Female Genital Warts: Global Trends and Treatments

The increasing incidence of human papillomavirus (HPV) infection and HPV-associated conditions such as genital warts in women is a global concern. Genital warts are a clinical manifestation of HPV types 6 and 11, and are estimated to affect 1% of sexually active adults aged between 15 and 49. HPV infection is also strongly associated with cervical cancer, and is prevalent in as many as 99% of cases. The psychological stress of having genital warts is often greater than the morbidity of the disease, and therefore successful treatment is crucial. Current treatments are patient-applied and provider-administered therapies. Imiquimod 5% cream, a patient-applied therapy, is an efficacious treatment with tolerable side-effects and a low recurrence rate, and has the potential to be an effective strategy for the management of genital warts

Herpes in Pregnancy

The management of genital herpesvirus infections in pregnancy has seen many changes over the past decade as we have continued to learn more about the epidemiology of the disease. This article reviews these changes and highlights ongoing controversies. Clinical management schemes are proposed based upon this most recent information

Moxalactam Therapy for Obstetric and Gynecologic Infections

Moxalactam, a new cephalosporin antibiotic with a broad spectrum of activity, was evaluated for safety and therapeutic efficacy in the treatment of genital tract infections in women. Fifty-three patients with postpartum endometritis or acute or chronic pelvic inflammatory disease were treated with 2 g of moxalactam iv every 8 hr, usually for five days or longer. Appropriate cultures of peripheral blood, endometrium, cul-de-sac aspirates, urine, wound, and endocervix (only for Neisseria gonorrhoeae) were performed. Overall, 90.6% (48 of 53) of the patients were successfully treated with moxalactam - 86.2% (25 of 29) and 95.8% (23 of 24) of the patients with endometritis and pelvic inflammatory disease, respectively. Therapy failed in one of five bacteremic patients with endometritis. Of all the bacteria isolated from appropriate culture sites, 58% (224 of 383) were anaerobes, with anaerobic gram-negative rods - particularly Bacteroides bivius-and gram-positive cocci being predominant. Of 206 anaerobic strains tested with moxalactam by agar dilution techniques, 82% (169 of 206) were susceptible (minimal inhibitory concentration [MIC], ⩽8 μg/ml), 11.6% (24 of 206) were moderately susceptible (MIC, 16-32 μg/ml), and 6.3% (13 of 206) were resistant (MIC, ⩾64 μg/ml). Among the aerobic isolates, enterococci were uniformly resistant. Thus, moxalactam performed well as a single agent in this open clinical trail for women with infections of the genital trac

Tissue Penetration of Meropenem in Patients Undergoing Gynecologic Surgery

The purpose of this study was to assess the tissue-penetrating ability of a new β-lactam antibiotic, meropenem, in 64 patients undergoing elective gynecologic surgery. Patients received a single 500-mg dose intravenously before surgery. Plasma and tissue concentrations of meropenem were highest at ∼1 hour, and good tissue penetration was seen in the variety of specimens evaluated. The median plasma concentration at ∼1 hour was 13.3 µg/mL. The median fluid and tissue concentrations at ∼1 hour were as follows: cervix, 8.5 µg/g; endometrium, 2.3 µg/g; fallopian tube, 1.9 µg/g; myometrium, 3.6 µg/g; ovary, 2.3 µg/g; and uterus, 2.3 µg/g. These tissue concentrations exceed the MICs of meropenem for 90% of typical pathogens associated with gynecologic infections. Meropenem readily penetrates gynecologic tissue. A single 500-mg dose provides adequate tissue concentrations for treatment of gynecologic infections caused by susceptible pathogen

Antigen expression determines adenoviral vaccine potency independent of IFN and STING signaling

Recombinant adenoviral vectors (rAds) are lead vaccine candidates for protection against a variety of pathogens, including Ebola, HIV, tuberculosis, and malaria, due to their ability to potently induce T cell immunity in humans. However, the ability to induce protective cellular immunity varies among rAds. Here, we assessed the mechanisms that control the potency of CD8 T cell responses in murine models following vaccination with human-, chimpanzee-, and simian-derived rAds encoding SIV-Gag antigen (Ag). After rAd vaccination, we quantified Ag expression and performed expression profiling of innate immune response genes in the draining lymph node. Human-derived rAd5 and chimpanzee-derived chAd3 were the most potent rAds and induced high and persistent Ag expression with low innate gene activation, while less potent rAds induced less Ag expression and robustly induced innate immunity genes that were primarily associated with IFN signaling. Abrogation of type I IFN or stimulator of IFN genes (STING) signaling increased Ag expression and accelerated CD8 T cell response kinetics but did not alter memory responses or protection. These findings reveal that the magnitude of rAd-induced memory CD8 T cell immune responses correlates with Ag expression but is independent of IFN and STING and provide criteria for optimizing protective CD8 T cell immunity with rAd vaccines

Obscured phylogeny and possible recombinational dormancy in Escherichia coli

<p>Abstract</p> <p>Background</p> <p><it>Escherichia coli </it>is one of the best studied organisms in all of biology, but its phylogenetic structure has been difficult to resolve with current data and analytical techniques. We analyzed single nucleotide polymorphisms in chromosomes of representative strains to reconstruct the topology of its emergence.</p> <p>Results</p> <p>The phylogeny of <it>E. coli </it>varies according to the segment of chromosome analyzed. Recombination between extant <it>E. coli </it>groups is largely limited to only three intergroup pairings.</p> <p>Conclusions</p> <p>Segment-dependent phylogenies most likely are legacies of a complex recombination history. However, <it>E. coli </it>are now in an epoch in which they no longer broadly share DNA. Using the definition of species as organisms that freely exchange genetic material, this recombinational dormancy could reflect either the end of <it>E. coli </it>as a species, or herald the coalescence of <it>E. coli </it>groups into new species.</p