HPV was 37.1 and 4.3%, respectively, (p < 0.0001). The presence of oral HPV was unrelated to the practice of fellatio (22% versus 19%). CONCLUSION: Patients with HPV genital infection have a greater frequency of HPV in their oral mucosa.

Adult↗
PubMed2006

Female genital malformations and their associated abnormalities.

OBJECTIVE: With an incidence of up to 5% in the general population, genital malformations are a frequent clinical occurrence. The aim of this study was to assess whether a connection could be demonstrated between various degrees of severity of genital malformations and associated abnormalities. DESIGN: All patients were classified using the Vagina, Cervix, Uterus, Adnex, and Associated Malformation (VCUAM) classification. SETTING: University hospital. PATIENT(S): Two hundred eleven premenopausal patients with female genital malformations. INTERVENTION(S): The patients underwent diagnostic workup for genital malformations using laparoscopy as well as hysteroscopy. Associated malformations were detected by either magnetic resonance imaging (MRI) or ultrasound. MAIN OUTCOME MEASURE(S): Demonstration of a connection between various degrees of severity of genital malformations and associated abnormalities. RESULT(S): In 72 cases (36%) out of 202 patients with uterine malformations (VCUAM U1-4) we found associated abnormalities. The predominant findings were alterations in the renal system. When vaginal abnormality (VCUAM V1-5) alone was taken into consideration, an associated developmental disturbance in the renal tract was found in 30% of cases (n = 32 from 107). CONCLUSION(S): A close connection was demonstrated between genital malformations and associated abnormalities. For this reason, the diagnostic workup in patients with malformations should always include the renal system. Depending on the severity of the clinical picture, examinations may need to be extended further.

Abnormalities, Multiple↗
PubMed2006

Migration of mouse antibody-secreting hybridoma cells from blood to genital tract and its regulation by sex hormones are associated with the differential expression patterns of adhesion molecules and chemokines in the tract rather than in the antibody-secreting cells.

To understand better the molecular mechanisms of differential migration of antibody-secreting cells (ASCs) into mouse genital tracts, and regulation by sex hormones, surface markers, hormone receptors and adhesion molecules in mouse SG2 and PA4 hybridoma cells, respectively, secreting IgG2b and polymeric IgA antibody were detected by flow cytometry or RT-PCR. Semi-quantitative RT-PCR was also used for measuring mRNA expression of adhesion molecules and chemokines (VCAM-1, ICAM-1, P-selectin, JAM-1 and CXCL12) in genital tracts of various adult mouse groups. The mRNAs of androgen receptor, estrogen receptor beta and CXCR4 were expressed in the ASCs. Sex hormones had no effect on expression of these molecules in ASCs. Except for VCAM-1, mRNA of all examined genes was expressed in normal mouse genital tracts. The mean of relative amounts of ICAM-1 and CXCL12 mRNA in all examined organs of females were higher (2.1- and 1.9-fold) than those in males. After orchiectomy or ovariectomy, the expression of ICAM-1, CXCL12 and P-selectin mRNA in the examined organs increased, except JAM-1 in male and CXCL12 in female. Sex hormone treatment recovered the changes to normal levels of mRNA expression in many examined genital tissues. In combination with our previous work, preferential migration of ASCs into female genital tract and regulation of migration by sex hormones are associated with expression patterns of adhesion molecules and chemokines in genital tract rather than in ASCs.

Animals↗
PubMedDate not supplied

Ano-genital herpes in children.

Many American children and families are affected by child sexual abuse. The diagnosis of sexual abuse is typically made on the basis of the child's history. Objective evidence of sexual abuse, including abnormal physical findings noted on physical examination or the presence of a sexually transmitted disease, are rare. Ano-genital herpes is one of the most common sexually transmitted diseases found in adults. However, is the presence of ano-genital herpes in children evidence of sexual abuse? The link between ano-genital herpes and sexual abuse requires an understanding of viral transmission and typing to properly interpret its significance. Ano-genital herpes in children creates serious medical, social, and legal implications. It is important that primary care providers have an understanding of the appearance, mode of transmission, and diagnostic technique of ano-genital herpes. Implications for practice will provide guidelines for diagnosing, evaluating, and properly managing ano-genital herpes in children.

Adolescent↗
PubMed2005

Genital trauma in children: classification and management.

OBJECTIVES: To determine the severity and, accordingly, the treatment of genital trauma in a pediatric population. METHODS: A total of 116 children with genital trauma and anorectal injury were retrospectively reviewed. The severity of trauma was graded according to the genital injury score (GIS), which we developed as a genital trauma scoring system. RESULTS: The median age was 8 years. Of the 116 children, 80 were girls and 36 were boys. The etiology of the trauma was traffic road accident (53 patients), fall, sexual abuse, and gunshot wound. Sixty-one patients had additional organ injuries. The GIS was I for 25 children, II for 19, III for 32, IV for 23, and V for 17. In addition to the primary repair, colostomy was performed in 22 patients. The most frequent postoperative complication was wound infection. The postoperative complication rate was significantly greater in patients with an injury severity score greater than 15, severe contamination, prolonged delay (longer than 8 hours), and a GIS of IV or V. CONCLUSIONS: The clarification of the mechanism and severity of the genital injury and associated organ injuries under general anesthesia may help in the appropriate classification. Primary repair should be the standard approach in genital trauma patients with a GIS of IV or less. Those with a GIS of V associated with severe contamination and prolonged delay require colostomy for improved outcome.

Adolescent↗
PubMed1997

Bacterial vaginosis as a risk factor for upper genital tract infection.

OBJECTIVE: The objective of this study was to determine whether the clinical diagnosis of bacterial vaginosis is associated with objective evidence of acute upper genital tract infection. STUDY DESIGN: Women who either met the Centers for Disease Control and Prevention's minimal criteria for acute pelvic inflammatory disease or had other "nonclassic" signs of upper genital tract infection (i.e., atypical pelvic pain, abnormal uterine bleeding, or cervicitis) were evaluated with either an endometrial biopsy or a laparoscopy with endometrial and fimbrial biopsies for objective evidence of upper genital tract infection. Bacterial vaginosis was considered present if three of the four following criteria were found: (1) homogeneous gray-white vaginal discharge, (2) vaginal pH > 4.5, (3) positive "whiff" test result, and (4) the presence of > 20% of epithelial cells classified as clue cells. Patients were considered to have upper genital tract infection if they had histologic, microbiologic, or laparoscopic evidence of upper tract infection. RESULTS: One hundred sixteen women were evaluated between August 1993 and March 1997 with complete evaluations. Objective evidence of upper tract infection was present in 56% (14/25) of women with the clinical diagnosis of bacterial vaginosis compared with 30% of women (27/91) who did not meet the clinical criteria (p = 0.015). Using logistic regression to control for confounding variables, we found that the presence of bacterial vaginosis was associated with a threefold increased risk of upper genital tract infection (adjusted odds ratio = 3.0, 95% confidence interval 1.2 to 7.6). CONCLUSIONS: Bacterial vaginosis is associated with an increased risk of objective evidence of acute upper genital tract infection. Future prospective studies are needed to determine whether treatment of bacterial vaginosis can reduce the risk of ascending infection.

Adult↗
PubMed1997

Lymphocyte shedding from genital tract of human immunodeficiency virus-infected women: immunophenotypic and clinical correlates.

OBJECTIVE: Our purpose was to describe the lymphocyte subpopulations in genital tract samples from human immunodeficiency virus-infected women and the clinical correlates associated with lymphocyte shedding. STUDY DESIGN: Genital tract samples of women infected with human immunodeficiency virus-1 were processed for immunophenotyping analysis with a FACScan flow cytometer. Immunologic and virologic characteristics of women with and without lymphocyte shedding were compared with t test, Wilcoxon rank test, or Fisher's exact test. RESULTS: The rate of genital lymphocyte shedding among human immunodeficiency virus-1-infected women was 39%. Genital shedding was not related to age, race, use of antiretroviral therapy, or positive human immunodeficiency virus-1 culture. A negative rank correlation (r = -0.71, p = 0.047) between CD3+ CD4+ counts in peripheral blood and genital tract was observed. The majority of the lymphocyte cells were CD3+ CD8+, and > 80% of the CD3+ CD4+ cells were memory cells. CONCLUSION: The immune profile of the genital tract lymphocytes is suggestive of a local mucosal immune response.

Adult↗
PubMed1996

Physiological parameters associated with the performance of a distracting task and genital self-stimulation in women with complete spinal cord injuries.

OBJECTIVE: To compare the physiological sexual responses of women with complete spinal cord injuries (SCI) with those of able-bodied women. DESIGN: Controlled laboratory-based analysis of responses to a distracting task coupled with manual genital stimulation versus masturbation. SETTING: The sexual physiology laboratory at our free-standing rehabilitation hospital. PARTICIPANTS: A volunteer sample of 10 women with complete SCI along with 10 able-bodied women, matched for age and educational status. INTERVENTIONS: A 78-minute protocol using 6-minute baselines alternating with 12-minute testing conditions. DEPENDENT-VARIABLES: Vaginal pulse amplitude, subjective arousal, heart rate, respiratory rate, and blood pressure. RESULTS: Subjective sexual arousal increased in able-bodied women with manual genital stimulation in conjunction with performance of a distracting task and was further augmented by removal of the distracting task and continuing with masturbation. In contrast, complete SCI subjects did not demonstrate increased subjective arousal with performance of the distracting task in conjunction with manual genital stimulation; however, they did evidence significant increases in arousal when the distracting task was eliminated. CONCLUSIONS: Genital responses tended to parallel subjective responses in able-bodied women; however, women with SCI revealed nonsignificant changes in genital responses throughout the treatment protocol. It is hypothesized that the genital and subjective responses of able-bodied subjects reflect the additive components of reflex and then psychogenic sexual arousal. Furthermore, the lack of responsivity in the SCI subjects was thought to be related to compromised upper extremity function in the majority of our subjects. Further work is necessary to validate these hypotheses.

Adult↗
PubMed1997

Genital herpes during pregnancy: inability to distinguish primary and recurrent infections clinically.

OBJECTIVE: To determine if the signs and symptoms of genital herpes in pregnancy accurately identify primary genital herpes infections using serologic testing for final classification. METHODS: Twenty-three women with clinical signs and symptoms suggestive of primary genital herpes infections in the second and third trimesters of pregnancy were subsequently cultured and tested serologically (for herpes simplex virus type 1 and herpes simplex virus type 2 antibodies) and classified as having true primary (no herpes simplex virus type 1 or type 2 antibodies), nonprimary (heterologous herpes simplex virus antibodies present), or recurrent (homologous antibodies present) infections. RESULTS: Only one of 23 women with clinical illnesses consistent with primary genital herpes virus simplex infections had serologically-verified primary infection. This primary infection was caused by herpes simplex virus type 1. Three women had nonprimary type 2 infections, and 19 women had recurrent infections. Among culture-proven recurrent infections, 12 were caused by herpes simplex virus type 2 and three by herpes simplex virus type 1. Only one infant was born preterm, and no clinically significant perinatal morbidity was observed. CONCLUSION: Correct classification of gestational genital herpes infections can be accomplished only when clinical evaluation is correlated with viral isolation and serologic testing using a type-specific assay. Severe first episodes of genital herpes infections among women in the second and third trimesters of pregnancy are not usually primary infections and are not commonly associated with perinatal morbidity.

Adolescent↗
PubMed2000

(A)symptomatic necrotizing arteritis of the female genital tract.

AIMS: The vasculitides represent a heterogenous set of disorders that differ in prognosis and response to therapy. Beside systemic vasculitides, the development of localized forms of arteritis is well known though uncommon and the etiopathogenesis is not yet definitely clear. METHODS: Patients with necrotizing arteritis of the female genital tract proven by histology are studied in a retrospective analysis. RESULTS: Three cases of necrotizing arteritis with histological features of panarteritis nodosa apparently confined to the female genital tract are presented. None of these patients had prior history of systemic vasculitis. The acute necrotizing vasculitis was confined only to the uterine cervix in two patients and involved all the internal genital organs in the third patient. The patients have been observed for up to 4 years without any therapy for these lesions and without any manifestation of systemic vasculitic progression. CONCLUSION: It is to speculate that focal arteritis of the female genital tract is a benign form of panarteritis nodosa or moreover a totally different entity with identical morphogenesis but possibly different pathogenesis. Furthermore it seems to be important to be aware of the specificity of focal arteritis in female genital tract as distinct from the generalized form to prevent unnecessary surgical or chemotherapeutical therapy for this lesion. The benign entity of local arteritis in the female genital tract is discussed in contrast to the severe prognosis of systemic panarteritis nodosa.

Aged↗
PubMed2000

Signs of genital trauma in adolescent rape victims examined acutely

Background: Adolescent females are the most frequent victims of sexual assault, but studies to document the presence of genital findings in patients examined within 72 hours, using magnification and dye, have not been published. This study was designed to document the frequency and types of genital injuries in adolescent women following acute sexual assault, using chart and photograph review.Methods: A retrospective chart review was done of examination records of all female patients age 14 to 19 years of age who were evaluated at a Sexual Assault Response Team program over a 5 year period. Data was abstracted from charts by the nurse examiners, and photographs were evaluated by the physician reviewer. Analysis was done to determine the frequency, location, and severity of genital and anal injuries, and any historical factors correlating with injury, using Pearson correlation and two-tailed t tests.Results: Charts of 214 female subjects (mean age 16.3 years) were reviewed. The most common findings recorded by the nurse examiner were posterior fourchette tear (36%), erythema of the labia minora, hymen, cervix or posterior fourchette (18% to 32%), and swelling of the hymen (19%). Uptake of Toluidine dye was noted in 66% of patients in whom it was applied. Overall, 21% of patients were found to have no findings, and 40% had tears of the posterior fourchette or fossa. Time to examination was highly correlated with the degree of injury noted (p =.000). The incidence of hymenal tears in self-described virgins was higher than in non-virgins (19% vs. 3%, p =.008), however the total number or severity of other injuries was not significantly higher in virgins. Reported anal penetration was associated with a high frequency of anal bruising, abrasions or tears (14/23, 61%), while only 2/150 victims who denied anal penetration had tears (1%, p =.000). Victims who reported multiple physical symptoms such as pain, nausea, or vomiting were significantly more likely to be older (p =.034) and to have an increased number of non-genital injuries such as bruising, abrasions, and bite marks (p =.001). A higher number of non-genital injuries was also correlated with a higher number of total genital injuries (p =.003).Conclusions: Adolescent victims of sexual assault who were examined within 72 hours, using a magnification and dye were found to have tears of the posterior fourchette or fossa in 40% of cases. Hymenal tears were rare, even in self-described virginal girls. Timely examination of adolescent victims is important to document injuries, however, many victims will still have non-specific examination findings.

Journal Article↗
PubMed2000

Labial adhesion as a complication of primary genital herpes in young women

Background: Genital herpes is a common sexually transmitted disease in adolescents. It may be associated with significant morbidity if not diagnosed on time or not properly treated. The objective of this study was to determine the incidence of labial adhesion secondary to primary herpes in young women and the possible predisposing factors for this complication.Methods: Analysis of the clinical data regarding primary genital herpes in young women in the adolescent clinic at a university hospital in outpatient clinic setting. Cases of primary genital herpes seen between December 1(st) 1998 and November 30(th) 1999 were included.Results: A total of 34 female adolescents with age range 12-19 years were diagnosed with primary genital herpes during this time period. 7 patients (20.6%) were found to have severe labial adhesion at time of diagnosis. All 7 patients were seen by other providers prior to their visit to the adolescent clinic and 4 were correctly diagnosed. All 7 patients were given antiviral therapy, but none was given local treatment. At time of diagnosis all 7 patients had anuria for more than 24 hours and severe pain and discomfort. 3 patients had Diabetes Mellitus (one of these was also pregnant) and one patient had asthma. The age range for these 7 patients was 13-17. Treatment with local anesthetics helped resolve the adhesion in 5 patients and surgical treatment was needed in the remaining two patients.Conclusion: Labial adhesion is a common, severe complication of primary genital herpes in young women. Very young age, chronic medical conditions, incorrect diagnosis and lack of topical treatment may predispose to the development of this complication. Use of topical therapy should be an integral part of the comprehensive treatment for primary genital herpes in female adolescents to alleviate discomfort and prevent urinary retention and labial adhesion.

Journal Article↗
PubMed2001

The sex determination gene doublesex regulates the A/P organizer to direct sex-specific patterns of growth in the Drosophila genital imaginal disc.

Each Drosophila genital imaginal disc contains primordia for both male and female genitalia and analia. The sexually dimorphic development of this disc is governed by the sex-specific expression of doublesex (dsx). We present data that substantially revises our understanding of how dsx controls growth and differentiation in the genital disc. The classical view of genital disc development is that in each sex, dsx autonomously "represses" the development of the inappropriate genital primordium while allowing the development of the appropriate primordium. Instead, we show that dsx regulates the A/P organizer to control growth of each genital primordium, and then directs each genital primordium to differentiate defined adult structures in both sexes.

Animals↗
PubMed1991

Children's memories of a physical examination involving genital touch: implications for reports of child sexual abuse.

Evaluation of child sexual abuse often necessitates interviewing children about genital touch, yet little scientific research exists on how best to obtain children's reports of genital contact. To examine this issue, 72 five- and seven-year-old girls experienced a standardized medical checkup. For half of the children, the checkup included a vaginal and anal examination (genital condition); for the other half, the checkup included a scoliosis examination instead (nongenital condition). The children's memories were later solicited through free recall, anatomically detailed doll demonstration, and direct and misleading questions. The majority of children in the genital condition revealed vaginal and anal contact only when asked directly about it. Children in the nongenital condition never falsely reported genital touch in free recall or doll demonstration; when asked directly, the false report rate was low. Significant age differences in free recall and doll demonstration, found only in the nongenital condition, implicated socioemotional factors as suppressing the reports of older children who experienced genital contact.

Child↗
PubMedDate not supplied

Gender differences for the predictors of depression in young adults with genital herpes.

Genital herpes is a chronic, stigmatizing, sexually transmitted disease (STD), which is increasing despite efforts to control its spread. Depression is commonly reported among people diagnosed with genital herpes and differences in depression by gender have been reported. Therefore, the purpose of this study was to identify gender differences in the predictors of depression in young adults with genital herpes by secondary analyses of baseline data from a randomized clinical trial (RCT). For the RCT, young adults (193 females, 59 males) with genital herpes were recruited from newspaper advertisements. Participants completed questionnaires measuring illness burden, attitudes toward herpes, stress symptoms, mood states, depression, self-concealment, self-disclosure, substance use, and demographics. Univariate analyses and multiple regression techniques were used to identify variables predictive of depression in this sample. In women, increased anger, decreased vigor, increased confusion, a negative attitude toward herpes, self-concealment, and stress symptoms from genital herpes predicted more depression (R2 = 0.63). In men, increased depression was predicted by increased anger, a negative attitude toward herpes, and a decreased willingness to share personal information with a stranger (R2 = 0.51). Findings suggest that future psychoeducational interventions should address anger as a predictor of depression in this population. Gender-specific interventions need to be developed in order to assist young adults who are living with genital herpes.

Adaptation, Psychological↗
PubMed1997

[Genital self-injury behavior--phenomenologic and differential diagnosis considerations from the psychiatric viewpoint].

There is only a small number of publications concerning psychiatric aspects of genital-self-mutilation, all of these are case reports. This presentation adds results of self-inflicted genital injuries in another seven males which are discussed in relation to relevant scientific literature focussing on psychopathology and dynamic considerations. It is argued that genital self-mutilations should primarily be considered as symptomatic behavioural patterns and that-beside quasi-normal psychological procedures as part of certain religious or cultural rituals-such acts can be interpreted as a common final pathway of a variety of psychopathological problems. The inclusion of sexually (co-)motivated genital-automutilations in a complete work up and analysis of this topic seems to be reasonable and is advocated by the authors. The assumption that genital self-injuries are more often seen in non-psychotic conditions than in productive psychotic states is substantiated. Finally, the relation between genital automutilations and self-harm in general is discussed and some recommendations on the management are listed.

Adult↗
PubMed1999

Quality of life and use of health care among people with genital herpes in France.

In order to assess psychological morbidity in France related to genital herpes infection, we carried out a transversal study comparing infected patients with a control group. A total of 236 patients with genital herpes were first identified by means of a postal survey, then matched against a witness group of 236 noninfected persons. Detailed questionnaires were sent out to each person in the 2 groups. A total of 150 herpes patients and 200 non-infected persons answered the questionnaire, which enabled us to measure the incidence of the disease by means of 2 indicators: a herpes-specific scale and the SF-36 quality of life questionnaire. Emotional trauma due to genital herpes was reported amongst 23% of the participants. Of the participants, 57% indicated that herpes interfered with their sexual relationships; 50% felt it difficult to live with genital herpes; and 37% felt that herpes ruins their lives. An analysis assessing health-related quality of life indicated significant differences between the scores of the 2 groups and showed that quality of life is lower amongst herpes patients. Respondents with genital herpes required more frequent consultations with GPs (81% vs. 73%), and significantly more frequent consultations with specialists (59% vs. 45%). Our study confirms that substantial psychological morbidity exists in patients with genital herpes.

Adolescent↗
PubMed2003

Independent levels of cell-free and cell-associated human immunodeficiency virus-1 in genital-tract secretions of clinically asymptomatic, treatment-naive African women.

Using ultrasensitive polymerase chain reaction-based techniques, we assessed levels of cell-free and cell-associated human immunodeficiency virus (HIV)-1 in paired blood and genital samples of 30 clinically asymptomatic, treatment-naive women. Levels of HIV-1 RNA in cervicovaginal-lavage samples were positively correlated with those in plasma samples (r=.50; P=.008), whereas levels of HIV-1 DNA in genital samples were loosely correlated with those in blood samples (r=.31; P=.041). In plasma of peripheral blood, levels of HIV-1 DNA were positively correlated with those of HIV-1 RNA (r=.64; P<.001), whereas no correlation between HIV-1 DNA and HIV-1 RNA was evident in genital secretions. Our results indicate that levels of HIV-1 RNA and HIV-1 DNA are unrelated in the genital tracts of treatment-naive women and suggest that the level of genital HIV-1 RNA is influenced by systemic viral replication-in contrast to genital HIV-1 provirus, which may be influenced as well by local cofactors triggering the migration of HIV-infected cells originating from the cervicovaginal submucosa. These features may be relevant for an understanding of HIV-1 transmission in heterosexual individuals.

Adolescent↗