由細菌引起的病原體感染一直是科學和醫學領域的一個難題。特別是在臨床實踐中，細菌感染給疾病的治療和預防帶來了諸多問題。這些包括水和食物中毒、尿道感染 (UTI) 中的大腸桿菌 (E. coli)以及產科和性傳播感染中的沙眼衣原體 (C. Trachomatis)。這些病症的正確診斷和治療需要臨床醫生進行適當評估，並藉助使用經過適當驗證的技術、設備以及訓練有素的操作人員進行科學分析。例如，為了幫助診斷細菌感染，標準程序包括細菌培養和使用傳統培養皿方法分離目標細菌，例如針對目標細菌 DNA 的聚合酶鏈反應 (PCR)。然而，儘管這些技術具有高度準確的趨勢，但它們通常需要大量的資源和時間。一些疾病如嚴重的尿路感染，需要及時診斷和正確治療，往往依賴於醫生的早期觀察和判斷。其他如沙眼衣原體引起的感染通常沒有症狀，但可能導致不孕等長期並發症，需要進行常規篩查和檢測，而這些篩查和檢測往往難以執行且成本高昂。臨床診斷的新興研究有可能通過提供早期、快速、替代的方法來篩查、診斷和治療患者的多種疾病，從而改變醫學格局。目前此研究提出了一項廣泛的工程概念開發，即以比色試紙形式進行的即時診斷設備，做為細菌的早期篩選替代工具。目前的研究還提出了另一項關於自我收集方法的試點可行性研究，用於常規篩查細菌性傳播感染，特別是沙眼衣原體。

Pathogenic infections due to bacteria has been a consistent problem in the field of science and medicine. In clinical practice in particular, bacterial infections have caused a number of problems in disease treatment and prevention. These include Escherichia coli (E. coli) in water and food poisoning and Urinary Tract Infections (UTI), and Chlamydia Trachomatis (C. Trachomatis) in obstetrics and sexually transmitted infections. Proper diagnosis and treatment of these conditions require proper assessment by clinicians, aided by scientific analyses using properly validated techniques, equipment, as well as highly trained personnel in its operation. To aid in the diagnosis of bacterial infections for example, gold standard techniques include bacteria culture and isolation of target bacteria using traditional plate culture methods among others such as Polymerase Chain Reaction (PCR) for target bacterial DNA. However, although these techniques have the tendency to be highly accurate, they often require significant amounts of resources and time. Some conditions such as severe UTI, which require timely diagnosis and proper treatment, often rely on physician’s early observations and judgment. Others such as an infection due to C. Trachomatis, which are often asymptomatic and can lead to long-term complications such as infertility, require routine screening and testing that are often difficult and costly to execute. Emerging research in point-of-care diagnostics has the potential to change the landscape of medicine by providing early, quick, alternative ways to screen, diagnose, and treat patients for a multitude of conditions. The current study proposes one broad engineering concept development study of a point-of-care diagnostic device in the form of colorimetric paper strips for early, alternative screening of bacteria. The current study also proposes another pilot feasibility study of self-collection methodology for the routine screening of bacterial sexually transmitted infections, in particular of Chlamydia Trachomatis.

Acknowledgments:3
Abstract (English):4
Abstract (Mandarin Chinese):5
Chapter 1 – Point-of-care Diagnostic Tools in Obstetrics and Gynaecology: Bacterial infections, engineering development, and project overview:6
Section 1 – Bacteria in Obstetrics and Gynaecology:6
Section 2 – Point-of-Care Diagnostic Tools:8
Chapter 2 – A Simple Colorimetric Point-of-Care Device for Early, Alternative Screening of Bacteria (Escherichia Coli):10
Section 1 – Background:10
Section 1.1 – Urinary Tract Infections:10
Section 1.2 – Biochemical Compounds:15
Section 1.3 – Potential Application of MTT in Bacteria Detection:19
Section 1.4 – Objective and Rationale:20
Section 2 – Methodology:26
Section 2.1 – Preparation of Samples and Reagents:26
Section 2.2 – Test Strips:29
Section 2.3 – Measurements and Data Processing:31
Section 2.4 – Procedure:37
Section 2.5 – Tested Parameters:39
Section 3 – Results:41
Section 3.1 – MTT-PMS ratio of 5:1:41
Section 3.2 – MTT-PMS ratio of 2:1:58
Section 3.3 – Further analyses:75
Section 4 – Discussion:82
Section 4.1 – Colorimetric Incubation Period and Limit of Detection:82
Section 4.2 – Error Margin Analyses:89
Section 4.3 – Implications and Potential:94
Chapter 3 – An NAAT based Self-Collected Vaginal Swab Device for the Screening of Chlamydia Trachomatis in Women:96
Section 1 – Background:96
Section 1.1 – Chlamydia Trachomatis in Women:96
Section 1.2 – Epidemiology, Risk Factors, and Prevention and Treatment of STIs:99
Section 1.3 – Chlamydia Trachomatis Serology, Screening, and Infertility:106
Section 1.4 – Nucleic Acid Amplification Tests (NAATs) and Chlamydia:107
Section 1.5 – Self-collected vaginal swabs:112
Section 1.6 – Objective and Rationale:117
Section 2 – Methodology:120
Section 2.1 – Study Participants:120
Section 2.2 – Questionnaire:122
Section 2.3 – Preparation of Samples and Reagents:123
Section 2.4 – Procedure:125
Section 2.5 – Measurement and Data Processing:128
Section 3 – Results:130
Section 3.1 – Demographics:130
Section 3.2 – Univariate Frequencies:138
Section 3.3 – Multivariate Frequencies and Cross-tabulations:140
Section 4 – Discussion:151
Section 4.1 – Demographics, Frequencies, Analyses:151
Section 4.2 – Implications and Potential:156
Section 4.3 – Limitations and Future Directions:159
Chapter 4 – Concluding Remarks: Utility, Project Contributions, and Future Directions:161
Section 1 – Overall Summary and Contributions:161
Section 1.1 – Overall Project Summary:161
Section 1.2 – Project Contributions:163
Section 2 – Future Directions:165
Section 2.1 – MTT-PMS Strips:165
Section 2.2 – Self-collected Vaginal Swab Device:172
Section 2.3 – MTT-PMS Strips and C. trachomatis – an Unlikely Marriage:175
Section 3 – Concluding Remarks:177
References:179
Appendix:186
Appendix 1 – Questionnaire:186

1. Vincent, J.-L., et al., International study of the prevalence and outcomes of infection in intensive care units. Jama, 2009. 302(21): p. 2323-2329.
2. Salvatore, S., et al., Urinary tract infections in women. European journal of obstetrics & gynecology and reproductive biology, 2011. 156(2): p. 131-136.
3. Tarr, P.I., C.A. Gordon, and W.L. Chandler, Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. The lancet, 2005. 365(9464): p. 1073-1086.
4. Gilstrap 3rd, L., F.G. Cunningham, and P.J. Whalley, Acute pyelonephritis in pregnancy: an anterospective study. Obstetrics and gynecology, 1981. 57(4): p. 409-413.
5. Jolley, J.A. and D.A. Wing, Pyelonephritis in pregnancy. Drugs, 2010. 70(13): p. 1643-1655.
6. Stamm, W.E., Recent developments in the diagnosis and treatment of urinary tract infections. Western Journal of Medicine, 1982. 137(3): p. 213.
7. Rouse, D.J., et al., Screening and treatment of asymptomatic bacteriuria of pregnancy to prevent pyelonephritis: a cost-effectiveness and cost-benefit analysis. Obstetrics & Gynecology, 1995. 86(1): p. 119-123.
8. Hunter, P.R., Drinking water and diarrhoeal disease due to Escherichia coli. Journal of water and health, 2003. 1(2): p. 65-72.
9. Ishii, S. and M.J. Sadowsky, Escherichia coli in the environment: implications for water quality and human health. Microbes and environments, 2008. 23(2): p. 101-108.
10. Cavaiuolo, M., et al., Development and optimization of an ELISA based method to detect Listeria monocytogenes and Escherichia coli O157 in fresh vegetables. Analytical Methods, 2013. 5(18): p. 4622-4627.
11. Liao, Y.-H., et al., Portable device for quick detection of viable bacteria in water. Micromachines, 2020. 11(12): p. 1079.
12. Foxman, B., Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. The American journal of medicine, 2002. 113(1): p. 5-13.
13. Flores-Mireles, A.L., et al., Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews microbiology, 2015. 13(5): p. 269-284.
14. Stamm, W.E. and S.R. Norrby, Urinary tract infections: disease panorama and challenges. The Journal of infectious diseases, 2001. 183(Supplement_1): p. S1-S4.
15. Foxman, B., Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious Disease Clinics, 2014. 28(1): p. 1-13.
16. Orenstein, R. and E.S. Wong, Urinary tract infections in adults. American family physician, 1999. 59(5): p. 1225.
17. Foxman, B., et al., Urinary tract infection: self-reported incidence and associated costs. Annals of epidemiology, 2000. 10(8): p. 509-515.
18. Kunin, C.M., Urinary tract infections in females. Clinical Infectious Diseases, 1994. 18(1): p. 1-10.
19. Rizvi, R.M. and K.M. Siddiqui, Recurrent urinary tract infections in females. Journal of the Pakistan Medical Association, 2010. 60(1): p. 55.
20. Medina, M. and E. Castillo-Pino, An introduction to the epidemiology and burden of urinary tract infections. Therapeutic advances in urology, 2019. 11: p. 1756287219832172.
21. Jolleys, J.V., The reported prevalence of urinary symptoms in women in one rural general practice. British Journal of General Practice, 1990. 40(337): p. 335-337.
22. Hooton, T.M., Uncomplicated urinary tract infection. New England Journal of Medicine, 2012. 366(11): p. 1028-1037.
23. Neal Jr, D.E., Complicated urinary tract infections. Urologic Clinics of North America, 2008. 35(1): p. 13-22.
24. Josset, S., et al., Numeration methods for targeting photoactive materials in the UV-A photocatalytic removal of microorganisms. Chemical Society Reviews, 2008. 37(4): p. 744-755.
25. Bermingham, S.L. and J.F. Ashe, Systematic review of the impact of urinary tract infections on health‐related quality of life. BJU international, 2012. 110(11c): p. E830-E836.
26. Wagenlehner, F.M., et al., Uncomplicated urinary tract infections. Deutsches Ärzteblatt International, 2011. 108(24): p. 415.
27. Belete, M.A. and M. Saravanan, A systematic review on drug resistant urinary tract infection among pregnant women in developing countries in Africa and Asia; 2005–2016. Infection and drug resistance, 2020. 13: p. 1465.
28. Vasudevan, R., Urinary tract infection: an overview of the infection and the associated risk factors. J Microbiol Exp, 2014. 1(2): p. 00008.
29. Berridge, M.V., P.M. Herst, and A.S. Tan, Tetrazolium dyes as tools in cell biology: new insights into their cellular reduction. Biotechnology annual review, 2005. 11: p. 127-152.
30. Altman, F.P., Tetrazolium salts and formazans. Progress in histochemistry and cytochemistry, 1976. 9(3): p. III-51.
31. Grela, E., J. Kozłowska, and A. Grabowiecka, Current methodology of MTT assay in bacteria–A review. Acta histochemica, 2018. 120(4): p. 303-311.
32. Kamiloglu, S., et al., Guidelines for cell viability assays. Food Frontiers, 2020. 1(3): p. 332-349.
33. Stentelaire, C., et al., Development of a rapid and highly sensitive biochemical method for the measurement of fungal spore viability. An alternative to the CFU method. Enzyme and microbial technology, 2001. 29(8-9): p. 560-566.
34. Bartlett, R.C., M. Mazens, and B. Greenfield, Acceleration of tetrazolium reduction by bacteria. Journal of Clinical Microbiology, 1976. 3(3): p. 327-329.
35. Chemical, C. Phenazine (methosulfate). [cited 2022 26 October 2022]; Available from: https://www.caymanchem.com/product/30558/phenazine-(methosulfate).
36. Sundberg, M.W., et al., Selective binding of metal ions to macromolecules using bifunctional analogs of EDTA. Journal of Medicinal Chemistry, 1974. 17(12): p. 1304-1307.
37. Zhang, K., et al., EDTA-based adsorbents for the removal of metal ions in wastewater. Coordination Chemistry Reviews, 2021. 434: p. 213809.
38. Leive, L., The barrier function of the Gram‐negative envelope. Annals of the New York Academy of Sciences, 1974. 235(1): p. 109-129.
39. Reynolds, B. and H. Pruul, Protective role of smooth lipopolysaccharide in the serum bactericidal reaction. Infection and Immunity, 1971. 4(6): p. 764-771.
40. Hafer, E., et al., Qualitative and quantitative 1H NMR spectroscopy for determination of divalent metal cation concentration in model salt solutions, food supplements, and pharmaceutical products by using EDTA as chelating agent. Magnetic Resonance in Chemistry, 2020. 58(7): p. 653-665.
41. Salvagno, G.L., et al., Clinical assessment of the Roche SARS-CoV-2 rapid antigen test. Diagnosis, 2021. 8(3): p. 322-326.
42. Tsao, Y.T., et al., Point‐of‐care semen analysis of patients with infertility via smartphone and colorimetric paper‐based diagnostic device. Bioengineering & translational medicine, 2021. 6(1): p. e10176.
43. Datta, J., et al., Prevalence of infertility and help seeking among 15 000 women and men. Human reproduction, 2016. 31(9): p. 2108-2118.
44. Smith, J.F., et al., Sexual, marital, and social impact of a man's perceived infertility diagnosis. The journal of sexual medicine, 2009. 6(9): p. 2505-2515.
45. Ruiz-Pesini, E., et al., Seminal quality correlates with mitochondrial functionality. Clinica Chimica Acta, 2000. 300(1-2): p. 97-105.
46. Amaral, A., et al., Mitochondria functionality and sperm quality. Reproduction, 2013. 146(5): p. R163-R174.
47. Shih, C.-M., et al., based ELISA to rapidly detect Escherichia coli. Talanta, 2015. 145: p. 2-5.
48. Sung, W.-H., et al., Urinalysis Using a Diaper-Based Testing Device. Biosensors, 2020. 10(8): p. 94.
49. Van Meerloo, J., G.J. Kaspers, and J. Cloos, Cell sensitivity assays: the MTT assay, in Cancer cell culture. 2011, Springer. p. 237-245.
50. Mishra, P., et al., Descriptive statistics and normality tests for statistical data. Annals of cardiac anaesthesia, 2019. 22(1): p. 67.
51. Stowe, R.P., et al., Nondestructive and continuous spectrophotometric measurement of cell respiration using a tetrazolium-formazan microemulsion. Journal of microbiological methods, 1995. 22(3): p. 283-292.
52. Wang, H., et al., An improved 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT) reduction assay for evaluating the viability of Escherichia coli cells. Journal of microbiological methods, 2010. 82(3): p. 330-333.
53. Li, X., et al., Are linear regression techniques appropriate for analysis when the dependent (outcome) variable is not normally distributed? Investigative ophthalmology & visual science, 2012. 53(6): p. 3082-3083.
54. EOS, Egyptian Organization for Standardization and Quality, Chilled fish. 2005.
55. Giacometti, F., et al., Sale of raw milk in northern Italy: food safety implications and comparison of different analytical methodologies for detection of foodborne pathogens. Foodborne pathogens and disease, 2012. 9(4): p. 293-297.
56. Giacometti, F., et al., Quantitative risk assessment of verocytotoxin-producing Escherichia coli O157 and Campylobacter jejuni related to consumption of raw milk in a province in Northern Italy. Journal of food protection, 2012. 75(11): p. 2031-2038.
57. Whalley, P., Bacteriuria of pregnancy. American Journal of Obstetrics and Gynecology, 1967. 97(5): p. 723-738.
58. Muljadi, M., C.-M. Cheng, and C.-J. Shen, Development of a Tetrazolium-Derived Paper-Based Diagnostic Device as an Early, Alternative Bacteria Screening Tool. Micromachines, 2021. 13(1): p. 44.
59. Gerbase, A., et al., Global prevalence and incidence estimates of selected curable STDs. Sexually transmitted infections, 1998. 74: p. S12-6.
60. Cohen, C.R. and R.C. Brunham, Pathogenesis of Chlamydia induced pelvic inflammatory disease. Sexually transmitted infections, 1999. 75(1): p. 21-24.
61. Mårdh, P.-A., Tubal factor infertility, with special regard to chlamydial salpingitis. Current opinion in infectious diseases, 2004. 17(1): p. 49-52.
62. Peipert, J.F., Genital chlamydial infections. New England Journal of Medicine, 2003. 349(25): p. 2424-2430.
63. Land, J., et al., Epidemiology of Chlamydia trachomatis infection in women and the cost-effectiveness of screening. Human reproduction update, 2010. 16(2): p. 189-204.
64. Brunham, R.C. and J. Rey-Ladino, Immunology of Chlamydia infection: implications for a Chlamydia trachomatis vaccine. Nature reviews immunology, 2005. 5(2): p. 149-161.
65. Brunham, R., et al., Etiology and outcome of acute pelvic inflammatory disease. Journal of Infectious Diseases, 1988. 158(3): p. 510-517.
66. Adams, D.A., et al., Summary of notifiable diseases--United States, 2011. 2013.
67. Rowley, J., et al., Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bulletin of the World Health Organization, 2019. 97(8): p. 548.
68. Organization, W.H., Prevention and control of sexually transmitted infections (STIs) in the era of oral pre-exposure prophylaxis (PreP) for HIV. Geneva: World Health Organization, 2019.
69. Liu, G., et al., Trends and patterns of sexual behaviors among adolescents and adults aged 14 to 59 years, United States. Sexually transmitted diseases, 2015. 42(1): p. 20.
70. Chen, K.-T., et al., Chlamydial infection among patients attending STD and genitourinary clinics in Taiwan. BMC public Health, 2007. 7(1): p. 1-5.
71. Fenton, K.A., et al., Sexual behaviour in Britain: reported sexually transmitted infections and prevalent genital Chlamydia trachomatis infection. The Lancet, 2001. 358(9296): p. 1851-1854.
72. Sun, X., et al., Determinants of risky sexual behavior and condom use among college students in China. AIDS care, 2013. 25(6): p. 775-783.
73. Alary, M., et al., Signs and symptoms of prevalent and incident cases of gonorrhea and genital chlamydial infection among female prostitutes in Kinshasa, Zaire. Clinical infectious diseases, 1996. 22(3): p. 477-484.
74. Langille, D.B., et al., A pilot project for chlamydia screening in adolescent females using self-testing. Canadian journal of public health, 2008. 99(2): p. 117-120.
75. Ford, C.A., et al., Perceived risk of chlamydial and gonococcal infection among sexually experienced young adults in the United States. Perspectives on Sexual and Reproductive Health, 2004. 36(6): p. 258-264.
76. Millstein, S.G., N.E. Adler, and C.E. Irwin Jr, Sources of anxiety about pelvic examinations among adolescent females. Journal of Adolescent Health Care, 1984. 5(2): p. 105-111.
77. Spielberger, C.D., R.L. Gorsuch, and R.E. Lushene, State-trait anxiety inventory (STAI): test manual for form X. 1968: Consulting Psychologists Press.
78. Malik, A., et al., Chlamydia trachomatis infection & female infertility. Indian Journal of Medical Research, 2006. 123(6): p. 770.
79. Thomas, K., et al., The value of Chlamydia trachomatis antibody testing as part of routine infertility investigations. Human reproduction, 2000. 15(5): p. 1079-1082.
80. Woodhall, S.C., et al., Advancing the public health applications of Chlamydia trachomatis serology. The Lancet infectious diseases, 2018. 18(12): p. e399-e407.
81. McNulty, C.A., et al., Barriers to opportunistic chlamydia testing in primary care. British Journal of General Practice, 2004. 54(504): p. 508-514.
82. Lau, A., et al., Socio‐demographic and structural barriers to being tested for chlamydia in general practice. Medical Journal of Australia, 2016. 204(3): p. 112-112.
83. Dowell, S.F., et al., Standardizing Chlamydia pneumoniae assays: recommendations from the centers for disease control and prevention (USA) and the laboratory centre for disease control (Canada). Clinical Infectious Diseases, 2001. 33(4): p. 492-503.
84. Schachter, J., Rapid diagnosis of sexually transmitted diseases--speed has a price. Diagnostic microbiology and infectious disease, 1986. 4(3): p. 185-189.
85. Hook, E.W., et al., Use of cell culture and a rapid diagnostic assay for Chlamydia trachomatis screening. Jama, 1994. 272(11): p. 867-870.
86. Tahamtan, A. and A. Ardebili, Real-time RT-PCR in COVID-19 detection: issues affecting the results. Expert review of molecular diagnostics, 2020. 20(5): p. 453-454.
87. Josephson, K., C. Gerba, and I. Pepper, Polymerase chain reaction detection of nonviable bacterial pathogens. Applied and Environmental Microbiology, 1993. 59(10): p. 3513-3515.
88. Jespersen, D.J., et al., Prospective comparison of cell cultures and nucleic acid amplification tests for laboratory diagnosis of Chlamydia trachomatis infections. Journal of clinical microbiology, 2005. 43(10): p. 5324-5326.
89. Papp, J.R., et al., Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae—2014. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports/Centers for Disease Control, 2014. 63: p. 1.
90. Patel, C.G., S. Trivedi, and G. Tao, The proportion of young women tested for chlamydia who had urogenital symptoms in physician offices. Sexually transmitted diseases, 2018. 45(9): p. e72.
91. Shafer, M.-A.B., R.H. Pantell, and J. Schachter, Is the routine pelvic examination needed with the advent of urine-based screening for sexually transmitted diseases? Archives of pediatrics & adolescent medicine, 1999. 153(2): p. 119-125.
92. Falk, L., et al., Sampling for Chlamydia trachomatis infection–a comparison of vaginal, first-catch urine, combined vaginal and first-catch urine and endocervical sampling. International journal of STD & AIDS, 2010. 21(4): p. 283-287.
93. Shafer, M.-A., et al., Comparing first-void urine specimens, self-collected vaginal swabs, and endocervical specimens to detect Chlamydia trachomatis and Neisseria gonorrhoeae by a nucleic acid amplification test. Journal of clinical microbiology, 2003. 41(9): p. 4395-4399.
94. Masek, B.J., et al., Performance of three nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae by use of self-collected vaginal swabs obtained via an Internet-based screening program. Journal of clinical microbiology, 2009. 47(6): p. 1663-1667.
95. Walker, G.T., et al., Strand displacement amplification—an isothermal, in vitro DNA amplification technique. Nucleic acids research, 1992. 20(7): p. 1691-1696.
96. Bang, D., et al., Comparison of the Becton Dickinson strand displacement amplification and Cobas Amplicor Roche PCR for the detection of Chlamydia trachomatis: pooling versus individual tests. Clinical microbiology and infection, 2003. 9(10): p. 1020-1023.
97. Doshi, J., J. Power, and E. Allen, Acceptability of chlamydia screening using self-taken vaginal swabs. International journal of STD & AIDS, 2008. 19(8): p. 507-509.
98. Wiesenfeld, H.C., et al., Self-collection of vaginal swabs for the detection of Chlamydia, gonorrhea, and trichomoniasis: opportunity to encourage sexually transmitted disease testing among adolescents. Sexually transmitted diseases, 2001. 28(6): p. 321-325.
99. Morris, S.R., et al., Performance of a single-use, rapid, point-of-care PCR device for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis: a cross-sectional study. The Lancet Infectious Diseases, 2021. 21(5): p. 668-676.
100. O’Connell, C.M. and M.E. Ferone, Chlamydia trachomatis genital infections. Microbial cell, 2016. 3(9): p. 390.
101. Schachter, J., et al., Vaginal swabs are appropriate specimens for diagnosis of genital tract infection with Chlamydia trachomatis. Journal of clinical microbiology, 2003. 41(8): p. 3784-3789.
102. Perhar, R., S. Rawat, and R. Pandey, Detection of chlamydial antibodies in women with pelvic inflammatory disease and infertility. The New Indian Journal of Obgyn, 2020. 6(2): p. 101-105.
103. Tsevat, D.G., et al., Sexually transmitted diseases and infertility. American journal of obstetrics and gynecology, 2017. 216(1): p. 1-9.
104. Paladine, H.L. and U.A. Desai, Vaginitis: diagnosis and treatment. American family physician, 2018. 97(5): p. 321-329.
105. Organization, W.H., International classification of diseases:[9th] ninth revision, basic tabulation list with alphabetic index. 1978: World Health Organization.
106. George, D., SPSS for windows step by step: A simple study guide and reference, 17.0 update, 10/e. 2011: Pearson Education India.
107. Muljadi, M., et al., A pilot clinical validation study of a self-collected vaginal swab device for the detection of chlamydia trachomatis in women. Frontiers in Bioengineering and Biotechnology, 2022. 10.
108. Malik, A., et al., Chlamydia trachomatis infection in women with secondary infertility. Fertility and sterility, 2009. 91(1): p. 91-95.
109. Kobashi, Y., et al., The difference between IgM and IgG antibody prevalence in different serological assays for COVID-19; lessons from the examination of healthcare workers. International immunopharmacology, 2021. 92: p. 107360.
110. Creighton, S., et al., Co-infection with gonorrhoea and chlamydia: how much is there and what does it mean? International journal of STD & AIDS, 2003. 14(2): p. 109-113.
111. Unemo, M., et al., Gonorrhoea. Nature Reviews Disease Primers, 2019. 5(1): p. 1-23.
112. Dombrowski, J.C., Chlamydia and gonorrhea. Annals of Internal Medicine, 2021. 174(10): p. ITC145-ITC160.
113. Adachi, K., et al., Chlamydia and gonorrhea in HIV-infected pregnant women and infant HIV transmission. Sexually transmitted diseases, 2015. 42(10): p. 554.