Can the Pessary Use Modify the Vaginal Microbiological Flora? A Cross-sectional Study / O uso de pessário vaginal pode alterar a flora microbiológica? Um estudo transversal

Abstract Introduction Vaginal pessary is used as a conservative treatment for pelvic organ prolapse (POP). Some studies have shown that common complaints of its use may include vaginal discomfort and increased vaginal discharge. Scant information is available about the microflora status after using this device. Objective To determine if the usage of vaginal pessary can interfere with the vaginal environment. Methods A cross-sectional study was performed from March of 2014 to July of 2015 including 90 women with POP. The study group was composed of 45 women users of vaginal pessary and 45 nom-users. All enrolled women answered a standardized questionnaire and were subjected to a gynecological exam to collect vaginal samples for microbiological evaluation under optic microscopy. Clinical and microbiological data were compared between study and control groups. Results Vaginal discharge was confirmed in 84% of the study group versus 62.2% in the control group (p< 0.01); itching was reported in 20 and 2.2%, respectively (p< .05); genital ulcers were only found in the pessary group (20%). There was no difference with regard to the type of vaginal flora. Bacterial vaginosis was prevalent in the study group (31.1% study group versus 22.2% control group), (p=.34). Conclusion Women using vaginal pessaries for POP treatment presented more vaginal discharge, itching and genital ulcers than non-users.

Resumo Introdução O pessário vaginal é utilizado como tratamento conservador para o prolapso de órgãos pélvicos (POP). Alguns estudos demonstraram que as queixas mais comuns do seu uso são o desconforto vaginal e um aumento do fluxo vaginal. As informações são escassas a respeito do que ocorre com a microflora vaginal após o uso do pessário. Objetivo Determinar se o uso do pessário pode interferir com o ambiente vaginal. Métodos Um estudo transversal realizado de março de 2014 a julho de 2015 com 90 mulheres com POP; metade delas usaram pessário e a outra metade permaneceu como grupo controle. Todas preencheram um questionário e realizaram exame ginecológico para coleta de amostras vaginais para análise microbiológica. Dados clínicos e microbiológicos foram comparados entre os grupos de estudo e de controle. Resultados O fluxo vaginal foi confirmado em 84% das mulheres do grupo de estudo versus 62,2% do grupo de controle (p< 0,01); prurido foi encontrado em 20 e 2,2%, respectivamente (p< 0,05). As úlceras genitais foram somente encontradas no grupo pessário (20%). Não houve diferenças com relação ao tipo de flora vaginal. A vaginose bacteriana fora encontrada em 31,1% das mulheres do grupo de estudo versus 22,2% do grupo de controle (p= 0,34). Conclusão Mulheres usando pessários vaginais para tratamento do POP apresentaram maior fluxo vaginal, prurido e úlcera genital do que as não usuárias do dispositivo.

Flora vaginal anormal y resultado perinatal adverso / Abnormal vaginal flora and adverse perinatal outcome

El parto pretérmino y sus complicaciones constituyen uno de los problemas más relevantes en el campo de la atención perinatológica. Se ha demostrado su estrecha relación con la infección intraútero, de manera que las alteraciones de la flora vaginal son la puerta de entrada. El objetivo de esta revisión es actualizar a la comunidad médica de esta disciplina en la necesidad de identificar la vaginosis bacteriana y la vaginitis aeróbica, tanto en el nivel primario de atención como en el secundario, lo cual permitirá realizar acciones preventivas y terapéuticas en la etapa preconcepcional, a fin de minimizar las infecciones intraútero y su relación con el nacimiento pretérmino, así como las complicaciones a corto y largo plazo. Se concluye que el diagnóstico de ambas afecciones necesita de un control preventivo y terapéutico para la reducción de las complicaciones perinatales.

Preterm birth and its complications are one of the most important problems in the field of perinatology care. Its close relationship with intrauterine infection has been demonstrated, so that changes of vaginal flora are the gateway. The purpose of this review is to update the medical community of this specialty on the need for identifying bacterial vaginosis and aerobic vaginitis, both at the primary and secondary care, allowing to perform preventive and therapeutic actions on the preconception stage, in order to minimize intrauterine infections and their relation to preterm birth and complications in the short and long term. It is concluded that the diagnosis of both conditions requires a preventive and therapeutic control for reducing perinatal complications.

Perfil de la flora bacteriana vaginal: Un riesgo potencial para la reproducción de vacas criollo limonero / Profile of vaginal bacterial flora: A potential risk for reproduction in criollo limonero cows

El objetivo del presente estudio fue determinar la población bacteriana vaginal de la vaca Criollo Limonero. Se tomaron muestras que consistieron en hisopados por duplicado a nivel del fornix de la vagina anterior, las cuales se sometieron a cultivos bacterianos en ambiente aerobio/anaerobio y pruebas bioquímicas convencionales para el aislamiento. De 102 hisopados se lograron 55 crecimientos (53,9%) y 47 sin crecimiento (46,1%). Los 55 crecimientos se distribuyeron de varias maneras: 23 (41,82%) aerobios y 32 (58,18%) anaerobios; 29 (52,72%) aislamientos puros y 26 (47,27%) aislamientos mixtos. Las bacterias Gram positivas predominaron (81,82 y 73,08%), con respecto a las Gram negativas (18,18 y 26,92%), tanto en aerobiosis como en anaerobiosis, respectivamente. Las bacterias más aisladas fueron Arcanobacterium pyogenes (22,92%), Staphilococcus aureus (15,63%), Staphylococcus coagulasa negativo (17,71%), Erysipelothrix rhusiopathiae (6,25%), Bacteroides spp. (13,54%) y Peptostreptococcus spp. (7,29%). En conclusión, se identificaron las bacterias que forman parte de la flora bacteriana vaginal de la vaca Criollo Limonero, su distribución en cuanto a especie, género, exigencia de oxígeno, tipo de aislamiento, tinción de Gram y potencial de patogenicidad son discutidos.

The objective of the current study was to determine the population of vaginal bacteria in Criollo Limonero cows. Two swabs from every cow were taken at the level of the fornix for bacterial isolation with biochemical test. From 102 swabs, 55 achieved bacterial growth (53.9%) and 47 did not get to any bacterial growth (46.1%). The 55 samples that achieved bacterial growth were distributed as follows: 23 (41.82%) aerobic bacteria and 32 (58.18%) anaerobic bacteria; 29 (52.72%) pure isolations and 26 (47.27%) mixed isolations. Gram positive bacteria were predominant (81.82 and 73.08%) compared to Gram negative bacteria (18.18 y 26.92%), both in aerobic and anaerobic media, respectively. Predominant bacteria were Arcanobacterium pyogenes (22.92%), Staphylococcus aureus (15.63%), Staphylococcus coagulase negative (17.71%), Erysipelothrix rhusiopathiae (6.25%), Bacteroides spp. (13.54%) and Peptostreptococcus spp. (7.29%). In conclusion, vaginal bacterial flora from Criollo Limonero cows were identified, in reference to the distribution of their specie, genus, oxygen requirements, type of isolation, Gram stain and potential pathogenic capacity were discussed.

Flora vaginal en adolescentes con embarazo a término y su relación con rotura prematura de membranas / Vaginal flora in pregnant adolescents with membrane premature failure

El objetivo de este trabajo fue determinar la relación existente entre flora vaginal y rotura prematura de membranas, en adolescentes embarazadas que acudieron a la consulta prenatal de la Maternidad “Dr. Armando Castillo Plaza” (MACP), perteneciente al Servicio Autónomo Hospital Universitario de Maracaibo. El diseño de este estudio fue explicativo, cuasi experimental. La población y muestra estuvo representada por 80 adolescentes embarazadas, en el último trimestre de gestación. El método de recolección de datos estuvo constituido por una entrevista personalizada y los datos fueron recogidos en un formulario conformado por preguntas abiertas. A todas las pacientes se les tomó muestra para cultivo de secreción vaginal identificándose la flora vaginal presente. Como resultados obtenidos se tuvo que la población mayormente afectada fueron las adolescentes mayores de 17 años; iniciando su actividad sexual entre los 15 y 17 años, las cuales viven en concubinato y pertenecen al Nivel V según Graffar. El diagnóstico de RPM se realizó a través de la maniobra de Tarnier y el Test de Nitrazina, con un periodo de latencia de 6-12 horas, la edad gestacional estuvo entre las 37-38 semanas. Los microorganismos reportados fueron bacilos Gram positivos en un 46%, combinación de bacilos Gram positivos y Gram negativos en el 16%, levaduras en el 15%, bacilos Gram negativos 8% y virus de papiloma humano (VPH) 3%. El cultivo de secreción vaginal fue positivo en el 57% de los casos, siendo Candida albicans el microorganismo predominante (25%). Se concluye que existe relación entre la flora vaginal patógena y RPM en las adolescentes con embarazo a término.

The objective of this work was to determine the existing relation between vaginal flora and membrane premature failure, in pregnant adolescents who went to the consultation of Maternity “Dr. Armando Castillo Plaza” (MACP), pertaining to the Independent Service University Hospital of Maracaibo. The design of this study was explanatory, cuasi experimental. The population was represented by 80 pregnant adolescents, in the last trimester of gestation. The method of data collection was constituted by a customized interview and the data were gathered in a form conformed by open questions. All the patients were taken vaginal secretion culture identifying the vaginal flora present. As obtained results it were had population mainly affected was the greater adolescents of 17 years; initiating its sexual activity between the 15 and 17 years, which live in concubines and belong at Level V according to Graffar. The diagnose of MPF was made through the maneuver of Tanier and Test of Nitrazina with a period of 6-12 latency hours; the gestacional age was between the 37-38 weeks. The reported microorganisms were Gram positive bacilli in a 46%, combination of Gram positive and Gram negative bacilli in 16%, yeast in 15%, bacilli Gram negative 8% and human papiloma virus (HPV) 3%. Vaginal secretion culture was positive in 57% of the cases, being Candida albicans predominant microorganism (25%). One concludes that relation between the pathogenic vaginal flora exists and MPF in the adolescents with pregnancy upon maturity.

Fixação de padrões de flora do trato cérvico-vaginal: contestação ao uso da classificação de Doderlein e modificações de Bozzini, 1993 e Linhares et al, 1995 / Flora patterns setting of cervicovaginal tract: to be opposed to the use of Doderlein classification and Bozzini modifications, 1993 and Linhares et al, 1995

Foi realizado o estudo microbiológico do trato cérvico-vaginal em 421 mulheres em idade reprodutiva e sexualmente ativas e em 100 mulheres entre 20 e 32 semanas de gestação. O estabelecimento de padrões de flora do referido trato se faz necessário para um correto esclarecimento diagnóstico, proporcionando fácil interpretação das informações transmitidas ao clínico solicitante, norteando portanto uma correta conduta terapêutica. Foram fixados os seguintes padrões, sugeridos para os laudos de exames de secreção vaginal: 1-Padrão Lactobacilar; 2-Padrão de Vaginites; 3-Padrão de Vaginose; 4-Padrão Anaeróbico; 5-Padrão Indeterminado.