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

Antimicrobial stewardship is one of the cornerstones in the battle against antimicrobial resistance. Restrictive legislation aims to foster antimicrobial stewardship. Prophylactic prescription of antimicrobials is still a widespread practice in canine breeding management to prevent suspected infectious infertility. The aim of this study was to evaluate the efficacy of restrictive legislation in Germany (Veterinary Home Pharmacy Ordinance, TÄHAV) based on resistance profiles of common bacterial isolates from the vaginal tract by comparing the resistance situation before (time frame (TF1)) and after (TF2) its amendment. In total, results of 13,373 antimicrobial susceptibility tests of bacterial isolates of Escherichia coli (n = 5209), beta-hemolytic streptococci (n = 4010), and Staphylococcus (Staph.) intermedius group (n = 4154) derived from canine vaginal swabs were assessed. Antimicrobial susceptibility testing was performed on pure cultures using the broth microdilution method. Susceptibility to selected antimicrobials was evaluated. Susceptibility of Escherichia coli generally increased within TF2 with, however, a significant increase in the number of non-susceptible isolates to cefalexin (p < 0.0001). Beta-hemolytic streptococci exhibited good susceptibility to most antimicrobials. Susceptibility developed ambivalently within the Staphylococcus intermedius group. Despite an overall positive effect of increased susceptibility, an increase in non-susceptibility to single antimicrobials was detected, possibly indicating a need for refinement of the legislation. [ABSTRACT FROM AUTHOR]

How bacterial infections of the reproductive tract cause infertility and the correlation between the health status of female dogs and the presence of Mycoplasma canis (M. canis) in the vagina are still unclear. The aim of this study was to determine the M. canis population in the vagina of breeding bitches and to correlate this microbial population with some fertility outcomes. A total of 275 breeding bitches were included in the study. Vaginal samples were collected for microbiological and PCR testing. Mycoplasma canis was identified in 34.91% of the samples. One-third of bitches from the problem-free group and 41.18% from the group with problems were positive. In general, there were no significant differences in the prevalence of M. canis between the groups (P-value > 0.05). Mycoplasma canis occurs in both mated and unmated bitches and was found in a large number of kennels (67%). There was a correlation between M. canis in the kennel and the incidence of single puppy deaths and low litter sizes. There was also some correlation between the presence of M. canis in the vagina with at least two other bacterial strains and reproductive disorders. Our results indicate that M. canis is part of the normal vaginal flora of breeding bitches, although a role for this bacterium in causing some reproductive disorders remains to be disproved. [ABSTRACT FROM AUTHOR]

Objective: The vaginal flora has been reported to be associated with human papillomavirus (HPV) infection. The purpose of this study was to investigate the characteristics of the cervical microbiota in patients with HPV infection and to analyse the changes in the vaginal flora and enzyme profiles in females with HPV infection. Methods: We conducted a cross-sectional study involving 206 participants who underwent HPV genotyping, sexually transmitted diseases pathogen testing, cytology examination, and microbiome analysis. additionally, we collected 115 HPV-negative samples and 48 HPV-positive samples for 16S rRNA amplicon sequencing. The vaginal microbial communities of both groups were analysed for diversity and differences to explore their association with HPV infection. Results: The abundance of Lactobacillus was found to be reduced, while Gardnerella vaginalis was significantly more prevalent in the HPV+group. In terms of alpha diversity indices, the Shannon index (P=.0036) and Simpson index (P=.02) were higher in the HPV+group compared to the HPV - group, indicating greater community diversity in the HPV+group. among the 10 sexually transmitted diseases pathogens analysed, Uup3 and Uup6 were significantly associated with HPV infection. Statistically significant differences were observed in Nugent scores and bacterial vaginosis between the two groups (P < .05). In functional analysis, 11 proteins and 13 enzymes were found to be significantly altered in the HPV+group. Conclusion: our study demonstrates that disruptions in the vaginal flora are associated with HPV infection. Reduced levels of Lactobacillus, increased prevalence of Gardnerella, and abnormal enzyme profiles are closely linked to HPV infection. [ABSTRACT FROM AUTHOR]

Background: Preterm rupture of membranes (PROM) refers to the breaking of the amniotic sac and leaking of amniotic fluid before labor begins, specifically before 37 weeks of gestation in the case of preterm PROM (PPROM). This condition is associated with several adverse maternal and neonatal outcomes, including infection, preterm birth, and complications related to prematurity. High vaginal swab culture (HVSC) is a diagnostic procedure used to detect and identify microorganisms in the vaginal flora. Owing to the scarce literature on the relationship between HVSC results and feto-maternal outcomes following PROM, this study was conducted to evaluate the same. Materials and Methods: 100 antenatal women who presented to the Labour room in the Department of Obstetrics and Gynaecology, Shadan Institute of Medical Sciences with PPROM and PROM, over 18 months, i.e. from 1st July 2022 to 30th November 2023, were studied. Results: most of the women belonged to 20-30 years of age group. 30% of women had a positive result for high vaginal swab (HVS) culture and sensitivity. The most common organism isolated in present study was E.coli, followed by Klebsiella. Most of the neonates had normal birth weight. 30% of the neonates required NICU admission. Conclusion: Premature rupture of fetal membranes is associated with increased risk of intrauterine infection, and it has been one of the most common causes of perinatal deaths and NICU admissions [ABSTRACT FROM AUTHOR]

Purpose: The goal of this preliminary study is to describe the vaginal microbiome of transgender and gender nonbinary (TGNB) individuals using nonculture-based techniques. TGNB individuals may undergo gender-affirming surgical procedures, which can include the creation of a neovagina. Little is known about microbial species that comprise this environment in states of health or disease. Methods: In this pilot study, vaginal swabs were self-collected from 15 healthy self-identified TGNB participants (age 26–69 years) and 8 cisgender comparator participants (age 27–50 years) between 2017 and 2018. Next-generation 16S ribosomal RNA sequencing was used to profile individual bacterial communities from all study samples. Results: The TGNB cohort demonstrated significantly higher intraindividual (alpha) diversity than the cisgender group (p=0.0003). Microbial species commensal to the gut and skin were identified only in specimens from TGNB participants. Although Lactobacillus species were dominant in all cisgender comparator samples, they were found at low relative abundance (≤3%) in TGNB samples. Conclusion: In this study, specimens collected from neovaginas showed increased alpha diversity and substantially different composition compared with natal vaginas. In contrast to natal vaginas, neovaginas were not dominated by Lactobacillus, but were hosts to many microbial species. Studies that help to improve our understanding of the neovaginal microbiome may enable clinicians to differentiate between healthy and diseased neovaginal states. [ABSTRACT FROM AUTHOR]

Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be found in the vagina of infected women remains unclear; moreover, the impact of the virus on the normal vaginal microbiota is not known.

Objective: To study the changes in the composition of vaginal flora in women with cervical cancer disease and to explore vaginal probiotics with the potential to prevent the development of cervical cancer. Methods: Twenty-four healthy women and 43 women with cervical cancer were selected from the Cancer Hospital of Xinjiang Medical University and community collections. Their vaginal flora composition was analysed using 16S rDNA and macro-genome sequencing techniques. Results: There was no statistically significant difference between the vaginal flora of the two groups of women in chao1 index and ASV number, suggesting a similar community abundance, while in Shannon and Simpson indices, which indicate species diversity, the cervical cancer group showed a significant increase, and the difference was statistically significant. At the phylum level of microbial classification, the thick-walled phylum was the main species of vaginal microorganisms in both groups, but the proportion of the cervical cancer group (45%) decreased compared with that of the healthy group (91%), while the proportion of the rest, such as Ascomycetes and Actinomycetes, was significantly higher. At the species level, the proportion of Lactobacillus spp. in the cervical cancer group (14.2%) decreased significantly compared to that in the healthy group (81%). On the basis of macro-genome sequencing, it was concluded that Lactobacillus convolvulus has a probiotic signature significance in healthy females and may exert a probiotic effect in the function of the ABC transporter, using LEfSe and LDA discriminant analysis. Conclusion: Women with cervical cancer are characterised by an increase in vaginal microbial diversity and a decrease in the level of Lactobacillus, in which the different species at the level of microbial species was explored by macro-genome sequencing technology to conclude that Lactobacillus convolvulus has a potential probiotic role in the function of the ABC transporter in the prevention of the development of cervical cancer, and this can provide theoretical evidence for the prevention of cervical carcinogenesis from the perspective of regulating the vaginal micro-ecology for the future clinic. [ABSTRACT FROM AUTHOR]

Bacterial vaginosis (BV) is the most common lower reproductive tract infection among women of childbearing age, leading to an increasing risk of pelvic inflammatory disease, poor pregnancy outcomes, and multiple sexually transmitted infections. At present, the main clinical drugs used for BV treatment are antibiotics such as metronidazole and clindamycin, but it is difficult to solve the problems of treatment failure and high recurrence rate in some patients. The reason might be that the antibiotics have a single mechanism of bacterial inhibition, and the intensity is insufficient, which cannot rebuild the vaginal microbiota dominated by Lactobacillus, nor can they inhibit the production of pathogenic biofilms dominated by Gardnerella vaginalis. Therefore, there is an urgent need to develop new alternative drugs or combination therapies for BV treatment. This article reviews the recent research advances in new treatment for BV based on its microbiological foundation, especially lactobacillus preparations and biofilm inhibitors. Most of these therapies have good safety and high effectiveness, with great research value. Some of the applications have been available in clinic practice in these years. [ABSTRACT FROM AUTHOR]

Objective: To explore the characteristics of vaginal microbiota in patients with repeated implantation failure (RIF). Methods: A total of 49 patients undergoing the frozen-thawed embryo transfer (FET) cycles were recruited. In the observation group, patients (n=29) with a history of RIF have failed pregnancy during the FET cycles. In the control group, patients (n=20) underwent the FET for the first time and achieved clinical pregnancy. In both groups, artificial hormone cycles were performed, and the top-quality blastocysts cultured on Day 5 were tranferred. Vaginal samples were collected on the FET day. Microbial diversity, microbial community composition and differential bacterial genera between the two groups were analyzed by 16S rRNA sequencing. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of the abundance of Lactobacillus for RIF. Results: The α diversity analysis showed that the microbial diversity (Shannon: P=0.049 8) and richness (Chao: P =0.047 1) of the observation group were significantly higher than those of the control group. The β diversity analysis showed that there was significant difference in the vaginal microbial community composition between the two groups (P=0.016). At the genus level, Lactobacillus was dominant in both groups. The abundance of Lactobacillus of the observation group was significantly lower than that of the control group, while the abundances of Acinetobacter and Pseudomonas of the observation group were significantly higher than those of the control group (LDA＞3, P＜0.05). The optimal cutoff value for diagnosing RIF with the abundance of Lactobacillus was 70%, and the area under curve (AUC) was 0.77. Conclusions: Vaginal microbiota was showed differences in RIF patients, including the decreased abundances of Lactobacillus. The low abundance of vaginal Lactobacillus may be related with the pathogenesis of RIF [ABSTRACT FROM AUTHOR]

Antimicrobial stewardship is one of the cornerstones in the battle against antimicrobial resistance. Restrictive legislation aims to foster antimicrobial stewardship. Prophylactic prescription of antimicrobials is still a widespread practice in canine breeding management to prevent suspected infectious infertility. The aim of this study was to evaluate the efficacy of restrictive legislation in Germany (Veterinary Home Pharmacy Ordinance, TÄHAV) based on resistance profiles of common bacterial isolates from the vaginal tract by comparing the resistance situation before (time frame (TF1)) and after (TF2) its amendment. In total, results of 13,373 antimicrobial susceptibility tests of bacterial isolates of Escherichia coli (n = 5209), beta-hemolytic streptococci (n = 4010), and Staphylococcus (Staph.) intermedius group (n = 4154) derived from canine vaginal swabs were assessed. Antimicrobial susceptibility testing was performed on pure cultures using the broth microdilution method. Susceptibility to selected antimicrobials was evaluated. Susceptibility of Escherichia coli generally increased within TF2 with, however, a significant increase in the number of non-susceptible isolates to cefalexin (p < 0.0001). Beta-hemolytic streptococci exhibited good susceptibility to most antimicrobials. Susceptibility developed ambivalently within the Staphylococcus intermedius group. Despite an overall positive effect of increased susceptibility, an increase in non-susceptibility to single antimicrobials was detected, possibly indicating a need for refinement of the legislation.

Simple Summary: To obtain a better understanding of the canine vaginal flora, we analyzed the results of 23,254 vaginal swab samples that had been sent for conventional aerobic bacterial culture to three commercial laboratories between 2015 and 2021. The results show that the canine vagina is inhabited by numerous microorganisms, mostly in mixed cultures of two or more bacterial isolates. Our study confirms the variability of the canine aerobic bacterial flora described in earlier studies, however, for the first time in a vast population. Microbiological examinations are frequently performed as part of breeding management examinations in the bitch, but also in case of (suspected) reproductive tract problems. As most bacteria are opportunistic pathogens, evaluation of bacterial findings is challenging for veterinarians. Besides, breeders might request antimicrobial treatment in breeding bitches, fearing conception failure—even without medical indication. Considering the rising threat of antimicrobial resistance, gaining deeper insights into the bacterial findings from the vagina of healthy and (suspected) reproductive-diseased bitches might contribute to the knowledge of the canine aerobic vaginal flora and consequently improve the responsible use of antibiotics. We analyzed results from bacteriological cultures of 23,254 vaginal swabs sent in to three commercial laboratories in Germany between 2015 and 2021, where standard aerobic microbiological examination was carried out. We found a variety of 319 bacterial species that mostly grew in mixed cultures of two or more bacterial species. Commonly found species were Escherichia coli, beta-hemolytic Streptococci, coagulase-positive Staphylococci, Pasteurellales, and aerobic sporulators, as well as other Streptococcus spp. Our results showed a large diversity of the canine vaginal flora in healthy and (suspected) reproductive-diseased bitches. They largely support earlier findings of small studies on the physiological canine vaginal flora, emphasizing that solely the results of a bacterial evaluation should not be the base for antimicrobial treatment. Instead, bacterial findings should be evaluated with the results of a clinical gynecological examination. [ABSTRACT FROM AUTHOR]

ABSTRACTAlthough vaginitis is closely related to vaginal microecology in females, the precise composition and functional potential of different types of vaginitis remain unclear. Here, metagenomic sequencing was applied to analyze the vaginal flora in patients with various forms of vaginitis, including cases with a clue cell proportion ranging from 1% to 20% (Clue1_20), bacterial vaginitis (BV), vulvovaginal candidiasis (VVC), and BV combined with VVC (VVC_BV). Our results identified Prevotella as an important biomarker between BV and Clue1_20. Moreover, a gradual decrease was observed in the relative abundance of shikimic acid metabolism associated with bacteria producing indole as well as a decline in the abundance of Gardnerella vaginalis in patients with BV, Clue1_20, and healthy women. Interestingly, the vaginal flora of patients in the VVC_BV group exhibited structural similarities to that of the VVC group, and its potentially functional characteristics resembled those of the BV and VVC groups. Finally, Lactobacillus crispatus was found in high abundance in healthy samples, greatly contributing to the stability of the vaginal environment. For the further study of L. crispatus, we isolated five strains of L. crispatus from healthy samples and evaluated their capacity to inhibit G. vaginalis biofilms and produce lactic acid in vitro to select the potential probiotic candidate for improving vaginitis in future clinical studies. Overall, we successfully identified bacterial biomarkers of different vaginitis and characterized the dynamic shifts in vaginal flora between patients with BV and healthy females. This research advances our understanding and holds great promise in enhancing clinical approaches for the treatment of vaginitis.IMPORTANCEVaginitis is one of the most common gynecological diseases, mostly caused by infections of pathogens such as Candida albicans and Gardnerella vaginalis. In recent years, it has been found that the stability of the vaginal flora plays an important role in vaginitis. Furthermore, the abundant Lactobacillus-producing rich lactic acid in the vagina provides a healthy acidic environment such as Lactobacillus crispatus. The metabolites of Lactobacillus can inhibit the colonization of pathogens. Here, we collected the vaginal samples of patients with bacterial vaginitis (BV), vulvovaginal candidiasis (VVC), and BV combined with VVC to discover the differences and relationships among the different kinds of vaginitis by metagenomic sequencing. Furthermore, because of the importance of L. crispatus in promoting vaginal health, we isolated multiple strains from vaginal samples of healthy females and chose the most promising strain with potential probiotic benefits to provide clinical implications for treatment strategies.

Objective·To investigate the distribution characteristics of vaginal flora in patients with cervical incompetence (CIC), and the effect of cervical cerclage on pregnancy outcome in patients with CIC with abnormal vaginal flora.Methods·A total of 1 261 pregnant women participated in the study. According to the diagnosis, they were divided into cervical incompetence group (CIC group) and normal pregnancy group (NP group). The CIC group patients randomly received cervical cerclage (CIC-C group) or expectation therapy (CIC-E group). Vaginal secretion samples of the patients in the groups were collected and analyzed in the laboratory. Meanwhile, through the results of vaginal flora, the CIC-C group and CIC-E group were further divided into normal vaginal flora groups (CIC-C-N group and CIC-E-N group) and abnormal vaginal flora groups (CIC-C-A group and CIC-E-A group). All groups were processed accordingly and analyzed on pregnancy outcomes. T-test and Chi-squared test were used for comparison between the groups, and One-way ANOVA was used for comparison among the three groups. Statistical significance was accepted at a value of P

Abstract Background Technology advancement has allowed more frequent monitoring of biomarkers. The resulting data structure entails more frequent follow-ups compared to traditional longitudinal studies where the number of follow-up is often small. Such data allow explorations of the role of intra-person variability in understanding disease etiology and characterizing disease processes. A specific example was to characterize pathogenesis of bacterial vaginosis (BV) using weekly vaginal microbiota Nugent assay scores collected over 2 years in post-menarcheeal women from Rakai, Uganda, and to identify risk factors for each vaginal microbiota pattern to inform epidemiological and etiological understanding of the pathogenesis of BV. Methods We use a fully data-driven approach to characterize the longitudinal patters of vaginal microbiota by considering the densely sampled Nugent scores to be random functions over time and performing dimension reduction by functional principal components. Extending a current functional data clustering method, we use a hierarchical functional clustering framework considering multiple data features to help identify clinically meaningful patterns of vaginal microbiota fluctuations. Additionally, multinomial logistic regression was used to identify risk factors for each vaginal microbiota pattern to inform epidemiological and etiological understanding of the pathogenesis of BV. Results Using weekly Nugent scores over 2 years of 211 sexually active and post-menarcheal women in Rakai, four patterns of vaginal microbiota variation were identified: persistent with a BV state (high Nugent scores), persistent with normal ranged Nugent scores, large fluctuation of Nugent scores which however are predominantly in the BV state; large fluctuation of Nugent scores but predominantly the scores are in the normal state. Higher Nugent score at the start of an interval, younger age group of less than 20 years, unprotected source for bathing water, a woman’s partner’s being not circumcised, use of injectable/Norplant hormonal contraceptives for family planning were associated with higher odds of persistent BV in women. Conclusion The hierarchical functional data clustering method can be used for fully data driven unsupervised clustering of densely sampled longitudinal data to identify clinically informative clusters and risk-factors associated with each cluster.

Objective·To investigate the distribution characteristics of vaginal flora in patients with cervical incompetence (CIC), and the effect of cervical cerclage on pregnancy outcome in patients with CIC with abnormal vaginal flora. Methods·A total of 1 261 pregnant women participated in the study. According to the diagnosis, they were divided into cervical incompetence group (CIC group) and normal pregnancy group (NP group). The CIC group patients randomly received cervical cerclage (CIC-C group) or expectation therapy (CIC-E group). Vaginal secretion samples of the patients in the groups were collected and analyzed in the laboratory. Meanwhile, through the results of vaginal flora, the CIC-C group and CIC-E group were further divided into normal vaginal flora groups (CIC-C-N group and CIC-E-N group) and abnormal vaginal flora groups (CIC-C-A group and CIC-E-A group). All groups were processed accordingly and analyzed on pregnancy outcomes. T-test and Chi-squared test were used for comparison between the groups, and One-way ANOVA was used for comparison among the three groups. Statistical significance was accepted at a value of P<0.05. Results·Among 1 261 vaginal secretion specimens, the positive rate of pathogenic bacteria was 22.0% (277/ 1 261). The pathogen detection rates in the CIC group and NP group were 32.9% (229/696) and 8.5% (48/565). Twenty-three types of vaginal flora were detected in the CIC group, and 9 were detected in the NP group. The proportions of women who had term birth were 75.94% in the CIC-C group, 70.03% in the CIC-E group, and 87.79% in the NP group (P=0.000). Compared with the CIC-C-A group, the CIC-E-A group had a lower term delivery rate (61.84% vs 77.78%, P=0.011) and a higher incidence of pregnancy complications (22.37% vs 9.15%, P=0.006). Conclusion·There are differences in the distribution and diversity of vaginal flora between CIC patients and normal pregnant women. Cervical cerclage can improve pregnancy outcomes in CIC patients with abnormal vaginal flora. [ABSTRACT FROM AUTHOR]

Background: Technology advancement has allowed more frequent monitoring of biomarkers. The resulting data structure entails more frequent follow-ups compared to traditional longitudinal studies where the number of follow-up is often small. Such data allow explorations of the role of intra-person variability in understanding disease etiology and characterizing disease processes. A specific example was to characterize pathogenesis of bacterial vaginosis (BV) using weekly vaginal microbiota Nugent assay scores collected over 2 years in post-menarcheeal women from Rakai, Uganda, and to identify risk factors for each vaginal microbiota pattern to inform epidemiological and etiological understanding of the pathogenesis of BV. Methods: We use a fully data-driven approach to characterize the longitudinal patters of vaginal microbiota by considering the densely sampled Nugent scores to be random functions over time and performing dimension reduction by functional principal components. Extending a current functional data clustering method, we use a hierarchical functional clustering framework considering multiple data features to help identify clinically meaningful patterns of vaginal microbiota fluctuations. Additionally, multinomial logistic regression was used to identify risk factors for each vaginal microbiota pattern to inform epidemiological and etiological understanding of the pathogenesis of BV. Results: Using weekly Nugent scores over 2 years of 211 sexually active and post-menarcheal women in Rakai, four patterns of vaginal microbiota variation were identified: persistent with a BV state (high Nugent scores), persistent with normal ranged Nugent scores, large fluctuation of Nugent scores which however are predominantly in the BV state; large fluctuation of Nugent scores but predominantly the scores are in the normal state. Higher Nugent score at the start of an interval, younger age group of less than 20 years, unprotected source for bathing water, a woman's partner's being not circumcised, use of injectable/Norplant hormonal contraceptives for family planning were associated with higher odds of persistent BV in women. Conclusion: The hierarchical functional data clustering method can be used for fully data driven unsupervised clustering of densely sampled longitudinal data to identify clinically informative clusters and risk-factors associated with each cluster. [ABSTRACT FROM AUTHOR]

Background: Mixed vaginitis is the infection of the vagina by at least two different pathogens at the same time, both of which contribute to an abnormal vaginal environment leading to signs and symptoms. Baicao Fuyanqing suppository (BCFYQ) is a Miao ethnomedicine, used to treat various vaginitis. The aim of this study was to investigate the efficacy and possible mechanism of BCFYQ in the treatment of mixed vaginitis based on 16S rRNA high-throughput sequencing and metabonomics. Methods: Escherichia coli and Candida albicans were used to establish mixed vaginitismodel in SD rats. Three groups of low, mediumand high doses (0.18/0.36/0.64 g.kg-1) were established, and administered vaginally once a day for 6 consecutive days. After the last administration, vaginal pH and IL-1β, IL-2, IL-13 and IgA levels were measured, and the vaginal tissue was examined pathologically. In addition, the vaginal flora was characterised by 16S rRNA, and endogenous metabolites in the vaginal tissue were detected by UHPLC-Q-Exactive MS. Results: Compared with the model group, BCFYQ can reduce the vaginal pH of rats, make it close to the normal group and improve the damaged vaginal epithelial tissue. The results of ELISA showed that BCFYQ decreased the levels of IL-1 β and IL-2 and increased the levels of IL-13 and IgA (P<0.05). In addition, BCFYQ may increase the abundance of vaginal flora, especially Lactobacillus. The differential metabolite enrichment pathway suggests that the therapeutic mechanism of BCFYQ is mainly related to lipid metabolism and amino acid metabolism. Conclusion: Our research shows that BCFYQ has a good therapeutic effect on mixed vaginitis. It repairs the damaged vaginal mucosa by regulating the vaginal flora and lipid metabolism disorders to improve the local immune function of the vagina and inhibit the growth and reproduction of pathogens. [ABSTRACT FROM AUTHOR]

Abstract Background The findings of the association of vaginal flora with preterm birth (PTB) or prelabor rupture of membranes (PROM) were conflicts. Moreover, vaginal flora was different by ethnicity and the evidence from China was limited. Methods This study was a nested case control study, based on Yiwu birth cohort. We assessed vaginal microbiota in the second or third trimester, using 16S rDNA Amplicon Sequencing and explored the association between the diversity and composition of vaginal flora and PTB or PROM. Results We finally included 144 pregnant women. In present study, the alpha diversity of TPROM (Term prelabor rupture of membranes) samples was lower than that of full term samples (Chao1 index: P

Background: Normal vaginal flora that is lactobacillus maintains the vaginal PH thus preventing women from day to day infection. Premature membrane rupture puts the mother and fetus at risk for complications such maternal infection, fetal infection, umbilical cord compression, cord prolapse, fetal death, poor Apgar score, pulmonary hypoplasia, preterm delivery, low birth weights, and fetal deformities. Our aim is to study spectrum of vaginal flora in women with premature rupture of membrane and it's association with maternal and perinatal outcome. Methodology: A prospective observational study was conducted in 128 women admitted with premature rupture of membrane in obstetric wards of R D Gardi Medical College, Ujjain; over one year. All pregnant women with gestational age more than 28weeks admitted in obstetrics ward having complaint of leaking per vagina were included in this study. Swab were collected for culture and sensitivity to laboratory. Result: Mean age was 26.28 ±4.12 years, and median age was 27 years. In high vaginal swab cultures, growth was observed in 73 women (57.0%). E.coli was the commonest observed organism ( 22.7%) followed by Staphylococcus aureus (14.1%). Mixed growth was seen in 8.6% women. Maternal outcome was fever (10.9%), UTI (9.4%), puerperal sepsis(3.1%), chorioamnionitis(4.7%) and wound infection(4.7%). Neonatal outcome were NICU admissions, Prematurity, Low Birth Weight and Neonatal Sepsis in 35.6%, 19.2%, 28.8%, 6.8% respectively. Conclusion: In this study we conclude that 57% women had abnormal vaginal flora in pregnant women presenting with PROM and were linked with adverse pregnancy outcome and adverse neonatal outcome. We conclude that microbiologic screening in early pregnancy may aid in the assessment of patient risk for preterm delivery. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the distribution and variations in vaginal pathogens throughout different trimesters of pregnancy, utilizing both vaginal culture and polymerase chain reaction (PCR) techniques, in order to ascertain the presence and prevalence of microorganisms across the various stages of pregnancy. Materials and Methods: A total of forty-six healthy pregnant women with no reported discharge complaints were recruited for this study. They were monitored at 6-13 weeks, 20-26 weeks, and 32-38 weeks of gestation until delivery. Vaginal swab samples were collected and subjected to multiplex PCR, microscopic examination, aerobic culture media, and gram staining. Results: Candida species (spp.) emerged as the most frequently isolated microorganisms in vaginal swab samples from each trimester, followed by Escherichia coli and Ureaplasma urealyticum. The prevalence of Candida spp. increased proportionally with advancing trimesters. Notably, the pregnancies of these women showed no complications such as premature labor or premature membrane rupture. Gardnerella vaginalis was the predominant microorganism isolated in the first trimester, succeeded by Atopobium vaginae, Bacteroides fragilis, Mobiluncus curtisii, and Mobiluncus mulieris in decreasing order. However, the quantity of Gardnerella vaginalis did not exhibit a significant increase in the second and third trimesters. Conclusion: This study suggests Gardnerella vaginalis as the most commonly isolated vaginal microorganism during the first trimester, alongside other bacterial species associated with bacterial vaginosis. Importantly, the quantities of these bacteria remained relatively stable in the second and third trimesters. These findings suggest a dynamic shift in vaginal microbiota during pregnancy, including an escalation in Candida spp. as pregnancy progresses. Further research is warranted to comprehend the implications of these changes and their potential ramifications for vaginal and feto-maternal health. [ABSTRACT FROM AUTHOR]

Objective To explore the characteristics and correlations of vaginal flora in women with cervical lesions. Methods A total of 132 women, including 41 women diagnosed with normal cervical (NC), 39 patients with low-grade cervical intraepithelial neoplasia (CIN 1), 37 patients with high-grade cervical intraepithelial neoplasia (CIN 2/3) and 15 patients with cervical squamous cell carcinoma (SCC), who came from the gynecological clinic of Second Hospital of Shanxi Medical University during January 2018 to June 2018, were enrolled in this study according to the inclusive and exclusive criteria strictly. The vaginal flora was detected by 16S rDNA sequencing technology. Co-occurrence network analysis was used to investigate the Spearman correlations between different genera of bacteria. Results The dominant bacteria in NC, CIN 1 and CIN 2/3 groups were Lactobacillus [constituent ratios 79.4% (1 869 598/2 354 098), 63.6% (1 536 466/2 415 100) and 58.3% (1 342 896/2 301 536), respectively], while Peptophilus [20.4% (246 072/1 205 154) ] was the dominant bacteria in SCC group. With the aggravation of cervical lesions, the diversity of vaginal flora gradually increased (Shannon index: F=6.39, P=0.001; Simpson index: F=3.95, P=0.012). During the cervical lesion progress, the ratio of Lactobacillus gradually decreased, the ratio of other anaerobes such as Peptophilus, Sneathia, Prevotella and etc. gradually increased, and the differential bacteria (LDA score >3.5) gradually evolved from Lactobacillus to other anaerobes. The top 10 relative abundance bacteria, spearman correlation coefficient>0.4 and P<0.05 were selected. Co-occurrence network analysis showed that Prevotella, Peptophilus, Porphyrinomonas, Anaerococcus, Sneathia, Atopobium, Gardnerella and Streptococcus were positively correlated in different stages of cervical lesions, while Lactobacillus was negatively correlated with the above anaerobes. It was found that the relationship between vaginal floras in CIN 1 group was the most complex and only Peptophilus was significantly negatively correlated with Lactobacillus in SCC group. Conclusions The increased diversity and changed correlations between vaginal floras are closely related to cervical lesions. Peptophilus is of great significance in the diagnosis, prediction and early warning of cervical carcinogenesis. [ABSTRACT FROM AUTHOR]

Antimicrobials are added to semen extenders to inhibit the growth of bacteria that are transferred to the semen during collection. However, this non-therapeutic use of antimicrobials could contribute to the development of antimicrobial resistance. The objective of this study was to determine changes in the antibiotic susceptibility of vaginal microbiota after artificial insemination. Swabs were taken from the vagina of 26 mares immediately before artificial insemination and again 3 days later. Bacteria isolated from the vagina at both time points were subjected to antibiotic susceptibility testing and whole-genome sequencing. In total, 32 bacterial species were identified. There were increases in the resistance of Escherichia coli to trimethoprim (p = 0.0006), chloramphenicol and (p = 0.012) tetracycline (p = 0.03) between day 0 and day 3. However, there was no significant effect of exposure to antibiotics in semen extenders with respect to the resistance of Staphylococcus simulans and Streptococcus equisimilis (p > 0.05). Whole-genome sequencing indicated that most phenotypic resistance was associated with genes for resistance. These results indicate that the resistance patterns of vaginal bacteria may be affected by exposure to antibiotics; therefore, it would be prudent to minimize, or preferably, avoid using antibiotics in semen extenders. [ABSTRACT FROM AUTHOR]

Microbiological examinations are frequently performed as part of breeding management examinations in the bitch, but also in case of (suspected) reproductive tract problems. As most bacteria are opportunistic pathogens, evaluation of bacterial findings is challenging for veterinarians. Besides, breeders might request antimicrobial treatment in breeding bitches, fearing conception failure—even without medical indication. Considering the rising threat of antimicrobial resistance, gaining deeper insights into the bacterial findings from the vagina of healthy and (suspected) reproductive-diseased bitches might contribute to the knowledge of the canine aerobic vaginal flora and consequently improve the responsible use of antibiotics. We analyzed results from bacteriological cultures of 23,254 vaginal swabs sent in to three commercial laboratories in Germany between 2015 and 2021, where standard aerobic microbiological examination was carried out. We found a variety of 319 bacterial species that mostly grew in mixed cultures of two or more bacterial species. Commonly found species were Escherichia coli, beta-hemolytic Streptococci, coagulase-positive Staphylococci, Pasteurellales, and aerobic sporulators, as well as other Streptococcus spp. Our results showed a large diversity of the canine vaginal flora in healthy and (suspected) reproductive-diseased bitches. They largely support earlier findings of small studies on the physiological canine vaginal flora, emphasizing that solely the results of a bacterial evaluation should not be the base for antimicrobial treatment. Instead, bacterial findings should be evaluated with the results of a clinical gynecological examination.

The upper female genital tract connects to the external world through the vaginal canal and can be a potential route of entry to pathogens into the reproductive organs. Lactobacilli exert their protective action by reducing the vaginal pH by producing lactic acid by degrading glycogen released by epithelial cells. Whenever a breach in this intricate defence mechanism or its balance is disturbed, the female genital tract becomes vulnerable to infections. A 30-year-old reported with complaints of abdominal pain and vaginal discharge with poor obstetrical history and had three consecutive Preterm Premature Rupture of Membranes (PPROM) at the 20th, 22nd, and 25th week of gestation. All three pregnancies were natural conceptions. Three consecutive miscarriages were presumed to be due to recurrent vaginitis, cervical inflammation, and chorioamnionitis. The vaginal discharge culture examination was negative for Lactobacilli and positive for gram-positive bacteria. The patient was advised topical antibiotics, oral probiotics containing Lactobacilli species, and prebiotic Lactoferrin 100mg. In a few weeks, Lactobacillus predominant vaginal flora was observed. During pregnancy, she used Lactoferrin and Lactobacillus combination orally until delivery. Cervical maturation was not observed before the term in this gestation. Lactobacillus had been the dominant vaginal flora during pregnancy, and the course of the pregnancy was good. She delivered vaginally at term a healthy male infant. Aetiopathogenesis of preterm delivery in humans has been hypothesised to be triggered by the inflammatory response caused by intrauterine infections. Lactoferrin inhibits the production of inflammatory cytokines and significantly prevents preterm delivery induced by infection.

Objective: To investigate abnormal vaginal and suture-based bacterial flora for associations with spontaneous preterm birth in high-risk singleton pregnancies with an ultrasound-indicated or emergency cervical cerclage. Materials and methods: A retrospective study of 196 singleton pregnancies with an ultrasound-indicated or emergency cerclage at the Royal Women’s Hospital, Australia, from 2004 to 2018. High vaginal swabs were collected regularly between 14 and 26 weeks’ gestation, including pre- and post-cerclage insertion, and sent for microscopy and culture. Cervical suture was cultured upon removal. Primary outcomes were spontaneous preterm birth <37, <34 and <30 weeks. Results: 43.4% (85/196) of women delivered preterm. The acquisition and persistence of vaginal Escherichia coli following cerclage insertion were independently associated with spontaneous preterm birth <37 weeks (p =.0225, p =.0477). Escherichia coli growth from the cervical suture upon removal was associated with spontaneous preterm birth <34 weeks (p =.0458). The acquisition of vaginal mixed anaerobes post-cerclage was independently associated with spontaneous preterm birth <34 weeks (p =.0480) Conclusion: For singleton pregnancies with an ultrasound-indicated or emergency cerclage, the presence of vaginal or suture-based Escherichia coli following cerclage insertion yields increased risk of cerclage failure and spontaneous preterm birth. Objective: To investigate abnormal vaginal and suture-based bacterial flora for associations with spontaneous preterm birth in high-risk singleton pregnancies with an ultrasound-indicated or emergency cervical cerclage. Materials and methods: A retrospective study of 196 singleton pregnancies with an ultrasound-indicated or emergency cerclage at the Royal Women’s Hospital, Australia, from 2004 to 2018. High vaginal swabs were collected regularly between 14 and 26 weeks’ gestation, including pre- and post-cerclage insertion, and sent for microscopy and culture. Cervical suture was cultured upon removal. Primary outcomes were spontaneous preterm birth <37, <34 and <30 weeks. Results: 43.4% (85/196) of women delivered preterm. The acquisition and persistence of vaginal Escherichia coli following cerclage insertion were independently associated with spontaneous preterm birth <37 weeks (p ¼ .0225, p ¼ .0477). Escherichia coli growth from the cervical suture upon removal was associated with spontaneous preterm birth <34 weeks (p ¼ .0458). The acquisition of vaginal mixed anaerobes post-cerclage was independently associated with spontaneous preterm birth <34 weeks (p ¼ .0480) Conclusion: For singleton pregnancies with an ultrasound-indicated or emergency cerclage, the presence of vaginal or suture-based Escherichia coli following cerclage insertion yields increased risk of cerclage failure and spontaneous preterm birth. [ABSTRACT FROM AUTHOR]

Introduction: Vaginal dysbiosis affects pregnancy outcomes, however, the relevance of abnormal findings on pre/post-surgical vaginal culture in women undergoing fetal spina bifida (fSB) repair is unknown. Objectives: To describe the incidence of normal and abnormal pre- and post-surgical vaginal microorganisms in fSB patients and to investigate potential associations between the type of vaginal flora and the occurrence of preterm prelabour rupture of membranes (PPROM) and preterm birth (PTB). Methods: 99 women undergoing fSB repair were eligible (2010–2019). Pre-surgical vaginal culture was routinely taken before surgery. Post-surgical cultures were taken on indication. Vaginal flora was categorized into four categories: healthy vaginal flora (HVF), bacterial vaginosis (BV), desquamative inflammatory vaginitis (DIV), and yeast infection. Results: The incidence of HVF, BV, DIV, or yeast infections was not statistically different between the pre- and postoperative patients. Furthermore, an abnormal pre/post-surgical vaginal flora was not associated with PPROM (OR 1.57 (0.74–3.32), p = 0.213)/OR 1.26 (0.62–2.55), p = 0.515), or with PTB (OR 1.19 (0.82–1.73), p = 0.315)/(OR 0.86 (0.60–1.24), p = 0.425). Conclusions: Abnormal vaginal microbiome was not associated with PPROM and PTB when appropriate treatment was performed. [ABSTRACT FROM AUTHOR]

ObjectiveVaginal microbiota imbalance is a high risk factor for premature birth, and is closely related to female pelvic inflammation and sexually transmitted diseases. The effect of vaginal microbiota on the outcome of assisted reproductive technology is still unclear. In this study, the vaginal microbial composition and the pregnancy outcome of frozen embryo transfer (FET) was investigated.MethodsFrom October 2020 to December 2021, 275 FET cycles were selected from the center of reproductive medicine in Affiliated Hospital of Nantong University. Vaginal secretions were collected on the day of endometrium transformation, and smears were Gram stained. According to the Nugent score they were divided into three groups, including normal group, mild dysbiosis group and sever dysbiosis group. The clinical outcomes of each group were compared.ResultsIn 275 FET cycles, the embryo implantation rate, clinical pregnancy rate and ongoing pregnancy rate in the normal group (66.9%,84.3% and 83.1%) were significantly higher than those in the mild dysbiosis group (45.5%, 57.3% and 49.3%) and in sever dysbiosis group (29.6%, 34.2% and 27%). The difference was statistically significant (P0.05).ConclusionNugent score is directly related to the clinical outcome of FET. The Lactobacilli-dominant vaginal flora was a favorable factor for the good clinical outcome of FET, while asymptomatic bacterial vaginosis had a negative correlation with the outcome of FET.

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

Leptothrix are long bacteria of rare occurrence; although these bacteria have been implicated in causing vaginal symptoms identical to candidiasis, studies on prevalence and effect on overall vaginal health are lacking. In this study, we evaluated data of women referred to a private clinic for treating vulvovaginal symptoms (n = 1847) and reassessed data of our previous and ongoing studies (n = 1773). The overall rate of leptothrix was 2.8% (102/3620), and the mean age of affected women was 38.8 ± 10.65 years (range 18−76). The majority of the women with leptothrix had normal vaginal flora (63.7% [65/102]). Leptothrix was associated with a higher risk of candidiasis (relative risk (RR) 1.90, 95% confidence interval (CI) 1.1600–3.1013; p = 0.010) and a lower risk of bacterial vaginosis (RR 0.55, 95% CI, 0.3221–0.9398; p = 0.029) and cytolytic vaginosis (RR 0.11, 95% CI, 0.0294–0.4643; p = 0.002). No cases of trichomoniasis were observed. Human immunodeficiency virus infection increased the risk of leptothrix (RR 3.0, 95% CI, 1.6335–5.7245; p = 0.000). Among the women evaluated for vulvovaginal symptoms, 2.4% (45/1847) had leptothrix, and in 26.7% (12/45), leptothrix was considered the causative entity. This study suggests that leptothrix occurrence is rare; it remains unresolved if it can be a cause of vulvar symptoms. [ABSTRACT FROM AUTHOR]

Preterm birth is a leading cause of perinatal morbidity and mortality and Preterm premature rupture of the membranes (PPROM) is a major risk factor contributing to approximately one third of preterm deliveries. Vaginal infections are often associated with PPROM and are characterised by loss of lactobacillin normal vaginal flora and overgrowth of other pathogenic microorganisms. Probiotics appear to have an emerging role in prolonging pregnancy after PPROM. This trial compared the efficacy of a vaginal probiotic in combination with standard antibiotic prophylaxis versus only antibiotic in prolongation of latency period and on perinatal outcome in cases of PPROM between 24 and 34 weeks. Although no significant difference was observed in the mean latency period (p = 0.937) and mean gestational age at birth (p = 0.863) between the two groups, the overall neonatal outcome was better in the study group. There is need of further large-scale clinical trials to demonstrate effectiveness of probiotics. What is already known on this subject? PPROM is an important cause of preterm birth. Prematurity leads significant global burden of neonatal morbidity and mortality. Antibiotics in PPROM have a proven benefit to prolong latency period from start of PPROM to birth. Probiotics have a role in improving vaginal flora and reducing infections and have been tried in PPROM. What do the results of this study add? The usefulness of probiotics in prolonging latency period and improving neonatal outcome has been reported in limited trials. In our study it has shown an improvement in neonatal outcome overall but not statistically significant compared to few studies which have reported significant beneficial effects. This might be due to existence of variation in the type of the vaginal microflora in different study population. What are the implications of these findings for clinical practice and/or further research? Preliminary results suggest that use of probiotic may benefit women with PPROM. This also implies need of multicentric larger scales trials with different types of probiotics so as to clarify whether any intervention in vaginal microflora can lead to any benefits in reducing the prematurity and its consequence, both on the neonate and heath care infrastructure. [ABSTRACT FROM AUTHOR]

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine 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.)

The upper female genital tract connects to the external world through the vaginal canal and can be a potential route of entry to pathogens into the reproductive organs. Lactobacilli exert their protective action by reducing the vaginal pH by producing lactic acid by degrading glycogen released by epithelial cells. Whenever a breach in this intricate defence mechanism or its balance is disturbed, the female genital tract becomes vulnerable to infections. A 30-year-old reported with complaints of abdominal pain and vaginal discharge with poor obstetrical history and had three consecutive Preterm Premature Rupture of Membranes (PPROM) at the 20th, 22nd, and 25th week of gestation. All three pregnancies were natural conceptions. Three consecutive miscarriages were presumed to be due to recurrent vaginitis, cervical inflammation, and chorioamnionitis. The vaginal discharge culture examination was negative for Lactobacilli and positive for gram-positive bacteria. The patient was advised topical antibiotics, oral probiotics containing Lactobacilli species, and prebiotic Lactoferrin 100mg. In a few weeks, Lactobacillus predominant vaginal flora was observed. During pregnancy, she used Lactoferrin and Lactobacillus combination orally until delivery. Cervical maturation was not observed before the term in this gestation. Lactobacillus had been the dominant vaginal flora during pregnancy, and the course of the pregnancy was good. She delivered vaginally at term a healthy male infant. Aetiopathogenesis of preterm delivery in humans has been hypothesised to be triggered by the inflammatory response caused by intrauterine infections. Lactoferrin inhibits the production of inflammatory cytokines and significantly prevents preterm delivery induced by infection. [ABSTRACT FROM AUTHOR]

Background: A healthy vagina is characterized by hydrogen peroxide and acid-producing lactobacilli, which are crucial to maintain the physiological vaginal ecosystem and their depletion speeds up bacterial overgrowth with pH elevation, salidase and amine production, leading to the observed signs and symptoms of vaginal dysbiosis. An effective treatment should be combined of lactobacillary flora and low doses of estrogen to maintain the physiology of the vaginal epithelium. Material and methods: This is a prospective randomized study that included 218 patients, who were divided into 2 groups according to the treatment regimen, performed between October 2018 and December 2019 at the Department of Obstetrics and Gynecology of Nicolae Testemitanu State University of Medicine and Pharmacy. Patients selected were divided into L1 (120 patients assigned to treatment with the combination of two microorganisms Lactobacillus rhamnosus and Lactobacillus reuteri with estriol 0.03 mg vaginal pessaries) and L2 (98 patients who were given Lactobacillus rhamnosus in vaginal capsules). The treatment regimen for both groups was the same – 1 pessary or 1 capsule once in 24 hours, in the evening, for 12 days. Patients were evaluated before treatment (visit 1) and on day 13 of treatment (visit 2) and 1 month after the end of treatment (visit 3). Results: Of the 120 women included in the study in the first group and 98 in the second group, a significant improvement (normocenosis) according to the research physician and patients was found in 93.3% (112) patients of group 1 and 71.4% (70) patients in group 2, satisfactory improvement (consistent with the intermediate type of biocenosis) in 5% (6) patients of group 1 and 15.3% (14) patients from group 2, unsatisfactory result 1.7% (2) patients from group 1 and 13.3% (13) of patients of group 2 (later relapse was noted in these patients). Conclusions: Probiotic treatment with vaginal Lactobacillus rhamnosus, Lactobacillus reuteri and low doses of estriol seems to be useful in hindering bacteria growth especially after antibiotic therapy; therefore this intervention may be considered a new prophylactic treatment for preventing recurrence of bacterial vaginosis, in particular in high-risk patients.

Objective: To analyze the characteristics of vaginal flora in patients with recurrent spontaneous abortion (RSA). Methods: The vaginal secretions of 20 patients with unexplained RSA (RSA group) and 20 women with normal early pregnancy abortion (control group) from December 2020 to September 2021 were collected. The vaginal flora of vaginal secretions were analyzed by 16S rRNA high-throughput sequencing technology. Results: The α diversity analysis showed that there were no significant differences in the Chao1 index, Shannon index, and Observed_OTU index between the two groups (all P＞0.05). The β diversity analysis showed the significant difference in the vaginal bacterial community structure between the two groups (P＜0.05). Taxonomic analysis showed that the common dominant bacteria at the gate, family and genus levels were Pseudomonas (Proteobacteria) in the two groups, and that the abundance of Pseudomonas in the RSA group at the gate, family and genus levels was 22.8%, 21.9%, and 21.9%, while the abundance of Pseudomonas in the control group was 17.9%, 17.3% and 17.3%, respectively. The abundance of Pseudomonas in the RSA group was increased significantly than that in the control group. Conclusions: Patients with RSA have vaginal flora imbalance, and the specific bacteria (such as Pseudomonas) may be related with the occurrence and development of RSA. [ABSTRACT FROM AUTHOR]

Abstract Background Although infection and inflammation within the genital tract during pregnancy is considered a major risk factor for spontaneous preterm birth (PTB), there are few studies on association between vaginal microorganisms in the early stage of pregnancy and PTB. The aim of this study was to investigate relationship between vaginal Group B streptococcus (GBS) colonization, a leading cause of infection during pregnancy, in the early stage of pregnancy and PTB. Methods This single-center, retrospective cohort study utilized data from 2009 to 2017 obtained at TOYOTA Memorial Hospital. Women with singleton pregnancies who underwent vaginal culture around 14 weeks of gestation during their routine prenatal check-up were included. Vaginal sampling for Gram staining and culture was performed regardless of symptoms. GBS colonization was defined as positive for GBS latex agglutination assay. Statistical analysis was performed to determine the factors associated with PTB. Results Overall 1079 singleton pregnancies were included. GBS (5.7%) and Candida albicans (5.5%) were the most frequently observed microorganisms. The incidence of PTB (before 34 and before 37 weeks of gestation) were significantly higher in the GBS-positive group than in the GBS-negative group (6.6% vs 0.5%, p = 0.001 and 9.8% vs 4.3%, p = 0.047). Our multivariable logistic regression analysis revealed that GBS colonization was a factor associated with PTB before 34 and before 37 weeks of gestation (Odds ratio [OR] 15.17; 95% confidence interval [CI] 3.73–61.74), and OR 2.42; 95%CI 1.01–5.91, respectively). Conclusions The present study found that vaginal GBS colonization in the early stage of pregnancy was associated with PTB. Our study indicates that patients at a high risk for PTB can be extracted by a simple method using conventional culture method.

Objective: To study the correlation between vaginal micro-ecological composition and the outcome of human papillomavirus (HPV) infection by High-Throughput Metagene Sequencing Information Technology on the Illumina Platform, and to improve the efficiency of clinical infection detection. Methods: With the aid of Illumina high-throughput sequencing platform and sequence research method, the composition and diversity of vaginal microorganisms in high-risk HPV (HR-HPV) infected women and healthy women were analyzed. The differences in vaginal flora of HR-HPV infected women and healthy women were compared to explore the correlation between HR-HPV infection and vaginal flora. Results: The structure of vaginal flora in healthy women was relatively single, with Lactobacillus as the dominant genus, accounting for more than 80%. The structure of vaginal flora in women infected with HR-HPV was significantly different from that in non-infected women. The former had a significantly increased species diversity, which was mainly manifested by a decrease in Lactobacillus and an increase in Gardnerella vaginalis. Mycoplasma and Ureaplasma urealyticum might play a synergistic role in the initial stage of cervical lesions caused by HR-HPV infection. Conclusion: The prevention and treatment of mycoplasma and Ureaplasma urealyticum should be valued clinically to prevent the occurrence of HR-HPV infection and cervical lesions.

Objective: The vaginal flora has been reported to be associated with human papillomavirus (HPV) infection. The purpose of this study was to investigate the characteristics of the cervical microbiota in patients with HPV infection and to analyse the changes in the vaginal flora and enzyme profiles in females with HPV infection., Methods: We conducted a cross-sectional study involving 206 participants who underwent HPV genotyping, sexually transmitted diseases pathogen testing, cytology examination, and microbiome analysis. Additionally, we collected 115 HPV-negative samples and 48 HPV-positive samples for 16S rRNA amplicon sequencing. The vaginal microbial communities of both groups were analysed for diversity and differences to explore their association with HPV infection., Results: The abundance of Lactobacillus was found to be reduced, while Gardnerella vaginalis was significantly more prevalent in the HPV + group. In terms of alpha diversity indices, the Shannon index ( P  = .0036) and Simpson index ( P  = .02) were higher in the HPV + group compared to the HPV - group, indicating greater community diversity in the HPV + group. Among the 10 sexually transmitted diseases pathogens analysed, Uup3 and Uup6 were significantly associated with HPV infection. Statistically significant differences were observed in Nugent scores and bacterial vaginosis between the two groups ( P  < .05). In functional analysis, 11 proteins and 13 enzymes were found to be significantly altered in the HPV + group., Conclusion: Our study demonstrates that disruptions in the vaginal flora are associated with HPV infection. Reduced levels of Lactobacillus , increased prevalence of Gardnerella , and abnormal enzyme profiles are closely linked to HPV infection.

Abstract Background Aerobic vaginitis (AV) is a reproductive tract infection that affects health of women. The objective of this study was to analyze the characteristics of simple and mixed AV patients in Xi’an district and provide reference data for the clinical treatment of AV. Methods Patients were recruited from the outpatient Department of Obstetrics and Gynecology in the First Affiliated Hospital of Xi’an Jiaotong University from September 2014 to April 2019 in strict accordance with inclusion and exclusion criteria. The study principally examined the vaginal ecosystem, age distribution, levels of functional enzymes, and changes in pH levels in these women. Differences within groups were analyzed. Results A total of 284 AV patients were enrolled to investigate the distribution of simple and mixed AV infection. AV infection was found to be mainly simple infection. Simple AV patients were generally aged 50–60 years, while mixed AV patients were mostly aged 30–40 years. In the present study, the density of vaginal bacteria (OR = 13.294, 95% CI = 5.869–30.115, P

Antimicrobials are added to semen extenders to inhibit the growth of bacteria that are transferred to the semen during collection. However, this non-therapeutic use of antimicrobials could contribute to the development of antimicrobial resistance. The objective of this study was to determine changes in the antibiotic susceptibility of vaginal microbiota after artificial insemination. Swabs were taken from the vagina of 26 mares immediately before artificial insemination and again 3 days later. Bacteria isolated from the vagina at both time points were subjected to antibiotic susceptibility testing and whole-genome sequencing. In total, 32 bacterial species were identified. There were increases in the resistance of Escherichia coli to trimethoprim (p = 0.0006), chloramphenicol and (p = 0.012) tetracycline (p = 0.03) between day 0 and day 3. However, there was no significant effect of exposure to antibiotics in semen extenders with respect to the resistance of Staphylococcus simulans and Streptococcus equisimilis (p > 0.05). Whole-genome sequencing indicated that most phenotypic resistance was associated with genes for resistance. These results indicate that the resistance patterns of vaginal bacteria may be affected by exposure to antibiotics; therefore, it would be prudent to minimize, or preferably, avoid using antibiotics in semen extenders.

Current gold-standard treatment of recurrent vulvovaginal candidiasis (RVVC) is mainly based on maintenance with fluconazole. Moderate to high recurrence rates at long-term use and secondary fluconazole resistance emerge as reasons to seek for new topical maintenance regimens. In this study, it is aimed to assess the efficacy and safety of boric acid-based treatment approach to treat clinical RVVC. In this retrospective study, patients who were diagnosed with RVVC received a treatment package for six months that consist of induction with boric acid vaginal suppositories 600 mg daily for 14 nights followed by maintenance for five nights starting with every fifth day of the menstrual cycles; a vaginal estriol-lactobacilli combination; and several rigorous life-style changes. The success was defined as the absence of symptomatic recurrence during the follow-up. Success rate at the first year was found to be 94.8% in a total of 173 patients. Mild, reversible side effects were observed in five patients (2.9%). Boric acid, along with a vaginal estriol-lactobacilli combination and lifestyle changes can be a safe and effective alternative in lieu of potent systemic antifungal drugs as a first-line treatment for the patients referred with RVVC. [ABSTRACT FROM AUTHOR]

Leptothrix are long bacteria of rare occurrence; although these bacteria have been implicated in causing vaginal symptoms identical to candidiasis, studies on prevalence and effect on overall vaginal health are lacking. In this study, we evaluated data of women referred to a private clinic for treating vulvovaginal symptoms (n = 1847) and reassessed data of our previous and ongoing studies (n = 1773). The overall rate of leptothrix was 2.8% (102/3620), and the mean age of affected women was 38.8 ± 10.65 years (range 18−76). The majority of the women with leptothrix had normal vaginal flora (63.7% [65/102]). Leptothrix was associated with a higher risk of candidiasis (relative risk (RR) 1.90, 95% confidence interval (CI) 1.1600–3.1013; p = 0.010) and a lower risk of bacterial vaginosis (RR 0.55, 95% CI, 0.3221–0.9398; p = 0.029) and cytolytic vaginosis (RR 0.11, 95% CI, 0.0294–0.4643; p = 0.002). No cases of trichomoniasis were observed. Human immunodeficiency virus infection increased the risk of leptothrix (RR 3.0, 95% CI, 1.6335–5.7245; p = 0.000). Among the women evaluated for vulvovaginal symptoms, 2.4% (45/1847) had leptothrix, and in 26.7% (12/45), leptothrix was considered the causative entity. This study suggests that leptothrix occurrence is rare; it remains unresolved if it can be a cause of vulvar symptoms.

Background: Although infection and inflammation within the genital tract during pregnancy is considered a major risk factor for spontaneous preterm birth (PTB), there are few studies on association between vaginal microorganisms in the early stage of pregnancy and PTB. The aim of this study was to investigate relationship between vaginal Group B streptococcus (GBS) colonization, a leading cause of infection during pregnancy, in the early stage of pregnancy and PTB.Methods: This single-center, retrospective cohort study utilized data from 2009 to 2017 obtained at TOYOTA Memorial Hospital. Women with singleton pregnancies who underwent vaginal culture around 14 weeks of gestation during their routine prenatal check-up were included. Vaginal sampling for Gram staining and culture was performed regardless of symptoms. GBS colonization was defined as positive for GBS latex agglutination assay. Statistical analysis was performed to determine the factors associated with PTB.Results: Overall 1079 singleton pregnancies were included. GBS (5.7%) and Candida albicans (5.5%) were the most frequently observed microorganisms. The incidence of PTB (before 34 and before 37 weeks of gestation) were significantly higher in the GBS-positive group than in the GBS-negative group (6.6% vs 0.5%, p = 0.001 and 9.8% vs 4.3%, p = 0.047). Our multivariable logistic regression analysis revealed that GBS colonization was a factor associated with PTB before 34 and before 37 weeks of gestation (Odds ratio [OR] 15.17; 95% confidence interval [CI] 3.73-61.74), and OR 2.42; 95%CI 1.01-5.91, respectively).Conclusions: The present study found that vaginal GBS colonization in the early stage of pregnancy was associated with PTB. Our study indicates that patients at a high risk for PTB can be extracted by a simple method using conventional culture method. [ABSTRACT FROM AUTHOR]

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Although vaginitis is closely related to vaginal microecology in females, the precise composition and functional potential of different types of vaginitis remain unclear. Here, metagenomic sequencing was applied to analyze the vaginal flora in patients with various forms of vaginitis, including cases with a clue cell proportion ranging from 1% to 20% (Clue1&#95;20), bacterial vaginitis (BV), vulvovaginal candidiasis (VVC), and BV combined with VVC (VVC&#95;BV). Our results identified Prevotella as an important biomarker between BV and Clue1&#95;20. Moreover, a gradual decrease was observed in the relative abundance of shikimic acid metabolism associated with bacteria producing indole as well as a decline in the abundance of Gardnerella vaginalis in patients with BV, Clue1&#95;20, and healthy women. Interestingly, the vaginal flora of patients in the VVC&#95;BV group exhibited structural similarities to that of the VVC group, and its potentially functional characteristics resembled those of the BV and VVC groups. Finally, Lactobacillus crispatus was found in high abundance in healthy samples, greatly contributing to the stability of the vaginal environment. For the further study of L. crispatus , we isolated five strains of L. crispatus from healthy samples and evaluated their capacity to inhibit G. vaginalis biofilms and produce lactic acid in vitro to select the potential probiotic candidate for improving vaginitis in future clinical studies. Overall, we successfully identified bacterial biomarkers of different vaginitis and characterized the dynamic shifts in vaginal flora between patients with BV and healthy females. This research advances our understanding and holds great promise in enhancing clinical approaches for the treatment of vaginitis., Importance: Vaginitis is one of the most common gynecological diseases, mostly caused by infections of pathogens such as Candida albicans and Gardnerella vaginalis . In recent years, it has been found that the stability of the vaginal flora plays an important role in vaginitis. Furthermore, the abundant Lactobacillus -producing rich lactic acid in the vagina provides a healthy acidic environment such as Lactobacillus crispatus . The metabolites of Lactobacillus can inhibit the colonization of pathogens. Here, we collected the vaginal samples of patients with bacterial vaginitis (BV), vulvovaginal candidiasis (VVC), and BV combined with VVC to discover the differences and relationships among the different kinds of vaginitis by metagenomic sequencing. Furthermore, because of the importance of L. crispatus in promoting vaginal health, we isolated multiple strains from vaginal samples of healthy females and chose the most promising strain with potential probiotic benefits to provide clinical implications for treatment strategies., Competing Interests: The authors declare no conflict of interest.

To study the correlation between vaginal micro-ecological composition and the outcome of human papillomavirus (HPV) infection by High-Throughput Metagene Sequencing Information Technology on the Illumina Platform, and to improve the efficiency of clinical infection detection. Methods: With the aid of Illumina high-throughput sequencing platform and sequence research method, the composition and diversity of vaginal microorganisms in high-risk HPV (HR-HPV) infected women and healthy women were analyzed. The differences in vaginal flora of HR-HPV infected women and healthy women were compared to explore the correlation between HR-HPV infection and vaginal flora. Results: The structure of vaginal flora in healthy women was relatively single, with Lactobacillus as the dominant genus, accounting for more than 80%. The structure of vaginal flora in women infected with HR-HPV was significantly different from that in non-infected women. The former had a significantly increased species diversity, which was mainly manifested by a decrease in Lactobacillus and an increase in Gardnerella vaginalis. Mycoplasma and Ureaplasma urealyticum might play a synergistic role in the initial stage of cervical lesions caused by HR-HPV infection. Conclusion: The prevention and treatment of mycoplasma and Ureaplasma urealyticum should be valued clinically to prevent the occurrence of HR-HPV infection and cervical lesions. [ABSTRACT FROM AUTHOR]

To investigate the correlation of the occurrence and development of cervical cancer with the disturbance of vaginal flora and the expression of programmed cell death receptor-1 ( PD- 1 l molecules on the surface of T cells in order to provide new direction for PD-1 immune checkpoint blocking therapy. Methods Twenty-four female SPF Kunming mice were randomly divided into two groups: normal control group ( CON J (n = 12 l and cervical cancer model group ( CCM) ( n = 12). We established the mouse cervical cancer Ul4 cell subcutaneous transplantation tumor model. After 21 days of rearing under the same conditions, vaginal secretions and blood samples of mice were collected. 16S rRNA gene amplification and sequencing technology were used to analyze the vaginal flora in the two groups. Flow cytometry was used to detect the subsets of Tlymphocytes in the peripheral blood of mice and the expression of PD-1 on its surface . Results Beta diversity analysis showed that the vaginal flora of the CON group and the CCM group were significantly different in species composition a nd relative abundance of each species. The dominant bacteria in the CON group were Lactobacillus. while the figure in the CCM group converted to Pasteurella and Helicobacter. The mean expression of PD-1 on the surface of T cells in mice in the CCM group was 12 . 78% . which was significantly higher than that in the CON group Cl0.45% l ( P·<0. 05l. The mean of the total number of T cells ( CD3+ T cells l and the number of CD8+ T cells in the CCM group were 38 .78% and 11. 98%. respectively. which were significantly lower than those in the CON group (51. 37% and 20 . 08% l ( P·< O. 05 l. Conclusion Cervical cancer can cause vagina l flora disorder . There may be a certain correlation between the vaginal flora disorder and the high expression of PD-1 on the surface of T cells, suggesting that there may be a new regulatory mechanism for the immune escape in cervical cancer . [ABSTRACT FROM AUTHOR]

Although tea contains antioxidant and antibacterial compounds, it has not yet been clinically tested in the context of abnormal vaginal flora. Our aim was to determine the safety and efficacy of vaginal ovule with 2 mg tea extract once-daily for 5-7 days for symptoms of intermediate vaginal flora. This was randomized blinded vehicle-controlled multicenter clinical trial with composite primary endpoint (drop in the Nugent score (NS), vaginal pH, or improvement of subjective symptoms) compared between the active and vehicle arm using Fisheŕs exact test at α=0.05. Wet mounts were taken from 274 participants from 14 centres, 97 + 95 participants fulfilled the inclusion criteria. In the active and vehicle arm, composite scores improved in 51.8 % (43/83) and 38.3 % (31/81) participants, respectively, representing an odds ratio = 1.73 (CI 0.93- 3.23, p=0.082). In all 274 participants, 7 mild adverse reactions were recorded of which 6 occurred in the passive arm. Intention-to-treat analysis showed more frequent improvement of subjective symptoms (p=0.047) and reduction in burning (p=0.006) in the active arm. The results suggest that as little as 2 mg of tea extract have the capacity to relieve subjective symptoms, notably the perception of genital burning. Tolerability of the tea ovule seems at least as good as that of the vehicle alone. Tea extract deserves further evaluation in larger doses. [ABSTRACT FROM AUTHOR]

L'infection urinaire correspond à une inflammation aiguë de la vessie due, chez la femme, à la propagation ascendante de bactéries commensales de l'intestin via l'urètre favorisée par la proximité entre le méat urinaire et l'anus. Sa prise en charge doit être mise en place dès l'apparition des premiers symptômes pour soulager la patiente et éviter l'apparition de complications. Les pharmaciens pourront prochainement, sous certaines conditions, délivrer un traitement antibiotique pour soulager une cystite. Urinary tract infection is an acute inflammation of the bladder due, in women, to the upward spread of commensal bacteria from the intestine via the urethra favored by the proximity between the urinary meatus and the anus. Its management must be initiated as soon as the first symptoms appear in order to relieve the patient and to avoid any complications. Pharmacists will soon be able to dispense antibiotic treatment to relieve cystitis, under certain conditions. [ABSTRACT FROM AUTHOR]