Abstracts From the First Annual International Infectious Disease Society for Obstetrics and Gynecology—USA

In the summer and fall of 199.5, the International Infectious Disease Society for Obstetrics and Gynecology-USA was founded, with a commitment to the discipline of infectious disease and the health care of women worldwide. Scientists from other corners of the world have different clusters of diseases, different laboratory approaches, and new methods of problem solving that often shed light on unresolved questions regarding society. By establishing this organization, the founding members have succeeded in their goal to share knowledge through freer access to infectious disease specialists around the world. Published in this issue are the abstracts of the first meeting of the International Infectious Disease Society for Obstetrics and Gynecology-USA held in Boulder, CO, on April 27-29, 1996. While the readers can judge for themselves the quality of the abstracts, what cannot be conveyed in writing are the zest of the discussions and the camaraderie of those attending the meeting. The American and international members as well as guests were enthusiastic about our new organization and plans for the next meeting in Nevada in the spring of 1997. We share their anticipation of an exciting and stimulating event.

In the last 8 years, the gynecologic population followed by a single practitioner in the City ofHouston has increased. Now, 600 HIV+ women are being followed. The cervical dysplasia rate in this group has ranged from 40-50%, although the diagnosis ofcervical cancer has antedated the HIV diagnosis in only 2 cases. An increasing problem has been recurrent herpetic ulcers. Twelve patients with markedly depressed CD4 counts (< 50) have had positive herpes cultures associated with a failure to respond to oral acyclovir. They have been treated with intravenous acyclovir to arrest the progression ofrectovaginal fistulas and erosive ulcers of2-3 cm in size. Two patients presenting with erosive ulcers were subsequently diagnosed with vulvar cancer, in both cases, after their herpes cultures were negative. In addition, there have been 2 cases of giant condyloma, measuring > 6 cm by 3 cm and requiting surgical correction. One patient was found to have giant (6 cm by 3 cm) molluscum contagiosum mimicking condyloma that occluded the perineum. These atypical presentations heighten the requirement for biopsies and cultures when such patients present for care. We evaluated the in vitro activity ofbenzydamine (BZ) against microorganisms in the vaginal ecosystem with timekill assays. The killing times for two strains (a wild type and an ATCC) of Candida albicans, C. glabrata, Streptococcus agalactiae, S. faecalis, Escherichia coli, and Gardnerella vaginalis were determined at 2X MBC, MBC, and 1/2 MBC. If 100% kill did not occur, a 3-1 og0 decrease in colony forming units (cfu) was considered a sufficient bactericidal response. C. albicans and C. glabrata had 100% kill at 2X MBC, MBC, and 1/2 MBC. E. coli had 100% kill at 2X MBC and MBC, but no decrease in cfu at 1/2 MBC. S. agalactiae, both strains, had 100% kill at 2X MBC. At MBC, only the S. agalactiae ATCC had a sufficient bactericidal response; both strains had insufficient responses at 1/2 MBC. G. vaginalis had 100% kill at 2X MBC and MBC. Only the wild type had a 3-1og10 decrease in cfu at 1/2 MBC. E.faecalis achieved 100% kill at 2X MBC. At lower levels, the decrease in cfu was variable. A sufficient bactericidal response to BZ occurred at 2X MBC and MBC for C. albicans, C. glabrata, E. coli, and G. vaginalis. Only Candida had 100% kill at 1/2 MBC. S. agalactiae and S. faecalis achieved bactericidal responses at 2X MBC. These results support the hypothesis that BZ has antibacterial and antimycotic properties warranting further testing against a greater number of vaginal pathogens.
Clinically recognizable congenital infections account for only a small proportion of infectious diseases in newbores. However, fetal infections may be one of the most frequent causes of perinatal mortality. The ability to identify ultrasound markers of embryo and fetal infections offers the possibility of identifying etiologic agents, correlating subtle infections with specific antepartum and postpartum syndromes, and reducing the problem of silent infections that result in unexplained adverse pregnancy outcomes. High resolution and color Doppler ultrasound were used to detect the structural and blood-flow changes caused by infection-induced vasculitis ofvillous stem arteries and ofuterine radial and spiral arteries produced by focal lymphocytic and histiocyte infiltration of villi and decidua with resultant necrosis, granular tissue and fibroblastic proliferation, or fibrosis. The placental edema that results from an infection of the villi can, at times, be detected prior to the changes of necrosis and fibrosis of villi. We detected fetal hydrops, fetal and placental pathologic calcification, umbilical-cord edema, and placental thickening in cases of prenatal toxoplasmosis, cytomegalovirus infection, Chagas' diseases, syphilis, and congenital hepatitis. Premature extravillous calcification, pathologic intravillous calcification, and ominous changes in the maternal uterine-artery flow, umbilicalcord blood flow, and fetal middle-cerebral-artery flow are of prognostic significance when associated with infection. Nonoxynol-9 is the most commonly used spermicidal agent in the United States. While Nonoxynol-9 has been approved for over 40 years, a recent observation has been made that its frequent use can predispose a patient to the formation of lower-genital-tract lesions. These lesions may become a portal ofinfection to HIV and other serious pathogens. Using quantitative vaginal cultures, we noted that the daily use of 100 mg ofNonoxynol-9 for 5-15 days caused a destruction ofthe vaginal lactobacilli and an "altered flora" in which the predominant organisms were the zenteric bacteria, Streptococcusfaecalis, and abnormally high numbers of anaerobes. These flora changes appear to predispose a patient to vaginal lesions, bacterial vaginosis, and urinarytract and yeast infections. We postulate that the effects of Nonoxynol-9 on the vaginal flora potentiate the formation ofthese lesions and, to a lesser extent, direct chemical irritation in a given patient. In patients with these Nonoxynol-9induced lesions, Inner Confidence TM vaginal suppositories Certain bacterial proteins called fimbriae, pili, or adhesins on the bacteria cell surface help the cell to adhere to specific receptors present on the tissue surface and colonize the host. One such bacterial protein is Dr-fimbriae which are present on Escherichia coli and associated with infection of the urinary tract. Recently, we reported that Dr-timbriae recognize a specific tissue receptor on the complement decay-accelerating factor (DAF), a complement regulatory protein. One of the primary functions of the human body defense mechanism is to protect the host from external or foreign cells including cancer cells. This function is performed by the human complement system by selectively killing the foreign or cancer cells by lytic action. The host cells are protected from this toxic or the killing effect by the presence ofthe host cell surface. The function of these proteins is to inactivate complement, and DAF is an important member of this group. In our studies on tissue samples from the human endometrium, we observed a 400-to 800-fold increase in the expression of DAF/Dr ligand in adenocarcinoma of the endometrium compared with normal tissues. This overexpression of DAF may help cancer cells escape the complement-mediated killing. We also observed a 40to 50-fold increase in DAF/Dr ligand expression in hyperplastic lesions of the human endometrium. This study may allow us to develop a simple diagnostic aid to detect and follow human cancers using purified Dr-fimbriae. In addition, the use ofDr-fimbriae to inactivate DAF function on cancer cells may provide an entirely new and efficient method to treat cancers by exposing cancer cells to specific drugs or antibodies.
A study of 97 postpartum patients was performed to analyze the relationship of mean body temperature, the amplitude of daily temperature fluctuations, and the variance of this relation within the sample. The data consisted of body temperature recordings, measured every 4 hours to within two-tenths of a degree Fahrenheit, in postpartum patients under normal clinical conditions. Ofthe 97 cases, 78 suffered from febrile morbidity, while 19 did not. The patients' hospital stays ranged from 2-18 days, with a median of 5 days. The temperature recordings were grouped into 24-hour segments (6 temperature readings) for each patient.
Within each 24-hour segment, 2 parameters were calculated: (1) the mean body temperature T and (2) the difference between the maximum and minimum readings (temperature fluctuation) F. For each patient in the study, a line was fitted to the (T,F) data pairs by minimum square error, yielding a slope coefficient S. For each patient, S served as a measure of the rate of increase in temperature fluctuations per unit increase in mean body temperature. Finally, the mean and standard deviations were computed for the distribution of S values over the patient sample. The entire sample yielded a mean S value of0.42, with a standard deviation of0.88. The subsample of 78 febrile patients yielded a mean S value of 0.38, with a standard deviation of 0.65. Both mean S values were statistically significantly distinct from 0 (P < 0.001).
This study demonstrated a statistically significant positive correlation between mean body temperature and amplitude of daily temperature fluctuations for the entire sample. The study also showed significant variance ofthis relation within the sample.
The World Health Organization, United States National Institutes of Health, and other health authorities have expressed their urgent concerns for the development of a female-controlled, safe, topically active microbicide that could prevent the heterosexual transmission ofHIV as well as other sexually transmitted diseases. Inner Confidence TM fulfills all ofthe efficacy and safety concerns ofthese organizations. The frequent use of Inner Confidence TM does not cause the vaginal lesions associated with Nonoxynol-9 products. It destroys both the white blood cells and spermatozoa which may act as carriers of infectious organisms and prevents the postcoital rise in vaginal pH. Moreover, it is compatible with latex condoms. Intravaginally, Inner Confidence TM kills Gardnerella vaginalis, Neisseria gonorrhoeae, the pyogenic cocci, the enterics, Candida, Chlamydia trachomatis, Trichomonas vaginalis, herpes simplex 2, HIV, and other pathogens for 8 hours. After the antimicrobial concentrations ebb, hydrogen peroxide and microcidin-producing, micro-encapsulated lactobacilli are released which replen-ishes the normal vaginal flora and appears to prevent genital-tract lesions. Trichomonas vaginalis (TV) is one of three major causes of vaginitis in women. The association of TV with bacterial vaginosis (BV) has been reported, but rarely analyzed. Before metronidazole, TV was treated by maintaining a normal pH range (3.8-4.2) of the vagina to decrease TV growth, indicating the important role of the vaginal pH in TV survival. Menstrual blood, semen, and vaginal discharges, pathogens, and syndromes such as BV transform the pH to a less acidic level (>4.5) favoring TV growth. To determine an association of BV in the pathogenicity of TV, we screened for both infections. Presenting to the gynecology clinic for nonannual examinations were 72 nonpregnant, premenopausal women, ofwhom 40 had complaints ofvaginal discharge (symptomatic) and 32 had no complaints (asymptomatic). Each patient had a vaginal sample examined for pH, wet preparation, 10% KOH, and Gram's stain smear. A patient was excluded if she had a positive screening test for Chlamydia trachomatis or Neisseria gonorrhoeae or if she had hyphae or yeast cells on the wet preparation. A TV culture using Diagmond's medium was also performed. The Gram's stain criteria for BV diagnosis described by Nugent et al. was followed. Twenty-seven (37%) patients were diagnosed with TV; 29 (40%) were noted to have met the Gram's stain criteria for BV (pH >4.5); 12 (16%) were considered normal; and 4 (7%) were excluded. Of the 27 TV patients, 21 (78%) were symptomatic and 6 (22%) were asymptomatic. Twenty-one ofthe 24 (88%) TV patients were also found to have a score of 7 according to the Gram's stain BV criteria. In asymptomatic patients, 4 of 6 with elevated pHs and WBCs on the wet preparations were positive for TV compared with 10 with elevated pHs, but no WBCs (P=0.008). The TV and BV patients appeared to share a similar environment, diverging only in the area of increased WBCs for the TV patients and increased clue cells for the BV patients. TV may require an altered environment for infection that is augmented or supplied by factors similar to those seen with BV. Therefore, an asymptomatic patient with an elevated pH and WBCs seen on the wet preparation should