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Sappenfield EC, Mellen C, Wilcox J, O'Hanlon DE, O'Sullivan DM, Tunitsky-Bitton E. The Impact of Vaginal Probiotics on Pessary Use: A Randomized Controlled Trial. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:50-58. [PMID: 37493229 DOI: 10.1097/spv.0000000000001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE Pessary-related adverse effects are common, and treatment options are limited. Probiotics may improve pessary-related adverse effects by altering the vaginal microenvironment. OBJECTIVE This study aimed to evaluate the effect of a vaginal probiotic suppository on the vaginal microenvironment among pessary users. STUDY DESIGN Women who used pessaries were randomized to vaginal probiotic suppository use versus without use. The intervention was a vaginal probiotic suppository and moisturizing vaginal gel. The vaginal microenvironment was assessed using Gram stain and Nugent's criteria at baseline and 3 months by a microbiologist blinded to group allocation. Symptoms and experience with use of the probiotic were assessed using questionnaires. The primary outcome was change in lactobacilli count on Nugent subscore at 3 months. RESULTS A total of 147 postmenopausal women were randomized (86 to the intervention arm and 61 to the control arm), and 124 (87.9%) presented for a 3-month follow-up. There was no difference between the arms in age, race, body mass index, and Charlson Comorbidity Index. A majority of participants had the pessary managed by the health care professional (intervention arm vs control arm, 46 [76.7%] vs 55 [68.8%]; P = 0.30). Composition of the vaginal microenvironment did not differ with or without probiotic treatment at 3 months. Bother from vaginal symptoms, including discharge, itching, and discomfort, did not differ between arms. Adverse effects from the intervention were minor, resolved with discontinuation, and occurred at 39.1%. CONCLUSION Vaginal probiotic suppository use did not affect the composition of the vaginal microenvironment, patient satisfaction, or vaginal symptoms after 3 months of use in pessary users.
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Affiliation(s)
- Elisabeth C Sappenfield
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
| | - Colleen Mellen
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
| | - Jennifer Wilcox
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
| | | | - David M O'Sullivan
- Department of Research Administration, Hartford HealthCare, Hartford, CT
| | - Elena Tunitsky-Bitton
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
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Camus C, Penaranda G, Khiri H, Camiade S, Molet L, Lebsir M, Plauzolles A, Chiche L, Blanc B, Quarello E, Halfon P. Acceptability and efficacy of vaginal self-sampling for genital infection and bacterial vaginosis: A cross-sectional study. PLoS One 2021; 16:e0260021. [PMID: 34793548 PMCID: PMC8601421 DOI: 10.1371/journal.pone.0260021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/30/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND & AIM Screening for genital infection (GI) such as bacterial vaginosis (BV) and yeast infection, for sexually transmitted infection (STI), and for asymptomatic carriage of group B streptococcus (GBS) in pregnant women are common reason for medical appointments. The diagnosis and control of GIs, STIs, and GBS are major issues, for fertility and overall well-being of affected women. Conventional testing is performed using vaginal/cervical classical sampling (VCS); this procedure requires pelvic examination performed by health care professionals which raises concerns among women. Vaginal-self-sampling (VSS), as an alternative to VCS, might capture more women. The aim was first to show non-inferiority of VSS compared with VCS to screen for GIs, STIs, and GBS; second to determine the feasibility of VSS. METHODS VSS and VCS from 1027 women were collected by health care professionals and simultaneously carried out on each patient. GIs, STIs, and GBS were systematically screened in both paired VSS and VCS samples. Non-inferiority of VSS compared with VCS was assessed using z statistic for binomial proportions. RESULTS Prevalence of GIs were 39.7% using VSS and 38.1% using VCS (p = 0.0016). Prevalence of STIs was 8.5% (VSS) vs 8.1% (VCS) (p = 0.0087). Prevalence of GBS was 13.4% (VSS) and 11.5% (VCS) (p = 0.0001). Most participants (84%) recommended the use of VSS. CONCLUSIONS This study shows that VSS was not inferior to VCS for the detection of GIs, STIs, and GBS. This study provides evidence that VSS can be used as a universal specimen for detection of lower genital tract infections in women. STUDY IDENTIFICATION NUMBER ID-RCB 2014-A01250-4.
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Affiliation(s)
- Claire Camus
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
- FCRIN INSERM US015, CHU de Toulouse, Hôpital PURPAN, Toulouse, France
| | - Guillaume Penaranda
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
| | - Hacène Khiri
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
| | - Sabine Camiade
- Bacteriology Department, Laboratoire Européen Alphabio - Biogroup, Marseille, France
| | - Lucie Molet
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
| | - Melissa Lebsir
- Bacteriology Department, Laboratoire Européen Alphabio - Biogroup, Marseille, France
| | - Anne Plauzolles
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
| | - Laurent Chiche
- Infectious and Internal Medicine Department, Hôpital Européen Marseille, Marseille, France
| | - Bernard Blanc
- Gynecology Department, Hôpital Européen Marseille, Marseille, France
| | - Edwin Quarello
- Prenatal Screening and Diagnostic Unit, Obstetrics and Gynecology Department, St Joseph Hospital, Marseille, France
- Image2 Center, Marseille, France
| | - Philippe Halfon
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
- Infectious and Internal Medicine Department, Hôpital Européen Marseille, Marseille, France
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The correlation between vaginal microecological dysbiosis-related diseases and preterm birth: A review. MEDICINE IN MICROECOLOGY 2021. [DOI: 10.1016/j.medmic.2021.100043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lagier JC, Diagne N, Fenollar F, Tamalet C, Sokhna C, Raoult D. Vaginal self-sampling as a diagnosis tool in low-income countries and potential applications for exploring the infectious causes of miscarriage. Future Microbiol 2017; 12:609-620. [PMID: 28604063 DOI: 10.2217/fmb-2016-0179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Gynecological health is a challenge in low-income countries. Personal opposition to perineal examination has been overcome by the use of vaginal self-sampling. Here, we review the use of this procedure notably in low-income countries and the main infectious causes of miscarriage. Vaginal self-sampling was mainly used for human papillomavirus detection but also to detect microorganisms causing sexually transmitted infections or bacterial vaginosis. 58 studies have been performed in low-resource countries, mainly studies performed to detect human papillomavirus in urban and peri-urban areas and demonstrating excellent acceptability. Several infectious causes of miscarriage could be tested using self-vaginal samples. In the future, such strategies coupled with a rapid-identification point-of-care method could allow the development of screening and treatment programs in rural areas in low-resource countries.
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Affiliation(s)
- Jean-Christophe Lagier
- Aix-Marseille Université, URMITE, IHU Méditerranée-Infection, UM63, CNRS 7278, IRD 198, Inserm U1095, Campus International UCAD-IRD, BP 1386, CP 18524, Dakar, Senegal
| | - Nafissatou Diagne
- Aix-Marseille Université, URMITE, IHU Méditerranée-Infection, UM63, CNRS 7278, IRD 198, Inserm U1095, Campus International UCAD-IRD, BP 1386, CP 18524, Dakar, Senegal
| | - Florence Fenollar
- Aix-Marseille Université URMITE, IHU Méditerranée-Infection, UM63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Catherine Tamalet
- Aix-Marseille Université URMITE, IHU Méditerranée-Infection, UM63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Cheikh Sokhna
- Aix-Marseille Université, URMITE, IHU Méditerranée-Infection, UM63, CNRS 7278, IRD 198, Inserm U1095, Campus International UCAD-IRD, BP 1386, CP 18524, Dakar, Senegal
| | - Didier Raoult
- Aix-Marseille Université URMITE, IHU Méditerranée-Infection, UM63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
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Redelinghuys MJ, Ehlers MM, Dreyer AW, Kock MM. Normal flora and bacterial vaginosis in pregnancy: an overview. Crit Rev Microbiol 2015; 42:352-63. [DOI: 10.3109/1040841x.2014.954522] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Remis RS, Liu J, Loutfy M, Tharao W, Rebbapragada A, Perusini SJ, Chieza L, Saunders M, Green-Walker L, Kaul R. The epidemiology of sexually transmitted co-infections in HIV-positive and HIV-negative African-Caribbean women in Toronto. BMC Infect Dis 2013; 13:550. [PMID: 24238493 PMCID: PMC3835625 DOI: 10.1186/1471-2334-13-550] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 11/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV disproportionately affects African-Caribbean women in Canada but the frequency and distribution of sexually transmitted infections in this community have not been previously studied. METHODS We recruited women based on HIV status through a Toronto community health centre. Participants completed a socio-behavioural questionnaire using Audio Computer Assisted Self-Interview (ACASI) and provided blood for syphilis, HIV, hepatitis B and C, herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), and human cytomegalovirus (CMV) serology, urine for chlamydia and gonorrhea molecular testing and vaginal secretions for bacterial vaginosis (BV) and human papillomavirus (HPV). Differences in prevalence were assessed for statistical significance using chi-square. RESULTS We recruited 126 HIV-positive and 291 HIV-negative women, with a median age of 40 and 31 years, respectively (p < 0.001). Active HBV infection and lifetime exposure to HBV infection were more common in HIV-positive women (4.8% vs. 0.34%, p = 0.004; and 47.6% vs. 21.2%, p < 0.0001), as was a self-reported history of HBV vaccination (66.1% vs. 44.0%, p = 0.0001). Classical STIs were rare in both groups; BV prevalence was low and did not vary by HIV status. HSV-2 infection was markedly more frequent in HIV-positive (86.3%) than HIV-negative (46.6%) women (p < 0.0001). Vaginal HPV infection was also more common in HIV-positive than in HIV-negative women (50.8% vs. 22.6%, p < 0.0001) as was infection with high-risk oncogenic HPV types (48.4% vs. 17.3%, p < 0.0001). CONCLUSIONS Classical STIs were infrequent in this clinic-based population of African-Caribbean women in Toronto. However, HSV-2 prevalence was higher than that reported in previous studies in the general Canadian population and was strongly associated with HIV infection, as was infection with hepatitis B and HPV.
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Affiliation(s)
- Robert S Remis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Effect of menses on clearance of Y-chromosome in vaginal fluid: implications for a biomarker of recent sexual activity. Sex Transm Dis 2010; 37:1-4. [PMID: 20118672 DOI: 10.1097/olq.0b013e3181b5f15d] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Self-reported sexual behaviors are subject to bias. We previously developed a polymerase chain reaction for the detection of Y-chromosome sequences in vaginal fluid as a potential biomarker of recent sexual activity. In this study, we found menses results in lower Y-chromosome concentrations but with similar decay patterns as non-menstrual samples.
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Comparison of self-collected and physician-collected vaginal swabs for microbiome analysis. J Clin Microbiol 2010; 48:1741-8. [PMID: 20200290 DOI: 10.1128/jcm.01710-09] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To our knowledge, no data are available on whether the microbial species composition and abundance sampled with self-collected vaginal swabs are comparable to those of swabs collected by clinicians. Twenty healthy women were recruited to the study during a routine gynecological visit. Eligible women were between 18 and 40 years old with regular menstrual cycles. Participants self-collected a vaginal swab using a standardized protocol and then were examined by a physician, who collected an additional five swabs from the lateral wall of the mid-vagina. In this study, the self-collected and three physician-obtained swabs were analyzed and compared using terminal restriction fragment length polymorphism and sequence analyses of the 16S rRNA genes. Vaginal microbial community comparative statistical analyses of both T-RFLP and 16S rRNA gene sequence datasets revealed that self-collected vaginal swabs sampled the same microbial diversity as physician collected swabs of the mid-vagina. These findings enable large-scale, field-based studies of the vaginal microbiome.
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Barbee L, Kobetz E, Menard J, Cook N, Blanco J, Barton B, Auguste P, McKenzie N. Assessing the acceptability of self-sampling for HPV among Haitian immigrant women: CBPR in action. Cancer Causes Control 2009; 21:421-31. [DOI: 10.1007/s10552-009-9474-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 11/10/2009] [Indexed: 12/24/2022]
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From the NIH: proceedings of a workshop on the importance of self-obtained vaginal specimens for detection of sexually transmitted infections. Sex Transm Dis 2008; 35:8-13. [PMID: 18157061 DOI: 10.1097/olq.0b013e31815d968d] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
On June 27, 2006, the NIH conducted a workshop to review published data and current field practices supporting the use of self-obtained vaginal swabs (SOVs) as specimens for diagnosis of sexually transmitted infections (STIs). The workshop also explored the design of studies that could support FDA clearance of SOVs for STI testing, particularly for specimens collected in nonclinical settings including patients' homes. This report summarizes the workshop findings and recommendations. Participants concluded that self-obtained vaginal swabs are well accepted by women of all ages and that SOVs perform as well as or better than other specimen types for Chlamydia trachomatis and Neisseria gonorrhoeae detection using transcription-mediated amplification. In addition, workshop participants recommended the validation of SOV testing by public health practitioners and manufacturers of STI diagnostic tests to expedite incorporation of SOVs as a diagnostic option in clinical and nonclinical settings for Chlamydia trachomatis and Neisseria gonorrhoeae testing. Similarly, SOVs should be explored for use in the diagnosis of other sexually transmitted pathogens.
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Trabert B, Misra DP. Risk factors for bacterial vaginosis during pregnancy among African American women. Am J Obstet Gynecol 2007; 197:477.e1-8. [PMID: 17980180 DOI: 10.1016/j.ajog.2007.03.085] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 03/14/2007] [Accepted: 03/27/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the study was to examine risk factors for bacterial vaginosis (BV) during pregnancy among African American women. STUDY DESIGN As part of a study of preterm birth, African American women residing in Baltimore, MD, were recruited from prenatal care sites. Women enrolled prenatally (between 22 and 28 weeks' gestation) were asked to provide a vaginal smear specimen for ascertainment of BV. Log-binomial analysis was utilized. RESULTS Approximately one quarter of the women were identified with BV (110 of 438). After adjusting for several confounders, vaginal douching during pregnancy remained significantly associated with an increased likelihood of BV. In addition, greater frequency of intercourse during the first trimester of pregnancy was significantly associated with an increased likelihood of BV. None of the social or psychosocial factors examined were associated with BV. CONCLUSION Douching and sexual activity were associated with an increased risk of BV in the second trimester of pregnancy.
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Affiliation(s)
- P Janet Say
- Auckland Sexual Health Service, Auckland, New Zealand.
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Abstract
PURPOSE OF REVIEW Bacterial vaginosis, a common disorder among young women, is associated with adverse reproductive health outcomes. This review summarizes our current understanding of bacterial vaginosis and where future research should be focused. Recommendations for prevention, diagnosis, and treatment in both nonpregnant and pregnant populations are discussed. RECENT FINDINGS Little progress has been made in understanding the causal factors. The results of several large prospective studies have shown that racial differences persist for rates of bacterial vaginosis even when other known risk factors are controlled for. Studies of the gene-environment interaction that examine the genetic aspects of immune response may explain racial differences and why some but not all women with bacterial vaginosis experience complications. Trials to prevent preterm birth by the treatment of bacterial vaginosis in pregnancy are disappointing. Resistance to clindamycin by bacterial vaginosis-associated anaerobic organisms has also been documented. New technology to provide rapid point-of-care diagnostic testing for bacterial vaginosis has emerged. SUMMARY To understand the vaginal ecosystem and its role in reproductive health and disease, we will need to study not only the microflora but also the host-immune response. Currently recommended treatment options for bacterial vaginosis are associated with high rates of recurrence. A new concern is the development of macrolide resistance to vaginal anaerobic flora when clindamycin is used as treatment. Further studies are still needed to determine whether prevention or control of bacterial vaginosis, particularly approaches that rely not on antibiotic treatment but on the maintenance of a healthy vaginal ecosystem, can reduce adverse health outcomes.
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Affiliation(s)
- Rebecca Flynn O'Brien
- Division of General Pediatrics and Adolescent Medicine, The Floating Hospital for Children at Tufts-New England Medical Center, and Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
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Morison L, Ekpo G, West B, Demba E, Mayaud P, Coleman R, Bailey R, Walraven G. Bacterial vaginosis in relation to menstrual cycle, menstrual protection method, and sexual intercourse in rural Gambian women. Sex Transm Infect 2005; 81:242-7. [PMID: 15923295 PMCID: PMC1744975 DOI: 10.1136/sti.2004.011684] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine the occurrence of bacterial vaginosis (BV) over the menstrual cycle and in relation to menstrual protection materials and sexual intercourse in a rural African setting. METHODS Married, regularly menstruating female volunteers were asked to collect self administered swabs on alternate days through four menstrual cycles. BV was assessed using Nugent scores. Menstruation and reported sexual intercourse data were recorded contemporaneously. A crossover design comparing traditional and modern menstrual protection methods was incorporated. Multivariate logistic regression was used to examine associations with BV. RESULTS 30 women completed four menstrual cycles in the study. Completeness and validity of data from the self administered swabs was high. Greater frequencies of BV were found for all women in the second week of the menstrual cycle relative to days 14+, and markedly higher frequencies of BV were found in the first week in women with infrequent BV. BV was (non-significantly) more frequent when modern pads were used compared with traditional cloths. No association was found between BV and intercourse reported in the previous 4 days; or between the frequency of reported intercourse in one menstrual cycle and BV in either the same menstrual cycle or the next. CONCLUSIONS Similar transient fluctuations over the menstrual cycle were found to those in industrialised countries. We found no evidence that sexual intercourse was associated with increased frequency of BV. Our data do not support hypotheses that menstrual hygiene materials might explain the high prevalences of BV found in sub-Saharan Africa compared to industrialised countries.
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Affiliation(s)
- L Morison
- MRC Tropical Epidemiology Group, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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