The prevalence of Chlamydia trachomatis infection among infertile males and its association with abnormal semen characteristics in Delta State, Nigeria

Chlamydia trachomatis is the most common cause of sexually transmitted diseases that is not of viral origin and there is accumulating evidence of a significant role played by this pathogen in causing male factor infertility. This study thus aimed to determine the prevalence of C. trachomatis among infertile males and to evaluate their association with fertility status and abnormal semen characteristics. This study included 215 infertile male subjects who visited a major fertility clinic in Warri, Delta state, Nigeria. Forty apparently healthy males without complaints of infertility were enrolled as controls. Blood samples were collected from patients aseptically using venous puncture and semen samples were obtained after masturbation. C. trachomatis IgG antibodies were assayed for in blood specimens using the Dot rapid Assay Kit flow through Ct cassette and positive samples were further screened with an enzyme immunoassay technique. Semen samples were analyzed following World Health Organization guidelines. Forty-two (19.5%) out of 215 infertile male subjects were found sero-positive for C. trachomatis. C. trachomatis was significantly associated with male infertility when compared to controls (P<0.001). Age groups 20-29 years (43.3%) and 30-39 years (22.1%) significantly had higher prevalence of C. trachomatis (P<0.001), as compared to age groups 40-49 (7.9%) and > 50 years (3.7%). Sero-positivity for C. trachomatis antibodies was significantly associated with oligozoospermia (22.5%) and azospermia (61.5%) than with teratozoospermia (7.3%) and asthenozoospermia (6.3%) (P<0.001). The prevalence of C. trachomatis among infertile males was high; there was an association between C. trachomatis infection and poor semen characteristics and infertility. There is need for routine screening for the pathogen in males with complaints of infertility so as to rule out this potentially correctable/reversible cause of infertility

Interventional studies for preventing surgical site infections in sub-Saharan Africa - A systematic review.

BACKGROUND: There is a great need for safe surgical services in sub-Saharan Africa, but a major difficulty of performing surgery in this region is the high risk of post-operative surgical site infection (SSI). METHODS: We aimed to systematically review which interventions had been tested in sub-Saharan Africa to reduce the risk of SSI and to synthesize their findings. We searched Medline, Embase and Global Health databases for studies published between 1995 and 2010 without language restrictions and extracted data from full-text articles. FINDINGS: We identified 24 relevant articles originating from nine countries in sub-Saharan Africa. The methodological quality of these publications was diverse, with inconsistency in definitions used for SSI, period and method of post-operative follow-up and classification of wound contamination. Although it was difficult to synthesise information between studies, there was consistent evidence that use of single-dose pre-operative antibiotic prophylaxis could reduce, sometimes dramatically, the risk of SSI. Several studies indicated that alcohol-based handrubs could provide a low-cost alternative to traditional surgical hand-washing methods. Other studies investigated the use of drains and variants of surgical technique. There were no African studies found relating to several other promising SSI prevention strategies, including use of checklists and SSI surveillance. CONCLUSIONS: There is extremely limited research from sub-Saharan Africa on interventions to curb the occurrence of SSI. Although some of the existing studies are weak, several high-quality studies have been published in recent years. Standard methodological approaches to this subject are needed

Ampicillin/Sulbactam versus Cefuroxime as antimicrobial prophylaxis for cesarean delivery: a randomized study

<p>Abstract</p> <p>Background</p> <p>The efficacy and safety of a single dose of ampicillin/sulbactam compared to a single dose of cefuroxime at cord clamp for prevention of post-cesarean infectious morbidity has not been assessed.</p> <p>Methods</p> <p>Women scheduled for cesarean delivery were randomized to receive a single dose of either 3 g of ampicillin-sulbactam or 1.5 g of cefuroxime intravenously, after umbilical cord clamping. An evaluation for development of postoperative infections and risk factor analysis was performed.</p> <p>Results</p> <p>One hundred and seventy-six patients (median age 28 yrs, IQR: 24-32) were enrolled in the study during the period July 2004 - July 2005. Eighty-five (48.3%) received cefuroxime prophylaxis and 91 (51.7%) ampicillin/sulbactam. Postoperative infection developed in 5 of 86 (5.9%) patients that received cefuroxime compared to 8 of 91 (8.8%) patients that received ampicillin/sulbactam (p = 0.6). In univariate analyses 6 or more vaginal examinations prior to the operation (p = 0.004), membrane rupture for more than 6 hours (p = 0.08) and blood loss greater than 500 ml (p = 0.018) were associated with developing a postoperative surgical site infection (SSI). In logistic regression having 6 or more vaginal examinations was the most significant risk factor for a postoperative SSI (OR 6.8, 95% CI: 1.4-33.4, p = 0.019). Regular prenatal follow-up was associated with a protective effect (OR 0.04, 95% CI: 0.005-0.36, p = 0.004).</p> <p>Conclusions</p> <p>Ampicillin/sulbactam was as safe and effective as cefuroxime when administered for the prevention of infections following cesarean delivery.</p> <p>Trial registration</p> <p>Clinicaltrials.gov identifier: NCT01138852</p

The prevalence of Chlamydia trachomatis infection among infertile males and its association with abnormal semen characteristics in Delta State, Nigeria

Chlamydia trachomatis is the most common cause of sexually transmitted diseases that is not of viral origin and there is accumulating evidence of a significant role played by this pathogen in causing male factor infertility. This study thus aimed to determine the prevalence of C. trachomatis among infertile males and to evaluate their association with fertility status and abnormal semen characteristics. This study included 215 infertile male subjects who visited a major fertility clinic in Warri, Delta state, Nigeria. Forty apparently healthy males without complaints of infertility were enrolled as controls. Blood samples were collected from patients aseptically using venous puncture and semen samples were obtained after masturbation. C. trachomatis IgG antibodies were assayed for in blood specimens using the Dot rapid Assay Kit flow through Ct cassette and positive samples were further screened with an enzyme immunoassay technique. Semen samples were analyzed following World Health Organization guidelines. Forty-two (19.5%) out of 215 infertile male subjects were found sero-positive for C. trachomatis. C. trachomatis was significantly associated with male infertility when compared to controls (P<0.001). Age groups 20-29 years (43.3%) and 30-39 years (22.1%) significantly had higher prevalence of C. trachomatis (P 50 years (3.7%). Sero-positivity for C. trachomatis antibodies was significantly associated with oligozoospermia (22.5%) and azospermia (61.5%) than with teratozoospermia (7.3%) and asthenozoospermia (6.3%) (P<0.001). The prevalence of C. trachomatis among infertile males was high; there was an association between C. trachomatis infection and poor semen characteristics and infertility. There is need for routine screening for the pathogen in males with complaints of infertility so as to rule out this potentially correctable/reversible cause of infertility

Single-dose compared with multiple day antibiotic prophylaxis for cesarean section in low-resource settings, a randomized controlled, noninferiority trial

Objective To investigate the efficacy of a single prophylactic dose of ampicillin combined with metronidazole to prevent postcesarean section infections compared with a multiple day regimen in low-resource settings. Design An evaluator-blinded randomized, controlled, noninferiority trial. Setting Two rural hospitals in Tanzania. Population Of 181 enrolled eligible women with an indication for cesarean section, information on 176 was analyzed by intention-to-treat. Methods The women were randomly assigned to either the intervention group who received a single dose of ampicillin and metronidazole, or to the control group who received a multiple-day regimen of ampicillin/amoxicillin and metronidazole. Main outcome measures The primary outcome was maternal postcesarean infection. Secondary outcomes were severity of these infections, other maternal complications, and the duration of hospital stay. Results In the intervention group (n = 89), six women (6.7%) developed a wound infection compared with nine (10.3%) in the control group (n = 87) (difference 3.60; 95% CI −4.65 to 11.85) (p = 0.40). Conclusions A single dose of prophylactic ampicillin and metronidazole is equally effective as a multiple-day regimen in preventing postcesarean wound infections in low-resource settings, therefore it can be considered as a good strategy in low-resource settings. The reduced quantity of prophylactic antibiotics will reduce costs without increasing the risk of maternal infection