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[Malignant neoplasms of the breast and female genital organs and carcinoma in situ of the uterine cervix in East Germany 1986. Statistical data of the national cancer register].

29,105 cases of cancer in the female population of the GDR have been registered 1986. The five most frequent localizations (breast, colon, uterine cervix, stomach, uterine corpus) had 15,130 cases (53.1%). The number of breast cancers continuously increased, whereas since the seventies a decrease of female genital cancers could be observed. 44 per cent of all cancers in the female had to be correlated to breast and genital organs. 96 per cent of cancers of breast and genital organs were histologically proved. More than 67 per cent of tumors of this group could be allotted to stage I or II. Cancers of breast and female genital organs participated with 5,883 deaths e.g. 33.2% of all female cancer deaths in the GDR 1986.

Breast Neoplasms↗

Histologic manifestations of perinatal genital mycoplasmal infection.

Genital mycoplasmas are controversial gynecologic and obstetric pathogens; their role in perinatal morbidity and mortality is ill defined. This retrospective study was conducted to identify autopsy manifestations of perinatal genital mycoplasmal infection. Bacterial and mycoplasmal cultures were obtained from multiple organ sites, along with detailed clinical, autopsy, and histologic information. All materials were screened by two pathologists. Twenty-nine cases were included in the study. In 17 only a genital mycoplasma was isolated, and in 12 cases a genital mycoplasma plus another bacterial pathogen were identified. Significant histologic findings included subpericardial and pleural hemorrhages, polymorphonuclear leukocytes in alveolar spaces, hemorrhage, and tubulocytic changes in the adrenal glands. The placentas revealed villous edema, deciduitis, and funicitis. The changes identified as significant suggest that mycoplasmas either cause hypoxia or promote histologic changes that mimick hypoxia.

Autopsy↗

Causes and treatment of sexually acquired genital ulceration in southern Africa.

The cause of sexually acquired genital ulceration was studied in 240 consecutive migrant mineworkers attending a sexually transmitted disease clinic in Carletonville, Transvaal. Chancroid proved to be the most common cause of genital ulcer disease, with Haemophilus ducreyi being isolated from 164 patients (68%). In 60% of cases the disease was locally acquired and in the remaining 40%, the infection was acquired in Lesotho, Botswana, Natal, Transkei and Malawi. Syphilis was diagnosed in 62 patients (26%), lymphogranuloma venereum in 16 (7%), genital herpes in 8 (3%) and granuloma inguinale in 1. No cause of ulceration could be found in 31 patients (13%). Mixed infections were documented in 41 patients (17%). Diagnosis of the cause of genital ulcer disease is not possible without relatively sophisticated laboratory support; however, simplified strategies for management and treatment have been developed.

Adult↗

Human papillomavirus and lower genital neoplasia in renal transplant patients.

Lower genital cytopathology was evaluated in 105 immunosuppressed renal transplant recipients. Evidence of human papillomavirus infection was found in 17.5% and of lower genital neoplasia in 9.5%. The rate of the virus infection in the immunosuppressed was nine times greater than in a general population and 17 times greater than in a matched immunocompetent population. The rate of cervical neoplasia was 16 times greater than in a general population and nine times greater than in a matched immunocompetent population. In one-third of patients with human papillomavirus lesions and one-half of patients with neoplastic lesions, multiple lower genital sites were also involved. Of risk factors evaluated, only the number of sexual partners was associated with the development of human papillomavirus/lower genital neoplasia.

Adult↗

Antibodies to papillomavirus genus-antigens in women with genital warts.

Thirty-three sera from women symptom-free for papillomatous disease and 27 sera from women with flat or exophytic genital warts were examined for the presence of IgG and IgM antibodies to papillomavirus (PV) genus-antigens. For this purpose, sera were challenged with genus-antigens extracted from both human and bovine purified virions of PVs, in a micro solid-phase enzyme-linked immunosorbent assay (ELISA). The assay performed with PV genus-antigens of human origin showed that in women with genital warts, IgG antibodies were present in a percentage of 70.37% and IgM antibodies in a percentage of 40.74%; in apparently uninfected women, IgG and IgM antibodies were present in a percentage of 54.54% and 24.24% respectively. When sera were challenged with PV genus-antigens of bovine origin for IgG antibody class, positivity was 70.37% in women with genital disease and 45.45% in symptom-free women. IgG and IgM antibody response in women with and without papillomatous genital lesions is discussed.

Adolescent↗

Coccidioidomycosis of the female genital tract.

Female genital tract involvement is a rare manifestation of disseminated coccidioidomycosis; to our knowledge, only ten patients have previously been described in the English literature. We describe a patient who seems to be unique in that she developed female genital tract coccidioidomycosis and coccidioidal peritonitis after chemotherapy for Hodgkin's disease. Coccidioidomycosis of the female genital tract is usually manifest as granulomatous endometritis and/or granulomatous tubo-ovarian disease with peritonitis. The diagnosis of coccidioidomycosis was unsuspected clinically in all 11 reported cases (including our patient); initial diagnosis was made by biopsy or culture in all 11 patients. In eight of the reported cases of female genital tract coccidioidomycosis (including our patient), clinical improvement occurred after treatment with surgery or antifungal chemotherapy; three patients died of disseminated coccidioidomycosis.

Adult↗

[Genital tuberculosis in African female patients (author's transl)].

Genital tuberculosis in 76 Senegalese women and 82 Nigerian women, have been compiled from statistical tables covering a period of 10 years. The authors present the features of genital tuberculosis in african females. In most cases, diagnosis is made through peroperative findings or anatomo-pathological control of exeresis specimens; still, biopsy of endometrium, systematically performed on each patient consulting for sterility, gave opportunity to detect an important number of cases of genital tuberculosis in Nigeria. The frequency of this disease is low among other unspecific genital infections. Its medical treatment is effective on tuberculous infection but not on sterility which is an unavoidable sequella.

Adolescent↗

Management of genital herpes simplex virus infection during pregnancy.

The clinical course and outcome of 58 pregnancies in 57 women with culture-verified genital herpes simplex virus (HSV) infection during gestation are reported. In 19 cases (33%) an active genital HSV infection was present within 1 week of delivery. Of the 60 infants delivered, 58 survived. No maternal or perinatal morbidity or mortality was attributable to HSV. This experience suggests that weekly culturing of the cervix and all other previously infected genital sites from the 36th week of gestation until delivery is an acceptable plan for managing such pregnancies. Women without evidence of infection at the onset of labor can be allowed to deliver vaginally. With appropriate precautions, breast-feeding by mothers with genital HSV infections is not contraindicated.

Breast Feeding↗

Female genital tuberculosis: report of seven cases.

Seven cases of histologically proven genital tuberculosis (TB) encountered at the National Taiwan University Hospital in the past 16 years were reviewed. From a total of 54,576 gynecologic specimens submitted for pathologic examination, the occurrence of genital TB was 0.01%. Of these seven patients, one suffered from primary infertility and one from secondary infertility. The patient with primary infertility had been married for 29 years. The patient with secondary infertility underwent a tuboplasty due to bilateral hydrosalpinx. Genital TB was not diagnosed preoperatively in any of the seven cases. The preoperative diagnoses included: postmenopausal spotting, ovarian malignancy, cervicitis, ectopic pregnancy and hydrosalpinx with secondary infertility. This review suggests that genital TB is becoming rare in Taiwan. It is difficult to diagnose from clinical symptoms and is usually discovered on pathologic examination.

Adult↗

Induction of immunoresponse by subclinical male genital tract infection?

OBJECTIVE: To determine the relationship of subclinical infection or inflammation of the male genital tract, as evaluated with seminal markers, with local antisperm antibodies as potential parameter of immunoresponse. PATIENTS: One hundred ninety-one randomly chosen males of subfertile couples who were asymptomatic in terms of genital tract infection. SETTING: Outpatient Infertility Clinic of the University of Heidelberg, Germany. MAIN OUTCOME MEASURES: Determination of leukocytes rates in semen using an immunocytochemical method for differentiation of round cells and measurement of polymorphonuclear (PMN) granulocyte elastase concentration in seminal plasma in addition to semen cultures as screening for subclinical infection of the male genital tract. Determination of local antisperm antibodies (Ab) with the mixed antiglobulin reaction ([MAR] immunoglobulin [Ig] G and IgA) in aliquots of the same ejaculates. RESULTS: Leukocyte rates of the round cells ranged from 0% to 93%, leukocytospermia was found in 6.8%. This was not related significantly to the presence of local antisperm antibodies of the IgG or IgA class. There was also no significant association of antisperm Ab with the concentration of PMN granulocyte elastase in seminal plasma and the outcome of semen cultures. CONCLUSIONS: The results of this prospective study suggest that when the rate or number of leukocytes or the concentration of PMN elastase in semen are taken as markers for subclinical infection or inflammation of the male genital tract, this is not associated significantly with the production of local antisperm Ab of the IgG or IgA class as indicator of immunoreaction.

Adult↗

Hormonal therapy and genital tract cancer.

The use of hormonal replacement therapy following genital tract cancer is often denied to women because of the fear of increasing the risk of recurrence or new growth. The paucity of articles written on this subject during the past decade is an indication of the attitude of the medical profession to the needs of women suffering from symptoms of sex hormone deficiency. During 1994-1995 there were few articles published on the use of hormonal therapy to treat menopausal symptoms following genital tract cancer. Several articles, however, reviewed the relationship between hormones and genital tract cancer, some explored the value of antioestrogens in controlling recurrent or secondary disease, and a few others discussed the risk of developing uterine cancer when tamoxifen was used to manage postmenopausal breast cancer. Some suggestions are made that will allow women suffering from symptoms of hormone deficiency to receive alternative regimens of hormonal therapy. Maintaining quality of life without reducing the potential length of life is paramount in reaching a decision on the use of hormonal therapy following genital tract cancer.

Contraindications↗

DNA analysis indicates patient-specific human papillomavirus type 16 strains in Bowen's disease on fingers and in archival samples from genital dysplasia.

Human papillomavirus (HPV) type 16 is casually involved in the pathogenesis of anogenital cancer and has also been demonstrated in some patients with Bowen's disease (BD) on the fingers. From two women with HPV 16 in BD on the fingers, and in archival samples from genital dysplasia, collected as long as 26 years ago, the non-coding region of the virus was amplified by the polymerase chain reaction and sequenced. The HPV 16 DNA sequences found in the finger lesions and in the genital archival samples showed no diversities within single patients. Compared with an HPV 16R reference sequence, one patient showed a unique T nucleotide at position 78, whereas the other patient exhibited T and A nucleotides at positions 7193 and 7521, respectively. In one of the patients, the same strain of HPV 16 was found in a digital tumour 26 years after its clearance from the genital tract. DNA sequence analysis indicated patient-specific HPV 16 strains. Auto-inoculation from the genital tract was favoured as a plausible explanation of why HPV 16 caused BD on the fingers.

Adult↗

[The national program for the early detection and treatment of premalignant and malignant diseases of the lower genital system in women].

Lower genital tract malignancies are often seen in our female population; their detection is often delayed and treatment fails frequently. Latest scientific data on their etiology and newer methods of their detection and treatment in the early stages opens roads in the field of primary and secondary prevention and for the effective therapy, as well. In order to improve current status of the women's health in this field, on October 10, 1995 year, the Section for cervical pathology and colposcopy in addition to Yugoslav Association of Gynecologists and Obstetricians (UGOJ), has been established. One of the most important aims of the Section is introduction of premalignant and malignant diseases of female lower genital tract. So far, the Section has: 1. Submitted the Program proposal to the Ministry of Health of Serbia; on the basis of that proposal, on April 10, 1996 year, the Ministry issued: "Expert instruction for the conduction of assignments aimed at early detection of the cancer of the uterine cervix". In that act obligatory for all health institutions, that have gynecology depts, all activities and goals for National Program introduction are prescribed. 2. The Yugoslav School for pathology of the cervix, vagina, vulva and colposcopy, opened in 1996, year, under the patronage of the Ministry of Health of the Republic Serbia provides the theoretical and practical training for the Program carriers and medical doctors receiving their training in gynecology and obstetrics. The first generation, the School attendees consisted of 149 doctors from the entire country. 3. Creation and submission of a draft common Health Form intended for the computerized and professional use, to provide for more efficient introduction of the National Program. The Form, should be introduced by the Health Ministry as an Official Health Document, to be used by all OBG institutions. 4. Submitted proposal of the activities and tasks in the field of Program realisation according to Health institutions' profiles. 5. Creation of the draft Protocol for actual activities and procedures in order to provide for an early detection and treatment of premalignant and malignant diseases of the female lower genital tract. Having the future mandatory character of this Protocol, the Section will divulge it to the professional audience. 6. Created a project of the National program and submitted it at the beginning of 1996 year, to the Republic Bureau of Health protection, with a request for its financial support in that program. In addition to the activities mentioned, the section management undertook and is taking measures for faster achievement of the aim-of the National Program introduction. Official Health institutions are assigned responsibilities of the Program introduction, the funding and a resolve all the legal, organisational and financial issues. Results that we are expected from this Program include introduction of the primary and secondary measures aimed at disease prevention; early detection of the diseases and its treatment; reduction of the numbers of cases in the advanced stages; significant improvement of gynecological status, and reduction of costs of the treatment of advanced stages of disease. The results should stimulate all, and become must for all subjects involved in the National Program realisation. The Program introduction into the daily OBG practice is a prerequisite of already well established practice in a number of countries, saving life and limb of most women affected by the lower genital tract malignancies.

Female↗

[Rokitamycin in the treatment of female genital Chlamydia and Mycoplasma infections. Comparative study vs josamycin ].

BACKGROUND: The macrolides are among the most effective antibiotics against infections due to Chlamydia and Mycoplasma. The drug in such cases must have marked antibacterial activity, good oral bioavailability, and high intracellular diffusion--indispensable for instance with Chlamydia infection. Rokitamycin, a macrolide with a 16-atom lactone ring, has the features for use in the treatment of genital infections caused by Chlamydia or Mycoplasma, penetrating the cell and reaching considerably higher concentrations than other drugs of the same class. The aim of this trial was to gain further knowledge of rokitamycin in genital infections, including cases infected with Mycoplasma hominis, comparing the efficacy and safety of this drug with josamycin, another macrolide widely employed in clinical practice. METHODS: Patients of either sex, over the age of 18 years, with infections due to Chlamydia trachomatis and Mycoplasma hominis, were admitted. The trial was conducted in accordance with the Declaration of Helsinki and amendments. Fifteen patients were given rokitamycin, one 400 mg tablet every 12 h, and another fifteen received josamycin, one 500 mg tablet every 8 h, for 14 days. Before starting treatment, after the 14 days and after 42 days' follow-up the severity of the following symptoms was assessed: pruritus, burning, erythema, pollakiuria, dysuria, using a four-point rating scale (0 = absent, 1 = mild, 2 = moderate, 3 = strong). The presence or absence of leukorrhea was noted. Patients entered the severity of subjective symptoms daily in a diary. At the end of the trial overall assessments were made on the clinical response, microbiological outcome and efficacy. RESULTS: Thirty patients of both sexes were admitted, age 21-43 years, with genital infections due to Chlamydia trachomatis and/or Mycoplasma hominis. Fifteen were given rokitamycin, 800 mg/day, and 15 josamycin, 1500 mg/day, for 14 days. In 13 cases in each group an antibiotic was prescribed for the partner too. At the start of the trial microbiological samples were taken; in 13 cases a urethral swab was taken (six in the josamycin and seven in the rokitamycin group), and 17 cervical swabs were taken (respectively nine and eight). At the end of the trial 93% of patients gave a negative microbiological result. Mycoplasma hominis was isolated from one patient treated with rokitamycin, and Chlamydia trachomatis from one patient given josamycin. Symptoms improved at a similar rate in both groups, with no significant differences between the drugs. Safety was excellent in both groups, with no complaints of adverse reactions. CONCLUSIONS: This trial demonstrates the excellent activity of macrolide antibiotics against genital infections due to Mycoplasma hominis and Chlamydia trachomatis. Rokitamycin and josamycin both gave good or excellent clinical and microbiological outcomes in more than 90% of the cases. Both were extremely well tolerated. These findings confirm and extend the indications for rokitamycin, found in earlier trials to be extremely effective in the treatment of urethritis due to Chlamydia trachomatis and--as a whole--in infections caused by this microrganism.

Anti-Bacterial Agents↗

The etiology of genital ulcer disease by multiplex polymerase chain reaction and relationship to HIV infection among patients attending sexually transmitted disease clinics in Pune, India.

OBJECTIVES: To determine the etiology of genital ulcer disease (GUD) among patients attending sexually transmitted disease (STD) clinics in Pune, India, and to examine the relationship to HIV infection and compare the clinical diagnosis of GUD with the results of a multiplex polymerase chain reaction (M-PCR) assay for Treponema pallidum, herpes simplex virus (HSV), and Hemophilus ducreyi infection. METHODS: Between June 20, 1994, and September 26, 1994, 302 patients with a genital ulcer were evaluated. Clinical etiology of GUD was based on physical appearance and microbiologic evaluations which included darkfield microscopy and serology for syphilis. Swabs of each genital ulcer were tested for HSV antigen by enzyme immunoassay (Herpchek; Dupont, Wilmington, DE) and processed in a multiplex PCR assay (M-PCR; Roche, Branchburg, NJ) for simultaneous detection of HSV, Treponema pallidum, and Hemophilus ducreyi. RESULTS: Two hundred seventy-seven men and 25 women with a median age of 25 were evaluated. The seroprevalence of HIV was 22.2%. The etiology of GUD as determined by M-PCR was HSV (26%), H. ducreyi (23%), T. pallidum (10%), and multiple infections (7%); no etiology was identified in 34%. HIV seroprevalence was higher among those patients positive for HSV compared with other etiologies (OR = 2.1, CI: 1.2-3.7; p = 0.01). When compared with M-PCR, the Herpchek test was 68.5% sensitive and 99.5% specific. Darkfield detection for T. pallidum was 39% sensitive and 82% specific, in contrast to rapid plasma reagin and fluorescent treponemal antibody absorption test, which was 66% sensitive and 90% specific. Clinical diagnosis alone or in combination with basic laboratory tests showed poor agreement with M-PCR.

Adolescent↗

Is genital human papillomavirus infection always sexually transmitted?

The occurrence of genital human papillomavirus (HPV) infection was studied prospectively by colposcopy and histology in 43 virginal and 162 sexually active women attending a colposcopy clinic. The study also included 111 husbands of the latter group. By colposcopic criteria, the prevalence of HPV infection was 51.1% in the virginal and 69.1% in the sexually active women. The prevalence was 77.1% among men whose wives had HPV infection compared to 13.3% among men whose wives did not have the infection (p less than 0.01). There was a strong association in genital HPV infection between husbands and wives as expected from a sexually transmissible disease. However, the high prevalence of the infection among the virginal women indicated that transmission of HPV by nonsexual modes was common. Genital HPV infection is ubiquitous and in women is not exclusively a venereal disease.

Adult↗

A randomized, placebo-controlled comparison of oral valacyclovir and acyclovir in immunocompetent patients with recurrent genital herpes infections. The Valaciclovir International Study Group.

OBJECTIVE: To compare valacyclovir hydrochloride with acyclovir in the treatment of recurrent genital herpes infection. DESIGN: A multicenter, double-blind, placebo-controlled, randomized, parallel-design study. SETTING: University clinics (dermatology, gynecology, and infectious diseases) and private practices. PATIENTS: One thousand two hundred patients with recurrent genital herpes simplex infections. INTERVENTIONS: Patients self-initiated oral therapy with 1000 mg of valacyclovir hydrochloride twice daily, 200 mg of acyclovir 5 times daily, or placebo for 5 days. MAIN OUTCOME MEASURES: Resolution of all signs and symptoms of recurrent genital herpes infection. RESULTS: Both drugs were significantly more effective than placebo in speeding resolution of herpetic episodes (median duration, 4.8, 4.8, and 5.9 days, respectively); the hazards ratios for valacyclovir and acyclovir vs placebo were 1.66 (95% confidence interval [CI], 1.38-2.01) and 1.71 (95% CI, 1.41-2.06) (both P < .001). Similarly, valacyclovir and acyclovir significantly hastened lesion healing (hazards ratios vs placebo were 1.88 [95% CI, 1.53-2.32] and 1.90 [95% CI, 1.55-2.34], respectively; P < .001). Pain duration was shorter in valacyclovir- and acyclovir-treated patients (median, 2 vs 3 days). Viral shedding stopped 2.55 times faster in patients treated with valacyclovir and 2.24 times faster in patients treated with acyclovir than in patients treated with placebo. Aborted episodes, in which lesions did not progress beyond the macule or papule stage, tended to occur in more patients treated with valacyclovir (25.9%) or acyclovir (24.8%) than in patients treated with placebo (19.8%). Valacyclovir and acyclovir did not differ significantly with regard to their respective effects on any of the above efficacy parameters. The nature, severity, and frequency of adverse events did not differ among the 3 treatment groups. CONCLUSIONS: Twice-daily valacyclovir was as effective and well tolerated in the treatment of recurrent genital herpes simplex virus infection as 5-times-daily acyclovir. Therefore, valacyclovir could prove a useful alternative to acyclovir when convenience of dosing or compliance issues are the prime considerations in treatment.

Acyclovir↗

Acyclovir-resistant genital herpes among persons attending sexually transmitted disease and human immunodeficiency virus clinics.

BACKGROUND: Genital herpes is epidemic in the United States; long-term acyclovir therapy is common; and long-term use of antimicrobials in suppressive doses favors development of resistance. OBJECTIVE: To determine the prevalence of and risk factors for acyclovir-resistant genital herpes. METHODS: We identified and attempted to enroll all patients 18 years or older with suspected genital herpes who attended 22 sexually transmitted disease and human immunodeficiency virus (HIV) clinics in the United States between October 1996 and April 1998. We conducted standardized interviews of all consenting patients. Lesions were cultured, and isolates were typed as herpes simplex virus (HSV) 1 or HSV-2 and tested for acyclovir sensitivity (using a 50% inhibitory concentration of 2 microg/mL) by plaque reduction, which was independently confirmed. RESULTS: Herpes simplex virus was isolated from 2088 of 3602 patients, and 90.2% of isolates were HSV-2. Fifteen isolates, all HSV-2, were acyclovir resistant. Three (0.18%) of 1644 HIV-negative patients had acyclovir-resistant isolates (95% confidence interval [CI], 0.04%-0.5%); resistance was associated with oral (P<.006) and topical (P<.001) acyclovir use. Twelve (5.3%) of 226 HIV-positive patients yielded resistant HSV isolates (95% CI, 2.8%-9.1%); resistance was associated with oral acyclovir use (P<.001), duration of the current episode (P<.001), history of recurrent genital herpes (P<.01), and low CD4 cell count (P<.05). CONCLUSIONS: In the 15 years following licensure of acyclovir, resistance to the drug remains low among immunocompetent patients. However, 5% of HIV-positive patients had resistant HSV-2 isolates. Continued surveillance is essential to monitor changes in acyclovir resistance and to characterize the clinical and public health importance of acyclovir-resistant HSV.

Acyclovir↗