Bacterial vaginosis and the role of prebiotics and probiotics: current practices

Bacterial vaginosis (BV) is characterized by overgrowth of opportunistic bacteria and a decrease in the levels of Lactobacilli. BV is commonly encountered by gynaecologists practicing in India. The opinions of 21 gynaecologists across India regarding diagnosis and management of BV were sought via focussed group discussions. In Indian women, BV is more common in the reproductive age group, perimenopausal women, women with polycystic ovarian disease (PCOD), pregnant women, and in teenagers/pubertal age group. BV is often underestimated as it is not diagnosed by family physicians. The panel of experts opined that they preferred to conduct screening for BV in all high-risk pregnant cases, women with bad obstetric history such as premature abortions and women with a history of tuberculosis. One challenge faced by clinicians in the real-world setting is recurrent infections of BV in their patients. For the treatment of BV, antibiotics can be prescribed along with pre-probiotics to avoid dysbiosis and to prevent recurrence of BV. Pre-probiotics should be administered in sufficient amounts for adequate management of BV. More than 80% of Lactobacilli species should be present in an ideal pre-probiotic to ensure adequate production of acid and bacteriocins for the destruction of unhealthy bacteria and prevention of microfilm formation. The results with the pre-probiotics used will depend on the quality of the formulation and the maintenance of the cold chain. Prebiotic -probiotic supplementation may be considered a new adjuvant treatment for BV.

Pregnancy outcome in women with bacterial vaginosis

Background: Bacterial vaginosis is a condition characterized by alteration in the vaginal flora. It is a common occurrence during pregnancy and is one of the established risk factors for preterm delivery, premature rupture of membranes and chorioamnionitis. The objective of the study was to study the prevalence and effects of bacterial vaginosis during pregnancy.Methods: : The study was a hospital based prospective study conducted in the department of obstetrics and gynaecology, RIMS, Imphal from January to December, 2021. 250 women between 20-28 weeks of gestation underwent examination and testing for bacterial vaginosis and were followed up till delivery. Pregnancy outcomes like pre-term labour, premature rupture of membrane; fetal outcomes like birth-weight, APGAR score, NICU admission, or any other complications were noted.Results: Out of the 250 singleton pregnancies, 48 women (19.2%) were found to have bacterial vaginosis. Pregnancies associated with bacterial vaginosis had more chances of premature rupture of membranes, low birth weight babies. But, there was no significant association of the same to preterm labor and to the rate of NICU admission of the newborns.Conclusions: Vaginal infection during pregnancy should also be entertained seriously and treated well since bacterial vaginosis may directly or indirectly be related to preterm delivery and low birth weight babies.

Infecciones cervicovaginales en la prueba de Papanicolaou de pacientes asintomáticas

Introducción: La prueba de Papanicolaou estudia las células exfoliadas de la unión escamo-columnar del cuello uterino para la detección de células anómalas y también es útil para el diagnóstico de infecciones cervicovaginales. Objetivo: Caracterizar a las pacientes con infecciones cervicovaginales asintomáticas, diagnosticadas por prueba de Papanicolaou. Métodos: Se realizó una investigación observacional, descriptiva y transversal, en 656 pacientes con infección cervicovaginal asintomática, diagnosticadas por prueba de Papanicolaou. Se estudiaron: gérmenes, edad, inicio de las relaciones sexuales, número de compañeros sexuales, anomalías de células epiteliales cervicales. La información se obtuvo mediante interrogatorio, examen clínico y prueba de Papanicolaou. Se utilizaron técnicas de estadística descriptiva para el cálculo de las frecuencias absolutas, porcentajes, media y desviación estándar. Resultado: Se halló un predominio de la vaginosis bacteriana (46 %), seguido de la infección por Candida spp (38,2 %). La edad media de las pacientes fue de 36,4 años. Se observó que en 244 mujeres la edad de inicio de las relaciones sexuales fue de 16 - 20 años (37,2 %). Tuvieron un compañero sexual activo 531 casos (80,9 %). El 86 % no presentó lesiones cervicales, pero el 72,7 % de las infecciones por VPH sí tuvieron. Conclusiones: La generalidad de las mujeres tiene vaginosis bacteriana, son adultas, con inicio precoz de las relaciones sexuales y un compañero sexual activo. Gran parte no presentan lesiones cervicales, la mayoría, con infección por VPH, poseen anomalías de las células epiteliales cervicales.

Introduction: The Papanicolaou test studies the exfoliated cells of the squamo-columnar junction of the cervix for the detection of abnormal cells and is also useful for the diagnosis of cervicovaginal infections. Objective: To characterize patients with asymptomatic cervicovaginal infections diagnosed by Papanicolaou test. Methods: An observational, descriptive and cross-sectional investigation was carried out in 656 patients with asymptomatic cervicovaginal infection, diagnosed by Papanicolaou test. The following were studied: germs, age, initiation of sexual relations, number of sexual partners, anomalies of cervical epithelial cells. The information was obtained through interrogation, clinical examination and Papanicolaou test. Descriptive statistical techniques were used to calculate absolute frequencies, percentages, mean and standard deviation. Result: A predominance of bacterial vaginosis was found (46%), followed by Candida spp infection (38.2%). The average age of the patients was 36.4 years. It was observed that in 244 women the age at which sexual relations began was 16 - 20 years (37.2%). 531 cases (80.9%) had an active sexual partner. 86% did not present cervical lesions, but 72.7% of HPV infections did. Conclusions: The majority of women have bacterial vaginosis, they are adults, with early onset of sexual relations and an active sexual partner. Most of them do not have cervical lesions, the majority, with HPV infection, have anomalies of the cervical epithelial cells.

Bacterial vaginosis: impact of treatment and associated risk factors: a cross section study

Background: Bacterial vaginosis (BV) is a condition caused by an overgrowth of normal vaginal flora. Many socio-demographic factors are associated with bacterial vaginosis. Antibiotic resistance to some organism is a challenge in treatment of bacterial vaginosis.Methods: This cross-sectional study was conducted including 100 women with reproductive age group presenting with complain of vaginal discharge. After clinical examination, vaginal swab was collected of patients who gave consent for same. Socio-demographic characteristics were recorded and risk factors were assessed. The slide smears were prepared from vaginal swabs, and the slides were heat-fixed, gram-stained and examined under oil immersion objective. Each slide was then graded as per the standardized quantitative morphological classification method developed by Nugent. Identification of bacteria to genus and/or species level was done by employing an array of routine biochemical tests for Gram-positive bacteria for Gram-negative bacteria. In vitro antibacterial susceptibility testing of bacterial isolates was performed by the Kirby-Bauer disc diffusion method. Sensitivity test results were interpreted according to the Clinical and Laboratory Standards Institute.Results: High incidence of bacterial vaginosis was found among 35 to 45 years age group (63.8%), married females (63.9%), illiterate (100%), females with more than 3 sexual partners (66.7%), those with any co-morbidity (80%) and females not using any method of contraception (100%). E coli (28%) was predominant organism causing bacterial vaginosis followed by Gardenella vaginalis (20%) among the gram-negative bacteria. Among gram positive bacterial S. pyogen (2%) and S. agalactiae (2%) were present. Drug resistance to trimethoprim/sulfamethxazole, erythromycin, cefoxitin, ceftriaxone and gentamycin was detected.Conclusions: Higher age, illiteracy, multiple sexual partners and absence of contraception use can increase risk of bacterial vaginosis. Gram negative organisms are common cause of bacterial vaginosis and they are resistant to trimethoprim/sulfamethoxazole and erythromycin.

Relationship between IL-1Ra gene polymorphism and the natural outcome of asymptomatic bacterial vaginosis / 安徽医科大学学报

Objective To investigate the relationship between interleukin 1 receptor a(IL-1Ra)gene polymorphism and different outcomes in asymptomatic bacterial vaginosis(aBV)patients with the aim of grouping and managing aBV patients.Methods In study on the natural attribution of aBV patients,all patients were enrolled and a sam-ple of venous blood and vaginal lavage fluid were separately frozen.After 4 months at the end of the clinical study,patients who completed the study were divided into three groups based on clinical outcomes:self-healing,progres-sive,and unchanged.The IL-1Ra gene polymorphism,the concentration of IL-1 β and IL-1Ra were tested,and the differences in the above indicators among three groups of patients with different outcomes were compared.Results 1 014 Chinese Han female patients were enrolled,and 984 patients completed clinical follow-up and obtained clini-cal outcome data.13 specimens were unusable during testing,with a total of 971 specimens completed the test.IL-1Ra gene was detected in all patients,with three genotypes:A1/A1,A1/A2,and A2/A2.Most population had a genotype of A1/A1,with the rarest genotype being A2/A2.No rare genotype of female was found.The frequency of A2 alleles in the progression group was significantly higher than that in the self-healing group(P＜0.05).IL-1 βand IL-1Ra were detected in all vaginal lavage fluid samples.Compared with the progression group,IL-1 β in the self-healing group was significantly lower(P＜0.05).When carrying the A2 allele,IL-1 β in progression group was relatively low,while the level of IL-1Ra was relatively high.The values of the unchanged group were middle.Con-clusion The polymorphism characteristics of the IL-1Ra gene in aBV patients are related to the IL-1Ra content in vaginal secretions.Carrying allele A2 is related to the elevation of IL-1Ra,the decrease of IL-1 β in vaginal secre-tions.Carrying allele A2 may affect the clinical outcome of aBV by some potential mechanism.

Bacterial vaginosis and trichomoniasis: prevalence, associated factors, and performance of diagnostic tests

Introduction: Bacterial vaginosis and vaginal trichomoniasis are frequent causes of health care demand. Objective: To estimate the prevalence, identify associated factors, and investigate the performance of diagnostic tests for bacterial vaginosis and trichomoniasis. Methods: Cross-sectional study with participants over 18 years old. All of them were submitted to an interview and gynecological examination with evaluation of vaginal secretion, pH verification, collection of material for Pap smear, wet mount test, Whiff test, bacterioscopy, and polymerase chain reaction for trichomoniasis detection. Logistic regression analysis was applied to identify associated factors with bacterial vaginosis. Diagnostic performance for bacterial vaginosis was evaluated following Amsel criteria, the Ison and Hay score, and the Pap smear, considering the Nugent score as the gold standard. As for trichomoniasis, diagnostic performance was evaluated through the Pap smear and the wet mount test, using the polymerase chain reaction as the gold standard. Results: The prevalence of bacterial vaginosis was 33.7%, and for trichomoniasis, 0.5%. The complaint of abnormal vaginal secretion was associated with the diagnosis of bacterial vaginosis (odds ratio 2.2). The diagnostic accuracy by Amsel criteria, the Ison and Hay score, and the Pap smear was 35.6, 97.0, and 84.2%, respectively. The sensitivity for trichomoniasis through wet mount test was 0.0%, and through the Pap smear, 100%. Conclusion: The prevalence of bacterial vaginosis was high, and trichomoniasis was low. The only associated factor with bacterial vaginosis was the report of abnormal vaginal secretion. The methods with the most accurate diagnostic performance for bacterial vaginosis were the Ison and Hay score and the Pap smear and, for trichomoniasis, the Pap smear

Efecto de la terapia combinada en la vaginosis bacteriana recurrente en mujeres del Eje Cafetero, Colombia / Effect of combined therapy on recurrent bacterial vaginosis in women from the Coffee Region, Colombia, 2017-2020

Objetivo: Evaluar el efecto de la terapia combinada, en la vaginosis bacteriana recurrente, en mujeres del Eje Cafetero (Colombia). Métodos: Estudio observacional, en 189 mujeres mayores de 18 años, con diagnóstico de vaginosis bacteriana recurrente siguiendo el puntaje de Nugent. Se les suministró terapia combinada (inducción oral con 500 mg de metronidazol por siete días más 600 mg de ácido bórico vaginal una vez al día durante veintiún días, seguido de 500 mg de nifuratel y 200 000 UI de nistatina vaginal por seis días, cada mes, durante seis meses); quienes asistieron a consulta entre 2017 y 2020. Se hizo seguimiento clínico y de laboratorio utilizando el puntaje de Nugent, a la semana de finalizado el tratamiento oral, al mes, a los tres, seis, nueve y doce meses. Se utilizó estadística descriptiva. Resultados: La edad media de las participantes fue 34,17 ± 5,31 años. La tasa de curación después de la terapia inicial fue 80,42 % (a la semana), al mes: 82,01 %, a los tres meses: 91,53 %, a los seis: 90,47 %, a los nueves: 90,47 % y a los doce meses: 86,24 %. Al finalizar el estudio, la tasa de fracaso fue 9,52 %. No hubo eventos adversos graves; la tasa de satisfacción fue elevada (90,47 %). Conclusiones: La terapia combinada en la vaginosis bacteriana recurrente mejoró la cura clínica y microbiológica y disminuyó el riesgo de recurrencia a los doce meses de seguimiento. Se requiere validación de los presentes resultados en un ensayo clínico controlado aleatorizado(AU)

Objective: To evaluate the effect of combined therapy in recurrent bacterial vaginosis in women from the Coffee Region (Colombia). Methods: Observational study, in 189 women over 18 years, diagnosed with recurrent bacterial vaginosis following the Nugent score. They were given combination therapy (oral induction with 500 mg metronidazole for seven days plus 600 mg vaginal boric acid once daily for twenty-one days, followed by 500 mg nifuratel and 200,000 IU vaginal nystatin for six days, every month, for six months); who attended consultation between 2017 and 2020. Clinical and laboratory follow-up was performed using Nugent's score, one week after the end of oral treatment, at one month, three, six, nine and twelve months. Descriptive statistics were used. Results: The mean age of participants was 34.17 ± 5.31 years. The cure rate after initial therapy was 80.42% (at week), at month: 82.01 %, three months: 91.53 %, six: 90.47 %, nine: 90.47 % and at twelve months: 86.24 %. At the end of the study, the failure rate was 9.52%. There were no serious adverse events; the satisfaction rate was high (90.47 %). Conclusions: Combination therapy in recurrent bacterial vaginosis improved clinical and microbiological cure and decreased the risk of recurrence at twelve months follow-up. Validation of the present results is required in a randomized controlled clinical trial(AU)

Sexually transmitted infections （STIs） and related factors among pregnant women with non-local household registration in Xuhui District， Shanghai / 上海预防医学

ObjectiveTo study the sexually transmitted infections （STIs） in pregnant women with non-local household registration in Xuhui District and analyze the risk factors for STIs. MethodsFrom April 2020 to March 2022， pregnant women with non-local household registration who received their first prenatal examination in a general hospital in Shanghai Xuhui District were selected to conduct a status survey of STIs. Logistic regression model was used to analyze the influencing factors of bacterial vaginitis and ureaplasma uaplasma infection. ResultsThe top three infection rates in the pregnant women were Ureaplasma urealyticum （13.2%）， bacterial vaginosis （9.8%） and mycotic vaginitis （4.7%）. Age between 25 and 35 years （aOR=0.53，95%CI： 0.28‒0.98） and monthly income ≥8 000 yuan （aOR=0.30，95%CI： 0.11‒0.82） were significantly correlated with ureaplasma uaplasma infection. Pregnancy number of 2 （aOR=4.95， 95%CI： 1.59‒15.46）， first sexual relationship occurred before marriage （aOR=2.83， 95%CI： 1.04‒7.74）， husband's alcoholism （aOR=3.83， 95%CI： 1.08‒13.56）， high school education （aOR=0.27， 95%CI： 0.08‒0.93）， and husband's travel history （aOR=0.30， 95%CI： 0.12‒0.79） were significantly correlated with bacterial vaginitis. ConclusionPregnant women with more gestation times， first sexual intercourse before marriage and husband with heavy drinking are more likely to be infected with bacterial vaginosis. Pregnant women with younger age and lower income are more likely to be infected with Ureaplasma urealyticum. Follow-up and monitoring should be strengthened in these groups.

Systematic review and Meta-analysis of efficacy and safety of Kushen Gelatum combined with antibiotics in treatment of bacterial vaginosis / 中国中药杂志

This study aims to systematically evaluate the clinical efficacy and safety of Kushen Gelatum combined with antibiotics for treating bacterial vaginosis. The randomized controlled trial(RCT) of Kushen Gelatum for treating bacterial vaginosis were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, and Cochrane Library with the time interval from inception to January 2023. Data were extracted from the included RCT by 2 investigators, including the sample size, characteristics of patients, interventions and controls, outcome indicators, and adverse effects. The Cochrane collaboration network's bias risk assessment tool was used for methodolo-gical quality evaluation of the included trials. RevMan 5.4 was employed to perform the Meta-analysis. A total of 19 RCTs were inclu-ded, involving 1 980 patients with bacterial vaginosis. Meta-analysis showed that, compared with nitroimidazoles alone, Kushen Gelatum + nitroimidazoles improved the total response rates in terms of clinical symptoms and laboratory tests(RR=1.24, 95%CI[1.13, 1.36], P<0.000 01), laboratory tests(RR=1.16, 95%CI[1.06, 1.26], P=0.000 9), and clinical symptoms(RR=1.26, 95%CI[1.08, 1.46], P=0.003), and reduced the leukocyte esterase positive rate(RR=0.29, 95%CI[0.17, 0.48], P<0.000 01) and the recurrence rate(RR=0.37, 95%CI[0.23, 0.58], P<0.000 1). Compared with lincomycin antibiotics(clindamycin) alone, Kushen Gelatum + lincomycin antibiotics(clindamycin) improved the total response rates in terms of clinical symptoms and laboratory tests(RR=1.18, 95%CI[1.06, 1.31], P=0.003) and laboratory tests(RR=1.27, 95%CI[1.04, 1.54], P=0.02), reduced the recurrence rate(RR=0.20, 95%CI[0.05, 0.75], P=0.02), and shortened the time to relief of burning sensation(MD=-1.70, 95%CI[-2.15,-1.26], P<0.000 01), vaginal itching(MD=-0.82, 95%CI[-1.30,-0.34], P=0.000 8), and abnormal leucorrhea(MD=-1.52, 95%CI[-1.98,-1.06], P<0.000 01). Compared with nitroimidazoles + probiotics, Kushen Gelatum + nitroimidazoles + probiotics improved the total response rate in terms of clinical symptoms and laboratory tests(RR=1.18, 95%CI[1.02, 1.36], P=0.03) and reduced the recurrence rate(RR=0.27, 95%CI[0.09, 0.76], P=0.01). Kushen Gelatum combined with antibiotics demonstrates a potential therapeutic effect on bacterial vaginosis, whereas the number and quality of the relevant clinical studies remain to be improved. The process of clinical trial should be standardized to improve the quality of evidence, so as to provide strong evidence to guide the application of Kushen Gelatum in clinical practice.

Screening of Lactobacillus that inhibit Gardnerella vaginalis and preliminary study on its bacteriostatic mechanism / 安徽医科大学学报

Objective @#To select and obtain vaginal Lactobacillus strains with inhibitory effect on Gardnerella vagi⁃ nalis , and to explore the possible mechanism of inhibition of Gardnerella vaginalis by Lactobacillus vaginalis strains , so as to provide a prerequisite for the development of dominant strains for human disease treatment. @*Methods @#Gardnerella vaginalis and vaginal Lactobacillus strains were isolated from vaginal secretions of patients with bacterial vaginosis (BV) and healthy women , respectively. The Lactobacillus strains with the ability to inhibit the proliferation of Gardnerella vaginalis were screened by spot on lawn. Double agar diffusion method was used to compare the inhibitory effects of Lactobacillus solutions , cell⁃free culture supernatants (CFCs) and bacteria on Gardnerella vaginalis. @*Results @#Sixty⁃two strains of vaginal Lactobacillus strains were isolated and purified from vaginal vaginal secretions of 10 patients with bacterial vaginosis. Among the 62 strains of vaginal Lactobacillus , 18 strains could inhibit the proliferation of Gardnerella vaginalis. The vaginal Lactobacillus solutions , the CFCs , and bacteria all had inhibitory effect on Gardnerella vaginalis. The inhibitory effects of vaginal Lactobacillus solutions were higher than those of the CFCs. After the CFCs were treated with proteinase K , the inhibitory effect of eight samples disappeared , and that of 10 samples weakened obviously. @*Conclusion @#In this paper, 62 vaginal Lactobacillus strains are purified and identified , of which 18 strains can inhibit the proliferation of Gardnerella vaginalis. The production of antimicrobial protein may be involved in the mechanism that vaginal Lactobacillus inhibits the proliferation of Gardnerella vaginalis.

Factors associated with Trichomonas vaginalis infection in reproductive-aged women attending cervical screening in southeast of Brazil

ABSTRACT Background: Sexually Transmitted Infections (STIs) can be caused by viruses, bacteria, and parasites. The World Health Organization estimated more than 300 million new global cases of curable STIs among individuals of reproductive age. Infection by Trichomonas vaginalis is one of the most prevalent curable STL Despite the current treatments available, the diagnosis of T. vaginalis can be difficult, and the resistance to the treatment increased concern for the healthcare system. Objectives: The aim of this study was to determine the prevalence and factors associated with Trichomonas vaginalis infection among women of reproductive age attending community-based services for cervical screening. Patients and methods: A total of 1477 reproductive-aged women attending 18 Primary Health Care Units in Botucatu, Brazil, from September to October 2012, were enrolled. A structured questionnaire was used for individual face-to-face interviews for obtaining data on sociodemographic, gynecologic, and obstetrics history, sexual and hygiene practices, among others. Cervicovaginal samples were obtained for detection of T. vaginalis by culture using Diamond's medium and microscopic vaginal microbiota classification according to Nugent. A multivariable logistic regression analysis was carried out to estimate Odds Ratios (OR) and 95% Confidence Intervals (95% CI) for the association between participants' sociodemographic, behavioral factors, and clinical factors with T. vaginalis infection. Results: Median age of study participants was 33 years (ranging from 18 to 50). The overall prevalence of T. vaginalis infection was 1.3% (n = 20). Several factors were independently associated with T. vaginalis infection, such as self-reporting as black or Pardo for ethnicity (OR = 2.70; 95% CI 1.03-7.08), smoking (OR=3.18; 95% CI 1.23-8.24) and having bacterial vaginosis (OR = 4.01; 95%CI = 1.55-10.38) upon enrollment. A protective effect of higher educational level (having high school degree) was observed (OR = 0.16; 95% CI 0.05-0.53). Conclusions: Our data suggest that screening programs to correctly detect T. vaginalis infection can be helpful to guide prevention strategies to the community. Our study supports an association between abnormal vaginal microbiota and T. vaginalis infection.

Factors associated with bacterial vaginosis in women with homosexual, bisexual and heterosexual practices

Abstract Background The factors associated with bacterial vaginosis in women with homosexual, bisexual and heterosexual practices are still poorly explored. Thus, the aim of this study was to analyze the factors associated with bacterial vaginosis in women with different sexual practices. Methods Cross-sectional study that included 453 women, 149 Women with Homosexual practice (WSW); 80 bisexual Women (WSWM) and 224 Women with heterosexual practice (WSM). The diagnosis of bacterial vaginosis was performed by microscopic examination of the vaginal smears stained by Gram method and classified according to the Nugent et al. (1991) score. Data analysis was performed by Cox multiple regression. Results Bacterial vaginosis was associated to years of education among WSW (0.91 [95% CI 0.82‒0.99]; p= 0.048) and non-white skin color (2.34 [95% CI 1.05‒5.19]; p= 0.037) between WSWM. Changing partners in the last 3-months (2.09 [95% CI 1.14‒3.82]; p= 0.017), inconsistent use of condoms (2.61 [95% CI 1.10‒6.20]; p= 0.030) and positive diagnosis of Chlamydia trachomatis (2.40 [95% CI 1.01‒5.73]; p= 0.048) were associated with bacterial vaginoses only in WSH. Conclusions The factors associated to bacterial vaginosis differ between different sexual practices, suggesting that the type of sexual partner may influence the risk of developing this classic dysbiosis.

Risk Factors Associated with Bacterial Vaginosis in Pregnant Women in Senegal

Background: Bacterial vaginosis (BV) is associated with a high risk of complications, particularly during pregnancy. Objectives: The aims of this study were to determine the prevalence of BV in pregnant women in Dakar, Senegal, and to identify its associated risk factors. Patients and Methods: This prospective cross-sectional study was conducted from July 2020 to March 2021 in pregnant women with 34 to 38 weeks of gestation and seen for their routine prenatal consultation at the Nabil Choucair health center in Dakar, Senegal. Vaginal swabs were taken and examined using the Nugent scoring system for the diagnosis of the BV. Data analysis on SPSS (version 25) was done using the chi-square test to measure the strength of association. A value of p ? 0.05 was considered statistically significant. Results: BV was found in 28.0% (112/400) of the screened women with a median age 24 (21-29) years. A pH >4.5 predictive of BV was found in 80.4% (90/112) of samples. BV was associated with vaginal candidiasis in 49.1% (55/112) while Trichomonas vaginitis was found in 1.8% (02/112). In 80.4% (90/112) of affected women, BV was caused by Gardnerella vaginalis. Mobiluncus spp. was found in 19.6% (22/112) pregnant women in association with G. vaginalis. Symptoms characterized by episodes of pruritus, pelvic pain, burning and/or dyspareunia were seen among 59.8% (67/112) of these women with BV while 40.1% (45/112) of them reported no symptoms. Conclusion: In view of these results and in order to reduce gestational complications and adverse outcomes in the newborn, screening for BV in pregnant women should be favored in developing countries.

Study Of Association Between Vaginal Infection And Preterm Labour

Background:Preterm birth is the most common of neonatal morbidity and mortality. 85% of neonatal morbidity and mortality is due to premature birth. A large number of studies demonstrate an association between specific organisms and preterm delivery. Material And Methods:A retrospective cohort study of pregnant women who received antenatal care between august 2017 and November 2018 at our tertiary care hospital. 70 Cases with high risk for preterm labor were included in the study and 70 cases with term labor in the control group. High vaginal swabs were collected from the posterior fornix of the vagina. Result:This study shows that there is no association of preterm labor with age, parity and numbers of previous abortions. There are high chances of preterm birth in patients with history of previous preterm birth. 48(68%) patients with preterm labor had vaginal infection in which bacterial vaginosis is more common. Other contributing factors for preterm delivery: Anaemia and lower socio-economic status. Conclusion:In this study, a significant difference in the presence of vaginal infection in patients of preterm labor and term labor was found (P<0.05).Women at risk for preterm birth or preterm premature rupture of membranes because of vaginal infections should be screened, diagnosed, treated , reevaluated, and re-treated if necessary.

Utility of Vaginal pH as Point of Care Test for Detection of Bacterial Vaginosis

Background & objectives: Bacterial vaginosis (BV) is a Reproduc?ve tract infec?on (RTI) among young sexually ac?ve women with high prevalence. It is associated with complica?ons related to pregnancy and an increased risk of acquiring STDs. This poses a need for cost-effec?ve detec?on of BV in low resource se?ngs. Hence, we propose to study the u?lity of vaginal pH determina?on for the detec?on of BV. Material & Methods: This is a single center, 1 year cross-sec?onal study. Swabs were collected from 250 non-pregnant women a?ending the out-pa?ent department of Obstetrics and Gynecology with vaginal discharge as a predominant symptom with or without backache and abdominal pain. Vaginal pH determina?on, Gram stain, wet mount, Whiff test, and Amsel’s criteria were used for BV detec?on. Results: 250 study par?cipants with vaginal discharge sugges?ve of BV were analyzed. Vaginal pH was significantly higher in women with BV with the mean pH being 6.2. Vaginal pH >4.5 had a sensi?vity of 85% and specificity of 66% to detect BV. The Whiff test had the least sensi?vity. Clue cells and Amsel’s criteria of ? 3 were significant for BV. A combina?on of pH and Whiff test performed be?er had high sensi?vity and specificity. Conclusions: A combina?on of pH determina?on and the Whiff test serves as a low-cost alterna?ve in resource-poor se?ngs for detec?on of BV. Though Clue cells and Amsel’s criteria ? 3 were most sensi?ve and specific, they cannot be used in low resource se?ngs. Vaginal pH alone can be used to detect BV in areas of low prevalence.

STUDY OF BACTERIAL VAGINOSIS IN PREGNANCY

AIM Ÿ To screen and diagnose bacterial vaginosis during first two trimesters of pregnancy. Ÿ To give early treatment for bacterial vaginosis during first two trimesters of pregnancy and prevent obstetric complications. METHODS – Pregnant women fitting in the inclusion criteria are recruited and explained about the procedure. Informed consent and ethics committee clearance is obtained. Vaginal smear is sent for microscopy. Vaginal pH is detected. Amine (fishy) odour in wet mount examination is identified. AMSELS score and NUGENTS criterion are applied. Positive specimens are sent for antibiotic culture and sensitivity and treatment is initiated accordingly. Afollow up is kept for all patients diagnosed as bacterial vaginosis to see the outcome of their pregnancy. CONCLUSION - Prevalence of Bacterial vaginosis in my study is 29.2%. BV in pregnancy is common among low socioeconomic status, multigravida, and less educated females. It is associated with significant risk of miscarriages, preterm labour and PROM. Universal screening of all pregnant women at booking visit may be recommended to initiate treatment with metronidazole / clindamycin in those women at risk for preterm delivery, symptomatic women and before surgical abortions.

Bacterial vaginosis, cervical Human Papillomavirus infection and cervical cytological abnormalities in adult women in Central Brazil: a cross-sectional study / Vaginose bacteriana, infecção cervical pelo Papilomavírus humano e anormalidades citológicas cervicais em mulheres adultas no Brasil Central: um estudo transversal

Bacterial vaginosis is the most common cause of vaginal discharge and occurs when there is an imbalance in the vaginal microbiota, predominantly composed of Lactobacillus spp. Human Papillomavirus is the most common sexually transmitted virus in the world. Persistent infection with high-risk Human Papillomavirus genotypes is the main cause of the development of cervical intraepithelial neoplasia and cervical cancer. Objective: To investigate the association between bacterial vaginosis and cervical Human Papillomavirus infection and between bacterial vaginosis and cervical cytological abnormalities in adult women. Methods: Cross-sectional study carried out in a gynecology outpatient clinic of the public health network. A total of 202 women were included in the study and underwent gynecological examination with cervical specimen collection. Cervical cytopathological examinations and bacterioscopy by the Nugent method were performed to identify bacterial vaginosis, and PCR and reverse hybridization were carried out for Human Papillomavirus detection and genotyping. Bivariate analysis was performed to investigate the association between bacterial vaginosis and cervical Human Papillomavirus infection, and between bacterial vaginosis and cervical cytological abnormalities. The odds ratio was calculated, with the respective 95% confidence intervals (95%CI) and 5% significance level (p≤0.05). Results: The prevalence of bacterial vaginosis was 33.2% (67/202), the prevalence of cervical Human Papillomavirus infection was 38.6% (78/202) and the prevalence of cervical cytological abnormalities was 6.0% (12/202). Bivariate analysis showed no significant association between bacterial vaginosis and cervical Human Papillomavirus infection (OR 0.69; 95% CI 0.37­ 1.27; p=0.23), or between bacterial vaginosis and cervical cytological abnormalities (OR 0.65; 95%CI 0.17­2.50; p=0.54). Conclusion: In this study, bacterial vaginosis did not represent a risk factor for cervical Human Papillomavirus infection or for the presence of cervical cytological abnormalities in the investigated adult women.

A vaginose bacteriana é a causa mais comum de corrimento vaginal e ocorre quando há um desequilíbrio da microbiota vaginal, composta predominantemente de Lactobacillus spp. O papilomavírus humano é o vírus sexualmente transmissível mais comum no mundo. A infecção persistente com genótipos do papilomavírus humano de alto risco é a principal causa do desenvolvimento de neoplasias intraepiteliais cervicais e câncer de colo do útero. Objetivo: Investigar a associação entre vaginose bacteriana e infecção cervical pelo papilomavírus humano e entre vaginose bacteriana e anormalidades citológicas cervicais em mulheres adultas. Métodos: Estudo de corte transversal realizado em um ambulatório de ginecologia da rede pública de saúde. O total de 202 mulheres foi incluído no estudo e submetido ao exame ginecológico com coleta de espécime cervical. Foram realizados os exames citopatológicos cervicais, a bacterioscopia pelo método de Nugent para a identificação da vaginose bacteriana e reação em cadeia da polimerase e hibridização reversa para a detecção e genotipagem do papilomavírus humano. Análise bivariada foi realizada para investigar a associação entre vaginose bacteriana e infecção cervical pelo papilomavírus humano e entre vaginose bacteriana e anormalidades citológicas cervicais. Foi calculado o odds ratio, com os respectivos intervalos de confiança de 95% (IC95%) e nível de significância de 5% (p≤0,05). Resultados: A prevalência da vaginose bacteriana foi de 33,2% (67/202), a da infecção cervical pelo papilomavírus humano foi de 38,6% (78/202) e a de anormalidades citológicas cervicais foi de 6,0% (12/202). A análise bivariada não demonstrou associação significativa entre vaginose bacteriana e infecção cervical pelo papilomavírus humano (OR 0,69; IC95% 0,37­1,27; p=0,23), nem entre vaginose bacteriana e anormalidades citológicas cervicais (OR 0,65; IC95% 0,17­2,50; p=0,54). Conclusão: Neste estudo a vaginose bacteriana não representou um fator de risco para a infecção cervical pelo papilomavírus humano e nem para presença de anormalidades citológicas cervicais nas mulheres adultas investigadas

Prevalence of bacterial vaginosis in pregnant women attending Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria using the complete Amsel's diagnostic criteria

Background: Bacterial vaginosis (BV) in pregnant women remains a cause for clinical concern among clinicians and health care professionals. BV has been linked to prenatal, antenatal and postnatal challenges in pregnant women. Information on prevalence of BV across trimesters of pregnancy is expected to give better clinical insight into the pathophysiology of this polymicrobial disorder. This study was conducted to determine the prevalence of BV in pregnant women attending the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. Methodology: This was a cross-sectional study of 120 pregnant women (40 in each trimester of pregnancy) who had symptoms suggestive of BV, selected by systematic random sampling from among the women attending the Obstetrics and Gynaecology (O & G) clinic of NAUTH, Nnewi. Each subject participant was examined by the attending clinician, and high vaginal swab (HVS) sample was collected for diagnostic analysis of BV using with complete Amsel's clinical criteria, which consists of three of the four criteria; (i) adherent and homogenous vaginal discharge, (ii) vaginal pH > 4.5, (iii) detection of clue cells on saline wet mount, and (iv) amine odor after the addition of potassium hydroxide (positive Whiff test). Results: The mean age of the 120 selected participants was 27.25±6.09 years. The age groups 25-29 (36.7%) and 20-24 years (33.3%) constituted the largest proportion, while age groups <20 (5.0%) and 40-45 years (5.0%) constituted the least. Of the 120 participants, 26 (21.7%) were positive for BV by the Amsel's criteria. Pregnant women in age group <20 years had the highest prevalence of BV (100%, 6/6), followed by those in the age groups 20-24 (27.5%), 40-45 (16.7%), 25-29 (15.9%), 30-34 (9.1%) and 35-39 years (0%) (X 2=28.063, p=0.0001). Prevalence of BV was significantly higher in single (unmarried) pregnant women (45.5%, X 2=4.038, p=0.045), women with primary school education level (66.7%, X 2=14.530, p=0.001), unemployed women (36.1%, X 2=13.278, p=0.0013), and nulliparous women [36.4%, X 2 (for trend) = 4.805, p=0.0274), while there was no significant difference in the prevalence of BV with relation to trimester of pregnancy (X 2=2.750, p=0.253). Conclusion: This study reveals a relatively high prevalence of BV and significant association with factors such as age group, education and occupational status among pregnant women attending NAUTH Nnewi. Regular screening of women for BV prenatally may enable appropriate interventions to prevent adverse pregnancy outcomes

Bacterial vaginosis and cervical human papillomavirus infection in young and adult women: a systematic review and meta-analysis

ABSTRACT OBJECTIVE To investigate the association between bacterial vaginosis and cervical human papillomavirus (HPV) infection in young and adult women. METHODS This systematic review and meta-analysis was based on the Prisma methodological guidelines. PubMed and Web of Science were searched using the following descriptors: "bacterial vaginosis and HPV", in June 2019. Articles published from 2012 to 2019 were included. Inclusion criteria were original studies that investigated the association between bacterial vaginosis and cervical HPV infection; articles published in English, Spanish or Portuguese; studies conducted in young and adult, non-pregnant, non-HIV-infected women; studies that used the Nugent criteria for the diagnosis of bacterial vaginosis and studies in which the detection of HPV used the polymerase chain reaction technique. Assembled data, odds ratio (OR) and respective 95% confidence intervals (95%CI) were estimated for the association between bacterial vaginosis and cervical HPV infection using random-effects models. A bilateral value of p < 0.05 was considered statistically significant. RESULT Six studies were selected for analysis and demonstrated association between bacterial vaginosis and cervical HPV infection (OR = 2.68; 95%CI: 1.64-4.40; p < 0.001). CONCLUSION Bacterial vaginosis was considered a risk factor for cervical HPV infection, since women with bacterial vaginosis were more likely to be infected with HPV.

Vaginal microbiota transplantation for treatment of bacterial vaginosis: a review / 生物工程学报

Bacterial vaginosis (BV) is a disease caused by vaginal microbiota dysbiosis. The conventional antibiotic treatment can aggravate microbial dysbiosis, alter the acid environment of the vagina and lead to drug resistance, thus shows low cure rate and high recurrence rate. This poses significant physiological and psychological burden to the BV patients. Vaginal microbiota transplantation (VMT) is a novel live biotherapeutic approach. It directly engrafts the whole vaginal microbiota from healthy women to the vaginal tract of patients to rapidly reconstruct the vaginal microbiota environment and restore the vaginal health. This article summarizes the development, present challenges, and future directions of using VMT, with the aim to explore new strategies for treatment of BV and promote the clinical use of VMT.