A Prospective, Open-Label Pilot Study of Concurrent Male Partner Treatment for Bacterial Vaginosis.

Up to 50% of women receiving first-line antibiotics for bacterial vaginosis (BV) experience recurrence within 12 weeks. Evidence suggests that reinfection from an untreated regular sexual partner contributes to recurrence. We conducted a pilot study of 34 heterosexual couples to describe the impact of concurrent partner treatment on the composition of the genital microbiota over a 12-week period. We also determined the acceptability and tolerability of concurrent partner treatment and obtained preliminary estimates of the efficacy of the intervention to inform a randomized controlled trial (RCT). Women received first-line antibiotic treatment for BV (i.e., oral metronidazole or intravaginal clindamycin), and their male partner received oral metronidazole, 400 mg, and 2% clindamycin cream applied topically to penile skin, both twice daily for 7 days. The genital microbiota was characterized at three anatomical sites (women, vaginal; men, cutaneous penile and first-pass urine [representing the urethra]) using 16S rRNA gene sequencing. Immediately posttreatment, concurrent partner treatment significantly reduced the abundance of BV-associated bacteria (false-discovery rate [FDR] corrected P value < 0.05) and altered the overall microbiota composition of all three anatomical sites (P = 0.001). Suppression of BV-associated bacteria was sustained in the majority (81%) of women over the 12-week period (FDR P value < 0.05), despite BV-associated bacteria reemerging at both genital sites in men. In this cohort of women at high risk for recurrence, five recurred within 12 weeks of treatment (17%; 95% confidence interval [CI], 6 to 34%). Importantly, men tolerated and adhered to combination therapy. Our findings provide support for an RCT of combined oral and topical male partner treatment for BV. IMPORTANCE Recurrence of BV following standard treatment is unacceptably high. Posttreatment recurrence is distressing for women, and it imposes a considerable burden on the health care system. Recurrences result in multiple presentations to clinical services and repeated antibiotic use, and the associated obstetric and gynecological sequelae are significant. New treatments to improve long-term BV cure are urgently needed. Here, we used 16S rRNA gene sequencing to investigate changes in the microbiota composition at three genital sites (vagina, penile skin, and male urethra) of heterosexual couples undergoing concurrent partner treatment for bacterial vaginosis (BV). We found that concurrent partner treatment immediately and significantly altered the composition of the genital microbiota of both partners, with a reduction in BV-associated bacteria seen at all three sites. BV cure at 12 weeks posttreatment was higher than expected. These microbiological data provide evidence for continued investigation of partner treatment as a strategy to improve BV cure.

The Cervicovaginal Mucus Barrier.

Preterm births are a global health priority that affects 15 million babies every year worldwide. There are no effective prognostic and therapeutic strategies relating to preterm delivery, but uterine infections appear to be a major cause. The vaginal epithelium is covered by the cervicovaginal mucus, which is essential to health because of its direct involvement in reproduction and functions as a selective barrier by sheltering the beneficial lactobacilli while helping to clear pathogens. During pregnancy, the cervical canal is sealed with a cervical mucus plug that prevents the vaginal flora from ascending toward the uterine compartment, which protects the fetus from pathogens. Abnormalities of the cervical mucus plug and bacterial vaginosis are associated with a higher risk of preterm delivery. This review addresses the current understanding of the cervicovaginal mucus and the cervical mucus plug and their interactions with the microbial communities in both the physiological state and bacterial vaginosis, with a focus on gel-forming mucins. We also review the current state of knowledge of gel-forming mucins contained in mouse cervicovaginal mucus and the mouse models used to study bacterial vaginosis.

Use of a Novel Couples' Verification Tool in a Male Partner Treatment Study of Women With Recurrent Bacterial Vaginosis.

Verification of relationship status beyond self-report is an important aspect in sexually transmitted infection research, including partner treatment studies where primary sexual partners are targeted for enrollment. This exploratory study describes the use of a novel couples' verification tool in a male partner treatment study of women with recurrent bacterial vaginosis.

Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review.

Recurrent vulvovaginal infections (RVVI) has not only become an epidemiological and clinical problem but also include large social and psychological consequences. Understanding the mechanisms of both commensalism and pathogenesis are necessary for the development of efficient diagnosis and treatment strategies for these enigmatic vaginal infections. Through this review, an attempt has been made to analyze vaginal microbiota (VMB) from scratch and to provide an update on its current understanding in relation to health and common RVVI i.e. bacterial vaginosis, vulvovaginal candidiaisis and Trichomoniasis, making the present review first of its kind. For this, potentially relevant studies were retrieved from data sources and critical analysis of the literature was made. Though, culture-independent methods have greatly unfolded the mystery regarding vaginal bacterial microbiome, there are only a few studies regarding the composition and diversity of vaginal mycobiome and different Trichomonas vaginalis strains. This scenario suggests a need of further studies based on comparative genomics of RVVI pathogens to improve our perceptive of RVVI pathogenesis that is still not clear (Fig. 5). Besides this, the review details the rationale for Lactobacilli dominance and changes that occur in healthy VMB throughout a women's life. Moreover, the list of possible agents continues to expand and new species recognised in both health and VVI are updated in this review. The review concludes with the controversies challenging the widely accepted dogma i.e. "VMB dominated with Lactobacilli is healthier than a diverse VMB". These controversies, over the past decade, have complicated the definition of vaginal health and vaginal infections with no definite conclusion. Thus, further studies on newly recognised microbial agents may reveal answers to these controversies. Conversely, VMB of women could be an answer but it is not enough to just look at the microbiology. We have to look at the woman itself, as VMB which is fine for one woman may be troublesome for others. These differences in women's response to the same VMB may be determined by a permutation of behavioural, cultural, genetic and various other anonymous factors, exploration of which may lead to proper definition of vaginal health and disease.

Prevalence of sexually transmitted infections and bacterial vaginosis among lesbian women: systematic review and recommendations to improve care.

Our aim was to systematically review data about the risk of sexually transmitted infections (STI) and bacterial vaginosis among lesbian women and to suggest strategies to improve prevention, diagnosis and treatment. A search strategy for lesbian, STI and bacterial vaginosis was applied to PubMed, LILACS and BDENF databases. Of 387 unique references retrieved, 22 fulfilled the inclusion criteria (cross-sectional studies reporting prevalence for 8 STIs/bacterial vaginosis and history of a STI). The most frequent infection reported was bacterial vaginosis, and none study reported data on hepatitis B. A wide range of prevalence was observed for most infections. In terms of risk factors, the number of sexual partners, the past or current smoking, a history of forced sex and sexual stigma seem to increase the risk of STI and bacterial vaginosis. The findings of this review are discussed considering guidelines directly addressing the LGBT community's health and relevant studies investigating both safe sexual practices and the intricate relationship between LGBT people and their care providers. A set of recommendations to improve preventive care for lesbian women is proposed. Affirming that little is known about the extent of STIs and bacterial vaginosis transmission in female-to-female sexual activities or about the risk factors for STI and bacterial vaginosis among lesbian women is reasonable. In fact, the overall quality of the studies was low or very low with significant uncertainty around their findings. However, we consider that the available knowledge indicates some paths to be followed by care providers and policy decision-makers to improve their actions towards better sexual health of lesbian women.

Incubation period and risk factors support sexual transmission of bacterial vaginosis in women who have sex with women.

OBJECTIVE: The epidemiology of bacterial vaginosis (BV) favours sexual transmission of BV-associated bacteria. We examined incubation period and risk factors for incident BV (iBV) in a prospective study of women who have sex with women (WSW). METHODS: Using daily self-collected vaginal swabs, WSW with normal vaginal microbiota (no Amsel criteria and a Nugent score of 0-3) were followed for 90 days or until iBV (Nugent score 7-10 on at least 2-3 consecutive days). Daily diaries of sexual activity and menses were completed. Time to iBV was estimated. Accounting for differing lengths of follow-up and age, rates of sexual activities (per 100 person-days (pd)) were compared according to iBV status. The relationship between menses and iBV was also investigated. RESULTS: Of the 36 WSW, the mean age was 30 years (SD 8) and 92% were African American. The probability of iBV at 30 and 60 days was 20% (SD 7%) and 36% (SD 8%), respectively; 14 (39%) developed iBV by 90 days. In WSW with iBV versus those without iBV, the relative rate of any sexual activity prior to iBV was 40% higher (20.4 vs 14.6 per 100 pd; p=0.010), sex with a woman was 38% higher (14.3 vs 10.3 per 100 pd; p=0.038), digital-vaginal sex was 57% higher (14.3 vs 9.1 per 100 pd; p=0.005) and digital-anal sex was 5.6 times higher (2.9 vs 0.5 per 100 pd; p<0.001). iBV was more likely for those WSW with menses in the prior 2 days as compared with those without recent menses (HR 3.4; p=0.029). Sexual activity occurred in 93% WSW at a median of 4 days (95% CI 2 to 6) prior to iBV. CONCLUSION: iBV was common and associated with sexual activity in this cohort of predominantly African American WSW. An incubation period of 4 days is consistent with other bacterial STIs.

Prevalence of sexually transmitted infections and bacterial vaginosis among lesbian women: systematic review and recommendations to improve care / Prevalência de infecções sexualmente transmissíveis e vaginose bacteriana em mulheres lésbicas: revisão sistemática e recomendações para melhoria do cuidado / Prevalencia de infecciones sexualmente transmisibles y vaginosis bacteriana entre mujeres lesbianas: revisión sistemática y recomendaciones para mejorar el cuidado

Our aim was to systematically review data about the risk of sexually transmitted infections (STI) and bacterial vaginosis among lesbian women and to suggest strategies to improve prevention, diagnosis and treatment. A search strategy for lesbian, STI and bacterial vaginosis was applied to PubMed, LILACS and BDENF databases. Of 387 unique references retrieved, 22 fulfilled the inclusion criteria (cross-sectional studies reporting prevalence for 8 STIs/bacterial vaginosis and history of a STI). The most frequent infection reported was bacterial vaginosis, and none study reported data on hepatitis B. A wide range of prevalence was observed for most infections. In terms of risk factors, the number of sexual partners, the past or current smoking, a history of forced sex and sexual stigma seem to increase the risk of STI and bacterial vaginosis. The findings of this review are discussed considering guidelines directly addressing the LGBT community's health and relevant studies investigating both safe sexual practices and the intricate relationship between LGBT people and their care providers. A set of recommendations to improve preventive care for lesbian women is proposed. Affirming that little is known about the extent of STIs and bacterial vaginosis transmission in female-to-female sexual activities or about the risk factors for STI and bacterial vaginosis among lesbian women is reasonable. In fact, the overall quality of the studies was low or very low with significant uncertainty around their findings. However, we consider that the available knowledge indicates some paths to be followed by care providers and policy decision-makers to improve their actions towards better sexual health of lesbian women.

Nosso objetivo foi revisar sistematicamente dados sobre o risco de infecções sexualmente transmissíveis (ISTs) e vaginose bacteriana em mulheres lésbicas e sugerir estratégias para melhorar prevenção, diagnóstico e tratamento. Uma estratégia de busca para lésbica, ISTs e vaginose bacteriana foi aplicada às bases PubMed, LILACS e BDENF. De 387 referências únicas identificadas, 22 preenchiam os critérios de inclusão (estudos seccionais relatando a prevalência de 8 ISTs/vaginose bacteriana e histórico de ISTs). A infecção mais frequentemente relatada foi vaginose bacteriana e nenhum estudo relatou dados sobre hepatite B. Uma ampla gama de prevalências foi observada para a maioria das infecções. Em termos de fatores de risco, o número de parceiras sexuais, ser ou ter sido fumante, histórico de sexo forçado e estigma sexual parecem aumentar o risco de ISTs e vaginose bacteriana. Os resultados desta revisão são discutidos à luz de diretrizes que abordam diretamente a saúde da comunidade LGBT e também de estudos relevantes que investigaram tanto práticas de sexo seguro quanto a complexa relação entre pessoas LGBT e profissionais de saúde. Um conjunto de recomendações para melhorar o cuidado preventivo para mulheres lésbicas é proposto. É razoável afirmar que pouco se sabe sobre a dimensão da transmissão de ISTs e vaginose bacteriana em atividades sexuais entre mulheres ou sobre os fatores de risco para ISTs e vaginose bacteriana em mulheres lésbicas. De fato, a qualidade dos estudos foi, de forma geral, baixa ou muito baixa, com incerteza significativa quanto a seus resultados. Contudo, consideramos que o conhecimento disponível indica alguns caminhos a serem seguidos por profissionais de saúde e na elaboração de políticas públicas para melhorar ações em direção a uma melhor saúde sexual de mulheres lésbicas.

Nuestro objetivo fue realizar una revisión sistemática de los datos sobre infecciones de trasmisión sexual (ITS) y riesgo de vaginosis bacteriana entre mujeres lesbianas y sugerir estrategias para mejorar su prevención, diagnóstico y tratamiento. La estrategia de búsqueda de lesbiana, ITS y vaginosis bacteriana se realizó en las bases de datos de PubMed, LILACS y BDENF. De 387 referencias únicas recogidas, 22 reunían criterios de inclusión (estudios transversales informaron sobre la prevalencia de 8 ITS/vaginosis bacteriana e historial de una ITS). La infección más frecuente fue vaginosis bacteriana y ningún estudio proporcionó datos sobre hepatitis B. se observó un amplio rango de prevalencia para la mayoría de las infecciones. En términos de factores de riesgo, el número de parejas sexuales, ser fumador o exfumador, un pasado de abusos sexuales, así como el estigma sexual parece que incrementaron el riesgo de ITS y vaginosis bacteriana. Los hallazgos del presente estudio se discuten a la luz de las directrices de salud directamente dirigidas a la comunidad LGBT, y también a estudios relevantes que investigaban tanto las prácticas sexuales seguras, como la relación intricada entre individuos del colectivo LGBT y sus proveedores de salud. Se propone un conjunto de recomendaciones para mejorar el cuidado preventivo de mujeres lesbianas. Es razonable afirmar que se conoce poco sobre el grado de transmisión de las ITS y vaginosis bacteriana en las relaciones sexuales entre mujeres o sobre los factores de riesgo para las ITS y vaginosis bacteriana entre mujeres lesbianas. De hecho, la calidad general de los estudios fue baja o muy baja con una incertidumbre significativa sobre sus resultados. No obstante, consideramos que el conocimiento disponible indica algunos caminos que pueden recorrer proveedores de salud y tomadores decisiones para mejorar sus acciones orientadas a una mejor salud sexual de las mujeres lesbianas.

Association of Recent Bacterial Vaginosis With Acquisition of Mycoplasma genitalium.

We assessed the association between recent bacterial vaginosis (BV) and incident Mycoplasma genitalium, a sexually transmitted bacterium associated with adverse female reproductive health outcomes. Female sex workers in Mombasa, Kenya, completed a monthly sexual behavior interview and clinical examination. During February 2005-February 2006, vaginal fluid specimens collected from women every other month were tested for M. genitalium by nucleic acid amplification testing. Vaginal microbiota were assessed monthly and categorized by Nugent score (0-3 = normal microbiota, 4-6 = intermediate microbiota disruption, and 7-10 = BV). A discrete failure time analysis for multiple events using logistic regression was employed to estimate the odds of incident M. genitalium infection at follow-up visits among women with BV (vs. normal microbiota) at the preceding visit. Among the 280 women, 54.3% were positive for human immunodeficiency virus. At baseline, 16.1% had prevalent M. genitalium infection and 40.4% had prevalent BV. There were 59 incident M. genitalium infections among 50 women, for an incidence rate of 34.6 cases per 100 person-years. Following adjustment for age, human immunodeficiency virus status, and time, prior BV was associated with a 3.5-fold increase in odds of incident M. genitalium (adjusted odds ratio = 3.49, 95% confidence interval: 1.86, 6.56). This strong association suggests that BV may enhance susceptibility to M. genitalium infection.

Current Treatment of Bacterial Vaginosis-Limitations and Need for Innovation.

Practitioners and patients alike widely recognize the limitations of current therapeutic approaches to the treatment of bacterial vaginosis (BV). Options remain extremely limited, and our inability to prevent the frequently, often relentless symptomatic recurrences of BV and to reduce serious sequelae such as preterm delivery, remains an acknowledged but unresolved shortcoming. Our incomplete understanding of the pathophysiology of this unique form of vaginal dysbiosis has been a significant impediment to developing optimal treatment and prevention approaches. New drugs have not been forthcoming and are not likely to be available in the immediate future; hence, reliance on the optimal use of available agents has become essential as improvised often unproven regimens are implemented. In this review, we will explore the limitations of currently recommended therapies, with a particular focus on the contribution of reinfection and pathogen persistence to BV recurrence, and the development of interventions that target these mechanisms. Ultimately, to achieve sustained cure and effectiveness against BV-associated sequelae, it is possible that we will need approaches that combine antimicrobials with biofilm-disrupting agents and partner treatments in those at risk of reinfection.

Gynecologic health and disease in relation to the microbiome of the female reproductive tract.

It is well established that the vagina is colonized by bacteria that serve important roles in homeostasis. Imbalances in the proportion of bacteria may lead to a predisposition to infection or reproductive complications. Molecular-based approaches demonstrated a greater degree of microbial diversity both within and between women than previously recognized. The vaginal microbiome may fluctuate during various states of health, such as during the menstrual cycle or after menopause, and there may be differences in the vaginal microbiome between women of different ethnicities. Furthermore, the specific composition of the vaginal microbiome may influence the predisposition to dysbiosis and the transmission of sexually transmitted infections. An understanding of the diversity of the vaginal microbial environment during states of health is essential for the identification of risk factors for disease and the development of appropriate treatment.

Incident bacterial vaginosis (BV) in women who have sex with women is associated with behaviors that suggest sexual transmission of BV.

BACKGROUND: Female same-sex partnerships provide a unique opportunity to study the pathogenesis and transmissibility of bacterial vaginosis (BV) because it can be diagnosed in both members of the partnership. We conducted a nationwide community-enrolled cohort study of women who have sex with women, including women coenrolled with their regular female sexual partner (FSP), to investigate the BV incidence rate and factors associated with incident BV. METHODS: Women who have sex with women, without prevalent BV in a cross-sectional study, were enrolled in a 24-month cohort study involving 3-monthly questionnaires and self-collected vaginal swabs that were scored by the Nugent method. We assessed the BV incidence rate per 100 woman-years (WY) and used univariate and multivariable Cox regression analysis to establish factors associated with BV acquisition. RESULTS: Two hundred ninety-eight participants were enrolled in the cohort; 122 were coenrolled with their regular FSP. There were 51 incident cases of BV (rate, 9.75/100 WY; 95% confidence interval [CI], 7.41-12.83). Incident BV was associated with exposure to a new sexual partner (adjusted hazard ratio [AHR], 2.51; 95% CI, 1.30-4.82), a partner with BV symptoms (AHR, 3.99; 95% CI, 1.39-11.45), receptive oral sex (AHR, 3.52; 95% CI, 1.41-8.79), and onset of BV symptoms (AHR, 2.80; 95% CI, 1.39-5.61). Women coenrolled with their BV-negative partner had a greatly reduced risk of incident BV (AHR, 0.26; 95% CI, .11-.61), and high concordance of Nugent category (74%), which was predominantly normal vaginal flora throughout follow-up. CONCLUSIONS: These data highlight the strong influence of sexual relationships and behaviors on BV acquisition and the vaginal microbiota. They provide epidemiological evidence to support exchange of vaginal bacterial species between women and the concept that BV is sexually transmitted.

Estrategia de atención al síndrome de flujo vaginal en gestantes. Sancti Spíritus / Strategy care in pregnant vaginal discharge syndrome. Sancti Spíritus

Fundamento: las infecciones de trasmisión sexual constituyen un problema de salud en todo el mundo, sin embargo en la provincia se carece de información sobre bases científicas de los resultados de la aplicación de la estrategia para la atención del síndrome de flujo vaginal en la Atención Primaria de Salud. Objetivo: describir los resultados de la aplicación de la estrategia para la atención del síndrome de flujo vaginal a partir de la información aportada por especialistas de 16 consultorios médicos de familia en tres municipios espirituanos. Metodología: se realizó investigación descriptiva, transversal que incluyó los 16 especialistas de Medicina General Integral de igual número de consultorios tipo 1 de municipios priorizados para las infecciones de trasmisión sexual, a quienes se le aplicó una encuesta, los resultados se presentaron en tablas utilizando frecuencias absolutas y relativas. Resultados: más de la mitad de las gestantes atendidas padecían el síndrome de flujo vaginal y a todas le estudiaron sus parejas sexuales, los médicos conocen la existencia del flujograma; en Sancti Spíritus y Fomento los facultativos dominan mejor el contenido del stock de medicamentos para su tratamiento; carecen de información sobre la entrega gratuita del módulo de medicamentos destinado a esta problemática y la totalidad conoce la conducta a seguir ante una gestante con flujo vaginal. Conclusiones: la estrategia para el manejo del síndrome de flujo vaginal en gestantes no es aplicada adecuadamente en los municipios estudiados, por el desconocimiento de la disponibilidad de medicamentos eficaces y gratuitos en el área de salud para el tratamiento de la gestante y su pareja.

Background: sexually transmitted infections are a health problem worldwide, but in the province there is a lack of information on scientific basis of the results of the implementation of the strategy for the care of vaginal discharge syndrome in Primary Health Care. Objective: to describe the results of the implementation of the strategy for the care of vaginal discharge from the information provided by specialists from 16 family doctor offices in three municipalities of Sancti Spíritus. Methodology: descriptive, cross investigation was used that included 16 specialists in Comprehensive General Medicine with equal number of Type 1 doctor offices of prioritized municipalities for sexually transmitted infections, to whom a survey was applied, the results were presented in tables using absolute and relative frequencies. Results: more than half of the cared pregnant women suffered vaginal discharge syndrome and their sexual partners were studied as well, doctors are aware of the flowchart; physicians dominate the content of the stock of medicines for treatment better in Sancti Spiritus and Fomento; they are lack of information about the free drug delivery module devoted to this condition and all of them know the medical procedures to follow in the presence of a woman with vaginal discharge. Conclusions: the strategy for the management of vaginal discharge syndrome in pregnant women is not properly implemented in the municipalities studied, due to the lack of availability of effective and free drugs in the healthcare area for the treatment of pregnant women and their partners.

Characterization of the vaginal microflora in health and disease.

BACKGROUND: Bacterial vaginosis (BV) is an imbalance of the vaginal bacterial microbiota and its aetiology is still unknown. Our aims were to investigate the diagnostic potential of species/genus specific quantitative PCR (qPCR) for bacteria present in swabs and first-void urine (FVU) samples using Nugent's and Claeys' criteria and 454 sequencing of the vaginal microbiome as reference. METHODS: Self-collected swabs, vaginal smears and FVU were obtained from 177 women from Greenland (Study I and III) and physician-collected vaginal swabs and smears were obtained from 163 Swedish women (Study II). BV was diagnosed by Nugent's criteria in Study I and III and by Amsel's criteria in Study II. The vaginal swabs and FVU samples were analysed by qPCR for selected vaginal bacteria in all three studies and for four sexually transmitted infections (STIs) in Study I. RESULTS: Study I: STIs were common in women from Greenland and BV was found in 45% of these women but was not associated with individual STIs. In multivariate logistic analysis, Atopobium vaginae and Prevotella spp. were both independently associated with BV in swabs. BV could be subdivided into clusters dominated by a single or a few species together. Seven vaginal bacteria (A. vaginae, Prevotella spp. Gardnerella vaginalis, Bacterial vaginosis associated bacterium (BVAB) 2, Eggerthella-like bacterium, Leptotrichia amnionii and Megasphaera type 1) had areas under the receiver operating characteristic (ROC) curve > 85% in swabs, suggesting that they were good predictors of BV according to Nugent. Study II: For the majority of species/genera, the kappa values indicated fair to good agreement when their presence was determined by 454 pyrosequencing versus real-time PCR. The same seven vaginal bacteria as found in Study I, had areas under the ROC-curve > 85% in swabs from Swedish women, demonstrating a good diagnostic accuracy for BV according to Amsel. Study III: In a multivariate model, Megasphaera type 1 and Prevotella spp. remained significantly associated with BV in FVU samples. A linear regression analysis showed good agreement between bacterial load from swabs and FVU, but Prevotella spp. could be detected in high numbers in a few FVU samples without being present in swabs. After applying ROC curve analysis, the same seven vaginal bacteria as previously mentioned showed good prediction for BV according to Nugent in FVU. BV could be detected with comparable sensitivity in FVU and vaginal swabs. CONCLUSION: BV can be diagnosed by molecular methods performed either on swabs or urine but it is important to apply thresholds in order to improve the accuracy of the diagnosis. Furthers it was possible to identify clusters of BV dominated by single or paired bacteria, and these clusters could classify BV into subgroups, providing a more detailed understanding of the condition. Seven vaginal bacteria were highly accurate for BV diagnosis both in swabs and FVU. Finally a good agreement between Nugent and Claeys was found.

Treatment of bacterial vaginosis: what we have and what we miss.

INTRODUCTION: The disturbing, foul-smelling discharge of bacterial vaginosis (BV) is a nuisance to women. Treatment possibilities for BV are limited and only achieve complete cure in 65 to 85% of cases. In most women, the condition relapses within weeks to months after treatment. AREAS COVERED: In search of new therapeutic actions to cure, prevent or delay recurrences of BV, PubMed and web of science were searched for papers with i) decent study layout, ii) proper statistics, iii) comparison group (placebo or standard treatment) and iv) language English, French, Dutch or German. The following keywords were used: bacterial vaginosis and treatment or management or therapy or prophylaxis or prevention. Results were grouped in treatment categories and were discussed. EXPERT OPINION: Clindamycin and metronidazole are the standard drugs for BV. As other antibiotic and acidifying treatments are progressively being studied, like tinidazole, rifaximin, nitrofuran, dequalinium chloride, vitamin C and lactic acid, more options have become available for switching therapy, combining therapies and long-term prophylactic use to prevent recurrences. Further studies are needed. Also, adjuvant therapy with probiotics may have a significant role in improving efficacy and in preventing recurrences. However, it is unlikely that probiotics will replace antibiotherapy.

Suspected heterosexual transmission of bacterial vaginosis without seminal fluid exposure.

This report describes a case of suspected heterosexual transmission of bacterial vaginosis to a woman from a male partner who had undergone a radical prostatectomy. The most likely method of transmission in this case was through contact with infected desquamated epithelial cells from the male partner's distal urethra or coronal sulcus.

Bacterial vaginosis-associated bacteria in men: association of Leptotrichia/Sneathia spp. with nongonococcal urethritis.

BACKGROUND: Approximately 45% of nongonococcal urethritis cases have no identified etiology. Novel bacteria recently associated with bacterial vaginosis (BV) in women may be involved. We evaluated the association of idiopathic nongonococcal urethritis and 5 newly described BV-associated bacteria (BVAB). METHODS: Heterosexual men 16 years or older attending a sexually transmitted disease clinic in Seattle, Washington, from May 2007 to July 2011 and negative for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticum-biovar2 were eligible. Cases had urethral discharge or 5 or more polymorphonuclear leukocytes per high-power field in urethral exudates. Controls had no urethral discharge and less than 5 polymorphonuclear leukocytes per high-power field. Urine was tested for Atopobium spp., BVAB-2, BVAB-3, Megasphaera spp., and Leptotrichia/Sneathia spp. using quantitative taxon-directed polymerase chain reaction. RESULTS: Cases (n = 157) and controls (n = 102) were of similar age, education, and income, and most were white. Leptotrichia/Sneathia spp. was significantly associated with urethritis (24/157 [15.3%] vs. 6/102 [5.9%], P = 0.03). BVAB-2 was more common in cases than in controls (7/157 [4.5%] vs. 1/102 [1.0%], P = 0.15), and BVAB-3 (n = 2) and Megasphaera spp. (n = 1) were only detected in men with urethritis, but these bacteria were found only in men who also had Leptotrichia/Sneathia spp. Atopobium spp. was not associated with urethritis. The quantity of bacteria did not differ between cases and controls. Among treated cases, doxycycline was more effective than azithromycin for clinical cure of men with Leptotrichia/Sneathia spp. (9/10 vs. 7/12, P = 0.16) and BVAB-2 (3/3 vs. 0/3, P = 0.10). CONCLUSIONS: Leptotrichia/Sneathia spp. may be urethral pathogens or contribute to a pathogenic microbiota that can also include BVAB-2, BVAB-3, and Megasphaera spp. Doxycycline may be more effective than azithromycin against these newly identified bacteria.

Vaginal microbiota and viral sexually transmitted diseases.

Healthy vaginal microbiota is an important biological barrier to pathogenic microorganisms. When this predominantly Lactobacillus community is disrupted, decreased in abundance and replaced by different anaerobes, bacterial vaginosis (BV) may occur. BV is associated with prevalence and incidence of several sexually transmitted infections. This review provides background on BV, discusses the epidemiologic data to support a role of altered vaginal microbiota for acquisition of sexually transmitted diseases and analyzes mechanisms by which lactobacilli could counteract sexually transmitted viral infections.

Exploring the diversity of Gardnerella vaginalis in the genitourinary tract microbiota of monogamous couples through subtle nucleotide variation.

BACKGROUND: Bacterial vaginosis (BV) is an enigmatic disease of unknown origin that affects a large percentage of women. The vaginal microbiota of women with BV is associated with serious sequelae, including abnormal pregnancies. The etiology of BV is not fully understood, however, it has been suggested that it is transmissible, and that G. vaginalis may be an etiological agent. Studies using enzymatic assays to define G. vaginalis biotypes, as well as more recent genomic comparisons of G. vaginalis isolates from symptomatic and asymptomatic women, suggest that particular G. vaginalis strains may play a key role in the pathogenesis of BV. METHODOLOGY/PRINCIPAL FINDINGS: To explore G. vaginalis diversity, distribution and sexual transmission, we developed a Shannon entropy-based method to analyze low-level sequence variation in 65,710 G. vaginalis 16S rRNA gene segments that were PCR-amplified from vaginal samples of 53 monogamous women and from urethral and penile skin samples of their male partners. We observed a high degree of low-level diversity among G. vaginalis sequences with a total of 46 unique sequence variants (oligotypes), and also found strong correlations of these oligotypes between sexual partners. Even though Gram stain-defined normal and some Gram stain-defined intermediate oligotype profiles clustered together in UniFrac analysis, no single G. vaginalis oligotype was found to be specific to BV or normal vaginal samples. CONCLUSIONS: This study describes a novel method for investigating G. vaginalis diversity at a low level of taxonomic discrimination. The findings support cultivation-based studies that indicate sexual partners harbor the same strains of G. vaginalis. This study also highlights the fact that a few, reproducible nucleotide variations within the 16S rRNA gene can reveal clinical or epidemiological associations that would be missed by genus-level or species-level categorization of 16S rRNA data.