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Multivariate logistic regression models were used to assess the adjusted relationship between uterine fibroids and BV. Of the 189 patients with uterine fibroids, individuals with BV were more likely to have a submucosal fibroid(s) as compared to those without BV (28.3% vs 10.5%, P = 0.003). The odds of a subsequent diagnosis of BV were higher among patients with submucosal fibroids as compared to those with fibroids in other locations (Odds Ratio: 3.0, 95% CI: 1.3–7.1). Patients with BV demonstrated higher likelihoods of abnormal uterine bleeding (65.5% vs 26.3%, P < 0.001) and anemia (52.2% vs 30.3%, P = 0.003). [ABSTRACT FROM AUTHOR]

Objectives: Bacterial vaginosis (BV) is a vaginal microbiota ecological imbalance that primarily affects women of reproductive age. The study's objectives were to evaluate the risk variables' associations with BV and examine the particular bacteria responsible for BV. Methods: From May to August 2023, 65 samples obtained from pregnant and non-pregnant women who were registered at the Outpatient Albatool Teaching Hospital participated in this study. In this study, the Vitek 2 compact device was utilized to diagnose BV. Results: 15 samples showed no clear growth and only 50 samples showed positive bacterial growth. These samples included 15 (30%) samples from pregnant women and 35 (70%) from non-pregnant women, who showed clinical symptoms associated with bacterial vaginosis (BV). Depending on the color of the homogeneous vaginal secretions, showed that bacterial isolation was from the yellow secretion, and it was at a rate of 19 (38 %), then it was followed by the yellow-green secretion, the percentage of isolation was It contained 18 (36 %), while the percentage of bacterial isolation from white vaginal secretions was 13 (26%). Conclusions: They were diagnosed using the Vitec device to diagnose bacterial isolates, isolated from vaginal secretions and determine their types. the results show that the 20 bacterial isolates were distributed to S. haemolyticus 20 (40%), S. aureus 8 (16%) S. epidermidis 5(10%) E. coli 8 (16 %) Klebsiella pneumonia 6(12%) Gardnerella Vaginalis 3(6%). [ABSTRACT FROM AUTHOR]

Pregnancy with bacterial vaginosis (BV) is accompanied by a high risk of various obstetric and perinatal complications, including miscarriage, preterm birth, placental dysfunction, premature rupture of membranes, chorionamnionitis, polyhydramnios, etc. Screening for BV is carried out in the first half of pregnancy during the registration of a woman, however, taking into account the gestational age, many drugs with antimicrobial and antiseptic effects are categorically contraindicated, as they have an embryo- and fetotoxic effect. Timely detection and correction of microbiocenosis disorders of the birth canal is an extremely important element to prevent a number of obstetric and perinatal complications. A balanced approach in the treatment of vaginal dysbiosis consists in the use of modern combined antiseptic preparations for local treatment, which do not contain antibacterial components and are safe for use during pregnancy. The objective: to determine the effectiveness of the treatment of BV in primigravida women in the first half of pregnancy. Materials and methods. 126 primigravida women aged 18–35 years in the first half of pregnancy were examined during pregnancy registration. The participants were selected randomly. The main group included 36 primigravida women with a gestation period of up to 20 weeks with a diagnosis of BV according to the Amsel and Hay–Ison criteria, who were treated with a combined antiseptic drug (chlorhexidine and chlorophyllipt) – suppository vaginally twice a day, the course of treatment – 5 days. The control group included 30 primigravida women with a gestational age of up to 20 weeks with vaginal normocenosis. For all women the pH of vaginal secretions was determined, followed by microscopy of a native smear, stained according to Gram, and a cultural study was performed. Adherence to the Amsel criteria was also determined, followed by evaluation by the Hay– Ison criteria. The clinical effect was evaluated according to clinical examination data before and on the 6th day of treatment with a combined antiseptic drug (chlorhexidine and chlorophyllipt) using bacterioscopic and bacteriological methods. Results. A normal pH was observed only in every fifth part of examined pregnant woman (28 women – 22.2%), while in the rest patients the acidity of the vaginal environment was not normal. Normocenosis was observed only among 1/3 of primigravida women (37 women – 29.4%). A third of the patients were diagnosed with BV (36 women - 28.6%), every fifth pregnant woman – vulvovaginal candidiasis (28 women - 22.2%). In healthy pregnant women (control group, n=30), the main component of the microbiocenosis was Lactobacillus spp. with a small content of facultatively anaerobic microorganisms. In the main group Atopobium vaginae (38.9%), Gardnerella vaginalis (33.3%), Prevotella bivia (27.8%), Candida spp. (22.2%), as well as Lactobacillus spp. in low titers were dominated. Before the treatment all 36 pregnant women of the main group corresponded to the 3rd type according to the Hay–Ison criteria with the dominance of Gardnerella vaginalis and/or Mobiluncus morphotypes and a small number or complete absence of lactobacilli, which served as the basis for establishing the diagnosis of BV. After treatment type 1 (94.4%) was found in 34 pregnant women, and type 2 (5.6%) – in 2 pregnant women. The results of the microbiological study indicate the normalization of the content of the biotope with the predominance of Lactobacillus spp. in women of the main group, in whom the indicators were similar to the control group. Conclusions. Since pregnancy with BV is accompanied by a high risk of obstetric and perinatal complications, the premorbid background of which is laid already in the first half of pregnancy, there is an urgent need to carry out the birth canal sanitation. The drugs of choice for the BV in the first half of pregnancy are local combined agents of a wide spectrum of action. A universal antiseptic with an anti-inflammatory effect, which includes two components – chlorhexidine and chlorophyllipt, fully meets the recommendations for efficiency and safety and can be used for the BV in the first half of pregnancy. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to investigate the epidemiology of bacterial vaginosis (BV) in Shanghai, China, and to explore the value of a dual-fluorescence staining method in the diagnosis of BV. Methods Specimens were collected from women with vaginitis at the Obstetrics and Gynecology Hospital of Fudan University from January 2020 to December 2021, and the proportions of various vaginitis types (such as Candida vaginitis, Trichomonas , and bacterial vaginitis) were analyzed statistically. To explore the diagnostic value of dual-fluorescence staining for BV, we first executed a dual-fluorescence staining method to analyze the vaginal secretions of 265 patients, then confirmed our diagnoses by consulting clinical physicians and by using Nugent scoring of Gram staining. Results There were 16,905 patients who were diagnosed with vaginitis over the previous 2 years, with a median age of 32 (minimum age of 9 years and maximum of 84 years). Of these patients, we noted 10,887 cases (64.40%) of BV. Our staining results revealed that the dual-fluorescence method was consistent with Gram staining in the diagnosis of BV, with a P value of less than.001 using a χ 2 test and a consistency kappa value of 0.896. Compared with Gram staining, the dual-fluorescence staining method required an acceptable time (2.2 min vs 2.5 min, respectively) and exhibited different visual effects (green and yellow vs purple and red, respectively). Conclusion Dual-fluorescence staining for the detection of bacterial diseases of the vagina exhibited acceptable consistency with Gram staining and performed well with respect to dyeing time, stability, and the interpretation of results. We argue that this method should be used in outpatient services. [ABSTRACT FROM AUTHOR]

Copyright of Matronas Hoy is the property of Asociacion Espanola de Matronas (AEM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

While machine learning (ML) has shown great promise in medical diagnostics, a major challenge is that ML models do not always perform equally well among ethnic groups. This is alarming for women's health, as there are already existing health disparities that vary by ethnicity. Bacterial Vaginosis (BV) is a common vaginal syndrome among women of reproductive age and has clear diagnostic differences among ethnic groups. Here, we investigate the ability of four ML algorithms to diagnose BV. We determine the fairness in the prediction of asymptomatic BV using 16S rRNA sequencing data from Asian, Black, Hispanic, and white women. General purpose ML model performances vary based on ethnicity. When evaluating the metric of false positive or false negative rate, we find that models perform least effectively for Hispanic and Asian women. Models generally have the highest performance for white women and the lowest for Asian women. These findings demonstrate a need for improved methodologies to increase model fairness for predicting BV. [ABSTRACT FROM AUTHOR]

Vaginitis is a common gynecological problem, nevertheless, its clinical evaluation is often insufficient. This study evaluated the performance of an automated microscope for the diagnosis of vaginitis, by comparison of the investigated test results to a composite reference standard (CRS) of wet mount microscopy performed by a specialist in vulvovaginal disorders, and related laboratory tests. During this single-site cross-sectional prospective study, 226 women reporting vaginitis symptoms were recruited, of which 192 samples were found interpretable and were assessed by the automated microscopy system. Results showed sensitivity between 84.1% (95%CI: 73.67–90.86%) for Candida albicans and 90.9% (95%CI: 76.43–96.86%) for bacterial vaginosis and specificity between 65.9% (95%CI: 57.11–73.64%) for Candida albicans and 99.4% (95%CI: 96.89–99.90%) for cytolytic vaginosis. These findings demonstrate the marked potential of machine learning-based automated microscopy and an automated pH test of vaginal swabs as a basis for a computer-aided suggested diagnosis, for improving the first-line evaluation of five different types of infectious and non-infectious vaginal disorders (vaginal atrophy, bacterial vaginosis, Candida albicans vaginitis, cytolytic vaginosis, and aerobic vaginitis/desquamative inflammatory vaginitis). Using such a tool will hopefully lead to better treatment, decrease healthcare costs, and improve patients' quality of life. [ABSTRACT FROM AUTHOR]

Introduction: The diagnosis of bacterial infection can only be made by gram stain with patient information. One of the problems with gram staining is that the resulting microscopic images look dim, making them prone to misinterpretation. Researchers conducted a study on modifying secondary dyes in gram staining to improve the accuracy of the diagnosis of Bacterial vaginosis infections. Methods: This research is a laboratory experimental study with a cross sectional approach. The sample of this study consisted of anaerobic gram-negative rods on vaginal swabs of patients diagnosed with Bacterial vaginosis at Dr. Moewardi Hospital and Sebelas Maret University Hospital during March to July 2022. The samples were then treated in the form of gram staining with different secondary dyes and then compared. Results: The color intensity of anaerobic gram-negative rod bacteria samples treated with gram staining using fuchsin secondary dye appeared to be stronger than safranin secondary dye. Likewise, the resulting focus looks clearer. The diagnostic test showed that modification of secondary dyes in gram staining by substituting safranin into fuchsin increased the color intensity and focus of preparations Conclusion: Modification of secondary dye on gram staining by replacing secondary dye of safranin to fuchsin can improve the quality of gram staining results on anaerobic gram negative bacteria thereby increasing the accuracy of diagnosis and treatment given. [ABSTRACT FROM AUTHOR]

Bacterial vaginosis (BV) represents a condition in which the normal protective Lactobacilli, especially those that produce H2O2, are replaced by high quantities of facultative anaerobes, leading to gynecologic and obstetric post-operative complications. BV is an important cause of obstetric and gynecological adverse sequelae and it could lead to an increased risk of contracting sexually transmitted infections such as gonorrhea, genital herpes, Chlamydia, Trichomonas, and human immunodeficiency virus. Herein, we reviewed bacterial vaginosis and its association with post-operative pelvic infections. In Obstetrics, BV has been associated with increased risk of preterm delivery, first-trimester miscarriage in women undergoing in vitro fertilization, preterm premature rupture of membranes, chorioamnionitis, amniotic fluid infections, postpartum and postabortal endomyometritis as well as postabortal pelvic inflammatory disease (PID). In gynecology, BV increases the risk of post-hysterectomy infections such as vaginal cuff cellulitis, pelvic cellulitis, pelvic abscess, and PID. BV is often asymptomatic, can resolve spontaneously, and often relapses with or without treatment. The American College of Obstetricians and Gynecologists recommends testing for BV in women having an increased risk for preterm delivery. Women with symptoms should be evaluated and treated. Women with BV undergoing gynecological surgeries must be treated to reduce the frequency of post-operative pelvic infections. Metronidazole and clindamycin are the mainstays of therapy. Currently, there is no consensus on pre-surgery screening for BV; decisions are made on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Background: Vaginal discharge is a common complaint among women attending the sexually transmissible infections (STIs) clinic and is a cause for concern and mental distress. It can be attributed to physiological or pathological causes. This study aims to understand the prevalence of various etiologies of vaginal discharge, which would help frame health policies based on local needs. Objectives: (1) To estimate the prevalence of discharge per vaginum among sexually active women attending the STI clinic at a tertiary care center during a 1-year period, (2) To identify the organisms causing vaginal discharge, (3) To have a clinicoetiological correlation of the cases, and (4) To identify the subspecies of Candida causing vaginal candidiasis. Materials and Methods: A total of 126 patients with vaginal discharge attending the STI clinic at a tertiary care center were included in the study. A detailed clinical history, physical examination of the external genitalia, and vaginal examination were done on each patient. Five swabs were taken from the posterior fornix and lateral vaginal wall for evaluation of the organisms. Results: The mean age of the study population was 31.51 ± 7.9 years. Vulvovaginal candidiasis (VVC) was found to be the most common cause of vaginal discharge, followed by bacterial vaginosis, mucopurulent cervicitis, herpes genitalis, and trichomoniasis. The most common species of Candida was found to be Candida albicans. Conclusion: Even though VVC still remains the major cause, other viral infections like herpes significantly contribute. Vaginal discharge is an important indicator of women's reproductive health and its detailed evaluation helps identify the prevalence of various STIs in the community. [ABSTRACT FROM AUTHOR]

Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To assess efficacy and safety of a single-dose vaginal clindamycin gel for bacterial vaginosis treatment.Methods: We conducted a double-blind, placebo-controlled, randomized study comparing clindamycin gel with placebo (2:1 ratio). Entry required clinical diagnosis of bacterial vaginosis, that is, all four Amsel's criteria, without other genital infections. Nugent scores of 7-10 were required for efficacy assessment, per updated 2019 U.S. Food and Drug Administration guidance. Patients were evaluated at screening, day 7-14, and day 21-30 (test of cure). Clinical cure was defined as resolution of three of four Amsel's criteria. Bacteriologic cure was defined as Nugent score lower than 4. Therapeutic cure was both clinical and bacteriologic cure. Primary outcome was clinical cure at the test-of-cure visit. Secondary endpoints were clinical cure at day 7-14, and bacteriologic and therapeutic cures at day 7-14 and test of cure. A sample size of 188 patients in the clindamycin group compared with 94 patients in the placebo group had 90% power to detect statistically significant difference (P=.05, 2-tailed).Results: Participants were seen between July 9, 2020, and November 12, 2020. Of 307 randomized women, 56.0% were Black and 88.3% reported one or more previous bacterial vaginosis episodes. In the modified intention-to-treat population, 70.5% of patients in the clindamycin group and 35.6% in the placebo group achieved clinical cure at test of cure (primary outcome) (difference of 34.9, 95% CI 19.0-50.8), as did 77.5% of patients in the clindamycin group and 42.6% of patients in the placebo group in the per-protocol population (difference of 34.9, 95% CI 17.0-52.7). Statistically significant differences between groups were seen for all secondary endpoints. Clinical cure rate in patients in the clindamycin group with more than three bacterial vaginosis episodes in the prior year was 70.0%. Approximately 15% (15.3%) of patients in the clindamycin group experienced one or more treatment-emergent adverse events related to study treatment, as did 9.7% of patients in the placebo group. The most frequent treatment-related, treatment-emergent adverse event was vulvovaginal candidiasis.Conclusion: A new, single-dose clindamycin vaginal gel was highly effective, with excellent safety, in women disproportionately affected by bacterial vaginosis, with Nugent scores of 7-10 at study entry.Funding Source: The study was funded by Daré Bioscience, Inc.Clinical Trials Registration: ClinicalTrials.gov, NCT04370548. [ABSTRACT FROM AUTHOR]

In preparation for the 2021 Centers for Disease Control and Prevention (CDC) sexually transmitted infections (STIs) treatment guidelines, the CDC convened an advisory group in 2019 to examine recent literature addressing updates in the epidemiology, diagnosis, and management of STIs. This article summarizes recent data in each of these key topic areas as they pertain to bacterial vaginosis (BV), the most common cause of vaginal discharge. The evidence reviewed primarily focused on updates in the global epidemiology of BV, risk factors for BV, data supportive of sexual transmission of BV-associated bacteria, BV molecular diagnostic tests, and novel treatment regimens. Additionally, recent literature on alcohol abstinence in the setting of 5-nitroimidazole use was reviewed. [ABSTRACT FROM AUTHOR]

Background: Screening for genital inflammation can reveal asymptomatic cases of sexually transmitted infections (STIs) and bacterial vaginosis (BV), useful in settings where only syndromic management is available. This study aimed to estimate the incremental cost of screening using a new cytokine biomarker rapid test and determine the budget impact of providing this service in primary health facilities in South Africa.Methods: Costs of adding genital inflammation screening to existing family planning services were estimated for women (15-49 years) attending 3 different family planning clinics in US $2016. The predicted unit cost per patient screened from a provider's perspective was calculated using bottom-up and top-down approaches and was used to analyze the budget impact of scaling up and providing this service in primary health facilities countrywide. Univariate sensitivity analyses tested the robustness of the findings.Results: The incremental cost per woman screened for genital inflammation ranged between US $3.19 and US $4.79. The scaled-up costs ranged between US $7,245,775 and US $22,212,636 countrywide, annually. This was based on the number of women of reproductive age currently seeking contraceptive care at all primary health care facilities, as a proxy for those most susceptible to asymptomatic STIs/BV. The cost estimates were sensitive to changes in personnel costs, utilization rate, and population coverage rates.Conclusions: This screening tool is likely to increase case detection, contributing to better STI/BV management and control, in addition to reducing women's risk of HIV acquisition. The incremental cost estimates could make implementation affordable. [ABSTRACT FROM AUTHOR]

Background: In a randomized controlled trial of 2 g (single-dose) metronidazole (MTZ) versus 500 mg twice daily for 7 days (multidose) for Trichomonas vaginalis treatment, multidose was superior. We examined if the effect was similar by select clinical factors to determine if treatment recommendations could be targeted.Methods: The primary outcome was T. vaginalis repeat infection at test-of-cure (TOC) 4 weeks after completion of therapy. Analyses were stratified by T. vaginalis history, baseline genital symptoms, and concurrent diagnosis of bacterial vaginosis (BV) per Nugent score at baseline.Results: Women who returned for TOC (n = 540) were included. At baseline, 52.9% had a self-reported history of T. vaginalis; 79.3%, genital symptoms; 5.8%, a gonorrhea diagnosis; and 47.5%, BV. During follow-up, 97.4% took all MTZ as instructed and 34.5% had interval condomless sex with a baseline partner. At TOC, 14.8% tested positive for T. vaginalis. In stratified analysis, women randomized to single-dose MTZ had a higher rate of TOC T. vaginalis positivity than those randomized to multidose if they were symptomatic at baseline (21.4% vs. 10.8%, P = 0.003) or had a reported history of T. vaginalis (24.1% vs. 12.6%, P = 0.01). Test-of-cure T. vaginalis positivity was higher for women receiving a single dose (18.9%) versus multidose (10.8%), irrespective of baseline BV status (P > 0.06). In multivariable analysis, only a history of T. vaginalis and single-dose MTZ were independently associated with a positive TOC for T. vaginalis.Conclusions: Although multidose MTZ is recommended for all women with T. vaginalis, it is especially important for women with a T. vaginalis history and, given high posttreatment infection rates, a TOC should be performed. [ABSTRACT FROM AUTHOR]

Objective: To compare the performance of vaginitis diagnosis based on clinical assessment to molecular detection of organisms associated with bacterial vaginosis, vulvovaginal candidiasis, and Trichomonas vaginalis using a vaginal panel assay.Methods: This cross-sectional diagnostic accuracy study included 489 enrolled participants from five collection sites where those with vaginitis symptoms had a vaginal assay swab collected during their visit and a clinical diagnosis made. The swab was later sent to a separate testing site to perform the vaginal panel assay. Outcome measures include positive, negative, and overall percent agreement (and accompanying 95% CIs) of clinical assessment with the vaginal panel assay. P<.05 was used to distinguish significant differences in paired proportions between the vaginal panel assay and clinical diagnosis, using the McNemar test. Inter-rater agreement between the two diagnostic approaches was determined using Cohen's kappa coefficient.Results: Clinical diagnosis had a positive percent agreement with the vaginal panel assay of 57.9% (95% CI 51.5-64.2%), 53.5% (95% CI 44.5-62.4%), and 28.0% (95% CI 12.1-49.4%) for bacterial vaginosis, vulvovaginal candidiasis, and T vaginalis, respectively. Negative percent agreement for clinical diagnosis was 80.2% (95% CI 74.3-85.2%), 77.0% (95% CI 72.1-81.4%), and 99.8% (95% CI 98.7-99.9%), respectively. Sixty-five percent (67/103), 44% (26/59), and 56% (10/18) of patients identified as having bacterial vaginosis, vulvovaginal candidiasis, and T vaginalis by assay, respectively, were not treated for vaginitis based on a negative clinical diagnosis. Compared with the assay, clinical diagnosis had false-positive rates of 19.8%, 23.0%, and 0.2% for bacterial vaginosis, vulvovaginal candidiasis, and T vaginalis, respectively. Significant differences in paired proportions were observed between the vaginal panel assay and clinical diagnosis for detection of bacterial vaginosis and T vaginalis.Conclusion: The vaginal panel assay could improve the diagnostic accuracy for vaginitis and facilitate appropriate and timely treatment.Funding Source: Becton, Dickinson and Company. [ABSTRACT FROM AUTHOR]

Objectives: STIs cause inflammation that is detrimental for both HIV risk and reproductive health. We assessed the impact of point-of-care (POC) STI testing, immediate treatment and expedited partner therapy (EPT) on genital tract cytokines among a cohort of young South African women.Methods: HIV-negative women underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) by Xpert CT/NG and OSOM TV, and for bacterial vaginosis (BV) by microscopy. Women with STIs and/or BV received immediate treatment, EPT for STIs and retested after 6 and 12 weeks. Concentrations of 48 cytokines were measured in cervicovaginal fluid at each visit using multiplex ELISA technology. The impact of STI treatment on cytokine concentrations was assessed by multivariable linear mixed models and principal component analysis.Results: The study enrolled 251 women with median age of 23 years (IQR 21-27). The prevalence of CT, NG and TV were 14.3%, 4.4% and 4.0%, and 34.3% had BV. Women with STIs or BV at baseline (n=94) had significantly higher concentrations of pro-inflammatory cytokines (interleukin (IL)-1α, IL-1β, IL-6, tumour necrosis factor (TNF)-α, TNF-β, IL-18 and macrophage inflammatory factor (MIF)) and chemokines (IL-8, IL-16, macrophage inflammatory protein (MIP)-1α, IFN-α2, monokine induced by gamma interferon (MIG), monocyte chemoattractant protein (MCP)-3, regulated on activation normal T cell expressed and secreted and eotaxin) compared with women without (n=157). STI treatment was strongly associated with reduced concentrations of pro-inflammatory cytokines IL-6 (p=0.004), IL-1β (p=0.013), TNF-α (p=0.018) and chemokines MIG (p=0.008) and growth-related oncogene (GRO)-α (p=0.025). A lower Nugent score was associated with a reduction in pro-inflammatory cytokines IL-1α (p=0.003), TNF-related apoptosis-inducing ligand (p=0.004), MIF (p=0.010) and IL-18 (p<0.001), but an increase in chemokines MIG (p=0.020), GRO-α (p<0.001), IP-10 (p<0.001), MIP-1β (p=0.008) and MCP-1 (p=0.005). Principal component analysis showed differences in STI and BV-related inflammatory profiles, but that resolution restored a profile consistent with vaginal health.Conclusions: A comprehensive STI intervention effectively reduced genital inflammation among young women, thereby improving vaginal health and potentially reducing HIV risk. [ABSTRACT FROM AUTHOR]

Background: The most common pathological cause of abnormal vaginal discharge in reproductive-aged women is bacterial vaginosis (BV). Amsel's criteria and Nugent scoring systems are commonly employed approaches for the diagnosis of BV. Despite the Nugent scoring system being the gold standard method for diagnosing BV, Amsel's criteria are generally preferred in clinical setup owing to the fact Nugent scoring requires considerable time and expert microscopist. This study was conducted to determine the diagnostic value of Amsel's criteria by comparing it with the Nugent scoring system.Methods: This was a descriptive cross-sectional study conducted at Tribhuvan University Teaching Hospital, Nepal from October 2016 to September 2017. Vaginal specimens were collected from a total of 141 women presenting with abnormal vaginal discharge. The sensitivity, specificity, positive predictive value, and negative predictive value of Amsel's criteria were calculated, and each component of Amsel's criteria was compared to the Nugent scoring system.Results: The sensitivity, specificity, positive predictive value, and negative predictive value of Amsel's criteria were 50%, 98.2%, 87.5%, and 88.8% respectively. The clue cells showed 100% specificity and vaginal discharge with pH > 4.5 had 89.3% sensitivity while compared with Nugent's scoring system.Conclusions: Amsel's criteria can be used as an adjunct method to Nugent scoring for the diagnosis of BV in the hands of skilled manpower in resources limited countries. The presence of clue cell and positive whiff test of Amsel's criteria shows good match with Nugent's score. [ABSTRACT FROM AUTHOR]

The Nugent score is the reference standard for bacterial vaginosis (BV) diagnosis but has not been validated in postmenopausal women. We compared relative abundances from 16S ribosomal RNA gene sequencing of vaginal microbiota with Nugent score in cohorts of premenopausal (n = 220) and postmenopausal (n = 144) women. In premenopausal women, 33 taxa were significantly correlated with Nugent score, including the classic BV-associated taxa Gardnerella, Atopobium, Sneathia, Megasphaera, and Prevotella. In postmenopausal women, 11 taxa were significantly associated with Nugent score, including Prevotella but no other BV-associated genera. High Nugent scores should not be used to infer BV in postmenopausal women. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the association of bacterial vaginosis and skin disorders in patients with autoimmune antibody positivity. STUDY DESIGN: This retrospective study consisted of 80 patients with autoimmune antibody positivity. All patients were evaluated for the presence of bacterial vaginosis and skin disorders. Cervicovaginal smears were used for the definitive diagnosis of bacterial vaginosis. RESULT: We found bacterial vaginosis in 13.75% (11/80) of the cases. 1 (9.1%) and 10 (90.9%) cases had skin disorders in bacterial vaginosis positive and negative groups respectively (p=0.531). CONCLUSION: There is no relationship between bacterial vaginosis and the presence of skin disorders in patients with autoimmune antibody positivity. [ABSTRACT FROM AUTHOR]

Objectives: Cytolytic vaginosis is a very rare entity that may be clinically misdiagnosed as vulvovaginal candidiasis. The aim of this study was to determine the incidence of cytolytic vaginosis in patients displaying symptoms similar to vulvovaginal candidiasis and to develop a clinicopathological diagnostic and therapeutic approach. Materials and Methods: In total, 3000 cervical smear samples were evaluated at our center between 2015 and 2018. Patients whose PAP smears demonstrated significant epithelial cytolysis, naked nuclei, excessive increase in lactobacilli population, absent or minimal neutrophils and no microorganisms were subjected to a symptom assessment questionnaire and had their vaginal pHs measured. They were classified into two groups according to their complaints, symptoms and vaginal pHs: Cytolytic vaginosis and Asymptomatic intravaginal lactobacillus overgrowth. A standardized NaHCO3 Sitz bath therapy was applied to the cytolytic vaginosis group. Results: Fifty-three of the patients (1.7%) were diagnosed as cytolytic vaginosis. After Sitz bath therapy, there was a statistically significant decrease in the cytolysis and lactobacillus scores of the patients. Vaginal discharge of 43 (81%) patients ceased completely while that of the remaining 10 (19%) patients decreased after the therapy. The improvement was statistically significant (P < 0.001). There was a complete resolution in 28 (96%) patients with severe; and in 21 (94%) patients with intermediate vaginal discomfort, after the therapy. Dyspareunia was resolved in 35 (97%) patients (P < 0.001). Conclusion: Cytolytic vaginosis is a rare entity that can be diagnosed with the help of cytopathology and has a therapy based on the modulation microbiota by decreasing the vaginal pH. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Multiple studies have shown that oral or vaginal probiotics can effectively treat and prevent recurrent bacterial vaginosis. The dose, route, and treatment protocols vary greatly between studies, but many have shown a statistically significant reduction in the rate of recurrence of bacterial vaginosis. Further research is needed to determine the adequate dose, specifi c probiotic, optimal duration, and route of administration, with or without antibiotics. [ABSTRACT FROM AUTHOR]

Background: Up to 50% of women with nonoptimal vaginal microbial community state type (CST) have bacterial vaginosis (BV). Little is known about what distinguishes women with and without BV diagnosis within nonoptimal CST. We identified features of women and their male sex partners associated with BV among women with nonoptimal vaginal CST.Methods: In this prospective study, 252 heterosexual couples were observed at 1, 6, and 12 months after baseline. Microbiomes were characterized in cervicovaginal lavage and penile meatal swabs through high-throughput 16s ribosomal RNA gene amplicon sequencing. Nonoptimal CST was defined as CST-IV. Bacterial vaginosis was defined as a Nugent score of 7 to 10. Generalized estimating equation analysis estimated adjusted odds ratios (aORs) for BV among women with nonoptimal CST.Results: At baseline, women with nonoptimal CST were a median age of 22 years, 44% had BV, 16% had HIV, and 66% had herpes simplex virus (HSV) type 2. Male partners were a median age of 27 years, 12% had HIV, 48% had HSV-2, and 55% were circumcised. Within nonoptimal CST, Sneathia sanguinegens, Prevotella species, Prevotella amnii, and Clostridiales, BV-associated bacteria-2 were statistically significantly enriched in observations with BV. In multivariable generalized estimating equation controlling for CST, HIV, and HSV-2, BV was increased among women with CST-IVA (aOR, 1.91; P = 0.087), HIV (aOR, 2.30; P = 0.051), HSV-2 (aOR, 1.75; P = 0.065), and enrichment of male partner penile taxa: Dialister (aOR, 1.16; P = 0.034), Megasphaera (aOR, 1.22; P = 0.001), and Brevibacterium (aOR, 1.13; P = 0.019).These results provide insights into factors differentiating women with BV among those with nonoptimal vaginal CST. Interrupting the sexual exchange of penile and vaginal taxa may be beneficial for preventing pathologic state of vaginal microbiome. [ABSTRACT FROM AUTHOR]

Human vaginal microbiota is dominated by Lactobacillus spp both in the non-pregnant and pregnant state. Bacterial vaginosis (BV) is an imbalance of vaginal microbiota caused by a reduction in the normal lactobacillary bacteria, and a heavy over-growth of mixed anaerobic bacteria. Various clinical (Amsel's Criteria), laboratory (Nugent's score) and molecular diagnostic method (quantitative PCR) are used for diagnosis. BV in pregnancy is associated with increased risk of preterm birth, low birth weight, chorioamnionitis and postpartum endometritis, apart from bothersome vaginal discharge. Antibiotic treatment with metronidazole or clindamycin are effective in eradicating bacterial vaginosis and safe to use in pregnancy. Treatment of bacterial vaginosis has not been shown to improve obstetric outcomes in women at low risk of preterm birth, but may reduce the risk of preterm birth and low birth weight in women at increased risk of preterm birth. Routine screening and treatment is not recommended in low risk women. Test for cure should be performed after treatment. Further research is required on other treatment modalities such as probiotic therapy and microbiota transplantation. [ABSTRACT FROM AUTHOR]

The concept of vaginal dysbiosis was for long considered synonymous with bacterial vaginosis (BV), which is characterized by a homogenous non-inflammatory vaginal discharge. The inflammatory variant of vaginal dysbiosis, called aerobic vaginitis (AV), has remained unknown to a large part of the global dermatology and venereology community, gynaecologists and reproductive tract infection specialists with consequential under diagnosis. AV significantly differs from BV, in clinical presentation, diagnostic criteria and management. The deleterious impact of untreated AV on pregnancy merits discussion. Understanding AV is also crucial for better comprehension of desquamative inflammatory vaginitis (DIV), the most severe form of the same entity. We review the condition's epidemiology, risk factors and suspected aetiology, symptoms and signs, and the latest evidence-backed approach to diagnosis and treatment. The ideal diagnostic approach and treatment for AV/DIV are yet to be established. The currently recommended diagnostic approach for AV/DIV merits an overhaul by incorporating changes to render it feasible for resource-constraint countries. The diagnostic criteria lack a uniform applicability in different physiological groups of women and cannot be used in postpartum or postmenopausal states at the same cut-off levels. Similarly, treatment guidelines merit a relook, and customization, given the equivocality of options suggested by different investigators. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with testing for and diagnosis of trichomoniasis in pregnancy and to describe patterns of treatment and tests of reinfection or persistence.Methods: We conducted a retrospective cohort study of women who delivered from July 2016 to June 2018 at one institution. Testing for Trichomonas vaginalis infection was done by wet mount microscopy or by nucleic acid amplification testing for routine prenatal testing or symptomatic visits. Poisson regression was used to identify factors associated with testing for trichomoniasis and testing positive in pregnancy. Treatment and re-testing patterns also were assessed.Results: Among 3,265 pregnant women, 2,489 (76%) were tested for T vaginalis infection. Of the total sample, 1,808 (55%) were tested by wet mount microscopy, 1,661 (51%) by nucleic acid amplification testing, and 980 (30%) by both modalities. The sensitivity for microscopy compared with nucleic acid amplification testing was 26%, with a specificity of 99%. Factors associated with increased likelihood of being tested included younger age (adjusted risk ratio [aRR] 0.99, 95% CI 0.99-1.00) and bacterial vaginosis (aRR 1.17, 95% CI 1.01-1.37). Prevalence of trichomoniasis was 15% among those tested by any modality (wet mount or nucleic acid amplification testing). Risk factors for trichomoniasis included younger age (aRR 0.97, P<.01), being of black race (aRR 2.62, P<.01), abnormal vaginal discharge (aRR 1.45, P<.01), and chlamydia during the current pregnancy (aRR 1.70, P<.01). Women diagnosed by microscopy had a shorter time to treatment compared with those diagnosed by nucleic acid amplification testing. Most (75%) women with positive infections had a test of reinfection; 29% of these were positive. Bacterial vaginosis was associated with decreased risk of a positive test of reinfection.Conclusion: Although testing for and treatment of trichomoniasis during pregnancy is not routinely recommended, the high burden of infection among some pregnant women demonstrates a need to further understand patterns of T vaginalis testing and infection. Opportunities exist for improving timely treatment of trichomoniasis and test of reinfection. [ABSTRACT FROM AUTHOR]

Importance: Preterm delivery results in adverse outcomes; identifying and treating bacterial vaginosis may reduce its occurrence.Objective: To update the evidence on screening and treatment of asymptomatic bacterial vaginosis in pregnancy for the US Preventive Services Task Force.Data Sources: MEDLINE, Cochrane Library, and trial registries through May 29, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through December 31, 2019.Study Selection: Fair- or good-quality English-language studies evaluating diagnostic accuracy of tests feasible within primary care; randomized clinical trials (RCTs); nonrandomized controlled intervention studies (for harms only); or meta-analyses of metronidazole or clindamycin.Data Extraction and Synthesis: Two reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; when at least 3 similar studies were available, meta-analyses were conducted.Main Outcomes and Measures: Sensitivity, specificity, preterm delivery, maternal adverse effects, congenital birth defects, childhood cancer.Results: Forty-four studies (48 publications) were included. No studies evaluated the benefits or harms of screening. Twenty-five studies (n = 15 785) evaluated the accuracy of screening tests; across individual studies and tests, sensitivity ranged from 0.36 to 1.0 and specificity ranged from 0.49 to 1.0. Among trials reporting findings from general obstetric populations (n = 7953), no significant association was observed between treatment and spontaneous delivery before 37 weeks (pooled absolute risk difference [ARD], -1.44% [95% CI, -3.31% to 0.43%]; 8 RCTs, n = 7571) or any delivery before 37 weeks (pooled ARD, 0.20% [95% CI, -1.13% to 1.53%]; 6 RCTs, n = 6307). Among 5 trials reporting findings among women with a prior preterm delivery, findings were inconsistent; 3 showed a significant beneficial effect, while 2 did not. Maternal adverse events from treatment were infrequent and minor (eg, candidiasis) but were slightly more common with active treatment compared with placebo across 8 RCTs. Two meta-analyses of observational studies reported no significant association between metronidazole exposure and congenital malformations (odds ratio, 0.96 [95% CI, 0.75 to 1.22]; odds ratio, 1.08 [95% CI, 0.90 to 1.29]). One cohort study reported no significantly increased incidence of childhood cancer among metronidazole-exposed children (adjusted relative risk, 0.81 [95% CI, 0.41 to 1.59]). However, studies of in utero exposure had important limitations.Conclusions and Relevance: Accuracy of screening tests for bacterial vaginosis varies. The evidence suggests no difference in the incidence of preterm delivery and related outcomes from treatment for asymptomatic bacterial vaginosis in a general obstetric population but was inconclusive for women with a prior preterm delivery. Maternal adverse events from treatment appear to be infrequent and minor, but the evidence about harms from in utero exposure was inconclusive. [ABSTRACT FROM AUTHOR]

Background: Advancements in next-generation sequencing have allowed for a more complete understanding of the vaginal microbiome and its role in health and disease. The role of race/ethnicity in the composition of the vaginal microbiome and what is deemed normal/healthy microbiome is conflicting. Thus, the purpose of this review is to synthesize research that investigated the vaginal microbiome in Black women in the United States by using advanced 16S analysis. Methods: Searches of Pubmed, Google Scholar, and relevant journals for publications between January 2008 and July 2018 were conducted. Eligibility criteria were that the study: (1) used a molecular technique for sequencing of the vaginal microbiome, (2) reported the microbiome by race/ethnicity that included Black women, and (3) was conducted in the United States. Results: Our review selected 18 manuscripts that met the inclusion criteria for full review. Three themes emerged: the vaginal microbiome in healthy women versus women with bacterial vaginosis (BV); vaginal microbiome considerations in HIV; and vaginal microbiome considerations in preterm labor/birth. Overall, our review found that a majority of Black women (including HIV-positive women) have a Lactobacillus dominant group. Specifically, Lactobacillus iners was the most frequently reported Lactobacillus species. Non-Lactobacillus dominant groups were also reported to be found in healthy asymptomatic Black women. The vaginal microbiome's influence on preterm labor and/or birth among Black women was inconclusive and warrants further investigation. Conclusions: The role that the microbiome plays in health and disease among Black women warrants further research to better elucidate the definition of a healthy versus pathogenic microbiome. The wide variability in methods for BV diagnostics and defining preterm labor/birth are significant limitations that should be considered when conducting comparative studies. [ABSTRACT FROM AUTHOR]

Bacterial vaginosis (BV) affects women of reproductive age and can either be symptomatic or asymptomatic. Approximately 50 % of women are symptomatic and experience vaginal malodor, discharge, itching and increased vaginal pH. BV can increase the risk of contracting many sexually transmitted infections (STIs) such as human immunodeficiency virus (HIV), Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and herpes simplex virus-2 (HSV-2). Though effective treatment options do exist, metronidazole or clindamycin, these methods have proven not to be effective long term. The purpose of this review is to summarize current literature on the epidemiology of BV and highlight areas of deficiency in current clinical practice with respect to BV. BV recurrence rates are high, approximately 80 % three months after effective treatment. Furthermore, in some instances treatment is ineffective and BV persists. Literature also documents the relationship between BV and human papillomavirus (HPV). HPV is the most common sexually transmitted infection among young adult women while BV is the most common cause of vaginal symptoms among women of reproductive age. BV is associated with high levels of anaerobic organisms which can damage the vaginal epithelium and increase the risk of HPV infection. Recent research also highlights the role of the vaginal microbiome in BV. The results of this review warrant further exploration into the etiology of BV as well as exploration of more long-term effective treatment and the investigation of prognostic indicators. Additionally, the need for a standard definition of recurrent and persistent BV is recognized. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis is an important female reproductive tract infection. It push a threat of miscarriage or fertility-related problems if it untreated. Cervico-vaginal E. coli (CVEC) is the common cause agent of microbial vaginosis. It equipped by a set of adhesins, immune-disguise protein, cytolysins, siderophores and metal efflux pump that enable them from establishing and endure the infection. Methodology: One hundred fifty seven (157) vaginal swabs were collected from female clinically diagnosed with bacterial vaginitis. The swab was put in tubes of broth of Brain heart infusion (BHIB) to keep them vital and non-dry until being taken to the laboratory and the inoculated on MacConkey agar Eosin methylene blue agar. The only pinky colony with green-metallic shine, on MacConkey agar Eosin methylene blue agar respectively, were selected for study. Polymerase chain reaction using specific primer pairs was used to investigate the virulence factors at molecular level. Results: The results revealed that, out of (157) clinical samples only 32 (20.38%) isolates were belonged to E. coli. Regarding the adhesins the results revealed that FimH adhesin was the most common virulence factor and was discovered in 25(78.13%) of CVEC strains, followed by FocG 23(71.87%), PapGII 22(68.75%), GafD 12(37.5%) and SfaS 8(21.87%) while PapGI and PapGIII not detected in the current study. Concern the cytolysins the results showed that 25(78.13%), 27(84.38%) of CVEC isolates possess hemolysin gene (hlyA) and phospholipase A gene (pldA). The investigation of both kpsMT-K1 and kpsMT-K5 genes. The results revealed that kpsMT-K1 were predominant and compile 10(31.25%), while kpsMT-K5 (which encodes for K5 capsule) were not detected. Aerobactin gene (iucD) were detected in 24(75%) of CVEC isolates. The presence of cusC gene (as a representative for cusCFBA operon responsible for copper/silver efflux) revealed that all CVEC have cusC 32(100%). Conclusion: The current study conclude possession of CVEC for a sets of virulence effectors that enable them from establish the infection, dissemination, immune system evading and sustainability of infection. [ABSTRACT FROM AUTHOR]

Background Mycoplasma genitalium has been significantly and nonsignificantly associated with cervicitis, urethritis, or vaginal discharge. This study examined the associations of M. genitalium with selected sexually transmitted infections (STIs) and demographic, behavioral, and clinical factors among women attending a sexually transmitted disease (STD) clinic in New Orleans. Methods Women aged ≥18 years who presented to the New Orleans STD clinic provided sociodemographic data and sexual behavior; STI, obstetric, and gynecologic history; and urine, vaginal, endocervical, and rectal specimens. Specimens were tested for M. genitalium , Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis , Mycoplasma hominis , Ureaplasma species, and yeast. Bacterial vaginosis (BV) was diagnosed by Nugent score, and cervicitis was defined as ≥30 polymorphonuclear leukocytes per high-power microscopic field on a cervical Gram stain or yellow mucopus on an endocervical swab. Results Among 400 women studied, M. genitalium was independently significantly associated with age <25 years (P <.03) and with ≥2 sexual partners in the last 12 months (P <.003). Neisseria gonorrhoeae (adjusted odds ratio [AOR], 1.75; P =.103), C. trachomatis (AOR, 1.43; P =.247), and T. vaginalis (AOR, 1.60; P =.120) independently increased the odds of infection with M. genitalium. Controlling for other STIs and BV, there was a positive trend for M. genitalium to predict cervicitis (AOR, 3.18 [95% confidence interval,.99–10.2]; P =.05). Conclusions Mycoplasma genitalium in our study displayed the clinical features of C. trachomatis and N. gonorrhoeae , the 2 organisms that drive research agendas in diagnosis, treatment, and prevention of bacterial STIs. [ABSTRACT FROM AUTHOR]

Bacterial vaginosis (BV) is a common gynaecological condition. Diagnosis of BV is typically based on Amsel criteria, Nugent score and/or bacterial culture. In this study, these conventional methods and two CE-IVD marked quantitative real-time (q)PCR assays were compared with microbiota analysis for the diagnosis of BV. Eighty women were evaluated for BV during two sequential hospital visits by Amsel criteria, Nugent score, culture, the AmpliSens® Florocenosis/Bacterial vaginosis-FRT PCR kit (InterLabService, Moscow, Russia), and the BD MAX™ Vaginal Panel (BD Diagnostics, MD, USA). Microbiota analysis based on amplicon sequencing of the 16S ribosomal RNA gene was used as reference test. The microbiota profile of 36/115 (31%) included cases was associated with BV. Based on microbiota analysis, the sensitivity of detecting BV was 38.9% for culture, 61.15% for Amsel criteria, 63.9% for Nugent score and the BD MAX assay, and 80.6% for the AmpliSens assay, while the specificity of all methods was ≥ 92.4%. Microbiota profiles of the cases with discrepant results between microbiota analysis and the diagnostic methods were variable. All five diagnostic methods missed BV positive cases with a relatively high abundance of the genus Alloscardovia, Bifidobacterium, or Dialister, which were categorised as unspecified dysbiosis by the AmpliSens assay. Compared to Amsel criteria, Nugent score, culture, and the BD MAX assay, the AmpliSens assay was most in agreement with microbiota analysis, indicating that currently, the AmpliSens assay may be the best diagnostic method available to diagnose BV in a routine clinical setting. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the BD MAX™ vaginal panel in the diagnosis of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis by comparing it with conventional methods: (i) combination of Hay criteria and presence of clue cells with predominant growth of Gardnerella vaginalis, (ii) yeast culture, and (iii) combination of culture, wet mount microscopic examination, and an alternative molecular assay. One thousand vaginal samples of women ≥ 14 years were analyzed; 5% of the samples belonged to pregnant women. 19.3% were classified as BV, in 33.6% yeasts were recovered and in 1.5% TV was detected. For BV, sensitivity and specificity were of 89.8% and 96.5%, respectively; for VVC, sensitivity and specificity were of 97.4% and 96.8%, respectively, and for T. vaginalis, the sensitivity and specificity were of 100%. The BD MAX™ vaginal panel is highly sensitive and specific and simplifies the identification of infectious vaginitis. [ABSTRACT FROM AUTHOR]

Abstract The objective was to estimate the prevalence of Mycoplasma hominis, Ureaplasma parvum , and Ureaplasma urealyticum in healthy women and patients with altered vaginal microflora. Vaginal samples from 2594 unselected female patients were divided into normal, bacterial vaginosis (BV), and aerobic vaginitis (AV) groups and tested for U. parvum, U. urealyticum and M. hominis. Normal flora was detected in 1773 patients (68.4%), BV in 754 patients (29.1%), and AV in 67 patients (2.6%). In the control group, 771 (43.5%) patients were U. parvum positive, 104 (5.9%) were U. urealyticum positive, and 158 (8.9%) were M. hominis positive. In the BV group, those bacteria were detected in 452 (59.9%), 102 (13.5%), and 202 (26.8%) patients, respectively (P < 0.001); in the AV group, those were detected in 16 (23.9%), 3 (4.5%), and 4 (6.0%) patients, respectively (P < 0.001; 0.63 and 0.40, respectively). This study demonstrated that mycoplasmas may be a marker or a symbiont of the BV flora but not AV flora. Highlights • Genital mycoplasmas (U. parvum, U. urealyticum, and M. hominis) are positively associated with bacterial vaginosis (BV), not aerobic vaginitis (AV). • U. parvum and M. hominis are detected in higher loads among patients with BV compared to healthy individuals and patients with AV. • Genital mycoplasmas may have symbiotic relationship with BV-associated microflora rather than be attracted by elevated pH in BV-positive patients. [ABSTRACT FROM AUTHOR]

Objectives: Vaginal dysbiosis and STIs are important drivers of the HIV epidemic and reproductive complications. These conditions remain prevalent, partly because most cases are asymptomatic. We have shown that inflammatory cytokines interleukin (IL)-1α, IL-1β and interferon-γ-induced protein (IP)-10 are biomarkers for detecting asymptomatic STIs and vaginal dysbiosis (bacterial vaginosis (BV) or intermediate microbiota). This study aimed to validate the performance of these biomarkers in African women recruited regardless of symptoms.Methods: IL-1α, IL-1β and IP-10 were measured in menstrual cup secretions, endocervical, lateral vaginal wall and vulvovaginal swabs from 550 women from Pretoria, Soweto and Cape Town, South Africa and Bondo, Kenya using Luminex and ELISA. STIs were assessed by PCR, BV by Nugent scoring and vaginal microbiota by 16S rRNA sequencing.Results: Across four study populations and four types of genital specimens, the performance of IL-1α, IL-1β and IP-10 for identification of women with STIs, BV or intermediate microbiota was consistent. Of the genital samples assessed, biomarkers measured in lateral vaginal wall swabs performed best, correctly classifying 76%(95% CI 70% to 81%) of women according to STI, BV or intermediate microbiota status (sensitivity 77%, specificity 71%) and were more accurate than clinical symptoms (sensitivity 41%, specificity 57%) (p=0.0003). Women incorrectly classified as STI/BV positive using the biomarkers had more abundant dysbiosis-associated bacteria, including Prevotella bivia and Gardnerella sp, detected by 16S rRNA sequencing, but not Nugent scoring. Including vaginal pH with the cytokine biomarkers improved the accuracy of the test (82% (95% CI 75% to 88%) correctly classified), although pH alone had poor specificity (61%).Conclusions: An inexpensive, point-of-care screening test including IL-1α, IL-1β and IP-10 (and potentially pH) could be used in resource-limited settings to identify women with asymptomatic STIs and dysbiosis. These women could then be referred for aetiological testing, followed by specific treatment. [ABSTRACT FROM AUTHOR]

Bacterial vaginosis (BV) affects approximately one third of women in the United States. While often asymptomatic, BV infection may be accompanied by serious health consequences, such as preterm birth and pelvic inflammatory disease, and may facilitate acquisition of sexually transmitted infections. Identifying appropriate patients for screening, such as pregnant women, women planning pregnancy, and women with multiple and/or new sexual partners, is imperative for treatment. Diagnosis of BV has traditionally depended on the presence of vaginal discharge and odor, elevated pH, and clue cells as determined by microscopy, but newer diagnostic modalities that utilize molecular techniques allow for more convenient and accurate testing for BV. Approved treatment options consist of antibiotics administered as oral or intravaginal formulations. Patient counseling and education regarding treatment options, including adherence to prescribed treatments, appropriate hygienic practices, and treatment of symptomatic same-sex partners, are crucial to optimize patient outcomes and prevent recurrence. [ABSTRACT FROM AUTHOR]

Background: One of the most common and recurrent vaginal infections is bacterial vaginosis (BV). The diagnosis is based on changes to the "normal" vaginal microbiome; however, the normal microbiome appears to differ according to reproductive status and ethnicity, and even among individuals within these groups. The Amsel criteria and Nugent score test are widely used for diagnosing BV; however, these tests are based on different criteria, and so may indicate distinct changes in the vaginal microbial community. Nevertheless, few studies have compared the results of these test against metagenomics analysis. Methods: Vaginal flora samples from 77 participants were classified according to the Amsel criteria and Nugent score test. The microbiota composition was analyzed using 16S ribosome RNA gene amplicon sequencing. Bioinformatics analysis and multivariate statistical analysis were used to evaluate the microbial diversity and function. Results: Only 3 % of the participants diagnosed BV negative using the Amsel criteria (A−) were BV-positive according to the Nugent score test (N+), while over half of the BV-positive patients using the Amsel criteria (A+) were BV-negative according to the Nugent score test (N−). Thirteen genera showed significant differences in distribution among BV status defined by BV tests (e.g., A − N−, A + N− and A + N+). Variations in the four most abundant taxa, Lactobacillus, Gardnerella, Prevotella, and Escherichia, were responsible for most of this dissimilarity. Furthermore, vaginal microbial diversity differed significantly among the three groups classified by the Nugent score test (N−, N+, and intermediate flora), but not between the Amsel criteria groups. Numerous predictive microbial functions, such as bacterial chemotaxis and bacterial invasion of epithelial cells, differed significantly among multiple BV test, but not between the A− and A+ groups. Conclusions: Metagenomics analysis can greatly expand our current understanding of vaginal microbial diversity in health and disease. Metagenomics profiling may also provide more reliable diagnostic criteria for BV testing. [ABSTRACT FROM AUTHOR]

The article presents a review which focuses on desquamative inflammatory vaginitis and bacterial vaginosis. Topics discussed include the natural fluctuations in the vaginal microbiome of women during their reproductive cycle, the association between abnormal vaginal discharge and Haemophilus vaginalis, and the characteristics of desquamative inflammatory vaginitis.

The study assessed and compared bacterial vaginosis (BV) prevalence in Thai women in reproductive age in four study groups - group 1, HIV-positive with copper intrauterine device (Cu-IUD); group 2, HIV-positive without Cu-IUD; group 3, HIV-negative with Cu-IUD; and group 4, HIV-negative without Cu-IUD. We conducted a cross-sectional study. BV prevalence was assessed by Nugent score and Amsel criteria. Descriptive statistics was used to present baseline characteristics; kwallis rank test - to compare variables between the four groups; logistic regression - to assess factors, related to BV prevalence. The analysis included 137 women in the four study groups with a median age of 39 years. Median BV prevalence by Nugent score was 45%, intermediate vaginal flora - 7% and normal vaginal flora - 48%. There was no statistically significant difference in the BV prevalence between the four study groups, p = 0.711. Threefold lower BV prevalence was found, assessed by Amsel criteria compared to Nugent score. Women with body mass index (BMI) < 20 had higher probability to have BV or intermediate vaginal flora, OR = 3.11, 95% CI (1.2-8.6), p = 0.025. The study found a high BV prevalence in the four study groups, related neither to HIV status, nor to Cu-IUD use. BV prevalence was associated only with low BMI. Thus, Cu-IUD could be a good contraceptive choice for HIV-positive women. Research in defining normal vaginal microbiota and improve diagnostic methods for BV should continue. [ABSTRACT FROM AUTHOR]

The study assessed and compared bacterial vaginosis (BV) prevalence in Thai women in reproductive age in four study groups - group 1, HIV-positive with copper intrauterine device (Cu-IUD); group 2, HIV-positive without Cu-IUD; group 3, HIV-negative with Cu-IUD; and group 4, HIV-negative without Cu-IUD. We conducted a cross-sectional study. BV prevalence was assessed by Nugent score and Amsel criteria. Descriptive statistics was used to present baseline characteristics; kwallis rank test - to compare variables between the four groups; logistic regression - to assess factors, related to BV prevalence. The analysis included 137 women in the four study groups with a median age of 39 years. Median BV prevalence by Nugent score was 45%, intermediate vaginal flora - 7% and normal vaginal flora - 48%. There was no statistically significant difference in the BV prevalence between the four study groups, p = 0.711. Threefold lower BV prevalence was found, assessed by Amsel criteria compared to Nugent score. Women with body mass index (BMI) < 20 had higher probability to have BV or intermediate vaginal flora, OR = 3.11, 95% CI (1.2-8.6), p = 0.025. The study found a high BV prevalence in the four study groups, related neither to HIV status, nor to Cu-IUD use. BV prevalence was associated only with low BMI. Thus, Cu-IUD could be a good contraceptive choice for HIV-positive women. Research in defining normal vaginal microbiota and improve diagnostic methods for BV should continue. [ABSTRACT FROM AUTHOR]

The vaginal immune system (VIS) is the first defense against antigens recognized as foreign. Substances capable of locally activating the VIS could be a valid strategy to treat vulvo-vaginal infections (VVI), caused by changes in the vaginal ecosystem, such as bacterial vaginosis (BV), vulvo-vaginal candidiasis (CA), and mixed vaginitis (MV). Bacterial lysates, obtained by crushing bacterial cultures, exert immuno-modulatory activities. The parietal fraction from Propionibacterium acnes is a patent of Depofarma (MoglianoVeneto, Italy). The preparation that associates such fraction to hyaluronic acid and polycarbophil is a registered trademark, commercially available in Italy as vaginal gel, Immunovag®. The study aimed to evaluate whether a 5-day-treatment with Immunovag® improves the symptoms and signs of VVI, in 60 women with Gardnerella vaginalis (GV), 154 with CA, 95 with MV, diagnosed with vulvar vaginal swab (VVS), and in 283 with BV, diagnosed with the Amsel criteria. At the end of the treatment (visit 2), the symptoms and signs of VVI disappeared in a significant number of subjects (χ2p < .02 vs pre-treatment) in all VVI groups, and their intensity was significantly (p < .0002) reduced in the subjects in which they were still present. Immunovag® represents a valid treatment of VVI induced by changes in the vaginal ecosystem. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis (BV), the leading cause of vaginal discharge, is associated with multiple adverse health outcomes; however, its etiology is unknown. BV treatment is not very effective, thus prevention approaches are needed. Studies investigating the impact of vitamin D on the risk of BV have had mixed findings, including two studies reporting increased risk of recurrent BV for women with higher vitamin D. Materials and Methods: Participants were nonpregnant women in a prospective fibroid study of African Americans (ages 23–34 years) from the Detroit area. The exposure was seasonally adjusted annual mean serum 25-hydroxyvitamin D [25(OH)D] at enrollment. The outcome was self-reported doctor-diagnosed BV over ∼20 months between baseline and follow-up. Multivariable-adjusted binomial regression models estimated the risk of BV for a doubling of 25(OH)D and sufficient (≥20 ng/mL) versus deficient (<20 ng/mL) 25(OH)D. Results: In total, 1459 women were included. Median 25(OH)D was 15.2 ng/mL and 73% were deficient. Sixteen percent of participants reported BV diagnoses over follow-up, 78% of whom had recurrent BV. In multivariable-adjusted analyses, a doubling of 25(OH)D was associated with an increased, rather than the hypothesized decreased, risk of self-reported BV (risk ratio [RR] 1.22, 95% confidence interval 1.02–1.48). Sufficient women also had a significantly higher, rather than lower, risk of self-reported BV (RR 1.31). Results were robust to sensitivity analyses, and post hoc analyses showed no evidence of reverse causation. Conclusions: Overall, our findings do not support vitamin D deficiency as a risk factor for BV in these young, nonpregnant African American women. [ABSTRACT FROM AUTHOR]

ABSTRACT: The aim of this study was to develop a method for the rapid detection of Gardnerella vaginalis, which is proposed to play a key role in the pathogenesis of bacterial vaginosis. Specific loop‐mediated isothermal amplification (LAMP) primers were designed and used to detect target DNA within 45 min under isothermal conditions. Comparative screening indicated that the LAMP assay is superior to PCR in terms of rapidity, and is equivalent in sensitivity and specificity. This LAMP assay can be used for rapid screening and detection of G. vaginalis in vaginal samples; the limit of detection is 10 fg DNA. [ABSTRACT FROM AUTHOR]

Vaginitis, inflammation of vagina, is a common condition encountered in day to day practice Factors causing disruption of . normal acidic environment of vagina can lead to development of vaginitis. Vaginal discharge is a prominent symptomof vaginitis. The nature of discharge varies depending upon the aetiology. Physical examination is done to look for the degree of vulvovaginal inflammation and the characteristics of the vaginal discharge. Examining the vaginal discharge for pH, odour, and cells on microscopy will lead to a definitive diagnosis. Oral and topical clindamycin andmetronidazole are equally effective at eradicating bacterial vaginosis Any nitroimidazole drug (e.g.,metronidazole) . given orally as a single dose or over a longer period resolves 90 percent of trichomoniasis cases. Sex partners should be treated simultaneously. Vulvovaginal candidiasis should be treatedwith topical or oral antifungals. Vaginosis due to simultaneous infection with at least two pathogens (mixed infection, e.g. bacterial vaginosis in patient with vulvovaginal candidiasis (VVC)) is also highly prevalent and makes up to 30% of all cases . The fixed dose combination of clindamycin and clotrimazole has been found to be effective in treatment of vaginosis and providing relief from the symptomsof infective vaginosis. [ABSTRACT FROM AUTHOR]

Abstract The vaginal mucosa is dominated by Gram positive, rod shaped lactobacilli which serve as a natural barrier against infection. In both healthy- and bacterial vaginosis (BV)-infected women Lactobacillus crispatus and Lactobacillus jensenii have been found to be the predominant Lactobacillus species. Many studies have been conducted to assess factors influencing lactobacilli dominance in the vaginal microbiome. In the present study two plasmids, pLc4 and pLc17, isolated from vaginal Lactobacillus strains of both healthy and BV-infected women were characterized. The smaller plasmid, pLc4 (4224 bp), was detected in both L. crispatus and L. jensenii strains, while pLc17 was only detected in L. crispatus. Based on its nucleotide sequence pLc4 appears highly novel, with its replication protein having 44% identity to the replication initiation protein of pSMQ173b_03. Phylogenetic analysis with other Rolling Circle Replication plasmids confirmed that pLc4 shows a low degree of similarity to these plasmids. Plasmid pLc17 (16,663 bp) appears to carry both a RCR replicon and a theta replicon, which is rare in naturally occurring plasmids. pLc4 was maintained at a high copy number of 29, while pLc17 appears to be a medium copy number plasmid maintained at 11 copies per chromosome. While sequence analysis is a valuable tool to study cryptic plasmids, further function-based analysis will be required in order to fully elucidate the role of these plasmids within the vaginal milieu. Highlights • Two cryptic plasmids associated with vaginal lactobacilli were partially characterized by sequence analysis • Both plasmids were detected in both healthy and BV-infected women • pLc4 appears to be highly novel with a low degree of similarity to other Rolling Circle Replication plasmids • pLc17 has a unique replication system and has both a RCR replicon and theta replicon. • pLc17 was only detected in L. crispatus strains, while pLc4 was detected in both L. crispatus and L. jensenii [ABSTRACT FROM AUTHOR]

Objective To estimate the prevalence of vaginal symptoms in postmenopausal women with breast cancer exposed to aromatase inhibitors, and to investigate if the risk of vaginal symptoms is associated with previous episodes of bacterial vaginosis. Methods Patients from Rigshospitalet and Herlev University Hospital, Denmark, were identified through the register of Danish Breast Cancer Cooperation Group and 78 patients participated in the study. Semiquantitave questionnaires and telephone interview were used to assess the prevalence of vaginal symptoms and previous episode(s) of bacterial vaginosis. Multivariable logistic regression models were used to assess the association between vaginal symptoms and previous episodes of bacterial vaginosis. Results Moderate to severe symptoms due to vaginal itching/irritation were experienced by 6.4% (95% CI: 2.8-14.1%), vaginal dryness by 28.4% (95% CI: 19.4-39.5%), and dyspareunia by 23.1% (95% CI: 11.0-42.1%). Patients with earlier episodes of bacterial vaginosis had an increased risk of vaginal dryness when exposed to a treatment with an aromatase inhibitor, adjusted OR 5.5 (95% CI 1.3-21.6). Conclusion A considerable number of patients exposed to aromatase inhibitor have vaginal symptoms and the risk is highest among patients with earlier episodes of bacterial vaginosis. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The main goal of this work was to highlight the significance of redox imbalance in the pathophysiology of bacterial vaginosis (BV). We studied the pro‐oxidant (malondialdehyde) and antioxidants (glutathione, total antioxidant capacity) in the vaginal fluids of women and compared them on the basis of their Nugent score (NS). Methods: Women were clinically screened using Amsel criteria (≥2 were regarded as positive) and were further screened for NS on the basis of microscopic examination. Subjects were classified into one of three groups – healthy controls, intermediate, and BV – on the basis of NS (0–3, 4–6, and 7–10, respectively). High vaginal swabs were collected from the study participants in order to estimate the levels of pro and antioxidants in the vaginal fluids. Results: Our results indicated that levels of both pro‐ and antioxidants were elevated in high vaginal swabs of women in the intermediate (NS: 4–6) and BV (NS: 7–10) groups as compared to those of healthy control women. The difference in mean values for total antioxidant capacity and glutathione was found to be statistically significant. Furthermore, in the BV group (NS: ≥7) both antioxidants (glutathione and total antioxidant capacity) and the pro‐oxidant, malondialdehyde, were found to be negatively correlated to NS. Interestingly, the correlation between NS and malondialdehyde was statistically significant. Conclusion: Our results suggest a significant correlation between redox imbalance and NS, which signifies changes in vaginal ecology from normal flora (Lactobacillus spp.) towards a more mixed bacterial population representing BV. [ABSTRACT FROM AUTHOR]