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Coudray MS, Madhivanan P. Bacterial vaginosis-A brief synopsis of the literature. Eur J Obstet Gynecol Reprod Biol 2020; 245:143-148. [PMID: 31901667 PMCID: PMC6989391 DOI: 10.1016/j.ejogrb.2019.12.035] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022]
Abstract
Bacterial vaginosis (BV) affects women of reproductive age and can either be symptomatic or asymptomatic. Approximately 50 % of women are symptomatic and experience vaginal malodor, discharge, itching and increased vaginal pH. BV can increase the risk of contracting many sexually transmitted infections (STIs) such as human immunodeficiency virus (HIV), Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and herpes simplex virus-2 (HSV-2). Though effective treatment options do exist, metronidazole or clindamycin, these methods have proven not to be effective long term. The purpose of this review is to summarize current literature on the epidemiology of BV and highlight areas of deficiency in current clinical practice with respect to BV. BV recurrence rates are high, approximately 80 % three months after effective treatment. Furthermore, in some instances treatment is ineffective and BV persists. Literature also documents the relationship between BV and human papillomavirus (HPV). HPV is the most common sexually transmitted infection among young adult women while BV is the most common cause of vaginal symptoms among women of reproductive age. BV is associated with high levels of anaerobic organisms which can damage the vaginal epithelium and increase the risk of HPV infection. Recent research also highlights the role of the vaginal microbiome in BV. The results of this review warrant further exploration into the etiology of BV as well as exploration of more long-term effective treatment and the investigation of prognostic indicators. Additionally, the need for a standard definition of recurrent and persistent BV is recognized.
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Affiliation(s)
- Makella S Coudray
- Department of Epidemiology, Stempel College of Public Health and Social Work, Florida International University, USA.
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, USA; Internal Medicine, Division of Infectious Diseases, College of Medicine, University of Arizona, Tuscon, Arizona, USA; Public Health Research Institute of India, Mysore, Karnataka, India; Family & Community Medicine, College of Medicine, University of Arizona, Tuscon, Arizona, USA
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Frølund M, Falk L, Ahrens P, Jensen JS. Detection of ureaplasmas and bacterial vaginosis associated bacteria and their association with non-gonococcal urethritis in men. PLoS One 2019; 14:e0214425. [PMID: 30946763 PMCID: PMC6448876 DOI: 10.1371/journal.pone.0214425] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022] Open
Abstract
No aetiology is found in up to 40% of men with symptomatic urethritis. Male partners of women with bacterial vaginosis (BV) may be at higher risk of non-gonococcal urethritis (NGU). The aim of this study was to examine the role of BV associated bacteria in first-void urine (FVU) in 97 asymptomatic men without urethritis (controls) and 44 men (cases) with NGU including 20 men with idiopathic urethritis (IU) attending a Swedish STD-clinic between January and October 2010. BV-associated bacteria and ureaplasmas were detected by quantitative PCR assays. All BV associated bacteria, except Megasphaera-like type 1, were strongly positively correlated with U. urealyticum p<0.005 and even stronger with the combined U. urealyticum and U. parvum load (p<0.0005) suggesting that ureaplasma induced elevated pH may stimulate the growth of BV associated bacteria. No statistically significant differences were found between IU cases and controls in the prevalence or load of BV associated bacteria or ureaplasmas. In multiple logistic regression, Megasphaera-like type 1 was associated with IU (p = 0.03), but most positive FVU samples contained very few bacteria and the finding may not be clinically relevant.
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Affiliation(s)
- Maria Frølund
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen S, Denmark
| | - Lars Falk
- Department of Dermatovenereology, Linköping University Hospital and Linköping University, Linköping, Sweden
| | - Peter Ahrens
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen S, Denmark
| | - Jørgen Skov Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen S, Denmark
- * E-mail:
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Baqui AH, Lee ACC, Koffi AK, Khanam R, Mitra DK, Dasgupta SK, Uddin J, Ahmed P, Rafiqullah I, Rahman M, Quaiyum A, Koumans EH, Christian P, Saha SK, Mullany LC, Labrique A. Prevalence of and risk factors for abnormal vaginal flora and its association with adverse pregnancy outcomes in a rural district in north-east Bangladesh. Acta Obstet Gynecol Scand 2019; 98:309-319. [PMID: 30346023 PMCID: PMC6389396 DOI: 10.1111/aogs.13492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/02/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The role of screening and treatment for abnormal vaginal flora (AVF) on adverse pregnancy outcomes remains unclear. Using data from women who participated in a population-based cluster randomized trial who were screened and treated for AVF, we report risk factors for AVF and association of persistent AVF with adverse perinatal outcomes. MATERIAL AND METHODS Pregnant women (n = 4221) <19 weeks of gestation provided self-administered mid-vaginal swabs; smears were Nugent-scored. AVF was treated with oral clindamycin; if AVF was present 3 weeks after treatment, persistent AVF was re-treated. We examined risk factors for AVF and the association of persistent AVF with adverse pregnancy outcomes. RESULTS The prevalence of AVF was 16.5%: 9.8% of women had bacterial vaginosis and 6.8% had intermediate flora. Lower economic and educational status of women were associated with increased risk of AVF. One-third of women with AVF had persistent abnormal flora; these women had a higher risk of a composite measure of adverse pregnancy outcomes from 20 to <37 weeks (preterm live birth, preterm still birth, late miscarriage) (relative risk [RR] 1.33, 95% confidence interval [CI] 1.07-1.65) and of late miscarriage alone (RR 4.15, 95% CI 2.12-8.12) compared to women without AVF. CONCLUSIONS In this study in Sylhet District, Bangladesh, rates of AVF and persistent AVF were high and persistent AVF was associated with adverse pregnancy outcomes, with an especially high associated risk for late miscarriage. Further characterization of the microbiome and relative bacterial species density associated with persistent AVF is needed.
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Affiliation(s)
- Abdullah H Baqui
- International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
| | - Anne C C Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, US
| | - Alain K Koffi
- International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
| | | | - Sushil K Dasgupta
- International Center for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jamal Uddin
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Parvez Ahmed
- International Center for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Mahmoodur Rahman
- International Center for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdul Quaiyum
- International Center for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emilia H Koumans
- Centers for Disease Control and Prevention, Atlanta, Georgia, US
| | | | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Luke C Mullany
- International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
| | - Alain Labrique
- International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
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Marconi C, Duarte MT, Silva DC, Silva MG. Prevalence of and risk factors for bacterial vaginosis among women of reproductive age attending cervical screening in southeastern Brazil. Int J Gynaecol Obstet 2015; 131:137-41. [DOI: 10.1016/j.ijgo.2015.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/01/2015] [Accepted: 07/22/2015] [Indexed: 11/29/2022]
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Abstract
There is some evidence that the risk of HIV infection per heterosexual act is higher in low-income countries than in high-income countries. We hypothesize that variations in per sex-act transmission probability of HIV may in part be attributed to differences in the composition and function of the vaginal microbiota between different populations. This paper presents data that are in support of this hypothesis. Experimental and clinical studies have provided evidence that the normal vaginal microbiota plays a protective role against acquisition of HIV and other sexually transmitted infections. Epidemiological studies have convincingly shown that disturbances of the vaginal microbiome, namely intermediate flora and bacterial vaginosis, increase the risk of acquisition of HIV infection. A review of the literature found large differences in prevalence of bacterial vaginosis between different populations, with the highest prevalence rates found in black populations. Possible explanations for these differences are presented including data suggesting that there are ethnic differences in the composition of the normal vaginal microbiota. Lastly, interventions are discussed to restore and maintain a healthy vaginal environment.
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Gynecologic infections seen in ThinPrep cytological test in Wuhan, China. Front Med 2014; 8:236-40. [PMID: 24652121 DOI: 10.1007/s11684-014-0322-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 12/30/2013] [Indexed: 10/25/2022]
Abstract
This study aimed to analyze the prevalence of bacterial, Candida, Trichomonas, and human papillomavirus (HPV) infections in ThinPrep cytological test (TCT) performed on women of Wuhan, China. ThinPrep smears were screened by two independent experienced pathologists and reported from 2008 to 2010. A total of 46 866 ThinPrep smears were studied, and smears with inflammation were analyzed. Of the 44 162 enrolled patients, inflammation changes were observed in 21 935 (49.7%) and specific infections in 6884 (31.4%). The infections detected were as follows: bacteria, 5663 (82.3%); Candida, 825 (12.0%); Trichomonas, 273 (4.0%); and HPV, 148 (2.1%). Significant changes were found in the prevalence of bacteria and Candida among women who underwent TCT before and after 2010. χ(2) revealed an increasing proportion of specific infections found in smears after 2010 (P = 0.000). In conclusion, bacterial infection was the most detectable in the ThinPrep smears, followed by Candida and Trichomonas. The prevalence of infection identified by TCT was found to be similar in previous literature in China.
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Kenyon C, Colebunders R, Crucitti T. The global epidemiology of bacterial vaginosis: a systematic review. Am J Obstet Gynecol 2013; 209:505-23. [PMID: 23659989 DOI: 10.1016/j.ajog.2013.05.006] [Citation(s) in RCA: 250] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/12/2013] [Accepted: 05/02/2013] [Indexed: 11/20/2022]
Abstract
Bacterial vaginosis (BV) enhances the acquisition and transmission of a range of sexually transmitted infections including human immunodeficiency virus. This has made it more important to uncover the reasons why some populations have very high BV prevalences and others not. This systematic review describes the global epidemiology of BV. It summarizes data from peer-reviewed publications detailing the population prevalence of BV as diagnosed by a standardized and reproducible methodology-Nugent scoring system. BV variations between countries, and between ethnic groups within countries, are described. We evaluated 1692 English- and non-English-language articles describing the prevalence of BV using MEDLINE and the Web of Science databases. A total of 86 articles met our inclusion criteria. BV prevalences were found to vary considerably between ethnic groups in North America, South America, Europe, the Middle East, and Asia. Although BV prevalence is, in general, highest in parts of Africa and lowest in much of Asia and Europe, some populations in Africa have very low BV prevalences and some in Asia and Europe have high rates.
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Affiliation(s)
- Chris Kenyon
- HIV/STD Unit, Institute of Tropical Medicine, Antwerp, Belgium; Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa.
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Abstract
INTRODUCTION Bacterial vaginosis (BV) has been associated with pelvic inflammatory disease, adverse pregnancy outcomes, increased susceptibility to sexually transmitted infections and infertility. Diagnosis of BV should be rapid, reliable and safe. This is especially vital in pregnant women where intervention may be necessary for the well-being of both the mother and the foetus. AREAS COVERED This paper consulted PUBMED, LISTA and Web of Science for point-of-care and laboratory-based tests commonly used for the diagnosis and management of BV in pregnant women. An overview of strengths and weaknesses of the methods used may partially explain why treatment plans have failed. Differences in sampling and detection methods, time of gestation, inter-examiner variability and interpretation of data, and the use of different reference tests, amongst many other factors, complicated a meta-analysis of the data. EXPERT OPINION Inconsistencies found in clinical and laboratory detection methods used for the monitoring of treatment have a direct impact on success rates. With current advances in technology, the diagnosis of BV is taking on a new perspective. New information implicating specific vaginal biofilms in adverse pregnancy outcomes through the application of advanced technology promises to change the way we view the aetiology, diagnosis and management of BV.
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Affiliation(s)
- Charlene W J Africa
- University of the Western Cape, Department of Medical Biosciences, Life Sciences Building, Cape Town, South Africa.
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Mangot-Bertrand J, Fenollar F, Bretelle F, Gamerre M, Raoult D, Courbiere B. Molecular diagnosis of bacterial vaginosis: impact on IVF outcome. Eur J Clin Microbiol Infect Dis 2012; 32:535-41. [DOI: 10.1007/s10096-012-1770-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
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Donders GGG. The prevalence of bacterial vaginosis and aerobic vaginitis in young Finish women. APMIS 2011; 119:224-5; author reply 226. [PMID: 21284741 DOI: 10.1111/j.1600-0463.2010.02715.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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