Institute Fournier

Saint-Jacques-de-la-Lande, France

Institute Fournier

Saint-Jacques-de-la-Lande, France
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Bohbot J.-M.,Institute Fournier
Gynecologie Obstetrique Fertilite | Year: 2011

The female prevalence of the genital infections due to Chlamydia trachomatis (Ct) is considered at 1.6%, but reached 3.6% among women from 18 to 24 years. Ct is one of the most implied bacteria in PID, even if it is not possible to quantify exactly the prevalence of chlamydial salpingitis because of the frequency of the asymptomatic forms. The physiopathology of these complications is not completely elucidated. The natural clearance of Ct at the cervical level has been demonstrated but it varies with the bacterial serovar. The period between cervical infection and salpingitis is also vague. However, we know that the risk of salpingitis increases with the time of start-up treatment. In addition, the risk of PID and sequelae increases with the number of cervical infections. The diagnosis can be evocated on a rise in the rate of anti-Ct IgG correlated with a rise in CRP. The diagnosis of certitude rests on the coelioscopy, but endo-vaginal echography or the MRI can direct the diagnosis. The prevention of these complications remains the targeted screening of chlamydial infections in at-risk populations, teenagers in particular. The recent techniques of self-administrated vaginal swabs are, in this respect, a real progress. © 2011 Elsevier Masson SAS. All rights reserved.


Bohbot J.-M.,Institute Fournier
Medecine Therapeutique Medecine de la Reproduction, Gynecologie et Endocrinologie | Year: 2015

Male genital infections are mostly due to sexually transmitted diseases (STI). Worldwide, the incidence of these infections steadily increases since 1990s. In France, an increase as high as 63.8% of cases of gonococcal infections and 29.3% of recent syphilis has been observed in the last two years. STI in male patients show a wide range of clinical presentations: urethritis, anitis, ano-genital lesions with, sometimes, atypical symptoms. This clinical variety can lead to a delayed etiological diagnosis and a delayed suitable treatment with a risk of complications (prostatitis, epidydimitis. . .). In addition, some microorganisms involved in STI, like Mycoplasma genitalium are not routinely screened even though this bacteria is responsible for 15 to 20% of urethritis. In case of urethritis or anitis, the prescription of a systematic treatment for all sexual partners is recommended even if this item creates of debate from a forensic point of view. At least, the increasing resistance of bacteria like Neisseria gonorrhoeae to antibiotics reduces the therapeutic choices and requires a steady updating of our prescriptions.


Bohbot J.-M.,Institute Fournier
Medecine Therapeutique Medecine de la Reproduction, Gynecologie et Endocrinologie | Year: 2015

Despite the increasing prevalence of sexually transmitted infections (STI) since fifteen years, the number of pelvic inflammatory diseases (PID) seems to stay stable, or even decreasing. The improvement of screening methods for STI (especially for Chlamydia trachomatis and Neisseria gonorrhoeae) using vestibular self-sampling methods, and the shortening of therapeutic protocols can explain a less frequent progression from STI to PID. However, the important proportion of subclincal PID is a concern as these subclinical PID lead to delayed diagnosis and treatment with a high risk of sequels (tubal infertility, ectopic pregnancies, chronic pelvic pains). Furthermore, the increasing implication of Mycoplasma genitalium in PID, the difficulties for its microbiological diagnosis and the limited range of efficient antibiotics are other causes of delayed diagnosis and treatment. The targeted screening for C. trachomatis and N. gonorrhoeae in high risk population (i.e. 14 to 25 years old female) lead to a reduction of PID. The epidemiological management of STI (systematic treatment of all sexual partners) is a determining factor to reduce the risk of recontamination, which increases the risk of developing PID.


Bohbot J.-M.,Institute Fournier | Lepargneur J.-P.,Novescia
Gynecologie Obstetrique Fertilite | Year: 2012

Bacterial vaginosis is one of the most frequent vaginal affections. It results from a deep imbalance of the vaginal ecosystem whose mechanisms remain mysterious, even if recent progress were accomplished in their comprehension: if the flora implied in the bacterial vaginosis is recognized like polymorphic, it appears that Gardnerella vaginalis plays a major part with two genomically different forms: a commensal form (slightly adhesive to the epithelial cells), and a pathogenic one (strongly adhesive to the epithelial cells); the changes in lactobacilli are also to take into account: L. iners could be a marker of the vaginal flora imbalance whereas L. crispatus is generally met in the normal vaginal flora. These findings could influence the composition of coming probiotics; it is recognized that bacterial vaginosis is involved in the risk of prematurity but molecular quantification of G. vaginalis (and of Atopobium vaginae) is more sensitive for the diagnosis of BV what could improve the detection of high-risk pregnant women. The isolated antibiotic treatments are not very effective on the prevention of recurrences. The rebalancing of the vaginal flora is essential. In this field, the local estrogens showed some effectiveness. The use of probiotics is promising and can be recommended in complement of the antibiotic treatment even if the results of the clinical studies are still too heterogeneous to lead to precise indications. © 2011 Elsevier Masson SAS. All rights reserved.


Bercot B.,Groupe Hospitalier Saint Louis Lariboisiere Fernand Widal | Bercot B.,French Institute of Health and Medical Research | Bercot B.,University Paris Diderot | Amarsy R.,Groupe Hospitalier Saint Louis Lariboisiere Fernand Widal | And 17 more authors.
Journal of Clinical Microbiology | Year: 2015

Anyplex STI-7 is a new molecular kit that detects seven sexually transmitted pathogens. Among 202 subjects screened for genital infection, 143 (70.4%) were diagnosed with at least one pathogen, in concordance with reference methods. In addition, the Anyplex STI-7 demonstrated coinfections, such as that with Ureaplasma parvum and Chlamydia trachomatis, in young women. Copyright © 2015, American Society for Microbiology. All Rights Reserved.


Bercot B.,Lariboisiere St Louis Fernand Widal Hospital | Bercot B.,French Institute of Health and Medical Research | Bercot B.,University Paris Diderot | Belkacem A.,Lariboisiere St Louis Fernand Widal Hospital | And 9 more authors.
Eurosurveillance | Year: 2014

We report the first case in France of a high-level azithromycin-resistant Neisseria gonorrhoeae (minimum inhibitory concentration (MIC) = 96 mg/L) assigned to MLST7363 (NG-MAST ST6360), also resistant to ciprofloxacin and tetracycline but susceptible to ceftriaxone. The patient was a 51 year-old heterosexual man who returned following 1g azithromycin monotherapy. Mechanisms of azithromycin resistance were a C2599T mutation in the four copies of the rrl gene and a novel mutation in the promoter of the mtrR gene. © 2014 European Centre for Disease Prevention and Control (ECDC). All rights reserved.


Bohbot J.-M.,Institute Fournier | Sednaoui P.,Institute Fournier | Verriere F.,Laboratoire Innotech International | Achhammer I.,Laboratoire Innotech International
Gynecologie Obstetrique Fertilite | Year: 2012

Objective: To establish the different etiologies of vaginitis and, especially, assess the distribution of responsible pathogens through a prospective study. Patients and methods: One hundred and sixty-nine women aged between 18 and 65 years (average age: 33.7 years old), consulting a physician for symptoms of vaginitis, were examined in 21 centers of gynaecology or infectious diseases. The clinical evaluation was completed by bacteriological sample that was tested for infections (including sexually transmitted infections (STIs)). Results: One hundred and eighteen patients (69.8%) had one or several infectious etiologies distributed as follows: 79 (46.7%) candidiasis (3 of which were caused by non albicans Candida), 37 (21.9%) bacterial vaginitis and 16 (9.5%) bacterial vaginosis. To be noticed that there were 38 cases of mixed etiologies out of the 118 infectious etiologies (32.2%), 3 of them were STIs. Discussion and conclusions: Although candidiasis was the most common etiology in this study, it only represented less than 1 out of every two patients. Among the infectious etiologies, 1 out of 3 women presented a bacterial or mixed vaginitis. The etiological diversity of vaginitis leads to consider broad-spectrum treatment as first-line therapy and to prescribe a microbiological analysis in case of failure. © 2012 Elsevier Masson SAS. All rights reserved.


PubMed | Institute Fournier
Type: Journal Article | Journal: Gynecologie, obstetrique & fertilite | Year: 2012

To establish the different etiologies of vaginitis and, especially, assess the distribution of responsible pathogens through a prospective study.One hundred and sixty-nine women aged between 18 and 65 years (average age: 33.7 years old), consulting a physician for symptoms of vaginitis, were examined in 21 centers of gynaecology or infectious diseases. The clinical evaluation was completed by bacteriological sample that was tested for infections (including sexually transmitted infections (STIs)).One hundred and eighteen patients (69.8%) had one or several infectious etiologies distributed as follows: 79 (46.7%) candidiasis (3 of which were caused by non albicans Candida), 37 (21.9%) bacterial vaginitis and 16 (9.5%) bacterial vaginosis. To be noticed that there were 38 cases of mixed etiologies out of the 118 infectious etiologies (32.2%), 3 of them were STIs.Although candidiasis was the most common etiology in this study, it only represented less than 1 out of every two patients. Among the infectious etiologies, 1 out of 3 women presented a bacterial or mixed vaginitis. The etiological diversity of vaginitis leads to consider broad-spectrum treatment as first-line therapy and to prescribe a microbiological analysis in case of failure.


PubMed | Institute Fournier
Type: Journal Article | Journal: Gynecologie, obstetrique & fertilite | Year: 2012

Bacterial vaginosis is one of the most frequent vaginal affections. It results from a deep imbalance of the vaginal ecosystem whose mechanisms remain mysterious, even if recent progress were accomplished in their comprehension: if the flora implied in the bacterial vaginosis is recognized like polymorphic, it appears that Gardnerella vaginalis plays a major part with two genomically different forms: a commensal form (slightly adhesive to the epithelial cells), and a pathogenic one (strongly adhesive to the epithelial cells); the changes in lactobacilli are also to take into account: L.iners could be a marker of the vaginal flora imbalance whereas L.crispatus is generally met in the normal vaginal flora. These findings could influence the composition of coming probiotics; it is recognized that bacterial vaginosis is involved in the risk of prematurity but molecular quantification of G.vaginalis (and of Atopobium vaginae) is more sensitive for the diagnosis of BV what could improve the detection of high-risk pregnant women. The isolated antibiotic treatments are not very effective on the prevention of recurrences. The rebalancing of the vaginal flora is essential. In this field, the local estrogens showed some effectiveness. The use of probiotics is promising and can be recommended in complement of the antibiotic treatment even if the results of the clinical studies are still too heterogeneous to lead to precise indications.


PubMed | Institute Fournier
Type: Journal Article | Journal: Gynecologie, obstetrique & fertilite | Year: 2011

The female prevalence of the genital infections due to Chlamydia trachomatis (Ct) is considered at 1.6%, but reached 3.6% among women from 18to 24years. Ct is one of the most implied bacteria in PID, even if it is not possible to quantify exactly the prevalence of chlamydial salpingitis because of the frequency of the asymptomatic forms. The physiopathology of these complications is not completely elucidated. The natural clearance of Ct at the cervical level has been demonstrated but it varies with the bacterial serovar. The period between cervical infection and salpingitis is also vague. However, we know that the risk of salpingitis increases with the time of start-up treatment. In addition, the risk of PID and sequelae increases with the number of cervical infections. The diagnosis can be evocated on a rise in the rate of anti-Ct IgG correlated with a rise in CRP. The diagnosis of certitude rests on the coelioscopy, but endo-vaginal echography or the MRI can direct the diagnosis. The prevention of these complications remains the targeted screening of chlamydial infections in at-risk populations, teenagers in particular. The recent techniques of self-administrated vaginal swabs are, in this respect, a real progress.

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