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1.
Artículo en Inglés | MEDLINE | ID: mdl-33466345

RESUMEN

OBJECTIVE: Female infections affecting the genital tract include sexually transmitted diseases, endogenous infections such as vulvovaginal candidiasis, bacterial vaginosis (BV) or aerobic vaginitis (AV) and healthcare-associated infections. The aim of the study was to analyze the etiological factors of the vaginal dysbacteriosis, and the antimicrobial susceptibility of the dominant bacterial and fungal infections in different age groups of outpatient women from the Silesian Region. MATERIALS AND METHODS: A retrospective laboratory-based multi-center study encompassed 4994 women of different ages in Silesian Voivodeship, in the south of Poland; patients who had vaginal swabs collected as per physicians' orders during the period from 1 January 2017 until 30 June 2018 were included in the study. The inclusion criteria were: non-hospitalized female, aged ≤80, with suspected vulvovaginal candidiasis or bacterial vaginosis and clinical sings of infections. RESULTS: Gram-positive cocci were the ones most often isolated: Enterococcus faecalis (29.2%) and Streptoccoccus agalactiae (13.1%), followed by bacilli from the Enterobacteriaceae group, including Escherichia coli (26.3%). The presence of Streptococcus agalactiae was confirmed in 13.1%, slightly more often in the 45-80 age group, and Gardnerella vaginalis in 6.4%, most often in women aged 15-24. The prevalence of yeast-like infections was 24.3%, Candida albicans accounted for 78.3%, whereas among C. non-albicans spp.-C. glabrata dominated (14.9%) followed by C. parapsilosis (3.8%). The highest resistance was observed only in Streptococcus agalactiae as the MLSB mechanism (Macrolide-lincosamide-streptogramin B) was identified in 38.6% of strains. The prevalence of vulvovaginal candidiasis was 24.3%, the highest in women aged 15-44. CONCLUSIONS: Drug resistance in studied vulvovaginitis was associated only with Streptococcus agalactiae. A high proportion of yeast-like aetiology was found, probably associated with recurrent infections. In the analyzed cases only the Amsel criteria and culture methods were used for diagnosis without preparations and microbiological Nugent criteria.


Asunto(s)
Candidiasis Vulvovaginal/epidemiología , Farmacorresistencia Bacteriana , Infecciones del Sistema Genital/microbiología , Vaginosis Bacteriana , Adolescente , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Polonia/epidemiología , Prevalencia , Estudios Retrospectivos , Vaginosis Bacteriana/epidemiología , Adulto Joven
2.
BMC Pregnancy Childbirth ; 21(1): 98, 2021 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-33516183

RESUMEN

BACKGROUND: This study estimated the prevalence of curable sexually transmitted and reproductive tract infections (STIs/RTIs) among pregnant women attending antenatal care (ANC) in rural Zambia, evaluated the effectiveness of syndromic management of STIs/RTIs versus reference-standard laboratory diagnoses, and identified determinants of curable STIs/RTIs during pregnancy. METHODS: A total of 1086 pregnant women were enrolled at ANC booking, socio-demographic information and biological samples were collected, and the provision of syndromic management based care was documented. The Piot-Fransen model was used to evaluate the effectiveness of syndromic management versus etiological testing, and univariate and multivariate logistic regression analyses were used to identify determinants of STIs/RTIs. RESULTS: Participants had a mean age of 25.6 years and a mean gestational age of 22.0 weeks. Of 1084 women, 700 had at least one STI/RTI (64.6%; 95% confidence interval [CI], 61.7, 67.4). Only 10.2% of infected women received any treatment for a curable STI/RTI (excluding syphilis). Treatment was given to 0 of 56 women with chlamydia (prevalence 5.2%; 95% CI, 4.0, 6.6), 14.7% of participants with gonorrhoea (prevalence 3.1%; 95% CI, 2.2, 4.4), 7.8% of trichomoniasis positives (prevalence 24.8%; 95% CI, 22.3, 27.5) and 7.5% of women with bacterial vaginosis (prevalence 48.7%; 95% CI, 45.2, 51.2). An estimated 7.1% (95% CI, 5.6, 8.7) of participants had syphilis and received treatment. Women < 20 years old were more likely (adjusted odds ratio [aOR] = 5.01; 95% CI: 1.23, 19.44) to have gonorrhoea compared to women ≥30. The odds of trichomoniasis infection were highest among primigravidae (aOR = 2.40; 95% CI: 1.69, 3.40), decreasing with each subsequent pregnancy. Women 20 to 29 years old were more likely to be diagnosed with bacterial vaginosis compared to women ≥30 (aOR = 1.58; 95% CI: 1.19, 2.10). Women aged 20 to 29 and ≥ 30 years had higher odds of infection with syphilis, aOR = 3.96; 95% CI: 1.40, 11.20 and aOR = 3.29; 95% CI: 1.11, 9.74 respectively, compared to women under 20. CONCLUSIONS: Curable STIs/RTIs were common and the majority of cases were undetected and untreated. Alternative approaches are urgently needed in the ANC setting in rural Zambia.


Asunto(s)
Coinfección/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones del Sistema Genital/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Adulto , Coinfección/diagnóstico , Coinfección/parasitología , Estudios Transversales , Femenino , Gonorrea/diagnóstico , Gonorrea/epidemiología , Humanos , Modelos Logísticos , Análisis Multivariante , Embarazo , Atención Prenatal , Prevalencia , Infecciones del Sistema Genital/diagnóstico , Infecciones del Sistema Genital/parasitología , Población Rural , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/parasitología , Factores Socioeconómicos , Sífilis/epidemiología , Tricomoniasis/epidemiología , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/parasitología , Adulto Joven , Zambia/epidemiología
3.
N Engl J Med ; 382(20): 1906-1915, 2020 05 14.
Artículo en Inglés | MEDLINE | ID: mdl-32402161

RESUMEN

BACKGROUND: Bacterial vaginosis affects 15 to 50% of women of reproductive age, and recurrence is common after treatment with an antibiotic agent. The high incidence of recurrence suggests the need for new treatments to prevent recurrent bacterial vaginosis. METHODS: We conducted a randomized, double-blind, placebo-controlled, phase 2b trial to evaluate the ability of Lactobacillus crispatus CTV-05 (Lactin-V) to prevent the recurrence of bacterial vaginosis. Women 18 to 45 years of age who had received a diagnosis of bacterial vaginosis and who had completed a course of vaginal metronidazole gel as part of the eligibility requirements were randomly assigned, in a 2:1 ratio, to receive vaginally administered Lactin-V or placebo for 11 weeks; follow-up occurred through week 24. The primary outcome was the percentage of women who had a recurrence of bacterial vaginosis by week 12. RESULTS: A total of 228 women underwent randomization: 152 to the Lactin-V group and 76 to the placebo group; of these participants, 88% in the Lactin-V group and 84% in the placebo group could be evaluated for the primary outcome. In the intention-to-treat population, recurrence of bacterial vaginosis by week 12 occurred in 46 participants (30%) in the Lactin-V group and in 34 participants (45%) in the placebo group (risk ratio after multiple imputation for missing responses, 0.66; 95% confidence interval [CI], 0.44 to 0.87; P = 0.01). The risk ratio for recurrence by week 24 (also calculated with multiple imputation for missing responses) was 0.73 (95% CI, 0.54 to 0.92). At the 12-week visit, L. crispatus CTV-05 was detected in 79% of participants in the Lactin-V group. The percentage of participants who had at least one adverse event related to Lactin-V or placebo by week 24 did not differ significantly between the groups. The percentage of participants with local or systemic adverse events was similar in the two groups. CONCLUSIONS: The use of Lactin-V after treatment with vaginal metronidazole resulted in a significantly lower incidence of recurrence of bacterial vaginosis than placebo at 12 weeks. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT02766023.).


Asunto(s)
Antibacterianos/administración & dosificación , Lactobacillus crispatus/fisiología , Vagina/microbiología , Vaginosis Bacteriana/microbiología , Vaginosis Bacteriana/prevención & control , Administración Intravaginal , Adolescente , Adulto , Antibacterianos/efectos adversos , Antibiosis , Método Doble Ciego , Femenino , Geles , Humanos , Incidencia , Lactobacillus crispatus/aislamiento & purificación , Metronidazol/uso terapéutico , Persona de Mediana Edad , Prevención Secundaria , Vaginosis Bacteriana/epidemiología , Adulto Joven
4.
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
5.
PLoS One ; 15(4): e0228574, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32236123

RESUMEN

Recent studies suggest that birth mode (Cesarean section [C-section] or vaginal delivery) is an important event in the initial colonization of the human microbiome and may be associated with long-term health outcomes. We sought to determine the association between a woman's birth mode and her vaginal microbiota in adulthood. We re-contacted 144 adult women from two U.S. studies and administered a brief survey. Vaginal microbiota was characterized on a single sample by amplicon sequencing of the V3-V4 hypervariable regions of the 16S rRNA gene and clustered into community state types (CSTs). We evaluated the association between birth mode and a CST with low relative abundance of Lactobacillus spp. ("molecular bacterial vaginosis" [Molecular-BV]) compared to Lactobacillus-dominated CSTs in logistic regression modeling which adjusted for body mass index, a confounder in this analysis. Twenty-seven women (19%) reported C-section. Overall, C-section showed a non-significant trend towards increased odds of Molecular-BV (aOR = 1.22, 95% CI: 0.45, 3.32), and Prevotella bivia was the strongest single taxa associated with C-section. However, because the two archived studies had different inclusion criteria (interaction p = 0.048), we stratified the analysis by study site. In the study with a larger sample size (n = 88), women born by C-section had 3-fold higher odds of Molecular-BV compared to vaginally-delivered women (aOR = 3.55, p = 0.06, 95% CI: 0.97-13.02). No association was found in the smaller study (n = 56, aOR = 0.19, p = 0.14, 95% CI: 0.02-1.71). This pilot cross-sectional study suggests a possible association between C-section and Molecular-BV in adulthood. However, the analysis is limited by small sample size and lack of comparability in participant age and other characteristics between the study sites. Future longitudinal studies could recruit larger samples of women, address the temporal dynamics of vaginal microbiota, and explore other confounders, including maternal factors, breastfeeding history, and socioeconomic status, which may affect the relationship between birth mode and vaginal microbiota.


Asunto(s)
Parto Obstétrico , Microbiota , Parto , Vagina/microbiología , Adolescente , Adulto , Cesárea , Estudios Transversales , Femenino , Humanos , Lactobacillus/aislamiento & purificación , Proyectos Piloto , Embarazo , Estados Unidos , Vaginosis Bacteriana/epidemiología , Adulto Joven
7.
BMC Womens Health ; 20(1): 62, 2020 03 26.
Artículo en Inglés | MEDLINE | ID: mdl-32216785

RESUMEN

BACKGROUND: Bacterial vaginosis (BV) is a common condition in reproductive-age women and is known to be positively associated with risk of acquisition of sexually transmitted infections (STI) such as chlamydia and gonorrhea. Mycoplasma genitalium is an emerging STI that has been linked to increased risk of pelvic inflammatory disease, adverse pregnancy outcomes and infertility. In the present study we sought to examine whether women diagnosed with symptomatic BV were at increased risk of having concurrent infection with Mycoplasma genitalium. METHODS: We used a novel PCR-based assay (ResistancePlus MG; SpeeDx Pty. Ltd., Sydney, Australia) to determine the prevalence of Mycoplasma genitalium infection and 23S rRNA macrolide-resistance mediating mutations (MRMM) in a cohort of 1532 women presenting with symptoms of vaginitis. RESULTS: M. genitalium was detected in 4.0% (62/1532) of samples with 37.1% (23/62) harboring MRMMs. The prevalence of M. genitalium infection in subjects with BV was significantly higher than in subjects with non-BV vaginitis (7.0% v 3.6%; OR = 1.97 (95% CI: 1.14-3.39). CONCLUSIONS: Prevalence of M. genitalium infection is associated with BV in women with symptomatic vaginitis. Improved management of BV is needed as a component of STI prevention strategies.


Asunto(s)
Mycoplasma genitalium/aislamiento & purificación , Vaginosis Bacteriana/epidemiología , Adolescente , Adulto , Antibacterianos/farmacología , Australia/epidemiología , Femenino , Humanos , Macrólidos/farmacología , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Infecciones por Mycoplasma/complicaciones , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/epidemiología , Mycoplasma genitalium/efectos de los fármacos , Mycoplasma genitalium/genética , Reacción en Cadena de la Polimerasa , Embarazo , Prevalencia , Adulto Joven
8.
PLoS One ; 15(3): e0230712, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32214342

RESUMEN

BACKGROUND: Although it is well acknowledged that persistent infection with high-risk human papillomavirus types in genital sites plays a crucial role in the development of squamous cell cervical carcinoma, there is no unanimous consensus on the association between non-HPV sexually transmitted infections and abnormal cervical cytology. METHODS: In the present study, we evaluated cervical cytology status, sexually transmitted infections and bacterial vaginosis status, and collected social-demographic information among recruited participants to explore the association of STIs and bacterial vaginosis with abnormal cervical cytology. RESULTS: 9,090 women's specimens were successfully tested, with a total of 8,733 (96.1%) women had normal cytology and 357 (3.9%) women exhibited abnormal cytology. The prevalence of HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, and bacterial vaginosis was significantly higher in the ≥ASC-US group than the NILM group (P<0.05). Women with Neisseria gonorrhoeae infection (AOR = 5.30, 95% CIs = 1.30-21.51, P = 0.020) or bacterial vaginosis (AOR = 1.94, 95% CIs = 1.08-3.47, P = 0.026) exhibited an increased risk of abnormal cervical cytology after adjusted for carcinogenic HPV-positive status. CONCLUSIONS: Our results demonstrated that Neisseria gonorrhoeae infection in genital sites and/or bacterial vaginosis may independently increase the risk for cervical cytology abnormalities after adjusted for carcinogenic HPV-positive status. Besides, these results improved our understanding of the etiology of abnormal cervical cytology and may be useful for the management of women with ASC-US cytology.


Asunto(s)
Cuello del Útero/patología , Características de la Residencia/estadística & datos numéricos , Enfermedades de Transmisión Sexual/patología , Encuestas y Cuestionarios , Vaginosis Bacteriana/patología , Adulto , China/epidemiología , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Enfermedades de Transmisión Sexual/epidemiología , Vaginosis Bacteriana/epidemiología , Adulto Joven
9.
Clinics (Sao Paulo) ; 75: e1508, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32215453

RESUMEN

OBJECTIVES: Evidence suggests that infection or inflammation is a major contributor to early spontaneous preterm birth (sPTB). Therefore, this study aimed to investigate the development and causes of maternal infection associated with maternal and neonatal outcomes in women with sPTB. METHODS: This was a secondary analysis of a multicenter cross-sectional study with a nested case-control component, the Brazilian Multicentre Study on Preterm Birth (EMIP), conducted from April 2011 to July 2012 in 20 Brazilian referral obstetric hospitals. Women with preterm birth (PTB) and their neonates were enrolled. In this analysis, 2,682 women undergoing spontaneous preterm labor and premature pre-labor rupture of membranes were included. Two groups were identified based on self-reports or prenatal or hospital records: women with at least one infection factor and women without any maternal infection (vulvovaginitis, urinary tract infection, or dental infection). A bivariate analysis was performed to identify potential individual risk factors for PTB. The odds ratios (ORs) with their respective 95% confidence intervals were calculated. RESULTS: The majority of women with sPTB fulfilled at least one criterion for the identification of maternal infection (65.9%), and more than half reported having urinary tract infection during pregnancy. Approximately 9.6% of women with PTB and maternal infection were classified as having periodontal infection only. Apart from the presence of a partner, which was more common among women with infectious diseases (p=0.026; OR, 1.28 [1.03-1.59]), other variables did not show any significant difference between groups. CONCLUSION: Maternal infection was highly prevalent in all cases of sPTBs, although it was not clearly associated with the type of PTB, gestational age, or any adverse neonatal outcomes.


Asunto(s)
Infecciones/epidemiología , Nacimiento Prematuro/epidemiología , Brasil/epidemiología , Corioamnionitis/epidemiología , Estudios Transversales , Femenino , Humanos , Recién Nacido , Vigilancia de la Población , Embarazo , Factores de Riesgo , Infecciones Urinarias/epidemiología , Vaginosis Bacteriana/epidemiología
11.
PLoS One ; 15(1): e0224359, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31914129

RESUMEN

Sexually transmitted infections (STIs) and vaginal dysbiosis (disturbed resident microbiota presenting with abnormal Nugent score or candidiasis) have been associated with mucosal inflammation and risk of HIV-1 infection, cancer and poor reproductive outcomes. To date, the temporal relationships between aberrant cervical innate immunity and the clinical onset of microbial disturbance have not been studied in a large population of reproductive age women. We examined data from a longitudinal cohort of 934 Ugandan and Zimbabwean women contributing 3,274 HIV-negative visits who had complete laboratory, clinical and demographic data. Among those, 207 women later acquired HIV, and 584 women were intermittently diagnosed with C. trachomatis (CT), N. gonorrhoeae (NG), genital herpes (HSV-2), T. vaginalis (TV), candidiasis, and abnormal intermediate (4-6) or high (7-10) Nugent score, i.e. bacterial vaginosis (BV). Immune biomarker concentrations in cervical swabs were analyzed by generalized linear and mixed effect models adjusting for site, age, hormonal contraceptive use (HC), pregnancy, breastfeeding, genital practices, unprotected sex and overlapping infections. High likelihood ratios (1.5-4.9) denoted the values of cervical immune biomarkers to predict onset of abnormal Nugent score and candidiasis at the next visits. When controlling for covariates, higher levels of ß-defensin-2 were antecedent to BV, CT and HSV-2, lower anti-inflammatory ratio IL-1RA:IL-1ß-to intermediate Nugent scores and candida, lower levels of the serine protease inhibitor SLPI-to candida, lower levels of the adhesion molecule ICAM-1 -to TV, and lower levels of the oxidative stress mitigator and endothelial activation marker VEGF-to NG. Changes in innate immunity following onset of dysbiosis and infections were dependent on HC use when controlling for all other covariates. In conclusion, imminent female genital tract dysbiosis or infection can be predicted by distinct patterns of innate immunity. Future research should characterize biotic and abiotic determinants of this pre-existing innate immunity state.


Asunto(s)
Disbiosis/inmunología , Inmunidad Innata/genética , Enfermedades de Transmisión Sexual/inmunología , Vaginosis Bacteriana/inmunología , Adolescente , Adulto , Biomarcadores/metabolismo , Cuello del Útero/inmunología , Cuello del Útero/microbiología , Cuello del Útero/patología , Disbiosis/epidemiología , Disbiosis/microbiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Infecciones por VIH/virología , Humanos , Molécula 1 de Adhesión Intercelular/inmunología , Molécula 1 de Adhesión Intercelular/metabolismo , Proteína Antagonista del Receptor de Interleucina 1/inmunología , Proteína Antagonista del Receptor de Interleucina 1/metabolismo , Interleucina-1beta/inmunología , Interleucina-1beta/metabolismo , Estrés Oxidativo/inmunología , Embarazo , Infecciones del Sistema Genital/epidemiología , Infecciones del Sistema Genital/inmunología , Inhibidor Secretorio de Peptidasas Leucocitarias/inmunología , Inhibidor Secretorio de Peptidasas Leucocitarias/metabolismo , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/microbiología , Uganda/epidemiología , Vagina/inmunología , Vagina/microbiología , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/microbiología , Factor A de Crecimiento Endotelial Vascular/inmunología , Factor A de Crecimiento Endotelial Vascular/metabolismo , Zimbabwe/epidemiología
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.
Sex Transm Infect ; 96(6): 436-438, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-31719170

RESUMEN

OBJECTIVE: To ascertain the prevalence of Trichomonas vaginalis and investigate associations between trichomoniasis, endometritis and sequelae among women with pelvic inflammatory disease (PID). METHODS: We assessed the prevalence of trichomoniasis identified via wet mount and its association with histologically confirmed endometritis, infertility and recurrent PID among 647 women in the PID Evaluation and Clinical Health (PEACH) study. Participants were treated for clinically suspected PID and followed for a mean of 84 months for incident sequelae. Analyses were adjusted for age, race, Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and bacterial vaginosis. Additional adjustments were incorporated for history of infertility (models of pregnancy and infertility), history of PID (recurrent PID), and self-reported partner treatment and intercourse between baseline and 30-day follow-up (persistent endometritis). RESULTS: T. vaginalis was present in the vagina of 12.8% of women. The odds of having endometritis at baseline were twice as high among women with trichomoniasis as compared with those without (adjusted OR (AOR): 1.9, 95% CI 1.0 to 3.3). Persistent endometritis was highly prevalent at 30 days (52.1%) and more common among women with baseline trichomoniasis (AOR: 2.6, 95% CI 0.7 to 10.1), although non-significantly. Infertility and recurrent PID were more common among women with trichomoniasis, while rates of pregnancy and live birth were lower. CONCLUSIONS: T. vaginalis was frequently isolated from the vagina of women with PID in the PEACH cohort. Wet mount microscopy for the identification of motile trichomonads was standard practice at the time of the PEACH study, but likely resulted in an underestimation of true T. vaginalis prevalence. Our findings of modest, although non-significant, prospective associations between trichomoniasis and sequelae are novel and underscore the need for additional investigation into whether T. vaginalis may play an aetiological role in adverse reproductive and gynaecological outcomes.


Asunto(s)
Endometritis/epidemiología , Infertilidad Femenina/epidemiología , Enfermedad Inflamatoria Pélvica/epidemiología , Índice de Embarazo , Vaginitis por Trichomonas/epidemiología , Adulto , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Femenino , Gonorrea/epidemiología , Humanos , Nacimiento Vivo/epidemiología , Infecciones por Mycoplasma/epidemiología , Mycoplasma genitalium , Enfermedad Inflamatoria Pélvica/tratamiento farmacológico , Embarazo , Recurrencia , Factores de Riesgo , Trichomonas vaginalis , Estados Unidos/epidemiología , Vaginosis Bacteriana/epidemiología
14.
J Infect Dis ; 221(3): 454-463, 2020 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-31544206

RESUMEN

BACKGROUND: Gardnerella vaginalis is detected in women with and without bacterial vaginosis (BV). Identification of 4 G. vaginalis clades raised the possibility that pathogenic and commensal clades exist. We investigated the association of behavioral practices and Nugent Score with G. vaginalis clade distribution in women who have sex with women (WSW). METHODS: Longitudinal self-collected vaginal specimens were analyzed using established G. vaginalis species-specific and clade-typing polymerase chain reaction assays. Logistic regression assessed factors associated with detection of G. vaginalis clades, and multinomial regression assessed factors associated with number of clades. RESULTS: Clades 1, 2, and 3 and multiclade communities (<2 clades) were associated with Nugent-BV. Clade 1 (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.65-6.84) and multiclade communities (relative risk ratio [RRR], 9.51; 95% CI, 4.36-20.73) were also associated with Lactobacillus-deficient vaginal microbiota. Clade 4 was neither associated with Nugent-BV nor Lactobacillus-deficient microbiota (OR, 1.49; 95% CI, 0.67-3.33). Specific clades were associated with differing behavioral practices. Clade 1 was associated with increasing number of recent sexual partners and smoking, whereas clade 2 was associated with penile-vaginal sex and sharing of sex toys with female partners. CONCLUSIONS: Our results suggest that G. vaginalis clades have varying levels of pathogenicity in WSW, with acquisition occurring through sexual activity. These findings suggest that partner treatment may be an appropriate strategy to improve BV cure.


Asunto(s)
Gardnerella vaginalis/clasificación , Gardnerella vaginalis/patogenicidad , Infecciones por Bacterias Grampositivas/epidemiología , Conducta Sexual , Minorías Sexuales y de Género , Vaginosis Bacteriana/epidemiología , Adulto , Australia/epidemiología , Femenino , Gardnerella vaginalis/genética , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Lactobacillus , Estudios Longitudinales , Microbiota , Filogenia , Reacción en Cadena de la Polimerasa , Prevalencia , ARN Ribosómico 16S/genética , Vagina/microbiología , Vaginosis Bacteriana/microbiología , Virulencia , Adulto Joven
15.
Sex Transm Infect ; 96(5): 380-386, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-31601641

RESUMEN

OBJECTIVES: To assess risk and protective factors associated with bacterial vaginosis (BV) chronicity ascertained by Nugent score criteria. METHODS: A longitudinal cohort study included 255 sexually experienced, postmenarcheal women who provided weekly self-collected vaginal swabs for up to 2 years. Vaginal swabs were scored using Nugent criteria and classified as normal (≤3), intermediate (4-6) and Nugent-BV (≥7). Detailed behavioural/health information were assessed every 6 months. A per-woman longitudinal summary measure of BV chronicity was defined as the percentage of each woman's weekly vaginal assessments scored as Nugent-BV over a 6-month interval. Risk and protective factors associated with BV chronicity were assessed using multiple linear regression with generalised estimating equations. RESULTS: Average BV chronicity was 39% across all follow-up periods. After adjustment, factors associated with BV chronicity included baseline Nugent-BV (ß=35.3, 95% CI 28.6 to 42.0) compared with normal baseline Nugent scores and use of unprotected water for bathing (ie, rainwater, pond, lake/stream) (ß=12.0, 95% CI 3.4 to 20.5) compared with protected water sources (ie, well, tap, borehole). Women had fewer BV occurrences if they were currently pregnant (ß=-6.6, 95% CI -12.1 to 1.1), reported consistent condom use (ß=-7.7, 95% CI -14.2 to 1.3) or their partner was circumcised (ß=-5.8, 95% CI -11.3 to 0.3). CONCLUSIONS: Factors associated with higher and lower values of BV chronicity were multifactorial. Notably, higher values of BV chronicity were associated with potentially contaminated bathing water. Future studies should examine the role of waterborne microbial agents in the pathogenesis of BV.


Asunto(s)
Circuncisión Masculina/estadística & datos numéricos , Condones/estadística & datos numéricos , Vaginosis Bacteriana/epidemiología , Abastecimiento de Agua/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Enfermedad Crónica , Femenino , Humanos , Higiene , Modelos Lineales , Estudios Longitudinales , Masculino , Factores Protectores , Factores de Riesgo , Parejas Sexuales , Uganda/epidemiología , Adulto Joven
16.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(4): 154-158, oct.-dic. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-184303

RESUMEN

Introducción: La mujer inmigrante presenta unas características específicas desde el punto de vista sanitario, debido a su procedencia, diferencias culturales y estrato social, que pueden afectar a sus consultas de salud. El ámbito ginecológico y la salud reproductiva son áreas de frecuente consulta en este grupo poblacional. Objetivo: Describir la enfermedad ginecológica por la que consultan las mujeres inmigrantes y definir posibles factores de riesgo. Material y métodos: Estudio descriptivo y transversal sobre las consultas de salud en la esfera ginecológica de las mujeres de origen inmigrante atendidas en la consulta de atención primaria. Estudio comparativo con una muestra de mujeres de origen nacional. Resultados: La mayoría de las pacientes inmigrantes del estudio eran de origen magrebí. La consulta de salud más habitual fueron las vaginitis de origen infeccioso. Hasta un 19% presentaban multiparidad (3 o más embarazos). Estos 2 procesos fueron significativamente mayores que en el colectivo de mujeres de origen nacional con quienes se comparó la muestra. Conclusiones: Las mujeres inmigrantes presentan, en general, una paridad elevada y más infecciones de la esfera ginecológica. Estos factores pueden causar una mayor vulnerabilidad en este colectivo


Introduction: Immigrant women have specific characteristics from the health point of view, due to their origin, cultural differences and social status, which can affect their health consultations. The gynaecological field and reproductive health are areas of frequent consultation by this population group. Objectives: To describe the gynaecological disorders for which immigrant women consult, and to define possible risk factors. Material and methods: A descriptive and cross-sectional study was conducted on gynaecological health consultations by women of immigrant origin seen in the primary care clinic. A comparative study was performed with a sample of women of Spanish origin. Results: The majority of the immigrant patients in the study were of Maghrebi origin. The most common health consultation was vaginitis of infectious origin. Up to 19% were multiparous (3 or more pregnancies) and these 2 processes were significantly greater than in the group of women of national origin in whom the sample was compared. Conclusions: Immigrant women have a high parity, in general, and have more gynaecological infections. These factors can cause greater vulnerability in this group


Asunto(s)
Humanos , Femenino , Emigrantes e Inmigrantes/estadística & datos numéricos , Factores de Riesgo , Salud Reproductiva , Atención Primaria de Salud , Enfermedades Urogenitales Femeninas/epidemiología , Estudios Transversales , Vaginitis/epidemiología , Vaginosis Bacteriana/epidemiología , Infertilidad Femenina , Enfermedades Transmisibles/epidemiología
17.
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
18.
Rev Colomb Obstet Ginecol ; 70(1): 49-56, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-31613070

RESUMEN

OBJECTIVE: To determine the prevalence of potentially pathogenic microbiological agents in vaginal exudates in a sample of asymptomatic pregnant women in the Department of Atlantico, Colombia. METHODS: Descriptive cross-sectional study of a sample of asymptomatic pregnant women who attended a private primary healthcare institution in Barranquilla, Colombia, between 2014 and 2015. Pregnant women having received antimicrobial treatment within the last 30 days, with vaginal bleeding, mental disability or immunosuppression, were excluded. Consecutive sampling was performed. The prevalence of colonization time by some of the microbiological agents as well as specific prevalence were estimated: number of women with infection by agent type/number of women at risk assessed. RESULTS: Overall prevalence was 24.8% (56/226); 55.4% (31/56) was due to vaginitis causal agents, and 44.6% (25/56) to vaginosis. The specific prevalence by type of pathogen, 13.3% (30/226) was vaginitis due to colonization by Candida spp. and 0.4% (1/226) was vaginitis due to T. vaginalis. Bacterial vaginosis (BV) was found in 8.0% (18/226). CONCLUSIONS: Substantial colonization of the lower genital tract by potentially pathogenic germs is found in pregnant women between 35 and 37 weeks of gestation. Further studies are required in order to determine the benefit of population screening in terms of avoiding poor maternal and perinatal out- comes, and the impact on the resulting overcosts.


Asunto(s)
Candidiasis Vulvovaginal/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Vaginitis por Trichomonas/epidemiología , Vaginosis Bacteriana/epidemiología , Adolescente , Adulto , Colombia/epidemiología , Estudios Transversales , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Prevalencia , Atención Primaria de Salud , Vagina/microbiología , Adulto Joven
19.
BMC Infect Dis ; 19(1): 879, 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31640583

RESUMEN

BACKGROUND: In Yemen, the underlying causes of infectious vaginitis have been neglected. Therefore, this study aimed to determine the prevalence and risk factors associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonal vaginitis (TV) among non-pregnant reproductive-aged women. METHODS: A cross-sectional study was conducted among 347 non-pregnant reproductive-aged women seeking primary healthcare in Sana'a city, Yemen. Data about sociodemographic characteristics, lifestyle-related behaviors, routine hygienic practices, menstrual care and history and type of contraceptive intake were collected using a structured questionnaire. Vaginal discharge samples were collected and examined for discharge characteristics and pH by a gynecologist. Then, samples were examined for BV, VVC and TV. Data were analyzed using suitable statistical tests. RESULTS: Vaginal infections were prevalent among 37.6% of reproductive-aged women, where BV was the most prevalent (27.2%). VVC was significantly higher among symptomatic women and significantly associated with itching (P = 0.005). Using bivariate analysis, the age of < 25 years (odds ratio [OR] = 1.9, 95% confidence interval [CI]: 1.16-3.10; P = 0.010) and using intrauterine contraceptive devices (IUCDs) (OR = 1.8, 95% CI: 1.09-2.89; P = 0.020) were significantly associated with BV, while history of miscarriage was significantly associated with a lower risk of BV (OR = 0.5, 95% CI: 0.31-0.85, P = 0.009). However, polygyny was significantly associated with VVC (OR = 3.4, 95% CI: 1.33-8.66; P = 0.007). Multivariable analysis confirmed that age of < 25 years and using IUCD were the independent predictors of BV, while history of miscarriage was an independent protective factor against BV. On the other hand, marriage to a polygamous husband was the independent predictor of VVC. CONCLUSIONS: More than a third of non-pregnant reproductive-aged women seeking PHC in Sana'a have single or mixed infections with BV, VVC or TV. BV is the most frequent cause of vaginitis and is significantly associated with the age of < 25 years and using IUCDs, while VVC is significantly higher among women with polygamous husbands. Health education of polygamous husbands and their wives, regular monitoring of BV among IUCD users and screening women for vaginitis before treatment are recommended.


Asunto(s)
Candidiasis Vulvovaginal/epidemiología , Vaginitis por Trichomonas/epidemiología , Vaginosis Bacteriana/epidemiología , Adolescente , Adulto , Candidiasis Vulvovaginal/etiología , Coinfección , Estudios Transversales , Femenino , Humanos , Dispositivos Intrauterinos/estadística & datos numéricos , Matrimonio , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Atención Primaria de Salud/estadística & datos numéricos , Factores de Riesgo , Vaginitis por Trichomonas/etiología , Vaginosis Bacteriana/etiología , Yemen/epidemiología , Adulto Joven
20.
BMC Pregnancy Childbirth ; 19(1): 341, 2019 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-31547803

RESUMEN

BACKGROUND: Vaginal infections usually caused by Candida sp, organisms responsible for bacterial vaginosis and Trichomonas vaginalis are associated with considerable discomfort and adverse outcomes during pregnancy and child birth. The study determined the prevalence of vulvovaginal candidiasis (VVC), bacterial vaginosis (BV) and trichomoniasis (TV) in pregnant women attending antenatal clinic at the Kintampo Municipal Hospital. METHODS: A study adopted a cross sectional design and recruited 589 pregnant women after seeking their informed consent from September, 2014 to March, 2015. Semi-structured questionnaire were administered to participants and vaginal swabs were collected. The samples were analysed using wet mount method and Gram stain (Nugent criteria) for vaginal infection. Univariate and multivariate analysis were used to investigate association of risk factors to vaginal infections. RESULTS: The overall prevalence of at least one vaginal infection was 56.4%. The prevalence of vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis were 36.5, 30.9 and 1.4% respectively. Women with more than four previous pregnancies (OR: 0.27, 95% CI: 0.13-0.58) and those in the third trimester of pregnancy (OR: 0.54, CI: 0.30-0.96) were associated with a lower risk of bacterial vaginosis. Douching and antibiotic use were neither associated with VVC or BV. CONCLUSION: The prevalence of vaginal infections was high among pregnant women in the Kintampo area. There is the need for interventions such as adequate investigations and early treatment of vaginal infections to reduce the disease burden to avoid associated complications.


Asunto(s)
Candidiasis Vulvovaginal/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Vaginitis por Trichomonas/epidemiología , Vaginosis Bacteriana/epidemiología , Adolescente , Adulto , Antibacterianos/uso terapéutico , Estudios Transversales , Femenino , Ghana/epidemiología , Número de Embarazos , Humanos , Embarazo , Tercer Trimestre del Embarazo , Atención Prenatal , Prevalencia , Factores de Riesgo , Ducha Vaginal/estadística & datos numéricos , Adulto Joven
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