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1.  Vaginal Candida parapsilosis: pathogen or bystander? 
OBJECTIVE: Candida parapsilosis is an infrequent isolate on vaginal cultures; its role as a vaginal pathogen remains unstudied. This retrospective study of women with positive culture for C. parapsilosis sought to characterize the significance of this finding and its response to antifungal therapy. METHODS: From February 2001 to August 2002, we identified all individuals with positive fungal isolates among a population of women with chronic vulvovaginal symptoms. Charts of women with C. parapsilosis cultures were reviewed with regard to patient demographics, clinical presentation and therapeutic response. Mycological cure, defined as a negative fungal culture at the next office visit, and clinical cure, i.e. symptom resolution, were determined for each subject. RESULTS: A total of 582 women had positive vaginal cultures for 635 isolates, of which 54 (8.5%) were C. parapsilosis. The charts of 51 subjects with C. parapsilosis were available for review and follow-up cultures and clinical information were available for 39 (76.5%). Microscopy was positive in 9 (17.6%). Antifungal treatment resulted in mycological cure in 17/19 patients with fluconazole, 7/7 with butoconazole, 6/6 with boric acid, 1/1 with miconazole and occurred spontaneously in 6/7: 24/37 (64.9%) patients with a mycological cure experienced clinical cure. CONCLUSIONS: Although C. parapsilosis is often a cause of vaginal symptoms, it seems to respond to a variety of antifungal agents and may even be a transient vaginal colonizer.
doi:10.1080/10647440400025603
PMCID: PMC1784559  PMID: 16040326
2.  Trospectomycin in Acute Pelvic Inflammatory Disease: A Preliminary Report 
Objective: The purpose of this study was to compare the clinical efficacy and safety of intravenous trospectomycin to that of cefoxitin plus doxycycline in the treatment of women hospitalized with acute pelvic inflammatory disease (PID).
Methods: Thirty-nine patients admitted with a clinical diagnosis of an acute PID were enrolled in this prospective, single-blind study. Patients were treated with either intravenous trospectomycin, 500 mg every 8 h, or intravenous cefoxitin, 2 g every 6 h, plus oral or intravenous doxycycline, 100 mg every 12 h, in a 2:1 ratio. The patients were followed for clinical response and side effects. Both groups of patients were discharged on oral doxycycline for 10 days. Appropriate cultures were obtained before starting inpatient treatment, on completion of inpatient treatment, and at 2 follow-up visits.
Results: The overall success rate for trospectomycin was 95.6% and for cefoxitin/doxycycline was 91.6%. This difference was not statistically significant (P = 0.63). Trospectomycin was found to be effective against Chlamydia trachomatis.
Conclusions: Single-agent therapy with trospectomycin may be as effective as cefoxitin plus doxycycline in the treatment of women hospitalized with acute PID.
doi:10.1155/S1064744997000355
PMCID: PMC2364539  PMID: 18476139
3.  Significance of Genital Mycoplasmas in Pelvic Inflammatory Disease: Innocent Bystander! 
Objective: Our objective was to determine the role of Mycoplasma hominis and Ureaplasma urealyticum in pelvic inflammatory disease (PID).
Methods: The clinical and microbiologic variables in 114 patients with a clinical diagnosis of PID were compared prospectively according to the isolation of M. hominis and U. urealyticum from their endometrial cavities.
Results: The groups were epidemiologically well matched. Clinical parameters such as temperature, leukocyte count, erythrocyte count, and C-reactive protein on admission and length of hospital stay were similar in the patients, regardless of their mycoplasma status. A significant percentage of the patients either continued or started to harbor genital mycoplasmas after the resolution of PID without any significant clinical sequelae.
Conclusions: The presence of genital mycoplasmas does not change the clinical presentation and course of PID. Both M. hominis and U. urealyticum can persist or colonize the endometrium after complete recovery from PID. Therefore, the genital mycoplasmas do not seem to have a dominant pathogenic role in PID.
doi:10.1155/S1064744996000518
PMCID: PMC2364503  PMID: 18476105
4.  Medical Management of Vulvar Vestibulitis: Results of a Sequential Treatment Plan 
Objective: The objectives of this study were to assess the efficacy of medical management for vulvar vestibulitis and to examine several historical variables and determine their predictive values as to which treatments will be most successful.
Methods: Seventy-four patients diagnosed with vulvar vestibulitis were evaluated. Each patient was treated using a sequence of consecutive medical therapies for vulvar vestibulitis. These therapies were topical aqueous 4% lidocaine with intercourse, topical corticosteroid therapy, oral amitriptyline, topical low-dose 5-fluorouracil (5-FU) cream, intralesional alpha-interferon, and a low-oxalate diet in combination with oral calcium citrate. The patients were followed over 3–30 months and their responses to therapy were assessed. In addition, a statistical analysis was performed to determine the positive predictive values of certain historical variables and specific treatment successes.
Results: Forty-nine patients reported positive responses to one of the initiated therapies. More specifically, 18.1% of the patients who used lidocaine, 33.8% who used topical corticosteroids, 57.1% who used amitriptyline, 16.7% who used 5-FU, none who received interferon, and 50% who tried a low-oxalate diet had positive responses to therapy. No historical variables were predictive of which therapies would have the most successful outcome.
Conclusions: Medical management is effective in alleviating the symptoms of vulvar vestibulitis. Various aspects of a patient's history are not helpful in selecting the therapy that will be most effective.
doi:10.1155/S1064744995000603
PMCID: PMC2366158  PMID: 18472890
5.  Chronic Endometritis and Positive Mycoplasma Cultures: Is There a Correlation? 
Objective: This study was undertaken to assess the impact of mycoplasma strains (Mycoplasma hominis or Ureaplasma urealyticum) on the development of chronic endometritis.
Methods: Fifty-eight patients with acute pelvic infection were enrolled in this prospective cohort study. Endometrial cultures and biopsies were obtained on admission and 5–7 and 21–28 days after completion of treatment.
Results: Of 148 samples, 40 were positive for mycoplasma strains (group A) and 58 were positive for mycoplasma with other pathogens (group B). Twenty-seven samples were positive for other pathogens only (group C). Chronic endometritis was seen in 7 (17.5%), 30 (51.7%), and 10 (37%) in group A, B, and C patients, respectively.
Conclusions: The presence of mycoplasma strains in the endometrial cavity was not found to be associated with an increased incidence of chronic endometritis.
doi:10.1155/S1064744995000226
PMCID: PMC2364415  PMID: 18475413
6.  Perihepatic Adhesions: Another Look 
Objective: The objective of our study was to determine if pelvic inflammatory disease (PID) was the only cause of perihepatic adhesions.
Methods: One hundred consecutive patients undergoing elective sterilization by laparoscopy were enrolled in this study. The preoperative workup included a history, physical examination, cervical culture for Neisseria gonorrhoeae and Chlamydia trachomatis, leukocyte count, C-reactive protein, and liver-function tests. During the laparoscopic procedure, the pelvis and liver surface were inspected for evidence of any adhesions. If perihepatic adhesions were discovered in a patient without any evidence of prior PID, then cultures from the adhesion, peritoneal fluid, and tubal specimens were obtained for N. gonorrhoeae, C. trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, anaerobes, and facultative aerobes. Tubal specimens were also obtained for histologic examination.
Results: Of 100 patients, 7 patients had perihepatic adhesions without any laparoscopic evidence of prior PID. The preoperative cultures were negative. Three of these patients had no history of sexually transmitted disease or PID. Their anti-chlamydial antibody titers were also negative. Of the remaining 4 patients with perihepatic adhesions, 2 had a history of gonococcal or chlamydial infection and 2 had histological evidence of chronic salpingitis.
Conclusions: The study suggests that PID may not be the only cause of perihepatic adhesions.
doi:10.1155/S1064744995000159
PMCID: PMC2364405  PMID: 18475406

Results 1-6 (6)