Frontiers in reproductive health最新文献

Background: Testicular torsion (TT) is a urological emergency that requires prompt diagnosis and urgent surgical intervention. Delayed presentation is strongly associated with testicular loss and long-term atrophy.

Objective: To systematically assess global trends in delayed consultation and mean symptom duration (MSD) in TT and to identify associated risk factors.

Methods: A systematic review and meta-analysis of studies (1970-2025) that reported delayed consultation rates, MSD, orchiectomy rates, misdiagnosis, and patient transfers (PROSPERO: CRD420251155132).

Results: A total of 176 studies from 45 countries (100,166 cases) were included in this study, of which 15 (5,221 cases) analyzed delayed consultation and 14 (1,513 cases) analyzed MSD. The consultation rate within 6 h ranged from 14.29% to 72.58%, whereas MSD ranged from 4.35 to 107.45 h. Pooled risk ratios (RRs) indicated that abdominal pain reduced the risk of delayed for >6 h [RR 0.91, 95% CI 0.68-1.21] but increased the risk for >12 h [1.19, 1.04-1.37] and >24 h [1.05, 0.77-1.43], while hydrocele decreased [>12 h [0.69, 0.47-1.02], >24 h [0.56, 0.34-0.92]]. Misdiagnosis [>12 h [1.52, 1.27-1.83], >24 h [1.10, 0.63-1.92]] and first visit to primary or secondary care unit [>12 h [1.29, 0.96-1.74], >24 h [1.36, 0.98-1.91]] significantly increased the risk. Transfer was protective and associated with lower odds of prolonged delays [>6 h [0.74, 0.50-1.08], >24 h [0.63, 0.44-0.90]]. A comparative meta-analysis of MSD demonstrated longer durations during the pandemic (SMD -0.37; 95% CI: -0.59, -0.14) in patients without manual detorsion (-0.70; -1.03, -0.37) and in patients misdiagnosed (2.36; 0.34, 4.38). Transfer from other hospitals was associated with shorter durations (-0.42; -0.60, -0.23).

Conclusions: Delayed presentation remains widespread with notable regional disparities. Symptoms, healthcare pathways, misdiagnosis, and public health crises affect timely care. Improved awareness, optimized referral pathways, and strengthened emergency access are essential to minimize testicular loss.

Systematic review registration: identifier CRD420251155132.

Background: Data is limited on the prevalence of sexually transmitted infections (STIs) among key populations in Honduras. Additionally, clinics largely rely on syndromic management of STIs, which has poor diagnostic performance. This study assesses STI prevalence and the feasibility and diagnostic utility of rapid nucleic acid amplification testing (NAAT) in comparison to syndromic identification among the LGBTQIA+ and sex worker community of San Pedro Sula attending a Médecins sans Frontières (MSF) clinic.

Methods: Patients attending MSF's San Pedro Sula clinic from February to June 2024, were invited to participate in the study. Clinicians assessed all participants for STI symptoms and, regardless of symptoms, collected whole blood, urine, and vaginal samples. Rapid testing [Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), Hepatitis C (HCV), and syphilis] and NAAT via GeneXpert [chlamydia, gonorrhea, trichomoniasis, and human papilloma virus (HPV)] were performed. Treatment was initially prescribed per WHO Syndromic Management Guidelines and revised following NAAT results. Descriptive statistics and diagnostic metrics were calculated. Focus groups with clinic staff assessed feasibility.

Results: Of the 157 patients enrolled, 31.8% (n = 50) tested positive for at least one STI: HPV 19.4% (7/36), syphilis 12.1% (19/157), chlamydia 10.2% (16/157), gonorrhea 8.3% (13/157), trichomoniasis 3.8% (6/157), HIV 3.8% (6/157), HBV 0% (0/157), and HCV 0% (0/157). Of those, 38.0% (n = 19) tested positive for multiple STIs. Only 29.3% (n = 46) of all participants and 56.6% (n = 22) of positive tests for chlamydia, gonorrhea, syphilis, or trichomoniasis were symptomatic. Staff felt GeneXpert benefited patient care but were concerned about sustainability.

Conclusion: This study underscores the high STI prevalence among key populations in San Pedro Sula, Honduras. Results show that point-of-care NAAT implementation is beneficial, appreciated, and feasible in this context and can successfully be integrated into basic clinic diagnostics. The added testing capacity improved diagnostic and management capacity of the clinic, especially regarding asymptomatic STIs, and thus improved quality of care for key populations. A translated version of this manuscript in Spanish can be found in Supplementary Appendix S1.

Background: Sexual and reproductive health (SRH) educational interventions in Ecuador show uneven effectiveness, particularly among adolescents and young people in socioculturally diverse settings. Although the "Rurankapak" methodology has been implemented as a participatory SRH education strategy, its standardized application has limited cultural relevance, acceptability, and sustainability.

Objectives: To collaboratively adapt the Rurankapak methodology for SRH education to diverse sociocultural contexts and to preliminarily assess its applicability and acceptability among adolescents and young people in Ecuador.

Methods: A mixed-methods quasi-experimental study was conducted in three phases. The qualitative phase included semi-structured interviews with key informants experienced in Rurankapak implementation, analyzed using thematic coding. Findings informed a participatory redesign process involving Obstetrics students trained as peer facilitators. The quantitative phase followed a before-after design, applying the adapted intervention to four population groups and administering pre-post knowledge assessments (Cronbach's α = 0.81) and satisfaction surveys.

Results: Qualitative findings identified the need to strengthen pre-workshop planning, referral pathways, and the management of complex topics. An adapted version of Rurankapak was developed, structured into seven educational stations with culturally tailored materials. Quantitative results showed high acceptability among adolescents and young people, with lower acceptance among parents. Peer facilitators demonstrated strong pedagogical performance and reported improvements in communication skills, empathy, and intercultural competence.

Conclusions: Contextual adaptation and participatory redesign enhance the cultural relevance and feasibility of SRH educational strategies. The use of peer facilitators supports adolescent engagement and contributes to the comprehensive training of future SRH professionals.

Background: We assessed US women's preferences to inform development of a novel nonhormonal multipurpose prevention technology (MPT)-a vaginal ring to prevent pregnancy, HIV, sexually transmitted infections (STIs), and bacterial vaginosis (BV).

Methods: In cross-sectional online surveys with US women ages 18-49 currently/interested in using contraception, we conducted a discrete choice experiment (DCE) comprising 7 MPT ring attributes. Mixed multinomial logit models examined relative attribute importance and sub-population preferences.

Results: Of 2,105 survey completers (mean age 31) from all 50 states (Dec 2023 to Jan 2024), 53% were married/cohabiting, 57% had ≥1 child, 43% ever had an unintended pregnancy, and 9% had an STI in the past year. Participants valued effectiveness for contraception about twice as much as for HIV prevention and about 3 times that of STI prevention. Younger women (18-29 vs. 30-49) desired higher pregnancy and HIV prevention effectiveness. Women who were worried about HIV valued effectiveness for HIV and pregnancy similarly. While most women valued BV prevention and no menstrual side effects, a nonhormonal formulation mattered only to women averse to hormonal contraception (61%) and on-demand use (vs. continuous-use only) was not preferred. Women were willing to trade off some pregnancy prevention effectiveness for other desired attributes. Overall, 73% reported being likely/very likely to use a nonhormonal MPT ring at moderate protection levels (80% pregnancy, 50% HIV/STIs).

Conclusions: Interest in an MPT ring was strong, even with conservative effectiveness estimates. Preferences and desired levels of prevention effectiveness and nonhormonal options were shaped by contraceptive history and personal context.

Autistic women navigating the menopause transition face a constellation of challenges that remain critically understudied. This paper explores the intersection of autism-specific traits and menopausal symptoms, with a focus on interoceptive awareness (IA)-the ability to perceive internal bodily signals-which is frequently dysregulated in autistic individuals. Dysregulated IA may contribute to misinterpretation of menopausal symptoms, which in turn amplifies vasomotor severity, anxiety, depression, and distress during this life stage. Systemic barriers further complicate care access. Autistic women often encounter communication challenges with healthcare providers, limited provider knowledge of autism and menopause, and reduced social support. Addressing these gaps requires interdisciplinary approaches, including autism-informed health education, clinician training, IA-targeted interventions, and peer support networks. This paper calls for expanded research into the relationship between autism, interoception, and menopause to inform clinical practice and improve quality of life for autistic women during midlife transitions.

Early embryonic arrest (EEA) can result in repeated failures of assisted reproductive technology, with genetic variation being the primary cause. The maternal protein nucleotide-binding oligomerization domain-like receptor protein 5 (NLRP5) plays a role in oocyte maturation and embryonic development before the blastocyst stage. Mutations in the NLRP5 gene can lead to various reproductive outcomes, including oocyte maturation disorder, fertilization failure, and EEA. We discovered a new homozygous nonsense mutation (c.779G > A; p.Trp260*) in NLRP5 in two sisters from a Chinese family. This clinically presented as halted embryonic development at the 2-7 cell stage. The parents and brother were heterozygous carriers and exhibited normal fertility, indicating that the pathogenic gene was inherited in an autosomal recessive manner. Analyses revealed significantly decreased expression of NLRP5 at the 3' end of the mRNA and the C-terminal of the protein in vitro (p < 0.05). This suggests that NLRP5 protein dysfunction is the primary cause of EEA in this case. Additionally, the expression levels are inconsistent with those of previous studies, indicating that different mutation sites lead to variations in NLRP5 protein expression and distinct pathogenic mechanisms. Our finding expands the spectrum of pathogenic variants in EEA caused by the NLRP5 gene.

Introduction: While various aspects of the embryo transfer (ET) procedure have been studied for their potential impact on treatment outcomes, the influence of ultrasound (US) operator guidance during ET has not been extensively explored. Therefore, this study aims to investigate the impact of US guidance performed by well-trained versus untrained medical staff on the clinical pregnancy rate.

Material and methods: This is a retrospective study that was conducted in a single university-affiliated IVF unit between February 2023 and April 2024. The study compared the clinical pregnancy rate between patients undergoing ET by an US operator versus an untrained operator.

Results: A total of 951 embryo transfers were analyzed: 442 performed by trained operators (46.5%) and 509 by untrained operators (53.5%). Demographic characteristics were comparable. Main diagnosis, day of transfer, and mean number of embryos transferred were similar between groups (p = 0.2, 0.3, 0.4, respectively). The main outcome measure, clinical pregnancy crude rate, was similar (31.6% untrained vs. 31.4% trained, p = 0.9). Factors identified as associated with achieving a clinical pregnancy were maternal age (p < 0.01), endometrial thickness (p = 0.012), type (frozen vs. fresh) of embryos (p = 0.029), and embryonal age (p = 0.012). In a conditional logistic regression analysis, the US operator was not found to be a significant effector.

Conclusions: The utilization of a trained versus untrained ultrasound operator during ET was not associated with a difference in clinical pregnancy rates.