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Background Aims Materials and Methods Results Conclusions Vaginal swab microbiological testing is commonly performed as routine clinical management for various obstetric and gynaecological presentations. The clinical utility and cost‐effectiveness of vaginal swab microscopy, culture and susceptibilities (MCS) in altering empirical management is ill‐defined.To describe the clinical use of vaginal swabs in a tertiary women's hospital emergency department (ED), measure the impact of vaginal swabs on altering empirical clinical management, and to determine the economic cost of vaginal swab MCS.Retrospective case‐series of vaginal swabs collected at a single, tertiary women's ED between January 2021 and July 2021. Symptomatology, clinical diagnosis, test results, and pre‐swab and post‐swab clinical management were determined upon medical record review. Economic costs of vaginal swab MCS were retrospectively determined via internal accounting records, permitting unit‐level activity‐based costing.A total of 660 vaginal swabs from 584 clinical episodes were included. Vulvovaginitis was the most common indication for swab collection (34.5%, 167 samples). Altered empirical management was observed in 9.8% of all swabs (95% CI 7.4–12.2%), with marked variability between clinical indications. Antimicrobial initiation was the most common alteration in management (8.9%, 95% CI 8.7–9.1%). The estimated cost of vaginal swab MCS was $29.71 AUD; labour, consumables and disposal costs accounted for 69.3, 29.8 and 0.9%, respectively.The impact of vaginal swab MCS on empirical clinical management is context‐specific and variable. The majority of swabs performed do not impact upon empirical management. Antimicrobial initiation is appreciably more common than antimicrobial cessation with vaginal swab results. [ABSTRACT FROM AUTHOR]

Problem: To investigate how asymptomatic bacterial imbalance affects the clinical pregnancy rate after artificial insemination with the husband's semen (AIH). Methods: This study included married heterosexual couples who underwent AIH. According to the follow‐up results, participants were divided into the pregnancy and non‐pregnancy groups. Based on the first 10 pair participants in each group with vaginal flora bacterial 16S rRNA sequencing results, six semen samples received bacterial‐sperm mixed test. Moreover, 34 cytokines were detected in the peripheral blood sera of the first three pairs by high‐throughput Luminex, which were verified in vaginal secretions, cervical mucus, and blood sera from the first 200 pairs by ELISA. Results: The results of the 16S sequencing of vaginal secretions showed that compared with the pregnant group, the non‐pregnant group had a significantly increased bacterial species diversity, which was mainly manifested by a decrease in Lactobacillus crispatus and an increase in Prevotella bivia. When Prevotella bivia or Lactobacillus crispatus were mixed with sperms, the sperm motility was decreased (p <.05). The vaginal posterior fornix secretions, cervical mucus, and peripheral blood sera of the non‐pregnant group showed decreased levels of MIP‐1α and increased levels of IL‐17A (p <.05). Conclusion: The imbalance of vaginal flora leading to the increase of Prevotella bivia and the decrease of Lactobacillus crispatus may cause an imbalance of immune regulation. Low expression of MIP‐1α and high expression of IL‐17A were associated with reduced clinical pregnancy rate in AIH. [ABSTRACT FROM AUTHOR]

Contents: Reports of the vaginal flora of wild cats such as lions or leopards are scarce. The micro‐organisms most commonly found in the vagina of clinically healthy cats are aerobic bacteria such as coagulase‐negative Staphylococcus, Streptococcus canis, and Escherichia coli. Simonsiella spp are large Gram‐negative bacteria belonging to the Neisseriaceae family, typically found in the oral cavity and upper respiratory tract of many species. To date, there are no reports of the detection of Simonsiella spp in the vaginal flora of any felid. For a period of six months, daily behaviour monitoring was performed on six captive lionesses at a South African conservation centre, in parallel with the collection of vaginal swabs and interpretation of the resultant vaginal cytologies every other day. Oestrus was identified by typical female reproductive behaviours, as well as by enlarged and separated vulvar lips, and a predominant proportion of superficial cornified cells, clearing of the background, and high bacterial presence in the vaginal smear. Simonsiella spp were identified by their characteristic morphology in 58% (60 of 103) of the vaginal samples collected during oestrus. They were also found in oral swabs of three out of three lions tested. Additionally, Simonsiella spp were opportunistically found in a vaginal smear from a zoo housed female Sri Lankan leopard in oestrus, during a routine reproduction assessment. The finding of Simonsiella spp may be more common than previously suspected, transitory, and without detectable clinical relevance. A connection between occurrence of these bacteria and oestrus was apparent. [ABSTRACT FROM AUTHOR]

Objective: To determine whether oral clindamycin reduces the risk of preterm birth (PTB) in women with abnormal vaginal microflora as evidenced by a vaginal pH ≥5.0.Design: Randomised double-blind placebo-controlled trial.Setting: Rural southern India.Population: Pregnant women with a singleton fetus between 13+0/7 weeks and 20+6/7 weeks.Methods: Pregnant women were recruited during prenatal visits in Karnataka, India, from October 2013 to July 2015. Women were required to have a singleton fetus between 13+0/7 weeks and 20+6/7 weeks and an elevated vaginal pH (≥5.0) by colorimetric assessment. Participants were randomised to either oral clindamycin 300 mg twice daily for 5 days or an identical-appearing placebo.Main Outcome Measures: The primary outcome was the incidence of PTB, defined as delivery before 37+0/7 weeks.Results: Of the 6476 screened women, 1727 women were randomised (block randomised in groups of six; clindamycin n = 866, placebo n = 861). The demographic, reproductive, and anthropomorphometric characteristics of the study groups were similar. Compliance was high, with over 94% of capsules being taken. The rate of PTB before 37 weeks was comparable between the two groups [clindamycin 115/826 (13.9%) versus placebo 111/806 (13.8%), between-group difference 0.2% (95% CI -3.2 to 3.5%, P = 0.93)], as was PTB at less than 34 weeks [clindamycin 40/826 (4.8%) versus placebo group 37/806 (4.6%), between-group difference 0.3% (95% CI -1.8 to 2.3%, P = 0.81)]. No differences were detected in the incidence of birthweight of<2500 g, <1500 g, miscarriage, stillbirth or neonatal death.Conclusion: In this setting, oral clindamycin did not decrease PTB among women with vaginal pH ≥5.0.Tweetable Abstract: Oral clindamycin between 13+0/7 and 20+6/7 weeks does not prevent preterm birth in women with a vaginal pH ≥5.0. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of abnormal vaginal flora during pregnancy and associated maternal risk factors.Methods: A retrospective study was undertaken of cervicovaginal smears performed on pregnant women at a center in Turin, Italy, between 2000 and 2010. Patients were divided into three groups: women with symptoms of genital infections (G1), asymptomatic women at risk of preterm birth (G2), and asymptomatic women with no risk (G3). Logistic regression models identified variables associated with microorganisms.Results: Among 11 219 samples, 4913 (43.8%) were positive, of which 3783 (77.0%) were positive for a single microorganism. Multivariate analysis for G1 showed positive associations between multiple sexual partners and bacterial vaginosis/Ureaplasma urealyticum, and multiparity with preterm birth and U. urealyticum (P<0.05 for all). In G2, there were significant associations between multiparity with preterm birth and bacterial vaginosis/aerobic vaginitis, and North African origin and bacterial vaginosis/U. urealyticum (P<0.05 for all). In G3, there were associations between little education (<8 years) and bacterial vaginosis/U. urealyticum, multiple sexual partners and bacterial vaginosis/U. urealyticum, and bacterial vaginosis and Eastern European origin and not being married (P<0.05 for all).Conclusion: Positive cervicovaginal smears were associated with a particular profile. Testing could be advisable for symptomatic women at any stage of pregnancy, during the first trimester for asymptomatic women at risk of preterm birth, and for some asymptomatic women. [ABSTRACT FROM AUTHOR]

Problem Pregnancy-mediated changes in immunity may influence risk of HIV-1 acquisition. This risk appears greatest among non- Caucasian women. Method of study Pregnant women with low risk of immune disruption were enrolled in a prospective observational cohort. Study visits occurred each trimester and postpartum. Semi-quantitative vaginal cultures and concentrations of cervical cytokines were compared between Caucasian and non- Caucasian women. Results In the second trimester, non- Caucasian women were more likely to be colonized with Gardnerella vaginalis (62% versus 25%, P = 0.02) and non-pigmented anaerobic gram-negative rods (43% versus 8%, P = 0.01). Mycoplasma hominis was more frequently isolated in non- Caucasian women throughout the second (29% versus 4%, P = 0.03) and third trimesters (35% versus 6%, P = 0.04). Non- Caucasian women had higher median interleukin ( IL)-10 concentrations throughout the second (128 pg/mL versus 7 pg/mL, P = 0.05) and third trimesters (224 pg/mL versus 7 pg/mL, P = 0.05). Conclusion Non- Caucasian women experienced a greater diversity of microorganisms and increased IL-10 in the second and third trimesters. [ABSTRACT FROM AUTHOR]

Problem In the vagina of women at the reproductive age, more than 170 strains of bacteria and yeasts are found. The effect of vaginal flora on neonatal T cells is yet to be investigated. Method of study We analyzed CD45RA and CD45RO expression on neonatal CD4+ T cells and cytokine production in CBMC cultures (interferon-γ (IFN-γ ), interleukin-4 (IL-4) and IL-12) related to vaginal bacteria isolated from a maternal vagina. We collected vaginal swabs from 36 women at the first stage of the delivery and cord blood from their newborns. IFN-γ, IL-4, and IL-12 in stimulated CBMC were measured and the expression of CD45RA/CD45RO on CD4+ T cells was assessed. Results We noted the difference in CD45RO CD4+ expression and IL-12 levels between the newborns whose mothers were or were not colonized with Lactobacillus in the vagina (newborns whose mothers were colonized with Lactobacillus: CD45RO-10%±3; IL-12-0.2 pg/mL ± 0.05; newborns whose mothers were not colonized with Lactobacillus: CD45RO-6%±3; IL-12-2.0 pg/mL ± 0.7). Conclusion Our results may indicate that lactobacilli in maternal vagina influence the development of neonatal immune system. Yet, more research is needed using specified bacterial antigens. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of additional topical Lactobacillus casei rhamnosus (Lcr35) subsequent to antibiotic treatment of bacterial vaginosis (BV) to restore the normal vaginal flora. Study design Single-centre, randomised, observerblinded study. Setting Population-based study in Vienna over 1 year. Sample 190 women were enrolled in the study. Methods Women with Nugent scores between 7 and 10 on initial vaginal swab were randomised to the one of two groups. All women were treated with standard antibiotic therapy for 7 days. Only women in the intervention group received vaginal capsules containing 109 colony-forming units of live Lcr35 for 7 days after antibiotic treatment. Final vaginal swabs for Nugent scoring were taken 4 weeks after the last administration of the study medication. Main outcome measures The primary efficacy variable was a change in the Nugent score between the baseline and the end of the study of at least 5 grades in each individual woman. Results Sixty-nine of the 83 women (83%) in the intervention group and 31 of the 88 women (35%) in the control group showed a reduction of the Nugent score by at least 5 grades. The difference in the number of women with improvement was highly significant ( P < 0.001). The median difference in Nugent scores between initial and final swabs was 6.61 in the intervention group and 4.13 in the control group ( P < 0.001). Conclusion Our data show that the restoration of the vaginal flora after antibiotic treatment of BV can be significantly enhanced by exogenously applied lactobacilli. [ABSTRACT FROM AUTHOR]

The ability to reproduce in captivity is an essential component of lion tamarin (Leontopithecus) conservation programs. However, infections such as vaginitis, cervicitis, and endometritis are important diseases that may influence the reproduction of these animals. Therefore, it is important to detect continuous or occasional vaginal microbial populations, and to understand their potential role as an endogenous source of infection [Collins, 1964; Blue, 1983; Pugh et al., 1986]. Vaginal swabs were collected from 25 female tamarins of the three currently available species (L. rosalia, L. chrysopygus, and L. chrysomelas) at the Center of Primatology in Rio de Janeiro, Brazil. The swabs were processed according to standard mycological protocols, and isolates were biochemically characterized. Fungal isolates were recovered from 16 animals (64.0%). The results showed that 70.6% of the isolated microorganisms consisted of yeast, including three species of Candida (mainly C. glabrata). We suggest that this species is a resident member of the normal vaginal flora in Leontopithecus. Filamentous fungi (mainly from Trichosporon, Aspergillus, and Penicillium genera) constituted 29.4% of the isolates, and were considered to be transitory contaminants of the genital area. We suggest that colonization of the vaginal environment is related to the endocrine pattern associated with the reproductive status of these animals, but not to parity. [ABSTRACT FROM AUTHOR]