Group B streptococcus carriage and vulvovaginal symptoms: causal or casual? A case-control study in a GUM clinic population

The ABCs of Perineal Streptococcal Dermatitis

Perineal streptococcal dermatitis (PSD) is largely known to be caused by group A β-hemolytic Streptococcus (GAS). We would like to bring cases of non-GAS PSD to the attention of dermatologists, as there are implications for workup and therapy. We report 3 pediatric cases of PSD: 1 caused by GAS, 1 caused by group B β-hemolytic Streptococcus (GBS), and 1 associated with group C β-hemolytic Streptococcus (GCS). GBS and GCS are very rarely reported in pediatric cases of PSD. The literature on non-GAS PSD is reviewed, which additionally revealed several instances of PSD caused by group G β-hemolytic Streptococcus (GGS) and Staphylococcus aureus. GBS, GCS, GGS, and S aureus are significant causes of PSD to consider, particularly among adult patients, based on our encountered cases and the literature. If using rapid antigen tests to expedite the diagnosis of GAS, we recommend supplementing with a lesional swab for bacterial culture and sensitivity as the rapid antigen test does not detect non-GAS organisms. Therapy should be tailored to the microbiologic cause.

Simultaneous detection of multiple lower genital tract pathogens by an impedimetric immunochip

Lower genital tract infections caused by both sexually and not-sexually transmitted pathogens in women are a key public health priority worldwide, especially in developing countries. Since standard analyses are time-consuming, appropriate therapeutic intervention is often neglected or delayed. Lab-on-chips and biosensors open new perspectives and offer innovative tools to simplify the diagnosis by medical staff, especially in countries with inadequate resources. Here we report a biosensing platform based on Electrochemical Impedance Spectroscopy (EIS) that allows multiplexed detection of Candida albicans, Streptococcus agalactiae and Chlamydia trachomatis with a single biochip, enabling a quick screening thanks to the presence of different immobilized antibodies, each specific for one of the different target pathogens.

Genital streptococcal infection in non-pregnant women: a case-note review

Summary

The purpose of this case-note review was to examine the clinical features and management of women with either vulval or vaginal swabs culturing positive for streptococci. Group B haemolytic streptococcus was isolated in all cases. The majority of women with vulval streptococci presented with irritation or soreness. Candidal infection was found in 43% and a dermatosis in 27%. All women with positive vaginal culture had vaginal soreness and/or discharge. Candida was isolated in 27% and there were features of desquamative vaginitis in 20%. Women treated with erythromycin failed to improve symptomatically. The findings of this study suggest that streptococci mostly play a secondary role and colonize an already damaged genital epithelium.

[The etiologic diversity of vaginitis]

OBJECTIVE

To establish the different etiologies of vaginitis and, especially, assess the distribution of responsible pathogens through a prospective study.

PATIENTS AND METHODS

One hundred and sixty-nine women aged between 18 and 65 years (average age: 33.7 years old), consulting a physician for symptoms of vaginitis, were examined in 21 centers of gynaecology or infectious diseases. The clinical evaluation was completed by bacteriological sample that was tested for infections (including sexually transmitted infections (STIs)).

RESULTS

One hundred and eighteen patients (69.8%) had one or several infectious etiologies distributed as follows: 79 (46.7%) candidiasis (3 of which were caused by non albicans Candida), 37 (21.9%) bacterial vaginitis and 16 (9.5%) bacterial vaginosis. To be noticed that there were 38 cases of mixed etiologies out of the 118 infectious etiologies (32.2%), 3 of them were STIs.

DISCUSSION AND CONCLUSIONS

Although candidiasis was the most common etiology in this study, it only represented less than 1 out of every two patients. Among the infectious etiologies, 1 out of 3 women presented a bacterial or mixed vaginitis. The etiological diversity of vaginitis leads to consider broad-spectrum treatment as first-line therapy and to prescribe a microbiological analysis in case of failure.

Rectal colonization by group B Streptococcus as a predictor of vaginal colonization

OBJECTIVE

The purpose of this article was to describe rectal colonization by group B Streptococcus (GBS) and its role in the prediction of vaginal colonization.

STUDY DESIGN

In this prospective cohort of 1248 nonpregnant women, vaginal and rectal swabs for GBS culture were obtained at enrollment and at three 4-month intervals. Generalized estimating equations were used to identify factors that are associated with colonization.

RESULTS

Eight hundred fourteen (65%) women had GBS colonization sometime during the observation period. Rectal GBS colonization was the strongest predictor of vaginal colonization (adjusted odds ratio, 14.3; 95% CI, 11.9-17.1). Recent sexual intercourse, vaginal colonization with yeast, and a vaginal Nugent score >/= 4 were also independent determinants of vaginal GBS colonization. Antimicrobial use decreased vaginal GBS colonization only among women who had no rectal colonization.

CONCLUSION

GBS in the gastrointestinal tract is a risk factor for vaginal GBS. Sexual activity and abnormal vaginal microflora are independent determinants of vaginal GBS colonization.

Syndromic approach to sexually transmitted infections in Tunisian women: bacteriological validation

The World Health Organization emphasizes an integrated primary care approach using syndromic management of sexually transmitted infections. The objective of our study was to evaluate the quality of care of the syndromic management of sexually transmitted disease in women in Rabta hospital in Tunisia. Algorithms have been developed for: cervicitis due to Neisseria gonorrhoeae or Chlamydia (algorithm 3a), vaginitis due to Trichomonas vaginalis or Chlamydia trachomatis (algorithm 3b) and vaginitis due to Candida (algorithm 3c). A total of 116 women were enrolled in the study during February 2003 to April 2004. The prevalence of each bacterium was Chlamydia (10%), N. gonorrhoeae (1%), Treponema pallidum (1%), T. vaginalis (5%) and Candida (21%). Algorithm '3a' had a sensitivity of 45%, a specificity of 42% and positive predictive value (PPV) of 11.9%. Algorithm '3b' had a sensitivity of 35.7%, a specificity of 68.9% and PPV of 20.8%. Algorithm '3c' had a sensitivity of 12%, a specificity of 88% and PPV of 33.3%. To improve the sensitivity of the syndromic approach, we suggest improving the quality of history taking.

Two cases of group A streptococcal vulvovaginitis in premenopausal adults in a sexual health setting

Two cases of group A streptococcus (GAS) causing vulvovaginitis in premenopausal adults are described. A review of the literature of genital GAS is made, as this is an uncommon cause of vulvovaginitis in premenopausal adults. Contrasts are made between anogenital carriage of GAS and group B streptococcus (GBS) to highlight the differences in anogenital carriage between these two organisms.

Genital tract shedding of herpes simplex virus type 2 in women: effects of hormonal contraception, bacterial vaginosis, and vaginal group B Streptococcus colonization

BACKGROUND

Genital infections due to herpes simplex virus type 2 (HSV-2) are characterized by frequent reactivation and shedding of the virus and by the attendant risk of transmission to sexual partners. We investigated the effects of vaginal coinfections and hormonal contraceptive use on genital tract shedding of HSV-2 in women.

METHODS

A total of 330 HSV-2-seropositive women were followed every 4 months for a year. At each visit, one vaginal swab specimen was obtained for detection of HSV-2 by polymerase chain reaction, a second vaginal swab specimen was obtained for detection of group B Streptococcus (GBS) organisms and yeast by culture, and a vaginal smear was obtained for the diagnosis of bacterial vaginosis by Gram staining.

RESULTS

HSV-2 DNA was detected in 88 (9%) of 956 vaginal swab specimens. Independent predictors of genital tract shedding of HSV-2 were HSV-2 seroconversion during the previous 4 months (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.3-6.8), bacterial vaginosis (aOR, 2.3; 95% CI, 1.3-4.0), high-density vaginal GBS colonization (aOR, 2.2; 95% CI, 1.3-3.8), and use of hormonal contraceptives (aOR, 1.8; 95% CI, 1.1-2.8).

CONCLUSIONS

The present study identifies hormonal contraceptive use, bacterial vaginosis, and high-density vaginal GBS colonization as risk factors for genital tract shedding of HSV-2 in women. Because hormonal contraceptives are used by millions of women worldwide and because bacterial vaginosis and vaginal GBS colonization are common vaginal conditions, even modest associations with HSV-2 shedding would result in substantial attributable risks for transmission of the virus.