Current Women's Health Reviews - Volume 8, Issue 3, 2012

Augmented levels of reactive oxygen species (ROS) that overpower the body's antioxidant defenses result in oxidative stress (OS). Physiologically balanced levels of ROS and antioxidants maintain homeostasis in the body and allow for normal physiological processes to proceed. Physiological processes that involve oxygen consumption inevitably produce ROS. However, an overabundance of ROS leads to widespread injury to cells, and can damage DNA, lipid membranes, and proteins. An unfavorable reproductive environment hinders normal physiology secondary to this disruption of homeostasis. Infertility may be attributed to reproductive pathologies, leading to OS. Infertile couples often turn to assisted reproductive techniques (ART) to improve their chances for a successful pregnancy. In vitro techniques create an unfavorable environment for gametes and embryos by exposing them to a surplus of ROS in the absence of enzymatic antioxidant protection that normally exists in vivo. This article will review the currently available literature on the effects of ROS and OS on ART outcomes. The role of antioxidant supplementation of ART culture media continues to be a subject of interest to increase the likelihood for ART success.

Gonorrhoea is a sexually transmitted infection caused by the diplococcus Neisseria gonorrhoeae. The infection is usually limited to the genital area, but it may also affect the pharyngeal or rectal mucosa, depending on sexual practices and can sometimes disseminate. This infection can also be vertically transmitted from a pregnant mother to the foetus at the time of delivery. Laboratory tests for the diagnosis of gonorrhoea are inexpensive and simple, with high sensitivity and specificity; antibiotic treatment is effective and can be administered during all stages of life. The current treatment for uncomplicated genital, rectal, and pharyngeal gonorrhoea is based on the use of third-generation cephalosporins as ceftriaxone and cefixime. For disseminated gonococcal infection, pelvic inflammatory disease, gonococcal meningitis or endocarditis, intravenous ceftriaxone and hospitalisation are recommended as the initial treatment. Despite the ease of diagnosis and treatment, the incidence of gonorrhoea has increased during the last decade, primarily among men who have sex with men. The most recent global data estimated by the World Health Organization (WHO) in 2005 revealed that there were 448 million new cases of curable STIs worldwide, of which 88 million were gonorrhoea, greater than 80% of all cases worldwide occur in developing countries. The Southeast Asia is the region where the highest rates of gonorrhoea incidence worldwide were registered , according to the WHO, in 2001, 27 million new cases of gonorrhoea were estimated to have occurred in, followed by Africa with 18.5 million cases occurring in and 7.5 million cases occurring in Latin America and the Caribbean. Education initiatives for sexual and reproductive health and systematic screening for gonorrhoea, especially among at-risk groups, are needed to produce substantial change in the incidence of this infection because it has been shown that interventions for curable sexually transmitted infections are cost effective.

Fertility-sparing surgery in the treatment of early cervical cancer is gaining acceptance in the gynecologic oncology community as a safe alternative to radical hysterectomy. In women who desire future child-bearing, more conservative treatments, such as radical trachelectomy with pelvic lymphadenectomy, have led to the achievement of successful pregnancies, and viable deliveries, while maintaining equivalent oncologic outcomes. This review of a total of 984 cases of radical vaginal trachelectomy reported thus far in the literature includes patient and tumor demographics, operative details, recurrence and fertility rates, and obstetrical outcomes. Oncologic outcomes after radical vaginal trachelectomy appears to be equivalent to outcomes after radical hysterectomy in appropriately selected patients, making radical vaginal trachelectomy a viable option for women desiring fertility preservation. Patients require counseling regarding potential obstetrical complications, including preterm pre-labor rupture of membranes and preterm delivery, as well as close oncologic follow-up. Other fertility sparing procedures such as radical abdominal trachelectomy and cone biopsy with lymphadenectomy have also been reported in the literature, but oncologic and fertility data are not yet mature. As more fertility-sparing procedures are performed and additional data is available on risk of recurrence, survival and pregnancy outcomes, further analyses will be possible.

Syphilis is a chronic sexually transmitted disease that is caused by a spirochete, Treponema pallidum subspecies pallidum. Syphilis infection can evolve to tertiary stages that affect all organs of the body. Additionally, syphilis can be transmitted from mother to fetus, resulting in congenital syphilis. Laboratory tests for the diagnosis of syphilis are rapid, inexpensive and simple and have high sensitivity and specificity. Syphilis treatment is effective and can be administered at all stages of life. However, the prevalence of syphilis has increased in the 21st century. The main increase has been among men who have sex with men (MSM) who have unsafe sex with multiple sexual partners. In addition, new methods of contacting sexual partners are appearing, such as saunas, bars and the Internet. Interventions aimed at curable sexually transmitted infections (STIs) are cost-effective; therefore, prenatal screening programs for syphilis are necessary to prevent congenital syphilis. Improved education initiatives concerning sexual and reproductive health, both in the general population and among healthcare workers, and systematic screening for syphilis can halt the increasing trend in the prevalence of this infection.

Introduction: Lynch syndrome was first described in the 1950s however until recently it was rarely included in medical school curricula. As a result, many practicing physicians have limited exposure, potentially contributing to significant under diagnosis. As identification of Lynch syndrome prior to malignancy allows for intensified screening, prophylactic surgery and improved patient outcomes, all physicians should be aware of the characteristics of affected families. We aim to determine the overall level of awareness of Lynch syndrome among medical students at an American medical school. Methods: A voluntary and anonymous questionnaire was delivered to students at an American medical school. The survey instrument assessed the respondent's perceived knowledge regarding the genetics and recommended screening for carriers of Lynch syndrome mutations. Results: The questionnaire was distributed to the entire student body (405 students) with a response rate of 50%. Fiftynine percent of students reported that they had learned about Lynch syndrome; 27% of first year students, 44% of second year students; 90% of third year students and 100% of fourth year students. Of the students familiar with Lynch syndrome, the reported knowledge of the underlying genetics was 46%, available genetic screening, 18%, criteria used to screen for the syndrome, 24%, recommendations for colon screening, 31% and recommendations for endometrial cancer screening, 17%. Conclusion: The majority of medical students surveyed had been exposed to Lynch syndrome and awareness increased over each year of education. Significantly more students were aware of recommendations for colon cancer screening than endometrial cancer screening (32% versus 17%, p = 0.01). Studies of the natural history of Lynch syndrome indicate that affected women are more likely to present with endometrial cancer than colon cancer and while there are no prospective data proving the efficacy of endometrial cancer screening in this high-risk population, the endometrium is easily accessible and can be sampled using simple office techniques. In addition, prophylactic hysterectomy and bilateral salpingo-oophorectomy are reasonable risk reducing interventions for the prevention of both uterine and ovarian cancer. Our findings suggest that increased emphasis must be placed on teaching the gynecologic manifestations of Lynch Syndrome in order to avoid the misconception that it is simply a colon cancer syndrome.

Adolescence is life stage typical of Homo sapiens. Reproduction during adolescence, i.e. teenage pregnancies is still listed among the most important public health problems of the 21rst century, although low maternal age may be a marker for social rather than biological or medical disadvantage. Data from developed countries indicate that an optimal prenatal program eliminates obstetrical risks among adolescent mothers and adverse pregnancy outcome is mainly due to socioeconomic cofactors. Most teenage pregnancies are unplanned and result often in a social disaster. It is well documented that teenage mothers are more likely to drop out of school and have a low educational level. They are faced with unemployment and poverty. Consequently nearly all developed countries try to reduce teenage pregnancies and teenage motherhood effectively. The different countries however, use different strategies and these strategies differ regarding their effectiveness. In this review beside general aspects of pregnancies during adolescence, strategies to reduce teenage pregnancy rates are discussed. In particular the decline in teenage motherhood in Austria since the 1970s and is highlighted.

Nicotine and the related oxidant/antioxidant imbalance cause point mutations in the DNA molecule thereby changing the program that controls lung growth and maintenance. It has also been shown that maternal nicotine exposure during gestation and lactation induces a persistent inhibition of glycolysis. These changes are thought to contribute to the faster aging of the lungs of the offspring of mothers that were exposed to nicotine. The lungs of these animals are more susceptible to damage as the animals age. The gradual deterioration can be attributed to increased numbers of senescent cells together with slower cell proliferation and thereby compromising the ability of the lung to adequately replace old cells. Remodeling of the airways of the offspring of nicotine exposed mothers results in a higher incidence of asthma and an increase in the susceptibility to lung cancer. The lower FEV1 of female rats than male rats that were exposed to nicotine during gestation and lactation suggests remodeling of the airways of the females are more severe than in males. The rapid metabolic and structural aging of the lungs of the animals that were exposed to nicotine via the placenta and mother's milk is likely due to “programming” induced by nicotine and an imbalance in the oxidant/antioxidant capacity of the mother and fetus. Restoration of the oxidant/antioxidant balance prevents the adverse effects of nicotine on the lungs of the offspring. Although restoration of the oxidant/antioxidant balance protects the lungs of the offspring it is not advisable for pregnant or lactating mothers to use nicotine replacement therapy during gestation and lactation in an effort to quit smoking.