Molecular characterization of vaginal microbiota using a new 22-species qRT-PCR test to achieve a relative-abundance and species-based diagnosis of bacterial vaginosis.

Background: Numerous bacteria are involved in the etiology of bacterial vaginosis (BV). Yet, current tests only focus on a select few. We therefore designed a new test targeting 22 BV-relevant species. Methods: Using 946 stored vaginal samples, a new qPCR test that quantitatively identifies 22 bacterial species was designed. The distribution and relative abundance of each species, α- and ß-diversities, correlation, and species co-existence were determined per sample. A diagnostic index was modeled from the data, trained, and tested to classify samples into BV-positive, BV-negative, or transitional BV. Results: The qPCR test identified all 22 targeted species with 95 - 100% sensitivity and specificity within 8 hours (from sample reception). Across most samples, Lactobacillus iners, Lactobacillus crispatus, Lactobacillus jensenii, Gardnerella vaginalis, Fannyhessea (Atopobium) vaginae, Prevotella bivia, and Megasphaera sp. type 1 were relatively abundant. BVAB-1 was more abundant and distributed than BVAB-2 and BVAB-3. No Mycoplasma genitalium was found. The inter-sample similarity was very low, and correlations existed between key species, which were used to model, train, and test a diagnostic index: MDL-BV index. The MDL-BV index, using both species and relative abundance markers, classified samples into three vaginal microbiome states. Testing this index on our samples, 491 were BV-positive, 318 were BV-negative, and 137 were transitional BV. Although important differences in BV status were observed between different age groups, races, and pregnancy status, they were statistically insignificant. Conclusion: Using a diverse and large number of vaginal samples from different races and age groups, including pregnant women, the new qRT-PCR test and MDL-BV index efficiently diagnosed BV within 8 hours (from sample reception), using 22 BV-associated species.

Development of a multiplex PCR assay and quantification of microbial markers by ddPCR for identification of saliva and vaginal fluid.

The identification of biological fluids at crime scenes contributes to crime scene reconstruction and provides investigative leads. Traditional methods for body fluid identification are limited in terms of sensitivity and are mostly presumptive. Emerging methods based on mRNA and DNA methylation require high quality template source. An exploitable characteristic of body fluids is their distinct microbial profiles allowing for the discrimination of body fluids based on microbiome content. Microbial DNA is highly abundant within the body, robust and stable and can persist in the environment long after human DNA has degraded. 16S rRNA sequencing is the gold standard for microbial analysis; however, NGS is costly, and requires intricate workflows and interpretation. Also, species level resolution is not always achievable. Based on the current challenges, the first objective of this study was to develop a multiplex conventional PCR assay to identify vaginal fluid and saliva by targeting species-specific 16S rRNA microbial markers. The second objective was to employ droplet digital PCR (ddPCR) as a novel approach to quantify bacterial species alone and in a mixture of body fluids. Lactobacillus crispatus and Streptococcus salivarius were selected because of high abundance within vaginal fluid and saliva respectively. While Fusobacterium nucleatum and Gardnerella vaginalis, though present in healthy humans, are also frequently found in oral and vaginal infections, respectively. The multiplex PCR assay detected L. crispatus and G. vaginalis in vaginal fluid while F. nucleatum and S. salivarius was detected in saliva. Multiplex PCR detected F. nucleatum, S. salivarius and L. crispatus in mixed body fluid samples while, G. vaginalis was undetected in mixtures containing vaginal fluid. For samples exposed at room temperature for 65 days, L. crispatus and G. vaginalis were detected in vaginal swabs while only S. salivarius was detected in saliva swabs. The limit of detection was 0.06 copies/µl for F. nucleatum (2.5 ×10-9 ng/µl) and S. salivarius (2.5 ×10-6 ng/µl). L. crispatus and G. vaginalis had detection limits of 0.16 copies/µl (2.5 ×10-4 ng/µl) and 0.48 copies/µl (2.5 ×10-7 ng/µl). All 4 bacterial species were detected in mixtures and aged samples by ddPCR. No significant differences were observed in quantity of bacterial markers in saliva and vaginal fluid. The present research reports for the first time the combination of the above four bacterial markers for the detection of saliva and vaginal fluid and highlights the sensitivity of ddPCR for bacterial quantification in pure and mixed body fluids.

Gardnerella Species and Their Association With Bacterial Vaginosis.

BACKGROUND: Bacterial vaginosis (BV) is a condition marked by high vaginal bacterial diversity. Gardnerella vaginalis has been implicated in BV but is also detected in healthy women. The Gardnerella genus has been expanded to encompass 6 validly named species and several genomospecies. We hypothesized that particular Gardnerella species may be more associated with BV. METHODS: Quantitative polymerase chain reaction (PCR) assays were developed targeting the cpn60 gene of species groups including G. vaginalis, G. piotii/pickettii, G. swidsinskii/greenwoodii, and G. leopoldii. These assays were applied to vaginal swabs from individuals with (n = 101) and without BV (n = 150) attending a sexual health clinic in Seattle, Washington. Weekly swabs were collected from 42 participants for up to 12 weeks. RESULTS: Concentrations and prevalence of each Gardnerella species group were significantly higher in participants with BV; 91.1% of BV-positive participants had 3 or more Gardnerella species groups detected compared to 32.0% of BV-negative participants (P < .0001). BV-negative participants with 3 or more species groups detected were more likely to develop BV within 100 days versus those with fewer (60.5% vs 3.7%, P < .0001). CONCLUSIONS: These results suggest that BV reflects a state of high Gardnerella species diversity. No Gardnerella species group was a specific marker for BV.

Vaginal flora in HPV infection: a cross­sectional analysis.

OBJECTIVE: The vaginal flora has been reported to be associated with human papillomavirus (HPV) infection. The purpose of this study was to investigate the characteristics of the cervical microbiota in patients with HPV infection and to analyse the changes in the vaginal flora and enzyme profiles in females with HPV infection. METHODS: We conducted a cross-sectional study involving 206 participants who underwent HPV genotyping, sexually transmitted diseases pathogen testing, cytology examination, and microbiome analysis. Additionally, we collected 115 HPV-negative samples and 48 HPV-positive samples for 16S rRNA amplicon sequencing. The vaginal microbial communities of both groups were analysed for diversity and differences to explore their association with HPV infection. RESULTS: The abundance of Lactobacillus was found to be reduced, while Gardnerella vaginalis was significantly more prevalent in the HPV + group. In terms of alpha diversity indices, the Shannon index (P = .0036) and Simpson index (P = .02) were higher in the HPV + group compared to the HPV - group, indicating greater community diversity in the HPV + group. Among the 10 sexually transmitted diseases pathogens analysed, Uup3 and Uup6 were significantly associated with HPV infection. Statistically significant differences were observed in Nugent scores and bacterial vaginosis between the two groups (P < .05). In functional analysis, 11 proteins and 13 enzymes were found to be significantly altered in the HPV + group. CONCLUSION: Our study demonstrates that disruptions in the vaginal flora are associated with HPV infection. Reduced levels of Lactobacillus, increased prevalence of Gardnerella, and abnormal enzyme profiles are closely linked to HPV infection.

The purpose of this study was to investigate the characteristics of the cervical microbiota in patients with human papillomavirus infection and to analyse the changes in the vaginal flora and enzyme profiles in females with human papillomavirus infection. We conducted a cross-sectional study involving 206 participants who underwent human papillomavirus genotyping, sexually transmitted diseases pathogen testing, cytology examination, and microbiome analysis. Additionally, we collected 115 HPV-negative samples and 48 HPV-positive samples for 16S rRNA amplicon sequencing. The abundance of Lactobacillus was found to be reduced, while Gardnerella vaginalis was significantly more prevalent in the HPV + group. In functional analysis, 11 proteins and 13 enzymes were found to be significantly altered in the HPV + group. Our study demonstrates that disruptions in the vaginal flora are associated with HPV infection. Reduced levels of Lactobacillus, increased prevalence of Gardnerella, and abnormal enzyme profiles are closely linked to HPV infection.

The microbiota of sexual intercourse and its effect on prostatitis.

It is estimated that microorganisms colonize 90% of the body surface. In some tracts, such as the genitourinary tract, the microbiota varies throughout life, influenced by hormonal stimulation and sexual practices. This study evaluated the semen differences and presence of Lactobacillus crispatus, Lactobacillus iners, Gardnerella vaginalis and Atopobium vaginae in semen samples from patients with symptoms of chronic prostatitis and men asymptomatic for urogenital infections. Fifty-three semen samples were included: 22 samples from men with symptoms of chronic prostatitis and 31 asymptomatic men (control group). In addition to the presence of L. crispatus, L. iners, G. vaginalis and A. vaginae, semen parameters, total antioxidant capacity of seminal plasma, prostatic antigen and some proinflammatory cytokines were evaluated in each semen sample. Volunteers with symptoms of chronic prostatitis presented a lower percentage of sperm morphology (4.3% vs. control group 6.0%, p = 0.004); in the semen samples of volunteers in the group asymptomatic for urogenital infections, microorganisms associated with the vaginal microbiota were detected more frequently. The presence of bacteria in the vaginal microbiota can also benefit male reproductive health, which undergoes various modifications related to lifestyle habits that are susceptible to modification. Microorganisms associated with the vaginal microbiota, such as L. crispatus, L. iners, G. vaginalis and A. vaginae, may have a protective role against the development of male genitourinary diseases such as prostatitis.

Associação entre Vaginose Bacteriana e Anormalidades Citológicas nos Exames Citopatológicos Analisados em um Laboratório Escola de Goiânia-GO / Association Between Bacterial Vaginosis and Cytological Abnormalities in Cytopathological Exams Analyzed in a Laboratory School of Goiânia-GO / Asociación entre Vaginosis Bacteriana y Anormalidades Citológicas en Exámenes Citopatológicos Analizados en una Escuela de Laboratorio de Goiânia-GO

Introdução: A Gardnerella vaginalis facilita a infecção pelo papilomavírus humano (HPV). Objetivo: Verificar a associação entre anormalidades citológicas e presença de Gardnerella vaginalis nos esfregaços cervicovaginais encaminhados ao Laboratório Clínico da Pontifícia Universidade Católica de Goiás (LAC/PUC Goiás) estratificadas por faixa etária. Método: Estudo transversal realizado no LAC/PUC Goiás entre janeiro de 2013 a dezembro de 2015. Para análises estatísticas, a variável idade foi categorizada em ≤39 anos e >40 anos, utilizando o programa IBM SPSS Statistics (Version 2.0, 2011®) para o teste de qui-quadrado (X²), com intervalo de confiança de 95% e valor p<0,05. Resultados: Foram analisados 4.558 exames citopatológicos, a maioria com presença de Lactobacillus spp. (46,97%). A prevalência dos agentes patogênicos foi a Gardnerella vaginalis (79,6%), seguida de Candida spp. (16,8%), Trichomonas vaginalis (2,2%), Herpes simplex (0,4 %) e Chlamydia trachomatis (0,1%). As anormalidades citológicas foram observadas em 9,1%, sendo atypical squamous cells of undetermined significance (ASC-US) 2,57%, low grade squamous intraepithelial lesion (LSIL) 1,78%, atypical squamous cells of undetermined significance cannot exclude high grade squamous intraepithelial lesion (ASC-H) 3,52%, high grade squamous intraepithelial lesion (HSIL) 1,08%, atypical endocervical cells, favor neoplastic (AGC-NEO) 0,22% e carcinoma 0,02%. Houve uma associação significante entre anormalidades citológicas graves e mulheres ≥40 anos, OR 3,01 (IC 95% 2,0-4,58) (p<0,0001). Mulheres ≤40 anos mostraram significância à presença de Gardnerella vaginalis (p<0,0004). Conclusão: Uma elevada prevalência de Gardnerella vaginalis foi encontrada associada com as anormalidades citológicas, principalmente em mulheres sexualmente ativas.

Introduction:Gardnerella vaginalis facilitates human papillomavirus (HPV) infection. Objective: To verify the association between cytological abnormalities and the presence of Gardnerella vaginalis in cervicovaginal smears sent to the Clinical Laboratory of the Pontifical Catholic University of Goiás (LAC/PUC Goiás) stratified by age range. Method: Cross-sectional study carried out at LAC/PUC Goiás from January 2013 to December 2015. For statistical analysis, the variable age was categorized as ≤39 years and >40 years, using the IBM SPSS Statistics program (Version 2.0, 2011®) for the chi-square test (X²), with a 95% confidence interval and p<0.05. Results:4,558 cytopathological exams were analyzed, most of them with the presence of Lactobacillus spp (46.97%). The prevalence of pathogens was Gardnerella vaginalis (79.6%), followed by Candida spp. (16.8%), Trichomonas vaginalis (2.2%), Herpes simplex (0.4%) and Chlamydia trachomatis (0.1%). Cytological abnormalities were observed in 9.1%, being atypical squamous cells of undetermined significance (ASC-US) 2.57%, low grade squamous intraepithelial lesion (LSIL) 1.78%, atypical squamous cells of undetermined significance cannot exclude high intraepithelial lesion (ASC-H) 3.52%, high grade squamous intraepithelial lesion (HSIL) 1.08%, atypical endocervical cells, neoplastic favor (AGC-NEO) 0.22% and carcinoma 0.02%. There was a significant association between severe cytological abnormalities and women >40 years old OR 3.01 (95% CI 2.0-4.58) (p<0.0001). Women ≤40 years old showed the presence of Gardnerella vaginalis (p<0.0004). Conclusion:A high prevalence of Gardnerella vaginalis was found and its association with cytological abnormalities, especially in sexually active women.

Introducción:Gardnerella vaginalis facilita la infección por el virus del papiloma humano (VPH). Objetivo: Verificar la asociación entre anormalidades citológicas y la presencia de Gardnerella vaginalis en frotis cervicovaginales enviadas al Laboratorio Clínico de la Pontificia Universidad Católica de Goiás (LAC/PUC Goiás) estratificadas por grupo de edad. Método: Estudio transversal realizado en LAC/PUC Goiás desde enero de 2013 hasta diciembre de 2015. Para el análisis estadístico, la edad variable se clasificó como ≤39 años y >40 años, utilizando el programa IBM SPSS Statistics (Versión 2.0, 2011®) para la prueba de chi-cuadrado (X²), con un intervalo de confianza del 95% y p <0,05. Resultados: Se analizaron 4.558 exámenes citopatológicos. La prevalencia de Lactobacillusspp. con 46,97%. Los patógenos como Gardnerella vaginalis fueron 79,6%, Candidaspp. 16,8%, Trichomonas vaginalis 2,2%, Herpes simplex 0,4%, y Chlamydia trachomatis 0,1%. Se observaron anormalidades citológicas en 9,1%, con células escamosas atípicas de significado indeterminado (ASC-US) 2,57%, lesión intraepitelial escamosa de bajo grado (LSIL) 1,78%, células escamosas atípicas de significación indeterminada no pueden excluir lesión intraepitelial (ASC-H) 3,52%, lesión intraepitelial escamosa de alto grado (HSIL) 1,08%, células endocervicales atípicas, favor neoplásico (AGC-NEO) 0,22% y carcinoma 0,02%. Hubo una asociación significativa entre anormalidades citológicas severas y mujeres >40 años OR 3,01 (IC 95% 2,0-4,58) (p<0,0001). Las mujeres ≤40 años mostraron la presencia de Gardnerella vaginalis (p<0,0004). Conclusión: Se encontró una alta prevalencia de Gardnerella vaginalis y su asociación con anomalías citológicas, especialmente en mujeres sexualmente activas.

Latencia al parto tras cerclaje de emergencia en gestación múltiple / Latency to delivery after emergency physical-examination indicated cerclage in twin pregnancy

Introducción: Las guías clínicas actuales recomiendan el uso del cerclaje de emergencia (CE) como tratamiento de la insuficiencia cervical con exposición de membranas en gestaciones únicas. Sin embargo, el CE en gestación múltiple es tema de controversia dado que no existen ensayos clínicos randomizados que demuestren su eficacia. Algunos estudios retrospectivos sugieren que el CE también podría prolongar la gestación en embarazos múltiples. El objetivo de nuestro estudio es evaluar los resultados de las gestaciones múltiples que se sometieron a un CE en nuestro centro. Materiales y métodos: Se diseñó un estudio retrospectivo que incluyó los CE realizados en gestaciones gemelares en nuestro centro entre 2007-2016. No fueron tributarias de CE gestaciones con malformaciones fetales, monocoriales-monoamnióticas, triple o superior y finalizaciones activas de la gestación. Variables primarias: latencia al parto espontáneo y edad gestacional al parto. Variables secundarias: mortalidad neonatal, ingreso en UCI neonatal, rotura prematura de membranas pretérmino, corioamnionitis y fallo del cerclaje. Resultados. El estudio incluyó 17 pacientes. La edad gestacional mediana (rango intercuartil) al parto fue de 27,1 (24,5-32,3) semanas y la latencia mediana (rango intercuartil) al parto fue de 43 (21-64) días. Hubo 4/17 (23,5%) casos de parto antes de las 24 semanas de gestación y 2/26 (7,7%) de muerte neonatal. Discusión: Estos resultados muestran que la latencia al parto después del CE en gestación múltiple es remarcable, por lo que podría ser considerado como una opción terapéutica. Sin embargo, se requiere evidencia basada en estudios randomizados para hacer una recomendación firme

Introduction: Current guidelines support the use of physical-examination indicated cerclage (PEIC) as a treatment for cervical insufficiency and membrane exposure in single pregnancies. However, PEIC in twin pregnancies is a controversial issue as no data from random clinical trial are available to demonstrate its efficacy. Few studies suggest that PEIC may prolong pregnancy also in twin pregnancies. The aim of this study was to evaluate the results of twin pregnancies that underwent a PEIC in our health centre. Material and methods: A retrospective review was performed on women that underwent a PEIC from 2007-2016 in our centre. Women were not eligible if they were carrying foetuses with major foetal anomalies, more than two foetuses or monochorionic-monoamniotic pregnancies, or three or more foetuses or requesting an elective termination of pregnancy. Primary outcomes: latency to spontaneous delivery and gestational age (GA) at delivery. Secondary outcomes: neonatal mortality and Neonatal Intensive Care Unit admission, preterm premature rupture of membranes (PPROM), chorioamnionitis and cerclage displacement. Results: The study included a total of 17 women. The median (inter-quartile range) gestational age at delivery was 27.1 (24.5-32.3) weeks, and median (inter-quartile range) latency, from cervical cerclage to delivery, was 43 (21-64) days. There were 4/17 (23.5%) cases of delivery before 24 weeks of pregnancy, and 2/26 (7.7%) cases of neonatal death. Discussion: These results suggest that latency to delivery after PEIC in twins is remarkable. Therefore, it could be considered as an optional management. Nevertheless, evidence based on random clinical trial is required to make firm recommendations on its formal use

Infecciones profundas por Gardnerella vaginalis en el varón. Revisión de la literatura y a propósito de un caso / Male deep infections by Gardnerella vaginalis. A literature review and a case report

No disponible

Bacterias relacionadas con vaginosis bacteriana y su asociación a la infección por virus del papiloma humano / Vaginosis-associated bacteria and its association with HPV infection

Antecedentes y objetivo: En México y en el mundo cada vez son más frecuentes los casos de cáncer de cérvix y aunque se sabe que existen diversos factores de riesgo para padecer este tipo de cáncer, se ha sugerido que las alteraciones en el microbioma cervical pueden desempeñar un papel importante en el establecimiento y progresión del cáncer, específicamente hablando de la presencia de aquellas bacterias asociadas a vaginosis bacteriana como lo son Atopobium vaginae y Gardnerella vaginalis. Material y métodos: Se estudió el ADN de un total de 177 muestras de raspado de cérvix, de las cuales 104 pertenecían a mujeres sin alteraciones citológicas o colposcópicas y 73 muestras de lesiones precursoras con antecedente de infección por virus del papiloma humano (VPH). Todas las muestras fueron sometidas a detección de secuencias de Atopobium vaginae, Gardnerella vaginalis y VPH por medio de PCR. Resultados: El VPH fue encontrado en mayor proporción en las muestras precursoras, y poco más del 30% de las muestras sin lesión fueron positivas para VPH. La mayoría de las muestras contienen secuencias de ambas bacterias sin asociación con la presencia viral, lo que podría indicar que estos microorganismos serían parte del microbioma cervical en población mexicana. Conclusiones: Los resultados obtenidos indican que las bacterias analizadas potencialmente forman parte del bioma normal en las mujeres mexicanas por lo que es de especial importancia reconsiderar el papel patógeno de estos microorganismos

Background and objective: Cervical cancer is an important health problem in our country. It is known that there are several risk factors for this neoplasm, and it has been suggested that cervical microbiome alterations could play a role in the development and progress of cancer. Bacterial vaginosis associated bacteria such as Atopobium vaginae and Gardnerella vaginalis has been suggested as potential risk factor for cervical lesions and cervical cancer. Material and methods: DNA from 177 cervical scraping samples was studied: 104 belonged to women without cytological or colposcopic alterations and 73 samples from precursor lesions with previous human papillomavirus (HPV) infection history. All samples were screened for Atopobium vaginae, Gardnerella vaginalis and HPV by PCR. Results: High HPV prevalence was found in precursor samples, and 30% of samples without lesions were positive for HPV. Virtually all samples contained sequences of both bacteria, and interestingly, there was not HPV association observed; these results could suggest that these microorganisms could be part of the cervical microbiome in Mexican population. Conclusions: The results obtained indicate that the bacteria analysed could be part of normal biome in Mexican women, suggesting a potential reconsideration of the pathogen role of these microorganisms

Bacteriemia por Gardnerella vaginalis en una paciente con urolitiasis complicada / Bacteremia by Gardnerella vaginalis in a case of complicated urolithiasis

No disponible

Lysozyme as a cotreatment during antibiotics use against vaginal infections: An in vitro study on Gardnerella vaginalis biofilm models

Bacterial vaginoses are frequent in women, most of them involving Gardnerella vaginalis. In more than 50% of the cases, usual antibiotic treatments are not capable of eliminating completely the infection, leading to recurrent vaginosis. In addition to the appearance of antibiotic resistance, recurrence can be due to the development of a biofilm by G. vaginalis. In vitro experiments on G. vaginalis biofilms showed that the biofilm protected bacteria from the antibiotic clindamycin. Also, recombinant human lysozyme (rhLys) was able to both degrade biofilms and prevent their formation. This degradation effect persisted whenever other vaginal commensal or pathogenic microorganisms were added to the culture and on each tested clinical biofilm-producing strain of G. vaginalis. The co-administration of rhLys and clindamycin or metronidazole improved both antibiotics’ efficiency and lysozyme-driven biofilm degradation. The comparison of both clindamycin and metronidazole antibacterial spectra showed that metronidazole was preferable to treat vaginosis. This suggests that human lysozyme could be added as an anti-biofilm cotreatment to vaginal antibiotherapy, preferably metronidazole, against Gardnerella vaginalis infection in vivo (AU)

No disponible

Prevalencia de Trichomonas vaginalis, Candida albicans y Gardnerella vaginalis en mujeres sin síntomas de vaginitis / Prevalence of Trichomonas vaginalis, Candida albicans and Gardnerella vaginalis in women without symptoms of vaginitis

Introducción: la vaginitis puede tener manifestaciones simples o combinaciones de síntomas de diferentes etiologías, siendo frecuente un comportamiento asintomático.Objetivo: determinar la prevalencia deTrichomonas vaginalis, Candida albicans y Gardnerella vaginalis en mujeres sin síntomas de vaginitis que asistieron a consultorios médicos de la familia en los municipios Güines y San José de las Lajas de la provincia Mayabeque.Métodos: estudio descriptivo, transversal y prospectivo Los métodos empleados para identificar los microorganismos fueron: tinción de Gram para Gardnerella vaginalis, cultivo en medio Sabouraud en la detección de Candida albicans y el medio Diamond modificado en la identificación de Trichomonas vaginalis.Resultados: de un total de 179 muestras estudiadas fueron negativas 100 55,87 por ciento, y 79 resultaron positivas 44,1 por ciento. La infección más frecuente fue la candidiasis, en 45 pacientes, lo que representa el 25,14 por ciento de todos los diagnósticos realizados; a continuación vaginosis bacteriana, diagnosticada en 33 pacientes 18,44 por ciento y, por último, trichomoniasis en 5 pacientes.Conclusiones: los resultados demostraron un porcentaje significativo de mujeres con infecciones vaginales a pesar de encontrarse asintomáticas, comportándose de forma similar en ambos municipios de estudio (AU)

Introduction: vaginitis can have simple manifestations or combinations of symptoms of different etiologies, being frequent an asymptomatic behavior.Objective: to determine the prevalence of Trichomonas vaginalis, Candida albicans and Gardnerella vaginalis in women without symptoms of vaginitis attending family doctor's offices in Güines and San José de las Lajas municipalities in Mayabeque province.Methods: descriptive, cross-sectional and prospective study. The methods used to identify the microorganisms were: Gram staining for Gardnerella vaginalis, Sabouraud culture for the detection of Candida albicans and modified Diamond media in the identification of Trichomonas vaginalis.Results: Of a total of 179 tested samples, 100 55,87 per cent were negative and 79 turned out positive which represents 44,1 per cent. The most common infection was candidiasis in 45 patients, accounting for 25,14 per cent of all diagnoses made; followed by bacterial vaginosis, which was diagnosed in 33 patients 18,44 per cent and, finally, trichomoniasis in 5 patients.Conclusions: The results showed a significant percentage of women with vaginal infections despite being asymptomatic, behaving similarly in both municipalities studied (AU)

Absceso suburetral en mujer joven / Suburethral abscess in young woman

No disponible

Gardnerella vaginalis: diagnóstico microbiológico en mujeres con edad fértil / Gardnerella vaginalis: microbiological diagnosis in women of childbearing age

Se realiza un estudio en el período comprendido enero-junio de 2012 en el Hospital General Docente Dr Agostinho Neto de Guantánamo, con el objetivo de diagnosticar Gardnerella vaginalis en 103 mujeres procedentes de la consulta de infertilidad y patología de cuello. Se analizaron las variables: edad, hijos, abortos, consulta de procedencia y características de la secreción. Se realiza diagnóstico microbiológico directo, frotis, cultivo y pruebas bioquímicas. Se identifica Gardnerella vaginalis en 63,16 por ciento de las pacientes, el grupo de edad que predominó fue de 26-36, las secreciones blanco-grisáceas y fétidas fueron las más frecuentes. La prueba del hidróxido de potasio al 10 por ciento resultó positiva en el 73 por ciento de los casos. Se concluye que el diagnóstico presuntivo con el hidróxido de potasio al 10 por ciento no es concluyente, por lo que es necesario aplicar los criterios evaluados por Amsel(AU)

A study was conducted from January to June 2012 at the Teaching General Hospital Dr Agostinho Neto Guantanamo, in order to diagnose Gardnerella vaginalis in 103 women from infertility consultation and neck pathology. The variables were analyzed: Age children, abortions, inquiry source and characteristics of the discharge. Direct microbiological diagnosis, smear, culture and biochemical tests were performed, too. Gardnerella vaginalis was identified and the predominant age groups 26-36 in 63.16por ciento of patients, the fetid and gray-white secretions were the most frequent. Proof of potassium hydroxide 10por ciento was positive in 73por ciento of cases. It is concluded that the presumptive diagnosis with potassium hydroxide 10por ciento is inconclusive, so it is necessary to apply the criteria evaluated by Amsel. Keywords: Gardnerella vaginalis, bacterial vaginosis

Leucorreas líquidas y cremosas: diferencias clínicas y microbiológicas (estudio prospectivo de 1 año) / A 1-year prospective study of liquid and creamy leukorrheas: clinical and microbiological differences

Objetivo Estudio prospectivo de 1 año sobre leucorreas, líquidas y cremosas, diferenciando sus características clínicas y microbiológicas. Diseño y método Se clasifican las leucorreas en líquidas y cremosas según su aspecto y características en la exploración vaginal con espéculo. Se toman muestras para citología cervicovaginal y muestra con escobillón a medio de transporte para cultivo microbiológico. Resultados La edad media de las mujeres fue 30 años (rango, 16-62 años). Eran nuligestas el 50%. En 60% las leucorreas se dieron en la 2.a fase del ciclo. Mayor frecuencia de casos en primavera (meses III y IV). En 50% las leucorreas eran blancas y en 25% amarillas. Había prurito en 25%. Estaban depiladas en 25%. No usaban contracepción en 60%. Eran extranjeras el 23%.La citología fue positiva en 35%. El diagnóstico más frecuente fue la vaginosis bacteriana en 17%.El cultivo fue negativo en 88%. En los cultivos positivos, los gérmenes más frecuentemente encontrados fueron: Gardnerella vaginalis en 37% y Candida albicans en 31%.ConclusionesLas leucorreas líquidas son más fisiológicas, tienen cultivo negativo en 50%. Los gérmenes más frecuentemente encontrados fueron: Gardnerella vaginalis y Candida albicans en 17,30%, respectivamente. Las leucorreas cremosas son más patológicas, con cultivo positivo en 61,42%. Los gérmenes más frecuentemente encontrados fueron: Gardnerella vaginalis en 22,85%, Candida spp. en 21,25% y Candida albicans en 14,28% (AU)

Objective We performed a prospective 1-year study to identify the clinical and microbiological characteristics of liquid and creamy leukorrheas. Design and method We classified leukorrheas into liquid and creamy, according to their appearance and characteristics in vaginal examination with a speculum. Samples were taken for cervicovaginal cytology. A further sample was taken with a cotton-swab for transfer to a medium for microbiological culture. Results The mean age of the women was 30 years (range, 16-62 years). Fifty percent were nulligravidas. The leukorrheas were found in the second phase of the menstrual cycle in 60% of the women and were more frequent in spring (March and April). The leukorrheas were white in 50% and yellow in 25%. Pruritus was found in 25%. The vulvas were depilated in 25%. Sixty percent of the women used no contraception. Twenty-three percent were foreigners. Cytology was positive in 35%. The most frequent diagnosis was bacterial vaginosis in 17%. Culture was negative in 88%. In positive cultures, the most frequent organisms were Gardnerella vaginalis in 37% and Candida albicans in 31%.ConclusionsLiquid leukorrheas were more physiologic as cultures were negative in 50%. The most frequent organisms were G. vaginalis and C. albicans, each being found in 17.30% of patients. Creamy leukorrheas were more pathologic, with positive culture in 61.42%. The most frequent organisms were G. vaginalis in 22.85%, Candida spp in 21.25%, and C. albicans in 14.28% (AU)

Posible papel de Bacteroides fragilis enterotoxigénico en la etiología de la vaginitis infecciosa / Possible role of enterotoxigenic Bacteroides fragilis in the etiology of infectious vaginitis

La vaginitis es un trastorno ginecológico frecuente producido por distintas causas, algunas de las cuales permanecen desconocidas. Bacteroides fragilis es el anaerobio más importante en bacteriología clínica. Algunas cepas son enterotoxigénicas y se asocian con síndromes intestinales y extraintestinales. Recientemente han sido aisladas de pacientes con vaginitis. En este trabajo se planteó investigar la posible asociación de B. fragilis enterotoxigénico con la vaginitis infecciosa. Fueron procesadas 265 muestras de exudado vaginal. 202 de mujeres sintomáticas y 63 mujeres sanas. La identificación de los microorganismos se realizó por métodos convencionales. En 31,2% de las pacientes sintomáticas se identificaron: Gardnerella vaginalis, Candida albicans, Mobiluncus, Mycoplasma hominis, Ureaplasma urealyticum y Streptococcus agalactiae. En 27 pacientes sintomáticas y en 5 mujeres sanas se identificó B. fragilis. Estas cepas fueron cultivadas en medio líquido e incubadas durante 48 h a 36° C en anaerobiosis. La toxicidad en los sobrenadantes se ensayó en células HT-29. 18 cepas de B. fragilis aisladas de pacientes sintomáticas fueron enterotoxigénicas, ya que indujeron alteraciones en la monocapa celular y en las células. No se identificó en mujeres sanas (P<0,05). 77,7% de las cepas de B. fragilis enterotoxigénicas no se encontraron asociadas con otros patógenos específicos. Este hecho sugiere que pudiera ser un agente causante de vaginitis, ya que el efecto de la enterotoxina sobre la E-cadherina del epitelio vaginal podría facilitar la invasión y su posible papel patógeno en la vagina. Esta es la primera investigación que asocia a Bacteroides fragilis enterotoxigénico como posible causa de vaginitis infecciosa.

Vaginitis is a common gynecologic disorder. It is due to several causes, some even unknown. Bacteroides fragilis is the most important anaerobe in clinical bacteriology, some strains of this group are notable for being enterotoxigenic and they have been associated with intestinal and extraintestinal syndromes. They have recently been isolated from patients with vaginitis. The purpose of this study was to investigate a possible association of enterotoxigenic B. fragilis with infectious vaginitis. 265 samples of vaginal exudate were processed, 202 from symptomatic patients and 63 healthy women. The identification of the microorganisms was carried out by conventional methods. In 31.2% of symptomatic patients were identified: Gardnerella vaginalis, Mobiluncus, Candida albicans, Mycoplasma hominis, Ureaplasma urealyticum and Streptococcus agalactiae. B. fragilis was identified in 27 symptomatic patients and 5 healthy women. These strains were cultivated in liquid medium and incubated during 48 h at 36°C in anaerobe chambers. Supernatant activity was assayed in HT-29 cells. Eighteen B. fragilis strains isolated from symptomatic patients were enterotoxigenic, because induced alterations in target cell morphology. It was not identified in healthy women (P<0.05). 77.7% of enterotoxigenic B. fragilis strains were not associated with other specific pathogens. This fact suggests that enterotoxigenic B. fragilis could be a cause for vaginitis. The effect of enterotoxin on E-cadherin of vaginal epithelium could facilitate invasion and its possible pathogenic role in the vagina. This is the first report that associates enterotoxigenic Bacteroides fragilis as a possible cause of infectious vaginitis.

Comportamiento de la Vaginosis Bacteriana por Gardnerella vaginalis. Centro Municipal de Higiene y Epidemiología, 2011 / Behavior of Bacterial vaginitis caused by Gardnerella vaginalis. Municipal Center of Epidemiology and Higiene, 2011

Se realizó un estudio descriptivo transversal del comportamiento de la Vaginosis Bacteriana por Gardnerella vaginalis en las pacientes que acudieron al Laboratorio de Microbiología del Centro Municipal de Higiene y Epidemiología (CMHE) de Manzanillo en el año 2011. Este constó de 300 exudados vaginales, realizados durante el período julio-septiembre del 2011, y cuyas edades fluctuaron entre los 18 y 44 años de edad. De ellos 86 fueron positivas a Gardnerella vaginalis (39,82 por ciento) y los grupos de edades más afectados fueron los comprendidos entre 18 y 29 años, (mayor incidencia reproductiva de las mujeres). Este microorganismo se diagnosticó mediante determinaciones específicas; además a las pacientes positivas se les aplicó una encuesta que determinó los factores epidemiológicos que produjeron la infección. La información obtenida se procesó en una base de datos (paquete estadístico SPSS 11.5) y se expuso en tablas para su mejor análisis y discusión de los resultados(AU)

It was performed a descriptive transversal study about the behavior of Bacterial Vaginitis caused by Gardnerella vaginalis in the patients who assisted to the Microbiology laboratory of the Municipal Center of Epidemiology and Hygiene(MCEH) of Manzanillo during the year 2012. It had around 300 vaginal exudates performed during the period july - september 2011 and their ages were between 18 and 44 years old. From them, 86 were positive to Gardnerella vaginalis (39.82 percent) and the group of ages mostly affected were between 18 and 29 years old (major reproductive incidence in women). This microorganism was diagnosed through specific determinations, besides it was applied a survey to the positive patients and it determined the epidemiologic factors that produced the infection. The information obtained was processed into a data basis (statistical package SPSS 11.5) and it was evidenced through tables for its better analysis and discussion of the results(EU)

Caracterización de la vaginosis bacteriana en edad reproductiva en el área de salud de Yara / Characterization of bacterial vaginosis in the reproductive age in the health area Yara

El presente trabajo se desarrolló en el laboratorio de Microbiología ubicado en el municipio de Yara, provincia Granma, donde se analizaron muestras de exudados vaginales a todas las pacientes que acudieron al laboratorio con la indicación médica de este tipo de complementario, el universo estuvo comprendido por 440 pacientes del área de salud de Yara, con los objetivos de identificar a los agentes causales más frecuentes de infecciones vaginales, principalmente Gardnerella, como causa de vaginosis bacteriana. Los datos para el estudio fueron: edad de comienzo de las relaciones sexuales, estado conyugal, uso de preservativo y área residencial. Para el análisis de los datos se aplicaron medidas de frecuencia relativa (porcentual) y se expresan a través de tablas para su mejor comprensión. Nuestros resultados indicaron que los agentes más frecuentes encontrados son Gardnerella vaginalis y Mobiluncus spp, siendo éste un indicador de la vaginosis bacteriana, el grupo etáreo más afectado fue el de 14-19 años(AU)

The present work was developed at the Microbiology laboratory located in Yara's municipality of Granma province, where there were examined signs of vaginal exudations to all of the patients that came to the laboratory with the medical indication of these complementary tests. The universe was made by 440 patients of the health area of Yara, with the objectives to identify the most frequent cause agents of vaginal infections, principally Gardnerella as the cause of bacterial vaginosis. The data for the research were: age of the beginning of sexual relations, conjugal status, use of condoms and residential area. For the analysis of the data there were applied measures of relative frequency (percentage) and they were evidenced through charts for their better understanding. Our results indicated that the more frequent agents met are Gardnerella vaginalis and Mobiluncus spp, being this one a bacterial vaginosis's indicator, the most affected etharian group was between 14-19 years(EU)

Utilidad de la determinación del pH vaginal para el diagnóstico de las vulvovaginitis y su relación con la patología obstétrica / Utility of vaginal pH determination in the diagnosis of vulvovaginitis and its association with obstetric pathology

Objetivos. Valorar la utilidad de la determinación del pH vaginal en el primer control del embarazo para el diagnóstico de vulvovaginitis y su relación con la patología obstétrica. Material y métodos. Hemos realizado el estudio en 200 embarazadas de bajo riesgo. Efectuamos el pH vaginal en el primer control del embarazo a las gestantes. Independientemente de su sintomatología, tomamos cultivo de exudado vaginal (CEV) a 103 pacientes; a las otras 97 pacientes lo realizamos si tenían síntomas y/o un pH > 4,5. Solo pusimos tratamiento si eran sintomáticas. Seguimos la evolución de sus embarazos para valorar su patología obstétrica y sus partos. Resultados. La media de pH en la muestra fue 4,41 (4,04–4,78). Encontramos una asociación estadísticamente muy significativa entre la elevación de pH vaginal superior a 4,5 y el aislamiento mediante cultivo de Gardnerella vaginalis (G. vaginalis) (p<0,000), con un OR de 35,15 (4,67–730,39). La mayoría de los cultivos fueron normales, y los gérmenes aislados por orden de frecuencia fueron: Candida albicans (C. albicans) (17,5%), G. vaginalis (7,8%) y Streptococcus agalactiae (7,8%), siendo más del 85% de las gestantes portadoras asintomáticas. La patología obstétrica registrada en nuestra muestra ha sido: amenazas de parto prematuro (2%), roturas prematuras de membranas (2%), partos pretérmino (4,5%) y abortos espontáneos (6%). Conclusiones. El pH vaginal puede ser una buena prueba de cribado para el diagnóstico de vaginosis bacterianas. El germen más prevalente en nuestra muestra ha sido C. albicans siendo la mayoría de gestantes portadoras asintomáticas. No hemos encontrado relación entre la patología obstétrica registrada y los gérmenes aislados en los cultivos de exudado vaginal (AU)

Objective. To assess the usefulness of vaginal pH determination in the first prenatal visit in the diagnosis of vulvovaginitis and its association with obstetric abnormalities. Material and methods. We determined vaginal pH in the first prenatal visit in 200 low-risk pregnancies. In 103 women, vaginal secretions were cultured, independently of their symptoms. In the remaining 97 women, culture was performed only if symptoms were present and/or pH was >4.5. Treatment was prescribed in symptomatic women only. The pregnancies were followed up to evaluate obstetric abnormalities and data on deliveries. Results. The mean pH in the study sample was 4.41 (4.04–4.78). We found a statistically significant association (P<.000) between an increase in vaginal pH over 4.5 and isolation through culture of Gardnerella vaginalis (G. vaginalis), with an OR of 35.15 (4.67–730.39). Most cultures were normal. In order of frequency, the identified microorganisms were Candida albicans (C. albicans) (17.5%), G. vaginalis (7.8%) and Streptococcus agalactiae (7.8%). More than 85% of the carriers were asymptomatic. Obstetric pathology in our sample consisted of preterm labor (2%), premature rupture of membranes (2%), preterm delivery (4.5%) and miscarriage (6%). Conclusions. Vaginal pH determination might be an effective screening test for the diagnosis of bacterial vaginosis. The most prevalent microorganism in our sample was C. albicans and most carriers were asymptomatic. We found no relationship between obstetric pathology and the microorganisms isolated in cultures of vaginal secretions (AU)

Vaginosis bacteriana en estudiantes universitarias de Antofagasta / BacteriaI vaginosis in university students of Antofagasta

The bacterial vaginosis (VE) is a clinical entity that one has proposed as sexually transmitted disease (ETS), which still is in discussion, provided that the principal agents etiologic (Gardnerella vaginalis and Mobiluncus spp), also are a part of the normal vaginal flora. VE's prevalence was investigated according to the Nugent's microbiological and Amsel's clinical criteria between 190 university students of Antofagasta city who consult spontaneously, during April and October, 2006. Other agents (bacteria, fungi and parasites) isolated of the vaginal secretion were diagnosed by means of standardized methods. One found a prevalence of 19% (36/190) of VE and 38% (72/190) of other pathologies: Candida albicans 76% (55/72); bacteria, predominating over Enterobacteriaceas 15% (21/72) and Trichomonas vaginalis 3% (2/72). One concludes that the high indicators of VE and other infectious pathologies of ETS's type in this group of women who begin in the sexual activity it needs of major educational support, special1y the related ones to the entity bacterial vaginosis, who still is not very frequently studied in these groups.

La vaginosis bacteriana (VB) es una entidad clínica que se ha propuesto como enfermedad de transmisión sexual (ETS), lo cual aún está en discusión, dado que los principales agentes etiológicos (Gardnerella vaginalis y Mobiluncus spp), también son parte de la flora normal vaginal. Se investigó la prevalencia de VB, según los criterios microbiológico de Nugent y clínico de Amsel en 190 estudiantes universitarias de la ciudad de Antofagasta que consultan espontáneamente, durante abril y octubre del 2006. Otros agentes patógenos (bacterias, hongos y parásitos) aislados de la secreción vaginal fueron diagnosticados mediante técnicas estandarizadas. Se encontró una prevalencia del 19% (36/190) de VB y 38% (72/190) de otras patologías causadas por: Candida albicans 76% (55/72); bacterias, predominando Enterobacteriaceas 15% (21/72); Y Trichomonas vaginalis 3% (2/72). Se concluye que los elevados indicadores de VB y de otras patologías infecciosas del tipo de las ETS, en este grupo de mujeres que se inician en la actividad sexual, requiere de mayor apoyo educativo y profiláctico, especialmente las relacionadas con la entidad vaginosis bacteriana, la cual aún no es muy frecuentemente estudiada en estos grupos etarios.