Microbiome and Vulvovaginitis.

Vulvovaginitis occurs in mostly reproductive aged women. Recurrent vaginitis affects overall quality of life, with a large financial burden on the patient, family, and health system. This review discusses a clinician's approach to vulvovaginitis with specific attention to the 2021 updated Center for Disease Control and Prevention guidelines. The authors discuss the role of the microbiome in vaginitis and evidence-based approaches for diagnosis and treatment of vaginitis. This review also provides updates on new considerations, diagnosis, management, and treatment of vaginitis. Desquamative inflammatory vaginitis and genitourinary syndrome of menopause are discussed as differential diagnosis of vaginitis symptoms.

Diagnostic Testing of Vaginitis: Improving the Value of Care.

Vaginitis is one of the most common reasons women access health care in the United States. Despite its prevalence and disruptive impact, it is frequently misdiagnosed and untreated, resulting in unnecessary patient discomfort, follow-up visits, and health care costs. This study presents a costs analysis of diagnostic testing technologies to demonstrate the potential of molecular tests to improve the value of care for women with vaginitis. This study tracks health care spending among women diagnosed with vaginitis and finds that nucleic acid amplification tests (NAATs) are cost-effective for the diagnosis of vaginal symptoms. Women who receive a NAAT on the day of their diagnosis have significantly lower 12-month follow-up costs compared to women who receive a direct probe test or those women who are clinically evaluated without the use of a molecular test. However, despite Food and Drug Administration approval, widely available molecular diagnostics have not been incorporated into clinical guidelines, and many payer policies fail to cover these tests. Greater utilization of NAAT for the diagnosis of vaginitis has the potential to improve the care of women seeking treatment for this prevalent condition and facilitate sexually transmitted infection testing without additional visits.

Novel Potential Probiotic Lactobacilli for Prevention and Treatment of Vulvovaginal Infections.

Lactobacilli in the vaginal tract are essential to protect against microbial infections. We therefore focused on isolating vaginal lactobacilli from pregnant women and testing their functional properties. Lactobacilli were isolated from 50 vaginal swabs and the purified isolates were identified by MALDI-TOF MS. Functional properties (antimicrobial activity, organic acids and hydrogen peroxide production, antibiotic susceptibility, auto-aggregation, and hydrophobicity) of selected isolates were tested. Lactobacilli (41 strains) were identified in 58% of swabs with a predominance of Lactobacillus crispatus (48%) followed by L. jensenii (21%), L. rhamnosus (14%), L. fermentum (10%), and L. gasseri (7%). The highest antibacterial activity was determined for L. fermentum and L. rhamnosus. Strong anti-Candida activity was observed for strains L. crispatus, L. fermentum, and L. rhamnosus. Strain L. jensenii 58C possessed the highest production of hydrogen peroxide (6.32 ± 0.60 mg/l). The best lactic acid producer was strain L. rhamnosus 72A (11.6 ± 0.2 g/l). All strains were resistant to fluconazole and metronidazole. The highest auto-aggregation was observed for strain L. crispatus 51A (98.8 ± 0.1% after 24 h). Strain L. rhamnosus 68A showed the highest hydrophobicity (69.1 ± 1.4%). Strains L. fermentum and L. rhamnosus showed high antibacterial activity and hydrophobicity, and strains L. crispatus possessed high auto-aggregation and anti-Candida activity. Thus, these strains alone or in a mix could be used for the preparation of probiotic products for treatment and prevention of vulvovaginal infections of pregnant and non-pregnant women.

Illnesses Encountered During Medical Volunteering in Takeo Province, Cambodia.

Background and Objectives: Medical volunteering seeks to meet the clinical needs of underserved areas, but has been criticized for difficulties in addressing local health issues and resultant lack of sustainability. Our team has visited rural Cambodia annually since 2012. This study reports the illnesses encountered during the recent mission and share our experiences to improve the efficiency of medical volunteering. Materials and Methods: Infrastructure, such as public electricity or water, was unavailable, hence most medical care and records were hand-performed. We categorized (1) primary diagnoses (chief complaints) by duration of symptoms, and (2) primary and secondary diagnoses (illnesses that were not related to the chief complaint) by severity of illness since patients commonly reported multiple symptoms. Blood pressure and anthropometric values were also checked and analyzed. Results: We encountered 317 adult and 141 pediatric patients. Among adults, 61.3% had persistent chronic (>6 month) symptoms of their chief complaints. The commonest diagnoses of chronic symptoms were musculoarthritis (31.5%) and gastroesophageal reflux disease and/or gastritis (21.7%). Hypertension and/or cardiac problems were relatively common among males (13.6%). The most common diagnosis among the severest cases (specialized or intensive care recommended) was cardiac problems (14.8%), often with abnormalities in sonography or electrocardiogram. For children, the overwhelming majority of diagnoses were related to acute symptoms and low severity, and approximately half were cases of the common cold. Commonly prescribed drugs were antacids or mucosal protectors (31.3%), Non-steroidal anti-inflammatory drugs (NSAIDs) or other painkillers (27.6%), and antiparasites (17.7%) in adults, and NSAIDs (44.7%) and antiparasites (23.2%) in children. Among adults, 32.7% were diagnosed with hypertension, and body mass index (p = 0.003) and age (p < 0.001) were both correlated with hypertension and its grade. Conclusion: Our study offers practical help to volunteer health workers planning to visit Southeast Asia.

Noncandidal vaginitis: a comprehensive approach to diagnosis and management.

Vaginitis is one of the most common causes of patient visits to gynecologists, primary care providers, and urgent care centers. However, many women leave without a clear diagnosis or experience recurrent symptoms despite treatment. The 3 most common etiologies of vaginitis are trichomonas, bacterial vaginosis, and vulvovaginal candidiasis, which account for an estimated 70% of cases. The remaining 30% may be related to other causes of vaginitis, including atrophic vaginitis, desquamative inflammatory vaginitis, and vaginal erosive disease. The purpose of this review is to describe the noncandidal causes of acute and recurrent vaginitis, with the goal of improving the likelihood of accurate diagnosis as well as efficient and effective therapy. We excluded candidal vaginitis from our review because there was a recently published review on this topic in the Journal. The clinical presentation and evaluation of patients with symptoms of vaginitis can be triaged into 1 of 2 diagnostic pathways: noninflammatory and inflammatory vaginitis. The most common noninflammatory cause is bacterial vaginosis. Features such as irritation, purulent discharge, and the presence of polymorphonuclear neutrophils are more suggestive of an inflammatory process. Trichomoniasis is the most common cause of inflammatory vaginitis. Other well-described forms of inflammatory vaginitis include atrophic vaginitis, desquamative inflammatory vaginitis, and erosive disease. We present a review of the pathogenesis, symptoms, examination findings, diagnostic testing, and treatment for each of these causes of noncandidal vaginitis.

Vaginitis in Nonpregnant Patients: ACOG Practice Bulletin Summary, Number 215.

Vaginitis is defined as inflammation or infection of the vagina and is associated with a spectrum of symptoms, including vulvovaginal itching, burning, irritation, dyspareunia, "fishy" vaginal odor, and abnormal vaginal discharge. Vaginal symptoms are some of the most frequent reasons for patient visits to obstetrician-gynecologists (1) and may have important consequences in terms of discomfort and pain, days lost from school or work, sexual functioning, and self-image (2). Distinguishing vaginal from vulvar symptoms is important to direct evaluation and treatment. The purpose of this document is to provide updated evidence-based guidance for the diagnosis and treatment of the common causes of vaginitis in nonpregnant patients. Information on the treatment of vaginitis in patients with human immunodeficiency virus (HIV) is covered elsewhere (3). Guidelines are subject to change. For the most up-to-date information on vaginitis diagnosis and treatment, see the Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases webpage, which is available at https://www.cdc.gov/std/.

Vaginitis in Nonpregnant Patients: ACOG Practice Bulletin, Number 215.

Vaginitis is defined as inflammation or infection of the vagina and is associated with a spectrum of symptoms, including vulvovaginal itching, burning, irritation, dyspareunia, "fishy" vaginal odor, and abnormal vaginal discharge. Vaginal symptoms are some of the most frequent reasons for patient visits to obstetrician-gynecologists () and may have important consequences in terms of discomfort and pain, days lost from school or work, sexual functioning, and self-image (). Distinguishing vaginal from vulvar symptoms is important to direct evaluation and treatment. The purpose of this document is to provide updated evidence-based guidance for the diagnosis and treatment of the common causes of vaginitis in nonpregnant patients. Information on the treatment of vaginitis in patients with human immunodeficiency virus (HIV) is covered elsewhere (). Guidelines are subject to change. For the most up-to-date information on vaginitis diagnosis and treatment, see the Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases webpage, which is available at https://www.cdc.gov/std/.

Use of probiotics in medical devices applied to some common pathologies.

Probiotics, defined as "living microorganisms that, whether ingested in useful amount, may have beneficial effects on human body", are widely used in various products for human use, such as dietary supplements, medical devices and pharmaceutical products. The European Directive on medical devices (MDs) (DDM 93/42), also includes those MDs containing live microorganisms, particularly probiotics, that may have various destinations of use, including that of assisting the therapy of several human pathologies. In this brief note we analyzed the use of probiotics in MDs and how probiotics administration could represent one of the new frontiers of scientific research on the prevention and treatment of various diseases. We'll analyze the literature on probiotics based MDs, to review their major targets in the therapy of some of the most common human pathologies: bacterial vaginosis and vaginitis, atopic dermatitis, infantile colic, obesity, type 2 diabetes, and pharyngotonsillitis.

A mobile video intervention for women's health of North Korean defectors.

BACKGROUND: The prevalence of North Korean female defectors is increasing in South Korea. Women who leave North Korea are exposed to sexual harassments, abuse, and other threats to their survival, which can have a devastating effect on their health. AIMS: In this study, a mobile video intervention program about selected aspects of women`s health was developed specifically for North Korean female defectors; its impact on behavioral change was evaluated. METHODS: A one group pre/posttest design was used with 61 female defectors who participated in the mobile video intervention. The program consisted of eight sessions focusing on the prevention and management of vaginitis and cervical cancer. RESULTS: The study results showed that knowledge and behavioral confidence on vaginitis and cervical cancer increased significantly among the participants following the intervention. CONCLUSIONS: This mobile video intervention program was effective in improving specific health knowledge and behavioral confidence of the participants. The program can be used to improve women`s health in this population.

Efficacy and safety of combined high-dose interferon and red light therapy for the treatment of human papillomavirus and associated vaginitis and cervicitis: A prospective and randomized clinical study.

BACKGROUND: We evaluated the efficacy and safety of combined high-dose interferon (IFN) and red light therapy for the treatment of subclinical and latent human papillomavirus (HPV) infections. METHODS: Ninety women diagnosed with subclinical or latent HPV infection were randomized to receive topical application of low-dose recombinant IFNα-2b (1 million IU), high-dose IFNα-2b (9 million IU), or a combination of high-dose IFNα-2b and red light therapy on the cervix and vagina. All patients received treatment once daily for 4 weeks. HPV titer was measured immediately and 4, 8, and 12 weeks after treatment to determine the rates of viral clearance and infection cure. Treatment of HPV-associated vaginitis and cervicitis was also evaluated. RESULTS: Results showed that immediately and 4, 8, and 12 weeks after treatment, the HPV clearance rates and infection cure rates were higher in the high-dose IFN and combination groups compared to the low-dose IFN group. High-dose IFN and combination therapies were significantly effective against both low-risk and high-risk HPV infections. Although the cure rates for vaginitis and cervicitis were significantly higher in the high- compared to the low-dose IFN group, rates were even higher in the combination group compared to the high-dose IFN group. Mild adverse effects were reported by a very small subset of patients (3/30) in the combination group. CONCLUSIONS: This study suggests that combination of high-dose IFN and red light therapy is safe and effective against subclinical and latent HPV infections.

Infections During Pregnancy.

Several infections have unique consequences or considerations in pregnancy. Some common infections such as urinary tract infections, influenza, sexually transmitted diseases, and vaginitis affect pregnant women differently than the general population, can cause pregnancy complications, and require treatments that are safe in pregnancy. Infections such as hepatitis B and C and human immunodeficiency virus can be transmitted vertically and therefore management focuses on decreasing perinatal transmission. Certain infections can be transmitted in utero and cause congenital infections. Classically, these were grouped together as the TORCH infections, although now several others, including varicella virus, parvovirus, and Zika virus, have also been recognized.

Vaginitis: Diagnosis and Treatment.

Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge, odor, irritation, itching, or burning. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Bacterial vaginosis is implicated in 40% to 50% of cases when a cause is identified, with vulvovaginal candidiasis accounting for 20% to 25% and trichomoniasis for 15% to 20% of cases. Noninfectious causes, including atrophic, irritant, allergic, and inflammatory vaginitis, are less common and account for 5% to 10% of vaginitis cases. Diagnosis is made using a combination of symptoms, physical examination findings, and office-based or laboratory testing. Bacterial vaginosis is traditionally diagnosed with Amsel criteria, although Gram stain is the diagnostic standard. Newer laboratory tests that detect Gardnerella vaginalis DNA or vaginal fluid sialidase activity have similar sensitivity and specificity to Gram stain. Bacterial vaginosis is treated with oral metronidazole, intravaginal metronidazole, or intravaginal clindamycin. The diagnosis of vulvovaginal candidiasis is made using a combination of clinical signs and symptoms with potassium hydroxide microscopy; DNA probe testing is also available. Culture can be helpful for the diagnosis of complicated vulvovaginal candidiasis by identifying nonalbicans strains of Candida. Treatment of vulvovaginal candidiasis involves oral fluconazole or topical azoles, although only topical azoles are recommended during pregnancy. The Centers for Disease Control and Prevention recommends nucleic acid amplification testing for the diagnosis of trichomoniasis in symptomatic or high-risk women. Trichomoniasis is treated with oral metronidazole or tinidazole, and patients' sex partners should be treated as well. Treatment of noninfectious vaginitis should be directed at the underlying cause. Atrophic vaginitis is treated with hormonal and nonhormonal therapies. Inflammatory vaginitis may improve with topical clindamycin as well as steroid application.

Disorders of vulva and vagina in children and adolescent.

Disorders of vulva and vagina are the most common problem in childhood in gynecological practice. As child is not the little adult, as young girl is not little woman. Childhood is characterized by changing hormone levels, which influenced hormone-dependent tissues. Etiology and diagnostics of this most common diseases are very often different of the same problem in adult woman. The most common diseases in childhood is synechia vulvae, inflammation of vulva and vagina called vulvovaginitis and skin disorders. It is very important to know everything about diagnostics and treatment to help young girls. Key words: vulvovaginitis, lichen sclerosus, synechia vulvae, child rest period, sexual development period, yeast infection.

Effects of Bone Marrow Multipotent Mesenchymal Stromal Cells and Their Secretion Products on the Cellular Composition of the Thymus and Spleen of Female Wistar Rats with Experimental Chronic Inflammation of the Internal Genitals.

The effects of bone marrow multipotent mesenchymal stromal cells and their secretion products on the subpopulation composition of thymic and splenic lymphocytes were studied in female Wistar rats with experimental chronic inflammatory process in the internal genitals. Stromal cells and medium conditioned by these cells in different administration routes (intravenous or lymphotropic injection) produces different modulating effect on blood leukocyte count and on subpopulation composition of the splenic and thymic lymphocytes. The most manifest anti-inflammatory effect was observed after lymphotropic injection of multipotent mesenchymal stromal cells creating a high concentration and long persistence of the factors produced by these cells in the focus of inflammation.

Vaginitis: Beyond the Basics.

Vaginal complaints are one of the most common reasons women seek the advice of a health care provider. Uncomplicated infections such as vulvovaginal candidiasis, bacterial vaginosis, or trichomoniasis are easy to diagnose and treat. However, about 8% of patients will have a more complicated course with failure to respond to treatment or rapid recurrence of symptoms. Understanding the need for a methodical, diagnostic approach to help these women with recurrent or refractory cases of vaginal symptoms will aid the clinician achieve successful patient outcomes.

Estudio PROBIT sobre la utilización de probióticos orales en las infecciones vaginales / PROBIT Study about the use of oral probiotics in vaginal infections

Introducción: las infecciones vulvovaginales afectan al 75 % de las mujeres a lo largo de su vida, siendo un motivo recurrente en las consultas de ginecología y observándose generalmente un desequilibrio de la microbiota normal. Por ello, la administración de probióticos y prebióticos orales que contribuyan a la regeneración de la microbiota, parece aumentar la efectividad del tratamiento farmacológico y disminuir la tasa de recidivas. Objetivos: conocer la situación clínica actual de las infecciones vaginales y la utilización de un complemento alimenticio a base de lactobacilos (Lactobacillus crispatus LBV88, Lactobacillus rhamnosus LBV96, Lactobacillus jensenii LBV116 y Lactobacillus gasseri LBV150) y fructooligosacáridos, para el tratamiento coadyuvante de estas infecciones. Métodos: se trata de un estudio observacional de carácter retrospectivo, desarrollado en un periodo de dos años en el que participaron 186 ginecólogos, obteniendo un tamaño de muestra de n=649 casos clínicos (mujeres). Los datos se obtuvieron mediante cuestionarios validados por profesionales y los resultados fueron analizados mediante el programa informático IBM SPSS Statistic 22.0. Resultados: la mayoría de los ginecólogos (57,4 %) reciben más de 20 consultas al mes por infecciones vaginales, con una alta incidencia de recidivas (25-50 % de los casos según el 59,1 % de los expertos). La vía de elección para la administración de probióticos y prebióticos es la oral, con una media (D.T) de 6,4 (2,5) mujeres de cada 10. En los casos en los que se indicó el complemento alimenticio por vía oral, en el 41% fue como coadyuvante en el tratamiento de candidiasis, en el 19,6% como coadyuvante para el tratamiento de vaginosis, el 33,3% de los casos para la prevención de infecciones vaginales de repetición y en un 38,4% para la recuperación y mantenimiento del equilibrio de la microbiota tras procesos infecciosos, combinando la posología indicada por el fabricante y la recomendación personalizada en función de la experiencia de los ginecólogos. En cuanto a la satisfacción de las pacientes, > 90 % de las mujeres afirma que la mejoría al utilizar el complemento alimenticio es alta. Entre las características más valoradas por los ginecólogos, destaca la eficiencia con una media de 9,2 puntos, la tolerabilidad (8,8 puntos), la experiencia previa (8,5 puntos), y el perfil de probióticos utilizados (8,1 puntos). Discusión: los resultados del estudio coinciden con los datos de las sociedades científicas en cuanto a incidencia de infecciones vaginales, perfil del paciente y aparición de recidivas. Además, se refuerza la evidencia de la eficacia de los complementos alimenticios con probióticos y prebióticos como coadyuvantes para el tratamiento de estas infecciones. Aparece la vía oral como preferente para la administración de probióticos y prebióticos y se respeta la posología indicada por el fabricante del complemento en la mayoría de los casos, predominando la preferencia personal y profesional de cada ginecólogo en aquellas ocasiones en los que se indica una pauta diferente. Conclusiones: la administración por vía oral de complementos alimenticios a base de probióticos y prebióticos como coadyuvante del tratamiento de las infecciones vaginales, se muestra como una estrategia eficaz para mejorar la resolución del proceso infeccioso y prevenir la aparición de recidivas mediante la recuperación del equilibrio de la microbiota normal

Introduction: vulvovaginal infections affect 75 % of women throughout their life, being a recurrent issue in the gynecological practices and generally observing an imbalance of the normal microbiota. Thus, the administration of oral probiotics and prebiotics that contribute to regenerate the microbiota, seems to increase the effectiveness of the pharmacological treatment and decrease the recurrence rate. Objectives: knowing the current clinic situation of vaginal infections and the use of a food supplement based on lactobacilli (Lactobacillus crispatus LBV88, Lactobacillus rhamnosus LBV96, Lactobacillus jensenii LBV116 y Lactobacillus gasseri LBV150) and Fructooligosaccharides, for the adjuvant treatment of these infections. Methods: this is a retrospective observational study, developed in a two years period in which 186 gynecologists participated, obtaining a sample size of n=649 clinical cases (women). Data were collected by questionnaires validated by professionals and results were analysed by the IBM SPSS Statistic 22.0 software. Results: most gynecologists (57,4 %) received more than 20 consultations per month due to vaginal infections, with a high recurrence rate (25-50 % of the cases according to 59,1 % of specialists). The route of choice for the administration of probiotics and prebiotics is oral, with a mean (SD) of 6,4 (2,5) women out of every 10. In the cases in which oral administration was indicated for the food supplement, 41 % was as adjuvant in the treatment of candidiasis, 19,6 % as adjuvant for vaginosis treatment, 33,3 % of cases for the prevention of recurrent vaginal infections and 38,4 % for the recovery and maintenance of the microbiota balance after infectious processes, combining the dosage indicated by the manufacturer and personalized recommendations based on the experience of gynecologists. As for patient’s satisfaction, > 90 % of women confirm that the improvement when using the food complement is high. Among the characteristics most valued by gynecologists, it is highlighted efficiency with a mean of 9,2 points, tolerability (8,8 points), previous experience (8,5 points), and the probiotic profile used (8,1). Discussion: The results of the study coincide with scientific societies data regarding vaginal infections incidence, patient profile and recurrences. Besides, evidence of the efficacy of food supplements with probiotics and prebiotics as adjuvants for the treatment of these infections, is reinforced. Oral route of administration appears as a referent for the administration of probiotics and prebiotics and the dosage indicated by the manufacturer is respected in most of the cases, taking into account personal and professional preference of each gynecologist in those cases in which a different dosage is indicated. Conclusions: oral route of administration for food supplements based on probiotics and prebiotics as adjuvants for the treatment of vaginal infections, is shown as an effective strategy to improve the infectious process resolution and to prevent recurrences by recovering the balance of normal vaginal microbiota

In Vitro Activity of Lactobacillus fermentum LF5 Against Different Candida Species and Gardnerella vaginalis: A New Perspective to Approach Mixed Vaginal Infections?

GOALS: This study was undertaken to demonstrate the ability of Lactobacillus fermentum LF5 (DSM 32277) to inhibit in vitro different Candida species and Gardnerella vaginalis to weigh its potential effectiveness even in mixed vaginal infections. BACKGROUND: A wide female population is suffering from various vulvovaginal infections. These diseases are often associated with a decrease in the concentration of Lactobacilli in the vagina. Mixed vaginal infections represent >20% of women with vulvovaginal infection. STUDY: LF5 strain was cocultured in De Man, Rogosa and Sharpe with Candida according to a 1:100 ratio in favor of the yeast. Each culture was sampled after 24 hours of incubation for the selective enumeration of the yeasts performed on yeast extract glucose chloramphenicol agar medium.The growth of Gardnerella alone (positive control) and in the presence of different concentrations of neutralized supernatants of L. fermentum LF5 ranging from 5% to 20% was quantified by means of optical density at 600 nm (OD600). RESULTS: L. fermentum LF5 demonstrated the ability to inhibit significantly the growth of the 5 species of Candida by at least 4 logarithms.Furthermore, L. fermentum LF5 showed a significant activity after both 24 and 48 hours (46% and 82% with 20% of neutralized supernatant, respectively). A significant dose-dependent growth inhibition was recorded in particular after 48 hours of incubation, even achieving a 80% inhibition of G. vaginalis growth. CONCLUSIONS: The biotherapeutic LF5 could be the only documented strain effective in mixed forms. For this purpose, a human clinical trial is in progress.