Trichomonas vaginalis follow-up and persistence in Colombian women.

Trichomonas vaginalis (TV), the most common non-viral sexually-transmitted infection is considered a neglected infection and its epidemiology is not well known. This study determined TV-infection dynamics in a retrospective cohort of Colombian women and evaluated associations between risk factors and TV-outcome. TV was identified by PCR. Cox proportional risk models were used for evaluating the relationship between TV-outcome (infection, clearance and persistence) and risk factors (sexually-transmitted infections and sociodemographic characteristics). Two hundred and sixty-four women were included in the study; 26.1% had TV at the start of the study, 40.9% suffered at least one episode of infection and 13.0% suffered more than one episode of TV during the study. Women suffering HPV had a greater risk of TV-infection (aHR 1.59), high viral-load (> 102) for HPV-16 being related to a greater risk of persistent parasite infection; a high viral load (> 102) for HPV-18 and -33 was related to a lower probability of TV-clearance. Ethnicity (afrodescendent/indigenous people: aHR 5.11) and having had more than two sexual partners (aHR 1.94) were related to greater risk of infection, contrasting with women having a background of abortions and lower probability of having TV (aHR 0.50). Women aged 35- to 49-years-old (aHR 2.08), increased years of sexual activity (aHR 1.10), multiple sexual partners (aHR 8.86) and multiparous women (aHR 3.85) led to a greater probability of persistence. Women whose cervical findings worsened had a 9.99 greater probability of TV-persistence. TV distribution was high in the study population; its coexistence with HPV and other risk factors influenced parasite infection dynamics. The results suggested that routine TV detection should be considered regarding populations at risk of infection.

Probiotic lactobacilli in formulas and hygiene products for the health of the urogenital tract.

Lactobacilli are the predominant microorganisms of the healthy human vagina. A novel alternative for the prevention and treatment of female urogenital tract infections (UGTI) is the inclusion of these microorganisms as active pharmaceutical ingredients in probiotic formulas, and more recently in female hygienic products. Probiotics are defined as "live microorganisms that, when administered in adequate amounts, confer a health benefit on the host." A list of requirements must be considered during the development of probiotic product/formula for the female urogenital tract (UGT). This review aims to resume the requirements, probiotic characteristics, and clinical trial applied to determine the effect of probiotic and potentially probiotic strains on different woman's physiological and pathological conditions, and in preterm birth prevention. A revision of female hygienic products available in the world market is included, together with novel studies applying nanotechnology for Lactobacillus incorporation in hygienic products. Further studies and well-designed clinical trials are urgently required to complement the current knowledge and applications of probiotics in the female UGT. The use of probiotic formulas and products will improve and restore the ecological equilibrium of the UGT microbiome to prevent and treat UGTI in women under different conditions.

Trichomonas vaginalis in Pregnancy: Patterns and Predictors of Testing, Infection, and Treatment.

OBJECTIVE: To identify factors associated with testing for and diagnosis of trichomoniasis in pregnancy and to describe patterns of treatment and tests of reinfection or persistence. METHODS: We conducted a retrospective cohort study of women who delivered from July 2016 to June 2018 at one institution. Testing for Trichomonas vaginalis infection was done by wet mount microscopy or by nucleic acid amplification testing for routine prenatal testing or symptomatic visits. Poisson regression was used to identify factors associated with testing for trichomoniasis and testing positive in pregnancy. Treatment and re-testing patterns also were assessed. RESULTS: Among 3,265 pregnant women, 2,489 (76%) were tested for T vaginalis infection. Of the total sample, 1,808 (55%) were tested by wet mount microscopy, 1,661 (51%) by nucleic acid amplification testing, and 980 (30%) by both modalities. The sensitivity for microscopy compared with nucleic acid amplification testing was 26%, with a specificity of 99%. Factors associated with increased likelihood of being tested included younger age (adjusted risk ratio [aRR] 0.99, 95% CI 0.99-1.00) and bacterial vaginosis (aRR 1.17, 95% CI 1.01-1.37). Prevalence of trichomoniasis was 15% among those tested by any modality (wet mount or nucleic acid amplification testing). Risk factors for trichomoniasis included younger age (aRR 0.97, P<.01), being of black race (aRR 2.62, P<.01), abnormal vaginal discharge (aRR 1.45, P<.01), and chlamydia during the current pregnancy (aRR 1.70, P<.01). Women diagnosed by microscopy had a shorter time to treatment compared with those diagnosed by nucleic acid amplification testing. Most (75%) women with positive infections had a test of reinfection; 29% of these were positive. Bacterial vaginosis was associated with decreased risk of a positive test of reinfection. CONCLUSION: Although testing for and treatment of trichomoniasis during pregnancy is not routinely recommended, the high burden of infection among some pregnant women demonstrates a need to further understand patterns of T vaginalis testing and infection. Opportunities exist for improving timely treatment of trichomoniasis and test of reinfection.

Noncandidal vaginitis: a comprehensive approach to diagnosis and management.

Vaginitis is one of the most common causes of patient visits to gynecologists, primary care providers, and urgent care centers. However, many women leave without a clear diagnosis or experience recurrent symptoms despite treatment. The 3 most common etiologies of vaginitis are trichomonas, bacterial vaginosis, and vulvovaginal candidiasis, which account for an estimated 70% of cases. The remaining 30% may be related to other causes of vaginitis, including atrophic vaginitis, desquamative inflammatory vaginitis, and vaginal erosive disease. The purpose of this review is to describe the noncandidal causes of acute and recurrent vaginitis, with the goal of improving the likelihood of accurate diagnosis as well as efficient and effective therapy. We excluded candidal vaginitis from our review because there was a recently published review on this topic in the Journal. The clinical presentation and evaluation of patients with symptoms of vaginitis can be triaged into 1 of 2 diagnostic pathways: noninflammatory and inflammatory vaginitis. The most common noninflammatory cause is bacterial vaginosis. Features such as irritation, purulent discharge, and the presence of polymorphonuclear neutrophils are more suggestive of an inflammatory process. Trichomoniasis is the most common cause of inflammatory vaginitis. Other well-described forms of inflammatory vaginitis include atrophic vaginitis, desquamative inflammatory vaginitis, and erosive disease. We present a review of the pathogenesis, symptoms, examination findings, diagnostic testing, and treatment for each of these causes of noncandidal vaginitis.

STI update: Testing, treatment, and emerging threats.

Fast, sensitive molecular diagnostic tests that use urine or self-collected swabs may lead to more screening opportunities and be more acceptable to patients, resulting in faster and more accurate diagnosis and treatment of gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium infection.

Vulvovaginitis: Find the cause to treat it.

Vulvar and vaginal disorders are among the most common problems seen in ambulatory care. The cause is usually infectious, but noninfectious causes should also be considered, and differentiating them can be challenging. Accurate diagnosis based on patient history, physical examination, and laboratory testing is necessary so that effective therapy can be chosen.

Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery.

BACKGROUND: Genital tract infection is associated with preterm birth (before 37 weeks' gestation). Screening for infections during pregnancy may therefore reduce the numbers of babies being born prematurely. However, screening for infections may have some adverse effects, such as increased antibiotic drug resistance and increased cost of treatment. OBJECTIVES: To assess the effectiveness of antenatal lower genital tract infection screening and treatment programs for reducing preterm birth and subsequent morbidity. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 7) and reference lists of retrieved reports. SELECTION CRITERIA: We included all published and unpublished randomised controlled trials in any language that evaluated any described methods of antenatal lower genital tract infection screening compared with no screening. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked for accuracy. MAIN RESULTS: One study (4155 women at less than 20 weeks' gestation) met the inclusion criteria. The intervention group (2058 women) received infection screening and treatment for bacterial vaginosis, trichomonas vaginalis and candidiasis; the control group (2097 women) also received screening, but the results of the screening program were not revealed and women received routine antenatal care. The rate of preterm birth before 37 weeks' gestation was significantly lower in the intervention group (3% versus 5% in the control group) with a risk ratio (RR) of 0.55 (95% confidence interval (CI) 0.41 to 0.75; the evidence for this outcome was graded as of moderate quality). The incidence of preterm birth for infants with a weight equal to or below 2500 g (low birthweight) and infants with a weight equal to or below 1500 g (very low birthweight) were significantly lower in the intervention group than in the control group (RR 0.48, 95% CI 0.34 to 0.66 and RR 0.34; 95% CI 0.15 to 0.75, respectively; both graded as moderate quality evidence). Based on a subset of costs for preterm births of < 1900 g, the authors reported that for each of those preterm births averted, EUR 60,262 would be saved. AUTHORS' CONCLUSIONS: There is evidence from one trial that infection screening and treatment programs for pregnant women before 20 weeks' gestation reduce preterm birth and preterm low birthweight. Infection screening and treatment programs are associated with cost savings when used for the prevention of preterm birth. Future trials should evaluate the effects of different types of infection screening programs.

Common sexually transmitted infections in adolescents.

Adolescents are often at higher risk for acquiring sexually transmitted infections (STIs). Medical providers should be alert for both asymptomatic and symptomatic STIs, and follow appropriate screening guidelines. Moreover, providers need to know how to best administer adolescent-friendly confidential care, treatment, and health education in the primary care setting. This article addresses the most common adolescent STIs and pertinent recommendations for screening, diagnosis, and management of infections, in addition to a brief focused discussion on human immunodeficiency virus and adolescents.

Protocolo Sociedad Española de Ginecología y Obstetricia de diagnóstico y tratamiento de las infecciones vulvovaginales. Protocolo actualizado en 2012 / The protocol of the Spanish Society of Obstetrics and Gynecology for the diagnosis and treatment of vulvovaginal infection. Update 2012

No disponible

[Bacterial vaginosis and trichomononiasis. Fundamental world guidelines on management and therapy of the patients].

The vaginal discharge is one of the most frequent symptoms requiring medical advise. Vaginal discharges are mainly associated with three diseases: bacterial vaginosis, trichomononiasis and candidiasis. The review is concerned with up-to-date approaches to the treatment of females with bacterial vaginosis and trichomononiasis, diseases different by the etiology and pathogenesis, but at the same time similar with respect to the treatment. The analysis is in compliance with the principles of the two fundamental world guidelines.

Tratamento das vulvovaginites na gravidez / Treatment of vulvovaginitis in pregnancy

As vulvovaginites constituem causa frequente de queixa pré-natal. Entre as mais comuns, destacam-se a candidíase, a vaginose bacteriana e a tricomoníase. Permanece polêmico se o rastreamento e o tratamento dessas afecções seriam medidas eficazes contra o parto prematuro. Esta revisão teve como objetivo avaliar as principais opções terapêuticas dessas vulvovaginites durante a gestação, com base nas melhores evidências científicas disponíveis. A literatura recomenda, para tratamento durante a gravidez, o uso tópico de imidazólicos durante sete dias nos casos de candidíase. O metronidazol é boa opção para o tratamento da vaginose bacteriana (via oral ou vaginal por sete dias) e também para os casos de tricomoníase (via oral, dose única e tratamento do parceiro). Nas gestações de alto risco para o parto pré-termo, sobretudo no segundo trimestre, o uso do metronidazol merece cautela, visto poder aumentar este risco

The vulvovaginitis is frequent cause of complaints prenatal. Among the most common, stand out as candidiasis, bacterial vaginosis and trichomoniasis. It remains controversial whether screening and treatment of these conditions would be effective against premature birth. This review aimed to evaluate the main therapeutic options for these vulvovaginitis during pregnancy based on the best available scientific evidence. The literature recommends for treatment during pregnancy, topical imidazole for seven days in cases of candidiasis. Metronidazole is a good choice for the treatment of bacterial vaginosis (orally or vaginally for seven days) and also in case of trichomoniasis (orally, single dose and partner’s treatment). In pregnancies at high risk for preterm delivery, especially in the second quarter, the use of metronidazole merits caution, since it may increase this risk

Does vaginal irrigation with saline solution in women with infectious vaginitis contribute to the clinical and microbiological results of antibiotic therapy?

AIM: To compare the clinical and microbiological results between patients with infectious vaginitis receiving vaginal irrigation with saline or no irrigation before standard antibiotic therapy. METHODS: Women with vaginitis (n = 109) were randomized to receive vaginal irrigation with saline or no irrigation before standard antibiotic therapy. The vaginal symptoms perceived by subjects and clinical findings were assessed with a standardized scale during four follow-up visits, and Gram stain Nugent scores and vaginal fluid cultures were analyzed at each visit. RESULTS: Vaginal discharge (z = 7.159; p < 0.001), pruritus (z = 5.169; p < 0.001), itching (z = 2.969; p < 0.003) and odor scores (z = 2.303; p < 0.021) were significantly reduced in the study group compared to the control group between the first visit and 3-5 days after irrigation, before the start of antibiotic therapy. The second and third visits (15 and 30-45 days after antibiotic therapy) showed that the patients' symptoms and amounts of visible vaginal discharge did not differ between the two groups. Moreover, the microbiological cures of patients in each group did not differ at these visits (z = 0.447; p = 0.655). CONCLUSION: Vaginal irrigation with saline significantly reduces self-reported symptoms in the short term but has no effect on long-term clinical and laboratory results in women with infectious vaginitis.

Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery.

BACKGROUND: Preterm birth is birth before 37 weeks' gestation. Genital tract infection is one of the causes of preterm birth. Infection screening during pregnancy has been used to reduce preterm birth. However, infection screening may have some adverse effects, e.g. increased antibiotic drug resistance, increased costs of treatment. OBJECTIVES: To assess the effectiveness and complications of antenatal lower genital tract infection screening and treatment programs in reducing preterm birth and subsequent morbidity. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008) and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2). SELECTION CRITERIA: We included all published and unpublished randomised controlled trials in any language that evaluated any described methods of antenatal lower genital tract infection screening compared with no screening. Preterm births have been reported as an outcome. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed eligibility, trial quality and extracted data. MAIN RESULTS: One study (4155 women) met the inclusion criteria. This trial is of high methodological quality. In the intervention group (2058 women), the results of infection screening and treatment for bacterial vaginosis, trichomonas vaginalis and candidiasis were reported; in the control group (2097 women), the results of the screening program for the women allocated to receive routine antenatal care were not reported. Preterm birth before 37 weeks was significantly lower in the intervention group (3% versus 5% in the control group) with a relative risk (RR) of 0.55 (95% confidence interval (CI) 0.41 to 0.75). The incidence of preterm birth for low birthweight preterm infants with a weight equal to or below 2500 g and very low birthweight infants with a weight equal to or below 1500 g were significantly lower in the intervention group than in the control group (RR 0.48, 95% CI 0.34 to 0.66 and RR 0.34; 95% CI 0.15 to 0.75, respectively). AUTHORS' CONCLUSIONS: There is evidence that infection screening and treatment programs in pregnant women may reduce preterm birth and preterm low birthweights. Future trials should evaluate the effects of types of infection screening program, gestational ages at screening test and the costs of introducing an infection screening program.

Asymptomatic trichomonas and candida colonization and pregnancy outcome.

Trichomonas vaginalis is a sexually transmitted surface pathogen of the lower urogenital tract, and may be associated with asymptomatic vaginal colonization or intensely symptomatic vaginitis. In pregnancy it is associated with an increased risk of preterm delivery. However, a randomized trial of treatment of asymptomatic trichomonas colonization in pregnancy showed an increase in the risk of preterm delivery in treated women. The reasons for this paradox are yet to be fully elucidated. Candida species, on the other hand, may be present--usually in the yeast form--in the vaginal flora of up to 40% of healthy pregnant women. Although candidiasis is not usually associated with chorioamnionitis or preterm delivery, there is some emerging evidence to suggest that screening for and eradication of candida during pregnancy may reduce the risk of preterm delivery. This chapter reviews the impact of these common vaginal infections on pregnancy outcome and appraises the recent evidence on the role of treatment during pregnancy.

[Lactofem--using of vital lactic acid bacteria in the cases of vaginal microflora imbalance].

The authors describe the microbiological content of the vaginal ecosystem in healthy, reproductive aged women, as well as women with different types of vaginitis, and the recovering possibilities that LACTOFEM offers. It contains vital H2O2 - producing Lactobacillus acidophilus and Lactobacillus rhamnosus.

Vulvovaginitis bacteriana en la prepúber / Bacterial vulvovaginitis in prepubertal girl

Considerando la alta incidencia de vulvovaginitis en la consulta de ginecología pediátrica y de adolescentes, y los aspectos únicos de la microbiología y endocrinología de la paciente prepúber se presenta una revisión de la literatura con lo más relevante de los últimos 5 años, en lo que se refiere a epidemiología, etiología, diagnóstico y tratamiento de la vulvovaginitis bacteriana específica de la niña prepúber. No existe claridad acerca de la microflora vaginal normal, lo cual dificulta en gran medida la interpretación de muestras. De acuerdo con la evidencia actual podemos decir que ante la vulvovaginitis específica de la prepúber debemos tener en consideración como principales agentes causales: patógenos respiratorios, epidérmicos y entéricos; higiene defectuosa, cuerpos extraños, irritantes, enfermedades dermatológicas vulvares, defectos anatómicos y abuso sexual. Streptococcus hemolitico del grupo A y Haemophilus influenzae son patógenos prevalentes.