Prevalence, Associated Risk Factors and Maternal Outcomes of Lower Genital Tract Injuries in the Bamenda Regional Hospital

BACKGROUND: Tears of the genital tract are lesions resulting from the breakage of the continuity of the lower genital tract during childbirth. These injuries are associated with high maternal morbidity or mortality if severe, poorly managed or delayed in repair. It is a frequent complication of vaginal delivery. This study was aimed at determining the prevalence, demographic characteristics, risk factors, patterns and the t-term maternal outcomes of lower genital tract injuries in the labour room and the post-natal ward of the Bamenda Regional Hospital. METHODS: This was a hospital-based cross-sectional study of women managed for genital tract injuries following vaginal birth in the Bamenda Regional Hospital (BRH) from March 2019 to July 2019. A non-probabilistic, consecutive and exhaustive sampling technique was used to select participants (sample size estimated at 237). Among those selected were women who had a vaginal birth. However, the researchers’ interest was particularly centered on the women who had genital tract injuries. Data was collected using a pretested questionnaire and analyzed using the SPSS version 22 software. RESULTS: In total, 310 participants were included in this study. The mean age of the participants was 26.1 years (SD = 5.2), while the median age was 25 years (interquartile range = 22 - 29). Of the 310 participants included in the study, 128 developed a birth tract injury giving a prevalence of 41.3% (95% CI, 35.8 - 47.0). The most common type of injury was spontaneous tears (33.9%), the majority of which were perineal (30.6%) compared to episiotomies (7.4%). Most perineal tears were first degree tears (23.2%) followed by second-degree tears (6.8%). Third-degree perineal tears were rare (0.6%). We did not have any cases of fourth-degree perineal tears. We also encountered a few cases of cervical tears (0.6%). The factors associated with birth tract injury were assessed using bivariate and multiple logistic regression analysis. On bivariate analysis, being an adolescent parturient (OR = 2.8, 95% CI: 1.4 - 5.7, p = 0.005), single (OR = 1.78, 95% CI, 1.04 - 3.03, p = 0.034), having a history of birth tract injury (OR = 1.69, 95% CI, 1.01 - 2.95, p = 0.042), a duration of active phase of labour (OR = 2.1, 95% CI, 1.3 - 3.3, p = 0.002), being a primipara (OR = 2.8, 95% CI, 1.0 - 8.4, p = 0.045), inducing labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), augmenting labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), birthweight of 4000 g or more (OR = 3.0, 95% CI, 1.3 - 7.4, p < 0.015), and foetal head circumference greater than 36 cm (OR = 3.3, 95% CI, 1.5 - 7.9, p = 0.005) were statistically significantly associated with birth tract injuries. The majority of the blood loss post-partum was between 200 and 500 cc. Only one participant had a blood loss of 500 cc and above. Also, the severity of genital pain lasting beyond 24 hours postpartum was mostly less than 5/10 (50.6%) followed by genital pains > 7/10 (41.7%). The prevalence of infection of the injury was (1.6%) and no maternal death from injury was recorded. CONCLUSION: The prevalence of lower genital tract injuries in the Bamenda Regional hospital is high. First-degree tears were the most common followed by episiotomies. The perineal outcome in the BRH is poor and should be improved upon.

Clinicopathologic analysis of angiomyofibroblastoma of the female genital tract

To study the clinicopathologic features and immunoprofile of angiomyofibroblastoma (AMF) with emphasis on differential diagnosis Methods Seven vulvar, two vaginal and one perineal angiomyofibroblastomas were evaluated by light microscopy and immunohistochemistry The immunohistochemical studies were performed on paraffin embedded sections using the standard ABC method with a panel of antibodies Results Angiomyofibroblastoma predominantly occurred in middle aged women in the genital region, especially in the superficial area of the vulva Clinically, most of the tumors presented as slowly growing painless masses and were often diagnosed as Bartholin’s gland cysts Histologically, the tumors were all well circumscribed and characterized by alternating hypocellular and hypercellular areas with abundant thin walled blood vessels The tumor cells were bland and spindle shaped or epithelioid and tended to concentrate around the vessels or cluster in small nests Immunohistochemically, the tumor cells expressed vimentin and estrogen receptor protein in all 10 cases and desmin in 9 cases Three cases showed weak or focal immunoreactivity to alpha smooth muscle actin and muscle specific actin All ten patients were treated by local excision Follow up showed a benign course with no signs of recurrence Conclusions Angiomyofibroblastoma is a distinctive neoplasm that has a propensity to occur in the female genital tract Recognition of this entity is important to avoid misdiagnosis with other vulvar angiomyxoid

Chlamydia trachomatis infection in the genital tractis associated with inflammation and hypospermia inthe infertile male of China

Chlamydia trachomatis (CT) infection is the most prevalent sexually transmitted bacterial disease worldwide. However, unlikethat in female infertility, the role of CT infection in male infertility remains controversial. The objective of this retrospective studywas to explore the impacts of CT infection in the genital tract on sperm quality, sperm acrosin activity, antisperm antibody levels,and inflammation in a large cohort of infertile males in China. A total of 7154 semen samples were collected from infertile malesubjects, 416 of whom were CT positive (CT+ group) and 6738 of whom were CT negative (CT− group), in our hospital betweenJanuary 2016 and December 2018. Routine semen parameters (semen volume, pH, sperm concentration, viability, motility,morphology, etc.), granulocyte elastase levels, antisperm antibody levels, and sperm acrosin activity were compared between theCT+ and CT− groups. Our results showed that CT infection was significantly correlated with an abnormally low semen volume, aswell as an increased white blood cell count and granulocyte elastase level (all P < 0.05) in the semen of infertile males;otherroutine semen parameters were not negatively impacted. The antisperm antibody level and sperm acrosin activity were not affectedby CT infection. These findings suggested that CT infection might contribute to inflammation and hypospermia but does not impairsperm viability, motility morphology, and acrosin activity or generate antisperm antibodies in the infertile males of China.

HIV Compartmentalization in Male Genital Tract:Relevance for Viral Eradication

Human immunodeficiency virus(HIV)has been shown to evolve independently in different anatomical compartments.Characterizing HIV genetic evolution in different tissues and cells provides insights into the mechanisms that maintain the viral reservoir.HIV compartmentalization has been well documented in the semen but rarely in male genital tract(MGT)organs.The precise mechanisms that result in the development of HIV compartmentalization in multiple genitourinary sites have been poorly explored due to the difficulty in accessing these tissues.Based on evidence from lymph nodes and gut tissues,mechanisms that may influence compartmentalization include immune pressures,local concentrations of antiviral drugs,clonal expansion of different cell types and inflammation that alters the cellular microenvironment.We reviewed phylogenetic evidences supporting viral compartmentalization between the blood and multiple genitourinary sites in HIV-infected people.Characterizing distinct viral subpopulations enhances our overall understanding of the HIV reservoir inMGTand could ultimately lead to the development of novel therapies to eradicate the virus in tissues.

A scoping review of SARS-CoV-2 and male infertility: Concerns and future prospects

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has been detected in the blood,urine,facial/anal swabs,semen,and vaginal discharge;all have been shown to contain SARSCoV-2 RNA.Recent findings have highlighted the prospect of SARS-CoV-2 invading the genital system in addition to other tissues,which might give rise to reproductive concerns.This investigation sheds light on male reproductive tract vulnerability to invasion by SARS-CoV-2 and provides a foundation for further researches into male fertility.Males are infected with COVID-19 at a higher rate than females.As a result,some data suggest that this viral infection might affect the male reproductive system.The probable causes for male genital tract abnormalities in COVID19 are:(1)high expression of angiotensin-converting enzyme 2 in the testes;(2)SARS-CoV-2 infection indirectly induces immune response in the testes;(3)SARS-CoV-2 directly damages male genital cells by virus-receptor binding activity;(4)fever in SARSCoV-2 infected males may cause damages to testicular cells;(5)testosterone level decreased in SAR-CoV-2 infected males;(6)males are more susceptible to COVID-19 than females,which may be due to differences in the physiology of the genital tract.This review seeks to offer some insights into the potential causes of COVID-19 that affect the male reproductive system,as well as future prospect on this issue.

Viral infections and implications for male reproductive health

Viral infections have haunted humankind since times immemorial.Overpopulation,globalization,and extensive deforestation have created an ideal environment for a viral spread with unknown and multiple shedding routes.Many viruses can infect the male reproductive tract,with potential adverse consequences to male reproductive health,including infertility and cancer.Moreover,some genital tract viral infections can be sexually transmitted,potentially impacting the resulting offspring's health.We have summarized the evidence concerning the presence and adverse effects of the relevant viruses on the reproductive tract(mumps virus,human immunodeficiency virus,herpes virus,human papillomavirus,hepatitis B and C viruses,Ebola virus,Zika virus,influenza virus,and coronaviruses),their routes of infection,target organs and cells,prevalence and pattern of virus shedding in semen,as well as diagnosis/testing and treatment strategies.The pathophysiological understanding in the male genital tract is essential to assess its clinical impact on male reproductive health and guide future research.