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Microbiological Research Apr 2024Vaginal infectious diseases caused by viruses and bacteria have been linked to the occurrence of dysbiosis, that is, a reduction in the abundance of the normally... (Review)
Review
A molecular view on the interference established between vaginal Lactobacilli and pathogenic Candida species: Challenges and opportunities for the development of new therapies.
Vaginal infectious diseases caused by viruses and bacteria have been linked to the occurrence of dysbiosis, that is, a reduction in the abundance of the normally dominating vaginal Lactobacillus species. Mucosal infections in the vagina and/or vulva caused by Candida species, usually known as vulvovaginal candidiasis (or VVC), are among the leading causes of diseases in the vaginal tract. The existence of a clear link between the occurrence of dysbiosis and the development of VVC is still unclear, although multiple observations point in that direction. Based on the idea that vaginal health is linked to a microbiota dominated by lactobacilli, several probiotics have been used in management of VVC, either alone or in combination with antifungals, having obtained different degrees of success. In most cases, the undertaken trials resorted to lactobacilli species other than those indigenous to the vaginal tract, although in vitro these vaginal species were shown to reduce growth, viability and virulence of Candida. In this paper we overview the role of lactobacilli and Candida in the vaginal micro- and myco-biomes, while discussing the results obtained in what concerns the establishment of interference mechanisms in vivo and the environmental factors that could determine that. We also overview the molecular mechanisms by which lactobacilli species have been shown to inhibit pathophysiology of Candida, including the description of the genes and pathways determining their ability to thrive in the presence of each other. In a time where concerns are increasing with the emergence of antifungal resistance and the slow pace of discovery of new antifungals, a thorough understanding of the molecular mechanisms underneath the anti-Candida effect prompted by vaginal lactobacilli is of utmost importance to assure a knowledge-based design of what can be a new generation of pharmaceuticals, eventually focusing therapeutic targets other than the usual ones.
Topics: Female; Humans; Candida; Lactobacillus; Antifungal Agents; Dysbiosis; Vagina; Candidiasis, Vulvovaginal; Candida albicans
PubMed: 38246122
DOI: 10.1016/j.micres.2024.127628 -
European Review For Medical and... Jan 2024To investigate the non-inferiority of efficacy and tolerability of Lactobacillus plantarum P 17630 soft vaginal capsules compared to the antifungal therapy with... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the non-inferiority of efficacy and tolerability of Lactobacillus plantarum P 17630 soft vaginal capsules compared to the antifungal therapy with miconazole nitrate 400 mg soft vaginal capsules in patients with symptomatic vulvovaginal infection due to Candida.
PATIENTS AND METHODS
Adult women with vulvovaginal candidiasis were randomized to either L. plantarum P17630 100,000,000 CFU soft vaginal capsules by vaginal route each day for 3 or 6 consecutive days or miconazole nitrate 400 mg soft vaginal capsule. Visual Analog Scale (VAS) scores for vaginitis symptoms were used, and vaginal fluid interleukin 6 (IL6) was dosed. The study was registered in EudraCT database (code LPP17630-C-018; number: 2018-003095-12).
RESULTS
200 patients were included in the study. The mean VAS scores for vaginitis symptoms were progressively reduced in both treatment groups at each visit, without significant difference between groups (p>0.05 for each symptom, at each time point). The efficacy of L. plantarum and the reference medicinal product was maintained at follow-up (day 21). The mean concentration of IL-6 decreased from visit 1 to visit 3 in both groups without a significant difference (p>0.05). No adverse events were reported.
CONCLUSIONS
L. plantarum P17630 100,000,000 CFU soft vaginal capsules are effective and safe for treating vaginal candidiasis without the concomitant use of an antifungal product, which rules out the risk of antimicrobic resistance. The long-term effect on vaginal microflora may add the possibility of reducing the risk of recurrences.
Topics: Adult; Female; Humans; Antifungal Agents; Candidiasis, Vulvovaginal; Lactobacillus plantarum; Miconazole; Vagina; Vulvovaginitis
PubMed: 38235890
DOI: 10.26355/eurrev_202401_34927 -
Melanoma Management Sep 2023Vulvo-vaginal melanomas are one of the rarest gynecological oncology diseases with a poor survival compared with other malignancies. The 5-year survival varies from 13%... (Review)
Review
Vulvo-vaginal melanomas are one of the rarest gynecological oncology diseases with a poor survival compared with other malignancies. The 5-year survival varies from 13% to 32.3%. Vulvo-vaginal melanomas involving the upper 2/3rds of the vagina are usually treated with total pelvic exenteration (TPE). TPE surgery carries a 50% risk of major complications and also morbidity associated with double stomas. Central pelvic compartment resection is a novel organ-sparing surgical approach entailing radical total laparoscopic hysterectomy, bilateral salpingo-oophrectomy, laparoscopic vaginectomy and vulvectomy to reduce morbidity compared with TPE. Permanent suprapubic catheters are used if there is urethral involvement but require quality of life studies to assess their long-term outcomes.
PubMed: 38229953
DOI: 10.2217/mmt-2023-0001 -
Experimental and Therapeutic Medicine Jan 2024Genitourinary symptoms of menopause (GSM) affect ~50% of women after menopause. Recently, CO laser therapy has been used for managing GSM but without high quality...
Genitourinary symptoms of menopause (GSM) affect ~50% of women after menopause. Recently, CO laser therapy has been used for managing GSM but without high quality evidence. The present review assessed the effectiveness of CO laser therapy in the management of GSM. PubMed, Embase, Web of Science, CENTRAL and Scopus databases were searched for randomized controlled trials (RCTs), published up to June 30, 2023, comparing CO laser and sham laser treatments for GSM management. The outcomes of interest included Female Sexual Function Index (FSFI), Vaginal Health Index (VHI) and visual analog scale (VAS) for dyspareunia, dryness, burning, itching and dysuria. A total of seven RCTs were included in the review and meta-analysis, with 6/7 studies using three sessions of laser therapy, 4-8 weeks apart. Meta-analysis demonstrated no statistically significant difference in FSFI [mean difference (MD), -1.48; 95% CI, -5.85, 2.89; I=45%] and VHI scores (MD, -0.18; 95% CI, -1.66, 1.31; I =72%) between laser and control groups. Meta-analysis also demonstrated no statistically significant difference in VAS scores for dyspareunia (MD, -1.63; 95% CI; -4.06, 0.80; I=91%), dryness (MD, -1.30; 95% CI, -3.14, 0.53; I=75%), burning (MD, -0.76; 95% CI, -2.03; 0.51 I=56%), itching (MD, -0.28; 95% CI, -0.95, 0.38; I=0%) and dysuria (MD, 0.15; 95% CI, -0.37, 0.67; I=23%) between the groups. The included RCTs had low risk of bias. In conclusion, meta-analyses of high-quality sham-controlled RCTs indicated that CO may not have any beneficial effect on GSM. Limited data and high heterogeneity in meta-analyses in this area of research are important limitations that need to be addressed by future RCTs.
PubMed: 38223331
DOI: 10.3892/etm.2023.12297 -
Indian Journal of Sexually Transmitted... 2023Sexually transmitted diseases (STDs) continue to be a major public health problem with significant burden on the society. Some of this can be attributed to our lack of...
INTRODUCTION
Sexually transmitted diseases (STDs) continue to be a major public health problem with significant burden on the society. Some of this can be attributed to our lack of knowledge about the change of disease spectrum from time to time.
AIMS
The aim of the study was to understand the changing pattern of STDs over the past 17 years (2003-2019).
MATERIALS AND METHODS
It was a retrospective study where data of patients who attended our Suraksha Clinic from 2003 to 2019 were collected. All the cases were subjected to detailed history, examination, and investigations done to rule out STDs.
RESULTS
A total of 2436 patients were included in the study. The majority of the patients were in the age group of 18-30 years. The most frequent diagnosis was vulvovaginal candidiasis, followed by herpes genitalis. 3.3% of patients had human immunodeficiency virus. 4.8% of patients were men sex men (MSM). Overall, viral STDs were most common, followed by fungal and bacterial. To understand the changing trends, data were divided into different phases according to the time period. During Phase 1 (2003-2007), viral STDs were most common, followed by bacterial and fungal. However, this trend changed in Phase 4 (2016-2019) and fungal STDs became most common.
CONCLUSIONS
Despite numerous health initiatives, the number of STD cases is rising day by day. The increasing number of MSM over the study period necessitates dedicated efforts to address the health needs of this population. The National AIDS Control Organization should take necessary measures and steps to address the overall increase in STDs considering recent trends showing a drop in bacterial STDs and an increase in fungal and viral STDs.
PubMed: 38223154
DOI: 10.4103/ijstd.ijstd_100_22 -
Taiwanese Journal of Obstetrics &... Jan 2024Probiotics, live microorganisms that confer health benefits to the host when administered in adequate amounts, have gained considerable attention for their potential... (Review)
Review
Probiotics, live microorganisms that confer health benefits to the host when administered in adequate amounts, have gained considerable attention for their potential role in maintaining women's health. This overview summarizes key clinical findings on the beneficial effects of probiotics in various aspects of women's health. Probiotics, particularly Lactobacillus species, contribute to vaginal health by promoting a balanced vaginal microbiome to prevent infections and maintain an acidic environment. In gynecologic conditions, probiotics show potential in preventing and managing bacterial vaginosis, vulvovaginal candidiasis, and sexually transmitted infections. Probiotic supplementation has also been associated with improvements in metabolic parameters and menstrual irregularities in polycystic ovary syndrome patients. During pregnancy, probiotics may be helpful in reducing the risk of gestational diabetes, maternal group B streptococcal colonization, obstetric anemia, and postpartum mastitis. In recent years, the potential role of probiotics in the prevention and management of gynecologic cancer has gained attention. Further research is needed to better understand the specific mechanisms and determine the optimal Lactobacillus strains and dosages regimens for gynecologic cancer prevention and therapy. In conclusion, probiotics offer a non-invasive and cost-effective approach to support women's health and prevent obstetric and gynecologic complications.
Topics: Pregnancy; Female; Humans; Women's Health; Vagina; Vaginosis, Bacterial; Probiotics; Lactobacillus; Polycystic Ovary Syndrome
PubMed: 38216265
DOI: 10.1016/j.tjog.2023.09.018 -
Scientific Reports Jan 2024The genitourinary symptom of menopause (GSM) affects up to 65% of women, resulting in symptoms such as vulvovaginal dryness, discomfort, and dysuria, which significantly...
The genitourinary symptom of menopause (GSM) affects up to 65% of women, resulting in symptoms such as vulvovaginal dryness, discomfort, and dysuria, which significantly impacts quality of life. The current assessment methods rely on subjective questionnaires that can be influenced by individual differences, as well as invasive measurements that are time-consuming and not easily accessible. In this study, we explore the potential of a non-invasive and objective assessment tool called diffuse reflectance spectroscopy and imaging (DRSI) to evaluate tissue chromophores, including water, lipid, oxyhemoglobin, and deoxyhemoglobin. These measurements provide information about moisture content, lipid levels, oxygen saturation, and blood fraction, which can serve as surrogate markers for genital estrogen levels. Our findings reveal distinct differences in these chromophores among pre, peri, and postmenopausal subjects. By using lipid and blood fraction tissue chromophores in a K-Nearest Neighbour classifier model, we achieved a prediction accuracy of 65% compared to vaginal maturation index (VMI) that is clinically used to assess estrogen-related hormonal changes. When age was included as the third feature, the accuracy increased to 78%. We believe that by refining the study protocol and configuring the fiber probe to examine tissue chromophores both in the superficial vulva skin for epidermal water content and the deeper layers, DRSI has the potential to provide objective diagnosis and aid in monitoring the treatment outcome of GSM.
Topics: Female; Humans; Pilot Projects; Quality of Life; Menopause; Vagina; Spectrum Analysis; Estrogens; Water; Lipids; Atrophy
PubMed: 38212347
DOI: 10.1038/s41598-023-49655-4 -
Cancers Jan 2024Mucosal melanoma (MM) is an uncommon melanoma subtype affecting mucosal surfaces of the head and neck, anorectal region, and vulvovaginal area. We aimed to present our...
Mucosal melanoma (MM) is an uncommon melanoma subtype affecting mucosal surfaces of the head and neck, anorectal region, and vulvovaginal area. We aimed to present our experience at a tertiary-level hospital regarding MM diagnosis, management, monitoring of progression, mutations, and outcome predictors. We performed a registry-based cohort study including MM cases diagnosed from 2012 to 2022 and retrospectively characterized somatic mutations on , and We employed Kaplan-Meier curves, log-rank tests, and Cox regression analysis to explore prognostic factors and survival outcomes in a cohort of 35 patients, mainly women (63%) with a median age of 70 years. Predominantly, MM occurred in the vulvovaginal region (48.6%). At diagnosis, 28.6% had lymph node involvement, and 31.4% also had distant metastasis. Mutations in and were identified in 3/35 (9%) and 2/6 patients (33%), respectively. Surgery was performed in 71.4% of patients, and most received systemic treatment (65.7%). Lower disease stage, thinner Breslow depth, and surgical resection were associated with improved overall survival. Notably, age, sex, radiotherapy, and mutant status did not affect survival. Standard management typically involves immunotherapy. Cases with or mutations may be considered for targeted therapies. Unfortunately, MM prognosis remains unfavorable, with a less than 50% survival rate at 2 years.
PubMed: 38201654
DOI: 10.3390/cancers16010227 -
Pediatric Annals Jan 2024Genital ulcers may be located on the vagina, penis, and anorectal or perineal areas and may be infectious or noninfectious. Vaginal ulcers affect patients of all ages... (Review)
Review
Genital ulcers may be located on the vagina, penis, and anorectal or perineal areas and may be infectious or noninfectious. Vaginal ulcers affect patients of all ages and are commonly due to sexually transmitted infections, such as herpes simplex virus, the most common cause of genital ulcers in the United States. Non-sexually transmitted infections, such as Epstein-Barr virus, and other noninfectious causes, such as trauma, medications, and autoimmune disease, rarely can present with genital ulcers. Appropriate history, examination findings, and targeted testing must be used to correctly diagnose and treat vaginal ulcers. .
Topics: Female; Humans; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Ulcer; Vagina; Vulvovaginitis
PubMed: 38194657
DOI: 10.3928/19382359-20231113-03 -
Applied Microbiology and Biotechnology Dec 2024Vulvovaginal candidiasis (VVC) affects approximately 30-50% of women at least once during their lifetime, causing uncomfortable symptoms and limitations in their daily...
Vulvovaginal candidiasis (VVC) affects approximately 30-50% of women at least once during their lifetime, causing uncomfortable symptoms and limitations in their daily quality of life. Antifungal therapy is not very effective, does not prevent recurrencies and usually causes side effects. Therefore, alternative therapies are urgently needed. The goal of this work was to investigate the potential benefits of using mannan oligosaccharides (MOS) extracts together with a Lactobacillus sp. pool, composed by the most significant species present in the vaginal environment, to prevent infections by Candida albicans. Microbial growth of isolated strains of the main vaginal lactobacilli and Candida strains was assessed in the presence of MOS, to screen their impact upon growth. A pool of the lactobacilli was then tested against C. albicans in competition and prophylaxis studies; bacterial and yeast cell numbers were quantified in specific time points, and the above-mentioned studies were assessed in simulated vaginal fluid (SVF). Finally, adhesion to vaginal epithelial cells (HeLa) was also evaluated, once again resorting to simultaneous exposure (competition) or prophylaxis assays, aiming to measure the effect of MOS presence in pathogen adherence. Results demonstrated that MOS extracts have potential to prevent vaginal candidiasis in synergy with vaginal lactobacilli, with improved results than those obtained when using lactobacilli alone. KEY POINTS: Potential benefits of MOS extracts with vaginal lactobacilli to prevent C. albicans infections. MOS impacts on growth of vaginal lactobacilli pool and C. albicans in SVF. MOS extracts in synergy with L. crispatus inhibit C. albicans adhesion in HeLa cells.
Topics: Female; Humans; Candida albicans; Mannans; HeLa Cells; Quality of Life; Candidiasis, Vulvovaginal; Lactobacillus
PubMed: 38194142
DOI: 10.1007/s00253-023-12909-2