Women in developing countries are at high risk of HIV, sexually transmitted infections, and unplanned pregnancy. The female condom (FC) is an effective dual protective method regarded as a tool for woman’s empowerment, yet supply and uptake are limited. Numerous individual, socioeconomic, and cultural factors influence uptake of new contraceptive methods. We reviewed studies of FC knowledge, attitudes, practices, and behaviors across developing countries, as well as available country-level survey data, in order to identify overarching trends and themes. High acceptability was documented in studies conducted in diverse settings among male and female FC users, with FCs frequently compared favorably to male condoms. Furthermore, FC introduction has been shown to increase the proportion of “protected” sex acts in study populations, by offering couples additional choice. However, available national survey data showed low uptake with no strong association with method awareness, as well as inconsistent patterns of use between countries. We identified a large number of method attributes and contextual factors influencing FC use/nonuse, most of which were perceived both positively and negatively by different groups and between settings. Male partner objection was the most pervasive factor preventing initial and continued use. Importantly, most problems could be overcome with practice and adequate support. These findings demonstrate the importance of accounting for contextual factors impacting demand in FC programming at a local level. Ongoing access to counseling for initial FC users and adopters is likely to play a critical role in successful introduction.

Lactobacillus species play an integral part in the health of the vaginal microbiota. We compared vaginal Lactobacillus species in women from India and the USA with and without bacterial vaginosis (BV). Between July 2009 and November 2010, a cross-sectional study was conducted among 40 women attending a women's health clinic in Mysore, India, and a sexually transmitted diseases clinic in San Francisco, USA. Women were diagnosed with BV using Amsel's criteria and the Nugent score. Lactobacillus 16S rDNA was sequenced to speciate the cultured isolates. Ten Indian and 10 US women without BV were compared with an equal number of women with BV. Lactobacilli were isolated from all healthy women, but from only 10 % of Indian and 50 % of US women with BV. 16S rDNA from 164 Lactobacillus colonies was sequenced from healthy women (126 colonies) and women with BV (38 colonies). Seven cultivable Lactobacillus species were isolated from 11 Indian women and nine species from 15 US women. The majority of Lactobacillus species among Indian women were L. crispatus (25 .0%), L. jensenii (25.0 %) and L. reuteri (16.7 %). Among US women, L. crispatus (32.0 %), L. jensenii (20.0 %) and L. coleohominis (12.0 %) predominated. L. jensenii and L. crispatus dominated the vaginal flora of healthy Indian and US women. Indian women appeared to have a higher percentage of obligate heterofermentative species, suggesting the need for a larger degree of metabolic flexibility and a more challenging vaginal environment. INTRODUCTIONIt is well accepted that Lactobacillus species are a critical component of the vaginal microflora of healthy women. These Gram-positive rods have been shown to have a protective effect against overgrowth by pathogenic microorganisms (Thomas, 1928). While studies have demonstrated that the vaginal microflora is dominated by four Lactobacillus species, L. crispatus, L. jensenii, L. gasseri and L. iners, there is substantial heterogeneity among different human populations (Pavlova et al., 2002).Studies in the USA, Europe and Japan have shown that women are predominantly colonized by obligate homofermentative lactobacilli that produce only lactic acid (Giorgi et al., 1987;Antonio et al., 1999;Song et al., 1999; Vásquez et al., 2002;Martín et al., 2008). Pavlova et al. (2002) found that the vaginal microbiota was dominated by L. crispatus, L. jensenii and L. gasseri in seven countries, while the microbiota of women from several low-and middle-income countries more often included heterofermentative Lactobacillus species such as L. All participants underwent a physical examination and biological specimens were collected to detect reproductive tract infections. The diagnosis of BV was initially based on the criteria of Amsel et al. (1983). Three vaginal swab specimens were obtained from the posterior fornix of the vagina. The first swab was used to measure the vaginal pH, with the swab smeared onto a microscope slide and then placed in a tube containing four drops of normal saline for wetmount preparation. The remaining two sw...

Printed educational materials (PEM) can serve as important tools to enhance and reinforce information presented during genetic counseling (GC) for BRCA1/2 testing, yet few such materials have been specifically developed for the Black community. The goal of the current study was to develop a BRCA1/2 genetic education booklet for Black women at increased risk for hereditary breast and ovarian cancer (HBOC). Investigators identified available PEM about BRCA1/2 targeted toward Blacks. To obtain possible perspectives of the target population regarding modified and newly developed materials, a Community Advisory Panel (CAP) comprising breast cancer survivors, advocates, and community leaders was convened. While the CAP felt PEM were an important adjunct to GC, the panel recommended developing materials that were more personalized and relevant to Black women. A 12-page booklet that follows the flow of a standard GC session was developed; it includes a limited amount of technical information, incorporates familiar terms and images to describe key concepts, and contains vignettes and photographs of Black women. Upon review of the newly developed booklet, CAP members agreed their input had been well implemented, and only had minor suggestions. The booklet is currently being used in a population-based study of BRCA1/2 mutations among Black women diagnosed with early-onset breast cancer. Involving members of the target community is critical to the development of culturally tailored PEM. Further evaluation of the utility of our booklet in increasing awareness and understanding of HBOC and promoting informed decision-making regarding genetic testing and medical management among Black women is needed.

community-based education programmes focusing on changes to sexual behaviour. However, STIs rates are still high, and the problem needs more concrete and sustained efforts for its control. Screening for Ct., Ng. and Uu. is recommended during pregnancy. Based on our finding in this study, the overall high incidence of Ct. and Uu. support screening recommendations for pregnant women in Sabzevar-Iran. Molecular TyPing and deTecTion of Macrolide resisTance MuTaTions in T. PalliduM sTrains froM cali, coloMbia