Prevalence of bacterial vaginosis in Portuguese pregnant women and vaginal colonization by Gardnerella vaginalis

Prevalence of bacterial vaginosis and its associated factors among pregnant women attending antenatal care clinics at public hospitals in West Shoa Zone, Oromia, Ethiopia

Bacterial vaginosis is a polymicrobial syndrome characterized by the decrease of Lactobacilli and an overgrowth of facultative and anaerobic bacteria in vaginal fluid. Though it has received little attention, it has been associated with poor pregnancy outcomes, such as pre-term labor and delivery, premature rupture of membranes, low birth weight, spontaneous abortion, and postpartum infections. This study aimed to determine the prevalence of bacterial vaginosis and its associated factors among pregnant women attending antenatal care clinics from September 15 to December 14, 2021, at public hospitals in West Shoa Zone, Oromia, Ethiopia. An institutional-based cross-sectional study was conducted on 260 pregnant women, and systematic random sampling was employed to recruit the study participants. Data were collected through a structured questionnaire and the vaginal swab was collected using a sterile cotton swab. The gram staining result was interpreted using the Nugent scoring system. Data was entered into an Excel spreadsheet and exported to STATA-14 for analysis. Data were presented using tables and graphs. Binary and multivariable logistic regressions were performed. Variables with a P value ≤ 0.25 at the binary logistic regression were entered into the multivariable logistic regression. Finally, variables with a P value ≤ 0.05 were considered predictors of bacterial vaginosis and interpreted using adjusted Odds Ratios (AOR) with a 95% confidence interval (CI). A total of 260 pregnant women attending antenatal care were included in the study. The prevalence of bacterial vaginosis according to the Nugent scoring system was 22.3% (95% CI 17.4 to 27.9%). Pregnant women with other marital status were at reduced risk of bacterial vaginosis as compared with married pregnant women (AOR = 0.260, 95% CI 0.068 to 0.9995; P = 0.05). Rural residence (AOR = 2.1, 95% CI 1.05 to 4.24; P = 0.036), use of one pant per week (AOR = 2.7, 95% CI 1.04 to 7.2; P = 0.041), and use of two or more pants per week (AOR = 4.96, 95% CI 1.49 to 16.57; P = 0.009) were significantly associated with bacterial vaginosis. In the current study, a high magnitude of bacterial vaginosis was reported. Residence, marital status, and number of pants used per week were found significantly associated among pregnant women. Hence, screening for the disease should be integrated into the recommended basic laboratory investigations during antenatal visits.

Oral microbiota imbalance: A predisposing factor for Henoch-Schönlein Purpura in children

Oral microecological dysregulation has been shown to be associated with various immune system disorders. Henoch-schonlein purpura (HSP) is an autoimmune small vessel inflammatory disease in children of uncertain etiology, and studies have suggested that streptococcal infection may be an influential factor in its development. However, the relationship between oral microecological dysregulation and HSP has not been clearly studied so far. In this study, an epidemiological survey on the oral health status of children with HSP was investigated in this paper, and collected dental plaque from four groups of children for 16SrDNA high-throughput sequencing to analyze the composition and changes of oral microbial diversity among different groups. The results showed that the oral health status of children with HSP was poor, except for the incidence of caries in the 5-year-old group, the caries rate and dmfs/DMFS in the 3,4 and 5-year-old groups were higher than the same age in the fourth Chinese Oral Health Epidemiological Survey. Moreover, the development of HSP is accompanied by disturbances in the oral microbiota; a decrease in the number of Firmicutes which producing butyric acid may be closely associated with the development of HSP; changes in the abundance of Streptococcus and Neisseria may be a risk factor for the development of HSP.

Miniaturized Polymeric Systems for the Intravaginal Gene Therapies: Recent Update on Unconventional Delivery

The prevalence of vaginal infection is increasing among women, especially at reproductive age. For proper eradication of infection, the effective concentration of a drug is required at the infection site. Therefore, local delivery is recommended to exert a direct therapeutic effect at the site action that causes a reduction in dose and side effects. The main focus of vaginal drug delivery is to enhance retention time and patient compliance. The high recurrence rate of vaginal infection due to the lack of effective treatment strategies opens the door for new therapeutic approaches. To combat these setbacks, intravaginal gene therapies have been investigated. High attention has been gained by vaginal gene therapy, especially for sexually transmitted infection treatment. Despite much research, no product is available in the market, although in vitro and preclinical data support the vaginal route as an effective route for gene administration. The main focus of this review is to discuss the recent advancement in miniaturized polymeric systems for intravaginal gene therapies to treat local infections. An overview of different barriers to vaginal delivery and challenges of vaginal infection treatment are also summarised.

Bacterial Vaginosis and Associated Factors Among Pregnant Women Attending Antenatal Care in Harar City, Eastern Ethiopia

Background

Bacterial vaginosis is one of the most common causes of abnormal vaginal discharge in women of reproductive age, especially pregnant women. It is characterized by the decrement of lactobacilli and increasing proliferation of diverse anaerobic bacteria. The prevalence of bacterial vaginosis and contributing factors vary between countries, within the same country, and among different populations.

Objective

The purpose of this study was to determine the prevalence of bacterial vaginosis and associated factors among pregnant women attending antenatal care from May 5-July 15, 2021 in health-care facilities found in Harar town, eastern Ethiopia.

Methods and Materials

An institutional-based cross-sectional study was conducted among 248 pregnant women attending antenatal care through systematic random sampling. Data were collected using a structured questionnaire and two vaginal swabs were collected using sterile swabs and transported to the microbiology laboratory. Samples were analyzed using Amsel's criteria or using Nugent scoring criteria and culture. Data were entered into EpiData version 3.1 and transferred to SPSS version 25 for analysis. Binary logistic regression was used to identify variables associated with bacterial vaginosis. P-value <0.05 was considered statistically significant.

Results

Altogether 248 pregnant women were included in the study. Overall, 21.4% (95% CI: 16, 27) of study participants had bacterial vaginosis. History of sexually transmitted infection (AOR = 6.0, 95% CI: 1.94, 19.07; P = 0.002), history of spontaneous abortion (AOR = 5.8, 95% CI: 1.55, 22.02; P = 0.009), multiple sex partners (AOR = 8.6, 95% CI: 2.93, 25.79; P = 0.000) and having vaginal discharge (AOR = 5.5, 95% CI: 2.48, 12.41; P = 0.000) were significantly associated with bacterial vaginosis.

Conclusion

The prevalence of bacterial vaginosis is higher among symptomatic pregnant women and associated with a history of sexually transmitted infection, vaginal discharge, multiple sexual partners and spontaneous abortion.

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

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

Predictors of Bacterial Vaginosis among Pregnant Women Attending Antenatal Clinic at Tertiary Care Hospital in Tanzania: A Cross Sectional Study

Background:

Bacterial vaginosis (BV) is one of the most common genital tract infections in pregnancy associated with an increased risk of pregnancy losses, maternal and perinatal morbidity and mortality. Different social behavioural and obstetric factors can contribute to the development of BV. Determining the predictors of BV could be the best way of identifying women at high risk of developing the disease.

Methods:

This was a cross-sectional study conducted between December 2017 and February 2018 to determine the prevalence and predictors of BV among pregnant women attending antenatal Clinic (ANC) at Muhimbili National Hospital (MNH), Tanzania. Participants were recruited using systematic random sampling. For each consented participant, a pretested questionnaire was filled, a pelvic examination was done and a sample was collected. BV was diagnosed using Nugent's score. Data was analysed using Statistical Package for Social Scientists (SPSS) version 23.0. Bivariate and multivariate logistic regression analysis was done to determine factors that were independently associated with BV.

Results:

178 (26.7%) pregnant women out of 667 were diagnosed positive for BV. In the bivariate analysis (Table 3), age (COR 1.71; 95% CI, 1.16–2.52), level of education (COR 4.08, 95% CI, 2.84–5.84), gravidity (COR, 1.52, 95% CI; 1.04–2.23), parity (COR 1.69, 95% CI; 1.18–2.42), vaginal douching (COR 2.89, 95% CI; 1.96–4.27), HIV status (COR 9.37, 95%CI; 4.12–21.28), history of STI (COR 2.49 95% CI; 1.46–4.25), LTSP (COR 2.76, 95% CI; 1.68–4.54) and age of first coitus (COR 3.19, 95% CI; 2.24–4.56) were significantly associated with BV. After adjusting for confounders in multivariate analysis, the following risk factors remained significantly associated with BV; age of 21–29 years (AOR, 2.22, 95%CI; 1.45–3.49), primary education level (AOR 3.97, 95% CI; 2.63–5.98), vaginal douching (AOR 3.68, 95% CI; 2.35–5.76), HIV status (AOR 6.44, 95% CI; 2.62–15.88), STI infection (AOR 2.34, 95% CI; 1.25–4.37), more than one LTSP (AOR 2.69, 95% CI; 1.53–4.74) and age of less than 18 years of first coitus (AOR 2.16, 95% CI; 1.42–3.30).

Conclusion:

The prevalence of BV in pregnant women was found to be high. Age of less than 30 years, primary education level and below, vaginal douching, HIV infection, STI, more than one lifetime sexual partners and early age of sexual debut were found to be significant predictors of BV. The high prevalence of BV in our population should necessitate policy makers to include screening and treatment of BV in the future policy of antenatal care package, as BV is associated with significant maternal and neonatal morbidity and mortality. Women should also be educated on harmful effects of certain behavioural practices such as vaginal douching that predispose to BV. In addition symptoms of BV such as abnormal vaginal discharge during pregnancy are inconsistent, under reported and often overlooked. Therefore, a high-risk approach can be used for screening and treatment of asymptomatic women.

Cervical Gardnerella vaginalis in women with preterm prelabor rupture of membranes

Objective

To determine the association between microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI) and the cervical prevalence of Gardnerella vaginalis DNA in pregnancies with preterm prelabor rupture of membrane (PPROM).

Method

In total, 405 women with singleton pregnancies complicated with PPROM were included. Cervical fluid and amniotic fluid samples were collected at the time of admission. Bacterial and G. vaginalis DNA were assessed in the cervical fluid samples using quantitative PCR technique. Concentrations of interleukin-6 and MIAC were evaluated in the amniotic fluid samples. Loads of G. vaginalis DNA ≥ 1% of the total cervical bacterial DNA were used to define the cervical prevalence of G. vaginalis as abundant. Based on the MIAC and IAI, women were categorized into four groups: with intra-amniotic infection (both MIAC and IAI), with sterile IAI (IAI without MIAC), with MIAC without IAI, and without either MIAC or IAI.

Results

The presence of the abundant cervical G. vaginalis was related to MIAC (with: 65% vs. without: 44%; p = 0.0004) but not IAI (with: 52% vs. without: 48%; p = 0.70). Women with MIAC without IAI had the highest load of the cervical G. vaginalis DNA (median 2.0 × 10⁴ copies DNA/mL) and the highest presence of abundant cervical G. vaginalis (73%).

Conclusions

In women with PPROM, the presence of cervical G. vaginalis was associated with MIAC, mainly without the concurrent presence of IAI.

Vaginal microbiota evaluation and prevalence of key pathogens in ecuadorian women: an epidemiologic analysis

Vaginal infection is a gynecological problem in women of reproductive age with multiple health outcomes. The most common forms of infection include bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and aerobic vaginitis (AV). Our main goals were to evaluate different types of vaginal infections in Ecuadorian women in a large urban area (Quito) and to characterize the vaginal microbiota colonization by opportunistic species. We collected vaginal swabs and epidemiological surveys from 414 women from June 2016 to July of 2017. We analyzed vaginal samples for the presence of any vaginal infection. The microbiological examination was done through Gram-stain, wet mount smears, and polymerase chain reaction (PCR) assays using primers for target genes, such as 16S rRNA (Atopobium vaginae, Mobiluncus mulieris, and Gardnerella species), ddl (Enterococcus faecalis), adk (Escherichia coli) and KER1 (Candida albicans) genes. Most women showed a healthy vaginal microbiota (66.7%). Nearly one-tenth (10.4%) of the participants had intermediate microbiota, and the remaining women (22.9%) had a single vaginal infection (BV, AV, or VC) or coinfections. From the 95 participants that had an infection, AV was the main diagnosed vaginal infection (51.6%), followed by BV (24.2%) and finally VC (7.4%). The remaining women (16.8%) showed coinfections, being BV and AV the most common coinfection. Using univariable logistic regression analyses we found an increased odds of healthy microbiota in women with a sexual partner (P = 0.02, OR = 1.64). Also, women in a free union relationship (P = 0.000, OR = 16.65) had an increased odds of having coinfections. On the other hand, the use of birth control (condom OR = 0.388 or other contraceptive method OR = 0.363) was associated with significantly lower odds of intermediate microbiota (P ≤ 0.05). We found no statistically significant differences between women with infection and a particular group age. Using multivariate logistic regression analyses we initially found an increased odds of having BV in women with M. mulieris (P = 0.020, OR = 4.98) and Gardnerella species (P = 0.010, OR = 4.16). Women with E. coli showed an increased odds of having AV (P = 0.009, OR = 2.81). The presence of C. albicans in women showed an increased odds of having VC (P = 0.007, OR = 17.94). Finally, women with M. mulieris showed a reverse odds of having healthy microbiota (P = 0.008, OR = 0.06). We found no statistically significant differences between women with symptomatic and asymptomatic infections or the presence of Enterococcus faecalis. We found using logistic regression analyses that M. mulieris was the most prevalent opportunistic pathogen among women with vaginal infection. Further studies should evaluate the possibility to use M. mulieris as a potential key predictor for vaginal infections.

Bacterial Vaginosis in Pregnant Women at Maternal and Child Hospital, West Java, Indonesia, 2018: High Prevalence in Asymptomatic Females

Bacterial vaginosis (BV) is a lower genital tract infection of reproductive women which can occur in pregnant and non-pregnant women. BV in pregnant women can increase the risk of complications, including increased incidence of abortion, premature rupture of membranes, preterm birth, and babies with low birth weight. BV can also increase the risk of acquired sexually transmitted infection (STI) and their further transmission, including human immuno-deficiency virus (HIV). Each country has a different prevalence of BV. The previous report of BV prevalence in pregnant women was submitted in Jakarta, Indonesia in 1990. Until now, there is no update data of BV in pregnant women, especially in West Java, Indonesia. Thus, we conducted a descriptive observational study using a cross-sectional design and a consecutive sampling method in June 2018. This study included 60 pregnant women in the Maternal and Child Hospital, Bandung, Indonesia. Out of 60 participants, seven (11.67%) participants had BV according to Amsel criteria. Asymptomatic BV was diagnosed in all participants. This study shows the prevalence of BV in pregnant women in the Maternal and Child Hospital in Bandung during June 2018. The assessment of screening BV should be recommended as a routine workup. To avoid complications in pregnant women and infants it should not be waited for the symptoms to reveal.

Prevalence of bacterial vaginosis and associated risk factors in pregnant women receiving antenatal care at the Kumba Health District (KHD), Cameroon

Background

Bacterial vaginosis (BV) is a common reproductive tract disorder in women of child bearing age, accounting for one third of vaginal infections. It is characterized by an increase in vaginal pH, decreased Lactobacilli, and overgrowth of facultative and anaerobic bacteria. Studies have consistently shown BV to be a risk factor for adverse obstetric and gynecological outcomes. BV is believed to play a critical role in the transmission of sexually transmitted infections. Its aetiology and risk factors are poorly understood. This study determined the prevalence and risk factors for BV among pregnant women in Kumba Health District (KHD) Cameroon to generate findings that could guide the design of interventions for prevention of infection and associated poor pregnancy outcomes.

Methods

A structured questionnaire was administered to 309 women seeking antenatal care (ANC) in three health facilities in KHD between May to July 2016, to capture data on demographic, gynecological and obstetric characteristics, and hygiene behavior. High vaginal swabs (HVS) collected from these women were gram stained, examined under a microscope and BV evaluated by Nugent scoring. Chi square (χ²) test was used to determine the relationship between BV and factors investigated. Statistical significance was set at p < 0.05.

Results

The prevalence of BV was 26.2%. Nine point 1 % of participants had a mixed infection with Candida. BV was higher (29.5%) in participants from the rural area (χ² = 8.609. P = 0.014), those who did not use antibiotics (31.9%) prior to the study (χ² = 12.893, P = 0.002) and women with no history of a genital tract infection (χ² = 18.154, P = 0.001). There was a significant difference in prevalence with respect to gestation age (χ² = 13.959, P = 0.007) with the highest occurring in women in the second trimester (31.7%). Women who practiced douching (χ² = 23.935, P = 0.000) and those who did not wash pants with disinfectant (χ² = 7.253, P = 0.027) had a high prevalence.

Conclusion

BV could be a health concern among pregnant women in study area. BV prevalence was affected by some hygiene behaviors, socio-demographic and clinical factors. Screening and treatment of positive cases during antenatal visits to prevent adverse outcomes, as well as education of women on vaginal hygiene is highly recommended.

Prevalence of bacterial vaginosis in pregnancy in a tertiary health institution, south western Nigeria

Introduction

Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of child bearing age. Bacterial vaginosis has emerged as a global health issue due to the adverse outcome in pregnancy and in the puerperium. The study determined the prevalence of BV and outcome of delivery among pregnant women.

Methods

Socio-demographic data and vaginal swab samples were obtained from 362 consecutive pregnant women with abnormal vaginal discharge attending antenatal clinic in Ekiti State University Teaching Hospital, Ado-Ekiti. Data were analysed using SPSS statistical software 21 and association between variables was compared using Chi square.

Results

The prevalence of BV among pregnant women with abnormal vaginal discharge in this study was 16.6%. Age group 25-34yrs, multiparity and higher education were significantly associated with BV, p < 0.05. Symptoms such as vulvar itching, dyspareunia, lower abdominal pains and characteristic of vaginal discharge such as colour and consistency were significantly associated with BV, p < 0.05. Women with bacterial vaginosis significantly had prelabour rupture of fetal membrane and their babies were born prematurely with low birth weight and Apgar score of less than 5 at one minute, p < 0.05. However, there was no difference statistically in rate of admission into special care baby unit among the women, p > 0.05.

Conclusion

The findings of this study suggest that there should be screening for BV in pregnant women presenting with abnormal vaginal discharge so that they could be treated accordingly. This will mitigate the complications arising from bacterial vaginosis.

Prevalence of bacterial vaginosis in pregnant and non-pregnant Iranian women: a systematic review and meta-analysis

PURPOSE

Bacterial vaginosis (BV) is a vaginal disorder which occurs either symptomatic or asymptomatic because of an imbalance between H₂O₂-producing Lactobacillus and Gardnerella vaginalis in the vagina. This systematic review and meta-analysis is the first to determine the prevalence of BV in pregnant and non-pregnant women in Iran.

METHODS

We used national (SID, Irandoc, Iranmedex and Magiran) and international (PubMed, Scopus, Google Scholar and ISI web of knowledge) electronic databases to systematically search and collect available studies using related keywords (up to 1 December 2017). Inclusion and exclusion criteria were defined to select eligible studies.

RESULTS

The overall prevalence of BV among Iranian women was 18.9% (95% CI 14-25). Gardnerella vaginalis was the most prevalent isolated bacteria. The prevalence of BV in non-pregnant women was 28% (95% CI 15.1-45.9) which was higher compared with pregnant women who had a prevalence of 16.5% (95% CI 12.5-21.6).

CONCLUSION

The present review revealed a high prevalence of BV in non-pregnant women. Given that BV is associated with a series of reproductive complications such as infertility, taking preventive measures such as awareness of patients as well as monitoring and controlling of syndrome are essential.