New Contraception Update — Annovera, Phexxi, Slynd, and Twirla

Purpose of Review In this review, we discuss the efficacy, safety, and benefits of four new contraceptive products available in the USA, specifically Annovera, Phexxi, Slynd, and Twirla. Recent Findings Annovera is a vaginal ring releasing ethinyl estradiol and segesterone acetate that can be used for up to one year (13 cycles), offering patients an effective, user-controlled option that may improve contraceptive access for those in low-resource settings or those with barriers to retrieving monthly prescriptions; however, given limited efficacy and safety data in people with body mass index (BMI) > 29 kg/m2, clinicians may consider whether Annovera is an appropriate contraceptive method for obese patients if there are other acceptable alternatives. Phexxi prescription-only vaginal gel is a user-controlled, non-hormonal, on-demand contraceptive method that represents a novel addition to the market with its additional uses as a personal lubricant and as a potential microbicide for urogenital infection prevention. Slynd, a drospirenone-only pill, provides more flexibility for delayed or missed pills while maintaining efficacy and a more favorable bleeding profile compared with previously available progestin-only pills. Lastly, Twirla is a transdermal patch releasing ethinyl estradiol and levonorgestrel that offers users an additional option for a user-controlled, combined hormonal contraceptive method without daily dosing; however, prescription is limited to patients with BMI < 30 kg/m2 due to decreased efficacy and VTE events in people with obesity. Summary The addition of these products expands the available options for pregnancy prevention to address unmet contraceptive needs.

Probiotics: Should All Patients Take Them?

The usefulness of probiotics in the treatment as well as prevention of many infections and disorders has been confirmed by previous clinical studies. They can protect not only against gastrointestinal diseases such as diarrhea or enteritis but they have proven efficacy against pneumonia, urogenital infection, depression/anxiety, cancer metastasis, obesity, and others. However, it should be mentioned that not all clinical trials have shown improvement of health in patients undergoing probiotic treatment, and very rarely have even reported that probiotic strains may be the causative agents of opportunistic infections. Studies have documented cases of sepsis/bacteremia, endocarditis, liver abscess, pneumonia, and fungemia caused by probiotic strains, mainly in high-risk groups. This review summarizes the cases of infections caused by probiotic strains and the potential hazard associated with the supplementation of probiotics in seriously ill and hospitalized patients.

Association between Human Papillomavirus and Chlamydia trachomatis genital infections in male partners of infertile couples

The prevalence of HPV infection and its relationship with other sexually transmitted infections was analyzed in a cohort of 117 male partners of infertile couples from Cordoba, Argentina. Semen samples and urethral swabs were obtained and the infection with HPV, Chlamydia trachomatis, HSV1, HSV2, Mycoplasma hominis and Ureaplasma urealyticum was analyzed. A prevalence of HPV infection of 27.4% was found. Interestingly, infections by exclusively low risk HPV genotypes or high/intermediate risk HPV genotypes were present in 64.5% and 22.6% of cases, respectively. Low risk-HPV6 was the most frequently detected genotype. Remarkably, HPV and C. trachomatis infections were significantly associated to each other (OR: 11.55, 95% CI 1.14–117.06). No significant differences in sperm quality were found between HPV-positive and HPV-negative patients indicating that HPV male urogenital infection does not impair sperm quality. Our results show a high prevalence of HPV urogenital infection among male partners of infertile couples, and that HPV and C. trachomatis infections are reciprocal risk factors of their co-infection. Moreover, our results suggest that men constitute a reservoir for continued transmission of C. trachomatis and HPV to women highlighting the need for routine screening for these two pathogens in male partners of infertile couples.

Risk factors for neonatal intrauterine infection in pregnant women with urogenital infection

Objective. To determine the clinical and anamnestic risk factors for neonatal intrauterine infection (IUI) in pregnant women with urogenital infections (UGI).Materials and methods. 431 patients were examined: the main group (group 1) — 353 women with UGI during pregnancy (subgroup 1A — 215 women whose children were diagnosed with IUI, subgroup 1B — 138 women whose children were born without signs of IUI; the comparison group (group 2) — 78 women without UGI during pregnancy (subgroup 2A — 44 patients whose children were born with signs of IUI, subgroup 2B — 34 women whose children did not have IUI. We studied the obstetric and gynecological, somatic anamnesis of the patients, the course of their pregnancy.Results. The presence of gynecological and somatic diseases in the anamnesis of the pregnant women with UGI was associated with a signifcant increase of the risk for neonatal IUI (p = 0.003 and p = 0.005, respectively). Vaginitis (p = 0.041), background and precancerous diseases of the cervix (p = 0.027) were signifcantly most prevalent in the pregnant women with UGIs in their history. Pregnancy complicated by UGI proceeded with a recurrent miscarriage risk (p = 0.046) was most often accompanied by acute respiratory infection (p ˂ 0.001) and signifcantly most often ended in premature birth — 24.7% (p = 0.009).Conclusion. The search for objective criteria for the development of neonatal IUI is an important and complex task of modern obstetrics. The analysis of the anamnesis of pregnant women with urogenital infections, as well as timely diagnosis and adequate treatment of urogenital infection and acute respiratory infection will reduce the miscarriage rate and the incidence rate of neonatal IUI.

Results from a large cross-sectional study assessing Chlamydia trachomatis, Ureaplasma spp. and Mycoplasma hominis urogenital infections in patients with primary infertility

Female and male infertility have been associated to Chlamydia trachomatis, Ureaplasma spp. and Mycoplasma hominis urogenital infections. However, evidence from large studies assessing their prevalence and putative associations in patients with infertility is still scarce. The study design was a cross-sectional study including 5464 patients with a recent diagnosis of couple’s primary infertility and 404 healthy control individuals from Cordoba, Argentina. Overall, the prevalence of C. trachomatis, Ureaplasma spp. and M. hominis urogenital infection was significantly higher in patients than in control individuals (5.3%, 22.8% and 7.4% vs. 2.0%, 17.8% and 1.7%, respectively). C. trachomatis and M. hominis infections were significantly more prevalent in male patients whereas Ureaplasma spp. and M. hominis infections were more prevalent in female patients. Of clinical importance, C. trachomatis and Ureaplasma spp. infections were significantly higher in patients younger than 25 years. Moreover, Ureaplasma spp. and M. hominis infections were associated to each other in either female or male patients being reciprocal risk factors of their co-infection. Our data revealed that C. trachomatis, Ureaplasma spp. and M. hominis are prevalent uropathogens in patients with couple’s primary infertility. These results highlight the importance of including the screening of urogenital infections in the diagnostic workup of infertility.

THE ROLE OF UROGENITAL INFECTIONS IN THE PATHOGENESIS OF THE DEVELOPMENT OF MALE INFERTILITY

Вопрос бесплодия на сегодняшний день остается актуальным как в Казахстане, так и во всем мире. На основании данных Всемирной Организации Здравоохранения, ежегодно число бесплодных пар составляет 4-5% от всеобщей популяции. Причин бесплодия - множество. Но одним из острых и первоочередных причин данной патологии является мужское бесплодие, частота возникновения которого составляет 48,8% от общего количества случаев. [1] По данным мировых исследований, в процентном соотношении причины мужского бесплодия составляют: бесплодие неясного генеза - 31,2%, варикоцеле - 14,7%, эндокринные нарушения - 8,45%, инфекции урогенитального тракта - 8,3%, иммунологические факторы - 4,8%, опухоли яичек - 1,17%. [2] The issue of infertility today remains relevant both in Kazakhstan and around the world. The World Health Organization accounts for 4-5% of the general population annually. There are many reasons for infertility. One of the acute and primary causes of this pathology is male infertility, the incidence of which is 48.8% of the total number of cases. According to world studies, the percentage of the causes of male infertility are: infertility of unknown origin - 31.2%, varicocele - 14.7%, endocrine disorders - 8.45%, infections of the urogenital tract - 8.3%, immunological factors - 4 , 8%, testicular tumors - 1.17%. Goal. Establishing the role of individual infections and their association of the urogenital tract in the development of male infertility. Materials and methods. The study was carried out on the basis of the GKP on the REM "City polyclinic No. 26" in Almaty. A retrospective analysis of individual cards of 538 men from 21 to 45 years old who consulted urologists with complaints of urination, pain and discomfort in the anogenital region and above the bosom from January to December 2020 was carried out. The patients were divided into two groups: the first group - 258 men suffering from infertility, and who have other causes of infertility, the second - 280 men with normal fertility. Diagnostic methods were selected: bacterial culture of urine and scraping from the urethra, PCR of urogenital infections. Result: The total dissemination of the urethra in patients of the first group is 3 times higher than in men of the second group. However, we were interested not only in the general dissemination and types of pathogens, as according to the literature [1,2] the most aggressive chlamydia trachomatis and ureoplasm. In our frequency of occurrence of chlamydial infection in both groups was 153 (59.3%) and 23 (8%); mycoplasma - 148 (57.3%) and 45 (16%); ureaplasma - 137 (53.1%) and 63 (22.5%); Candida - 98 (37.9%) and 35 (12.5%); Trichomonas - 87 (33.7%) and 48 (17.1%); gardnerella - 94 (36.4%) and 56 (20%) people, respectively. Conclusions. Urogenital tract infections are the main reason people see a doctor. Infections are one of the factors in the development of infertility in men. For infection of the urogenital tract, PCR is the most sensitive and accurate compared to urine culture and urethral scrapings. The total dissemination of urogenital infection in the group of men with infertility is 46.3%, in comparison with the group of men with a normal norm in whom the percentage of STIs is 16%, indicates a direct effect of urogenital infection on the development of the male population. Along with the revealed, as the main factor of influence of the reproductive system, chlamydia trachomatis 59.3%, mycoplasma 57.3%, ureoplasm 53.1%, which moved to the second and third place in the development of infertility in the studied men. This factor and methods of treatment will be studied in studies.

Prevalence of common urogenital infections among menstrual cup users

There has been an increased awareness among girls and women in India, especially from middle and higher income group on menstrual cup, due to health or environmental reasons. Use of various sanitary products during menstruation can impact menstrual health with incidence of urogenital infection like rashes, irritation etc. being common among women. To determine prevalence of symptoms related to urogenital infections before and after switching to menstrual cups. In this retrospective self-reported study, females using menstrual cup were administered a questionnaire consisting of questions related to symptoms of urogenital infections in their lifetime. A total of 301 menstrual cup users were included in this study. The most common symptom reported by the respondents included rashes (48%), itching (48%), abdominal pain (40%.), foul smelling white discharge (22%), excessive white discharge (20.6%) and burning sensation while passing urine (15%). The prevalence of the symptoms was lower after switching to menstrual cups. Among the most common symptoms, 92% women were relieved from rashes, 79% from symptoms of itching and 42% from abdominal pain. Approximately, 1-5% women reported symptoms only after switching to menstrual cups.The results demonstrate lower prevalence of symptoms of urogenital infections among women when compared to their previously used menstrual product. Symptoms of urogenital infections did not affect the acceptance and continuance of menstrual cups usage. Additional clinical studies will be required to compare changes in occurrence of symptoms post switching to menstrual cups and develop linkage between these symptoms with usage of menstrual cup.

Influence of age on sperm characteristics evaluated by light and electron microscopies

The impact of male aging on male fertility has only recently become of interest to the scientific community. This study aims to assess the relationship between age and fertility among a sample of men, considering the individual and pathological characteristics. In this retrospective study data of semen analysis and medical history of 1294 Italian male patients were considered. Semen analysis was performed by light microscopy and transmission electron microscopy mathematically elaborated. A generalized linear model was used to explore the influence of male age on semen quality, considering as confounders wine consumption, smoking habits, presence of varicocele, consanguinity and positive semen bacteriological analysis and urethral swab. The mean age of the participants was 36.41 ± 6.379. Male aging without impact of confounders was correlated with a decrease in sperm concentration and motility and an increased in sperm necrosis. Sperm concentration and progressive motility were negatively related to the presence of confounders as wine consumption (sperm motility), urogenital infection (sperm concentration and motility), varicocele (sperm concentration) and consanguinity (sperm motility). Urogenital infection, varicocele and consanguinity positively correlated with sperm necrosis. The most important finding was the observation of a negative effect of male aging on sperm parameters such as concentration, motility, and viability. It is possible to hypothesize age-dependent changes of testicular environment, probably related to reactive oxygen species production. The demonstration, in a large sample of patients, that aging influences sperm quality strongly motivates further research focused on the mechanisms involved in this phenomenon and its effects on offspring fitness.

Reducing suspicion of sexual abuse in paediatric chlamydial conjunctivitis using ompA genotyping

Chlamydia trachomatis is a Gram-negative bacterium that causes urogenital tract infections, and ocular infections including trachoma, neonatal conjunctivitis and adult chlamydial inclusion conjunctivitis. A positive C. trachomatis diagnosis in children often raises suspicions of sexual abuse. While outer membrane protein A (ompA) genotypes A–C are non-invasive and are associated with trachoma; ompA genotypes D–K are often associated with sexually transmitted urogenital infections or sexually acquired chlamydial conjunctivitis. A 10-year-old female presented with a 7-month history of unilateral conjunctivitis with itching, watering and hyperaemia. She had recently moved from an urban centre in Afghanistan to the UK. A conjunctival swab taken from the child tested positive for C. trachomatis. Application of ompA genotyping to conjunctival swab chlamydial DNA demonstrated that the C. trachomatis had an ompA genotype C. Chlamydial strains with this ompA genotype cause trachoma and have never previously been associated with urogenital infection. This result supported cessation of child protection investigations.

Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis urogenital infections in patients with infertility. Results from a large cross-sectional study.

Female and male infertility have been associated to Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis urogenital infections. However, evidence from large studies assessing their prevalence and putative associations in patients with infertility is still needed. The study design was a cross-sectional study including 1554 female and 3610 male patients with infertility in Cordoba, Argentina. In women, the prevalence of C. trachomatis, U. urealyticum and M. hominis urogenital infection was 4.3%, 31.1% and 12.1% whereas in men it was 5.8%, 19.2% and 5.3%, respectively. C. trachomatis infection was significantly more prevalent in men whereas U. urealyticum and M. hominis infections were more prevalent in women. Besides, C. trachomatis and U. urealyticum infections were significantly higher patients younger than 25 years. Moreover, U. urealyticum and M. hominis infections were associated to each other in either infertile women or men. Our data revealed that C. trachomatis, U. urealyticum and M. hominis are prevalent uropathogens in infertile patients. Of clinical importance, C. trachomatis and U. urealyticum infections were more prevalent in young patients whereas U. urealyticum and M. hominis are reciprocal risk factors of their co-infection. These results highlight the importance of including the screening of urogenital infections in the diagnostic workup of infertility.