Double-blind placebo-controlled treatment trial ofChlamydia trachomatis endocervical infections in pregnant women

Martín, David H.; Eschenbach, David A.; Cotch, Mary Frances; Nugent, Robert P.; Rao, Adupa P.; Klebanoff, Mark A.; Lou, Yu; Rettig, Philip J.; Gibbs, Ronald S.; Pastorek, Joseph G.; Regan, Joan A.; Kaslow, Richard A.

doi:10.1002/(sici)1098-0997(1997)5:1<10::aid-idog5>3.0.co;2-i

Cited by 20 publications

(54 citation statements)

References 19 publications

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“…It has been hypothesised that the iron-rich environment of the vagina in menstruating women provides conditions conducive to TV growth and persistence 8. One unique feature of the TV genome is the duplicity for the majority of genes, of which 117 are upregulated in iron-rich environments, and 78 in iron-restricted environments 9.…”

Section: Hormonal Effects As a Major Driver Of Tv Epidemiologymentioning

confidence: 99%

“…One unique feature of the TV genome is the duplicity for the majority of genes, of which 117 are upregulated in iron-rich environments, and 78 in iron-restricted environments 9. The presence of iron facilitates the adherence of TV to the genital tract epithelium 8. This feature may facilitate survival of the parasite in iron-rich environments, like the vagina in menstruating women, where haeme from the breakdown of menstrual blood provides an abundant supply of iron.…”

Section: Hormonal Effects As a Major Driver Of Tv Epidemiologymentioning

confidence: 99%

“…Greater availability of iron in the female genital tract due to menstrual bleeding may contribute to sex-dependent epidemiological patterns of TV infection 8. One study suggests that the TV genome has adapted to existing in the setting of cyclic variation in iron availability,9 such as that present during menstrual cycles.…”

Section: Introductionmentioning

confidence: 99%

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Global epidemiology ofTrichomonas vaginalis

2013

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Despite having the highest prevalence of any sexually transmitted infection (STI) globally, there is a dearth of data describing Trichomonas vaginalis (TV) incidence and prevalence in the general population. The lack of basic epidemiological data is an obstacle to addressing the epidemic. Once considered a nuisance infection, the morbidities associated with TV have been increasingly recognised over the past decade, highlighting the importance of this pathogen as a public health problem. Recent developments in TV diagnostics and molecular biology have improved our understanding of TV epidemiology. Improved characterisation of the natural history of TV infection has allowed us to hypothesise possible explanations for observed variations in TV prevalence with age. Direct and indirect hormonal effects on the female genital tract provide a likely explanation for the greater burden of persistent TV infection among women compared with men. Further characterisation of the global epidemiology of TV could enhance our ability to respond to the TV epidemic.

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Section: Hormonal Effects As a Major Driver Of Tv Epidemiologymentioning

confidence: 99%

Section: Hormonal Effects As a Major Driver Of Tv Epidemiologymentioning

confidence: 99%

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Global epidemiology ofTrichomonas vaginalis

2013

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“…A single trial of treatment for reproductive tract infection due to chlamydia failed to reduce the risk of preterm birth. 355 In a recent review of the impact of treatments for bacterial vaginosis, Joesoef et al 347 concluded that women with symptomatic disease, whether pregnant or not, should be treated with metronidazole (500 mg, twice daily, for 7 days), clindamycin vaginal cream (2%, once daily as a nocturnal intravaginal application, for 7 days), or metronidazole vaginal gel (0.75%, twice daily, for 4 days), because these regimens have produced equivalent cure rates. For pregnant women with high risk of an adverse pregnancy outcome (ie, those with a prior preterm birth) but asymptomatic disease, intravaginal clindamycin is not recommended, because it has failed to reduce rates of preterm births.…”

Section: Antibiotics For Bacterial Vaginosismentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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ABSTRACT. Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developingcountry communities has not been reported.Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in communitybased neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning.Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies.Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care.Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy...

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“…62–72 Moreover, randomized clinical trials have been undertaken to test the effect of antibiotics in patients with bacterial vaginosis (BV), 73–87 Trichomonas vaginalis , 88 group B streptococci (GBS), 89,90 Ureaplasma urealyticum , 91,92 and Chlamydia trachomatis. 93 …”

mentioning

confidence: 99%

Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis

Lamont¹,

Nhan-Chang²,

Sobel³

et al. 2011

American Journal of Obstetrics and Gynecology

165

139

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The purpose of this study was to determine whether the administration of clindamycin to women with abnormal vaginal flora at <22 weeks of gestation reduces the risk of preterm birth and late miscarriage. We conducted a systematic review and metaanalysis of randomized controlled trials of the early administration of clindamycin to women with abnormal vaginal flora at <22 weeks of gestation. Five trials that comprised 2346 women were included. Clindamycin that was administered at <22 weeks of gestation was associated with a significantly reduced risk of preterm birth at <37 weeks of gestation and late miscarriage. There were no overall differences in the risk of preterm birth at <33 weeks of gestation, low birthweight, very low birthweight, admission to neonatal intensive care unit, stillbirth, peripartum infection, and adverse effects. Clindamycin in early pregnancy in women with abnormal vaginal flora reduces the risk of spontaneous preterm birth at <37 weeks of gestation and late miscarriage. There is evidence to justify further randomized controlled trials of clindamycin for the prevention of preterm birth. However, a deeper understanding of the vaginal microbiome, mucosal immunity, and the biology of bacterial vaginosis will be needed to inform the design of such trials.

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Double-blind placebo-controlled treatment trial ofChlamydia trachomatis endocervical infections in pregnant women

Cited by 20 publications

References 19 publications

Global epidemiology ofTrichomonas vaginalis

Global epidemiology ofTrichomonas vaginalis

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis

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