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Nutrients Jan 2020Spontaneous preterm birth is associated with vaginal microbial dysbiosis. As certain strains of lactobacilli help restore homeostasis in non-pregnant women, the goal was... (Randomized Controlled Trial)
Randomized Controlled Trial
Spontaneous preterm birth is associated with vaginal microbial dysbiosis. As certain strains of lactobacilli help restore homeostasis in non-pregnant women, the goal was to determine the effect of GR-1 and RC-14 administered orally, twice daily for 12 weeks on the vaginal microbiota, cytokines and chemokines of low-risk pregnant women. A double-blind, placebo-controlled, randomized trial comparing probiotic lactobacilli to placebo daily was performed in 86 asymptomatic pregnant women who had an Intermediate or Bacterial Vaginosis Nugent score at 13 weeks. After drop outs, 32 women receiving probiotics and 34 receiving placebo completed the study. The Nugent score returned to normal in 30% of the women in both groups at 28 weeks and was maintained until 35 weeks. The majority of subjects had normal pregnancy outcomes. Ninety-three bacterial species were detected at 13 weeks, with and being the most abundant across pregnancy. There was no difference in the Shannon diversity index between the probiotic and placebo groups at 13, 28 or 35 weeks. Almost all subjects consumed fermented foods and many of the organisms in the vagina are also known to be present in fermented foods. Interleukin-4 in the placebo group and Interleukin-10 in both probiotic and placebo groups increased slightly at 28 weeks but were not different at 35 weeks when compared to 13 weeks. In conclusion, this study showed no adverse issues resulting from 12 week use of probiotic strains GR-1 and RC-14 during pregnancy in women at low risk for premature birth. The vaginal microbiota demonstrated flux irrespective of this oral probiotic administration.
Topics: Administration, Oral; Adult; Chemokines; Cytokines; Double-Blind Method; Dysbiosis; Female; Humans; Limosilactobacillus reuteri; Lacticaseibacillus rhamnosus; Microbiota; Pregnancy; Pregnancy Complications, Infectious; Premature Birth; Probiotics; Treatment Outcome; Vagina; Vaginosis, Bacterial
PubMed: 32019222
DOI: 10.3390/nu12020368 -
Archives of Razi Institute Aug 2022Abortion is a common complication in the life cycle of pregnancy. Based on the American College of Obstetricians and Gynecologists, spontaneous abortion is defined as...
Abortion is a common complication in the life cycle of pregnancy. Based on the American College of Obstetricians and Gynecologists, spontaneous abortion is defined as the expulsion of an embryo or the extraction of a fetus at the age of 20-22 weeks of pregnancy. This study aimed to investigate the relationship between socioeconomic factors and bacterial vaginosis (BV) in women having an abortion. As a secondary aim, it attempted to detect common bacteria that cause vaginosis associated with miscarriage and are related to Cytomegalovirus (CMV) and species (spp.). A total of 113 high vaginal swabs were taken from women having an abortion. Some variables that have been investigated in this study include age, education, and infection. After the vaginal discharge collection, the smear was prepared. Afterward, one or two drops of normal saline solution were put on the prepared smear with a cover slip, and then, they were examined under a microscope. Gram stain kits (Hi-media, India), were used to differentiate between the shapes of bacterial isolates. The wet mount technique was then utilized for the detection of and aerobic BV. All the samples were used for smear gram staining and were cultured on blood agar, chocolate agar, as well as MacConkey agar. Biochemical examinations performed on suspicious cultures included the Urease test, Oxidase test, Coagulase test, and Catalase test. In the present study, the participants' age ranged from 14 to 45 years. Women aged 24-34 years had a high rate of miscarriage, determined at 48 (42.5%), which was considered a high incidence rate. The results showed that 28.6% of the studied population experienced abortion once and 71.4% of them experienced it twice due to aerobic BV. The recorded data also revealed that 50% of the studied population, who were infected with CMV or , experienced abortion once and the other 50% experienced it twice. From 102 samples infected with spp., 45.17% experienced abortion once and 42.2% experienced it twice.
Topics: Female; Pregnancy; Agar; Culture Media; Cytomegalovirus; Cytomegalovirus Infections; Lactobacillus; Vaginosis, Bacterial; Bacteria, Aerobic; Humans; Abortion, Induced; Abortion, Spontaneous; Young Adult; Adult
PubMed: 36883142
DOI: 10.22092/ARI.2022.357615.2068 -
The Journal of Infectious Diseases Aug 2016Practitioners and patients alike widely recognize the limitations of current therapeutic approaches to the treatment of bacterial vaginosis (BV). Options remain... (Review)
Review
Practitioners and patients alike widely recognize the limitations of current therapeutic approaches to the treatment of bacterial vaginosis (BV). Options remain extremely limited, and our inability to prevent the frequently, often relentless symptomatic recurrences of BV and to reduce serious sequelae such as preterm delivery, remains an acknowledged but unresolved shortcoming. Our incomplete understanding of the pathophysiology of this unique form of vaginal dysbiosis has been a significant impediment to developing optimal treatment and prevention approaches. New drugs have not been forthcoming and are not likely to be available in the immediate future; hence, reliance on the optimal use of available agents has become essential as improvised often unproven regimens are implemented. In this review, we will explore the limitations of currently recommended therapies, with a particular focus on the contribution of reinfection and pathogen persistence to BV recurrence, and the development of interventions that target these mechanisms. Ultimately, to achieve sustained cure and effectiveness against BV-associated sequelae, it is possible that we will need approaches that combine antimicrobials with biofilm-disrupting agents and partner treatments in those at risk of reinfection.
Topics: Anti-Infective Agents; Biofilms; Dysbiosis; Female; Gardnerella vaginalis; Humans; Male; Penis; Recurrence; Sexually Transmitted Diseases, Bacterial; Vagina; Vaginosis, Bacterial
PubMed: 27449869
DOI: 10.1093/infdis/jiw159 -
Sexually Transmitted Diseases Nov 2021Reproductive tract infections are hypothesized to influence uterine fibroid development, yet few studies have investigated the common condition of bacterial vaginosis...
BACKGROUND
Reproductive tract infections are hypothesized to influence uterine fibroid development, yet few studies have investigated the common condition of bacterial vaginosis (BV). The literature is currently limited to data using self-report of BV.
METHODS
We conducted a nested case-control study of 200 women (100 cases and 100 controls) from a large study of 23- to 35-year-old African American women, 1310 of whom were fibroid-free and prospectively followed up for 5 years to identify incident fibroids with standardized ultrasound examinations. We used quantitative polymerase chain reaction, an objective molecular method, to assess 9 BV-associated and 4 Lactobacillus species from vaginal swab specimens. We used hierarchical logistic regression to compute odds ratios and 95% confidence intervals to examine associations between bacterial species (both individually and grouped as (1) "optimal" Lactobacillus and (2) BV-associated species) with fibroid incidence and number. We also examined vaginal imbalance (quantitatively more BV-associated bacteria than optimal Lactobacilli).
RESULTS
Contrary to our hypothesis, we found no increase in fibroid incidence or number among women with more BV-associated bacteria. High imbalance (only BV-associated bacteria, no optimal Lactobacillus bacteria) was actually inversely associated with fibroid incidence (odds ratio, 0.38; 95% confidence interval, 0.17-0.81).
CONCLUSIONS
This is the first study of ultrasound-detected incident fibroids and molecular vaginal bacterial assessment. We found no evidence that BV-associated bacteria increase the risk of fibroid incidence or number.
Topics: Adult; Bacteria; Case-Control Studies; Female; Humans; Leiomyoma; Ultrasonography; Vagina; Vaginosis, Bacterial; Young Adult
PubMed: 33993160
DOI: 10.1097/OLQ.0000000000001466 -
PloS One 2012Bacterial vaginosis (BV), the most common vaginal disorder among women of reproductive age, has been suggested as co-factor in the development of cervical cancer.... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Bacterial vaginosis (BV), the most common vaginal disorder among women of reproductive age, has been suggested as co-factor in the development of cervical cancer. Previous studies examining the relationship between BV and cervical intra-epithelial neoplasia (CIN) provided inconsistent and conflicting results. The aim of this study is to clarify the association between these two conditions.
METHODS
A systematic review and meta-analysis were conducted to summarize published literature on the association between BV and cervical pre-cancerous lesions. An extensive search of electronic databases Medline (Pubmed) and Web of Science was performed. The key words 'bacterial vaginosis' and 'bacterial infections and vaginitis' were used in combination with 'cervical intraepithelial neoplasia', 'squamous intraepithelial lesions', 'cervical lesions', 'cervical dysplasia', and 'cervical screening'. Eligible studies required a clear description of diagnostic methods used for detecting both BV and cervical pre-cancerous lesions. Publications were included if they either reported odds ratios (OR) and corresponding 95% confidence intervals (CI) representing the magnitude of association between these two conditions, or presented data that allowed calculation of the OR.
RESULTS
Out of 329 articles, 17 cross-sectional and 2 incidence studies were selected. In addition, two studies conducted in The Netherlands, using the national KOPAC system, were retained. After testing for heterogeneity and publication bias, meta-analysis and meta-regression were performed, using a random effects model. Although heterogeneity among studies was high (χ(2) = 164.7, p<0.01, I(2) = 88.5), a positive association between BV and cervical pre-cancerous lesions was found, with an overall estimated odds ratio of 1.51 (95% CI, 1.24-1.83). Meta-regression analysis could not detect a significant difference between studies based on BV diagnosis, CIN diagnosis or study population.
CONCLUSIONS
Although most studies were cross-sectional and heterogeneity was high, this meta-analysis confirms a connection between BV and CIN.
Topics: Adult; Cervix Uteri; Female; Humans; Odds Ratio; Regression Analysis; Uterine Cervical Neoplasms; Vaginosis, Bacterial; Young Adult; Uterine Cervical Dysplasia
PubMed: 23056195
DOI: 10.1371/journal.pone.0045201 -
Sexually Transmitted Infections Feb 2000
Topics: Anti-Infective Agents; Female; HIV Infections; Humans; Metronidazole; Risk Factors; Vaginosis, Bacterial
PubMed: 10817059
DOI: 10.1136/sti.76.1.3 -
Sexual Medicine Reviews Apr 2022Secnidazole (SEC), newly FDA-approved for trichomoniasis, is a potent 5-nitroimidazole with selective toxicity against various infections. It has been used... (Review)
Review
INTRODUCTION
Secnidazole (SEC), newly FDA-approved for trichomoniasis, is a potent 5-nitroimidazole with selective toxicity against various infections. It has been used internationally to treat trichomoniasis, bacterial vaginosis, and other infections for decades. Trichomoniasis is the most common non-viral sexually transmitted infection worldwide and is associated with significant morbidity. In comparison to the only other approved treatments for trichomoniasis in the U.S.-metronidazole and tinidazole-SEC has favorable pharmacokinetics, including a longer half-life, and a lower minimal lethal concentration against Trichomonas vaginalis.
OBJECTIVES
Provide an updated, comprehensive review of the literature evaluating SEC as a treatment for trichomoniasis in women and men.
METHODS
We conducted a search to identify existing research on SEC and trichomoniasis. On August 6, 2021, we searched MEDLINE using the terms "secnidazole" and "trichomon.*" We excluded reviews, editorials, case reports, and small case series.
RESULTS
We identified 29 articles; 14 of which were included: 5 reported in vitro pharmacologic data on SEC, 6 were observational studies, and 4 were controlled clinical trials (1 observational study also reported in vitro pharmacologic data). Six studies reported data on women only, 1 on men only, and 3 on women and men. These studies showed that SEC-as a single dose or 3-day course-had comparable efficacy to multi-dose metronidazole for treating trichomoniasis in women and men, was generally well tolerated by patients, and had a favorable pharmacokinetic profile. A single 2-g dose of SEC also led to a microbiologic cure rate of 92.2% in the first randomized, double-blind, placebo-controlled study of trichomonas-infected US-based women.
CONCLUSION
SEC is an efficacious and safe treatment for women and men with trichomoniasis. Single-dose administration makes it a favorable treatment option for patients, especially in cases where adherence to other multi-dose treatment regimens could be problematic. Christina A. Muzny and Olivia T. Van Gerwen. Secnidazole for Trichomoniasis in Women and Men. Sex Med Rev 2022;10:255-262.
Topics: Female; Humans; Male; Metronidazole; Observational Studies as Topic; Randomized Controlled Trials as Topic; Trichomonas Infections; Trichomonas vaginalis; Vaginosis, Bacterial
PubMed: 35153156
DOI: 10.1016/j.sxmr.2021.12.004 -
Acta Obstetricia Et Gynecologica... Dec 2011Bacterial vaginosis (BV) was originally described as a sexually transmitted infection caused by a single microbe. The prevailing concept describes BV as a polymicrobial... (Review)
Review
Bacterial vaginosis (BV) was originally described as a sexually transmitted infection caused by a single microbe. The prevailing concept describes BV as a polymicrobial coitus-associated disease of uncertain origin. In this overview the natural history of BV as a monobacterial and polymicrobial entity is examined with respect to the physiological concept of BV in relation to sexual behavior before and after introduction of the hormonal contraceptive pill. Bacterial vaginosis, characterized by low vaginal acidity (elevated pH) and replacement of vaginal Lactobacillus by Gardnerella vaginalis flora, could be caused by unprotected intercourse when a low pH changes through the neutralizing power of male ejaculate, vaginal coital transudate and vaginal neurogenic transudate. A monobacterial form, G. vaginalis vaginitis, could be a physiological post-coital condition for protection of ejaculated spermatozoa, characterized by 'pure'Gardnerella flora and elevated pH as an immediate result of an incidental unprotected coital act through neutralization of vaginal acid and replacement of Lactobacillus by Gardnerella flora. A polymicrobial form of BV could be autoinfection of the post-coital physiological G. vaginalis flora, characterized by a mixture of G. vaginalis, Mycoplasma hominis and anaerobic bacteria at lower vaginal acidity, possibly resulting from suppression of normal vaginal acidity through repeated sexual acts, with a resultant higher pH and transfer of enteric bacteria from the perianal region. Monobacterial and polymicrobial auto-infectious forms of BV may be clinically distinct and share a common origin. The understanding of BV as a basic physiological entity could influence the prophylaxis and treatment of the largely therapy-resistant polymicrobial BV.
Topics: Coitus; Female; Gardnerella vaginalis; Humans; Hydrogen-Ion Concentration; Vagina; Vaginosis, Bacterial
PubMed: 21916857
DOI: 10.1111/j.1600-0412.2011.01279.x -
Frontiers in Cellular and Infection... 2022Clue cells (epithelial cells heavily covered with adherent bacteria) are an accepted clue to the diagnosis of bacterial vaginosis. However, the exact morphologic...
INTRODUCTION
Clue cells (epithelial cells heavily covered with adherent bacteria) are an accepted clue to the diagnosis of bacterial vaginosis. However, the exact morphologic criteria of clue cells and bacterial adherence were never elaborated.
MATERIALS AND METHODS
We investigated adhesive and cohesive patterns of main microbiota groups in vaginal discharge using fluorescence hybridization (FISH). Samples from 500 women diagnosed with bacterial vaginosis and positive for clue cells with classic microscopy were collected from 42 gynecologic practices in Berlin and reexamined in our FISH laboratory for the spatial distribution of Bifidobacteriaceae, , (); low G+C (guanine+cytosine) bacteria, lactobacilli, ; , Gamma-Proteobacteria; and Enterobacteriaceae, , , and groups.
RESULTS
Bacterial taxa present in vaginal smears were not accidentally assembled according to their relative abundance but were built in group-specific distribution patterns, which can be well described by two features: cohesiveness to each other and adherence to epithelial cells. Accordingly, four patterns can be distinguished: dispersed (non-adherent bacteria), dispersed adherent bacteria, cohesive (non-adherent) bacteria, and cohesive adherent bacteria. Direct cohesive adherence to the epithelial cells representing true clue cells was unique for species and observed only in 56% of the investigated samples. In the remaining vaginal samples, the epithelial cells were mechanically entrapped in bacterial masses, and the composition was unrelated to the epithelial cell surface, building non-adherent pseudo clue cells. The proportion of women with true clue cells in their samples from different gynecologic practices varied from 19% to 80%.
DISCUSSION
Taxon indifferent imaging is inadequate for the exact analysis of the microbial layer adjacent to the vaginal epithelial cells. Morphologically seen bacterial vaginosis is a mix of at least two different conditions: biofilm vaginosis and bacterial excess vaginosis.
Topics: Bacteria; Female; Gardnerella; Gardnerella vaginalis; Humans; In Situ Hybridization, Fluorescence; Microbiota; Vagina; Vaginosis, Bacterial
PubMed: 35719334
DOI: 10.3389/fcimb.2022.905739 -
BMC Infectious Diseases Apr 2023Bacterial vaginosis (BV) is the most common vaginal dysbiosis among women of reproductive age. Micronutrient deficiencies, including vitamin D deficiency, can increase...
INTRODUCTION
Bacterial vaginosis (BV) is the most common vaginal dysbiosis among women of reproductive age. Micronutrient deficiencies, including vitamin D deficiency, can increase the risk of BV. The findings of previous studies regarding the relationship between vitamin D deficiency and BV were conflicting. Therefore, this study aimed to evaluate the association between BV and serum level of 25-hydroxy vitamin D.
MATERIALS AND METHODS
This case-control study was conducted in Gonabad County in 2021. One hundred and twenty-five confirmed BV cases and 125 controls who were matched based on age and intercourse frequency (maximum difference of two days per week) enrolled in the study. Data collection was performed using a demographic and reproductive data questionnaire and a checklist for recording Whiff test results, serum 25-hydroxy vitamin D level, litmus paper observation, and microscopic findings (clue cells). Serum level of vitamin D was evaluated based on enzyme-linked immunoassay method (Monobind kit) from 0.5 ml venous blood drawn from each participant. The conditional logistic regression model was used to analyze data.
RESULTS
The BV cases had significantly lower 25-hydroxy vitamin D serum levels than controls. The odds of BV increased with vitamin D deficiency (Adjusted odds ratio (AOR): 4.34, 95% confidence interval (CI): 1.39-13.4, p = 0.011, FDR q-value = 0.051), vitamin D insufficiency (AOR: 3.65, 95% CI: 1.23-10.85; p = 0.020; FDR q-value = 0.053), cigarette/hookah smoking (AOR: 3.65, 95% CI: 1.23, 10.85; p = 0.020; FDR q-value = 0.053) and lower age at first intercourse (AOR: 1.16, 95% CI: 1.05, 1.28; p = 0.004; FDR q-value = 0.048). The odds of BV was 0.80 and 0.78 times lower in participants who had coitus interruptus (AOR: 0.20, 95% CI: 0.06, 0.63; p = 0.006; FDR q-value = 0.048) and condom use (AOR: 0.28, 95% CI: 0.10, 0.79; p = 0.016; FDR q-value = 0.051), respectively, compared to participants who did not use contraceptives.
CONCLUSION
These findings suggested that lower serum vitamin D levels were associated with an increased risk of developing BV. However, further studies are needed to confirm the results of the present study.
Topics: Humans; Female; Vaginosis, Bacterial; Case-Control Studies; Vitamin D; Vitamin D Deficiency; Vitamins; Calcifediol; Surveys and Questionnaires; Risk Factors
PubMed: 37024856
DOI: 10.1186/s12879-023-08120-3