Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 958
Filtrar
3.
Pediatr Rev ; 41(10): 522-537, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33004664

RESUMEN

Sexually transmitted infections (STIs) disproportionately affect young people, with more than half of the infections occurring in youth aged 15 to 25 years. (1)(2) This review, the second in a 2-part series on STIs, focuses on infections that may cause abnormal vaginal or penile discharge, including trichomonas, chlamydia, gonorrhea, and pelvic inflammatory disease (PID). Most infected persons, however, are asymptomatic. Nucleic acid amplification tests are the most sensitive and specific for the detection of chlamydia, gonorrhea, and trichomoniasis, and they can be performed on provider- or patient-collected swabs. Providers should have a low threshold for diagnosing and treating PID because untreated PID can have serious long-term complications for young women. Indications for hospitalization for PID include the presence of a tubo-ovarian abscess, severe illness with systemic symptoms, pregnancy, human immunodeficiency virus infection, and failure to respond to outpatient oral treatment (within 48-72 hours) or inability to tolerate the oral treatment.


Asunto(s)
Enfermedad Inflamatoria Pélvica/diagnóstico , Enfermedades de Transmisión Sexual/diagnóstico , Excreción Vaginal/microbiología , Adolescente , Candidiasis/complicaciones , Candidiasis/diagnóstico , Infecciones por Chlamydia/complicaciones , Infecciones por Chlamydia/diagnóstico , Femenino , Gonorrea/complicaciones , Gonorrea/diagnóstico , Humanos , Masculino , Enfermedad Inflamatoria Pélvica/etiología , Parejas Sexuales , Enfermedades de Transmisión Sexual/complicaciones , Vaginitis por Trichomonas/diagnóstico , Cervicitis Uterina/complicaciones , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/diagnóstico
4.
New Microbiol ; 43(3): 121-126, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32656571

RESUMEN

The etiological cause of bacterial vaginosis (BV) is the change of the vaginal ecosystem characterized by a decrease of lactobacilli and an increase of other germs, such as Gardnerella vaginalis and Atopobium vaginae. Molecular tools have revolutionized the diagnosis of these conditions. The aim of this paper was to compare results obtained from 158 vaginal swabs collected from women aged between 18 and 59 years old and subjected to microscopic evaluation (Nugent Score), culture and to the multiparametric molecular assay Vaginitis and Vaginosis Multiplex-Tandem (MT) PCR (AU27117) - Nuclear Laser Medicine. In 50 samples we also used matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for bacterial microbiome identification. Our results showed a moderate concordance between traditional and molecular methods for diagnosis of candidiasis and a lower concordance for BV and normal flora. MALDI TOF MS allowed us to discriminate more than 10 species of lactobacilli with a greater abundance of Lactobacillus gasseri, Lactobacillus paracasei spp. paracasei, Lactobacillus pentosus and Lactobacillus crispatus in BV and altered flora. This work underlined how the integration of different assays and metagenomics studies can greatly expand our current understanding of vaginal microbial diversity, providing more reliable diagnostic criteria for BV and its intermediate condition diagnosis.


Asunto(s)
Gardnerella vaginalis , Vaginosis Bacteriana , Actinobacteria , Adolescente , Adulto , Femenino , Gardnerella vaginalis/genética , Gardnerella vaginalis/aislamiento & purificación , Humanos , Lactobacillus , Persona de Mediana Edad , Vagina , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/genética , Adulto Joven
5.
Obstet Gynecol ; 135(5): 1136-1144, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32282605

RESUMEN

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.


Asunto(s)
Complicaciones Infecciosas del Embarazo/diagnóstico , Diagnóstico Prenatal/métodos , Vaginitis por Trichomonas/diagnóstico , Trichomonas vaginalis , Excreción Vaginal/diagnóstico , Adulto , Femenino , Humanos , Microscopía , Técnicas de Amplificación de Ácido Nucleico , Distribución de Poisson , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/terapia , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/terapia , Excreción Vaginal/epidemiología , Excreción Vaginal/microbiología , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/epidemiología , Adulto Joven
7.
JAMA ; 323(13): 1293-1309, 2020 04 07.
Artículo en Inglés | MEDLINE | ID: mdl-32259235

RESUMEN

Importance: Preterm delivery results in adverse outcomes; identifying and treating bacterial vaginosis may reduce its occurrence. Objective: To update the evidence on screening and treatment of asymptomatic bacterial vaginosis in pregnancy for the US Preventive Services Task Force. Data Sources: MEDLINE, Cochrane Library, and trial registries through May 29, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through December 31, 2019. Study Selection: Fair- or good-quality English-language studies evaluating diagnostic accuracy of tests feasible within primary care; randomized clinical trials (RCTs); nonrandomized controlled intervention studies (for harms only); or meta-analyses of metronidazole or clindamycin. Data Extraction and Synthesis: Two reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; when at least 3 similar studies were available, meta-analyses were conducted. Main Outcomes and Measures: Sensitivity, specificity, preterm delivery, maternal adverse effects, congenital birth defects, childhood cancer. Results: Forty-four studies (48 publications) were included. No studies evaluated the benefits or harms of screening. Twenty-five studies (n = 15 785) evaluated the accuracy of screening tests; across individual studies and tests, sensitivity ranged from 0.36 to 1.0 and specificity ranged from 0.49 to 1.0. Among trials reporting findings from general obstetric populations (n = 7953), no significant association was observed between treatment and spontaneous delivery before 37 weeks (pooled absolute risk difference [ARD], -1.44% [95% CI, -3.31% to 0.43%]; 8 RCTs, n = 7571) or any delivery before 37 weeks (pooled ARD, 0.20% [95% CI, -1.13% to 1.53%]; 6 RCTs, n = 6307). Among 5 trials reporting findings among women with a prior preterm delivery, findings were inconsistent; 3 showed a significant beneficial effect, while 2 did not. Maternal adverse events from treatment were infrequent and minor (eg, candidiasis) but were slightly more common with active treatment compared with placebo across 8 RCTs. Two meta-analyses of observational studies reported no significant association between metronidazole exposure and congenital malformations (odds ratio, 0.96 [95% CI, 0.75 to 1.22]; odds ratio, 1.08 [95% CI, 0.90 to 1.29]). One cohort study reported no significantly increased incidence of childhood cancer among metronidazole-exposed children (adjusted relative risk, 0.81 [95% CI, 0.41 to 1.59]). However, studies of in utero exposure had important limitations. Conclusions and Relevance: Accuracy of screening tests for bacterial vaginosis varies. The evidence suggests no difference in the incidence of preterm delivery and related outcomes from treatment for asymptomatic bacterial vaginosis in a general obstetric population but was inconclusive for women with a prior preterm delivery. Maternal adverse events from treatment appear to be infrequent and minor, but the evidence about harms from in utero exposure was inconclusive.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Asintomáticas , Tamizaje Masivo , Complicaciones Infecciosas del Embarazo/diagnóstico , Nacimiento Prematuro/prevención & control , Vaginosis Bacteriana/diagnóstico , Antibacterianos/efectos adversos , Clindamicina/uso terapéutico , Femenino , Humanos , Tamizaje Masivo/efectos adversos , Metronidazol/uso terapéutico , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Factores de Riesgo , Vaginosis Bacteriana/tratamiento farmacológico
8.
JAMA ; 323(13): 1286-1292, 2020 04 07.
Artículo en Inglés | MEDLINE | ID: mdl-32259236

RESUMEN

Importance: Bacterial vaginosis is common and is caused by a disruption of the microbiological environment in the lower genital tract. In the US, reported prevalence of bacterial vaginosis among pregnant women ranges from 5.8% to 19.3% and is higher in some races/ethnicities. Bacterial vaginosis during pregnancy has been associated with adverse obstetrical outcomes including preterm delivery, early miscarriage, postpartum endometritis, and low birth weight. Objective: To update its 2008 recommendation, the USPSTF commissioned a review of the evidence on the accuracy of screening and the benefits and harms of screening for and treatment of bacterial vaginosis in asymptomatic pregnant persons to prevent preterm delivery. Population: This recommendation applies to pregnant persons without symptoms of bacterial vaginosis. Evidence Assessment: The USPSTF concludes with moderate certainty that screening for asymptomatic bacterial vaginosis in pregnant persons not at increased risk for preterm delivery has no net benefit in preventing preterm delivery. The USPSTF concludes that for pregnant persons at increased risk for preterm delivery, the evidence is conflicting and insufficient, and the balance of benefits and harms cannot be determined. Conclusions and Recommendation: The USPSTF recommends against screening for bacterial vaginosis in pregnant persons not at increased risk for preterm delivery. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for bacterial vaginosis in pregnant persons at increased risk for preterm delivery. (I statement).


Asunto(s)
Infecciones Asintomáticas , Tamizaje Masivo , Complicaciones Infecciosas del Embarazo/diagnóstico , Nacimiento Prematuro/prevención & control , Vaginosis Bacteriana/diagnóstico , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Femenino , Humanos , Tamizaje Masivo/efectos adversos , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Factores de Riesgo , Vaginosis Bacteriana/tratamiento farmacológico
11.
Sci Rep ; 10(1): 1978, 2020 02 06.
Artículo en Inglés | MEDLINE | ID: mdl-32029862

RESUMEN

Bacterial vaginosis (BV) is one of the most common vaginal infections among women of childbearing age. Gardnerella vaginalis (G. vaginalis) is a keystone microorganism present in more than 95% of all BV cases. The first step of the infection process in BV is mediated by interaction of microorganisms with epithelial cells (ECs). However, the role of these cells in BV pathogenesis is largely unknown. The present study aimed to investigate the vaginal EC response during BV. Twenty healthy women and 34 women with BV were enrolled in this study. The number of ECs in the vaginal swab was counted and analyzed for intracellular signals and apoptosis by flow cytometry. Cell damage was evaluated by lactate dehydrogenase assay. Compared to that in healthy donors, the percentage of exfoliated vaginal ECs was increased in women with BV, and an absence of neutrophils was observed in both groups. Activation signals, such as p-IκBα and c-Fos were unmodulated in the vaginal ECs of women with BV. Moreover, EC damage and apoptosis were significantly increased in patients with BV. Apoptosis was related to caspase-3 activation and the presence of G. vaginalis. This study provides the first evidence of a direct involvement of G. vaginalis in the apoptotic process of vaginal ECs during BV. This effect was mediated by caspase-3 activation, and G. vaginalis appeared to be one of causes for inducing EC apoptosis in BV. Hence, our findings suggest a possible explanation for the increased exfoliation of ECs in the vagina during BV.


Asunto(s)
Apoptosis/inmunología , Células Epiteliales/patología , Gardnerella vaginalis/inmunología , Vagina/patología , Vaginosis Bacteriana/inmunología , Adulto , Estudios de Casos y Controles , Células Epiteliales/inmunología , Células Epiteliales/microbiología , Femenino , Gardnerella vaginalis/aislamiento & purificación , Voluntarios Sanos , Humanos , Persona de Mediana Edad , Vagina/citología , Vagina/inmunología , Vagina/microbiología , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/microbiología , Vaginosis Bacteriana/patología , Adulto Joven
12.
Eur J Obstet Gynecol Reprod Biol ; 245: 143-148, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31901667

RESUMEN

Bacterial vaginosis (BV) affects women of reproductive age and can either be symptomatic or asymptomatic. Approximately 50 % of women are symptomatic and experience vaginal malodor, discharge, itching and increased vaginal pH. BV can increase the risk of contracting many sexually transmitted infections (STIs) such as human immunodeficiency virus (HIV), Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and herpes simplex virus-2 (HSV-2). Though effective treatment options do exist, metronidazole or clindamycin, these methods have proven not to be effective long term. The purpose of this review is to summarize current literature on the epidemiology of BV and highlight areas of deficiency in current clinical practice with respect to BV. BV recurrence rates are high, approximately 80 % three months after effective treatment. Furthermore, in some instances treatment is ineffective and BV persists. Literature also documents the relationship between BV and human papillomavirus (HPV). HPV is the most common sexually transmitted infection among young adult women while BV is the most common cause of vaginal symptoms among women of reproductive age. BV is associated with high levels of anaerobic organisms which can damage the vaginal epithelium and increase the risk of HPV infection. Recent research also highlights the role of the vaginal microbiome in BV. The results of this review warrant further exploration into the etiology of BV as well as exploration of more long-term effective treatment and the investigation of prognostic indicators. Additionally, the need for a standard definition of recurrent and persistent BV is recognized.


Asunto(s)
Vaginosis Bacteriana/epidemiología , Femenino , Humanos , Microbiota , Recurrencia , Vagina/microbiología , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/microbiología , Vaginosis Bacteriana/terapia
13.
Diagn Microbiol Infect Dis ; 96(2): 114950, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31836253

RESUMEN

Allplex Bacterial vaginosis assay (Seegene, South Korea) is a molecular test for bacterial vaginosis (BV). A machine learning algorithm was devised on 200 samples (BV = 23, non-BV = 177) converting 7 identified bacterial strains polymerase chain reaction results to binary output of BV detected or not. Comparing algorithm interpretation of molecular results to the consensus Gram stain (Hay's criteria), the sensitivity was 65% [95% confidence interval (CI) 42-83%], specificity was 98% (95% CI 95-99%), positive predictive value was 83% (95% CI 58-96%), and negative predictive value was 95% (91-98%) with area under the curve of 0.82 (95% CI 0.76-0.87). For the second phase, 100 samples were processed using the 2 techniques in parallel, with the scientists blinded to the result of the other method. There was agreement 90% of the cases (n = 90/100). The samples that were called BV by the algorithm but non-BV by Gram stain all cluster with the concordant BV samples, suggesting that the molecular test was correct.


Asunto(s)
Infección Hospitalaria , Maternidades , Aprendizaje Automático , Técnicas de Diagnóstico Molecular , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/microbiología , Algoritmos , Femenino , Humanos , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/normas , Reacción en Cadena de la Polimerasa/métodos , Reacción en Cadena de la Polimerasa/normas , Prueba de Estudio Conceptual , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
14.
Am J Obstet Gynecol ; 222(3): 219-223, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31499057

RESUMEN

Bacterial vaginosis is the most common cause of abnormal vaginal discharge or malodor, affecting up to one third of US women. Most women with bacterial vaginosis are unaware of the infection, making it difficult to diagnose in the absence of a microscopic examination of vaginal discharge or using point-of-care testing. Untreated bacterial vaginosis elevates the risk of postoperative surgical infections in women undergoing obstetric and gynecological procedures. Treatment with antimicrobial agents that target bacterial vaginosis has been shown to reduce the rate of postoperative infections following hysterectomy and surgical abortions. Furthermore, in a cost-comparison model, screening for and treatment of bacterial vaginosis prior to hysterectomy was shown to be superior to no screening in terms of infection rates and cost. The bacterial vaginosis diagnostic criteria are simple and screening tests are inexpensive; bacterial vaginosis screening is a relatively fast process in patients who present for preoperative appointments. Treatment options approved by the Food and Drug Administration include metronidazole, clindamycin, tinidazole, and secnidazole. Given the prevalence of bacterial vaginosis and the risks associated with operating on a woman with untreated bacterial vaginosis, women undergoing hysterectomy, surgical abortion, and potentially cesarean delivery should be screened for bacterial vaginosis, and those who screen positive should be treated with an appropriate antimicrobial agent.


Asunto(s)
Antibacterianos/uso terapéutico , Complicaciones Infecciosas del Embarazo/prevención & control , Premedicación , Infección de la Herida Quirúrgica/prevención & control , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/tratamiento farmacológico , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/etiología , Cuidados Preoperatorios , Infección de la Herida Quirúrgica/etiología , Vaginosis Bacteriana/microbiología
15.
Am J Obstet Gynecol ; 222(2): 114-122, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31513780

RESUMEN

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.


Asunto(s)
Antiinfecciosos/uso terapéutico , Vaginitis Atrófica/diagnóstico , Candidiasis Vulvovaginal/diagnóstico , Vaginitis por Trichomonas/diagnóstico , Vaginosis Bacteriana/diagnóstico , Administración Intravaginal , Administración Oral , Antiinflamatorios/uso terapéutico , Vaginitis Atrófica/terapia , Clindamicina/uso terapéutico , Deshidroepiandrosterona/uso terapéutico , Diagnóstico Diferencial , Terapia de Reemplazo de Estrógeno , Estrógenos/uso terapéutico , Femenino , Humanos , Hidrocortisona/uso terapéutico , Inflamación , Liquen Plano/diagnóstico , Liquen Plano/terapia , Metronidazol/análogos & derivados , Metronidazol/uso terapéutico , Penfigoide Benigno de la Membrana Mucosa/diagnóstico , Penfigoide Benigno de la Membrana Mucosa/terapia , Penfigoide Ampolloso/diagnóstico , Penfigoide Ampolloso/terapia , Pénfigo/diagnóstico , Pénfigo/terapia , Tamoxifeno/análogos & derivados , Tamoxifeno/uso terapéutico , Tinidazol/uso terapéutico , Vaginitis por Trichomonas/terapia , Vaginitis/diagnóstico , Vaginitis/terapia , Vaginosis Bacteriana/terapia
16.
Eur J Clin Microbiol Infect Dis ; 39(2): 345-351, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31705339

RESUMEN

The purpose was to evaluate whether probiotics can increase the effectiveness of antimicrobial therapy. Ninety women with Trichomonas vaginalis (TV) in the presence BV were included in the study of regimens for therapy combination with metronidazole and vaginal probiotics. For 7 days, the probiotics group patients received metronidazole at 500 mg twice a day and 1 capsule of probiotic Gynophilus® vaginally twice a day; the placebo group patients in addition to metronidazole received a placebo instead of a probiotic. For the next 7 days, patients in both groups in order restore normal microflora were given the probiotics vaginally. Before the treatment, on the 4th, 8th, and 15th day of therapy complaints, pH and redox potential of the vaginal fluid were recorded, TV detection culturally, microflora of the vagina with the qPCR-RT and microscopically. Adding probiotics to traditional therapy of TV in the presence of BV increased the likelihood of cure from TV (88.6 and 42.9% in the probiotic and placebo groups, respectively) and from BV (63.6 and 11.9%, respectively). We have found that the addition of probiotics to antimicrobial therapy causes the decrease in the inflammatory response and significant changes in the vagina's physicochemical parameters (decreased of the pH values, increased of the redox potential) already on the fourth day of the therapy. The changes in the metronidazole's antimicrobial action implementation when a probiotic is added are the reason of increasing the TV therapy's effectiveness in the BV presence.


Asunto(s)
Antiprotozoarios/uso terapéutico , Coinfección , Metronidazol/uso terapéutico , Probióticos/administración & dosificación , Vaginitis por Trichomonas/tratamiento farmacológico , Vaginitis por Trichomonas/parasitología , Trichomonas vaginalis/efectos de los fármacos , Vaginosis Bacteriana/microbiología , Administración Intravaginal , Adulto , Antiprotozoarios/farmacología , Terapia Combinada , Femenino , Humanos , Concentración de Iones de Hidrógeno , Metronidazol/farmacología , Resultado del Tratamiento , Vaginitis por Trichomonas/diagnóstico , Trichomonas vaginalis/citología , Vaginosis Bacteriana/diagnóstico , Adulto Joven
17.
Trials ; 20(1): 648, 2019 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-31775859

RESUMEN

BACKGROUND: Bacterial vaginosis (BV) affects 30-50% of women at some time in their lives and is an embarrassing and distressing condition which can be associated with potentially serious comorbidities. Current antibiotic treatments such as metronidazole are effective but can result in side effects, and recurrence is common. This trial aims to investigate whether lactic acid gel is clinically effective and cost effective in the treatment of recurrent BV compared with metronidazole. METHODS: VITA is an open-label, multicentre, parallel group randomised controlled trial for women with a clinical diagnosis of BV and at least one previous BV episode in the past 2 years. Participants will be randomised 1:1 to intravaginal lactic acid gel 5 ml once daily for 7 days or oral metronidazole tablets 400 mg twice daily for 7 days. All participants will be followed up for 6 months to assess health status and healthcare costs. A subgroup will be interviewed to further explore adherence, tolerability and acceptability of treatment. The estimated sample size is 1900 participants to detect a 6% absolute increase in response rate to 86% in those receiving lactic acid gel. The primary outcome is participant-reported resolution of BV at Week 2. DISCUSSION: Results from this trial will help inform UK treatment guidelines for BV and may provide an alternative effective treatment for recurrent episodes of this condition which avoids repeated exposure to antibiotics. TRIAL REGISTRATION: ISRCTN, ISRCTN14161293. Registered on 8 September 2017.


Asunto(s)
Antibacterianos/administración & dosificación , Costos de los Medicamentos , Ácido Láctico/administración & dosificación , Ácido Láctico/economía , Metronidazol/administración & dosificación , Metronidazol/economía , Vaginosis Bacteriana/tratamiento farmacológico , Vaginosis Bacteriana/economía , Administración Intravaginal , Antibacterianos/efectos adversos , Antibacterianos/economía , Investigación sobre la Eficacia Comparativa , Análisis Costo-Beneficio , Femenino , Geles , Humanos , Ácido Láctico/efectos adversos , Metronidazol/efectos adversos , Estudios Multicéntricos como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Retratamiento/economía , Factores de Tiempo , Resultado del Tratamiento , Reino Unido , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/microbiología
18.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 37(9): 592-601, nov. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-189577

RESUMEN

Los últimos avances en el microbioma vaginal y el diagnóstico molecular de la vaginosis bacteriana han permitido un mayor conocimiento de esta entidad caracterizando aspectos de su patogenia y el establecimiento de la biocapa vaginal, los modelos y nuevas teorías de la etiología de la misma, cómo se transmite al considerarse hoy como una probable infección de transmisión sexual, la separación de otras entidades como la vaginitis aerobia, el diagnóstico molecular de la misma y el tratamiento y nuevas moléculas que eviten las recaídas frecuentes. Esta entidad y el estudio del microbioma vaginal han permitido considerar estas infecciones como un síndrome polimicrobiano acabando con el dogma: un microorganismo, una enfermedad. Además, se actualiza una entidad menos conocida como es la vaginitis aerobia y los métodos para su detección


The latest advances in the vaginal microbiome and molecular diagnosis of bacterial vaginosis have allowed for a better knowledge of this entity, characterising aspects of its pathogenesis and the establishment of the vaginal biolayer, the models and new theories of its aetiology, how it is transmitted, with it being considered nowadays as a probable sexually transmitted infection, the separation of other entities such as aerobic vaginosis, its molecular diagnosis and treatment with new molecules to prevent frequent relapses. This entity and the study of the vaginal microbiome have made it possible to consider these infections as a polymicrobial syndrome, putting an end to the dogma: one microorganism, one disease. In addition, a lesser-known entity such as aerobic vaginosis and the methods for its detection are updated


Asunto(s)
Humanos , Femenino , Vaginosis Bacteriana/microbiología , Microbiota , Vaginosis Bacteriana/tratamiento farmacológico , Vaginosis Bacteriana/epidemiología , Vagina/microbiología , Vaginosis Bacteriana/diagnóstico , Factores de Riesgo , Excreción Vaginal/microbiología
19.
Infect Immun ; 87(12)2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31527125

RESUMEN

Gardnerella vaginalis is a hallmark of vaginal dysbiosis, but it is found in the microbiomes of women with and without vaginal symptoms and those who do not have microbiologically defined dysbiosis. G. vaginalis encompasses diverse taxa differing in attributes that are potentially important for virulence, and there is evidence that clades or subgroups within the species are differentially associated with clinical outcomes. The G. vaginalis species description was recently emended, and three new species within the genus were defined (G. leopoldii, G. swidsinskii, and G. piotii). 16S rRNA sequences for the four Gardnerella species are all >98.5% identical, and no signature sequences differentiate them. We demonstrated that Gardnerella species can be resolved using partial chaperonin 60 (cpn60) sequences, with pairwise percent identities of 87.1 to 97.8% among the type strains. Pairwise cooccurrence patterns of Gardnerella spp. in the vaginal microbiomes of 413 reproductive aged Canadian women were investigated, and several significant cooccurrences of species were identified. Abundance of G. vaginalis and G. swidsinskii was associated with vaginal symptoms of abnormal odor and discharge. cpn60 barcode sequencing can provide a rapid assessment of the relative abundance of Gardnerella spp. in microbiome samples, providing a powerful method of elucidating associations between these diverse organisms and clinical outcomes. Researchers should consider using cpn60 instead of 16S RNA for better resolution of these important organisms.


Asunto(s)
Chaperonina 60/genética , Gardnerella vaginalis/clasificación , Gardnerella vaginalis/genética , Vaginosis Bacteriana/diagnóstico , Canadá , Código de Barras del ADN Taxonómico , Disbiosis/microbiología , Femenino , Gardnerella vaginalis/aislamiento & purificación , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Microbiota , ARN Ribosómico 16S/genética , Vagina/microbiología , Vaginosis Bacteriana/microbiología
20.
BMJ Open ; 9(8): e025013, 2019 08 27.
Artículo en Inglés | MEDLINE | ID: mdl-31462459

RESUMEN

OBJECTIVES: Self-collected vaginal swabs can facilitate diagnosis of vaginal discharge (VD) in resource-limited settings, provided reliability of the method is established. The aim of this study was to evaluate the concordance between self-collected and physician-collected vaginal swabs for aetiological diagnosis of VD and to determine the prevalence of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonas vaginitis (TV). METHODS: A total of 550 females (median age: 32 years; range: 18-45 years) attending two sexually transmitted infection/reproductive tract infection (STI/RTI) clinics with VD from January 2015 to May 2016 were included in the study after obtaining written informed consent. Swabs were self-collected by patients after instructions and subsequently by a physician under speculum examination. Samples were processed for standard bedside tests, Gram staining, wet mount and culture (gold standard) according to the national guidelines. Concordance between the two methods was determined by the Cohen's kappa value. RESULTS: BV, VVC and TV were diagnosed in 79 (14.4%), 144 (26.2%) and 3 (0.5%) patients, respectively. VVC coexisted with BV in 58 (10.5%) patients. There was no coinfection of TV with BV or VVC. Candida albicans was isolated in 84 (58.3%) VVC cases. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of self-collected swabs for diagnosing BV was 91.1%, 100%, 100% and 98.5%, respectively, while for the C. albicans VVC and TV, sensitivity, specificity, PPV and NPV all were 100% as compared with physician-collected swabs. Highly concordant results were obtained between two methods by the Kappa values of 0.95 (BV), 0.99 (VVC) and 1.0 (TV). CONCLUSION: The comparative performance of self-collected and physician-collected vaginal swabs establishes self-collection of samples for BV, VVC and TV as a viable alternative tool in the management of STIs/RTIs, especially in peripheral and resource-constrained settings. This would be effective in implementing the diagnostic approaches for STIs/RTIs in community-based surveillance studies at national or regional level and therefore strengthening the National STI/RTI Control Programme.


Asunto(s)
Candidiasis Vulvovaginal/diagnóstico , Autocuidado , Vaginitis por Trichomonas/diagnóstico , Frotis Vaginal/métodos , Vaginosis Bacteriana/diagnóstico , Adolescente , Adulto , Factores de Edad , Candidiasis Vulvovaginal/epidemiología , Estudios Transversales , Países en Desarrollo , Femenino , Humanos , India/epidemiología , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los Resultados , Vaginitis por Trichomonas/epidemiología , Vaginosis Bacteriana/epidemiología , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...