Does Aerobic Vaginitis Have Adverse Pregnancy Outcomes? Prospective Observational Study

Cracking the Code: Investigating the Correlation between Aerobic Vaginitis and Preterm Labor

Aerobic vaginitis (AV) is a distinct clinical entity characterized by inflammation and abnormal vaginal microflora. Often mistaken for bacterial vaginosis, AV remains relatively unknown and underdiagnosed. AV's understanding is evolving, with some experts suggesting it may primarily be an immunological disorder, the prevalence of which has a range of 7-13% in non-pregnant women and 4.1-8.3% during pregnancy. Pregnancy can affect susceptibility to vaginal infections, leading to adverse outcomes for the woman and the newborn. This review summarizes the correlation between AV and adverse pregnancy outcomes, particularly preterm birth, the leading cause of morbidity and mortality among neonates. An improved understanding of AV's impact on pregnancy outcomes can lead to early recognition, proper management, and effective interventions. While some studies support an association between AV and preterm labor, the existing knowledge of this relationship remains limited. The evidence suggests that AV may contribute to adverse pregnancy outcomes, mainly preterm birth, but further research is needed to establish a definitive link. Further studies are needed to investigate the underlying mechanisms and clarify AV's role in premature labor. A comprehensive understanding of AV's impact on pregnancy outcomes is crucial for early recognition, appropriate management, and effective interventions.

[Preliminary Study on the Identification of Aerobic Vaginitis by Artificial Intelligence Analysis System]

Objective

To develop an artificial intelligence vaginal secretion analysis system based on deep learning and to evaluate the accuracy of automated microscopy in the clinical diagnosis of aerobic vaginitis (AV).

Methods

In this study, the vaginal secretion samples of 3769 patients receiving treatment at the Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University between January 2020 and December 2021 were selected. Using the results of manual microscopy as the control, we developed the linear kernel SVM algorithm, an artificial intelligence (AI) automated analysis software, with Python Scikit-learn script. The AI automated analysis software could identify leucocytes with toxic appearance and parabasal epitheliocytes (PBC). The bacterial grading parameters were reset using standard strains of lactobacillus and AV common isolates. The receiver operating characteristic (ROC) curve analysis was used to determine the cut-off value of AV evaluation results for different scoring items were obtained by using the results of manual microscopy as the control. Then, the parameters of automatic AV identification were determined and the automatic AV analysis scoring method was initially established.

Results

A total of 3769 vaginal secretion samples were collected. The AI automated analysis system incorporated five parameters and each parameter incorporated three severity scoring levels. We selected 1.5 μm as the cut-off value for the diameter between Lactobacillus and common AV bacterial isolates. The automated identification parameter of Lactobacillus was the ratio of bacteria ≥1.5 μm to those <1.5 μm. The cut-off scores were 2.5 and 0.5, In the parameter of white blood cells (WBC), the cut-off value of the absolute number of WBC was 103 μL－1 and the cut-off value of WBC-to-epithelial cell ratio was 10. The automated identification parameter of toxic WBC was the ratio of toxic WBC toWBC and the cut-off values were 1% and 15%. The parameter of background flora was bacteria<1.5 μm and the cut-off values were 5×103 μL－1 and 3×104 μL－1. The parameter of the parabasal epitheliocytes was the ratio of PBC to epithelial cells and the cut-off values were 1% and 10%. The agreement rate between the results of automated microscopy and those of manual microscopy was 92.5%. Out of 200 samples, automated microscopy and manual microscopy produced consistent scores for 185 samples, while the results for 15 samples were inconsistent.

Conclusion

We developed an AI recognition software for AV and established an automated vaginal secretion microscopy scoring system for AV. There was good overall concordance between automated microscopy and manual microscopy. The AI identification software for AV can complete clinical lab examination with rather high objectivity, sensitivity, and efficiency, markedly reducing the workload of manual microscopy.

Effect of bacterial vaginosis on preterm birth: a meta-analysis

PURPOSE

Bacterial vaginosis is a common genital tract disorder. It can lead to preterm birth, but its contribution is equivocal. Bacterial vaginosis is curable and, if diagnosed and appropriately treated, may reduce preterm births. The study desired to confirm the association between bacterial vaginosis and preterm birth.

METHODS

It was a meta-analysis. We included articles published from 2008 to 2022. The authors included studies that measured the association between bacterial vaginosis and preterm birth by relative risk/risk ratio (RR) or odds ratio (OR). We excluded studies with qualitative data. The study utilized five search engines, PubMed, Scopus, Google Scholar, Cochrane, and LILAC. We used the statistical package for social sciences (SPSS) to draw forest and funnel plots separately for RR and OR.

RESULTS

After an extensive search, the study included 20 articles yielding 26 relevant results with a total of 290,397 observations. This meta-analysis proves that bacterial vaginosis is undoubtedly associated with preterm birth. The overall relative risk of preterm delivery is about two-fold as overall OR1.79 (95% Confidence Interval 1.32-2.43). The overall RR of preterm birth is 1.44 (95% Confidence Interval 1.19-1.73).

CONCLUSION

Our study shows a significant association between bacterial vaginosis and preterm birth. The study concludes that investigation for bacterial vaginosis and management should be a part of the routine examination of a pregnant woman. The health system must initiate this strategy soon to reduce the prevalence of preterm births and consequent neonatal mortality.

Aerobic Vaginitis Caused by Enterococcus Faecalis - Clinical Features and Treatment

Bckground

Aerobic vaginitis is an imbalance of the vaginal flora and the main characteristic is an abnormal vaginal flora that contains aerobic and intestinal pathogens with varying degrees of vaginal inflammation. The frequency of AV varies from 12% to 23.7% in symptomatic women who are not pregnant and 4 to 8% during pregnancy and has an increased risk for sexually transmitted diseases (STI). The causative agents of AV are: Enterococcus faecalis (E. faecalis), Esherichia coli, group B streptococcus and Staphylococcus aureus.

Objective

The aim of this review was to present the most important features of aerobic vaginitis regarding description of this frequent clinical problems within population in Bosnia and Herzegovina and also worlfwide.

Methods

Author analized aerobic vaginitis based on scientific literature by searching published papers in important indexed databases.

Results and Discussion

The most frequently isolated AV pathogen is E. faecalis in about 31%. New works indicate the presence of the HPV 16 gene and genome in E. faecalis in the biopsied material of cervical cancer, as well as the ability that HPV 16 genes can be translated and transcribed in these bacteria, and that the HPV gene can form viral particles in these bacteria leads to certain connection that can be a risk factor in the progression of cervical lesions to cancer. A decrease in the number of lactobacilli in the vaginal secretion reduces the defense ability and changes the pH value of the vaginal environment, which favors the development of bacterial inflammation. AV positive for E. faecalis leads to a change in the pH value of the vaginal environment above 5, and the increased pH value of the vaginal environment in HPV positive women can be an association for cervical intraepithelial lesion (CIN). A dominant pathogen in AV such as E. faecalis can reduce the protective effect of lactobacilli by causing inflammation, as well as an increase in IL-6, IL-8 and TNF, increasing the risk of HPV 16 infection resulting in CIN and cervical cancer. In cervical cancer research, the presence of genes and genomes (except E1) of human papillomavirus (HPV) type 16 was found in bacteria such as: E. faecalis and Staphylococcus aureus from cervical cancer biopsies. Intensive treatment of AV could be a very important factor in preventing the onset of precancerous lesions and cervical cancer. The recommended treatment of AV includes a combination of therapy such as: antibacterial (antiseptic and antibiotic), hormonal, non-steroidal anti-inflammatory and/or probiotics, which can be prescribed in the form of local or systemic therapy.

Conclusion

There is no generally accepted clinical strategy for the treatment of AV caused by E. faecalis. Most authors suggest that therapy be based on microscopic or microbiological findings using a topical antibiotic for the infectious agent, a topical steroid to reduce inflammation, and estrogen to treat atrophy.

Prevalence of adverse birth outcomes and associated factors in Jazan, Saudi Arabia: A cross-sectional study

This study aimed to measure the prevalence of adverse birth outcomes and associated factors among mothers from the Jazan region in Saudi, Arabia. This was a cross-sectional investigation where data was collected via a semi-structured questionnaire. The questionnaire was completed during interviews to assess data regarding the participants' demographics, morbidity, the reported adverse birth outcomes, and maternal complications during pregnancy. Chi-squared and Fisher's Exact tests were both used to compare the distribution of demographic and obstetric risk factors according to the historical presence of adverse birth outcomes. A total of 1315 women with a combined history of 4950 pregnancies were involved in the current investigation. The mean age of the participants was 33.1 years. The total number of adverse birth outcomes was 1009. The most frequently reported adverse birth outcome was miscarriage (12.1%), followed by premature birth (2.3%) and underweight birth (1.9%). Reports of a minimum of 1 adverse birth outcome were higher among women who reported family incomes of more than 10,000 Saudi Arabian Riyal (SAR), women who were first-degree cousins of their husbands, and women with less than a secondary level education (P values <.05). This study found a relatively high prevalence of miscarriage. Further investigations are needed to assess factors associated with this high frequency level of miscarriage. Furthermore, these findings have preventive and clinical implications concerning pregnant women with a history of obesity, anemia, consanguinity, and hypertension. The goal is to target them with a better range of antenatal care services to reduce the incidence of potential adverse birth outcomes.

Aerobic vaginitis in the third trimester and its impact on pregnancy outcomes

Background

Aerobic vaginitis (AV) is a vaginal inflammation characterized by disruption of the lactobacillus microbiota and increased counts of different aerobic bacteria. AV may result in severe complications, especially during pregnancy, including preterm delivery, neonatal and maternal infections. This study aimed to determine the prevalence of AV in the third trimester of pregnancy, and the relationship between AV and pregnancy outcomes. 

Methods

A cross-sectional descriptive study included 323 pregnant women attending for routine antenatal care in the Hue University Hospital. Vaginal samples collected at the third trimester of pregnancy were evaluated for AV according to the scoring system of Donders and cultured for identification of predominant bacteria. Pregnancy was followed to its end, and pregnancy outcomes were recorded for both mothers and infants.

Results

The proportion of pregnant women diagnosed with AV in the third trimester was found to be 15.5%, with the vast majority of the cases (84%) displaying the light AV and 16% the moderate AV. The vaginal cultures in the women with AV revealed most frequently Streptococcus agalactiae (6%), followed by Enterococcus spp (4%), Staphylococcus aureus (4%), and Acinetobacter baumannii (2%). In addition, AV during the last trimester of pregnancy was associated with an increased risk of puerperal sepsis (OR 8.65, 95% CI: 1.41—53.16, p = 0.020) and there was a slightly increased risk for neonatal infections, which was statistically insignificant.

Conclusions

The proportion of AV is relatively high in Vietnamese pregnant women. Since it is associated with an increased risk of puerperal sepsis, it needs to be diagnosed and treated before delivery.

Prevalence of bacterial vaginosis and aerobic vaginitis and their associated risk factors among pregnant women from northern Ethiopia: A cross-sectional study

This study aimed to determine the prevalence of bacterial vaginosis (BV) and aerobic vaginitis (AV) and their associated risk factors among pregnant women from Ethiopia. Also, this study investigated the bacterial pathogens and their antibiotic resistance in AV cases. A total of 422 pregnant women from northern Ethiopia were participated in this study. Socio-demographic and clinical data were recorded. Vaginal swabs were collected and used for wet mount and Gram stain methods to evaluate the AV and BV scores according to the Nugent’s and Donder’s criteria, respectively. In AV cases the bacterial pathogens and their antibiotic resistance were determined using standard methods. The possible risk factors for AV and BV in pregnant women were investigated. The prevalence rates of BV and AV were 20.1% (85/422) and 8.1% (34/422), respectively. BV was more common in symptomatic vs. asymptomatic people (P < 0.001), and in second trimester vs. first trimester samples (P = 0.042). However, AV was more common in secondary school vs. primary and those who were unable to read and write (P = 0.021) and in housewife women vs. employee (P = 0.013). A total of 44 bacterial strains were isolated from AV cases, of which the coagulase-negative staphylococci (CoNS) (38.6%) and Staphylococcus aureus (29.5%) were the most predominant bacteria, respectively. The highest resistance rate was observed against penicillin (100.0%) in staphylococci, while 86.7% of them were sensitive to ciprofloxacin. The resistance rate of Enterobacteriaceae ranged from 0.0% for ciprofloxacin and chloramphenicol to 100.0% against amoxicillin/clavulanate. The prevalence of BV was higher than AV in pregnant women. This higher prevalence of BV suggests that measures should be taken to reduce the undesired consequences related to BV in the pregnancy. The circulation of drug-resistant bacteria in vaginal infections requires a global surveillance to reduce the risks to pregnant mothers and infants.

Vulvovaginitis Prevalence Among Women in Gondar, Northwest Ethiopia: Special Emphasis on Aerobic Vaginitis Causing Bacterial Profile, Antimicrobial Susceptibility Pattern, and Associated Factors

Background

Genital tract infections are posing a series of public health challenges for women in both developed and developing countries. Microbial infections of the vagina can lead to serious medical complications such as preterm labor, amniotic fluid infection, premature rupture of the fetal membranes, and low birth weight of the neonate, leading to high perinatal morbidity and mortality. In Ethiopia, limited information is found on the burden, antimicrobial susceptibility profile and associated factors for aerobic vaginitis. Thus, this study was aimed to determine the burden of AV, antimicrobial susceptibility profile of aerobic bacterial isolates and associated factors among women attending Gondar town health facilities, northwest Ethiopia.

Methods

A health facility-based cross-sectional study was conducted on 214 study participants from February 1 to May 31, 2019. For all consecutive women, demographic variables were collected using a structured questionnaire and two vaginal swabs for each were collected. The diagnosis of AV and BV was based on the composite score of Donders and Nugent criteria, respectively. All bacteria were isolated and characterized by conventional culture techniques. The antimicrobial susceptibility pattern was performed using the disc diffusion technique. Logistic regression, univariate and multivariate analysis were carried out. A p-value ≤ 0.05 at 95% CI was considered as statistically significant.

Results

The overall prevalence of vulvovaginitis among women was 50%. The identified aetiologies of vulvovaginitis were bacterial vaginosis (35.5%), candidiasis (23.8%), aerobic vaginitis (22.9%) and trichomoniasis (3.3%). Aerobic bacteria, especially Enterococcus faecalis and Escherichia coli, were predominantly isolated in the vaginal samples. The prevalence of the multidrug resistance rate was 38.98%. The isolated Gram positive bacteria were sensitive to antibiotics like vancomycin, cefoxitin, ciprofloxacin, clindamycin, and gentamicin, whereas the Gram negative bacteria isolates were sensitive to ciprofloxacin, gentamicin and meropenem.

Conclusion

The high burden of bacterial vaginosis and aerobic vaginitis was reported. Therefore, regular screening of women using microbiological diagnosis should be promoted. The common bacteria isolated were Enterococcus faecalis and Escherichia coli. Additionally, antibiotics like vancomycin, cefoxitin, ciprofloxacin, clindamycin, gentamicin, and meropenem were shown to have good action against the majority of bacteria isolates.

Association between maternal cervicovaginal swab positivity for Ureaplasma spp. or other microorganisms and neonatal respiratory outcome and mortality

OBJECTIVE

We investigated the association between maternal cervicovaginal cultures, its antibiotic treatment, and neonatal outcome.

STUDY DESIGN

This retrospective cohort study enrolled 480 neonates born prior to 32 weeks' gestation. They were divided into groups according to maternal cervicovaginal culture results. Multivariate logistic regression analysis was used to predict neonatal outcome based on maternal culture results, adjusted for perinatal risk factors and neonatal morbidities.

RESULT

Maternal cervicovaginal Ureaplasma colonization was independently associated with bronchopulmonary dysplasia at 36 weeks (BPD) (OR 8.34; 95% CI 1.21-57.45). In neonates with and without maternal cervicovaginal Ureaplasma colonization BPD occurred in 12.3% and 3.8%, respectively. Maternal colonization with other microorganisms was associated with a higher neonatal mortality (p = 0.002), lower gestational age (p = 0.026), and birth weight (p = 0.036).

CONCLUSIONS

This study underscores the role of the maternal cervicovaginal microbiome as a predictor of neonatal outcome. Cervicovaginal Ureaplasma colonization seems not to be an innocent bystander in the multifactorial etiology of BPD.

The Association Between Vaginal Microbiota Dysbiosis, Bacterial Vaginosis, and Aerobic Vaginitis, and Adverse Pregnancy Outcomes of Women Living in Sub-Saharan Africa: A Systematic Review

Background: Previous studies have described the association between dysbiosis of the vaginal microbiota (VMB) and related dysbiotic conditions, such as bacterial vaginosis (BV) and aerobic vaginitis (AV), and various adverse pregnancy outcomes. There is limited overview of this association from countries in sub-Saharan Africa (SSA), which bear a disproportionally high burden of both vaginal dysbiotic conditions and adverse pregnancy outcomes. This systematic review assesses the evidence on the association between VMB dysbiosis, BV, and AV, and late adverse pregnancy outcomes in women living in SSA.

Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA) guidelines were followed. Three databases [PubMed, Embase (Ovid), and Cochrane] were used to retrieve observational and intervention studies conducted in SSA that associated VMB dysbiosis, BV, or AV and preterm birth/labor/delivery, preterm rupture of membranes (PROM), low birthweight, small for gestational age, intrauterine growth restriction, intrauterine infection, intrauterine (fetal) death, stillbirth, perinatal death, or perinatal mortality.

Results: Twelve studies out of 693 search records from five SSA countries were included. One study identified a positive association between VMB dysbiosis and low birthweight. Despite considerable differences in study design and outcome reporting, studies reported an association between BV and preterm birth (7/9), low birthweight (2/6), PROM (2/4), intrauterine infections (1/1), and small for gestational age (1/1). None of the retrieved studies found an association between BV and pregnancy loss (5/5) or intrauterine growth retardation (1/1). At least two studies support the association between BV and PROM, low birthweight, and preterm birth in Nigerian pregnant women. No reports were identified investigating the association between AV and late adverse pregnancy outcomes in SSA.

Conclusion: Two of the included studies from SSA support the association between BV and PROM. The remaining studies show discrepancies in supporting an association between BV and preterm birth or low birthweight. None of the studies found an association between BV and pregnancy loss. As for the role of VMB dysbiosis, BV, and AV during pregnancy among SSA women, additional research is needed. These results provide useful evidence for prevention efforts to decrease vaginal dysbiosis and its contribution to adverse pregnancy outcomes in SSA.