Search

Objective: Our objective was to determine any associations among midtrimester cervical fluid sialidase activity, bacterial vaginosis, and subsequent spontaneous preterm birth.Study Design: In this nested case-control study all patients (n = 126) with spontaneous preterm birth at <35 weeks' gestation and selected control subjects delivered at >/=37 weeks' gestation (n = 126, matched for race, parity, and center) were derived from women enrolled in the multicenter National Institute of Child Health and Human Development Preterm Prediction Study. Sialidase activity and presence of bacterial vaginosis according to Gram stain were determined in cervical swabs and vaginal smears, respectively, obtained at 22 weeks' to 24 weeks 6 days' gestation.Results: The mean +/- SD sialidase activities were similar in case patients and control subjects (0.64 +/- 1.60 vs 0.41 +/- 0.94 nmol. mL-1. min-1, P =.21). Neither sialidase activity above the 90th percentile (10.3% vs 9.5%, P =.8) nor sialidase activity above the 95th percentile (7.9% vs 4. 8%, P =.3) of control specimens (>1.43 and >2.23 nmol. mL-1. min-1, respectively) was associated with spontaneous preterm birth. The frequency of combinations of bacterial vaginosis and elevated sialidase activity was similar (P >/=.63 with either cutoff) in case patients and control subjects. Sialidase activity was significantly higher among women with bacterial vaginosis than among those without bacterial vaginosis (1.35 +/- 1.87 vs 0.03 +/- 0.14 nmol. mL-1. min-1, P <.0001).Conclusions: Elevated cervical fluid sialidase activity at 22 to 24 weeks' gestation did not distinguish women at increased risk for spontaneous preterm birth, nor did it discriminate a subgroup of patients who had bacterial vaginosis associated with spontaneous preterm birth. [ABSTRACT FROM AUTHOR]

In early 1996, 481 women visiting the antenatal services of the 3 major governmental health centres in the capital city of the Central African Republic (CAR) were included in the study. All study participants underwent the health centre's routine gynaecological examination, including laboratory diagnosis of trichomoniasis, candidiasis, gonorrhoea, syphilis and bacterial vaginosis. Cervical secretions and blood samples from study participants were sent to the National STD Reference Centre for diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans, Treponema pallidum, and HIV. Overall, 34% of the study women were diagnosed with at least one sexually transmitted infection (STI) (3.1% N. gonorrhoeae, 6.2% C. trachomatis, 9.9% T. vaginalis, 6.7% T. pallidum, 12.2% HIV-1). In addition, 29.1% of women were diagnosed with bacterial vaginosis and 46.6% with candidiasis. Only a small proportion of these women had sought treatment during the weeks before, despite the recognition of genital symptoms. Self-reported and health worker-recognized symptoms, signs and laboratory results exhibited only low sensitivities, specificities, and positive predictive values in the diagnosis of STIs. These findings confirm the high vulnerability of young African women to STIs and emphasize the need for specific control interventions which should include affordable and user-friendly services. Moreover, these results call for more effective quality control in case of laboratory-based STI control strategies and question the validity of syndromic STI management strategies in women attending antenatal care services in Africa. [ABSTRACT FROM AUTHOR]

The article focuses on the diagnosis and treatment of sexually transmitted bacterial infections in industrialized countries. Information about several types of infections such as chlamydia trachomatis, mycoplasmal and ureaplasmal infections, trichomonas vaginalis infection and bacterial vaginosis is included.

Objective: To evaluate the association between various microorganisms isolated from the genital tract in pregnant women with bacterial vaginosis.Study Design: A cross-sectional population-based study among pregnant women addressed at their first antenatal visit before 24 full gestational weeks from the referring area of the Department of Obstetrics and Gynecology at Odense University Hospital, Denmark, from November 1992 to February 1994. The main outcome measures were prevalence of various microorganisms and statistical estimates of interactions (crude, adjusted, and relative odds ratios) between the microorganisms isolated from the lower genital tract in pregnant women with and without clinical diagnosis of bacterial vaginosis.Results: Three thousand five hundred ninety-six (3596) pregnant women were asked to participate. Of the 3596 pregnant women 3174 (88.4%) agreed to participate before 24 full gestational weeks. After controlling for the presence of other microorganisms, strong associations between Gardnerella vaginalis, anaerobic bacteria, Mycoplasma hominis, and present bacterial vaginosis were found. Similarly Lactobacillus spp. were found to be associated with the absence of bacterial vaginosis. The combination of G. vaginalis and anaerobic bacteria and/or M. hominis was found in 59.6% of the cases with bacterial vaginosis and in 3.9% of the cases without bacterial vaginosis (odds ratio 36.4, 95% confidence interval 27.8 to 47.8). The crude odds ratio was found to be as high as 74.8 (95% confidence interval 32.3 to 174.1) when the combination of G. vaginalis, M. hominis, anaerobic bacteria, and no Lactobacillus spp. was associated with bacterial vaginosis.Conclusion: There is a microbial foundation for bacterial vaginosis, and it is possibly due to an intermicrobial interaction in which the microorganisms G. vaginalis, anaerobic bacteria, and M. hominis are dominating, indicating that these constitute the pathologic core of bacterial vaginosis. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate any association between vaginal carriage of Mycoplasma hominis and genital signs and symptoms, other microbial findings, and some risk behavior factors in women with and without bacterial vaginosis.Study Design: Women who had attended two family planning clinics and a youth clinic for contraceptive advice were divided depending on the result of vaginal culture for Mycoplasma hominis and the occurrence of bacterial vaginosis. The study population included 123 (12.3%) women who harbored Mycoplasma hominis. Those 873 (87.7%) with a negative culture for Mycoplasma hominis served as a comparison group. In the former group, 50 (40.7%) had bacterial vaginosis, which was also the case in 81 (9.3%) of the women in the comparison group. The groups were compared with regard to genital signs and symptoms, results of vaginal wet smear microscopy and other office tests, vaginal flora changes as detected by culture, and other means and detection of sexually transmitted diseases. Any history of sexually transmitted diseases and other genital infections, reproductive history, use of oral contraceptives, and smoking habits were registered.Results: Women who harbored Mycoplasma hominis had significantly more often complained of a fishy odor, had a positive amine test, a vaginal pH > 4.7, and clue cells than did the comparison group; all these statements were true before and after bacterial vaginosis had been excluded. Vaginal discharge was not significantly more often complained of, and a pathologic discharge was not more often detected in the Mycoplasma hominis carriers. Ureaplasma urealyticum occurred in 75% of the Mycoplasma hominis-positive women and in 59% of the comparison group (p = 0.001). The leukocyte/epithelial cell ratio did not differ significantly from that of the Mycoplasma hominis culture-negative controls.Conclusion: The study suggests that Mycoplasma hominis is associated with a number of genital signs and symptoms even after exclusion of bacterial vaginosis. [ABSTRACT FROM AUTHOR]

Objectives: (1) To compare the effectiveness of two clinical protocols for the management of vaginal discharge in the situations where no laboratory facilities are available but speculum examination is possible and where basic laboratory facilities are available. (2) To determine clinical and simple laboratory indicators for diagnosis of patients with vaginal discharge in the local setting.Design: Alternate allocation of subjects to one of two management protocols.Subjects: Women presenting to university gynaecology outpatients department with a complaint of vaginal discharge.Methods: Subjects were alternately allocated management according to one of two protocols: one without (group A) and one with (group B) immediate access to results of basic laboratory tests. Full clinical assessment including speculum examination and microbiological assessment for infection with gonorrhoea, chlamydia, candida, trichomonas, and bacterial vaginosis was performed on all women. Follow up assessment of clinical and microbiological response was performed 1-2 weeks later.Results: At initial assessment, both groups were similar in all respects except that more group B women had inflammation of the vulva. The prevalences of various conditions were: candidiasis 22%, bacterial vaginosis 38%, trichomoniasis 4%, chlamydia 4%, gonorrhoea 0.4%. There was no association between any demographic characteristic and diagnosis of cause of the discharge. Both protocols resulted in clinically and statistically significant improvements for women with candidiasis, bacterial vaginosis, and trichomoniasis. There were no clinically important differences in outcomes between the two protocols. The sensitivities and specificities of various indicators were: curd-like vaginal discharge for candidiasis, 72% and 100%; homogeneous vaginal discharge for bacterial vaginosis or trichomoniasis, 94% and 88%; absent or scanty lactobacilli for bacterial vaginosis, 99% and 68%; > 20% clue cells for bacterial vaginosis, 81% and 99%; visible endocervical mucopus for chlamydia or gonorrhoea, 36% and 86%; microscopic endocervical mucopus for chlamydia or gonorrhoea, 64% and 69%.Conclusions: Both protocols were equally effective in managing women with abnormal vaginal discharge. Simple clinical indicators for candidiasis, bacterial vaginosis, or trichomonas as in protocol A are sufficiently sensitive and specific for use in situations with no laboratory support. A modification to protocol A could increase detection of bacterial vaginosis at basic health service level. Further work is needed to identify appropriate indicators for infection with chlamydia or gonorrhoea. [ABSTRACT FROM AUTHOR]

Background: Bacterial Vaginosis (BV) is characterized by an increased thin homogenous white vaginal discharge accompanied by fishy odour and increased vaginal pH. It is associated with different gynecologic and poor obstetric outcome. Bacterial vaginosis can be easily diagnosed by combination of two Amsel's criteria. Objective: The aim of this study was to evaluate the accuracy of Amsel's criteria individually or in combination of two for the clinical diagnosis of bacterial vaginosis among pregnant women in Ethiopia. Material and Methods: In this crosssectional study 252 pregnant women were screened for bacterial vaginosis. Vaginal swabs were collected for pH determination, saline wet mount microscopic examination to detect clue cells, KOH preparation for whiff test and Gram-stain evaluation of vaginal flora for diagnosis of bacterial vaginosis by Nugent scoring system. Accuracy of clinical diagnosis using individual and two of Amsel's criteria was evaluated. Results: The prevalence of BV was 18.3% by Amsel's two of three criteria and 19.4% Gram by Nugent's methods. Comparing with Nugent scoring methods, the clinical diagnosis by Amsel's criteria had sensitivity of 85.7%, specificity of 98%. The most sensitive and specific individual Amsel's criterion was clue cells. Amsel's criteria with the lowest sensitivity and specificity were whiff test and vaginal pH respectively. Combination of clue cells with vaginal pH test were the highest in sensitive while whiff test with clue cells were the highest in specificity than the other combined two Amsel's criteria. Conclusion: Amsel's criteria diagnosis of bacterial vaginosis can be simplified by using a combination of the two criteria, vaginal pH and clue cells, in settings where time or Gram staining is not available. [ABSTRACT FROM AUTHOR]

The article highlights legal and ethical responsibilities associated with prescribing and discusses the seven-step pattern devised by the National Prescribing Centre. It demonstrates a structured and safe approach on the treatment of bacterial vaginosis. A figure showing the prescribing pyramid and tabular arrays which present constructive history-taking sequence of an illness, assessment, The Socrates Mnemonic and what drugs to use, The Ease Mnemonic are also shown.

The article focuses on methods of diagnosis of recurrent vaginitis, bacterial vaginosis and trichomoniasis.

Abstract: Objective: To determine the prevalence of bacterial vaginosis (BV) in patients with vaginal discharge and evaluate the efficacy of OSOM BV blue test in diagnosis. Methods: OSOM BV blue test, a rapid diagnostic test based on the principle of detection of bacterial sialidase activity in vaginal fluid specimens was conducted. A total of 405 patients in the reproductive age group (15–45 years) having vaginal discharge were included in the study along with 10 healthy age-matched controls. Two high vaginal swabs were collected aseptically from each patient. One swab was used to make smear for gram staining, and the other was for OSOM BV blue test. Amine test and vaginal pH test were taken as well. Results: The prevalence of bacterial vaginosis was 60.7%. OSOM BV blue test showed good efficacy, as compared with gram staining in diagnosing BV. The sensitivity and specificity of OSOM BV blue test were 97.6% and 97.5% respectively. Amsel''s criteria diagnosed 180 (44.4%) cases of BV and had sensitivity and specificity of 67.1% and 90.6% respectively. Thus the performance of OSOM BV blue was better than the methods based on Amsel''s criteria. Conclusions: OSOM BV blue test is an efficacious bed side test, helpful in rapidly making an accurate diagnosis of BV in setups lacking laboratory facilities or expert microbiologists. [Copyright &y& Elsevier]

Objectives: Low participation rates for gynaecological examination and low reliability of clinical reporting of gynaecological examination findings are problems in community studies of gynaecological morbidity in India. This pilot study aimed to describe the reliability of a new examination protocol for recording the findings of gynaecological examination and the reliability and acceptability of the use of self administered vaginal swabs for the diagnosis of reproductive tract infections.Method: 75 women attending a gynaecology outpatient clinic were purposively sampled. Each woman was examined by two gynaecologists independently who recorded findings on the new examination protocol. Two swabs were collected from each woman, one by the gynaecologist and one by the woman. Swabs were smeared on separate slides which were stained and read for bacterial vaginosis and candidiasis by laboratory technicians blind to the mode of collection of the slides.Results: The study showed a high inter-rater reliability for most of the items of the examination protocol. The interslide agreement for the diagnosis of the two RTIs was high. One third of women preferred the self administered swab.Conclusions: The examination protocol is a reliable method of recording gynaecological examination findings, and self administered swabs a useful way of obtaining vaginal specimens from women who did not wish to undergo gynaecological examinations in studies in the Indian setting. [ABSTRACT FROM AUTHOR]

Objectives: To validate a simplified grading scheme for Gram stained smears of vaginal fluid for the diagnosis of bacterial vaginosis (BV) against the accepted "gold" standard of Amsel's composite criteria.Methods: Women attending genitourinary medicine (GUM) clinics, as part of a multicentre study, were diagnosed as having BV if three or more of the following criteria were present; homogeneous discharge, elevated vaginal pH, production of amines, and presence of "clue" cells. Women with less than three of the criteria were considered as normal. Simultaneously, smears were made of vaginal fluid and Gram stained and then assessed qualitatively as normal (grade I), intermediate (grade II), or consistent with BV (grade III). Two new grades were used, grade 0, epithelial cells only with no bacteria, and grade IV, Gram positive cocci only.Results: BV was diagnosed in 83/162 patient visits using the composite criteria, the remainder being regarded as normal. The majority of patients with BV had a smear assessed as grade III (80/83, 96%) and the majority of normal women had a smear assessed as grade I (normal, 48/79, 61%), giving a high sensitivity (97.5%), specificity (96%), and predictive value for a positive (94.1%) and negative (96%) test, kappa index = 0.91. Smears assessed as grade II were found predominantly (12/13) among patients diagnosed as normal, with less than three of the composite criteria. Grades 0 and IV were both only found among normal women.Conclusion: This simplified assessment of Gram stained smears can be used as an alternative to Amsel's criteria and is more applicable for use in busy GUM clinics. [ABSTRACT FROM AUTHOR]

The article reports on the market authorization from the U.S. Food and Drug Administration earned by a molecular diagnostic test for use by diagnostic laboratories in October 2016. The test, that accurately distinguishes the three most common causes of vaginitis such as vulvovaginal candidiasis, trichomoniasis and bacterial vaginosis, is licensed to BD Diagnostics of Franklin Lakes, New Jersey, that markets it under the BD MAX Vaginal Panel.

The article reports on the efforts of inside knowledge campaign materials to improve gynecologic cancer knowledge in underserved women. It mentions the purpose of this project at increasing and assessing awareness of risk, symptoms, and recommended screenings and prevention activities in underserved women, through unique collaboration between the Centers for Disease Control and Prevention's (CDC).

The article discusses about clue cells, the vaginal squamous epithelial cells coated with the anaerobic gram-variable coccobacilli Gardnerella vaginalis and other anaerobic bacteria causing bacterial vaginosis. It has the capacity to detect on simple wet mount of vaginal secretions and can be demonstrated by microscopic examination. The presence of clue cells in vaginal discharge has also been used to predict postoperative infections after abdominal hysterectomy.

OBJECTIVE: The purpose of this study is to compare costs of 3 strategies for women undergoing hysterectomy: (1) test all patients for bacterial vaginosis; treat if positive; (2) treat all patients for bacterial vaginosis; (3) neither test nor treat patients for bacterial vaginosis. For comparison purposes, a fourth strategy is examined: (4) no surgical site infection prophylaxis or bacterial vaginosis treatment. STUDY DESIGN: A cost minimization model was created using estimates obtained from the published literature, Medicare reimbursement data, and wholesale drug costs. RESULTS: In the base case, the optimal strategy was to treat all patients for bacterial vaginosis, with a cuff infection rate of 4.0% and mean cost of $593. The 'test all patients for bacterial vaginosis; treat if positive' strategy was also inexpensive, with a mean cost of $623 and 4.2% cuff infection rate. 'Neither test nor treat patients for bacterial vaginosis' and 'no surgical site infection prophylaxis or bacterial vaginosis treatment' were more expensive and less effective than other strategies. CONCLUSION: This model suggests that consideration should be given to adding metronidazole to standard surgical site infection prophylaxis before hysterectomy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Conventional diagnosis of bacterial vaginosis contains some controversial points. To understand accurately the relationship between clinical stages and the microbiotas, the intravaginal microbial flora was analyzed by the clone library method. STUDY DESIGN: Vaginal fluid samples from 31 patients were examined. Lactobacillary grade, Nugent score, culture-based method, and clone library analysis using the 16SrRNA gene sequencing were performed and were compared with each other. RESULTS: Patients were categorized by Lactobacillary grade as I (normal) (n = 6), II (intermediate) (n = 11), and III (bacterial vaginosis) (n = 14). The clone library analysis detected 36 bacterial genera and 60 species from all 31 samples. A principal component analysis of the microbial proportions revealed a novel classification, which suggested the significance of the relative ratio of Lactobacillus iners, Atopobium vaginae and anaerobes in bacterial vaginosis. CONCLUSION: Clone library analysis in combination with the conventional method provides substantial information for diagnosis of bacterial vaginosis. [ABSTRACT FROM AUTHOR]

Objective: The objective was to examine the use of a tailor-made DNA microarray containing probes representing the vaginal microbiota to examine bacterial vaginosis. Study Design: One hundred one women attending a health center for HIV testing in South Africa were enrolled. Stained, liquid-based cytology slides were scored for bacterial vaginosis. An inventory of organisms was obtained using microarray technology, probing genera associated with bacterial vaginosis in more detail, namely Gardnerella, Atopobium, Dialister, Leptotrichia, Megasphaera, Mobiluncus, Peptostreptococcus, Prevotella, and Sneathia. Results: Of 101 women, 34 were diagnosed positive for bacterial vaginosis. This condition was associated with an increased microbial diversity. It is no longer useful to base the diagnosis of bacterial vaginosis on Gardnerella alone. Rather, its presence with Leptotrichia and Prevotella species, and especially Atopobium was more indicative of an aberrant state of the vaginal flora. Conclusion: To understand the vaginal microbiota in more detail, microarray-based identification can be used after microscopic scoring. [ABSTRACT FROM AUTHOR]

Background: The aetiology of bacterial vaginosis (BV) remains unknown.Objective: To describe longitudinal changes in vaginal microbiota.Methods: Thirty-nine women (mean age 36.8 years; 22 (56.4%) African-American) self-collected vaginal specimens twice weekly for 16 weeks as part of a vaginal douching cessation study. In an analysis where each woman serves as her own control, conditional logistic regression was used to evaluate daily, time-varying factors associated with a woman's incident BV episode(s) as compared with her persistently BV-negative sample(s). BV was defined by a Nugent's Gram stain score >or=7.Results: 46.2% of participants had BV in the first 4 weeks of observation. Rapid fluctuation of vaginal microbiota was observed in 226 transitions to BV or spontaneous remission. Duration of BV was often short: 51% of the episodes lasted for only one sample interval (3 days). Among women who had at least one BV episode, the median number of episodes per woman was 8.7 (SD 7.4, range 1-22). Lubricant use 1 day before specimen collection (adjusted OR (aOR)=11.75, 95% CI 1.96 to 70.27) and rectal sex 2 days before (aOR=4.48, 95% CI 2.79 to 7.17) were associated with BV onset.Conclusion: Rapid fluctuation of the vaginal microbiota was seen. Longitudinal studies with long intervals between sampling are likely to miss episodes of BV. Recent report of lubricant use and rectal sex were associated with incident BV. [ABSTRACT FROM AUTHOR]

Presents an abstract of the paper "A Cost-Benefit Analysis, Diagnosing Bacterial Vaginosis in Pregnancy, Wet-Mount Versus FemExam Card," by Raksha Joshi et al to be presented at the ACOG 52nd Annual Clinical Meeting on May 3, 2004.

Presents an abstract of `Is Bacterial Vaginosis (BV) in Pregnant Women a Sexually Transmitted Disease (STD): Variation By Ethnicity,' by A.R. Goepfert, M. Klebanoff, et al presented at the 17th Annual Meeting of the Society of Perinatal Obstetricians on January 20-25, 1997 in Anaheim, California. Determination of whether risk factors for STD could predict presence of BV in pregnant women.