Background: Artificial insemination is a commonly performed
procedure for the treatment of various forms of infertility. Infectious complications have only
rarely been noted as a complication of intrauterine insemination (IUI).
Case: In this presentation, we report the first case of an ovarian
abscess following IUI with the husband's semen. Despite treatment with triple antibiotics,
an oophorectomy was required. Surgical as well as pathological evaluation confirmed the
diagnosis of an ovarian abscess. Following surgery, the patient responded well to antibiotic
Conclusion: Since pelvic infections are ascending processes, the
violation of the natural cervical barrier with IUI can theoretically place the patient at
increased risk for this complication. While few advocate routine cultures of semen
samples, the clinician must be acutely alert to potential infectious morbidity following
this procedure. Early diagnosis and intervention are necessary to minimize
morbidity and optimize treatment.
Objective: The aim of this study was to evaluate the effect of a voluntary
protocol for selective intrapartum chemoprophylaxis on the incidence of early onset group
B streptococcal sepsis (GBS EOS).
Methods: Cases of GBS EOS were defined as a positive GBS culture
from a normally sterile fluid obtained during the first 7 days of life. All cases of GBS EOS at an
urban, university-affiliated community hospital were reviewed during 2 time periods.
The 2-year period before instituting a resident education program to promote selective
chemoprophylaxis (1988–89) was retrospectively reviewed; the 2-year period after the
education program was introduced (1990–91) was prospectively recorded. The outcome
measure was the incidence of GBS EOS.
Results: The rate of GBS EOS was 7/14,335 deliveries (0.05%) before
and 9/13,999 (0.064%) after the introduction of the education program (observed
difference between proportions 0.016%, 95% confidence interval [CI] for the difference
between the proportions –0.071% to 0.04%, P = not significant [NS]). The rate of GBS EOS
in preterm infants was 5/1,331 (0.376%) before and 3/1,297 (0.23%) afterward (observed
difference between proportions 0.14%, 95% CI –0.28% to 0.56%, P = NS). The incidence
of GBS EOS did not decrease during the latter period due to failure of antepartum
cultures to predict intrapartum GBS colonization (2 cases); non-compliance with voluntary
recommendations to administer chemoprophylaxis (2 cases); failure of chemoprophylaxis or
therapy for intraamniotic infection to prevent neonatal infection (3 cases); and occurrence
of GBS EOS in infants without risk factors (2 cases).
Conclusions: An education program for resident physicians regarding
chemoprophylaxis for GBS EOS did not significantly reduce the absolute incidence
of disease. Alternative strategies are needed that redress the causes of failure inherent
in the current guidelines. Some cases of GBS EOS are not preventable because the parturient
does not have risk factors that indicate chemoprophylaxis.
There appears to be a resurgence of puerperal sepsis due to a historically important
pathogen, group A β-hemolytic streptococcus.
Objective: The objective of this study was to observe pregnancy
outcomes in mice infected transvaginally with Chlamydia trachomatis.
Methods: Pregnant mice were inoculated transvaginally with either C. trachomatis
(CT) or sterile calf serum (CON) on pregnancy day 4. Pregnancy outcomes as
well as genital tract histology and culture were compared. Statistical analysis was
performed using Fisher's exact test and Student's t-test.
Results: Twenty-four of 26 CT mice had positive uterine cultures for
C. trachomatis. Inflammation occurred in 9 (34.6%) (P = 0.002, 95% confidence interval = 1.7–3.5)
and intrauterine fetal demise occurred in 5 (19.2%) (P = 0.05, 95% confidence interval = 1.6–2.9)
of CT mice. No mice in the CON group (0/24) had positive uterine cultures, developed
inflammation, or experienced intrauterine fetal demise.
Conclusions: Lower genital tract chlamydial infection is associated
with intrauterine fetal demise in Swiss-Webster mice.
Objective: The objective of this study was to assess whether antibiotic
therapy plus tocolysis given to women in preterm labor would prolong pregnancy
compared with tocolysis alone.
Methods: A randomized, double-blind trial of intravenous
mezlocillin and oral erythromycin therapy vs. placebo was used in addition to
tocolysis among women in preterm labor ≤34 weeks gestation with intact
membranes. Amniocentesis was performed, and chorioamnionic membranes
were examined histologically and cultured for microorganisms after delivery.
Results: Clinical characteristics including gestational age at
enrollment, frequency of contractions, cervical Bishop's score, and white blood
cell count on admission were similar in the 2 groups. Antibiotic therapy was well tolerated.
No significant differences in the interval to delivery, birth weight, and neonatal outcomes
were observed between the 2 groups. Women in the antibiotic group had a significantly
lower incidence of postpartum infections compared with women in the placebo group.
Patients with evidence of upper genital tract infection in either group had a significantly
shorter interval to delivery, lower gestational age at delivery, lower mean birth weight,
and increased neonatal hospitalization time.
Conclusions: Lack of an antibiotic effect on the gestational age
at delivery may be due to the low prevalence of upper genital tract infection among
unselected women in preterm labor, to advanced preterm labor unresponsive to antibiotic
therapy, or to an inability of antibiotics given alone to inhibit the cytokine response.
Further work is needed to identify markers of upper genital tract infection
among women in preterm labor and to evaluate other potential therapeutic interventions.
Objective: The purpose of this study was to determine the
epidemiology of sexually transmitted diseases (STDs) among pregnant adolescents.
Methods: Charts of all patients (n = 735) who attended the Maternal and
Infant Care Clinic at University Hospital, Newark, NJ, between July 1, 1991, and June 30,
1992, were reviewed for STDs which included gonorrhea, chlamydia, syphilis, and human
immunodeficiency virus (HIV). At the first prenatal visit, each registrant had endocervical
specimens obtained to detect gonorrhea and chlamydia. A serum sample was obtained
for syphilis screening. HIV testing was made available to all patients and testing was
done on a voluntary basis. The same STD screening that was done at the initial visit was
repeated at 28 and 36 weeks.
Results: Twenty-five percent of patients tested positive for one or
more STDs. The mean patient age was 17.3 years. The mean gestational age at first visit
was 19.5 weeks. The mean number of visits was 7.3. The following STDs were identified:
4.8% of patients tested positive for gonorrhea, 20.9% tested positive for chlamydia,
and 1.7% tested positive for syphilis. Twenty-one percent of patients had a positive
STD diagnosed at the initial visit. Another 4.8% of patients had an STD diagnosed at some
time after the initial visit when the initial screen was negative for STDs. An additional
1% of patients who initially tested positive for an STD had subsequent screening which
revealed another STD (different organism). Seven patients tested HIV positive.
Sixty-one percent of patients with STDs agreed to HIV testing. One patient had
HIV coexistent with another STD.
Conclusions: Pregnant adolescents are at risk for multiple
STDs. HIV testing should be offered. STD screening should be repeated in the third
trimester in adolescent patients.
Objective: The objectives of this study were to 1) determine the
prevalance and characterize the symptomatology of Trichomonas vaginalis (TV)
infection in pregnant women on entry into prenatal care in an inner-city population; 2)
compare conventional microscopic methods vs. culture techniques in diagnosing
TV in both symptomatic and asymptomatic pregnant patients; and 3) correlate
wet mount microscopic and microbiologic characteristics of varying manifestations of
Methods: One thousand two hundred sixty patients in an inner-city
population were tested at entry into prenatal care for TV by saline wet mount and culture
techniques. Other tests for lower genital tract infection were also performed.
Vaginal symptoms were ascertained through standardized questioning prior to examination.
Standard microscopic and microbiologic data were also obtained for analysis. Wet
mounts were systematically examined and considered negative if no TV was identified in
10 high powerfields (HPFs). Cultures were inspected from days 4 to 7 or until positive
results were obtained. Results were analyzed using McNemar's test for correlated proportions,
chi-squared test, or Fisher exact test where appropriate.
Results: Culture and wet mount results were available in 1,175
patients. TV infection was documented by one or both techniques in 110/1,175 (9.4%).
Culture methods detected 105/110 (94.5%) of all patients while wet mount detected
90/110 (73%) (P <0.001). Vaginal symptoms were present in only 20/110 patents
(18.2%). Among asymptomatic patients, culture detected 94% while wet mount
detected 70% (P < 0.001). Among symptomatic patients, wet mount and culture were
both effective and diagnosed 85% and 95% of infections, respectively (P = not significant).
Patients with TV were more likely to have increased vaginal fluid wlaite blood cells (WBCs)
and more severe vaginal flora disruption than uninfected controls. Subgroup analysis
revealed wet mount-positive/culture-positive patients were more likely to have vaginal
flora disruption, as evidenced by decreased lactobacilli and elevated vaginal pH, than
wet mount-negative/culture-positive subjects. Coexistent infection rates were similar
regardless of wet mount status. Elevated vaginal fluid WBCs were more
common among patients with symptoms.
Conclusions: 1) Screening pregnant women for TV based solely
on symptomatology is ineffective in this population; 2) culture techniques detected
more infections than conventional microscopic evaluation; and 3) significant increases
in vaginal fluid WBCs and altered vaginal flora are found in both symptomatic and
asymptomatic TV, suggesting that both infestations have the potential to adversely
affect pregnancy outcome. Studies on the influence of TV on pregnancy outcomes are
Background: Disseminated herpetic infections during pregnancy have
been reported in the literature.
Case: This case presentation describes a pregnant patient who
presented with fever, elevated liver enzymes, and upper abdominal tenderness and
succumbed from fulminant herpetic hepatitis.
Conclusion: Early diagnosis and treatment are essential because of the
high mortality rate.
Objective: The objective of this study was to determine whether human
papillomavirus (HPV) infections are involved in the development of papillomatosis lesions
of the lower female genital tract.
Methods: A total of 616 biopsy specimens of genital papillomatous
lesions (307 nodular and 309 papular types) from 598 patients were anaylyzed for the
presence of HPV DNA sequences by polymerase chain reaction (PCR). These specimens
were also examined by histopathological assessment for characteristic HPV-associated
cytological changes, by immunohistochemical staining for HPV-associated antigen,
and by electron microscopy for the presence of virions.
Results: HPV DNA sequences were found in 97.9% (140 of 143 cases)
and 1.1% (1 of 91 cases) of the nodular and papular papillomatosis cases tested,
respectively. In 18 patients who had both types of papillomatosis lesions, HPV DNA was
invariably found only in nodular tissues. HPV-associated antigen, koilocytosis, and
virions were found in 53.6% (98 of 183 cases), 70.5% (129 of 183 cases),
and 5.9% (5 of 85 cases) of nodular papillomatosis lesions tested, respectively.
Conclusions: These data suggest that nodular papillomatosis was
closely associated with HPV infection, but that papular papillomatosis of the lower
female genital tract may have an etiology other than HPV infection,
Objective: The incidence, morbidity, and risk factors associated with Clostridium difficile-associated
diarrhea (CDAD) were studied in a group of gynecologic oncology patients.
Methods: A case-control analysis of gynecologic oncology patients with CDAD was carried out
from August 1986 through January 1989 in a university medical center.
Results: One hundred twenty-three stool samples were tested for C. difficile using the CDT latex
agglutination test (Marion Diagnostics, Kansas City, MO). Thirty episodes of CDAD developed in
23 patients. From August 1986 through July 1988, the incidence was stable at 1.5 episodes/100
admissions. From August 1988 through January 1989, the incidence increased to 9.9 episodes/100
admissions (P = 0.005). Compared with patients with nonspecific antibiotic-associated diarrhea, the
study patients were hospitalized longer prior to the development of symptoms (mean 15.2 vs. 9.2
days, P = 0.006) and were admitted more frequently with diarrhea (37% vs. 11%, P = 0.015). The
rates of surgery, chemotherapy, and radiation therapy were similar. Fever (57% vs. 14%, P < 0.001),
abdominal pain (40% vs. 6%, P < 0.001), bloody stools (27% vs. 3%, P = 0.006), and leukocytosis
(64% vs. 26%, P = 0.011) were more common among the study cases. The duration, indication, and
number of antibiotics administered were similar, though once started, the mean time to symptoms
was longer in the study cases (13.7 vs. 6.1 days, P = 0.004). Seven relapses, 1 death, and 1 unplanned
colostomy occurred among women with CDAD.
Conclusions: C. difficile is a serious cause of nosocomial morbidity in gynecologic oncology
patients. Diarrhea developing after antibiotic exposure is more likely to be associated with C. difficile
in patients whose symptoms develop several days after completing antibiotics and in patients with a
history of CDAD.
Objective: The reactivity of gynecologic cancer proteins with monoclonal antibody (MAb) directed
against the human immunodeficiency virus I (HIV-I) was tested.
Methods: Cytoplasmic and nuclear proteins, extracted from a broad range of gynecologic cancers
obtained during standard surgical procedures, were tested in Western blotting with MAb 5023
developed against the amino acid sequences 308–322 of the envelope protein gp120 of HIV-I.
Results: Three cell membrane proteins, Mrl20,000 (p120), Mr41,000 (p41), and Mr24,000 (p24), and
one chromatin protein, Mr24,000 (p24), were detected by MAb 5023 in invasive, poorly differentiated
cervical squamous-cell carcinoma; ovarian serous cystadenocarcinoma; poorly and well-differentiated
endometrial carcinoma; vulvar squamous-cell carcinoma; and malignant mixed müllerian tumor. The
same antigens were identified in cervical carcinoma cell line SiHa. Neither p120 nor p24 was recognized
by other MAbs directed against the variable loop of gp120. Antigens p120 and p41 were undetectable in
normal ovarian tissue and in biopsy samples of normal vaginal and rectal mucosa. Rectosigmoid cancer
as well as colon carcinoma, lung carcinoma, and melanoma cell lines all tested negative.
Conclusions: The identified antigens may represent either the products of human genes (proto-onc-ogenes)
or, more likely, the products of an unknown virus specifically expressed in female cancer.
Objective: The purpose of this study was to determine whether selected fetal heart-rate (FHR)
patterns and the interval from diagnosis to delivery in pregnancies complicated by chorioamnionitis
could predict neonatal outcome.
Methods: During a 6-month period, 217 consecutive patients with acute chorioamnionitis were
prospectively identified in labor. Following delivery, the fetal monitor strips and hospital courses
were reviewed for both the mother and neonate. Multiple logistic regression was used to analyze the
presence of a nonreassuring FHR pattern and the effect on neonatal outcome. Fisher exact tests
were used to analyze the time intervals from the diagnosis of chorioamnionitis to delivery and their
significance on neonatal outcome parameters.
Results: The overall incidence of chorioamnionitis in our population was 2.3%. None of the
independent variables analyzed following the diagnosis of chorioamnionitis until delivery were
significantly associated with an umbilical artery (Ua) pH < 7.20. There were no differences in cord
pH, Apgar scores, sepsis, admission to special-care nursery, and oxygen requirements in neonates
based on the duration of time from the diagnosis of chorioamnionitis to delivery in our study. None of
the newborns had pathologic fetal acidemia (Ua pH < 7.00). None of the FHR patterns we
identified after the diagnosis of acute chorioamnionitis were significantly associated with neonates
with a Ua pH < 7.20.
Conclusions: An interval from diagnosis to delivery of up to 12 h plays little if any role in neonatal
Septic shock is a life-threatening clinical syndrome that, despite its rare occurrence in obstetrics,
remains a leading cause of maternal mortality. Its pathophysiology is explained by a profound
systemic response to a complex variety of host cellular and humoral mediators elaborated after
exposure to microbial toxins. Early recognition, prompt diagnostic workup, and immediate initiation
of therapy improve outcomes. Therefore, recent publications have popularized the concept of the
“sepsis syndrome,” a preshock list of clinical criteria associated with progressive sepsis. Needed
diagnostic studies should never be withheld because of “pregnancy concerns.” With critically ill
patients, the risk-to-benefit ratio supports the use of these diagnostic studies in almost all circumstances.
Standard therapy is directed principally at restoring tissue perfusion by intravascular
volume expansion and in some instances vasoactive pharmacological intervention. Simultaneously,
identification of the source of infection and commencement of appropriate empiric antibiotic treatment
are critical. In some cases, surgical abscess drainage or debridement of infected necrotic tissue
will need to be considered. Novel approaches to treatment that attempt to reduce the systemic
response to microbial toxins are promising and under active investigation. Pregnancy-specific considerations
include the following: 1) initial signs or symptoms of septic shock may be masked by
normal physiologic alterations of pregnancy; 2) a mixed polymicrobial group of organisms, consistent
with lower genital tract flora, should be anticipated; and 3) initial therapy should be directed
at maternal concerns since adverse fetal effects are most likely the result of maternal decompensation.
Background: The presumed ascending route of group B β-hemolytic streptococcus (GBS) infection
from the colonized maternal genital tract is well accepted. This case report proposes a hematogenous,
selective infection of one unruptured amniotic sac over the other ruptured amniotic sac in a
twin gestation in a patient with known GBS vaginal colonization.
Case: This is a case report of GBS sepsis in twin B with intact membranes. Twin A, with 28 h of
ruptured membranes, failed to show any signs of infection. The pathology of the placenta confirmed
chorioamnionitis in twin B and the absence of infection in twin A.
Conclusion: The presence of culture-positive GBS sepsis in the twin with the unruptured amniotic
sac, as well as the absence of GBS infection in the twin with the ruptured sac, suggests an alternative
means of infection for GBS infection, such as hematogenous transplacental transmission.
Objective: This study was undertaken to determine the prevalence of human papillomavirus (HPV)
in loop electrosurgical excision procedure (LEEP) plumes.
Methods: Forty-nine consecutive patients with colposcopic and cytologic evidence of cervical
intraepithelial neoplasia (CIN) were tested. Smoke plumes were collected through a filter placed in
the suction tubing. DNA was harvested by proteinase K digest of the filters and prepared for
polymerase chain reaction (PCR) by L1 consensus primers.
Results: Thirty-nine (80%) tissue samples were positive for HPV, with types 6/11 in 4, 16/18 in 19,
31/33/35 in 2, and other types in 6 patients. The tissue sample was inadequate for typing in 8 patients.
HPV DNA was detected in 18 (37%) filters.
Conclusions: Although the consequences of HPV in LEEP plume are unknown, it would be
prudent to adopt stringent control procedures.
Objective: The purpose of this prospective investigation was to determine if the presence of bacterial
vaginosis (BV) at the time of delivery was associated with the development of maternal and neonatal
Methods: Vaginal fluid was collected from 390 laboring patients. Smears of the vaginal secretions
were gram stained, and slides were scored and interpreted as normal, intermediate, and BV based on
Gram's stain criteria. Results of the Gram's stains were correlated with the clinical diagnoses of
chorioamnionitis, endometritis, and neonatal sepsis.
Results: Eighty-eight percent of patients were term and 12% were preterm. The overall prevalence of BV was 30%. The frequency of BV was similar in both term and preterm women. BV was
significantly more prevalent among nonwhites than whites (37% vs. 25%, P = 0.005). Maternal
characteristics such as mean age, parity, status of the membranes, mean duration of labor, mean
duration of ruptured membranes, mean length of fetal monitoring, mean number of vaginal examinations,
and mode of delivery were similar in patients with BV, intermediate, and normal Gram's
stains. Forty-seven (12%) women developed peripartum infection. The frequencies of chorioamnionitis
or endometritis in women with BV or intermediate Gram's stains were 19/116 (16.4%) and
11/63 (17.5%), respectively. The frequency in each of the 2 groups was significantly increased
compared with the rate in women with normal Gram's stains: 17/211 (8.1%), [P = 0.034, OR = 2.0
(95% CI, 1.07–3.73) for BV and P = 0.054, OR = 2.1 (95% CI, 1.12–3.94) for intermediate Gram's
stain]. The incidence of suspected or confirmed neonatal infection was significantly higher in mothers
with intermediate Gram's stains compared with mothers with normal Gram's stains (P = 0.02,
OR = 2.18, 95% CI, 1.12–3.94), while no difference in incidence was observed between mothers
with BV and normal Gram's stains (P > 0.05). The rate of neonatal infection directly correlated
with maternal group B streptococcal colonization rather than with BV.
Conclusions: In this population, patients with BV and intermediate Gram's stains had an increased
frequency of peripartum infection.
Background: Salmonella typhi may be a cause of significant morbidity and mortality in both the
mother and fetus. Febrile illness during pregnancy, especially that associated with hemolysis, is
associated with chorioamnionitis, pyelonephritis, or viral syndrome. As such, S. typhi should be
considered when a patient presents with a fever and hemolysis. We present a case of S. typhi
Case: A primigravida at 26 weeks gestation presented with persistent spiking temperature and
severe hemolysis. Her presenting signs and symptoms included fever, vomiting, cough, earache,
jaundice, dark urine, and anemia. After 4 units of blood, her posttransfusion hematocrit was 29%.
Hemolysis was evident on a peripheral blood smear. Total bilirubin was 2.5 mg/dl and direct
bilirubin was 1.2 mg/dl. Gentamicin and clindamycin were administered empirically. Stool, blood,
and urine cultures were obtained. Blood cultures were positive for S. typhi. Antibiotic coverage was
changed to gentamicin and ceftriaxone. She defervesced on the 5th day and had no further problems.
A healthy male infant was delivered vaginally at term.
Conclusion: Typhoid fever is a serious infection, and special concern arises when S. typhi complicates
pregnancy. The diagnosis of S. typhi should be considered in a gravida presenting with fever
with prompt institution of antibiotic therapy. Appropriate cultures are essential for confirming the
Objective: The objective of this investigation was to determine the usefulness of blood cultures in
evaluating patients with chorioamnionitis who were treated in accordance with a specific antibiotic protocol.
Methods: We reviewed the records of 539 patients with chorioamnionitis who delivered at our
facility over a 3 year period (July 1, 1989–June 30, 1992). Patients had one set of aerobic and anaerobic blood cultures
at the time of their initial assessment. They were treated initially with ampicillin or vancomycin plus gentamicin. Those
who required cesarean delivery also received clindamycin postoperatively. Patients who had a poor initial response to
therapy were treated empirically with selected antibiotics targeted against likely resistant organisms until the results of
bacteriologic cultures were available. Bacteremic patients had repeat blood cultures while on therapy. We analyzed the
medical records to determine the frequency with which blood culture results led to meaningful changes in patient
management. We also compared the duration of febrile morbidity in bacteremic vs. nonbacteremic patients.
Results: Thirty-nine of 538 patients (7.2%, 95% confidence interval [CI] 5.2–9.2%) had
positive blood cultures. In only one patient did the result of the blood culture definitively alter therapy. This patient had
a fever of unknown origin, and the finding of a positive blood culture ultimately led to the diagnosis of chorioamnionitis.
The mean duration of febrile morbidity was not significantly different in bacteremic vs. nonbacteremic patients (2.03 vs. 1.74 days). None of the repeat blood cultures was positive. The cost of blood cultures in the study population was
Conclusions: The routine use of blood Cultures in the assessment of patients with chorioamnionitis
rarely provides information that justifies a change in clinical management when patients are treated in accordance with
the specific antibiotic protocol outlined in this investigation.
Objective: The purpose of this study was to evaluate the Equate Strep B® test for clinical use in
patients at high risk for complications from group B streptococcus (GBS) disease.
Methods: Vaginoperineal swabs were obtained from patients with preterm premature rupture of
the membranes and/or preterm labor and semiquantitative GBS cultures and Equate® assay were performed.
Results: From May 14, 1990, to April 30, 1992, 650 patients were enrolled; 626 had both culture
and Equate® results available, of whom 24% were colonized with GBS. The sensitivity, specificity, positive predictive value, and negative predictive value of the rapid assay were 28%, 84%, 35%, and 79%, respectively. Although the prevalence of GBS was higher in patients with ruptured membranes compared with those with intact membranes, rupture of membranes did not affect test sensitivity or specificity.
Conclusions: We conclude that the Equate® rapid assay is not a sensitive method of GBS detection in high-risk patients.
Cytomegalovirus (CMV) infection is of great importance to obstetrician-gynecologists because maternal infection
is relatively common and can result in severe injury to the fetus. The greatest risk to the fetus occurs when the mother
develops a primary CMV infection in the first trimester. Forty to 50% of infants delivered to mothers with primary
CMV infections will have congenital infections. Of these neonates, 5–18% will be overtly symptomatic at birth. Approximately 30% of severely infected infants die, and 80% have severe neurologic morbidity. Eighty-five to 90% of infants will be asymptomatic, and 10–15% of these babies subsequently have sequelae such as visual and auditory defects. If the mother develops a recurrent or reactivated CMV infection during pregnancy, the risk of a severe congenital infection is very low. Perinatal infection, as opposed to congenital infection, may result from exposure to the virus during delivery or lactation and rarely leads to serious sequelae. Antimicrobial therapy and immunotherapy for CMV are, at present, unsatisfactory. Therefore, all patients, pregnant women in particular, must be educated about preventive measures.
Objective: Although the incidence of reported cases of toxic shock syndrome (TSS) has declined in
recent years, the disease continues to occur in menstruating women using the newer, less-absorbent tampons or barrier
contraceptives. Extant tampons and other vaginal devices were tested for the ability to induce TSS toxin-1 (TSST-1)
by a TSS strain of Staphylococcus aureus MN8, a known high-toxin producer. Tested for the first time were 20 varieties
of tampons, including 2 all-cotton brands newly introduced in the United States, a polyurethane contraceptive sponge,
a latex diaphragm, and a polymer menstrual collection cup.
Methods: All products were washed in sterile distilled water prior to use to reduce the effect of
leachable chemicals. Duplicate experiments with unwashed products were also performed. Entire tampons and other
test products were immersed in brain heart infusion broth plus yeast extract (BHIY) and inoculated with S.
aureus MN8, a known TSST-1 producer. After incubation, the culture supernatants were assayed for TSST-1 by
Results: Except for all-cotton tampons, greater amounts of TSST-1 were detected in the supernatant
fluid of washed tampons than detected in those which were not washed. While TSST-1 levels in unwashed non-cotton
tampons ranged from 0.5 to 8 μg/ml, when these products were washed, TSST-1 levels increased to 2–32
μg/ml. In all-cotton tampons, whether washed or not, there was no detectable TSST-1.
Conclusions: The propensity for all-cotton tampons not to amplify TSST-1 in vitro suggests they
would lower the risk for tampon-associated TSS.
Objective: The objective of this study was to reevaluate the incidence of occult early midtrimester
intraamniotic infection in asymptomatic patients at the time of genetic amniocentesis.
Methods: A total of 177 amniotic fluid (AF) specimens from patients referred for genetic amniocentesis between 15 and 20 postmenstrual weeks were evaluated for the presence of bacteria by
detailed light microscopy, after Gram and Wright stain, and by cultures for aerobic and anaerobic
baceria, Mycoplasma sp., and Ureaplasma urealyticum. Seventy-seven AF specimens were also tested for the presence of bioactive leukoattractants by a leukotaxis bioassay.
Results: All fluids were negative for bacteria and bioactive leukoattractants [95% confidence interval (CI), 0–1.9%; 99% CI, 0–2.9%]. This is significantly less than a recently reported incidence of 5.09% (P = 0.002). Incidentally, artifacts with light microscopic morphology consistent with spermatozoa were found during the detailed light microscopic evaluation of AF Gram stains from 2 (1.1%) AF samples in otherwise uneventful pregnancies, a previously unreported finding. Scanning electron microscopy was used to confirm the light microscopic findings.
Conclusions: Occult intraamniotic infection in the second trimester is not as high as recently
reported. AF culture in all cases of second-trimester amniocentesis is not necessary. The identification
of spermatozoa on Gram stain of second-trimester AF specimens needs further confirmation.