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Bignoumba M, Mbombe Moghoa KH, Muandze-Nzambe JU, Kassa Kassa RF, Mouanga Ndzime Y, Gafou A, Longo Pendy NM, Onanga R, Kumulungui BS. Vaginal Infections' Etiologies in South-Eastern Gabon - An Overview. Int J Womens Health 2022; 14:505-515. [PMID: 35437354 PMCID: PMC9013257 DOI: 10.2147/ijwh.s349754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Discomfort in women of childbearing age associated with vaginal infections, namely bacterial vaginosis (BV), aerobic vaginitis (AV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV), represent a serious and ongoing gynecological complication throughout the world. Objective This study aimed to investigate the etiologies of vaginal infections among outpatients in south-eastern Gabon. Methodology A cross-sectional study was designed using participants referred directly by their treating doctor for a vaginal swab. Socio-demographic data were collected using a structured questionnaire. Microscopic examinations were used for TV and BV diagnostic. All vaginal swabs were cultured for AV and VVC isolates using standard microbiology methods. Results A total of 573 women of reproductive age participated in the study. The most common identified vaginal infections were BV (62.8%) and AV (51.1%) followed by VVC (34.1%). No significant difference was observed for each etiology compared to socio-demographic data. Streptococcus B (23.9%), Staphylococcus aureus (17.7%), Klebsiella spp. (11.6%), and E. coli (5.8%) were the bacteria most associated with AV. A high incidence of non-C. albicans Candida (NCAC) strains causing vulvovaginitis were found. The prevalence of TV (2.1%) was low. Mixed infections had been common among participants. No association was found with TV and other vaginal infections, unlike others studies. The present study identified BV 228 (83.5%) and AV 227 (83.2%) as the main cause of mixed infections. The mixed infection AV-BV 113 (41.4%) was the most represented. Conclusion Also that simultaneous AV-BV-VVC represented 69 (25.3%) of mixed infections. Molecular analyses would be needed to identify the key species commonly associated with these vaginal infections.
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Affiliation(s)
- Michelle Bignoumba
- Medical Analysis Research Unit (URAM)/Bacteriology, International Center for Medical Research (CIRMF), Franceville, BP 769, Gabon.,Doctoral School of Science and Technology, Masuku University of Science and Technology (USTM), Franceville, BP 067, Gabon
| | - Kelly H Mbombe Moghoa
- Medical Analysis Research Unit (URAM)/Bacteriology, International Center for Medical Research (CIRMF), Franceville, BP 769, Gabon.,Central African Regional Doctoral School in Tropical Infectiology (ECODRAC), Masuku University of Science and Technology (USTM), Franceville, BP 876, Gabon
| | - Jean Ulrich Muandze-Nzambe
- Medical Analysis Research Unit (URAM)/Bacteriology, International Center for Medical Research (CIRMF), Franceville, BP 769, Gabon.,Laboratory of Biochemistry and Applied Immunology (LABIA), Department de Biochimie-Microbiologie, Joseph KI-ZERBO University, Ouagadougou 03, 03 BP 7021, Burkina Faso
| | - Roland Fabrice Kassa Kassa
- Medical Analysis Research Unit (URAM)/Bacteriology, International Center for Medical Research (CIRMF), Franceville, BP 769, Gabon
| | - Yann Mouanga Ndzime
- Medical Analysis Research Unit (URAM)/Bacteriology, International Center for Medical Research (CIRMF), Franceville, BP 769, Gabon
| | - Amahani Gafou
- Medical Analysis Research Unit (URAM)/Bacteriology, International Center for Medical Research (CIRMF), Franceville, BP 769, Gabon
| | - Neil Michel Longo Pendy
- Central African Regional Doctoral School in Tropical Infectiology (ECODRAC), Masuku University of Science and Technology (USTM), Franceville, BP 876, Gabon
| | - Richard Onanga
- Medical Analysis Research Unit (URAM)/Bacteriology, International Center for Medical Research (CIRMF), Franceville, BP 769, Gabon
| | - Brice Serge Kumulungui
- Medical Analysis Research Unit (URAM)/Bacteriology, International Center for Medical Research (CIRMF), Franceville, BP 769, Gabon.,Doctoral School of Science and Technology, Masuku University of Science and Technology (USTM), Franceville, BP 067, Gabon
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Thurman AR, Ravel J, Gajer P, Marzinke MA, Ouattara LA, Jacot T, Peet MM, Clark MR, Doncel GF. Vaginal Microbiota and Mucosal Pharmacokinetics of Tenofovir in Healthy Women Using a 90-Day Tenofovir/Levonorgestrel Vaginal Ring. Front Cell Infect Microbiol 2022; 12:799501. [PMID: 35350436 PMCID: PMC8957918 DOI: 10.3389/fcimb.2022.799501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/09/2022] [Indexed: 01/04/2023] Open
Abstract
Background A relationship between the vaginal microbiota and tenofovir (TFV) concentrations and activity after topical administration has been previously reported. Objective CONRAD A15-138 was a randomized, placebo-controlled Phase I study aimed at characterizing the safety, pharmacokinetics (PK), and pharmacodynamics (PD) of TFV and levonorgestrel (LNG) administered through a vaginal ring (IVR) for 90 days. Herein, we describe changes from baseline in the vaginal microbiota with IVR use and the impact of the vaginal microbiota on mucosal TFV PK. Methods The study screened 68 participants and randomized 47 (37 TFV/LNG, 10 placebo), assessing the vaginal microbiota by sequencing the V3–V4 regions of 16S rRNA genes prior to IVR insertion and monthly for 3 months. Concentrations of TFV in vaginal fluid (VF), and TFV and TFV-diphosphate (TFV-DP) in vaginal tissue, and modeled PD against HIV-1 in vitro were measured before and after treatment. Results There were no clinically significant changes in relative abundance of vaginal bacterial phylotypes from pre-insertion baseline at any month among active and placebo IVR users. There were no significant changes in community state type (CST) with IVR use. Participants with diverse, anaerobic CST IVA/B microbiota had higher in vivo release of TFV from the IVR compared to women with Lactobacillus-dominated (LbD) microbiota, who had expected in vivo TFV release rates. Median VF TFV concentrations were significantly higher among women with CST IVA/B microbiota in months 1 (3,135 ng/mg VF) and 2 (3,800 ng/mg). Women with LbD microbiota had significantly higher median VF TFV concentration (1,423 ng/mg) and median TFV (103 ng/mg) and TFV-DP (5,877 fmol/mg) tissue concentrations versus women with CST IVA/B microbiota at month 3. All women demonstrated a significant increase from pre-insertion baseline of in vitro HIV-1 inhibition by VF (p values <0.05). PD differences in tissue according to CST, however, were not statistically significant. Conclusion TFV/LNG IVR use did not change the vaginal microbiota nor increase the incidence of CST IVA/B. Vaginal microbiota, and in particular CST IVA/B, possibly through increased vaginal pH, impacted in vivo TFV release and cervicovaginal (CV) PK, but both PK and PD data suggest CV protection against HIV-1. Clinical Trial Registration ClinicalTrials.gov (#NCT03279120)
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Affiliation(s)
- Andrea R. Thurman
- Department of Obstetrics and Gynecology, CONRAD, Eastern Virginia Medical School, Norfolk, VA, United States
- *Correspondence: Andrea R. Thurman,
| | - Jacques Ravel
- Institute for Genome Sciences and Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Pawel Gajer
- Institute for Genome Sciences and Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mark A. Marzinke
- Departments of Pathology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Louise A. Ouattara
- Department of Obstetrics and Gynecology, CONRAD, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Terry Jacot
- Department of Obstetrics and Gynecology, CONRAD, Eastern Virginia Medical School, Norfolk, VA, United States
| | - M. Melissa Peet
- Department of Obstetrics and Gynecology, CONRAD, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Meredith R. Clark
- Department of Obstetrics and Gynecology, CONRAD, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Gustavo F. Doncel
- Department of Obstetrics and Gynecology, CONRAD, Eastern Virginia Medical School, Norfolk, VA, United States
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Bitew A, Mengist A, Belew H, Aschale Y, Reta A. The Prevalence, Antibiotic Resistance Pattern, and Associated Factors of Bacterial Vaginosis Among Women of the Reproductive Age Group from Felege Hiwot Referral Hospital, Ethiopia. Infect Drug Resist 2021; 14:2685-2696. [PMID: 34285521 PMCID: PMC8286113 DOI: 10.2147/idr.s305329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background Bacterial vaginosis is an infection of the vagina, which results due to change in the normal balance of vaginal bacteria. The aim of this study was to assess the magnitude and determinants of bacterial vaginosis among women of reproductive age group from Felege Hiwot Referral Hospital. Materials and Methods A cross-sectional study was conducted among women during the reproductive period at Felege Hiwot Referral Hospital from September 1, 2019 to October 2020. About 413 vaginal swab samples were collected and examined using the Nugent scoring system and culture. Data were analyzed by SPSS version 25. The odds ratio (OR) was used as a measure of the strength of association and reported with 95% confidence intervals. P-value ≤ 0.05 was considered to be statistically significant. Bivariate and multivariate logistic regression models were used to identify possible associated factors with bacteria causing bacterial vaginosis. Results The overall prevalence of bacteria causing bacterial vaginosis was 39.5%. The predominant bacteria were S. aureus (25.4%), G. vaginalis (22.7%), S. agalactiae (14.1%), and E. coli (13.5%). S. aureus was resistant to erythromycin (69.8%) and trimethoprim/sulfamethoxazole (53.5%); despite this, it was susceptible to ciprofloxacillin (93%), gentamycin (93%), and cefoxitin (90.7%). On the other hand, E. coli was resistant to trimethoprim/sulfamethoxazole (91.3%) and ceftriaxone (63.6%), but was susceptible to ciprofloxacillin (95.5%) and gentamycin (93%). Conclusion The high prevalence of bacterial vaginosis was significantly associated with the pH level of the vagina (≥4.5), participant age ≤20, pregnancy, and history of HIV infection. Therefore, early identification of factors leading to bacterial overgrowth on the vagina is very important to protect maternal and child morbidity and mortality.
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Affiliation(s)
- Abebaw Bitew
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Abeba Mengist
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Habtamu Belew
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yibeltal Aschale
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Alemayehu Reta
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Baldewijns S, Sillen M, Palmans I, Vandecruys P, Van Dijck P, Demuyser L. The Role of Fatty Acid Metabolites in Vaginal Health and Disease: Application to Candidiasis. Front Microbiol 2021; 12:705779. [PMID: 34276639 PMCID: PMC8282898 DOI: 10.3389/fmicb.2021.705779] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 12/28/2022] Open
Abstract
Although the vast majority of women encounters at least one vaginal infection during their life, the amount of microbiome-related research performed in this area lags behind compared to alternative niches such as the intestinal tract. As a result, effective means of diagnosis and treatment, especially of recurrent infections, are limited. The role of the metabolome in vaginal health is largely elusive. It has been shown that lactate produced by the numerous lactobacilli present promotes health by limiting the chance of infection. Short chain fatty acids (SCFA) have been mainly linked to dysbiosis, although the causality of this relationship is still under debate. In this review, we aim to bring together information on the role of the vaginal metabolome and microbiome in infections caused by Candida. Vulvovaginal candidiasis affects near to 70% of all women at least once in their life with a significant proportion of women suffering from the recurrent variant. We assess the role of fatty acid metabolites, mainly SCFA and lactate, in onset of infection and virulence of the fungal pathogen. In addition, we pinpoint where lack of research limits our understanding of the molecular processes involved and restricts the possibility of developing novel treatment strategies.
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Affiliation(s)
- Silke Baldewijns
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
- VIB-KU Leuven Center for Microbiology, Leuven, Belgium
| | - Mart Sillen
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
- VIB-KU Leuven Center for Microbiology, Leuven, Belgium
| | - Ilse Palmans
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
- VIB-KU Leuven Center for Microbiology, Leuven, Belgium
| | - Paul Vandecruys
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
- VIB-KU Leuven Center for Microbiology, Leuven, Belgium
| | - Patrick Van Dijck
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
- VIB-KU Leuven Center for Microbiology, Leuven, Belgium
| | - Liesbeth Demuyser
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
- VIB-KU Leuven Center for Microbiology, Leuven, Belgium
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Sule-Odu AO, Oluwole AA, Akadri AA, Andu BA, Akiseku AK, Osinupebi OA, Lawal IA, Oritogun KS. Bacterial vaginosis in pregnancy and early labour using Nugent scoring and the implication on foetal outcome. Ghana Med J 2021; 54:10-16. [PMID: 32863408 PMCID: PMC7445705 DOI: 10.4314/gmj.v54i1.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background To compare the pattern of vaginal microflora during pregnancy with pattern in early labour using Nugent scoring and determine the effect of these changes on fetal outcome. Design A prospective longitudinal study. Setting and Population Pregnant women attending antenatal clinics of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between June 2017 and May 2018. Methods Consenting pregnant women who attended antenatal clinics were recruited. Vaginal secretions were obtained for Nugent scoring during pregnancy and at presentation in labour. Main Outcome Measures Prevalence of abnormal vaginal flora in pregnancy and early labour, birth outcome, birth weight, gestational age at delivery, APGAR scores, need for neonatal ward admission. Results Sixty-seven (33.3%) of pregnant women had abnormal flora which was consistent with bacterial vaginosis. At the presentation of these women in labour, 14.4% of them had bacterial vaginosis thus indicating a significant reduction in abnormal vaginal flora in labour compared to the proportion of abnormal flora in antenatal period (P<0.001). There were no significant differences in the fetal outcomes of mothers with bacterial vaginosis when compared with those with normal vaginal flora (P-value >0.05). Conclusions Persistence of abnormal vaginal microflora from pregnancy till early labour did not seem to be associated with poorer foetal outcomes when compared with women with normal vaginal microflora in labour. The possibility of persistent infection or re-infection before labour may justify the need for re-evaluation of vaginal smears in the late third trimester to allow for prompt treatment before the onset of labour. Funding This research work was sponsored by the Tertiary Education Trust Fund, Nigeria (TETFund) with reference number OOU/IBR/010.
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Affiliation(s)
- Adewale O Sule-Odu
- Department of Obstetrics and Gynecology, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria
| | - Adedayo A Oluwole
- Department of Obstetrics and Gynecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Adebayo A Akadri
- Department of Obstetrics and Gynecology, Babcock University, Ilishan-Remo, Ogun State, Nigeria
| | - Babatunde A Andu
- Department of Obstetrics and Gynecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Adeniyi K Akiseku
- Department of Obstetrics and Gynecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Olubunmi A Osinupebi
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria
| | - Ismail A Lawal
- Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Kolawole S Oritogun
- Department of Community Medicine and Primary Care, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria
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Nava-Memije K, Hernández-Cortez C, Ruiz-González V, Saldaña-Juárez CA, Medina-Islas Y, Dueñas-Domínguez RA, Aguilera-Arreola MG. Bacterial Vaginosis and Sexually Transmitted Infections in an HIV-Positive Cohort. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:660672. [DOI: 10.3389/frph.2021.660672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
The World Health Organization (WHO) and the Joint United Nations Programme on HIV and AIDS (UNAIDS) suggest that sexually transmitted infection (STI) surveillance should include other genital infections and not only human immunodeficiency virus (HIV). To monitor the concomitance of bacterial vaginosis (BV) and STIs in HIV-seropositive (HIV+) and HIV-seronegative (HIV–) patients, a prospective study was conducted in a cohort of 349 volunteers at a clinic specializing in treating STIs in Mexico City. Microbiological and molecular methods were used to detect STIs and dysbiosis in HIV+ and HIV– individuals. The prevalence of infection was higher in HIV+ (69.28%) than in HIV– (54.87%) individuals. BV was the most frequent infection in HIV+ individuals, and polymicrobial infections were 3 times more common in HIV+ individuals than in HIV– individuals (31.48 vs. 10.98%). Behaviors documented in a self-administered questionnaire included low condom use frequency in HIV+ individuals co-infected with BV or a STI. This finding highlights the importance of surveillance using routine microbiological evaluations for the correct management of genital infections in HIV+ patients because in the presence of HIV, the clinical presentations, courses, and therapeutic responses of some STIs can differ from those in patients without HIV infection.
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Poojari VG, Dawson S, Vasudeva A, Hegde N, Kaipa G, Eshwara V, Tellapragada C, Kumar P. Multimodality Screening for Lower Genital Tract Infections Between 18 and 24 Weeks of Pregnancy and its Efficacy in Predicting Spontaneous Preterm Delivery. J Obstet Gynaecol India 2020; 70:36-43. [PMID: 32030004 PMCID: PMC6982619 DOI: 10.1007/s13224-019-01287-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/28/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Predicting spontaneous preterm birth (SPTB) during mid-trimester would be very useful. We used a multimodality screening approach mainly focusing on urogenital infections among unselected obstetric population between 18 and 24 weeks in a tertiary center. METHOD Diagnosis of lower genital tract infection (LGTI) was attempted among 228 pregnant women using several factors-symptom of vaginal discharge, characteristic appearance of discharge on speculum, point of care tests using Amsel's criteria and gram staining of vaginal swab. Nugent's scoring was taken as gold standard. Urine microscopy/culture was obtained. Serum inflammatory markers were done. Total leukocyte count, neutrophil/lymphocyte ratio and C-reactive protein were obtained. Data on cervical length were obtained from mid-trimester scan. RESULTS Thirty patients complained of vaginal discharge. Speculum examination revealed discharge in 221 (96.92%), appearing pathological in 192 (86.87%). Amsel's criteria showed poor sensitivity to detect full (57%) and partial (24%) bacterial vaginosis (BV). On gram staining, 104 (45.61%) showed evidence of LGTI; 14 full BV (6.1%); 45 partial BV (19.5%); 40 candidiasis (17.5%); and two each of trichomoniasis and aerobic vaginitis. Appearance of vaginal discharge and microscopic diagnosis of LGTI were poorly correlated. Forty women (17.5%) had SPTB, 24 following membrane rupture and 16 following spontaneous labor. The presence of BV (specifically partial) increased the likelihood of SPTB with OR of 3.347 (CI 1.642, 6.823). Three of seven women with short cervix delivered preterm. No other screening modality was associated with SPTB. CONCLUSION Active screening for LGTI between 18 and 24 weeks shows high prevalence of BV in Indian setting. There is a strong link between partial BV and SPTB.
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Affiliation(s)
- Vidyashree Ganesh Poojari
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - Samantha Dawson
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - Akhila Vasudeva
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - Nivedita Hegde
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - Geetha Kaipa
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - Vandana Eshwara
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | | | - Pratap Kumar
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
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Bellad MB, Hoffman MK, Mallapur AA, Charantimath US, Katageri GM, Ganachari MS, Kavi A, Ramdurg UY, Bannale SG, Revankar AP, Sloan NL, Kodkany BS, Goudar SS, Derman RJ. Clindamycin to reduce preterm birth in a low resource setting: a randomised placebo-controlled clinical trial. BJOG 2018; 125:1601-1609. [PMID: 29790266 DOI: 10.1111/1471-0528.15290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine whether oral clindamycin reduces the risk of preterm birth (PTB) in women with abnormal vaginal microflora as evidenced by a vaginal pH ≥5.0. DESIGN Randomised double-blind placebo-controlled trial. SETTING Rural southern India. POPULATION Pregnant women with a singleton fetus between 13+0/7 weeks and 20+6/7 weeks. METHODS Pregnant women were recruited during prenatal visits in Karnataka, India, from October 2013 to July 2015. Women were required to have a singleton fetus between 13+0/7 weeks and 20+6/7 weeks and an elevated vaginal pH (≥5.0) by colorimetric assessment. Participants were randomised to either oral clindamycin 300 mg twice daily for 5 days or an identical-appearing placebo. MAIN OUTCOME MEASURES The primary outcome was the incidence of PTB, defined as delivery before 37+0/7 weeks. RESULTS Of the 6476 screened women, 1727 women were randomised (block randomised in groups of six; clindamycin n = 866, placebo n = 861). The demographic, reproductive, and anthropomorphometric characteristics of the study groups were similar. Compliance was high, with over 94% of capsules being taken. The rate of PTB before 37 weeks was comparable between the two groups [clindamycin 115/826 (13.9%) versus placebo 111/806 (13.8%), between-group difference 0.2% (95% CI -3.2 to 3.5%, P = 0.93)], as was PTB at less than 34 weeks [clindamycin 40/826 (4.8%) versus placebo group 37/806 (4.6%), between-group difference 0.3% (95% CI -1.8 to 2.3%, P = 0.81)]. No differences were detected in the incidence of birthweight of<2500 g, <1500 g, miscarriage, stillbirth or neonatal death. CONCLUSION In this setting, oral clindamycin did not decrease PTB among women with vaginal pH ≥5.0. TWEETABLE ABSTRACT Oral clindamycin between 13+0/7 and 20+6/7 weeks does not prevent preterm birth in women with a vaginal pH ≥5.0.
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Affiliation(s)
- M B Bellad
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - M K Hoffman
- Department of Obstetrics & Gynecology, Christiana Care Health System, Newark, DE, USA
| | - A A Mallapur
- S Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot, Karnataka, India
| | - U S Charantimath
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - G M Katageri
- S Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot, Karnataka, India
| | - M S Ganachari
- KLE Academy of Higher Education and Research's College of Pharmacy, JNMC University Campus, Belgaum, Karnataka, India
| | - A Kavi
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - U Y Ramdurg
- S Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot, Karnataka, India
| | - S G Bannale
- S Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot, Karnataka, India
| | - A P Revankar
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - N L Sloan
- Department of Obstetrics & Gynecology, Christiana Care Health System, Newark, DE, USA
| | - B S Kodkany
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - S S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - R J Derman
- Thomas Jefferson University, Philadelphia, PA, USA
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9
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Noyes N, Cho KC, Ravel J, Forney LJ, Abdo Z. Associations between sexual habits, menstrual hygiene practices, demographics and the vaginal microbiome as revealed by Bayesian network analysis. PLoS One 2018; 13:e0191625. [PMID: 29364944 PMCID: PMC5783405 DOI: 10.1371/journal.pone.0191625] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 01/06/2018] [Indexed: 12/13/2022] Open
Abstract
The vaginal microbiome plays an influential role in several disease states in reproductive age women, including bacterial vaginosis (BV). While demographic characteristics are associated with differences in vaginal microbiome community structure, little is known about the influence of sexual and hygiene habits. Furthermore, associations between the vaginal microbiome and risk symptoms of bacterial vaginosis have not been fully elucidated. Using Bayesian network (BN) analysis of 16S rRNA gene sequence results, demographic and extensive questionnaire data, we describe both novel and previously documented associations between habits of women and their vaginal microbiome. The BN analysis approach shows promise in uncovering complex associations between disparate data types. Our findings based on this approach support published associations between specific microbiome members (e.g., Eggerthella, Gardnerella, Dialister, Sneathia and Ruminococcaceae), the Nugent score (a BV diagnostic) and vaginal pH (a risk symptom of BV). Additionally, we found that several microbiome members were directly connected to other risk symptoms of BV (such as vaginal discharge, odor, itch, irritation, and yeast infection) including L. jensenii, Corynebacteria, and Proteobacteria. No direct connections were found between the Nugent Score and risk symptoms of BV other than pH, indicating that the Nugent Score may not be the most useful criteria for assessment of clinical BV. We also found that demographics (i.e., age, ethnicity, previous pregnancy) were associated with the presence/absence of specific vaginal microbes. The resulting BN revealed several as-yet undocumented associations between birth control usage, menstrual hygiene practices and specific microbiome members. Many of these complex relationships were not identified using common analytical methods, i.e., ordination and PERMANOVA. While these associations require confirmatory follow-up study, our findings strongly suggest that future studies of the vaginal microbiome and vaginal pathologies should include detailed surveys of participants' sanitary, sexual and birth control habits, as these can act as confounders in the relationship between the microbiome and disease. Although the BN approach is powerful in revealing complex associations within multidimensional datasets, the need in some cases to discretize the data for use in BN analysis can result in loss of information. Future research is required to alleviate such limitations in constructing BN networks. Large sample sizes are also required in order to allow for the incorporation of a large number of variables (nodes) into the BN, particularly when studying associations between metadata and the microbiome. We believe that this approach is of great value, complementing other methods, to further our understanding of complex associations characteristic of microbiome research.
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Affiliation(s)
- Noelle Noyes
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Kyu-Chul Cho
- Department of Statistics, University of Idaho, Moscow, Idaho, United States of America
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore Maryland, United States of America
| | - Larry J. Forney
- Department of Biological Sciences, University of Idaho, Moscow, Idaho, United States of America
| | - Zaid Abdo
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
- * E-mail:
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Rezk M, Sayyed T, Masood A, Dawood R. Risk of bacterial vaginosis, Trichomonas vaginalis and Candida albicans infection among new users of combined hormonal contraception vs LNG-IUS. EUR J CONTRACEP REPR 2017; 22:344-348. [DOI: 10.1080/13625187.2017.1365835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mohamed Rezk
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
| | - Tarek Sayyed
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
| | - Alaa Masood
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
| | - Ragab Dawood
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
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