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1.
Wiad Lek ; 74(3 cz 1): 460-464, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813450

RESUMEN

OBJECTIVE: The aim: To assess the condition of the vaginal ecosystem in pregnant women with BV. PATIENTS AND METHODS: Materials and methods: The main group consisted of 60 pregnant women with BV in the II trimester. The bacterioscopic examination, of vaginal smears was carried out. DNA diagnostics of the microbial spectrum of vaginal contents was performed. Bacteria with biofilm were visualized by fluorescence hybridization in situ. RESULTS: Results: Biofilms were found in 25 women (41.65%) of the main group, the main component of which was bacteria belonging to the Gardnerella cluster at a concentration of 7.9 ± 0.13 log CFU/ g. Atopobium vagine cluster bacteria gave positive hybridization signals in more than half of the patients and amounted to 6.8 ± 0.15 lg CFU / g. In addition, Snethia spp. was determined as a part of the biofilm at a concentration of 5.8 ± 0.3 lg CFU / g. CONCLUSION: Conclusions: Thus, the use of the proposed treatment regimen for women with vaginal dysbiosis led to the elimination of pathogenic and conditionally pathogenic microflora. However, the effectiveness of treatment in 5 cases was lower than expected, which indicates the emergence of bacterial resistance.


Asunto(s)
Vaginosis Bacteriana , Disbiosis , Ecosistema , Femenino , Humanos , Embarazo , Mujeres Embarazadas , Vagina , Vaginosis Bacteriana/tratamiento farmacológico
4.
BJOG ; 128(4): 756-767, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33480468

RESUMEN

OBJECTIVE: Determine the associations between factors and sexual practices and the composition of the vaginal microbiome (VM) of women treated for bacterial vaginosis (BV). DESIGN: Prospective cohort study. SETTING: The Melbourne Sexual Health Centre, Melbourne, Australia. POPULATION: Seventy-five reproductive-age women diagnosed with clinical BV, treated with first-line antibiotics and followed for up to 6 months. METHODS: Women self-collected vaginal swabs and completed questionnaires at enrolment, the day following antibiotics and monthly for up to 6months until BV recurrence or no BV recurrence (n = 430 specimens). Bacterial composition was determined using 16S rRNA gene amplicon sequencing. The effects of ongoing factors on VM composition (utilising 291 monthly specimens) were assessed using generalised estimating equations population-averaged models, which accounted for repeated measures within individuals. MAIN OUTCOME MEASURES: The relative abundance of vaginal bacterial taxa. RESULTS: Women who reported ongoing sex with a regular sexual partner (RSP) had a VM comprised of increased relative abundance of non-optimal BV-associated bacteria (Adjusted co-efficient [Adjusted co-eff] = 11.91, 95% CI 3.39to20.43, P = 0.006) and a decreased relative abundance of optimal, Lactobacillus species (Adjusted co-eff = -12.76, 95% CI -23.03 to -2.49, P = 0.015). A history of BV was also associated with a decreased relative abundance of Lactobacillus spp. (Adjusted co-eff = -12.35, 95% CI -22.68, P = 0.019). The relative abundance of Gardnerella, Atopobium and Sneathia spp. increased following sex with an RSP. CONCLUSIONS: Sex with an untreated RSP after BV treatment was associated with a VM comprised of non-optimal BV-associated bacteria. BV treatment approaches may need to include partner treatment if they are to achieve a sustained optimal VM associated with improved health outcomes. TWEETABLE ABSTRACT: Sex drives a return to a 'non-optimal' vaginal microbiota after antibiotics for bacterial vaginosis.


Asunto(s)
Antibacterianos/uso terapéutico , Coito , Microbiota , Vagina/microbiología , Vaginosis Bacteriana/tratamiento farmacológico , Vaginosis Bacteriana/microbiología , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Resultado del Tratamiento , Adulto Joven
5.
BMC Infect Dis ; 20(1): 834, 2020 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-33176727

RESUMEN

BACKGROUND: Bacterial vaginosis (BV) is estimated to affect 1 in 3 women globally and is associated with obstetric and gynaecological sequelae. Current recommended therapies have good short-term efficacy but 1 in 2 women experience BV recurrence within 6 months of treatment. Evidence of male carriage of BV-organisms suggests that male partners may be reinfecting women with BV-associated bacteria (henceforth referred to as BV-organisms) and impacting on the efficacy of treatment approaches solely directed to women. This trial aims to determine the effect of concurrent male partner treatment for preventing BV recurrence compared to current standard of care. METHODS: StepUp is an open-label, multicentre, parallel group randomised controlled trial for women diagnosed with BV and their male partner. Women with clinical-BV defined using current gold standard diagnosis methods (≥3 Amsel criteria and Nugent score (NS) = 4-10) and with a regular male partner will be assessed for eligibility, and couples will then be consented. All women will be prescribed oral metronidazole 400 mg twice daily (BID) for 7 days, or if contraindicated, a 7-day regimen of topical vaginal 2% clindamycin. Couples will be randomised 1:1 to either current standard of care (female treatment only), or female treatment and concurrent male partner treatment (7 days of combined antibiotics - oral metronidazole tablets 400 mg BID and 2% clindamycin cream applied topically to the glans penis and upper shaft [under the foreskin if uncircumcised] BID). Couples will be followed for up to 12 weeks to assess BV status in women, and assess the adherence, tolerability and acceptability of male partner treatment. The primary outcome is BV recurrence defined as ≥3 Amsel criteria and NS = 4-10 within 12 weeks of enrolment. The estimated sample size is 342 couples, to detect a 40% reduction in BV recurrence rates from 40% in the control group to 24% in the intervention group within 12 weeks. DISCUSSION: Current treatments directed solely to women result in unacceptably high rates of BV recurrence. If proven to be effective the findings from this trial will directly inform the development of new treatment strategies to impact on BV recurrence. TRIAL REGISTRATION: The trial was prospectively registered on 12 February 2019 on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000196145, Universal Trial Number: U1111-1228-0106, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376883&isReview=true ).


Asunto(s)
Antibacterianos/uso terapéutico , Clindamicina/uso terapéutico , Metronidazol/uso terapéutico , Parejas Sexuales , Vaginosis Bacteriana/tratamiento farmacológico , Administración Intravaginal , Administración Oral , Antibacterianos/administración & dosificación , Australia , Clindamicina/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Metronidazol/administración & dosificación , Nueva Zelanda , Pene/microbiología , Estudios Prospectivos , Recurrencia , Resultado del Tratamiento , Vaginosis Bacteriana/microbiología
7.
PLoS One ; 15(7): e0236036, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32722712

RESUMEN

The human vagina harbor a rich microbiota. The optimal state is dominated by lactobacilli that help to maintain health and prevent various diseases. However, the microbiota may rapidly change to a polymicrobial state that has been linked to a number of diseases. In the present study, the temporal changes of the vaginal microbiota in patients treated for sexually transmitted diseases or bacterial vaginosis (BV) and in untreated controls were studied for 26 days. The patients included 52 women treated with azithromycin, tetracyclines or moxifloxacin for present or suspected infection with Chlamydia trachomatis or Mycoplasma genitalium. Women with concurrent BV were also treated with metronidazole. The controls were 10 healthy women of matching age. The microbiota was analyzed by 16S rRNA gene deep sequencing, specific qPCRs and microscopy. There was generally good correlation between Nugent score and community state type (CST) and qPCR confirmed the sequencing results. By sequencing, more than 600 different taxa were found, but only 33 constituted more than 1 ‰ of the sequences. In both patients and controls the microbiota could be divided into three different community state types, CST-I, CST-III and CST-IV. Without metronidazole, the microbiota remained relatively stable regarding CST although changes were seen during menstrual periods. Administration of metronidazole changed the microbiota from CST-IV to CST-III in approximately 50% of the treated patients. In contrast, the CST was generally unaffected by azithromycin or tetracyclines. In 30% of the BV patients, Gardnerella vaginalis was not eradicated by metronidazole. The majority of women colonized with Ureaplasma parvum remained positive after azithromycin while U. urealyticum was eradicated.


Asunto(s)
Antibacterianos/farmacología , Infecciones por Chlamydia/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Microbiota/efectos de los fármacos , Infecciones por Mycoplasma/microbiología , Vagina/microbiología , Vaginosis Bacteriana/microbiología , Adolescente , Adulto , Infecciones por Chlamydia/tratamiento farmacológico , Chlamydia trachomatis/efectos de los fármacos , Chlamydia trachomatis/aislamiento & purificación , Femenino , Gardnerella vaginalis/efectos de los fármacos , Gardnerella vaginalis/aislamiento & purificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Infecciones por Mycoplasma/tratamiento farmacológico , Mycoplasma genitalium/efectos de los fármacos , Mycoplasma genitalium/aislamiento & purificación , Vagina/efectos de los fármacos , Vaginosis Bacteriana/tratamiento farmacológico , Adulto Joven
8.
PLoS Pathog ; 16(6): e1008559, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32497109

RESUMEN

Antibiotics continue to be the standard-of-care for bacterial vaginosis (BV), although recurrence rates are high. Vaginal probiotics may improve durability of BV treatment, although few probiotics for vaginal health contain Lactobacillus spp. that commonly colonize the lower female genital tract. Characteristics of vaginal Lactobacillus strains from South African women were evaluated for their probiotic potential in vitro compared to strains from commercial vaginal products, including growth at varying pHs, ability to lower pH, produce D-/L-lactate and H2O2, influence growth of BV-associated Gardnerella vaginalis and Prevotella bivia, adherence to cervical cells and susceptibility to antibiotics. Fifty-seven Lactobacillus strains were purified from cervico-vaginal fluid, including L. crispatus, L. jensenii, L. gasseri, L. mucosae, and L. vaginalis. L crispatus strains grew better at pHs below 4.5 and lowered pH more effectively than other strains. Production of D-/L-lactate and H2O2 varied between Lactobacillus species and strains. Lactobacillus strains generally inhibited P. bivia more uniformly than G. vaginalis isolates. All vaginal Lactobacillus isolates were resistant to metronidazole while susceptibility to clindamycin varied. Furthermore, vaginal Lactobacillus strains tended to be broadly susceptible to penicillin, amoxicillin, rifampicin and rifabutin. Whole-genome-sequencing of five of the best-performing vaginal Lactobacillus strains confirmed their likely safety, due to antimicrobial resistance elements being largely absent, while putative intact prophages were present in the genomes of two of the five strains. Overall, vaginal Lactobacillus strains largely performed better in these in vitro assays than probiotic strains currently used in probiotics for vaginal health. Including the best-performing vaginal Lactobacillus isolates in a region-specific probiotic for vaginal health may result in improved BV treatment options.


Asunto(s)
Infecciones por Bacteroidaceae/microbiología , Gardnerella vaginalis , Infecciones por Bacterias Grampositivas/microbiología , Lactobacillus , Prevotella , Vaginosis Bacteriana/microbiología , Adolescente , Adulto , Infecciones por Bacteroidaceae/tratamiento farmacológico , Infecciones por Bacteroidaceae/genética , Infecciones por Bacteroidaceae/metabolismo , Clindamicina/farmacología , Farmacorresistencia Bacteriana/efectos de los fármacos , Farmacorresistencia Bacteriana/genética , Femenino , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/genética , Infecciones por Bacterias Grampositivas/metabolismo , Humanos , Peróxido de Hidrógeno/metabolismo , Ácido Láctico/metabolismo , Lactobacillus/genética , Lactobacillus/aislamiento & purificación , Lactobacillus/metabolismo , Metronidazol/farmacología , Sudáfrica , Especificidad de la Especie , Vaginosis Bacteriana/tratamiento farmacológico , Vaginosis Bacteriana/genética
9.
Medicine (Baltimore) ; 99(25): e20732, 2020 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-32569213

RESUMEN

This study aimed to analyze the clinical characteristics, responsible pathogens, and antibiotic sensitivity of aerobic vaginitis (AV) infection in women in late pregnancy in western China.We enrolled 246 pregnancy with AV (≥35 weeks gestation) and 204 reproductive non-pregnancy with AV from West China between January 2019 and December 2019. Then, bacterial culture, identification and antibiotic sensitivity testing were performed. Subsequently, we retrospectively analyzed the vaginal microbiota of 250 healthy pregnant women with no AV and compared the maternal features and pregnancy outcomes.Regarding bacterial diversity, Streptococcus and Lactobacillus were highly abundant in women with AV in late pregnancy, whereas Staphylococcus spp. and other bacteria were significantly more abundant in reproductive non-pregnant women with AV. In addition, 82.5% (343/416) of the single isolate comprised Escherichia coli, group B Streptococcus, Enterococcus faecalis, and Staphylococcus aureus. Among the top 4 isolates, 13.4% (46/343) were multidrug-resistant, but all isolates were highly susceptible to nitrofurantoin. Escherichia coli was 100% susceptible to amikacin, meropenem, ertapenem, and imipenem (100%, 157/157), and gram-positive cocci were 100% (186/186) susceptible to vancomycin and linezolid. Finally, we found that pregnant women with AV had high rates of histories of vaginitis, premature rupture of membranes and neonatal infection.Our study reveals new insights into AV infection during pregnancy and highlights the different vaginal bacterial microbiome compositions between pregnant and reproductive non pregnant women with AV, these results may translate to treatments that are more cost-effective than current standard treatments.


Asunto(s)
Bacterias Aerobias/aislamiento & purificación , Vaginosis Bacteriana/microbiología , Adulto , Antibacterianos/uso terapéutico , Estudios de Casos y Controles , China , Femenino , Humanos , Pruebas de Sensibilidad Microbiana , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/microbiología , Estudios Retrospectivos , Frotis Vaginal , Vaginosis Bacteriana/tratamiento farmacológico
10.
PLoS One ; 15(6): e0235286, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32598394

RESUMEN

Bacterial vaginosis (BV) is a common vaginal infection among women of reproductive age. Increasing evidence suggests BV may be sexually transmitted indicating a potential role for the treatment of sexual partners. If partner treatment reduces BV recurrence in women, real-world success will depend on sexual partners' willingness to accept it. However, a lack of data exists on the acceptability of partner treatment among sexual partners, and no data exists on male partners' experience of BV specifically. The aim of this study was to explore male partners' views and experience of BV and their attitudes toward associated partner treatment. A social constructionist approach informed the framework of this study. Semi structured interviews were conducted with eleven men who participated in a BV partner treatment trial. Interviews were transcribed verbatim and analysed thematically. In the absence of symptoms in themselves, BV had little impact on men beyond their concerns for their partner's health and self-esteem. Acceptance of treatment was largely a demonstration of care and support. While all participants had accepted treatment, men surmised the primary reasons other men may reject treatment as being: if they felt BV had "nothing to do with them", which was related to not wanting to be viewed as having a 'problem' and exacerbated by norms of masculinity and STI-related stigma; lack of a diagnostic test to indicate if a male "had BV"; and a casual or less established relationship. Men's attitudes to BV and partner treatment were primarily influenced by the nature of their relationships. The ambiguous aetiology of BV appears to attenuate STI related stigma and questions of infidelity.


Asunto(s)
Aceptación de la Atención de Salud , Conducta Sexual/psicología , Parejas Sexuales/psicología , Enfermedades de Transmisión Sexual/transmisión , Vagina/microbiología , Vaginosis Bacteriana/tratamiento farmacológico , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de Transmisión Sexual/diagnóstico , Vaginosis Bacteriana/etiología , Vaginosis Bacteriana/psicología , Adulto Joven
11.
Rev. iberoam. fertil. reprod. hum ; 37(2): 3-11, abr.-jun. 2020. tab
Artículo en Español | IBECS | ID: ibc-193739

RESUMEN

El uso de probióticos es un área de investigación traslacional en continuo progreso debido al creciente interés de los clínicos del área de fertilidad y sus pacientes. Por lo que el objetivo principal de este trabajo es recabar y resumir la información de la literatura científica relevante sobre los probióticos y su posible papel modulador efectivo en alteraciones relacionadas con la fertilidad y reproductivas. Para ello se describen los aspectos de interés relativos a: 1. La microbiota humana y sitios naturales de colonización relacionados con la salud reproductiva: microbiota vaginal, microbiota endometrial, microbiota y embarazo. 2. A continuación, hemos resaltado las disbiosis de los sitios de colonización y las repercusiones en fertilidad del estado de salud/enfermedad y por último 3. La hipótesis sobre los tratamientos efectivos con probióticos orales vs vaginales y sus vías fisiológicas de transferencia y actuación; que lleva asociado la descripción del concepto de translocación efectiva o llegada de los probióticos alsitio natural de colonización tras su administración como suplementos. La mayoría de probióticos utilizados en disbiosis relacionadas con la fertilidad pertenecen al género Lactobacillus. Se suelen administrar principalmente por vía oral a una concentración del orden de 1x109UFC/día y una duración de4-12 semanas, siendo diferencial en función de la disbiosis a tratar


The use of probiotics is an area of translational research in continuous progress due to the growing interest of fertility clinicians and their patients. Therefore, the main objective of this work is to collect and summarise relevant information from the available scientific literature on probiotics and their effective modulating role in fertility-related and reproductive disorders. To approach this objective, we have summarised the knowledge regarding the following pertinent aspects: 1. The human microbiota: intestinal microbiota already well studied, and other natural colonization sites related to reproductive health: vaginal microbiota, endometrial microbiota, pregnancy microbiota. 2. Next, we have highlighted the dysbiosis of the colonization sites and the repercussions on the state of health / disease and finally 3. The hypothesis that exists about effective treatments with oral probiotics and their physiological transfer and performance pathways and the associated concept of translocation or arrival at the natural site of colonization. Most probiotics used in fertility-related dysbiosis be-long to the genus Lactobacillus. They are mainly administered via oral at average concentrations of 1x109CFU/day during 4-12 weeks, being differential depending on the dysbiosis to be treated


Asunto(s)
Humanos , Femenino , Probióticos/administración & dosificación , Disbiosis/tratamiento farmacológico , Microbiota/efectos de los fármacos , Vaginosis Bacteriana/tratamiento farmacológico , Endometriosis/tratamiento farmacológico , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Complicaciones del Embarazo/tratamiento farmacológico
12.
PLoS One ; 15(5): e0232394, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32365097

RESUMEN

BACKGROUND: Astodrimer Gel contains a novel dendrimer intended to treat and prevent bacterial vaginosis. We assessed the efficacy and safety of Astodrimer Gel for treatment of bacterial vaginosis. METHODS: 132 women with bacterial vaginosis were randomized 1:1:1:1 to Astodrimer 0.5% (N = 34), 1% (N = 33), or 3% (N = 32) Gel or hydroxyethyl cellulose placebo gel (N = 33) at a dose of 5 g vaginally once daily for 7 days at 6 centers in the United States. The primary endpoint was clinical cure (no bacterial vaginosis vaginal discharge and no more than one of 1) vaginal pH ≥4.5; 2) ≥20% clue cells; or 3) positive whiff test) at study days 21-30. Secondary analyses included clinical cure at study days 9-12, patient-reported symptoms, acceptability and adverse events. RESULTS: The Astodrimer 1% Gel dose was superior to placebo for the primary and selected secondary efficacy measures in the modified intent-to-treat population. Clinical cure rates at day 9-12 were superior to placebo for the Astodrimer 3%, 1% and 0.5% Gel groups (62.5% [15/24; P = .002], 74.1% [20/27; P < .001], and 55.2% [16/29; P = .001], respectively, vs. 22.2% [6/27]). At day 21-30, clinical cure rates were 46.2% (12/26) for the 1% dose vs. 11.5% for placebo (3/26; P = .006). A greater proportion of patients reported absence of vaginal discharge and vaginal odor at day 9-12 and day 21-30 for Astodrimer Gel groups compared with placebo. Adverse events considered potentially treatment-related occurred in only 25% of Astodrimer Gel-treated patients vs. 22% of placebo patients. CONCLUSION: Astodrimer Gel once daily for 7 days was superior to placebo for treatment of bacterial vaginosis and was well-tolerated. The 1% dose consistently showed the strongest efficacy across endpoints. These results support a role for Astodrimer Gel, 1%, as an effective treatment for bacterial vaginosis.


Asunto(s)
Antibacterianos/administración & dosificación , Dendrímeros/administración & dosificación , Polilisina/administración & dosificación , Excreción Vaginal/tratamiento farmacológico , Vaginosis Bacteriana/tratamiento farmacológico , Administración Intravaginal , Adulto , Antibacterianos/efectos adversos , Dendrímeros/efectos adversos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Esquema de Medicación , Femenino , Geles , Humanos , Polilisina/efectos adversos , Resultado del Tratamiento , Adulto Joven
13.
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
14.
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
15.
Benef Microbes ; 11(1): 5-17, 2020 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-32066254

RESUMEN

Vaginal lactobacilli (LAB) in probiotic formulas constitute a promising alternative for microbiome reconstitution and for the prevention and treatment of urogenital infections. A double-blind, randomised clinical trial was conducted to assess the safety of LAB-gelatine capsules vaginally administered to healthy sexually active women. Participants were randomised into three groups: intervention A: Lactobacillus reuteri CRL1324, Lactobacillus gasseri CRL1263 and CRL1307; intervention B: Lactobacillus rhamnosus CRL1332, L. gasseri CRL1256 and CRL1320; and intervention C: placebo. In a survey and clinical evaluation, participants received a blister with 7 capsules to be administered 1 per day. A second sampling and a new survey were conducted 3-10 days after completing application. Colposcopy was performed to assess adverse effects on vaginal-cervical mucosa. Vaginal swabs were taken for Gram staining to determine the Nugent score, and obtainment of viable-cell cultures to quantify cultivable lactic acid bacteria and pathogens. The main outcomes evaluated were overall satisfaction and secondary effects, including discomfort, urogenital infection, inflammatory response or other symptoms. No significant differences were found in Nugent score or in leukocyte numbers in vaginal samples either before or after the three interventions. However, a tendency to decrease in both the Nugent score and in leukocyte numbers was observed after interventions A and B, though not after C. A significant increase in cultivable lactobacilli was determined after LAB interventions. No severe adverse events were detected. LAB-containing capsules were well tolerated by subjects, so they could be proposed as an adequate alternative to restore vaginal lactobacilli in sexually active women.


Asunto(s)
Microbiota/efectos de los fármacos , Probióticos , Vagina/microbiología , Administración Intravaginal , Adulto , Cápsulas , Colposcopía , Método Doble Ciego , Femenino , Humanos , Lactobacillus gasseri , Lactobacillus reuteri , Lactobacillus rhamnosus , Persona de Mediana Edad , Probióticos/administración & dosificación , Probióticos/efectos adversos , Probióticos/uso terapéutico , Vaginosis Bacteriana/tratamiento farmacológico
16.
Eur J Obstet Gynecol Reprod Biol ; 245: 13-18, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31812702

RESUMEN

OBJECTIVE: Astodrimer is a dendrimer formulated in a vaginal gel to treat bacterial vaginosis (BV) and prevent recurrence. The objective of these studies was to confirm the efficacy and safety of Astodrimer 1 % Gel for treatment of BV. STUDY DESIGN: Women with bacterial vaginosis were randomized 1:1 to Astodrimer 1 % Gel (Study 1 conducted in the United States, N = 127; Study 2 conducted in the United States, Germany and Belgium, N = 128) or placebo gel (Study 1, N = 123; Study 2, N = 123) at a dose of 5 g vaginally once daily for 7 days. The primary endpoint was clinical cure, defined as i) absence of bacterial vaginosis vaginal discharge; ii) <20 % clue cells; and iii) negative whiff test at day 9-12. Secondary efficacy analyses included clinical cure at day 21-30. Other endpoints at days 9-12 and 21-30 included Nugent cure (Nugent score ≤3), absence of symptoms, and adverse events. The primary analysis in the modified intent-to-treat population used the Cochran Mantel Haenszel test stratified by analysis center with a two-sided significance level of α = .05. RESULTS: Astodrimer 1 % Gel was superior to placebo for the primary and selected secondary efficacy measures. Clinical cure rates at day 9-12 were 50.4 % (59/117) vs 16.5 % (19/115, P < .001) (Study 1) and 56.7 % (68/120) vs 21.4 % (25/117, P < .001) (Study 2) for astodrimer vs placebo. At day 21-30, clinical cure results showed a similar trend but the difference to placebo was not statistically significant. Nugent cure rates at day 9-12 were 12.8 % (15/117) vs 2.6 % (3/115, P = .004) (Study 1) and 13.3 % (16/120) vs 5.1 % (6/117, P = .030) (Study 2) for astodrimer vs placebo. A greater proportion of women receiving astodrimer reported absence of vaginal discharge and absence of vaginal odor at day 9-12 and day 21-30 compared with placebo. Adverse events were generally mild and self-limiting. For the combined studies, adverse events potentially related to treatment occurred in 14.7 % (37/252) of astodrimer patients vs 9.4 % (23/244) for placebo, including vulvovaginal candidiasis reported for 2.4 % (6/252) of astodrimer patients. CONCLUSION: These results support a role for Astodrimer 1 % Gel as an effective, safe and well-tolerated treatment for women with bacterial vaginosis.


Asunto(s)
Antibacterianos/administración & dosificación , Dendrímeros/administración & dosificación , Polilisina/administración & dosificación , Vaginosis Bacteriana/tratamiento farmacológico , Administración Intravaginal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopelículas/efectos de los fármacos , Método Doble Ciego , Femenino , Humanos , Análisis de Intención de Tratar , Persona de Mediana Edad , Resultado del Tratamiento , Vagina/microbiología , Cremas, Espumas y Geles Vaginales , Adulto Joven
17.
J Infect Dis ; 221(4): 627-635, 2020 02 03.
Artículo en Inglés | MEDLINE | ID: mdl-31573603

RESUMEN

We characterized the composition and structure of the vaginal microbiota in a cohort of 149 women with genital Chlamydia trachomatis infection at baseline who were followed quarterly for 9 months after antibiotic treatment. At time of diagnosis, the vaginal microbiota was dominated by Lactobacillus iners or a diverse array of bacterial vaginosis-associated bacteria including Gardnerella vaginalis. Interestingly, L. iners-dominated communities were most common after azithromycin treatment (1 g monodose), consistent with the observed relative resistance of L. iners to azithromycin. Lactobacillus iners-dominated communities have been associated with increased risk of C. trachomatis infection, suggesting that the impact of antibiotic treatment on the vaginal microbiota could favor reinfections. These results provide support for the dual need to account for the potential perturbing effect(s) of antibiotic treatment on the vaginal microbiota, and to develop strategies to protect and restore optimal vaginal microbiota.


Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Infecciones por Chlamydia/tratamiento farmacológico , Chlamydia trachomatis/genética , Microbiota/efectos de los fármacos , Vagina/microbiología , Vaginosis Bacteriana/tratamiento farmacológico , Adolescente , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Antibacterianos/farmacología , Azitromicina/administración & dosificación , Azitromicina/efectos adversos , Azitromicina/farmacología , Infecciones por Chlamydia/microbiología , Estudios Transversales , Femenino , Estudios de Seguimiento , Gardnerella vaginalis/efectos de los fármacos , Gardnerella vaginalis/genética , Humanos , Lactobacillus/efectos de los fármacos , Lactobacillus/genética , Microbiota/genética , Estudios Prospectivos , ARN Ribosómico 16S , Resultado del Tratamiento , Vaginosis Bacteriana/microbiología , Adulto Joven
18.
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
19.
Am J Obstet Gynecol ; 222(2): 157.e1-157.e13, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31404542

RESUMEN

BACKGROUND: Metronidazole is the first-line treatment for bacterial vaginosis, but cure rates are suboptimal and recurrence rates high. OBJECTIVES: To evaluate the impact of a standard course of oral metronidazole treatment (500 mg twice per day for 7 days) on the vaginal microbiota of Rwandan bacterial vaginosis patients using microscopy and 16S rRNA gene sequencing, and to evaluate correlates of treatment failure. STUDY DESIGN: HIV-negative, nonpregnant women aged 18-45 years with bacterial vaginosis and/or Trichomonas vaginalis (N=68) were interviewed and sampled before and after metronidazole treatment. They were also screened, and treated if applicable, for other urogenital infections. The vaginal microbiota was assessed by Gram stain Nugent scoring, Illumina 16S rRNA HiSeq sequencing (relative abundances), and BactQuant 16S gene quantitative polymerase chain reaction (estimated concentrations). Only women with a pretreatment Nugent score of 7-10 and a valid posttreatment Nugent score (N=55) were included in metronidazole treatment failure analyses, with treatment failure defined as a posttreatment Nugent score of 4-10. RESULTS: The bacterial vaginosis cure rate by Nugent scoring was 54.5%. The mean total vaginal bacterial concentration declined from 6.59 to 5.85 log10/µL (P<.001), which was mostly due to a reduction in mean bacterial vaginosis-associated anaerobes concentration (all bacterial vaginosis-associated anaerobe taxa combined) from 6.23 to 4.55 log10/µL (P<.001). However, only 16.4% of women had a bacterial vaginosis anaerobes concentration reduction of more than 50%, and only 3 women had complete eradication. The mean concentration of lactobacilli (all species combined) increased from 4.98 to 5.56 log10/µL (P=.017), with L. iners being the most common species pre- and posttreatment. The mean concentration of pathobionts (defined as Proteobacteria, streptococci, staphylococci, enterococci, and a few others) did not change significantly: from 1.92 log10/µL pretreatment to 2.01 log10/µL posttreatment (P=.939). Pretreatment pathobionts concentration, and having a pretreatment vaginal microbiota type containing more than 50% Gardnerella vaginalis (compared with less than 50%), were associated with increased likelihood of treatment failure, but the latter did not reach statistical significance (P=.044 and P=.084, respectively). CONCLUSIONS: Metronidazole alone may not cure women with high G. vaginalis relative abundance, potentially due to biofilm presence, and women with high pathobionts concentration. These women may benefit from additional biofilm-disrupting and/or pathobiont-targeting treatments.


Asunto(s)
Antiinfecciosos/uso terapéutico , Metronidazol/uso terapéutico , Vaginitis por Trichomonas/tratamiento farmacológico , Vaginosis Bacteriana/tratamiento farmacológico , Adulto , Bacterias Anaerobias , Biopelículas , Enterococcus , Femenino , Gardnerella vaginalis , Humanos , Lactobacillus , Proteobacteria , ARN Ribosómico 16S/genética , Rwanda , Staphylococcus , Streptococcus , Insuficiencia del Tratamiento , Resultado del Tratamiento , Vaginitis por Trichomonas/complicaciones , Vaginitis por Trichomonas/microbiología , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/microbiología , Adulto Joven
20.
BJOG ; 127(2): 275-284, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-30932317

RESUMEN

OBJECTIVE: To determine the effects on the vaginal microbiota of an oral probiotic preparation administered from early pregnancy. DESIGN: Randomised, double blind, placebo-controlled trial. SETTING: Four maternity units in the UK. POPULATION: Women aged 16 years or older recruited at 9-14 weeks' gestation. METHODS: Participants were randomly allocated to receive oral capsules of probiotic containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 each at 2.5 × 109 colony-forming units (CFUs) or placebo once daily from recruitment until the end of pregnancy. MAIN OUTCOME MEASURE: Rates of bacterial vaginosis (BV, defined as Nugent score ≥7) at 18-20 weeks' gestation compared by logistic regression adjusted for possible confounders. RESULTS: The primary analysis included 78% (238/304) of participants who initially consented (probiotic group 123, placebo group 115). Of these participants, 95% (227/238) reported an intake of 93% or more of the required number of capsules. The rates of BV did not differ between groups at 18-20 weeks' gestation (15% (19/123) in the probiotic group vs. 9% (10/115) in the placebo group, adjusted odds ratio 1.82, 95% confidence interval 0.64-5.19). There were also no differences between the groups in the proportion of women colonised with the probiotic strains, Escherichia coli, group B streptococci or other vaginal microbiota. There were no differences in the alpha diversity or composition of the bacterial communities between or within the probiotic and placebo groups at 9-14 and 18-20 weeks' gestation. CONCLUSIONS: Oral probiotics taken from early pregnancy did not modify the vaginal microbiota. TWEETABLE ABSTRACT: The oral probiotic preparation used in this study does not prevent BV in pregnant women.


Asunto(s)
Microbiota/fisiología , Complicaciones Infecciosas del Embarazo/microbiología , Probióticos/uso terapéutico , Vagina/microbiología , Adulto , Método Doble Ciego , Femenino , Humanos , Lactobacillus reuteri/efectos de los fármacos , Lactobacillus rhamnosus/efectos de los fármacos , Embarazo , Primer Trimestre del Embarazo , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/tratamiento farmacológico , Vaginosis Bacteriana/microbiología , Adulto Joven
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