Risk score for antenatal bacterial vaginosis: BV PIN points

Assessment of Symptoms and Risk Factors as a Screening Tool of Bacterial Vaginosis Among Reproductive Age-Group Females in West Bengal, India

Background Bacterial vaginosis (BV) is a ubiquitous vaginal discomfort and has overlapping symptoms with other reproductive tract infections. The World Health Organization suggested a symptomatic approach for diagnosing BV with insufficient laboratory setup. However, due to symptom overlap, BV is often misled and ends up with injudicious drug application. Objective The study aims to identify the most relevant symptoms and behavioral risk factors associated with BV in tertiary healthcare settings in West Bengal, India. It also seeks to develop a scoring system based on clinical symptoms to screen for BV, especially when laboratory facilities are limited. Methodology The study is a retrospective case-control study involving 95 women of reproductive age. It employs both univariate and multivariate binary logistic regression models to identify risk factors and symptoms associated with BV. The study also compares these clinical symptoms with laboratory tests (Amsel's test) and attempts to create a scoring system for BV diagnosis. Key Findings Good menstrual hygiene and condom use were identified as key behavioral practices reducing the risk of BV. Four clinical symptoms, like malodor (P = 0.007), lower abdominal pain (P = 0.015), abnormal vaginal discharge (P = 0.071), and painful intercourse (P = 0.08), were identified as notable predictors. Based on these four symptoms, the scoring system showed a sensitivity of 88.2%, a specificity of 67.25%, and an overall accuracy of 74.7%. An additional diagnosis of vulvovaginal candidiasis (VVC) revealed that the odds of malodor (P= 0.006) and burning sensation (P= 0.011) increased significantly during co-infection.

Maternal and fetal outcomes of pregnant women with bacterial vaginosis

Background

Bacterial vaginosis (BV) is a common infection in women of reproductive age group because of vaginal dysbiosis. The impact of BV during pregnancy is still not well defined. The objective of this study is to assess the maternal-fetal outcome in women with BV.

Materials and Methods

A prospective cohort study over one-year duration was conducted from December, 2014 until December, 2015, involving 237 women who presented with abnormal vaginal discharge, preterm labour or preterm prelabour rupture of membrane between 22- and 34-weeks period of gestation. Vaginal swabs were sent for culture and sensitivity, BV® Blue testing and PCR for Gardnerella vaginalis (GV).

Results

BV was diagnosed in 24/237 (10.1%) cases. The median gestational age was 31.6 weeks. GV was isolated from 16 out of 24 (66.7%) in the BV positive group. There was a significantly higher preterm birth rate, below 34 weeks (22.7% vs. 6.2%, p = 0.019) in women with BV. There was no statistically significant difference in maternal outcome such as clinical chorioamnionitis or endometritis. However, placental pathology revealed more than half (55.6%) of women with BV had histologic chorioamnionitis. Neonatal morbidity was significantly higher with exposure to BV, with a lower median birth weight, higher rate of neonatal intensive care unit admission (41.7% vs. 19.0%, p = 0.010), increased intubation for respiratory support (29.2% vs. 7.6%, p = 0.004) and respiratory distress syndrome (33.3% vs. 9.0%, p = 0.002).

Conclusion

More research is needed to formulate guidelines for prevention, early detection and treatment of BV during pregnancy to reduce intrauterine inflammation and the associated adverse fetal outcomes.

Prevalence and risk factors of bacterial vaginosis during the first trimester of pregnancy in a large French population-based study

OBJECTIVES

Bacterial vaginosis is a risk factor for preterm delivery. Its prevalence and risk factors in Europe are not well known. Our objective was to assess both in early pregnancy.

STUDY DESIGN

As part of the PREMEVA randomized controlled trial, this population-based study included 14,193 women screened before 14 weeks' gestation for bacterial vaginosis in the 160 laboratories of the Nord-Pas-de-Calais region in France. Bacterial vaginosis was defined by a Nugent score ≥ 7. Data were collected about maternal tobacco use, age, education, and history of preterm birth. We estimated the prevalence of bacterial vaginosis and used a multilevel logistic regression model to identify significant risk factors for it.

RESULTS

Among the 14,193 women assessed before 14 weeks' gestation, the prevalence of bacterial vaginosis was 7.1% (95% CI: 6.6-7.5%). In the multivariate analysis, smoking during pregnancy tobacco (adjusted OR: 1.38; 95% CI: 1.19-1.60), maternal age 18-19 years (adjusted OR: 1.40; 95% CI: 1.01-1.93), and educational level (completed only primary school: adjusted OR: 1.77; 95% CI: 1.35-2.31; completed only secondary school: adjusted OR: 1.27; 95% CI: 1.10-1.48) were independent risk factors for bacterial vaginosis. History of preterm delivery was not an independent risk factor of bacterial vaginosis: adjusted OR: 1.15; 95% CI: 0.90-1.47.

CONCLUSION

In a large sample of women in their first trimester of pregnancy in France, the prevalence of bacterial vaginosis was lower than rates reported in other countries, but risk factors were similar: young age, low level of education, and tobacco use during pregnancy. These results should be considered in future strategies to reduce preterm delivery.

Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study

OBJECTIVE

To compare the fetomaternal outcome in women with spontaneous preterm labor, with or without bacterial vaginosis (BV).

METHODS

One hundred and fifty-two pregnant patients presenting with spontaneous preterm labor between 28 and 35 weeks of gestation were screened for BV using Amsel's criteria and Nugent score, and were divided into two groups of 30 patients each, based on the BV positive or negative screen. Both the groups were followed till puerperium, and the fetal-maternal outcome was studied. The data was analyzed using Chi-square test and Man-Whitney test.

RESULTS

BV was detected in 37 out of 152 women with preterm labor (24.34%). There was a significant increase in the incidence of respiratory distress (14% vs. 6%), requirement of intermittent positive pressure ventilation (IPPV) (14% vs. 5%), admission in neonatal intensive care unit (NICU) (15% vs. 6%), and duration of NICU stay >2 days (15% vs. 6%) in patients with BV. No significant difference was found in the mean birth weight, Apgar score, incidence of neonatal sepsis, perinatal mortality, and postpartum fever between the two groups.

CONCLUSIONS

BV is a risk factor for increased neonatal morbidity. More research is needed for designing appropriate screening and treatment guidelines for prevention of adverse outcomes associated with BV.

Phase 1 dose-ranging safety trial of Lactobacillus crispatus CTV-05 for the prevention of bacterial vaginosis

BACKGROUND

Bacterial vaginosis is a very common vaginal infection. The lack of endogenous lactobacilli and overgrowth of pathogens facilitate numerous gynecological complications.

METHODS

A phase I dose-ranging safety trial tested the safety, tolerability, and acceptability of Lactobacillus crispatus CTV-05 (LACTIN-V) administered by vaginal applicator. Twelve healthy volunteers were enrolled in 3 blocks of 4 (5 x 10, 1 x 10, and 2 x 10 cfu/dose). Each block was randomized in a 3:1 ratio of active product to placebo. Participants used study product for 5 consecutive days, returned for follow-up on days 7 and 14, and had phone interviews on days 2 and 35.

RESULTS

All 12 participants took 5 doses and completed study follow-up.Overall, 45 adverse events (AEs) occurred, of which 31 (69%) were genitourinary (GU) AEs. GU AEs appeared evenly distributed between the 3 treatment blocks and between LACTIN-V and placebo arms. The most common GU AEs were vaginal discharge in 5 subjects (42%), abdominal pain in 4 subjects (33%), metrorrhagia in 4 subjects (33%), vulvovaginitis in 4 subjects (33%), vaginal candidiasis in 3 subjects (25%), and vaginal odor in 3 subjects (25%). Forty-one (91%) AEs were mild (grade 1) in severity. All 4 moderate AEs (grade 2) were unrelated to product use. No grade 3 or 4 AEs or serious adverse events (SAE) occurred. Laboratory parameters and colposcopy findings were within normal limits or clinically insignificant. The product was well-tolerated and accepted.

CONCLUSION

All 3 dose levels of LACTIN-V appeared to be safe and acceptable in healthy volunteers.

[Self-reported vaginal discharge among pregnant women in an urban area in Southern Brazil: prevalence and associated factors]

The purpose of this study was to determine the prevalence and risk factors associated with self-reported vaginal discharge among pregnant women in the city of Rio Grande, South Brazil. Using a cross-sectional design, a standard interview was applied to pregnant women at home by previously trained interviewers, covering the following: demographic, reproductive, and socioeconomic data, household conditions, health care, and illnesses during pregnancy, including vaginal discharge. The chi-square test was used to compare proportions, and Poisson regression was used in the multivariate analysis. Among the 339 pregnant women interviewed, 52% reported vaginal discharge. The following variables were significantly associated with the outcome: age (prevalence rate, PR = 1.49), marital status (PR = 1.31), urinary tract infection (PR = 1.56), hyperglycemia (PR = 1.48), use of an intrauterine device (PR = 2.35), and history of preterm delivery (PR = 1.37), with oral contraception showing a protective effect (PR = 0.79). Prevalence of self-reported discharge was high among this group of pregnant women. Several risk factors were also identified for the disease under study. These findings can contribute to the implementation of preventive interventions.

Vaginal symptoms and bacterial vaginosis (BV): how useful is self-report? Development of a screening tool for predicting BV status

Vaginal complaints compel an evaluation of bacterial vaginosis (BV), however, many cases of BV are asymptomatic. We evaluated the sensitivity and specificity of vaginal symptoms in the diagnosis of BV and examined the utility of creating a BV screening tool using clinical, behavioural and demographic characteristics. A total of 1916 pregnant women were included in this analysis. In total, 757 women screened positive for BV and over one third of BV-positive women presented without any lower genital tract symptoms (39.4%). African American race, abnormal vaginal odour, and smoking were independently related to BV positivity. A BV screening tool including these three factors was fairly predictive of BV status with the area under the ROC curve equal to 0.669. This three-item prediction rule may be useful in identifying high- risk pregnant women in need of BV screening and, given the high specificity, accurately identify the group of BV-negative pregnant women.

Vaginal Douching Practices of Women in Eight Florida Panhandle Counties

OBJECTIVE

To document knowledge, beliefs, douching practices, prevalence of bacterial vaginosis, and preterm births in women who douche.

DESIGN

Descriptive, cross-sectional nonexperimental design.

SETTING

Six private midwifery/nurse practitioner offices and eight county health departments in the Florida panhandle.

PARTICIPANTS

Four hundred eighty-three English- or Spanish-speaking women aged 14 to 45 years.

METHODS

Self-administered questionnaire about douching; medical record review.

MAIN OUTCOME MEASURES

Prevalence of douching, history of preterm labor, preterm births, and prevalence of bacterial vaginosis.

RESULTS

Of 483 women, 76% had douched, 43% douched at least once per month, and 36% were unaware they should not douche. As determined by odds ratio, women who douched monthly were 2.5 times more likely to have a history of bacterial vaginosis than women who did not douche (p < .001), and women who douched weekly were 2.75 times more likely to have bacterial vaginosis (p = .004). Of 409 clients with medical records available, 32 had preterm births of which 69% had a history of bacterial vaginosis (x2 = 4.5, df = 1, p = .034). Among women with preterm births who douched regularly prior to pregnancy (n = 14), 87% had a history of bacterial vaginosis (x2 = 7.14, df = 1, p = .008).

CONCLUSIONS

Associations of douching with bacterial vaginosis and bacterial vaginosis with preterm labor were significant. Health care professionals should initiate discussions to discourage douching.

Prospective validation of a perinatal bacterial vaginosis screening risk score

OBJECTIVE

Prospectively validate an antenatal bacterial vaginosis (BV) risk score at two public health department obstetrics clinics.

STUDY DESIGN

Women (n=409) entering prenatal care received a BV risk score (range 0 to 16) at their first visit and at 24 to 28 weeks' gestation. BV was measured with Gram-stained vaginal smears. Normal discharge was used as a surrogate for being asymptomatic.

RESULTS

Approximately half of the women scored > or =3 at each assessment. In total 29% had true BV at the first assessment (13% at the second assessment). The BV risk score (> or =3) had 91% sensitivity and 63% specificity, and the BV risk score (> or =5) had 88% sensitivity and 76% specificity. Among true cases, 42% were asymptomatic, of which 77% had risk scores > or =3. All symptomatic BV cases had risk scores > or =3.

CONCLUSION

In practice, the risk score identified both asymptomatic and symptomatic cases. Asymptomatic women are of particular interest because they are not screened for BV under current practice guidelines.

Maternal bacterial vaginosis and fetal/infant mortality in eight Florida counties, 1999 to 2000

This study determined the prevalence of maternal bacterial vaginosis (BV) in fetal/infant mortality cases and factors associated with BV. A retrospective descriptive study was utilized. Data were obtained from review of vital statistics and medical records of 176 women experiencing fetal/infant deaths in eight Florida counties, 1999 to 2000. Non-White mothers accounted for 68.96% of deaths (chi square = 10.119, df = 4, p = 0.038), although the population of the eight counties was 64% White. Of 121 non-White mothers (68.8%) with infections, 37 (30.6%) had BV. Most fetal/infant deaths (39.7%) occurred 20-23 weeks' gestation and at birthweights <500 g, as did most cases of BV (46%). Women with BV were more likely to be non-White (OR 2.756, 95% CI 1.075, 7.066), single (OR 2.090, 95% CI 1.081, 7.246), <24 years old (t = 3.172, p = 0.002), and have <12 years of education (t = 2.56, p = 0.011). Findings support early screening and treatment for BV in women with these risk factors or a history of prior fetal/infant loss or preterm/low-birthweight infant. Factors contributing to racial disparity in BV and fetal/infant mortality need further exploration.

The potential for probiotics to prevent bacterial vaginosis and preterm labor

Infections of the urogenital tract in women represent a major burden on the quality of life of women and on the health care system of Canada and other countries. Complications arising from bacterial vaginosis (BV) include increased risk of sexually transmitted diseases including human immunodeficiency virus and elevated risk of preterm birth (PTB). Pharmaceutical interventions, such as antibiotics, have been suboptimally effective and have failed to reduce the incidence of PTB. The absence of lactobacilli in the vagina, a specific feature of BV, raises the question as to whether restoration of lactobacilli, by probiotic therapy, can restore the normal flora and improve the chances of having a healthy term pregnancy. The rationale for probiotic use in pregnant women is quite strong. Certain lactobacilli strains can safely colonize the vagina after oral and vaginal administration, displace and kill pathogens including Gardnerella vaginalis and Escherichia coli, and modulate the immune response to interfere with the inflammatory cascade that leads to PTB. Additional attributes of probiotics include their potential to degrade lipids and enhance cytokine levels, which promote embryo development. In a society that focuses on disease rather than health and drug therapy rather than natural preventive measures, it will take some effort to get remedies such as probiotics into mainstream care. Perhaps the escalating health care budgets and emergence of "superbugs" will provide the incentives to put in place clinical trials designed to evaluate how best to use the commensal organisms that, after all, make up more of our body than human cells, and without which none of us would survive.