1
|
Mulato-Briones IB, Rodriguez-Ildefonso IO, Jiménez-Tenorio JA, Cauich-Sánchez PI, Méndez-Tovar MDS, Aparicio-Ozores G, Bautista-Hernández MY, González-Parra JF, Cruz-Hernández J, López-Romero R, del Rosario Rojas-Sánchez TM, García-Palacios R, Garay-Villar Ó, Apresa-García T, López-Esparza J, Marrero D, Castelán-Vega JA, Jiménez-Alberto A, Salcedo M, Ribas-Aparicio RM. Cultivable Microbiome Approach Applied to Cervical Cancer Exploration. Cancers (Basel) 2024; 16:314. [PMID: 38254804 PMCID: PMC10813707 DOI: 10.3390/cancers16020314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 01/24/2024] Open
Abstract
Traditional microbiological methodology is valuable and essential for microbiota composition description and microbe role assignations at different anatomical sites, including cervical and vaginal tissues; that, combined with molecular biology strategies and modern identification approaches, could give a better perspective of the microbiome under different circumstances. This pilot work aimed to describe the differences in microbiota composition in non-cancer women and women with cervical cancer through a culturomics approach combining culture techniques with Vitek mass spectrometry and 16S rDNA sequencing. To determine the possible differences, diverse statistical, diversity, and multivariate analyses were applied; the results indicated a different microbiota composition between non-cancer women and cervical cancer patients. The Firmicutes phylum dominated the non-cancer (NC) group, whereas the cervical cancer (CC) group was characterized by the predominance of Firmicutes and Proteobacteria phyla; there was a depletion of lactic acid bacteria, an increase in the diversity of anaerobes, and opportunistic and non-typical human microbiota isolates were present. In this context, we hypothesize and propose a model in which microbial composition and dynamics may be essential for maintaining the balance in the cervical microenvironment or can be pro-oncogenesis microenvironmental mediators in a process called Ying-Yang or have a protagonist/antagonist microbiota role.
Collapse
Affiliation(s)
- Irma Berenice Mulato-Briones
- Laboratorio de Producción y Control de Biológicos, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico; (I.B.M.-B.); (I.O.R.-I.); (J.A.J.-T.); (J.A.C.-V.); (A.J.-A.)
- Unidad de Investigación en Biomedicina y Oncología Genómica (UIBOG), del Hospital de Gineco Pediatría No. 3A, del Instituto Mexicano del Seguro Social (IMSS), Mexico City 07300, Mexico;
- Laboratorio de Biotecnología Molecular y Farmacéutica, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico
| | - Ismael Olan Rodriguez-Ildefonso
- Laboratorio de Producción y Control de Biológicos, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico; (I.B.M.-B.); (I.O.R.-I.); (J.A.J.-T.); (J.A.C.-V.); (A.J.-A.)
- Unidad de Investigación en Biomedicina y Oncología Genómica (UIBOG), del Hospital de Gineco Pediatría No. 3A, del Instituto Mexicano del Seguro Social (IMSS), Mexico City 07300, Mexico;
- Laboratorio de Biotecnología Molecular y Farmacéutica, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico
| | - Julián Antonio Jiménez-Tenorio
- Laboratorio de Producción y Control de Biológicos, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico; (I.B.M.-B.); (I.O.R.-I.); (J.A.J.-T.); (J.A.C.-V.); (A.J.-A.)
- Unidad de Investigación en Biomedicina y Oncología Genómica (UIBOG), del Hospital de Gineco Pediatría No. 3A, del Instituto Mexicano del Seguro Social (IMSS), Mexico City 07300, Mexico;
| | - Patricia Isidra Cauich-Sánchez
- Laboratorio de Bacteriología Médica, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico; (P.I.C.-S.); (G.A.-O.)
| | - María del Socorro Méndez-Tovar
- Laboratorio de Bacteriología Clínica, Hospital General, Centro Médico Nacional “La Raza”, IMSS, Mexico City 02990, Mexico;
| | - Gerardo Aparicio-Ozores
- Laboratorio de Bacteriología Médica, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico; (P.I.C.-S.); (G.A.-O.)
| | - María Yicel Bautista-Hernández
- Unidad de Radiología, Hospital General de México “Dr. Eduardo Liceaga”, Secretaría de Salud, Mexico City 07300, Mexico; (M.Y.B.-H.); (J.F.G.-P.); (J.C.-H.)
| | - Juan Francisco González-Parra
- Unidad de Radiología, Hospital General de México “Dr. Eduardo Liceaga”, Secretaría de Salud, Mexico City 07300, Mexico; (M.Y.B.-H.); (J.F.G.-P.); (J.C.-H.)
| | - Jesús Cruz-Hernández
- Unidad de Radiología, Hospital General de México “Dr. Eduardo Liceaga”, Secretaría de Salud, Mexico City 07300, Mexico; (M.Y.B.-H.); (J.F.G.-P.); (J.C.-H.)
| | - Ricardo López-Romero
- Unidad de Investigación en Biomedicina y Oncología Genómica (UIBOG), del Hospital de Gineco Pediatría No. 3A, del Instituto Mexicano del Seguro Social (IMSS), Mexico City 07300, Mexico;
| | | | | | - Ónix Garay-Villar
- Departamento de Braquiterapia, Hospital de Oncología, Centro Médico Nacional Siglo XXI, IMSS (DBHOCMN-IMSS), Mexico City 07300, Mexico;
| | - Teresa Apresa-García
- Unidad de Investigación Médica en Enfermedades Oncológicas, Hospital de Oncología, Centro Médico Nacional Siglo XXI, IMSS, Mexico City 07300, Mexico;
| | - Juan López-Esparza
- Laboratorio de H109, Academia de Microbiología, Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez 32310, Mexico;
| | - Daniel Marrero
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Mexico City 07300, Mexico;
| | - Juan Arturo Castelán-Vega
- Laboratorio de Producción y Control de Biológicos, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico; (I.B.M.-B.); (I.O.R.-I.); (J.A.J.-T.); (J.A.C.-V.); (A.J.-A.)
- Laboratorio de Biotecnología Molecular y Farmacéutica, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico
| | - Alicia Jiménez-Alberto
- Laboratorio de Producción y Control de Biológicos, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico; (I.B.M.-B.); (I.O.R.-I.); (J.A.J.-T.); (J.A.C.-V.); (A.J.-A.)
- Laboratorio de Biotecnología Molecular y Farmacéutica, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico
| | - Mauricio Salcedo
- Unidad de Investigación en Biomedicina y Oncología Genómica (UIBOG), del Hospital de Gineco Pediatría No. 3A, del Instituto Mexicano del Seguro Social (IMSS), Mexico City 07300, Mexico;
| | - Rosa María Ribas-Aparicio
- Laboratorio de Producción y Control de Biológicos, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico; (I.B.M.-B.); (I.O.R.-I.); (J.A.J.-T.); (J.A.C.-V.); (A.J.-A.)
- Laboratorio de Biotecnología Molecular y Farmacéutica, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11350, Mexico
| |
Collapse
|
2
|
San Juan Galán J, Poliquin V, Gerstein AC. Insights and advances in recurrent vulvovaginal candidiasis. PLoS Pathog 2023; 19:e1011684. [PMID: 37948448 PMCID: PMC10637712 DOI: 10.1371/journal.ppat.1011684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Javier San Juan Galán
- Department of Microbiology, Faculty of Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vanessa Poliquin
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aleeza Cara Gerstein
- Department of Microbiology, Faculty of Science, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Statistics, Faculty of Science, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
3
|
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: 19] [Impact Index Per Article: 6.3] [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.
Collapse
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
| |
Collapse
|
4
|
Ajiji P, Uzunali A, Ripoche E, Vittaz E, Vial T, Maison P. Investigating the efficacy and safety of metronidazole during pregnancy; A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X 2021; 11:100128. [PMID: 34136799 PMCID: PMC8176309 DOI: 10.1016/j.eurox.2021.100128] [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: 03/16/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We aimed to review and analyze studies focusing on the efficacy of metronidazole in reducing the risk of preterm birth and the safety of metronidazole taking into account the different doses, duration of treatment and routes of administration. STUDY DESIGNS Embase, Cochrane Library and PubMed were searched up to 29 July 2019 to identify studies assessing metronidazole exposure during pregnancy. Additional studies were identified from reference lists of retrieved papers. Measured outcomes were preterm births (<37 weeks of gestation) and associated delivery outcomes such as spontaneous abortions (≤ 20 weeks of gestation), stillbirths (≥20 weeks of gestation) and low birth weight (<2500 g) irrespective of the period of exposure and major malformations after first-trimester exposure. Overall effect estimates for RCTs and observational studies were calculated using the random-effects model and pooled using Risk Ratios (RR) and Odds Ratios (OR) respectively. ROB-2 and ROBINS-I tool were used to assess Risk of Bias for RCTs and observational studies, respectively. RESULTS Twenty-four studies (17 observational studies and 7 RCTs) were selected. Pooled RR was 1.10 (95 % CI 0.78-1.55; n = 7; I2 = 72 %) for preterm birth. Subgroup analysis found RR 1.67; 95 % CI 1.07-2.62; n = 3; I² = 32 %) for treatment duration of ≤3 days among women with a previous preterm delivery. Pooled OR for spontaneous abortion was 1.72 (95 % CI 1.40-2.12; n = 5; I2 = 72 %) and 1.15 (95 % CI 0.98-1.34; n = 12; I2 = 25 %) for major malformations. After exclusion of studies with critical risk of bias, pooled OR were 1.7 (1.42-2.04; n = 3; I2 = 19 %) and 1.13 (0.93-1.36; n = 9; I2 = 28 %) respectively. Among several specific malformations analyzed, only congenital hydrocephaly was significantly increased at 4.06 (95 % CI 1.75-9.42; n = 2; I² = 0%). CONCLUSIONS Data do not confirm the efficacy of metronidazole in reducing the risk of preterm birth and associated delivery outcomes. Further research is required to confirm the effect of high dose and short duration of metronidazole treatment on preterm birth among the high-risk group. Regarding the increased odds of spontaneous abortion, RCTs are required to assess the role of the underlying infection. The need for further studies to confirm the risk of congenital hydrocephaly is paramount.
Collapse
Affiliation(s)
- Priscilla Ajiji
- Agence Nationale de Sécurité du Médicament et des Produits de santé (ANSM), France
- EA 7379, EpiDermE Faculté de Santé, Université Paris-Est Créteil, France
| | - Anil Uzunali
- Agence Nationale de Sécurité du Médicament et des Produits de santé (ANSM), France
| | - Emmanuelle Ripoche
- Agence Nationale de Sécurité du Médicament et des Produits de santé (ANSM), France
| | - Emilie Vittaz
- Agence Nationale de Sécurité du Médicament et des Produits de santé (ANSM), France
| | - Thierry Vial
- Service Hospitalo-Universitaire de Pharmacotoxicologie, CHU-Lyon, Lyon, France
| | - Patrick Maison
- Agence Nationale de Sécurité du Médicament et des Produits de santé (ANSM), France
- EA 7379, EpiDermE Faculté de Santé, Université Paris-Est Créteil, France
| |
Collapse
|
5
|
van den Munckhof EHA, van Sitter RL, Lamont RF, le Cessie S, Kuijper EJ, Knetsch CW, Molijn A, Quint WGV, Boers KE, Leverstein-van Hall MA. Developing an algorithm for the diagnosis of abnormal vaginal discharge in a dutch clinical setting: a pilot study. Diagn Microbiol Infect Dis 2021; 101:115431. [PMID: 34153570 DOI: 10.1016/j.diagmicrobio.2021.115431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 04/29/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
Abnormal vaginal discharge may be caused by bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis and/or aerobic vaginitis. For the development of a diagnostic algorithm, tree-based classification analysis was performed on symptoms, signs and bedside test results of 56 patients, and laboratory tests (culture, Nugent score, qPCRs) were compared. Amplicon sequencing of the 16S rRNA gene was used as reference test for bacterial vaginosis and aerobic vaginitis, culture for vulvovaginal candidiasis and qPCR for trichomoniasis. For bacterial vaginosis, the best diagnostic algorithm was to screen at the bedside with a pH and odour test and if positive, to confirm by qPCR (sensitivity 94%; specificity 97%) rather than Nugent score (sensitivity of 59%; specificity 97%; P = 0.031). The analysis for the other infections was less conclusive due to the low number of patients with these infections. For bacterial vaginosis, the developed algorithm is sensitive, specific, and reduces the need for laboratory tests in 50% of the patients.
Collapse
Affiliation(s)
| | | | - Ronald F Lamont
- Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK; Department of Gynecology and Obstetrics, Odense University Hospital, Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Saskia le Cessie
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Medical Center, The Netherlands
| | | | - Anco Molijn
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Wim G V Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Kim E Boers
- Department of Gynecology, Haaglanden Medical Center, The Hague, The Netherlands
| | | |
Collapse
|
6
|
Masero AR, Frutos LMS, Vizcaíno E, Palma M, Velasco-Ortega S, Nieto C. Real-world effectiveness and tolerability of Zelesse cream® for treating vulvovaginitis in adult women: an observational, prospective study. J Int Med Res 2021; 49:3000605211013226. [PMID: 33983051 PMCID: PMC8127803 DOI: 10.1177/03000605211013226] [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] [Indexed: 11/17/2022] Open
Abstract
Objective To assess the efficacy, acceptability, and tolerability of a vaginal cream based on plant extracts for treating signs and symptoms of vulvovaginitis (VV) (Zelesse cream®), either as monotherapy (non-infectious VV) or adjuvant to antimicrobial therapy (infectious VV). Methods This prospective, observational, multicenter study included women who attended outpatient offices for VV. The severity of signs (vaginal discharge, erythema, and edema) and symptoms (pruritus, burning, and dysuria) was assessed before and after 15±5 days of daily treatment with Zelesse cream on a 4-point scale (18-point global score). Results The study included 58 women aged 43.0±13.2 years, including 42 who were treated with Zelesse cream only and 16 who used Zelesse cream as adjuvant to antimicrobial therapy. All participants showed significantly reduced scores and absolute prevalence of individual signs and symptoms in both groups. Similarly, the median signs/symptoms decreased by 4.0 and 8.0 points in women using Zelesse only and those using Zelesse plus antimicrobial therapy, respectively. This product was well tolerated and had high acceptability. Conclusions Zelesse cream relieves signs and symptoms of VV, either as monotherapy in non-infectious VV or as adjuvant to antimicrobial therapy in infectious VV. Future randomized, placebo-controlled trials with larger sample sizes are warranted.
Collapse
Affiliation(s)
| | | | - Ernesto Vizcaíno
- Center of Obstetrics and Gynecology Vizcaíno S.L., Madrid, Spain
| | - María Palma
- Medical Department, ITF Research Pharma S.L.U., Madrid, Spain
| | | | | |
Collapse
|
7
|
The Role of T Helper 17 (Th17) and Regulatory T Cells (Treg) in the Pathogenesis of Vulvovaginal Candidiasis among HIV-Infected Women. Int J Microbiol 2020. [DOI: 10.1155/2020/8841113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background. The study sought to describe relationships between 20 cytokines and chemokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17, G-CSF, GM-CSF, IFN-γ, MCP-1, MIP-1β, TNF-α, TGF-β1, TGF-β2, and TGF-β3) and the presence of vulvovaginal candidiasis (VVC) in women, stratified by HIV status. Methods. Plasma and genital samples were obtained from 51 clinic attendees in KwaZulu-Natal between June 2011 and December 2011. Cytokine and chemokine concentrations were measured by Luminex® multiplex immunoassays. Multiple comparisons of means of cytokine/chemokine levels displaying significant differences in univariate analyses across the study groups were performed using post hoc Bonferroni pairwise tests considering a type I error rate of 0.05. A discriminant analysis (DA) was carried out to identify linear combinations of variates that would maximally discriminate group memberships. Results. Of the 51 participants, 16/26 HIV-infected and 15/25 HIV-uninfected women were diagnosed with VVC. DA identified 2 variables (MIP-1β and TGF-β3) in plasma (Box’s M (5.49),
(0.57) > α (0.001); Wilks’ lambda = 0.116,
) and 1 variable (IL-13) in vaginal secretions (Box’s M (2.063),
(0.37) > α (0.001); Wilks’ lambda = .677,
) as able to discriminate the HIV + VVC + group, whilst TGF-β1 in plasma discriminated the HIV + VVC − group. Mean concentrations of genital IL-6, IL-8, IL-10, IL-17, and TGF-β3 were significantly higher in HIV infected women coinfected with VVC. Conclusions. In HIV-infected women, VVC might be explained by a decline of Th17 cells, hence a decrease of Th17/Treg ratio.
Collapse
|
8
|
Rosca AS, Castro J, Sousa LGV, Cerca N. Gardnerella and vaginal health: the truth is out there. FEMS Microbiol Rev 2020; 44:73-105. [PMID: 31697363 DOI: 10.1093/femsre/fuz027] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/06/2019] [Indexed: 12/16/2022] Open
Abstract
The human vagina is a dynamic ecosystem in which homeostasis depends on mutually beneficial interactions between the host and their microorganisms. However, the vaginal ecosystem can be thrown off balance by a wide variety of factors. Bacterial vaginosis (BV) is the most common vaginal infection in women of childbearing age but its etiology is not yet fully understood, with different controversial theories being raised over the years. What is generally accepted is that BV is often characterized by a shift in the composition of the normal vaginal microbiota, from a Lactobacillus species dominated microbiota to a mixture of anaerobic and facultative anaerobic bacteria. During BV, a polymicrobial biofilm develops in the vaginal microenvironment, being mainly composed of Gardnerella species. The interactions between vaginal microorganisms are thought to play a pivotal role in the shift from health to disease and might also increase the risk of sexually transmitted infections acquisition. Here, we review the current knowledge regarding the specific interactions that occur in the vaginal niche and discuss mechanisms by which these interactions might be mediated. Furthermore, we discuss the importance of novel strategies to fight chronic vaginal infections.
Collapse
Affiliation(s)
- Aliona S Rosca
- Centre of Biological Engineering (CEB), Laboratory of Research in Biofilms Rosário Oliveira (LIBRO), University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Joana Castro
- Centre of Biological Engineering (CEB), Laboratory of Research in Biofilms Rosário Oliveira (LIBRO), University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Lúcia G V Sousa
- Centre of Biological Engineering (CEB), Laboratory of Research in Biofilms Rosário Oliveira (LIBRO), University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Nuno Cerca
- Centre of Biological Engineering (CEB), Laboratory of Research in Biofilms Rosário Oliveira (LIBRO), University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| |
Collapse
|
9
|
Donders G, Bellen G, Oerlemans E, Claes I, Ruban K, Henkens T, Kiekens F, Lebeer S. The use of 3 selected lactobacillary strains in vaginal probiotic gel for the treatment of acute Candida vaginitis: a proof-of-concept study. Eur J Clin Microbiol Infect Dis 2020; 39:1551-1558. [PMID: 32356027 DOI: 10.1007/s10096-020-03868-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
In vitro studies suggest that certain probiotic bacterial strains have potential activity against opportunistic infections such as Candida. There are few in vivo trials using probiotics as a single treatment for acute Candida vulvovaginitis (CV). In this open-label, proof-of-concept study, selected Lactobacillus strains were tested in women with acute Candida vaginitis. Twenty women diagnosed with proven, symptomatic CV were instructed to administer a vaginal probiotic gel with L. plantarum YUN-V2.0, L. pentosus YUN-V1.0 and L. rhamnosus YUN-S1.0 for 10 consecutive days. Vaginal rinsing fluid, vaginal culture swab and vaginal smear for fresh wet-mount microscopy were collected before and 7, 14 and 28 days after start of treatment. On average, participating women were 39 years old and had an history of 5 vaginal infections of which 95% was CV. Nine women (45%) completed the study without the need of rescue medication. Women who needed rescue treatment experienced twice as much Candida infections in the past. A negative correlation was found between the clinical composite score and the time to use rescue medication (R2 = 0.127). Seventy-four per cent of participants found the study gel comfortable to use, and 42% of all women would use the tested gel again for this indication. Forty-five per cent of women were treated successfully for acute CV with a novel vaginal gel containing 3 selected Lactobacillus strains. Patients needing rescue treatment were suffering from more severe and long-standing disease. These results warrant for further testing of this new product, especially of its potential in cases with mild to moderate severity, as an adjuvant to antimycotics or as a preventive measure in women with recurrent vulvovaginal candidosis.
Collapse
Affiliation(s)
- Gilbert Donders
- Femicare, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium. .,Department of Gynaecology and Obstetrics, University Hospital of Antwerp, Antwerp, Belgium.
| | - Gert Bellen
- Femicare, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium
| | - Eline Oerlemans
- Department of Bioscience Engineering, Research group Environmental Ecology and Microbiology, University of Antwerp, Antwerp, Belgium
| | - Ingmar Claes
- Department of Bioscience Engineering, Research group Environmental Ecology and Microbiology, University of Antwerp, Antwerp, Belgium.,YUN NV, Aartselaar, Belgium
| | - Kateryna Ruban
- Femicare, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium
| | - Tim Henkens
- Department of Pharmaceutical, Biomedical and Veterinary Sciences, Laboratory of Pharmaceutical Technology and Biopharmacy, University of Antwerp, Antwerp, Belgium
| | - Filip Kiekens
- Department of Pharmaceutical, Biomedical and Veterinary Sciences, Laboratory of Pharmaceutical Technology and Biopharmacy, University of Antwerp, Antwerp, Belgium
| | - Sarah Lebeer
- Department of Bioscience Engineering, Research group Environmental Ecology and Microbiology, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
10
|
Gaziano R, Sabbatini S, Roselletti E, Perito S, Monari C. Saccharomyces cerevisiae-Based Probiotics as Novel Antimicrobial Agents to Prevent and Treat Vaginal Infections. Front Microbiol 2020; 11:718. [PMID: 32373104 PMCID: PMC7186379 DOI: 10.3389/fmicb.2020.00718] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022] Open
Abstract
Vaginal infections affect 70% of women during their lifetimes and account for millions of annual doctors’ visits. These infections are predominantly represented by vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV). Although standard antimicrobial agents remain the major strategy for the prevention and treatment of vaginal infections, both VVC and BV are difficult to treat due to high rates of resistance and recurrence, high probability of complications, and negative effects on the vaginal microbiota. This review focuses on a new approach of yeast-based probiotics for the prevention and/or treatment of these common vaginal infections.
Collapse
Affiliation(s)
- Roberta Gaziano
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Samuele Sabbatini
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Elena Roselletti
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Stefano Perito
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Claudia Monari
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| |
Collapse
|
11
|
Athanasiou S, Pitsouni E, Antonopoulou S, Zacharakis D, Salvatore S, Falagas ME, Grigoriadis T. Response letter to comments related to “The effect of microablative fractional CO2 laser on vaginal flora of postmenopausal women”. Neurourol Urodyn 2020; 39:1026-1027. [DOI: 10.1002/nau.24315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Stavros Athanasiou
- Urogynecology Unit, First Department of Obstetrics and Gynecology, Medical School, “Alexandra” HospitalNational and Kapodistrian University of Athens Athens Greece
| | - Eleni Pitsouni
- Urogynecology Unit, First Department of Obstetrics and Gynecology, Medical School, “Alexandra” HospitalNational and Kapodistrian University of Athens Athens Greece
- Alpha Institute of Biomedical Sciences (AIBS) Athens Greece
| | | | - Dimitris Zacharakis
- Urogynecology Unit, First Department of Obstetrics and Gynecology, Medical School, “Alexandra” HospitalNational and Kapodistrian University of Athens Athens Greece
| | - Stefano Salvatore
- Department of Urogynecology, Obstetrics and Gynecology UnitIRCCS San Raffaele Hospital, Vita‐Salute San Raffaele University Milan Italy
| | - Matthew E. Falagas
- Alpha Institute of Biomedical Sciences (AIBS) Athens Greece
- Department of MedicineHenry Dynant Hospital Center Athens Greece
- Department of MedicineTufts University School of Medicine Boston Massachusetts
| | - Themos Grigoriadis
- Urogynecology Unit, First Department of Obstetrics and Gynecology, Medical School, “Alexandra” HospitalNational and Kapodistrian University of Athens Athens Greece
| |
Collapse
|
12
|
Tien V, Punjabi C, Holubar MK. Antimicrobial resistance in sexually transmitted infections. J Travel Med 2020; 27:5678669. [PMID: 31840758 DOI: 10.1093/jtm/taz101] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 12/13/2022]
Abstract
RATIONALE FOR REVIEW International travel facilitates the spread of drug-resistant infections, including sexually transmitted infections (STIs). In 2016, the World Health Organization highlighted the global burden of 'curable' STIs, estimating 376 million new infections of gonorrhoea, chlamydia, syphilis and trichomoniasis annually, with considerable geographic variation in both the burden of disease and prevalence of resistance. Travelers' risk of contracting and transmitting drug-resistant STIs depends in part on their geographic exposure. In this review, we describe the epidemiology of antimicrobial resistance (AMR) and the management of these four common STIs and Mycoplasma genitalium, an increasingly recognized cause of non-gonococcal urethritis. KEY FINDINGS Multi-drug and extensively drug resistant gonorrhoea strains have been associated with international spread, particularly in travelers returning from Southeast Asia. Chlamydia is the most common bacterial STI worldwide. Although in vitro resistance has been reported, surveillance data suggest that clinically significant resistance to macrolides and tetracyclines is rare. Macrolide resistance in syphilis is now endemic in much of the world but there is no documented penicillin resistance, which remains first-line therapy. Trichomoniasis is the most common non-viral STI worldwide. Although clinical failure after treatment occurs, resistance to metronidazole is thought to be uncommon. Mycoplasma genitalium exhibits intrinsic resistance to many antibiotics, and the prevalence of resistance to both first- and second-line regimens (macrolides and fluoroquinolones) is increasing worldwide, with limited alternative therapeutic options. RECOMMENDATIONS International travelers are at risk for acquiring resistant STIs with limited therapeutic options. Improved diagnostics are urgently needed to improve AMR surveillance and the management of infected patients. As no vaccinations are currently available for these STIs, and pre-exposure prophylaxis is an area of active study with limited data, condom use is critical for prevention. Travel medicine providers should incorporate STI risk reduction counselling, with an emphasis on condom use, into the routine pre-travel consultation.
Collapse
Affiliation(s)
- Vivian Tien
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Chitra Punjabi
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marisa K Holubar
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
13
|
Durai V, Varadharajan S, Muthuthandavan AR. Reproductive tract infections in rural India - A population-based study. J Family Med Prim Care 2019; 8:3578-3583. [PMID: 31803656 PMCID: PMC6881949 DOI: 10.4103/jfmpc.jfmpc_703_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 11/07/2022] Open
Abstract
Context: Reproductive tract infections (RTI) occupy the second position among public health problems. Aims: To find out the prevalence of RTI and its associated conditions among ever married women in the reproductive age group (15–49 years). Settings and Design: This cross-sectional study was conducted among 330 women in a rural area of Poonamallee block at Thiruvallur district in Tamil Nadu from August 2013 to January 2014. Materials and Methods: In this cross-sectional study, the selection of participants was done through cluster sampling and data on symptoms by questionnaires. Statistical Analysis Used: For descriptive prevalence, statistics was used. Using Chi-Square, categorical data were analyzed and using the odds ratio P value associations were assessed. Results: About 21% had anyone symptom of RTI. Occupation of women (OR2.0), occupation of spouse (OR1.9), anemia (OR 2.0), dysuria (OR51.5), burning micturition (OR15.9), frequency (OR3.3)/the urgency of urination (OR2.7), and incomplete urination (OR5.4)/defecation (OR3.6) were significantly associated with RTI. The prevalence rate of abnormal vaginal discharge was more (12%) than any other symptoms (each < 4%) of RTIs. Conclusions: The prevalence of RTI was high. Moreover, women with dysuria, burning micturition, incomplete urination/defecation, frequency/the urgency of urination, and anemia are at a higher risk of developing RTI.
Collapse
Affiliation(s)
- Vanitha Durai
- Department of Community Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra (Deemed to be) University, Porur, Chennai-116, Tamil Nadu, India
| | - Suresh Varadharajan
- Department of Community Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra (Deemed to be) University, Porur, Chennai-116, Tamil Nadu, India
| | - Anitha R Muthuthandavan
- Department of Community Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra (Deemed to be) University, Porur, Chennai-116, Tamil Nadu, India
| |
Collapse
|
14
|
Parra Linares AM, Amaya-Guio J, Grillo-Ardila CF, Toro Cubides AM. Antiseptics and disinfectants for the treatment of vaginal discharge in non-pregnant women. Cochrane Database Syst Rev 2019. [DOI: 10.1002/14651858.cd013467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Jairo Amaya-Guio
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
| | - Carlos F Grillo-Ardila
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
| | - Angelica Maria Toro Cubides
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana; Department of Obstetrics and Gynaecology; Bogota Colombia
| |
Collapse
|
15
|
Salvatore S, Athanasious S, Yuen HTH, Karram M. LASER users’ expert opinion in response to “The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document”. Neurourol Urodyn 2019; 38:2383-2384. [DOI: 10.1002/nau.24140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Stefano Salvatore
- Division of Obstetrics and GynecologySan Raffaele Hospital Milano Italy
| | - Stavros Athanasious
- Division of Obstetrics and Gynecology, Faculty of MedicineNational and Kapodistrian University of Athens Athens Greece
| | - Hoi T. H. Yuen
- Division of Obstetrics and GynecologyChrist Hospital Cincinnati Ohio United States
| | - Mickey Karram
- Division of Obstetrics and GynecologyChrist Hospital Cincinnati Ohio United States
| |
Collapse
|
16
|
In Vitro Activity of Fenticonazole against Candida and Bacterial Vaginitis Isolates Determined by Mono- or Dual-Species Testing Assays. Antimicrob Agents Chemother 2019; 63:AAC.02693-18. [PMID: 31061161 DOI: 10.1128/aac.02693-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/02/2019] [Indexed: 01/07/2023] Open
Abstract
We determined the in vitro activity of fenticonazole against 318 vaginitis isolates of Candida and bacterial species and selected 28 isolates for time-kill studies. At concentrations equal to 4× MIC, fenticonazole reached the 99.9% killing endpoint by ∼10 h for Staphylococcus aureus, Streptococcus agalactiae, and Escherichia coli and by ∼17 h for Candida albicans and Candida parapsilosis; and at concentrations equal to 8× MIC, by ∼19 and ∼20 h for Candida glabrata and Candida tropicalis, respectively. At concentrations equal to 2× MIC, fenticonazole required ∼20 h to reach the above endpoint against C. albicans in mixed culture with S. aureus, S. agalactiae, or E. coli versus ∼17 h against C. albicans in pure culture. Supra-MICs are achievable in topically treated patients' vaginal surfaces.
Collapse
|
17
|
de Vrese M, Laue C, Papazova E, Petricevic L, Schrezenmeir J. Impact of oral administration of four Lactobacillus strains on Nugent score - systematic review and meta-analysis. Benef Microbes 2019; 10:483-496. [PMID: 31012733 DOI: 10.3920/bm2018.0129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We aimed at assessing the evidence for an effect on vaginal dysbiosis by oral administration of a mixture of Lactobacillus strains isolated from vaginal microbiota. For this purpose, we systematically reviewed the literature for randomised clinical trials (RCTs) in which the effect of oral administration of a mixture of four Lactobacillus strains (Lactobacillus crispatus LbV 88 (DSM 22566), Lactobacillus gasseri LbV 150N (DSM 22583), Lactobacillus jensenii LbV 116 (DSM 22567) and Lactobacillus rhamnosus LbV96 (DSM 22560)) on vaginal dysbiosis was examined based on Nugent score. Four RCTs were identified: a double-blind (DB)-RCT in 60 male-to-female transsexual women with neovagina; an open label RCT in 60 pregnant women with herpes virus infection; a DB-RCT in 36 women with bacterial vaginosis; a DB-RCT in 22 postmenopausal breast cancer patients receiving chemotherapy. Only in the three DB-RCTs Nugent score was assessed. The meta-analysis of these trials showed a significant reduction of Nugent score by probiotics compared to placebo in the fixed (standardised mean differences (SMD) -0.561; confidence interval (CI) -0.935 to -0.186; P=0.004 and random effect models (SMD -0.561; CI -0.935 to -0.186; P=0.004). The odds ratio (OR) of the cases presenting with improved Nugent score after probiotics compared to placebo treatment showed a significant effect in the fixed (OR=3.936; CI 1.702 to 9.100; P=0.001) and random effect model (OR=3.902; CI 1.681 to 9.059; P=0.001) Cochran's Q and I2 statistics showed no heterogeneity. This meta-analysis indicates that the oral intake of the pertinent Lactobacillus strains improves the microbial pattern in vaginal dysbiosis.
Collapse
Affiliation(s)
- M de Vrese
- 1 Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Department of Microbiology and Biotechnology; Hermann-Weigmann-Straβe 1, 24117 Kiel, Germany
| | - C Laue
- 2 Clinical Research Center, Schauenburgerstraβe 116, 24118 Kiel, Germany
| | - E Papazova
- 2 Clinical Research Center, Schauenburgerstraβe 116, 24118 Kiel, Germany
| | - L Petricevic
- 3 Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - J Schrezenmeir
- 2 Clinical Research Center, Schauenburgerstraβe 116, 24118 Kiel, Germany
- 4 University Medicine, Langenbeckstraβe 1, 55131 Mainz, Germany
| |
Collapse
|
18
|
Kalia N, Singh J, Sharma S, Kaur M. Impact of SNPs interplay across the locus of MBL2, between MBL and Dectin-1 gene, on women's risk of developing recurrent vulvovaginal infections. Cell Biosci 2019; 9:35. [PMID: 31080578 PMCID: PMC6505208 DOI: 10.1186/s13578-019-0300-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background Human mannose binding lectin (MBL) and dendritic cell-associated C-type lectin-1 (Dectin-1) are the two prototypical PRRs of innate immunity, whose direct role in recurrent vulvovaginal infections (RVVI) defense has been defined. Previously, MBL insufficiency was proposed as a possible risk factor for the rapid progression of RVVI while, Dectin-1 was found to be playing an active role in the defense. However, the complete genetic bases for the observed low MBL levels are still lacking as our previous studies in harmony with others demonstrated the un-expected genotype–phenotype patterns. This suggested the presence of unidentified regulatory variants that may modulate sMBL levels and risk of RVVI. Therefore, the present study was designed for more inclusive locus-wide MBL2 analysis and for the possible non-linear interaction analysis of two PRRs that may impact RVVI susceptibility. Methods The present study has extended the previous findings by investigating (1) the role of chosen additional SNPs falling in the 5′ near region relating to sMBL levels and RVVI susceptibility, using polymerase chain reaction-restriction fragment length polymorphism, (2) interactions among SNPs within gene by comprehensive locus-wide haplotype analyses of two MBL2 blocks, (3) gene–gene interaction analyses between two PRRs, using multifactor dimensionality reduction. Results rs11003124_G, rs7084554_C, rs36014597_G, and rs11003123_A were observed as the minor alleles in the representative North Indian cohort. RVVI cases and its types showed an appreciably high frequency of C allele, its homozygosity and heterozygosity, explaining the observed dominant mode of inheritance of rs7084554 polymorphism in contributing 1.81 fold risk of RVVI. The rs36014597 polymorphism showed the overdominant mode of inheritance, which further depicts that the carrier of a heterozygous genotype of this polymorphism had more extreme phenotype than either of its homozygous carriers in developing 4.07 fold risk of RVVI. sMBL levels significantly varied for rs11003124, rs36014597 and rs11003123 polymorphisms in bacterial vaginosis, while for rs7084554 polymorphism in mixed infection. Independent analysis of 5′ and 3′ haplotype blocks suggested the risk-modifying effect of all the 5′ additional variants, Y/X secretor polymorphism and 3′-UTR SNP i.e. rs10824792. Combined 5′/3′ haplotype analyses depicted the importance of rs36014597; an additional 5′ variant, Y/X and rs10824792 polymorphisms from both the blocks in regulating sMBL levels and RVVI risk. Three gene–gene interaction models involving uni-variant, bi-variant and tri-variant appeared as significant predictors of RVVI risk with cross-validation consistency of 10/10, 9/10 and 5/10, respectively. Conclusions The study presented a low-cost reproducible screening design for additional 5′ variants i.e. rs11003124, rs7084554, rs36014597 and rs11003123 of MBL2 that can act as markers of susceptibility for RVVI or any other diseases. Two additional 5′ variants of MBL2 i.e. rs7084554 and rs36014597 were suggested as novel molecular markers that may contribute to RVVI risk by varying sMBL levels. Variants of two blocks were found to have more of a combined effect than the independent effect in modulating RVVI susceptibility and sMBL levels. The study presented weak synergistic interaction between MBL2 and CLEC7A in association with RVVI risk. The preliminary data will establish the foundation for the investigation of within gene and between genes interaction analyses towards RVVI susceptibility. Electronic supplementary material The online version of this article (10.1186/s13578-019-0300-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Namarta Kalia
- 1Department of Molecular Biology & Biochemistry, Guru Nanak Dev University, Amritsar, India
| | - Jatinder Singh
- 1Department of Molecular Biology & Biochemistry, Guru Nanak Dev University, Amritsar, India
| | - Sujata Sharma
- 2Department of Obstetrics & Gynaecology, Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar, India
| | - Manpreet Kaur
- 3Department of Human Genetics, Guru Nanak Dev University, Amritsar, India
| |
Collapse
|
19
|
Buggio L, Somigliana E, Borghi A, Vercellini P. Probiotics and vaginal microecology: fact or fancy? BMC Womens Health 2019; 19:25. [PMID: 30704451 PMCID: PMC6357464 DOI: 10.1186/s12905-019-0723-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 01/23/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Probiotics are live microorganisms that, when administered in adequate amounts, should confer a health benefit to the host. Media sources tend to present probiotics as an appealing health promotion method able to prevent or treat a wide variety of clinical conditions. In obstetrics and gynaecology, Lactobacilli species are mainly used to restore the physiologic vaginal microbiota in order to treat bacterial vaginosis and vulvovaginal candidiasis (VVC) and prevent preterm birth. DISCUSSION Several RCTs investigated the potential benefits of probiotics in gynaecological and obstetrics conditions. For all potential indications, recent specific meta-analyses have been published. Considering vulvovaginal candidiasis in non-pregnant women, probiotics slightly improved the short-term clinical and mycological cure, and reduced the 1-month relapse. However, no important impact of probiotic use was observed on long-term clinical or mycological cure. Similarly, the addition of probiotics to metronidazole for the treatment of bacterial vaginosis was not shown to provide any additional benefit. In obstetrics, using probiotics during pregnancy neither decreased nor increased the risk of preterm birth before 34 weeks or before 37 weeks. Similarly, no benefits emerged for gestational diabetes, preterm premature rupture of membrane, and small and large for gestational age infants. CONCLUSION Despite increasing marketing of probiotics for the treatment of vulvovaginal candidiasis and prevention of preterm birth robust evidence demonstrating a beneficial effect is scarce. Moreover, there was considerable heterogeneity among the different studies in terms of route of administration, strain/s of probiotic adopted, and length of probiotic use. Before recommending the systematic use of probiotics to treat bacterial vaginosis and VVC and prevent preterm birth, high-quality research is needed. Professional medical associations should issue recommendations defining if, when, and how probiotics should be used for gynaecological disorders.
Collapse
Affiliation(s)
- Laura Buggio
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda, 12 - 20122 Milan, Italy
| | - Edgardo Somigliana
- Deparment of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Borghi
- Deparment of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda, 12 - 20122 Milan, Italy
- Deparment of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy
| |
Collapse
|
20
|
Tarrahi MJ, Kianersi S, Nasirian M. Latent class analysis of symptoms for sexually transmitted infections among Iranian women: Results from a population-based survey. Health Care Women Int 2019; 41:461-475. [PMID: 30689520 DOI: 10.1080/07399332.2019.1566335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A preliminary symptom-based screening test would lower the financial burden of sexually transmitted infections (STIs) caused by clinical testing. To develop such a screening method, we should first identify the most specific STI symptoms. We aim to distinguish the specific STI symptom(s) that are most likely to be found in the truly infected individuals. We used data from a population-based survey that was conducted in Iran, in 2014. Using Latent Class Analysis (LCA) in R software, we classified 3049 Iranian women, 18-60 years old, with reference to seven self-reported STI-associated symptoms. Using LCA, we categorized nearly 1% of women as "probably STI-infected". Above 70% of participants reported the "seven symptoms" that are associated with STIs, except for genital ulcer. These symptoms could be used to distinguish healthy participants from infected ones. The "probably healthy" class incorporated about 77% of the participants. Lower abdominal pain and abnormal vaginal discharge were the most frequently reported symptoms of this class. The LCA determined classes along with the WHO syndromic guidelines for STI diagnosis can help physicians to make a more accurate diagnosis. Hence, cost-effectively, only patients who are classified as probably infected need to be referred to medical laboratories for further investigations.
Collapse
Affiliation(s)
- Mohammad Javad Tarrahi
- Epidemiology and Biostatistics Department, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sina Kianersi
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Nasirian
- Epidemiology and Biostatistics Department, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
21
|
Kalia N, Singh J, Sharma S, Kaur M. SNPs in 3'-UTR region of MBL2 increases susceptibility to recurrent vulvovaginal infections by altering sMBL levels. Immunobiology 2018; 224:42-49. [PMID: 30482481 DOI: 10.1016/j.imbio.2018.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 12/11/2022]
Abstract
Recurrent vulvovaginal infections (RVVI), owing to their adverse health consequences, have become a serious dilemma worldwide. Low serum levels of Mannose-Binding Lectin (sMBL), a main component of innate immunity, was found to be associated with RVVI risk, though complete genetic bases are still elusive. To reveal unrecognised regulatory variants, 3'-UTR region of MBL2 with six putative functional SNPs i.e. rs10824792, rs2120132, rs2120131, rs2165813, rs2099903 and rs2099902 was sequenced and genotyped in the present study for 109 RVVI cases and age matched healthy controls. sMBL levels were measured by enzyme-linked immunosorbent assay. The homozygous CC genotype of rs10824792 polymorphism was found to be conferring risk (OR = 2.94) of developing RVVI. Significantly high frequency of corresponding CC genotype was found in Vulvovaginal Candidiasis (VVC) and Mixed Infections (MI) relative to controls. Significantly insufficient sMBL levels were observed in RVVI and its types (Bacterial Vaginosis, VVC and MI) than controls. sMBL levels varied for rs10824792 SNP as expected from the genetic analyses. Six marker haplotype analyses have shown CTTGCT, the haplotype containing only risk allele of rs10824792, conferred risk of RVVI and its types by lowering sMBL levels. In conclusion, a 3'-UTR SNP i.e. rs10824792 was identified as novel associated genetic marker for contributing low sMBL levels and RVVI risk. Our findings contribute to the novel future research directions for the development of emerging MBL substitution as effectual therapy for RVVI.
Collapse
Affiliation(s)
- Namarta Kalia
- Department of Molecular Biology & Biochemistry, Guru Nanak Dev University, Amritsar, India
| | - Jatinder Singh
- Department of Molecular Biology & Biochemistry, Guru Nanak Dev University, Amritsar, India.
| | - Sujata Sharma
- Department of Gynaecology & Obstetrics, Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar, India
| | - Manpreet Kaur
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, India.
| |
Collapse
|
22
|
Emergence of Resistance to Fluconazole in Candida albicans Isolated From Vaginal Discharge. CURRENT FUNGAL INFECTION REPORTS 2018. [DOI: 10.1007/s12281-018-0329-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
23
|
Kalia N, Kaur M, Sharma S, Singh J. A Comprehensive in Silico Analysis of Regulatory SNPs of Human CLEC7A Gene and Its Validation as Genotypic and Phenotypic Disease Marker in Recurrent Vulvovaginal Infections. Front Cell Infect Microbiol 2018; 8:65. [PMID: 29616193 PMCID: PMC5869923 DOI: 10.3389/fcimb.2018.00065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/26/2018] [Indexed: 01/25/2023] Open
Abstract
Recurrent Vulvovaginal infections (RVVI) are the commonly reported microbiological syndrome affecting millions of women globally. Various molecules of innate immune system are instrumental in clearance of these microbial pathogens, thus suggested as one of the most important contributing factor in determining the disease outcome. Dendritic cell-associated C-type lectin-1 (Dectin-1) is an important molecule of innate immunity that is primarily known for its role in antifungal defenses. However, role of dectin-1 in recognition of other pathogens is also documented. The intracellular expression of dectin-1 was shown to be up-regulated by Mannose Binding Lectin (MBL)-mediated opsonophagocytosis of pathogens. Dectin-1 is encoded by CLEC7A, postulated to be a candidate gene in modulating risk of developing RVVI. In this study, we identified CLEC7A causal variants using in silico analysis. To assess their impact on susceptibility to RVVI, these causal variants along with serum dectin-1 levels (sDectin-1) were investigated using polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) and Enzyme Linked Immnosorbent Assay (ELISA) respectively, under a case-control design. Furthermore, effect of these polymorphisms was also assessed on sMBL levels. In silico analysis revealed 9 putative functional conserved SNPs of CLEC7A. Association analysis revealed a significantly lower risk of developing RVVI and its types in carriers of CLEC7A rs3901533 G allele and its homozygous genotypes (p < 0.05). The heterozygous genotype was associated with significant protection against RVVI (p = 0.004). Haplotypes GGG and GTA showed significant protection against RVVI (p < 0.0001; p = 0.0003), Bacterial Vaginosis (p = 0.03; p = 0.002), Vulvovaginal Candidiasis (p = 0.03; p = 0.01) and Mixed Infections (p = 0.007; p = 0.04). Mean sDectin-1 levels were significantly high in RVVI and its types compared to controls (p < 0.05). Further, genotype-phenotype stratification showed significant differences within/between cases groups and controls. The CLEC7A rs3901533 polymorphism was also found to be associated with sMBL levels. The present study contributed novel insights into the role of dectin-1 in RVVI. CLEC7A rs3901533 polymorphism and high sDectin-1 levels along with low sMBL levels were found to be associated with RVVI susceptibility. Thus, screening of women with RVVI for these novel associations may lead to better diagnosis and treatment. Also genotyping method used in this study constitutes a simple and reliable assay, which can be confidently, used as a cheaper alternative for genotyping these variants in clinical settings. Finally, new restorative markers for other infectious diseases might be found by exploring nine functionally identified CLEC7A SNPs.
Collapse
Affiliation(s)
- Namarta Kalia
- Department of Molecular Biology & Biochemistry, Guru Nanak Dev University, Amritsar, India
| | - Manpreet Kaur
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, India
| | - Sujata Sharma
- Department of Gynaecology & Obstetrics, Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar, India
| | - Jatinder Singh
- Department of Molecular Biology & Biochemistry, Guru Nanak Dev University, Amritsar, India
| |
Collapse
|
24
|
Serwin AB, Bulhak-Koziol V, Sokolowska M, Golparian D, Unemo M. Trichomonas vaginalis is very rare among women with vaginal discharge in Podlaskie province, Poland. APMIS 2017; 125:840-843. [PMID: 28612378 DOI: 10.1111/apm.12713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/30/2017] [Indexed: 11/29/2022]
Abstract
Trichomonas vaginalis is the most common curable sexually transmitted pathogen globally. However, in the European Union (EU), trichomoniasis appears to be a rare condition. The aim of this study was to examine the prevalence of T. vaginalis among females attending an STI centre in Bialystok, Poland, using the highly sensitive and specific APTIMA T. vaginalis assay. Consecutive females, referred by gynaecologists mainly because of abnormal vaginal discharge, were diagnosed using wet mount microscopy, culture and APTIMA T. vaginalis assay. Among 272 women studied, 82% were pre- and 18% postmenopausal. The average age was 36.0 ± 13.9 (range: 18-86) years. Abnormal discharge (alone or accompanied by itch or vulvovaginal burning) was the most frequent complain in both groups (66.2% and 48.0%). Erythema and discharge were the most frequent abnormal signs (58.6% and 56.0%). Not a single T. vaginalis-positive sample was detected using wet mount microscopy, culture or APTIMA T. vaginalis assay. Despite using the highly sensitive APTIMA T. vaginalis assay for detection, the pathogen could not be identified in females in the studied setting, similar to results from other EU settings. The need for general screening using NAAT for this pathogen while diagnosing vulvovaginal symptoms in females in Poland appears to be low.
Collapse
Affiliation(s)
- Agnieszka Beata Serwin
- Department of Dermatology and Venereology, Medical University of Bialystok, Bialystok, Poland
| | | | - Marianna Sokolowska
- Diagnostic and Research Centre for Sexually Transmitted Diseases, Bialystok, Poland
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
25
|
Sonkar SC, Wasnik K, Kumar A, Sharma V, Mittal P, Mishra PK, Bharadwaj M, Saluja D. Evaluating the utility of syndromic case management for three sexually transmitted infections in women visiting hospitals in Delhi, India. Sci Rep 2017; 7:1465. [PMID: 28469158 PMCID: PMC5431118 DOI: 10.1038/s41598-017-01422-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/28/2017] [Indexed: 12/25/2022] Open
Abstract
Utility of syndromic case management (SCM) in women visiting obstetrics & gynecology department needs to be evaluated as it is subjective and imperfect. Consequently, antibiotic resistance has accelerated along with increased risk of infection to the partners. To understand the effectiveness and/or inadequacies of SCM, 11000 women were recruited and examined by clinicians for infection by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Bacterial vaginosis (BV) and others. Amongst these patients, 1797 (16.3%) reported vaginal discharge (VD). Other symptoms included: vaginitis (97%), cervicitis (75%), genital ulcers (60%), abnormal vaginal discharge (55%) and lower abdominal pain (48%). The patients were treated for single or co-infections using pre-packed National Aids Control Program III STI/RTI Kits. However, based on PCR diagnostics, 1453/1797 (81%) subjects were uninfected for NG/TV/CT. Amongst 344 (19%) infected patients, 257 (75%) carried infection with single pathogen (TV/NG/CT) while 87/344 (25%) were co-infected with multiple pathogens. Prevalence of TV, NG & CT was 4%, 7% and 8% respectively. Co-infection with CT + NG was highest, 51% (44/87), whereas, co-infection with CT + TV was 21% and NG + TV was 18% while co-infection with all three pathogens was 1.3%. We conclude that SCM is imprecise and successful intervention requires accurate and confirmatory diagnostic approach.
Collapse
Affiliation(s)
- Subash Chandra Sonkar
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Kirti Wasnik
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Anita Kumar
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Vineeta Sharma
- National Institute of Cancer Prevention and Research, Formerly Institute of Cytology and Preventive Oncology (Indian Council of Medical Research), Noida, Uttar Pradesh, India
| | - Pratima Mittal
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Prashant Kumar Mishra
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Mausumi Bharadwaj
- National Institute of Cancer Prevention and Research, Formerly Institute of Cytology and Preventive Oncology (Indian Council of Medical Research), Noida, Uttar Pradesh, India
| | - Daman Saluja
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India.
| |
Collapse
|
26
|
Matheson A, Mazza D. Recurrent vulvovaginal candidiasis: A review of guideline recommendations. Aust N Z J Obstet Gynaecol 2017; 57:139-145. [DOI: 10.1111/ajo.12592] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 12/09/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Alexia Matheson
- Department of General Practice; School of Primary Healthcare; Monash University; Notting Hil Victoria Australia
| | - Danielle Mazza
- Department of General Practice; School of Primary Health Care; Monash University; Notting Hill Victoria Australia
| |
Collapse
|
27
|
Otero-Guerra L, Fernández-Blázquez A, Vazquez F. Rapid diagnosis of sexually transmitted infections. Enferm Infecc Microbiol Clin 2017; 35:444-450. [PMID: 28238505 DOI: 10.1016/j.eimc.2017.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
Sexually transmitted infections (STIs) are responsible for an enormous burden of morbidity and mortality. Worldwide, millions of cases of STIs, such as syphilis, chlamydia, or gonorrhoea occur every year, and there is now an increase in antimicrobial resistance in pathogens, such as gonococcus. Delay in diagnosis is one of the factors that justifies the difficulty in controlling these infections. Rapid diagnostic tests allow the introduction of aetiological treatment at the first visit, and also leads to treating symptomatic and asymptomatic patients more effectively, as well as to interrupt the epidemiological transmission chain without delay. The World Health Organisation includes these tests in its global strategy against STIs.
Collapse
Affiliation(s)
| | | | - Fernando Vazquez
- Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, España; Departamento de Biología Funcional, Área de Microbiología, Facultad de Medicina, Oviedo, España; Fundación de Investigación Oftalmológica, Instituto Oftalmológico Fernández-Vega, Oviedo, España.
| |
Collapse
|
28
|
Parsapure R, Rahimiforushani A, Majlessi F, Montazeri A, Sadeghi R, Garmarudi G. Impact of Health-Promoting Educational Intervention on Lifestyle (Nutrition Behaviors, Physical Activity and Mental Health) Related to Vaginal Health Among Reproductive-Aged Women With Vaginitis. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017; 18:e37698. [PMID: 28184325 PMCID: PMC5292014 DOI: 10.5812/ircmj.37698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/19/2016] [Accepted: 07/25/2016] [Indexed: 12/30/2022]
Abstract
Background Vaginitis is one of the most common diseases in reproductive-aged women (15 - 49 years of age). Side effects of vaginitis can affect other aspects of health, which could be prevented by promoting a healthy lifestyle related to vaginal health. Objectives This study aimed at determining the impact of health-promoting educational intervention on lifestyle (nutrition behaviors, physical activities, and mental health) related to vaginal health among reproductive-aged women with vaginitis. Methods The data set was collected as part of an experimental study conducted on 350 reproductive-aged women with vaginitis. Participants were selected through a stratified two-stage clustered sampling and simple randomization from 10 attending health centers affiliated with Kermanshah University of Medical Sciences in five regions (North, South, East, West, and Center) of Kermanshah (a city in western Iran) in 2015. Two clinics in each region were selected; patients from the first center were chosen as the intervention group and patients from the second center made up the control group. To collect data, a questionnaire including socio-demographic and lifestyle questions was used. The questionnaire was designed and validated via the psychometric process. Educational intervention was performed over twenty sessions of 25 to 35 minutes. The intervention group was followed up with face-to-face education, a pamphlet, phone contact, and by social media. The control group continued the routine treatment without contacting the intervention group. Data were collected from both groups before the intervention and six months after the intervention. Data were analyzed using the SPSS-20 package, using the independent t-test, paired t-test, chi-square test, and analysis of covariance (ANCOVA) test. The confidence interval was 95% and P < 0.05 was considered statistically significant. Results ANCOVA showed that after adjusting for effects of pretest scores, the difference between mean scores on the scale of lifestyle related to vaginal health in the intervention group (28.48 ± 0.38) and control group (23.65 ± 1.23) was significant (P < 0.001). Intervention has a positive significant effect on increasing the mean scores of lifestyle in the intervention group (P < 0.001). Comparing mean differences between the two groups indicated significant difference between them (P < 0.001). Results of the paired t-test in the control group did not show significant changes in lifestyle scores after 6 months (P > 0.05). The independent t-test did not show significant statistical differences between the two groups in terms of demographic characteristics (P > 0.05). Conclusions According to the findings, educational intervention is beneficial in promoting three aspects of women's lifestyle related to vaginal health. Therefore, a health-promoting lifestyle seems essential for having a healthy vagina and for preventing vaginitis.
Collapse
Affiliation(s)
- Roxana Parsapure
- Health Promotion and Education Department, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Abbas Rahimiforushani
- Biostatistics’ and Epidemiology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Abbas Rahimiforushani, Biostatistics’ and Epidemiology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2142933037; +98-9123906599, Fax: +98-2188989127, E-mail:
| | - Fereshteh Majlessi
- Health Promotion and Health Education Department, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Center, Institut for Health Sciences Research, ACECR, Tehran, IR Iran
| | - Roya Sadeghi
- Health Promotion and Education Department, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Gholamreza Garmarudi
- Health Promotion and Education Department, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
29
|
Kalia N, Singh J, Sharma S, Arora H, Kaur M. Genetic and Phenotypic Screening of Mannose-Binding Lectin in Relation to Risk of Recurrent Vulvovaginal Infections in Women of North India: A Prospective Cohort Study. Front Microbiol 2017; 8:75. [PMID: 28197138 PMCID: PMC5281598 DOI: 10.3389/fmicb.2017.00075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/11/2017] [Indexed: 12/25/2022] Open
Abstract
Recurrent Vulvovaginal Infections (RVVI) is common problem associated with women of reproductive age. The function and deleterious effect of Mannose Binding Lectin 2 (MBL2) common polymorphisms are reported to be associated with various diseases. However, the role of MBL2 promoter gene polymorphisms and their combined effect with structural variant along with Serum Mannose Binding Lectin (sMBL) levels in RVVI has not been investigated. The study included 258 RVVI cases and 203 age matched healthy controls. These were investigated for the distribution of MBL2 codon 54 and promoter polymorphisms by Amplification Refractory Mutation System-Polymerase Chain Reaction (ARMS-PCR). sMBL levels were quantified by Enzyme Linked Immnosorbent Assay (ELISA). The frequency of X allele and its genotypes was significantly high in cases than controls conferring risk toward RVVI and its types (p < 0.05). The HXPA (OR; 2.0), LXQB (OR; 1.43) haplotypes were associated with susceptibility to RVVI cases while haplotype LYQB significantly protected against RVVI (OR; 0.58), Bacterial Vaginosis (BV) (OR; 0.27) and Mixed Infections (MI) cases (OR; 0.62) with high frequency observed in controls (p < 0.05). Mean sMBL levels were significantly low in RVVI, BV, Vulvovaginal Candidiasis (VVC), and MI cases compared to controls (p < 0.05). VVC patient showed significantly low sMBL levels than RVVI and MI cases (p < 0.05). The mean sMBL levels segregated based on MBL2 genotypes and haplotypes showed significant difference in different cases groups with controls. The findings of the present study suggested that MBL2 Y/X polymorphism and low sMBL levels were associated with susceptibility to RVVI either it is BV, VVC, or MI. Thus MBL deficiency in women with RVVI may contribute to decreased efficiency in clearing of pathogens. Hence, specific measures like administration of purified or recombinant MBL might decrease the incidence of vaginal infections recurrences and more-effective treatment.
Collapse
Affiliation(s)
- Namarta Kalia
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University Amritsar, India
| | - Jatinder Singh
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University Amritsar, India
| | - Sujata Sharma
- Department of Gynaecology and Obstetrics, Bebe Nanki Mother and Child Care Centre, Government Medical College Amritsar, India
| | - Hardesh Arora
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University Amritsar, India
| | - Manpreet Kaur
- Department of Human Genetics, Guru Nanak Dev University Amritsar, India
| |
Collapse
|
30
|
Athanasiou S, Pitsouni E, Antonopoulou S, Zacharakis D, Salvatore S, Falagas ME, Grigoriadis T. The effect of microablative fractional CO2 laser on vaginal flora of postmenopausal women. Climacteric 2016; 19:512-8. [PMID: 27558459 DOI: 10.1080/13697137.2016.1212006] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To assess the effect of microablative fractional CO2 laser (MFCO2-Laser) therapy on the vaginal microenvironment of postmenopausal women. METHODS Three laser therapies at monthly intervals were applied in postmenopausal women with moderate to severe symptoms of genitourinary syndrome of menopause, pH of vaginal fluid >4.5 and superficial epithelial cells on vaginal smear <5%. Vaginal fluid pH values, fresh wet mount microscopy, Gram stain and aerobic and anaerobic cultures were evaluated at baseline and 1 month after each subsequent therapy. Nugent score and Hay-Ison criteria were used to evaluate vaginal flora. RESULTS Fifty-three women (mean age 57.2 ± 5.4 years) participated and completed this study. MFCO2-Laser therapy increased Lactobacillus (p < 0.001) and normal flora (p < 0.001) after the completion of the therapeutic protocol, which decreased vaginal pH from a mean of 5.5 ± 0.8 (initial value) to 4.7 ± 0.5 (p < 0.001). The prevalence of Lactobacillus changed from 30% initially to 79% after the last treatment. Clinical signs and symptoms of bacterial vaginosis, aerobic vaginitis or candidiasis did not appear in any participant. CONCLUSION MFCO2-Laser therapy is a promising treatment for improving the vaginal health of postmenopausal women by helping repopulate the vagina with normally existing Lactobacillus species and reconstituting the normal flora to premenopausal status.
Collapse
Affiliation(s)
- S Athanasiou
- a Urogynecology Unit, 1st Department of Obstetrics and Gynecology , "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - E Pitsouni
- a Urogynecology Unit, 1st Department of Obstetrics and Gynecology , "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece ;,b Alpha Institute of Biomedical Sciences (AIBS) , Athens , Greece
| | - S Antonopoulou
- c Microbiology Department , "G. Gennimatas" General Hospital , Athens , Greece
| | - D Zacharakis
- a Urogynecology Unit, 1st Department of Obstetrics and Gynecology , "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - S Salvatore
- d Obstetrics and Gynecology Unit , Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital , Milan , Italy Urogynecology Unit
| | - M E Falagas
- b Alpha Institute of Biomedical Sciences (AIBS) , Athens , Greece ;,e Department of Medicine-Infectious Diseases , IASO General Hospital , Athens , Greece ;,f Department of Medicine , Tufts University School of Medicine , Boston, MA , USA
| | - T Grigoriadis
- a Urogynecology Unit, 1st Department of Obstetrics and Gynecology , "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| |
Collapse
|
31
|
Mason MJ, Winter AJ. How to diagnose and treat aerobic and desquamative inflammatory vaginitis. Sex Transm Infect 2016; 93:8-10. [PMID: 27272705 DOI: 10.1136/sextrans-2015-052406] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/22/2016] [Accepted: 05/14/2016] [Indexed: 11/04/2022] Open
|
32
|
Sonkar SC, Wasnik K, Kumar A, Mittal P, Saluja D. Comparative analysis of syndromic and PCR-based diagnostic assay reveals misdiagnosis/ overtreatment for trichomoniasis based on subjective judgment in symptomatic patients. Infect Dis Poverty 2016; 5:42. [PMID: 27146362 PMCID: PMC4857337 DOI: 10.1186/s40249-016-0133-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/18/2016] [Indexed: 12/11/2022] Open
Abstract
Background Trichomoniasis, a sexually transmitted disease (STD), is caused by Trichomonas vaginalis in both men and women. Screening of trichomoniasis is problematic in resource challenged settings as currently available, inexpensive diagnostic methods are of low sensitivity and/or specificity. In India, National AIDS Control organization (NACO) recommended syndromic case management (SCM) for treatment. The objective of the present study was to compare the utility of the NACO-NACP III Algorithms for STI/RTI treatment used by clinicians with PCR based diagnosis. Methods Patients visiting Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi from January 2011 to June 2014 were enrolled in the study to compare the diagnostic efficiency of PCR-based assays against SCM. Based on SCM, patients (n = 820) were treated with antibiotics using pre-packed STI/RTI kits (sexually transmitted infection/reproductive tract infection; procured by National AIDS Control/State AIDS Control Society (NACO/SACS), Ministry of Health and Family Welfare, Govt of India.) under National AIDS Control Programme (NACP III) for syndromic case management (SCM). Ectocervical dry swab samples were also obtained from these patients and out of that 634 samples were tested by PCR. Total genomic DNA was extracted from these samples and used as template for PCR amplification using pfoB, gyrA and orf1 gene specific primers for diagnosis of T. vaginalis (TV), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) respectively. Results Out of 6000 patients who visited OPD, 820 (14 %) female patients reported vaginal discharge and were recommended antibiotic treatment for one or more pathogens namely, TV, CT, NG and Candida or for co-infection. On the basis of signs & symptoms and NACO guidelines, the following distribution of various infections was observed: TV (46 %), CT (20 %), coinfection with TV and CT (12 %), coinfection with CT and NG (11 %), coinfection with TV, CT and Candida (7 %) and coinfection with TV and NG (2 %). Others were infected with NG alone (1 %), coinfected with TV and Candida (0.4 %) and 0.3 % were coinfected with CT, NG and Candida. Based on PCR method, 110 (17 %) women tested positive for one or more of these three pathogens while 524 (83 %) women were negative for any of these three pathogens but could be positive for other STIs not tested in this study. Since all the patients (634) were given antibiotics, we estimate that the over-treatment was 85 % while 524 (83 %) patients were also misdiagnosed by SCM. Conclusions The over-treatment and inaccurate diagnosis of pathogens due to subjective judgment based on syndromic approach in symptomatic women is a large economic wastage and may also contribute towards increased resistance. The misdiagnosed patients will also serve as a reservoir for transmission of pathogens to their sexual partner. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0133-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Subash Chandra Sonkar
- Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, 110007, India
| | - Kirti Wasnik
- Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, 110007, India
| | - Anita Kumar
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Pratima Mittal
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Daman Saluja
- Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, 110007, India.
| |
Collapse
|
33
|
Abstract
INTRODUCTION Bacterial vaginosis (BV) is a common clinical condition that affects millions of women annually. Serious sequelae exist from untreated infection. Recurrent BV (RBV) is also common with few approved clinical treatment modalities. Review of the current recommendations yields practical tips to aid busy professionals. AIM To review the current treatment recommendations for recurrent bacterial vaginosis. METHODS A literature review was conducted using the keywords: bacterial vaginosis, recurrent bacterial vaginosis, vaginal probiotics, vaginal reacidifiers, and trichomoniasis. MAIN OUTCOME MEASURE Patients with RBV should be treated with the approved suppressive antimicrobial regimen, but new modalities and adjuncts are currently under review and appear safe; however, rates of efficacy still need to be established. RESULTS There is no defined etiology of RBV, and thus, a curative treatment remains elusive. Sexual practices, hygiene practices, and the type of sexual partner all affect the rate of BV recurrence. Vaginal reacidifiers and probiotics may offer effective alternatives to the current antimicrobial regimens. Clinicians should obtain an in-depth history to have an accurate picture of the patient's pattern of infection, ensure they are using all clinical tools available to make the correct diagnosis, and educate the patient regarding simple behavioral changes they can make to prevent RBV. CONCLUSION More research is needed to explain and treat RBV. In the meantime, if clinicians maximize all current modalities, they will reduce the recurrence rate in certain patients. Marshall AO. Managing recurrent bacterial vaginosis: Insights for busy providers. Sex Med Rev 2015;3:88-92.
Collapse
Affiliation(s)
- Alison O Marshall
- School of Nursing and Health Sciences, Simmons College, Boston, MA, USA.
| |
Collapse
|
34
|
Durugbo II, Nyengidiki TK, Bassey G, Wariso KT. Bacterial vaginosis among women with tubal factor infertility in Nigeria. Int J Gynaecol Obstet 2015; 131:133-6. [PMID: 26341172 DOI: 10.1016/j.ijgo.2015.05.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/26/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the prevalence of bacterial vaginosis among women with tubal factor infertility. METHODS A cross-sectional prospective study of women with tubal factor infertility was conducted at a Nigerian teaching hospital between March and September 2014. An equal number of fertile women attending the family planning clinic were recruited as controls. Interviews were conducted to collect data on sociodemographic characteristics, history and characteristics of vaginal discharge, knowledge, and practices. Bacterial vaginosis was diagnosed using the Amsel criteria. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine predisposing factors. RESULTS Overall, 178 women with tubal factor infertility were recruited. Bacterial vaginosis was noted in 50 (28.1%) of these women, compared with 14 (7.9%) of 178 fertile women (P < 0.001). Patients with tubal factor infertility had an increased risk of bacterial vaginosis when they were of low socioeconomic class (OR 11.89; 95% CI 5.20-27.69), practiced vaginal douching (OR 19.15; 95% CI 7.26-47.75), used vaginal drying agents (OR 17.04; 95% CI 6.91-43.24), had an early sexual debut (OR 32.08; 95% CI 12.02-88.89), and had a history of sexually transmitted infections (OR 12.42; 95% CI 5.36-29.35). CONCLUSION The prevalence of bacterial vaginosis was high among patients with tubal factor infertility. Socioeconomic and cultural factors contribute to the risk of the condition.
Collapse
Affiliation(s)
- Innocent I Durugbo
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Tamunomie K Nyengidiki
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
| | - Goddy Bassey
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Kennedy T Wariso
- Department of Microbiology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| |
Collapse
|
35
|
Francis SC, Looker C, Vandepitte J, Bukenya J, Mayanja Y, Nakubulwa S, Hughes P, Hayes RJ, Weiss HA, Grosskurth H. Bacterial vaginosis among women at high risk for HIV in Uganda: high rate of recurrent diagnosis despite treatment. Sex Transm Infect 2015; 92:142-8. [PMID: 26253744 PMCID: PMC4783330 DOI: 10.1136/sextrans-2015-052160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/12/2015] [Indexed: 01/24/2023] Open
Abstract
Objectives Bacterial vaginosis (BV) is associated with increased risk for sexually transmitted infections (STIs) and HIV acquisition. This study describes the epidemiology of BV in a cohort of women at high risk for STI/HIV in Uganda over 2 years of follow-up between 2008–2011. Methods 1027 sex workers or bar workers were enrolled and asked to attend 3-monthly follow-up visits. Factors associated with prevalent BV were analysed using multivariate random-effects logistic regression. The effect of treatment on subsequent episodes of BV was evaluated with survival analysis. Results Prevalences of BV and HIV at enrolment were 56% (573/1027) and 37% (382/1027), respectively. Overall, 905 (88%) women tested positive for BV at least once in the study, over a median of four visits. Younger age, a higher number of previous sexual partners and current alcohol use were independently associated with prevalent BV. BV was associated with STIs, including HIV. Hormonal contraception and condom use were protective against BV. Among 853 treated BV cases, 72% tested positive again within 3 months. There was no difference in time to subsequent BV diagnosis between treated and untreated women. Conclusions BV was highly prevalent and persistent in this cohort despite treatment. More effective treatment strategies are urgently needed.
Collapse
Affiliation(s)
- Suzanna C Francis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Looker
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Yunia Mayanja
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | | | - Peter Hughes
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Richard J Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Heiner Grosskurth
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| |
Collapse
|
36
|
Rakhmatuuna MR, Gushchin AYE, Tsoi YEG. Vaginal candidal infection: clinical features of diagnostics methods. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-2-122-129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Goal. To study clinical features of the vaginal candidal infection and carry out a comparative analysis of the microscopy, cultural and real-time PCR methods for identifying Candida fungi. Materials and methods. The study involved 107 female subjects: Group 1: 56 women with Candida fungi found in their vaginal secrets by laboratory tests; Group 2: 51 women with absent clinical and laboratory signs of the urogenital infection. The laboratory test methods were as follows: microscopy, cultural and biomolecular (real-time PCR (RT PCR) - Florocenosis-Candida). Key findings. Pathologic vaginal secretion (76.8%) and hyperemia of vaginal and vulvar mucous tunic (41.1%) belong to the key clinical manifestations of the vaginal candidal infection. Caseous vaginal discharge was revealed in 33.9% of patients from Group 1, homogenous creamy discharge - in 42.9%, and homogenous mucous non-transparent vaginal discharge - in 23.2% of patients from Group 1. The patients had the following etiologic agents: C. albicans (94.6%), C. glabrata, (3.6%) and C. krusei (1.8%). Candida spp. identification results using the cultural and microscopy methods coincided in 78.6% of all cases, RT PCR and microscopy - in 66.1%, and RT PCR and cultural methods - in 87.5% of all cases. There were no reliable differences in the quantitative results for Candida fungi by the cultural and RT PCR methods: below 102 CFU/mL and below 102 GE/mL - 12.2 and 8.9%, respectively, 103-104 CFU/mL and 103-104 GE/mL - 44.9% and 33.9%, over 104 CFU/mL and over 104 GE/mL - 42.9 and 57.2%, respectively(p > 0.05). Conclusion. Candidal colonization of the vaginal mucous tunic was accompanied by specific clinical manifestations of urogenital candidosis in 76.8% of all cases; C. albicans was revealed in most of the subjects (94.6%). The real-time PCR method used for Candida spp. identification and quantitative determination demonstrated higher sensitivity and specificity vs. microscopy as well as sensitivity and specificity being comparable to the cultural diagnostics method.
Collapse
|
37
|
|
38
|
Choukri F, Benderdouche M, Sednaoui P. In vitro susceptibility profile of 200 recent clinical isolates of Candida spp. to topical antifungal treatments of vulvovaginal candidiasis, the imidazoles and nystatin agents. J Mycol Med 2014; 24:303-7. [PMID: 25442913 DOI: 10.1016/j.mycmed.2014.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 04/27/2014] [Accepted: 05/12/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Topical antifungal treatment of vulvovaginal candidiasis is widely recommended. The most commonly recommended topical antifungals (the imidazoles clotrimazole, miconazole and econazole and the polyene nystatin) have been on the market for more than 30 years. There are only a few recent data available on the susceptibility of different Candida species to these antifungals, especially of non-albicans Candida species which appear to be less responsive to treatment with imidazoles. The study aimed to determine the in vitro susceptibility profile of a large number of recent clinical isolates of Candida spp. to the most commonly recommended topical antifungals. MATERIALS AND METHODS An antifungal susceptibility test was performed according to the CLSI M27-A3 broth microdilution method, and minimal inhibitory concentrations were determined for econazole, miconazole, clotrimazole and nystatin. RESULTS The clinical isolates comprised of: 113 Candida albicans, 54 Candida glabrata, 11 Candida krusei, 11 Candida tropicalis and 11 Candida parapsilosis. The three azoles agents exhibited MIC90 values of 0.06 mg/L against C. albicans isolates, while nystatin exhibited a MIC90 of 4 mg/L. For non-albicans Candida isolates, MIC90 values ranged from 0.5 to 8 mg/L, from 1 to 4 mg/L and from 0.12 to 4 mg/L, for econazole, miconazole, clotrimazole, respectively. Nystatin MIC90 remained at 4 mg/L for all non-albicans Candida species tested. CONCLUSION These results confirmed the susceptibility of C. albicans to the most frequently used topical agents and may support the use of alternative agents to imidazoles, such as nystatin, to treat vulvovaginal candidiasis caused by non-albicans Candida species.
Collapse
Affiliation(s)
- F Choukri
- Laboratoire de microbiologie, institut Alfred-Fournier, 25, boulevard Saint-Jacques, 75014 Paris, France.
| | - M Benderdouche
- Laboratoire de microbiologie, institut Alfred-Fournier, 25, boulevard Saint-Jacques, 75014 Paris, France
| | - P Sednaoui
- Laboratoire de microbiologie, institut Alfred-Fournier, 25, boulevard Saint-Jacques, 75014 Paris, France
| |
Collapse
|
39
|
Determinants of symptomatic vulvovaginal candidiasis among human immunodeficiency virus type 1 infected women in rural KwaZulu-Natal, South Africa. Infect Dis Obstet Gynecol 2014; 2014:387070. [PMID: 24812479 PMCID: PMC4000633 DOI: 10.1155/2014/387070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 11/11/2013] [Accepted: 12/17/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction. We sought to determine the association between HIV-induced immunosuppression, virologic correlates, and vulvovaginal candidiasis (VVC). Methods. This is a retrospective cohort study, where HIV infected and uninfected women were studied with VVC being the primary outcome. Ninety-seven HIV-infected and 101 HIV-uninfected women were enrolled between June and December 2011. Cases of VVC were confirmed. HIV RNA load was determined by RT-PCR and CD4 counts were obtained from medical records. Results. Fifty-two of 97 (53.6%) HIV-infected and 38/101 (37.6%) HIV-uninfected women were diagnosed with VVC (P = 0.032). The relative risk for VVC amongst HIV-infected patients was 1.53 (95% CI: 1.04–2 P = 0.024). Cases of VVC increased at CD4+ T cell count below 200 cells/mm3 (P < 0.0001) and plasma HIV RNA load above 10 000 copies/mL (P < 0.0001). VVC was associated with increased genital shedding of HIV (P = 0.002), and there was a linear correlation between plasma HIV load and genital HIV shedding (r = 0.540; R2 = 0.292; P < 0.0001). Women on HAART were 4-fold less likely (P = 0.029) to develop VVC. Conclusion. CD4 counts below 200 cells/mm3 and plasma HIV loads ≥10 000 copies/mL were significantly associated with VVC.
Collapse
|