Vaginal States: Detection of Conversion Processes in Women Using Contraception and Characterization of Vaginal Lactobacillus Species.

BACKGROUND: The vaginal microenvironment, regulated by an immune system, can be protected or altered by many factors, including contraceptive methods. OBJECTIVE: The objective of this study is to evaluate the impact of contraceptive methods on the basic vaginal states (BVSs) and to identify culturable vaginal Lactobacillus species. METHODS: This is a prospective, consecutive, longitudinal, and descriptive study. The vaginal contents of 208 women were sampled prior to initiating contraception and six months later. The BVSs were established using the balance of vaginal content (BAVACO) methodology that evaluates microbiota and vaginal inflammatory reaction (VIR). Lactobacillus species were characterized by biochemical tests and mass spectrometry. The following contraceptive methods were evaluated: combined oral contraceptive pill (COCP), condom (CON) and rhythm method (RHYT). McNemar's test was used. RESULTS: Of the 208 women, 171 attended both examinations. In the COCP group (n=127), 83 vaginal contents maintained a normal microbiota, 1 sample became dysbiotic, and 37/43 dysbiotic microbiota samples reverted to normal (p<0.0001). A conversion to BVS with VIR was detected in the CON group (n=31) (p=0.001). The RHYT group (n=13) maintained its initial BVSs. The predominant Lactobacillus species found were L. crispatus and L. gasseri, with a trend toward a positive association between L. crispatus and COCP (OR=2.82; p=0.058). CONCLUSION: Hormone administration corrected the dysbiosis and preserved a normal BVS. The CON increased the VIR. The protection of the microbiota observed in the rhythm method probably responds to a systemic hormonal influence. The trend toward a positive association between COCP and L. crispatus, with its protective properties, evidenced an effective hormonal relationship.

Estudio multicéntrico de disfunción vaginal de la Red Nacional de Laboratorios BACOVA de la República Argentina: prevalencia, influencia de factores seleccionados, evaluación clínica y distribución de casos por región / Multicenter study on vaginal dysfunction of the National Network of BACOVA Laboratories in Argentina: prevalence, influence of selected factors, clinical evaluation and case distribution by region / Estudo multicêntrico de disfunção vaginal da Rede Nacional de Laboratórios BACOVA da República Argentina: prevalência, influência de fatores selecionados, avaliação clínica e distribuição dos casos por região

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Abstract The aims of this study were to update the prevalence of vaginal dysfunction (VD) in non-pregnant women of childbearing age, pregnant women and menopausal women, to analyse microbiological aspects, to evaluate the influence of parity and contraception in the vaginal microenvironment, to analyse case studies, and to compare the prevalence in the five regions of Argentina: Northeast, Northwest, Centre, Cuyo and South. Eight thousand three hundred twenty-four (8324) vaginal content samples of patients from 39 institutions, examined between May 2019 and June 2020, were prospectively and consecutively studied. The samples were analysed applying the standardized BAVACO-VIR methodology (study of the balance of vaginal content and genital inflammatory response). Of the 8324 samples, 5947 (71.5%) corresponded to women of childbearing age; 1627 (19.5%) to pregnant women and 750 (9.0%) to menopausal women. The most frequent basic vaginal state (BVS) in the three groups was BVS I with normal microbiota, accounting for 33.5% of the entire studied population. Moreover, 66.5% of vaginal dysfunction states were detected. In the pregnant women and menopausal women group there was a significant increase in the frequency of normal BVS I, in contrast with the group of women of childbearing age, where a significant increase of vaginosis and vaginitis was observed. In asymptomatic women, a predominance of BVS I was detected in the three groups. In symptomatic women, there was a predominance of BVS II and V in pregnant women, of BVS II, IV and V in women of childbearing age, and of BVS III and V in menopausal women. Asymptomatic VD was detected in 56.6% of pregnant women, 62.8% of women of childbearing age and 50.9% of menopausal women. A significantly positive association was detected between the presence of yeasts and BVS II and V and the presence of trichomonas and BVS V. The multiparity history variable showed a statistically significant positive association with BVS V and a negative association with BVS I. With regard to contraception, in women who used hormonal contraceptives it was observed that oral contraceptives increased the frequency of BVS I and II and decreased the frequency of BVS III, IV and V of VD; in those who used an intradermal device, there was a decrease in the frequency of BVS I, II and III and an increase in the frequency of BVS IV and V, whereas in women using injectable contraceptives, there was no association. The intrauterine device decreased the frequency of BVS I and II and increased the frequency of BVS V; the condom increased the frequency of BVS IV and the rhythm method decreased the frequency of BVS II. In BVS I, a decrease in the frequency of signs and symptoms was detected. The prevalence of VD in some regions accounted for values over 80%, a higher figure than that described at the national and international levels, which reflects the poor and insufficient action in Sexual and Reproductive Health. The high percentage of asymptomatic women with VD highlights the importance of studying the vaginal content, even in the absence of symptoms. A history of multiparity and contraception showed a link with vaginal function, reflecting the importance of considering this fact in a gynecological evaluation. Although the relationship of BVS with signs and symptoms does not constitute a diagnostic tool, it contributes to the understanding of pathogenic mechanisms.

Resumo Os objetivos deste estudo foram: atualizar a prevalência de disfunção vaginal (DV) em mulheres não grávidas em idade fértil (MEF), mulheres grávidas (EMB) e mulheres menopausadas (MPN), analisar aspectos microbiológicos, avaliar a influência da paridade e contracepção no microambiente vaginal, analisar quadros clínicos e comparar as prevalências das 5 regiões do nosso país: Nordeste, Noroeste, Centro, Cuyo e Sur. 8324 conteúdos vaginais de pacientes de 39 instituições, que compareceram entre maio de 2019 e junho de 2020, foram estudados prospectiva e facilitadoconsecutivamente. As amostras foram analisadas aplicando-se a metodologia padronizada BACOVA-ERIGE (estudo do equilíbrio do conteúdo vaginal e resposta inflamatória genital). Das 8324 amostras de conteúdo vaginal, 5947 (71,5%) corresponderam às MEF; 1627 (19,5%) às EMB e 750 (9,0%) às MNP. O estado vaginal básico (EVB) mais frequente nos três grupos foi EVB I de microbiota normal e representou 33,5% de toda a população global. Foram detectados 66,5% dos estados de disfunção vaginal. No grupo EMB e MNP, um aumento significativo na frequência de EVB I normal foi registrado, em contraste com o grupo MEF, onde foi reconhecido um aumento significativo de EVB de vaginose e vaginite. Em mulheres assintomáticas, foi detectado predomínio de EVB I nos três grupos. Em mulheres sintomáticas foi detetado: nas EMB, predomínio de EVB II e V; nas MEF, predominância de EVB II, IV e V, e nas MNP, predominância de EVB III e V. 56,6% das EMB, 62,8% das MEF e 50,9% das MNP apresentaram DV na ausência de sintomas. Foi detectada associação significativamente positiva entre a presença de leveduras e EVB II e V e a presença de tricomonas e EVB V. A variável antecedente de multiparidade apresentou associação positiva estatisticamente significativa com EVB V e associação negativa com EVB I. Em relação à contracepção, observou-se em mulheres que usavam anticoncepcionais hormonais, que os anticoncepcionais orais aumentaram a frequência de EVB I e II e diminuíram a frequência de EVB III, IV e V de DV; Em mulheres com dispositivo intradérmico, foi observada uma diminuição na frequência de EVB I, II e III e um aumento na frequência de EVB IV e V, e finalmente em mulheres com anticoncepcionais injetáveis, nenhuma associação foi demonstrada. O dispositivo intrauterino diminuiu a frequência de EVB I e II e aumentou a frequência de EVB V; o preservativo aumentou a frequência de EVB IV e o método do ritmo diminuiu a frequência de EVB II. Na EVB I, foi detectada diminuição da frequência de sinais e sintomas. A prevalência de DV em algumas regiões ultrapassou valores de 80%, valor superior ao descrito a nível nacional e internacional, o que reflete a atuação precária e insuficiente em Saúde Sexual e Reprodutiva. O alto percentual de mulheres assintomáticas com DV demonstra a importância da realização do estudo do conteúdo vaginal, mesmo na ausência de sintomas. A história de multiparidade e contracepção mostrou ligação com a função vaginal, refletindo a importância da sua consideração na avaliação ginecológica. Embora a relação da EVB com os sinais e sintomas não constitua uma ferramenta diagnóstica, ela contribui para o entendimento dos mecanismos patogênicos.

Contraception: Influence on Vaginal Microbiota and Identification of Vaginal Lactobacilli Using MALDI-TOF MS and 16S rDNA Sequencing.

BACKGROUND: The vaginal microbiome is influenced by a wide variety of factors, including contraceptive methods. AIM: To evaluate the effect of contraceptive methods on vaginal microbiota and to compare MALDI-TOF MS and 16S rDNA sequencing for lactobacilli identification. PATIENTS AND METHODS: One hundred and one (101) women consulting for birth control were included in a prospective study. Their vaginal content was sampled and analyzed once before they started using the contraceptive method of their choice, and twice after the initiation of contraception, at three months (94/101 women attended) and at six months (89/101 women attended). The relative frequencies of yeasts and trichomonas were analyzed. MALDI-TOF MS and 16S rDNA sequence analysis were applied for the identification of lactobacilli in their vaginal microbiota. The following contraceptive methods were assessed: Combined Oral Contraceptive Pill (COCP), Condom (CON) and The Rhythm Method (RHYT). McNemar's statistical test was applied. RESULTS: A statistically significant association between COCP and normal microbiota was observed after three months (p< 0.01) and after six months (p< 0.0001), when the vaginal microbiota was modified. At six months, inflammatory reaction was detected in 3/7 women in the CON group, while 6/7 patients using RHYT showed the same state. Yeast colonization increased with the COCP. Identification of lactobacilli by MALDI-TOF MS analysis compared to 16S rDNA sequencing yielded 92.9% concordant results. Lactobacillus gasseri and L. crispatus were the predominant species. CONCLUSION: The pattern of vaginal states was significantly modified. Hormone administration apparently corrected the alterations and retained a normal vaginal state. MALDI-TOF MS has the potential of being an accurate tool for the identification of vaginal lactobacilli species L. murinus was for the first time isolated from the vagina.

Portación nasal de Staphylococcus aureus en individuos de la comunidad: factores epidemiológicos / Nasal carriage of Staphylococcus aureus in community individuals: epidemiological factors / Carreamento nasal de Staphylococcus aureus em indivíduos da comunidade: fatores epidemiológicos

La portación nasal de Staphylococcus aureus (SAU) en individuos sanos confirma su diseminación, constituye una fuente potencial de infección y se la relaciona con patologías atópicas. El objetivo del trabajo fue determinar la prevalencia de colonización nasal de SAU en individuos de la comunidad, sus respectivos patrones de resistencia antimicrobiana (PRA) y su asociación con factores epidemiológicos. Se realizó un estudio en 150 hisopados nasales. Se identificaron los aislados de SAU por métodos convencionales, y se evaluó su sensibilidad antimicrobiana por el método de difusión con discos de Kirby-Bauer y en cepas de Staphylococcus aureus resistentes a meticilina (SAMR) se confirmó la presencia del gen mec A y se investigó el gen lpv codificante de la toxina de Panton y Valentine (LPV) por PCR. Se analizó su asociación con factores epidemiológicos (lesiones, rinitis, etc.) con el programa SPSS. Se obtuvieron 119 aislamientos de SAU (79%) con 12 PRA. Las PCR de las cepas SAMR fueron positivas para el gen mec A y negativas para el gen lpv. Estadísticamente se detectó asociación de colonización nasal con sexo masculino y rinitis. Se concluye que la prevalencia de portación nasal de SAU en la comunidad fue elevada y mayor en varones. Los aislamientos multirresistentes y SAMR- LPV (-) sugieren relación hospitalaria y su diseminación a la comunidad. Es importante el hallazgo de la asociación epidemiológica con rinitis, la cual confirma vinculación con patologías atópicas.

Nasal carriage of Staphylococcus aureus (SAU) in healthy individuals confirms its spreading, constitutes a potential infection source and is related to atopic pathologies. The objetive was to determine the prevalence of SAU nasal carriage in community individuals, its antimicrobial resistance patterns (ARP) and its association with epidemiological factors. A total of 150 nasal swabs were studied, where SAU isolates were identified by conventional methods and their antimicrobial sensitivity was evaluated by disk diffusion Kirby Bauer test. In addition, the presence of mec A gene was confirmed and the lpv gene coding for Panton-Valentine toxin (PVL) was investigated by PCR in methicillin resistant Staphylococcus aureus (MRSA) strains. Its association with epidemiological factors (injuries, rhinitis, etc) was analyzed with SPSS program. One hundred and nineteen (79%) SAU isolates with 12 ARP were obtained. PCR assays of MRSA strains were positive for the mec A gene and negative for the lpv gene. Association between nasal colonization and both male sex and rhinitis was detected statistically. It can be concluded that high prevalence of SAU nasal carriage was found in the community, mainly in males. Multiresistant isolates and lpv (-) MRSA suggest a hospital-acquired infection with subsequent dissemination to the community. The epidemiological association with rhinitis, which confirms the link with atopic pathologies, deserves to be highlighted.

O carreamento nasal de Staphylococcus aureus (SAU) em individuos saudáveis confirma sua disseminagao, constitui uma fonte potencial de infecgao e é relacionada com patologias atópicas. O objetivo do trabalho foi determinar a prevalencia de colonizagao nasal de SAU em individuos da comunidade, seus respectivos padróes de resistencia antimicrobiana (PRA) e sua associagao com fatores epidemiológicos. Foi realizado um estudo em 150 esfregagos nasais. Identificaramse os isolados de SA U por métodos convencionais, e foi avaliada sua sensibilidade antimicrobiana pelo método de difusao com discos de Kirby-Bauer e em cepas de Staphylococcus aureus resistentes a meticilina (SAMR) foi confirmada a presenga do gene mec A e se investigou o gene lpv codificante da toxina de Panton - Valentine (LPV) por PCR. Foi analisada sua associagao com fatores epidemiológicos (lesóes, rinite, etc.) com o programa SPSS. Obtiveramse 119 isolamentos de SAU (79%) com 12 PRA. As PCR das cepas SAMR foram positivas para o gene mec A e negativas para o gene lpv. Estatisticamente se detectou associagao de colonizagao nasal com sexo masculino e rinite. Concluise que a prevalencia de carreamento nasal de SAU na comunidade foi elevada e maior em homens. Os isolamentos multirresistentes e SAMR- LPV (-) sugerem relagao hospitalar e sua disseminagao para a comunidade. É importante o achado da associagao epidemiológica com rinite, a qual confirma vinculagao com patologias atópicas.

Portación nasal de Staphylococcus aureus en individuos de la comunidad: factores epidemiológicos / Nasal carriage of Staphylococcus aureus in community individuals: epidemiological factors / Carreamento nasal de Staphylococcus aureus em indivíduos da comunidade: fatores epidemiológicos

La portación nasal de Staphylococcus aureus (SAU) en individuos sanos confirma su diseminación, constituye una fuente potencial de infección y se la relaciona con patologías atópicas. El objetivo del trabajo fue determinar la prevalencia de colonización nasal de SAU en individuos de la comunidad, sus respectivos patrones de resistencia antimicrobiana (PRA) y su asociación con factores epidemiológicos. Se realizó un estudio en 150 hisopados nasales. Se identificaron los aislados de SAU por métodos convencionales, y se evaluó su sensibilidad antimicrobiana por el método de difusión con discos de Kirby-Bauer y en cepas de Staphylococcus aureus resistentes a meticilina (SAMR) se confirmó la presencia del gen mec A y se investigó el gen lpv codificante de la toxina de Panton y Valentine (LPV) por PCR. Se analizó su asociación con factores epidemiológicos (lesiones, rinitis, etc.) con el programa SPSS. Se obtuvieron 119 aislamientos de SAU (79%) con 12 PRA. Las PCR de las cepas SAMR fueron positivas para el gen mec A y negativas para el gen lpv. Estadísticamente se detectó asociación de colonización nasal con sexo masculino y rinitis. Se concluye que la prevalencia de portación nasal de SAU en la comunidad fue elevada y mayor en varones. Los aislamientos multirresistentes y SAMR- LPV (-) sugieren relación hospitalaria y su diseminación a la comunidad. Es importante el hallazgo de la asociación epidemiológica con rinitis, la cual confirma vinculación con patologías atópicas.(AU)

Nasal carriage of Staphylococcus aureus (SAU) in healthy individuals confirms its spreading, constitutes a potential infection source and is related to atopic pathologies. The objetive was to determine the prevalence of SAU nasal carriage in community individuals, its antimicrobial resistance patterns (ARP) and its association with epidemiological factors. A total of 150 nasal swabs were studied, where SAU isolates were identified by conventional methods and their antimicrobial sensitivity was evaluated by disk diffusion Kirby Bauer test. In addition, the presence of mec A gene was confirmed and the lpv gene coding for Panton-Valentine toxin (PVL) was investigated by PCR in methicillin resistant Staphylococcus aureus (MRSA) strains. Its association with epidemiological factors (injuries, rhinitis, etc) was analyzed with SPSS program. One hundred and nineteen (79%) SAU isolates with 12 ARP were obtained. PCR assays of MRSA strains were positive for the mec A gene and negative for the lpv gene. Association between nasal colonization and both male sex and rhinitis was detected statistically. It can be concluded that high prevalence of SAU nasal carriage was found in the community, mainly in males. Multiresistant isolates and lpv (-) MRSA suggest a hospital-acquired infection with subsequent dissemination to the community. The epidemiological association with rhinitis, which confirms the link with atopic pathologies, deserves to be highlighted.(AU)

O carreamento nasal de Staphylococcus aureus (SAU) em individuos saudáveis confirma sua disseminagao, constitui uma fonte potencial de infecgao e é relacionada com patologias atópicas. O objetivo do trabalho foi determinar a prevalencia de colonizagao nasal de SAU em individuos da comunidade, seus respectivos padróes de resistencia antimicrobiana (PRA) e sua associagao com fatores epidemiológicos. Foi realizado um estudo em 150 esfregagos nasais. Identificaramse os isolados de SA U por métodos convencionais, e foi avaliada sua sensibilidade antimicrobiana pelo método de difusao com discos de Kirby-Bauer e em cepas de Staphylococcus aureus resistentes a meticilina (SAMR) foi confirmada a presenga do gene mec A e se investigou o gene lpv codificante da toxina de Panton - Valentine (LPV) por PCR. Foi analisada sua associagao com fatores epidemiológicos (lesóes, rinite, etc.) com o programa SPSS. Obtiveramse 119 isolamentos de SAU (79%) com 12 PRA. As PCR das cepas SAMR foram positivas para o gene mec A e negativas para o gene lpv. Estatisticamente se detectou associagao de colonizagao nasal com sexo masculino e rinite. Concluise que a prevalencia de carreamento nasal de SAU na comunidade foi elevada e maior em homens. Os isolamentos multirresistentes e SAMR- LPV (-) sugerem relagao hospitalar e sua disseminagao para a comunidade. E importante o achado da associagao epidemiológica com rinite, a qual confirma vinculagao com patologias atópicas.(AU)

Portación nasal de Staphylococcus aureus en individuos de la comunidad: factores epidemiológicos / Nasal carriage of Staphylococcus aureus in community individuals: epidemiological factors / Carreamento nasal de Staphylococcus aureus em indivíduos da comunidade: fatores epidemiológicos

La portación nasal de Staphylococcus aureus (SAU) en individuos sanos confirma su diseminación, constituye una fuente potencial de infección y se la relaciona con patologías atópicas. El objetivo del trabajo fue determinar la prevalencia de colonización nasal de SAU en individuos de la comunidad, sus respectivos patrones de resistencia antimicrobiana (PRA) y su asociación con factores epidemiológicos. Se realizó un estudio en 150 hisopados nasales. Se identificaron los aislados de SAU por métodos convencionales, y se evaluó su sensibilidad antimicrobiana por el método de difusión con discos de Kirby-Bauer y en cepas de Staphylococcus aureus resistentes a meticilina (SAMR) se confirmó la presencia del gen mec A y se investigó el gen lpv codificante de la toxina de Panton y Valentine (LPV) por PCR. Se analizó su asociación con factores epidemiológicos (lesiones, rinitis, etc.) con el programa SPSS. Se obtuvieron 119 aislamientos de SAU (79%) con 12 PRA. Las PCR de las cepas SAMR fueron positivas para el gen mec A y negativas para el gen lpv. Estadísticamente se detectó asociación de colonización nasal con sexo masculino y rinitis. Se concluye que la prevalencia de portación nasal de SAU en la comunidad fue elevada y mayor en varones. Los aislamientos multirresistentes y SAMR- LPV (-) sugieren relación hospitalaria y su diseminación a la comunidad. Es importante el hallazgo de la asociación epidemiológica con rinitis, la cual confirma vinculación con patologías atópicas.(AU)

Nasal carriage of Staphylococcus aureus (SAU) in healthy individuals confirms its spreading, constitutes a potential infection source and is related to atopic pathologies. The objetive was to determine the prevalence of SAU nasal carriage in community individuals, its antimicrobial resistance patterns (ARP) and its association with epidemiological factors. A total of 150 nasal swabs were studied, where SAU isolates were identified by conventional methods and their antimicrobial sensitivity was evaluated by disk diffusion Kirby Bauer test. In addition, the presence of mec A gene was confirmed and the lpv gene coding for Panton-Valentine toxin (PVL) was investigated by PCR in methicillin resistant Staphylococcus aureus (MRSA) strains. Its association with epidemiological factors (injuries, rhinitis, etc) was analyzed with SPSS program. One hundred and nineteen (79%) SAU isolates with 12 ARP were obtained. PCR assays of MRSA strains were positive for the mec A gene and negative for the lpv gene. Association between nasal colonization and both male sex and rhinitis was detected statistically. It can be concluded that high prevalence of SAU nasal carriage was found in the community, mainly in males. Multiresistant isolates and lpv (-) MRSA suggest a hospital-acquired infection with subsequent dissemination to the community. The epidemiological association with rhinitis, which confirms the link with atopic pathologies, deserves to be highlighted.(AU)

O carreamento nasal de Staphylococcus aureus (SAU) em individuos saudáveis confirma sua disseminagao, constitui uma fonte potencial de infecgao e é relacionada com patologias atópicas. O objetivo do trabalho foi determinar a prevalencia de colonizagao nasal de SAU em individuos da comunidade, seus respectivos padróes de resistencia antimicrobiana (PRA) e sua associagao com fatores epidemiológicos. Foi realizado um estudo em 150 esfregagos nasais. Identificaramse os isolados de SA U por métodos convencionais, e foi avaliada sua sensibilidade antimicrobiana pelo método de difusao com discos de Kirby-Bauer e em cepas de Staphylococcus aureus resistentes a meticilina (SAMR) foi confirmada a presenga do gene mec A e se investigou o gene lpv codificante da toxina de Panton - Valentine (LPV) por PCR. Foi analisada sua associagao com fatores epidemiológicos (lesóes, rinite, etc.) com o programa SPSS. Obtiveramse 119 isolamentos de SAU (79%) com 12 PRA. As PCR das cepas SAMR foram positivas para o gene mec A e negativas para o gene lpv. Estatisticamente se detectou associagao de colonizagao nasal com sexo masculino e rinite. Concluise que a prevalencia de carreamento nasal de SAU na comunidade foi elevada e maior em homens. Os isolamentos multirresistentes e SAMR- LPV (-) sugerem relagao hospitalar e sua disseminagao para a comunidade. E importante o achado da associagao epidemiológica com rinite, a qual confirma vinculagao com patologias atópicas.(AU)