1
|
Das S, Konwar BK. Prophylactic application of vaginal lactic acid bacteria against urogenital pathogens and its prospective use in sanitary suppositories. Int Microbiol 2024; 27:179-202. [PMID: 37258658 DOI: 10.1007/s10123-023-00376-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/30/2023] [Accepted: 05/09/2023] [Indexed: 06/02/2023]
Abstract
Beneficial and pathogenic microbes coexist in the vaginal canal, where a diminishing population of lactic acid bacteria may cause recurring urogenital infections. Probiotic bacteria Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus vaginalis, and pathogenic microbes Enterococcus faecalis, Enterobacter cloacae, Shigella sp., Staphylococcus epidermidis, and Escherichia fergusonii were isolated from vaginal swabs. Lactobacillus sp. and their probiotic culture free supernatant (PCFS) inhibited the growth of the above-mentioned urogenital pathogens. L. crispatus produced both lactic acid and hydrogen peroxide, exhibiting the best antimicrobial potential against the studied pathogens. Lyophilized L. crispatus had a shelf life of 12 months and the lyophilized PCFS also retained its antibacterial property with a minimum inhibition concentration of 1 μg/μL. Carboxy-methyl cellulose-alginate, a green alternative to super-absorbent polymers, was encapsulated with L. crispatus cells. The probiotic in its encapsulated state retained its viability for 21 days, and the bead showed 30% solvent absorptive capacity. PCFS-laced non-woven fabric displayed antibacterial property with no change in its physicochemical properties. These probiotic and postbiotic formulations have excellent prophylactic potential for urogenital infections. Such formulations can be exploited as additives in sanitary suppositories to enhance vaginal health.
Collapse
Affiliation(s)
- Shreaya Das
- Department of MBBT, Tezpur University, Napaam-784028, Assam, India
| | | |
Collapse
|
2
|
Das S, Bhattacharjee MJ, Mukherjee AK, Khan MR. Recent advances in understanding of multifaceted changes in the vaginal microenvironment: implications in vaginal health and therapeutics. Crit Rev Microbiol 2023; 49:256-282. [PMID: 35312419 DOI: 10.1080/1040841x.2022.2049696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The vagina endures multifaceted changes from neonatal to menopausal phases due to hormonal flux, metabolite deposition, and microbial colonization. These features have important implications in women's health. Several pre-factors show dynamic characteristics according to the phases that shift the vaginal microbiota from anaerobes to aerobes which is a hallmark of healthy vaginal environment. These factors include oestrogen levels, glycogen deposition, and vaginal microstructure. In the adult phase, Lactobacillus is highly dominant and regulates pH, adherence, aggregation, immune modulation, synthesis of bacteriocins, and biosurfactants (BSs) which are antagonistic to pathogens. Maternal factors are protective by favouring the colonization of lactobacilli in the vagina in the neonatal phase, which diminishes with age. The dominance of lactobacilli and dysbiosis in the adult phase depends on intrinsic and extrinsic factors in women, which vary between ethnicities. Recent developments in probiotics used against vaginal microbiome dysbiosis have shown great promise in restoring the normal microbiota including preventing the loss of beneficial bacteria. However, further in-depth studies are warranted to ensure long-term protection by probiotics. This review highlights various aspects of the vaginal microenvironment in different phases of growth and diverse ethnicities. Furthermore, it discusses future trends for formulating more effective population-specific probiotics and implications of paraprobiotics and postbiotics as effective therapeutics.
Collapse
Affiliation(s)
- Sushmita Das
- Division of Life Science, Institute of Advanced Study in Science and Technology, Guwahati, India
| | | | - Ashis K Mukherjee
- Division of Life Science, Institute of Advanced Study in Science and Technology, Guwahati, India.,Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, India
| | - Mojibur Rohman Khan
- Division of Life Science, Institute of Advanced Study in Science and Technology, Guwahati, India
| |
Collapse
|
3
|
Alexe M, Benedicte L, Catherine S. A case report of pelvic inflammatory disease due to Streptococcus pneumoniae. CLINICAL INFECTION IN PRACTICE 2022. [DOI: 10.1016/j.clinpr.2022.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
|
4
|
Biographical Feature: Andrew B. Onderdonk, Ph.D. J Clin Microbiol 2021; 59:e0150521. [PMID: 34524890 DOI: 10.1128/jcm.01505-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
5
|
Joseph RJ, Ser HL, Kuai YH, Tan LTH, Arasoo VJT, Letchumanan V, Wang L, Pusparajah P, Goh BH, Ab Mutalib NS, Chan KG, Lee LH. Finding a Balance in the Vaginal Microbiome: How Do We Treat and Prevent the Occurrence of Bacterial Vaginosis? Antibiotics (Basel) 2021; 10:719. [PMID: 34203908 PMCID: PMC8232816 DOI: 10.3390/antibiotics10060719] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 12/30/2022] Open
Abstract
Bacterial vaginosis (BV) has been reported in one-third of women worldwide at different life stages, due to the complex balance in the ecology of the vaginal microbiota. It is a common cause of abnormal vaginal discharge and is associated with other health issues. Since the first description of anaerobic microbes associated with BV like Gardnerella vaginalis in the 1950s, researchers have stepped up the game by incorporating advanced molecular tools to monitor and evaluate the extent of dysbiosis within the vaginal microbiome, particularly on how specific microbial population changes compared to a healthy state. Moreover, treatment failure and BV recurrence rate remain high despite the standard antibiotic treatment. Consequently, researchers have been probing into alternative or adjunct treatments, including probiotics or even vaginal microbiota transplants, to ensure successful treatment outcomes and reduce the colonization by pathogenic microbes of the female reproductive tract. The current review summarizes the latest findings in probiotics use for BV and explores the potential of vaginal microbiota transplants in restoring vaginal health.
Collapse
Affiliation(s)
- Rebecca Jane Joseph
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbes and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (R.J.J.); (H.-L.S.); (Y.-H.K.); (L.T.-H.T.); (V.L.); (P.P.); (N.-S.A.M.)
| | - Hooi-Leng Ser
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbes and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (R.J.J.); (H.-L.S.); (Y.-H.K.); (L.T.-H.T.); (V.L.); (P.P.); (N.-S.A.M.)
| | - Yi-He Kuai
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbes and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (R.J.J.); (H.-L.S.); (Y.-H.K.); (L.T.-H.T.); (V.L.); (P.P.); (N.-S.A.M.)
| | - Loh Teng-Hern Tan
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbes and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (R.J.J.); (H.-L.S.); (Y.-H.K.); (L.T.-H.T.); (V.L.); (P.P.); (N.-S.A.M.)
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru 80100, Malaysia;
| | | | - Vengadesh Letchumanan
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbes and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (R.J.J.); (H.-L.S.); (Y.-H.K.); (L.T.-H.T.); (V.L.); (P.P.); (N.-S.A.M.)
| | - Lijing Wang
- Vascular Biology Research Institute, Guangdong Pharmaceutical University, Guangzhou 510006, China;
| | - Priyia Pusparajah
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbes and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (R.J.J.); (H.-L.S.); (Y.-H.K.); (L.T.-H.T.); (V.L.); (P.P.); (N.-S.A.M.)
| | - Bey-Hing Goh
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia;
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Nurul-Syakima Ab Mutalib
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbes and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (R.J.J.); (H.-L.S.); (Y.-H.K.); (L.T.-H.T.); (V.L.); (P.P.); (N.-S.A.M.)
- UKM Medical Molecular Biology Institute (UMBI), UKM Medical Centre, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia
- International Genome Centre, Jiangsu University, Zhenjiang 212013, China
| | - Learn-Han Lee
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbes and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (R.J.J.); (H.-L.S.); (Y.-H.K.); (L.T.-H.T.); (V.L.); (P.P.); (N.-S.A.M.)
| |
Collapse
|
6
|
Lacroix G, Gouyer V, Gottrand F, Desseyn JL. The Cervicovaginal Mucus Barrier. Int J Mol Sci 2020; 21:ijms21218266. [PMID: 33158227 PMCID: PMC7663572 DOI: 10.3390/ijms21218266] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 12/19/2022] Open
Abstract
Preterm births are a global health priority that affects 15 million babies every year worldwide. There are no effective prognostic and therapeutic strategies relating to preterm delivery, but uterine infections appear to be a major cause. The vaginal epithelium is covered by the cervicovaginal mucus, which is essential to health because of its direct involvement in reproduction and functions as a selective barrier by sheltering the beneficial lactobacilli while helping to clear pathogens. During pregnancy, the cervical canal is sealed with a cervical mucus plug that prevents the vaginal flora from ascending toward the uterine compartment, which protects the fetus from pathogens. Abnormalities of the cervical mucus plug and bacterial vaginosis are associated with a higher risk of preterm delivery. This review addresses the current understanding of the cervicovaginal mucus and the cervical mucus plug and their interactions with the microbial communities in both the physiological state and bacterial vaginosis, with a focus on gel-forming mucins. We also review the current state of knowledge of gel-forming mucins contained in mouse cervicovaginal mucus and the mouse models used to study bacterial vaginosis.
Collapse
|
7
|
Tranæus A, Heimbürger O, Lindholm B. Peritonitis during Continuous Ambulatory Peritoneal Dialysis (CAPD): Risk Factors, Clinical Severity, and Pathogenetic Aspects. Perit Dial Int 2020. [DOI: 10.1177/089686088800800405] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study of 228 episodes of peritonitis occurring during a total observation time of 2365 treatment months over a six-year period in a uniformly selected, trained, and treated continuous ambulatory peritoneal dialysis (CAPD) population (N = 124) showed the following major findings: 1) the risk of developing peritonitis was 55% within the first year and 89% within the first three years on CAPD; 2) high age (≥60 years) and year of CAPD start were risk factors for peritonitis; 3) neither sex, diabetes, or hypoalbuminemia were found to be risk factors for peritonitis; 4) the year of start, but neither the degree of severity, nor the time of the first episode affected the risk of developing a second episode of peritonitis; 5) no specific characteristics were identified in patients with the highest mean peritonitis incidence or in the patients without peritonitis; 6) in 27% of all episodes, turbidity of the dialysate was the only clinical finding; 7) the proportion of asymptomatic episodes was lower in patients ≥ 60 years; 8) the degree of clinical severity of peritonitis was not statistically influenced by the number of previous episodes; 9) the cause of peritonitis was established in only 26% of all cases; and 10) no statistical association was found between the cause of peritonitis and patient characteristics.
Collapse
Affiliation(s)
- Anders Tranæus
- Department of Renal Medicine, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| | - Olof Heimbürger
- Department of Renal Medicine, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| | - Bengt Lindholm
- Department of Renal Medicine, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| |
Collapse
|
8
|
Vazquez F, Fernández-Blázquez A, García B. Vaginosis. Vaginal microbiota. Enferm Infecc Microbiol Clin 2018; 37:592-601. [PMID: 30594321 DOI: 10.1016/j.eimc.2018.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/18/2018] [Indexed: 11/30/2022]
Abstract
The latest advances in the vaginal microbiome and molecular diagnosis of bacterial vaginosis have allowed for a better knowledge of this entity, characterising aspects of its pathogenesis and the establishment of the vaginal biolayer, the models and new theories of its aetiology, how it is transmitted, with it being considered nowadays as a probable sexually transmitted infection, the separation of other entities such as aerobic vaginosis, its molecular diagnosis and treatment with new molecules to prevent frequent relapses. This entity and the study of the vaginal microbiome have made it possible to consider these infections as a polymicrobial syndrome, putting an end to the dogma: one microorganism, one disease. In addition, a lesser-known entity such as aerobic vaginosis and the methods for its detection are updated.
Collapse
Affiliation(s)
- Fernando Vazquez
- Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, España; Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, España; Fundación de Investigación Oftalmológica, Instituto Oftalmológico Fernández-Vega, Oviedo, España; Fundación para la Investigación y la Innovación Biosanitaria del Principado de Asturias (FINBA), Oviedo, España; Grupo GEITS de la SEIMC.
| | | | - Beatriz García
- Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, España; Fundación de Investigación Oftalmológica, Instituto Oftalmológico Fernández-Vega, Oviedo, España; Fundación para la Investigación y la Innovación Biosanitaria del Principado de Asturias (FINBA), Oviedo, España
| |
Collapse
|
9
|
Mattson JN, Hardy-Fairbanks AJ. Clostridium sordelli Toxic Shock After Endometrial Ablation: Review of Gynecologic Cases. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jordan N. Mattson
- Department of Obstetrics and Gynecology, Division of General Obstetrics/Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Abbey J. Hardy-Fairbanks
- Department of Obstetrics and Gynecology, Division of General Obstetrics/Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA
| |
Collapse
|
10
|
Abdi H, Elzayat E, Cagiannos I, Lavallée LT, Cnossen S, Flaman AS, Mallick R, Morash C, Breau RH. Female radical cystectomy patients have a higher risk of surgical site infections. Urol Oncol 2018; 36:400.e1-400.e5. [PMID: 30064934 DOI: 10.1016/j.urolonc.2018.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/13/2018] [Accepted: 05/21/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Surgical site infections (SSI) are common after radical cystectomy. The objectives of this study were to evaluate if female sex is associated with postoperative SSI and if experiencing an SSI was associated with subsequent adverse events. METHODS This was a historical cohort study of radical cystectomy patients from the American College of Surgeons' National Surgical Quality Improvement Program database between 2006 and 2016. The primary outcome was development of a SSI (superficial, deep, or organ/abdominal space) within 30 days of surgery. Multivariable logistic regression analyses were performed to determine the association between sex and other patient/procedural factors with SSI. Female patients with SSI were also compared to those without SSI to determine risk of subsequent adverse events. RESULTS A total of 9,275 radical cystectomy patients met the inclusion criteria. SSI occurred in 1,277(13.7%) patients, 308 (16.4%) females and 969 (13.1%) males (odds ratio = 1.27; 95% confidence interval 1.10-1.47; P = 0.009). Infections were superficial in 150 (8.0%) females versus 410 (5.5%) males (P < 0.0001), deep in 40 (2.1%) females versus 114 (1.5%) males (P = 0.07), and organ/abdominal space in 118 (6.2%) females versus 445 (6.0%) males (P = 0.66). On multivariable analysis, female sex was independently associated with SSI (odds ratio = 1.21 confidence interval 1.01-1.43 P = 0.03). Females who experience SSI had higher probability of developing other complications including wound dehiscence, septic shock, and need for reoperation (all P < 0.05). CONCLUSIONS Female sex is an independent risk factor for SSI following radical cystectomy. More detailed study of patient factors, pathogenic microbes, and treatment factors are needed to prescribe the best measures for infection prophylaxis.
Collapse
Affiliation(s)
- Hamidreza Abdi
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Ehab Elzayat
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Sonya Cnossen
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Anathea S Flaman
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Chris Morash
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada.
| |
Collapse
|
11
|
Dausset C, Patrier S, Gajer P, Thoral C, Lenglet Y, Cardot JM, Judlin P, Ravel J, Nivoliez A. Comparative phase I randomized open-label pilot clinical trial of Gynophilus ® (Lcr regenerans ®) immediate release capsules versus slow release muco-adhesive tablets. Eur J Clin Microbiol Infect Dis 2018; 37:1869-1880. [PMID: 30032443 PMCID: PMC6154122 DOI: 10.1007/s10096-018-3321-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/02/2018] [Indexed: 02/01/2023]
Abstract
Gynophilus® (Lcr regenerans®) is a live biotherapeutic product (LBP) that contains the live biotherapeutic microorganism Lactobacillus rhamnosus Lcr35®, which is indicated to restore vaginal health. The aim of the study was to compare the safety, ease of use, and compliance of two formulations (immediate release: IR capsule and slow release: SR muco-adhesive tablets) as well as the colonization of Lcr35® in healthy women. This phase I study (Comprigel) is a parallel, randomized, 4-arm, and open-label clinical trial evaluating an IR daily capsule formulation vs. a SR tablet administered every 3, 4, or 5 days for 21 days. Self-collected vaginal swabs were used to quantify Lcr35® and characterize the composition and structure of the vaginal microbiota. Both LBPs were well-tolerated, and no severe adverse effects were reported. All groups had Lcr35® vaginal concentrations over 107 colony forming unit per milliliter of vaginal secretion on each day in the study. The new Gynophilus® slow release tablets administered either every 3, 4, or 5 days provided vaginal concentrations that were not significantly different from those of classic Gynophilus® (capsule) once-a-day regimen. The LBPs and the different regimens did not adversely influence the abundance of native Lactobacillus spp. and indeed tended to favor their growth and reduce colonization by non-Lactobacillus spp. This study illustrates that the SR muco-adhesive LBP tablet (Gynophilus® SR) administered every 3 or 4 days as a safe, well-tolerated, and efficacious alternative to a more demanding IR daily capsule and could protect women's healthy vaginal microbiome by promoting endogenous Lactobacillus spp.
Collapse
Affiliation(s)
| | | | - Pawel Gajer
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Claudia Thoral
- Research and Development Department, BIOSE, Aurillac, France
| | - Yann Lenglet
- Gynecology and Obstetrics Department, Jacques Lacarin Hospital Center, Vichy, France
| | - Jean-Michel Cardot
- Biopharmaceutical Department, UMR MEDIS, Faculty of Pharmacy, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Philippe Judlin
- Gynecology and Obstetrics Department, Nancy University Hospital, Nancy, France
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adrien Nivoliez
- Research and Development Department, BIOSE, Aurillac, France
| |
Collapse
|
12
|
Babu G, Singaravelu BG, Srikumar R, Reddy SV, Kokan A. Comparative Study on the Vaginal Flora and Incidence of Asymptomatic Vaginosis among Healthy Women and in Women with Infertility Problems of Reproductive Age. J Clin Diagn Res 2017; 11:DC18-DC22. [PMID: 28969122 DOI: 10.7860/jcdr/2017/28296.10417] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/29/2017] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The normal vaginal flora is highly complex, dominated by lactobacilli of doderlein that plays a vital role in maintaining the women's health and inhibits other pathogenic microorganisms. Fluctuation in local environment or exposure to any exogenous and endogenous sources changes the vaginal flora over a period of time. Disruption of the vaginal ecosystem changes the microflora of the healthy vagina, altering the pH and predisposing to lower reproductive tract infections. The change in the microflora of the female genital tract by pathogenic organisms may ascend from vagina to upper genital tract and may cause infertility. Although several studies demonstrate a higher prevalence of bacterial vaginosis in infertile population. The role of vaginal microbiome in infertility is not clear and need to be explored further. AIM To compare the vaginal flora and analyse the incidence of asymptomatic vaginosis among healthy women and in women with infertility problems. MATERIALS AND METHODS A cross-sectional study was conducted over a period of six months at Sri Lakshmi Narayana Medical College and Hospital Puducherry, India. A total of 200 high vaginal swabs were collected from Group 1 which included 84 healthy women with regular menstrual cycles without any gynaecological disorder and from Group 2, 116 women with infertility problems attending fertility clinic within the age group of 18 to 45 years. All swabs were subjected to routine aerobic, anaerobic and fungal culture. Saline wet mount was performed for the detection of clue cells and Trichomonas vaginalis, 10% KOH was performed for demonstration of budding yeast cells and pseudo hyphae, Gram's staining to determine the presence of yeast cells, leucocytes and bacterial morphotypes. The smear was also graded using Nugent scoring system. RESULTS The vaginal flora of Group 1 was dominated by Lactobacillus (40, 27.8 %) followed by Micrococcus (22, 15.3 %), Enterococcus (16, 11.1%), Coagulase negative Staphylococcus spp. (12, 8.3%). Whereas in Group 2, the most dominant flora was Candida spp. (30, 26.5 %), Enterococcus (26, 23%) followed by Gram negative bacilli such as E. coli (16, 14.1 %). The percentage of Lactobacillus in Group 2 women with infertility problems was relatively low (4, 3.5%). Asymptomatic vaginosis was present in 32 (27.6 %) of Group 2 women compared to Group 1 women were only 6 (7.1%) had asymptomatic vaginosis. CONCLUSION Women with infertility problems showed higher prevalence of asymptomatic vaginosis and abundance of Bacterial Vaginosis (BV) associated bacteria compared to healthy women. Hence, this study recommends the screening of vaginal flora as a routine for all women, especially in women undergoing infertility treatment and also suggests the importance of vaginal culture and sensitivity in routine practice.
Collapse
Affiliation(s)
- Geethavani Babu
- Assistant Professor, Department of Microbiology, DM Wayanad Institute of Medical Sciences, Wayanad, Kerala and Research Scholar, Bharath University, BIHER Chennai, Tamil Nadu, India
| | - Balamuru Ganvelu Singaravelu
- Professor, Department of Microbiology, DM Wayanad Institute of Medical Sciences, Wayanad, Kerala and Research Scholar, Bharath University, BIHER Chennai, Tamil Nadu, India
| | - R Srikumar
- Research Associate, Department of Microbiology, Centre For Research, Sri Lakshmi Narayana Institute of Medical Sciences, Bharath University, Puducherry, India
| | - Sreenivasalu V Reddy
- Professor, Department of Microbiology, Bharath University, Chennai, Tamil Nadu, India
| | - Afraa Kokan
- Student, Sri Lakshmi Narayana Institute of Medical Sciences, Bharath University, BIHER, Chennai, Tamil Nadu, India
| |
Collapse
|
13
|
Jung HS, Ehlers MM, Lombaard H, Redelinghuys MJ, Kock MM. Etiology of bacterial vaginosis and polymicrobial biofilm formation. Crit Rev Microbiol 2017; 43:651-667. [PMID: 28358585 DOI: 10.1080/1040841x.2017.1291579] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Microorganisms in nature rarely exist in a planktonic form, but in the form of biofilms. Biofilms have been identified as the cause of many chronic and persistent infections and have been implicated in the etiology of bacterial vaginosis (BV). Bacterial vaginosis is the most common form of vaginal infection in women of reproductive age. Similar to other biofilm infections, BV biofilms protect the BV-related bacteria against antibiotics and cause recurrent BV. In this review, an overview of BV-related bacteria, conceptual models and the stages involved in the polymicrobial BV biofilm formation will be discussed.
Collapse
Affiliation(s)
- Hyun-Sul Jung
- a Department of Medical Microbiology, Faculty of Health Sciences , University of Pretoria , Pretoria , South Africa
| | - Marthie M Ehlers
- a Department of Medical Microbiology, Faculty of Health Sciences , University of Pretoria , Pretoria , South Africa.,b Department of Medical Microbiology, Tshwane Academic Division , National Health Laboratory Service (NHLS) , Pretoria , South Africa
| | - Hennie Lombaard
- c Gauteng Department of Health, Rahima Moosa Mother and Child Hospital, Wits Obstetrics and Gynaecology Clinical Research Division, Department of Obstetrics and Gynaecology , University of Witwatersrand , Johannesburg , South Africa
| | - Mathys J Redelinghuys
- a Department of Medical Microbiology, Faculty of Health Sciences , University of Pretoria , Pretoria , South Africa
| | - Marleen M Kock
- a Department of Medical Microbiology, Faculty of Health Sciences , University of Pretoria , Pretoria , South Africa.,b Department of Medical Microbiology, Tshwane Academic Division , National Health Laboratory Service (NHLS) , Pretoria , South Africa
| |
Collapse
|
14
|
Muhleisen AL, Herbst-Kralovetz MM. Menopause and the vaginal microbiome. Maturitas 2016; 91:42-50. [DOI: 10.1016/j.maturitas.2016.05.015] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/27/2016] [Accepted: 05/31/2016] [Indexed: 02/07/2023]
|
15
|
Abstract
Urogenital complaints such as vaginal discomfort, dysuria, dyspareunia, recurrent lower urinary tract infections and urinary incontinence are more common in women after the menopause. Epidemiological studies have demonstrated that more than 50% of postmenopausal women suffer from at least one of these symptoms. They cause not only discomfort, but may also negatively influence sexual health. Many women are so embarrassed that they are unable to discuss their dilemma with other women or their doctor. Embryologically the female genital tract and urinary systems develop in close proximity, both arising from the primitive urogenital sinus. Animal and human studies have shown that the urethra is oestrogen sensitive, and oestrogen receptors have been identified in the urethra, urinary bladder, the vagina and the pelvic floor muscles. There is now a wealth of evidence to support the efficacy of exogenous oestrogens in the treatment of urogenital symptoms caused by postmenopausal ovarian insufficiency.
Collapse
Affiliation(s)
- Ian Milsom
- Department of Obstetrics and Gynecology, University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Ulla Molander
- Department of Geriatric Medicine, University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden
| |
Collapse
|
16
|
Lin WC, Chang CYY, Hsu YA, Chiang JH, Wan L. Increased Risk of Endometriosis in Patients With Lower Genital Tract Infection: A Nationwide Cohort Study. Medicine (Baltimore) 2016; 95:e2773. [PMID: 26962775 PMCID: PMC4998856 DOI: 10.1097/md.0000000000002773] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Endometriosis results from the ectopic invasion of endometrial glands and stroma in the peritoneal cavity. The exact etiology of endometriosis is still unknown. It has, however, been shown that there are higher numbers of Escherichia coli in menstrual blood, and higher endotoxin levels in menstrual fluid, as well as, in the peritoneal fluid of patients with endometriosis. In this study, we aimed to determine whether lower genital tract infections could increase the risk of endometriosis.We used the Taiwan National Health Insurance database to conduct a population-based cohort study. We included patients diagnosed with inflammatory diseases of the cervix, vagina, and vulva, and a control group comprising patients matched by age, sex, and comorbidities but without inflammatory diseases of the cervix, vagina, or vulva.A total of 79,512 patients were included in the inflammatory disease group and an equal number of control individuals were selected. The incidence of endometriosis (hazard ratio, 2.01; 95% confidence interval, 1.91-2.12; P < 0.001) was higher among patients than controls. Cox proportional hazards models showed that irrespective of comorbidities, lower genital tract infection was an independent risk factor for endometriosis.Patients with lower genital tract infections exhibit a substantially higher risk for developing endometriosis.
Collapse
Affiliation(s)
- Wu-Chou Lin
- From the Department of Obstetrics and Gynecology (W-CL, CY-YC, LW); School of Chinese Medicine (W-CL, Y-AH, LW); School of Medicine, China Medical University, Taichung (CY-YC); Institute of Molecular Medicine, National Tsing Hua University, Hsinchu (Y-AH); Management Office for Health Data, China Medical University Hospital (J-HC); Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University (J-HC) and Department of Biotechnology, Asia University (LW), Taichung, Taiwan
| | | | | | | | | |
Collapse
|
17
|
Csángó PA. First International Conference on Vaginosis: Nonspecific Vaginitis Kristiansand, Norway, April 16–17, 1982. ACTA ACUST UNITED AC 2015. [DOI: 10.3109/inf.1982.14.suppl-40.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
18
|
Stingley RL, Liu H, Mullis LB, Elkins CA, Hart ME. Staphylococcus aureus toxic shock syndrome toxin-1 (TSST-1) production and Lactobacillus species growth in a defined medium simulating vaginal secretions. J Microbiol Methods 2014; 106:57-66. [PMID: 25135489 DOI: 10.1016/j.mimet.2014.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 11/18/2022]
Abstract
Lactobacillus species are commensal with the healthy vaginal environment and inhibit the growth of many pathogenic bacteria in the vaginal tract by a variety of mechanisms, such as the production of hydrogen peroxide, organic acids, and antimicrobial substances. Simulation of the vaginal environment is crucial for proper investigation of the effects of Lactobacillus species on pathogenic bacteria. In this study, we modified a medium used to simulate vaginal secretions to improve the growth of toxic shock syndrome toxin-1 (TSST-1)-producing Staphylococcus aureus clinical strains and Lactobacillus species so that interactions between these bacteria may be examined. A medium consisting of basal salts, vitamins, albumin, glycogen, mucin, urea, sodium bicarbonate, polyoxyethylene sorbitan monolaurate, and amino acids supported the growth of S. aureus and the production of TSST-1 as determined by Western analysis. Improved growth of the Lactobacillus species was seen when this same medium was supplemented with manganese chloride, sodium acetate, and an increase in glucose concentration. However, growth of S. aureus in the supplemented medium resulted in reduced levels of TSST-1. Production of TSST-1 was not detected in a medium routinely used for the growth of Lactobacillus species although S. aureus growth was not inhibited. The development of an improved genital tract secretion medium provides a more authentic environment in which to study the interactions of Lactobacillus species and vaginal pathogens, such as S. aureus.
Collapse
Affiliation(s)
- Robin L Stingley
- Office of Scientific Coordination, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA
| | - Huanli Liu
- Office of Regulatory Affairs, Arkansas Regional Laboratories, U.S. Food and Drug Administration, Jefferson, AR, USA
| | - Lisa B Mullis
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA
| | - Christopher A Elkins
- Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Laurel, MD, USA
| | - Mark E Hart
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA; Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| |
Collapse
|
19
|
Ledger WJ. Prophylactic antibiotics in obstetrics–gynecology: a current asset, a future liability? Expert Rev Anti Infect Ther 2014; 4:957-64. [PMID: 17181412 DOI: 10.1586/14787210.4.6.957] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Currently, prophylactic antibiotics have proven effective in lowering the postoperative and postprocedure infection rate following vaginal hysterectomy, emergency cesarean section for the patient in labor, radical hysterectomy, abdominal hysterectomy, pregnancy termination, hysterosalpingogram and intrauterine device insertion. Guidelines for the most effective and safe use are presented. Concerns are raised regarding the widespread prolonged use of prophylactic antibiotics on women in labor to prevent Group B streptococcal infections in newborn children and women with prolonged preterm membrane rupture. There is also an awareness needed of a growing incidence of infections seen in the hospital from community-acquired methicillin-resistant Staphylococcus aureus and Clostridium difficile. These problems have not been addressed by the current prophylactic antibiotic strategies.
Collapse
Affiliation(s)
- William J Ledger
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, 525 East 68th Street, J-130, New York, NY 10021, USA.
| |
Collapse
|
20
|
Spitz IM. Progesterone receptor antagonists and selective progesterone receptor modulators: proven and potential clinical applications. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.2.227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
21
|
Abstract
Female genital tract microbiota play a crucial role in maintaining health. Disequilibrium of the microbiota has been associated with increased risk of pelvic infections. In recent years, culture-independent molecular techniques have expanded understanding of the composition of genital microbiota and the dynamic nature of the microbiota. There is evidence that upper genital tract may not be sterile and may harbor microflora in the physiologic state. The isolation of bacterial vaginosis-associated organisms in women with genital infections establishes a link between pelvic infections and abnormal vaginal flora. With the understanding of the composition of the microbiota in healthy and diseased states, the next logical step is to identify the function of the newly identified microbes. This knowledge will further expand our understanding of the causation of pelvic infections, which may lead to more effective prevention and treatment strategies.
Collapse
Affiliation(s)
- Harsha Sharma
- Department of Obstetrics and Gynecology, Mt Sinai School of Medicine Jamaica Program, Queens Hospital Center, Queens, New York
| | - Reshef Tal
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Natalie A Clark
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | | |
Collapse
|
22
|
Chaban B, Links MG, Jayaprakash TP, Wagner EC, Bourque DK, Lohn Z, Albert AYK, van Schalkwyk J, Reid G, Hemmingsen SM, Hill JE, Money DM. Characterization of the vaginal microbiota of healthy Canadian women through the menstrual cycle. MICROBIOME 2014; 2:23. [PMID: 25053998 PMCID: PMC4106219 DOI: 10.1186/2049-2618-2-23] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/31/2014] [Indexed: 05/11/2023]
Abstract
BACKGROUND The vaginal microbial community plays a vital role in maintaining women's health. Understanding the precise bacterial composition is challenging because of the diverse and difficult-to-culture nature of many bacterial constituents, necessitating culture-independent methodology. During a natural menstrual cycle, physiological changes could have an impact on bacterial growth, colonization, and community structure. The objective of this study was to assess the stability of the vaginal microbiome of healthy Canadian women throughout a menstrual cycle by using cpn60-based microbiota analysis. Vaginal swabs from 27 naturally cycling reproductive-age women were collected weekly through a single menstrual cycle. Polymerase chain reaction (PCR) was performed to amplify the universal target region of the cpn60 gene and generate amplicons representative of the microbial community. Amplicons were pyrosequenced, assembled into operational taxonomic units, and analyzed. Samples were also assayed for total 16S rRNA gene content and Gardnerella vaginalis by quantitative PCR and screened for the presence of Mollicutes by using family and genus-specific PCR. RESULTS Overall, the vaginal microbiome of most women remained relatively stable throughout the menstrual cycle, with little variation in diversity and only modest fluctuations in species richness. Microbiomes between women were more different than were those collected consecutively from individual women. Clustering of microbial profiles revealed the expected groupings dominated by Lactobacillus crispatus, Lactobacillus iners, and Lactobacillus jensenii. Interestingly, two additional clusters were dominated by either Bifidobacterium breve or a heterogeneous mixture of nonlactobacilli. Direct G. vaginalis quantification correlated strongly with its pyrosequencing-read abundance, and Mollicutes, including Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum, were detected in most samples. CONCLUSIONS Our cpn60-based investigation of the vaginal microbiome demonstrated that in healthy women most vaginal microbiomes remained stable through their menstrual cycle. Of interest in these findings was the presence of Bifidobacteriales beyond just Gardnerella species. Bifidobacteriales are frequently underrepresented in 16S rRNA gene-based studies, and their detection by cpn60-based investigation suggests that their significance in the vaginal community may be underappreciated.
Collapse
Affiliation(s)
- Bonnie Chaban
- Department of Veterinary Microbiology, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK S7N 5B4, Canada
| | - Matthew G Links
- Department of Veterinary Microbiology, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK S7N 5B4, Canada
- Agriculture and AgriFood Canada, 107 Science Place, Saskatoon, SK S7N 0X2, Canada
| | - Teenus Paramel Jayaprakash
- Department of Veterinary Microbiology, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK S7N 5B4, Canada
| | - Emily C Wagner
- Department of Obstetrics and Gynecology, University of British Columbia, 1190 Hornby Street, Vancouver, BC V6Z 2K5, Canada
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Danielle K Bourque
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Zoe Lohn
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Arianne YK Albert
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Julie van Schalkwyk
- Department of Obstetrics and Gynecology, University of British Columbia, 1190 Hornby Street, Vancouver, BC V6Z 2K5, Canada
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Gregor Reid
- Department of Microbiology and Immunology, University of Western Ontario and Lawson Health Research Institute, London, ON, Canada
| | - Sean M Hemmingsen
- National Research Council Canada, 110 Gymnasium Place, Saskatoon, SK S7N 0W9, Canada
- Department of Microbiology & Immunology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Janet E Hill
- Department of Veterinary Microbiology, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK S7N 5B4, Canada
| | - Deborah M Money
- Department of Obstetrics and Gynecology, University of British Columbia, 1190 Hornby Street, Vancouver, BC V6Z 2K5, Canada
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| |
Collapse
|
23
|
Hickey RJ, Abdo Z, Zhou X, Nemeth K, Hansmann M, Osborn TW, Wang F, Forney LJ. Effects of tampons and menses on the composition and diversity of vaginal microbial communities over time. BJOG 2013; 120:695-704; discussion 704-6. [DOI: 10.1111/1471-0528.12151] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2012] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - K Nemeth
- FemCare Product Safety and Regulatory Affairs; The Procter & Gamble Company; Cincinnati; OH; USA
| | - M Hansmann
- FemCare Product Safety and Regulatory Affairs; The Procter & Gamble Company; Cincinnati; OH; USA
| | - TW Osborn
- FemCare Product Development; The Procter & Gamble Company; Cincinnati; OH; USA
| | - F Wang
- FemCare Product Development; The Procter & Gamble Company; Cincinnati; OH; USA
| | - LJ Forney
- Institute for Bioinformatics and Evolutionary Studies; University of Idaho; Moscow; ID; USA
| |
Collapse
|
24
|
Brotman RM. Vaginal microbiome and sexually transmitted infections: an epidemiologic perspective. J Clin Invest 2011; 121:4610-7. [PMID: 22133886 DOI: 10.1172/jci57172] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Vaginal bacterial communities are thought to help prevent sexually transmitted infections. Bacterial vaginosis (BV) is a common clinical syndrome in which the protective lactic acid-producing bacteria (mainly species of the Lactobacillus genus) are supplanted by a diverse array of anaerobic bacteria. Epidemiologically, BV has been shown to be an independent risk factor for adverse outcomes including preterm birth, development of pelvic inflammatory disease, and acquisition of sexually transmitted infections. Longitudinal studies of the vaginal microbiome using molecular techniques such as 16S ribosomal DNA analysis may lead to interventions that shift the vaginal microbiota toward more protective states.
Collapse
Affiliation(s)
- Rebecca M Brotman
- Department of Epidemiology and Public Health and Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
| |
Collapse
|
25
|
Santiago GLDS, Cools P, Verstraelen H, Trog M, Missine G, El Aila N, Verhelst R, Tency I, Claeys G, Temmerman M, Vaneechoutte M. Longitudinal study of the dynamics of vaginal microflora during two consecutive menstrual cycles. PLoS One 2011; 6:e28180. [PMID: 22140538 PMCID: PMC3227645 DOI: 10.1371/journal.pone.0028180] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 11/02/2011] [Indexed: 11/23/2022] Open
Abstract
Background Although the vaginal microflora (VMF) has been well studied, information on the fluctuation of the different bacterial species throughout the menstrual cycle and the information on events preceding the presence of disturbed VMF is still very limited. Documenting the dynamics of the VMF during the menstrual cycle might provide better insights. In this study, we assessed the presence of different Lactobacillus species in relation to the BV associated species during the menstrual cycle, assessed the influence of the menstrual cycle on the different categories of vaginal microflora and assessed possible causes, such as menstruation and sexual intercourse, of VMF disturbance. To our knowledge, this is the first longitudinal study in which swabs and Gram stains were available for each day of two consecutive menstrual cycles, whereby 8 grades of VMF were distinguished by Gram stain analysis, and whereby the swabs were cultured every 7th day and identification of the bacterial isolates was carried out with a molecular technique. Methods Self-collected vaginal swabs were obtained daily from 17 non pregnant, menarchal volunteers, and used for daily Gram staining and weekly culture. Bacterial isolates were identified with tDNA-PCR and 16 S rRNA gene sequencing. Results Nine women presented with predominantly normal VMF and the 8 others had predominantly disturbed VMF. The overall VMF of each volunteer was characteristic and rather stable. Menses and antimicrobials were the major disturbing factors of the VMF. Disturbances were always accompanied by a rise in Gram positive cocci, which also appeared to be a significant group within the VMF in general. Conclusions We observed a huge interindividual variability of predominantly stable VMF types. The importance of Gram positive cocci in VMF is underestimated. L. crispatus was the species that was most negatively affected by the menses, whereas the presence of the other lactobacilli was less variable.
Collapse
Affiliation(s)
- Guido Lopes Dos Santos Santiago
- Laboratory for Bacteriology Research, Department of Clinical Chemistry, Microbiology, and Immunology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Kumar N, Behera B, Sagiri SS, Pal K, Ray SS, Roy S. Bacterial vaginosis: Etiology and modalities of treatment-A brief note. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2011; 3:496-503. [PMID: 22219582 PMCID: PMC3249696 DOI: 10.4103/0975-7406.90102] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/23/2011] [Accepted: 07/31/2011] [Indexed: 11/05/2022] Open
Abstract
A large women population of the world is suffering from a vaginal infection commonly known as bacterial vaginosis. The disease is associated with the decrease in the lactobacilli count in the vagina. Till date, there is a lack of full proof treatment modalities for the cure of the disease. The treatment includes the use of antimicrobials and/or acidifying agents and probiotics, either separately or in combination. This note discusses about the etiology and the various present-day modalities of treatment of bacterial vaginosis.
Collapse
Affiliation(s)
- Nikhil Kumar
- Departments of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, India
| | - Beauty Behera
- Departments of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, India
| | - Sai S. Sagiri
- Departments of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, India
| | - Kunal Pal
- Departments of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, India
| | - Sirsendu S. Ray
- Departments of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, India
| | - Saroj Roy
- Department of Pharmaceutics, School of Pharmacy and Technology Management, Narsee Monjee Institute of Management Studies, Mumbai, India
| |
Collapse
|
27
|
Gustafsson RJ, Ahrné S, Jeppsson B, Benoni C, Olsson C, Stjernquist M, Ohlsson B. The Lactobacillus flora in vagina and rectum of fertile and postmenopausal healthy Swedish women. BMC WOMENS HEALTH 2011; 11:17. [PMID: 21609500 PMCID: PMC3118184 DOI: 10.1186/1472-6874-11-17] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 05/25/2011] [Indexed: 01/05/2023]
Abstract
Background Lactobacillus species are the most often found inhabitants of vaginal ecosystem of fertile women. In postmenopausal women with low oestrogen levels, Lactobacillus flora is diminishing or absent. However, no studies have been performed to investigate the correlation between oestrogen levels and the lactobacilli in the gut. The aim of the present study was to investigate the relation in healthy women between vaginal and rectal microbial flora as well as possible variations with hormone levels. Methods Vaginal and rectal smears were taken from 20 healthy fertile women, average 40 years (range 28-49 years), in two different phases of the menstrual cycle, and from 20 postmenopausal women, average 60 years (range 52-85 years). Serum sex hormone levels were analyzed. Bacteria from the smears isolated on Rogosa Agar were grouped by Randomly Amplified Polymorphic DNA and identified by multiplex PCR and partial 16S rRNA gene sequencing. Results Lactobacillus crispatus was more often found in the vaginal flora of fertile women than in that of postmenopausal (p = 0.036). Fifteen of 20 fertile women had lactobacilli in their rectal smears compared to 10 postmenopausal women (p = 0.071). There was no correlation between the number of bacteria in vagina and rectum, or between the number of bacteria and hormonal levels. Neither could any association between the presence of rectal lactobacilli and hormonal levels be found. Conclusion Lactobacillus crispatus was more prevalent in the vaginal flora of fertile women, whereas the Lactobacillus flora of rectum did not correlate to the vaginal flora nor to hormonal levels.
Collapse
Affiliation(s)
- Rita J Gustafsson
- Department of Clinical Sciences, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
| | | | | | | | | | | | | |
Collapse
|
28
|
Genc MR, Onderdonk A. Endogenous bacterial flora in pregnant women and the influence of maternal genetic variation. BJOG 2010; 118:154-63. [DOI: 10.1111/j.1471-0528.2010.02772.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
29
|
Brotman RM, Ravel J, Cone RA, Zenilman JM. Rapid fluctuation of the vaginal microbiota measured by Gram stain analysis. Sex Transm Infect 2010; 86:297-302. [PMID: 20660593 DOI: 10.1136/sti.2009.040592] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The aetiology of bacterial vaginosis (BV) remains unknown. OBJECTIVE To describe longitudinal changes in vaginal microbiota. METHODS Thirty-nine women (mean age 36.8 years; 22 (56.4%) African-American) self-collected vaginal specimens twice weekly for 16 weeks as part of a vaginal douching cessation study. In an analysis where each woman serves as her own control, conditional logistic regression was used to evaluate daily, time-varying factors associated with a woman's incident BV episode(s) as compared with her persistently BV-negative sample(s). BV was defined by a Nugent's Gram stain score >or=7. RESULTS 46.2% of participants had BV in the first 4 weeks of observation. Rapid fluctuation of vaginal microbiota was observed in 226 transitions to BV or spontaneous remission. Duration of BV was often short: 51% of the episodes lasted for only one sample interval (3 days). Among women who had at least one BV episode, the median number of episodes per woman was 8.7 (SD 7.4, range 1-22). Lubricant use 1 day before specimen collection (adjusted OR (aOR)=11.75, 95% CI 1.96 to 70.27) and rectal sex 2 days before (aOR=4.48, 95% CI 2.79 to 7.17) were associated with BV onset. CONCLUSION Rapid fluctuation of the vaginal microbiota was seen. Longitudinal studies with long intervals between sampling are likely to miss episodes of BV. Recent report of lubricant use and rectal sex were associated with incident BV.
Collapse
Affiliation(s)
- Rebecca M Brotman
- Department of Epidemiology and Preventive Medicine, Institute for Genome Sciences, University of Maryland School of Medicine, BioPark Building II, 801 West Baltimore Street, Baltimore, MD 21201, USA.
| | | | | | | |
Collapse
|
30
|
Creech CB, Litzner B, Talbot TR, Schaffner W. Frequency of detection of methicillin-resistant Staphylococcus aureus from rectovaginal swabs in pregnant women. Am J Infect Control 2010; 38:72-4. [PMID: 19836855 DOI: 10.1016/j.ajic.2009.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 06/09/2009] [Accepted: 06/16/2009] [Indexed: 11/17/2022]
Abstract
Clinical samples from 250 pregnant women undergoing screening for rectovaginal group B streptococcus colonization were evaluated concurrently for the presence of methicillin-resistant Staphylococcus aureus (MRSA). Overall, S aureus was detected in 21.6% of the women; 53.7% of the isolates were MRSA. Despite a lack of risk factors for MRSA colonization, rectovaginal MRSA was detected in 10.4% of pregnant women in this study.
Collapse
Affiliation(s)
- C Buddy Creech
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center and Vanderbilt Children's Hospital, Nashville, TN 37232-2573, USA.
| | | | | | | |
Collapse
|
31
|
Farage MA, Miller KW, Sobel JD. Dynamics of the Vaginal Ecosystem—Hormonal Influences. ACTA ACUST UNITED AC 2010. [DOI: 10.4137/idrt.s3903] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The vagina is a dynamic and finely tuned ecosystem in which homeostasis depends on mutually beneficial interactions between a human female and her resident microorganisms, an ecosystem that can be thrown off balance by a wide variety of both intrinsic and extrinsic factors. Although a functional equilibrium provides stability to the ecosystem considered crucial to maintaining vaginal health, “normal flora” is a concept currently being redefined. New methodologies enable molecular analyses of the vaginal microbiota which have widened the definition of “normal” from a single specific microbiological profile to a range of functional microbial equilibria dependent upon pertinent host and microbial factors. One of the strongest influences on the vaginal microbiota is the hormonal changes that define the reproductive phases of a woman's life. The vaginal environment is particularly responsive to estrogen, a hormone that creates distinctive changes in the vaginal microbiota. This review summarizes the components of a healthy vaginal ecosystem during the reproductive years, including the characteristics of a healthy equilibrium and factors that can disturb a functional balance. It also summarizes what is known about the vaginal microbiota in childhood and after menopause. Healthful ecosystems at any stage of a female's reproductive life will be characterized by a microbiota that both maintains physiological function and though changeable, adapts to normal perturbation without succumbing to disease.
Collapse
Affiliation(s)
- Miranda A. Farage
- The Procter and Gamble Company, Winton Hill Business Center, Cincinnati, OH USA
| | - Kenneth W. Miller
- The Procter and Gamble Company, Winton Hill Business Center, Cincinnati, OH USA
| | - Jack D. Sobel
- Wayne State University, Infectious Diseases, Detroit, MI USA
| |
Collapse
|
32
|
Pybus V, Onderdonk AB. The Effect of pH on Growth and Succinate Production byPrevotella bivia. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.3109/08910609609167725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- V. Pybus
- Charming Laboratory, Harvard Medical School, Boston, USA
| | | |
Collapse
|
33
|
Konstandi M, Voidarou C, Papadaki A, Tsiotsias A, Kotsovolou O, Evangelou E, Bezirtzoglou E. Stress modifies the vaginal flora in cyclic female rats. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.1080/08910600601072464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Maria Konstandi
- Department of Pharmacology, School of Medicine, University of Ioannina, Ioannina
| | - Chrissa Voidarou
- Department of Pharmacology, School of Medicine, University of Ioannina, Ioannina
| | - Aikaterini Papadaki
- Department of Pharmacology, School of Medicine, University of Ioannina, Ioannina
| | - Arsenis Tsiotsias
- Department of Pharmacology, School of Medicine, University of Ioannina, Ioannina
| | - Olga Kotsovolou
- Department of Pharmacology, School of Medicine, University of Ioannina, Ioannina
| | - Evaggelos Evangelou
- Department of Pharmacology, School of Medicine, University of Ioannina, Ioannina
| | - Eugenia Bezirtzoglou
- Laboratory of Microbiology, Biotechnology and Hygiene, Democritus University of Thrace, Faculty of Agricultural Development, Department of Food Science and Technology, Greece
| |
Collapse
|
34
|
Furr PM, Taylor-robinson D. The Influence of Hormones on the Bacterial Flora of the Murine Vagina and Implications for Human Disease. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.3109/08910609109140135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- P. M. Furr
- Division of Sexually Transmitted Diseases, Clinical Research Centre, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
| | - D. Taylor-robinson
- Division of Sexually Transmitted Diseases, Clinical Research Centre, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
| |
Collapse
|
35
|
Sutherland A, Tester R, Al-Ghazzewi F, Mcculloch E, Connolly M. Glucomannan hydrolysate (GMH) inhibition ofCandida albicansgrowth in the presence ofLactobacillusandLactococcusspecies. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.1080/08910600802355726] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alastair Sutherland
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Elaine Mcculloch
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Michael Connolly
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
36
|
Abstract
Sexual transmission is the most common route of spread of human immunodeficiency virus (HIV), with heterosexual transmission of HIV infection accounting for 90% of those infected in 1992 and over 75% of the 10–12 million of those infected to date worldwide. Yet, heterosexual transmission is poorly understood. Since HIV can be transmitted from HIV-infected people who are asymptomatic as well as from those who have the acquired immunodeficiency syndrome (AIDS), we must better define the potential for transmission of HIV from HIV-infected individuals as well as the factors which influence the susceptibility of HIV-uninfected individuals.
Collapse
|
37
|
|
38
|
Brotman RM, Ghanem KG, Klebanoff MA, Taha TE, Scharfstein DO, Zenilman JM. The effect of vaginal douching cessation on bacterial vaginosis: a pilot study. Am J Obstet Gynecol 2008; 198:628.e1-7. [PMID: 18295180 DOI: 10.1016/j.ajog.2007.11.043] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 10/17/2007] [Accepted: 11/19/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of the study was to evaluate the risk for bacterial vaginosis (BV) in a douching cessation trial. STUDY DESIGN Thirty-nine reproductive-age women who reported use of douche products were enrolled into a 20-week study consisting of a 4 week douching observation (phase I) followed by 12-weeks of douching cessation (phase II). In phase III, participants then chose to resume douching or continue cessation for the remaining 4 weeks. Self-collected vaginal samples were obtained twice weekly in the first 16 weeks, and 1 sample was collected during week 20 (1107 samples total). BV was diagnosed by Nugent score of 7 or greater. Conditional logistic regression was used to evaluate douching cessation on the risk of BV. RESULTS The adjusted odds ratio (aOR) for BV in the douching cessation phase, as compared with the douching-observation phase was 0.76 (95% confidence interval [CI], 0.33 to 1.76). Among women who reported their primary reason for douching was to cleanse after menstruation, BV was significantly reduced in douching cessation (aOR:0.23; 95% CI, 0.12 to 0.44). CONCLUSION Vaginal douching cessation may reduce the risk for BV in a subset of women.
Collapse
|
39
|
Kalra A, Palcu CT, Sobel JD, Akins RA. Bacterial vaginosis: Culture- and PCR-based characterizations of a complex polymicrobial disease’s pathobiology. Curr Infect Dis Rep 2008; 9:485-500. [DOI: 10.1007/s11908-007-0074-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
40
|
Schellenberg J, Blake Ball T, Lane M, Cheang M, Plummer F. Flow cytometric quantification of bacteria in vaginal swab samples self-collected by adolescents attending a gynecology clinic. J Microbiol Methods 2008; 73:216-26. [PMID: 18423913 DOI: 10.1016/j.mimet.2008.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 02/12/2008] [Accepted: 03/04/2008] [Indexed: 01/19/2023]
Abstract
Bacterial vaginosis (BV) is an important risk factor in reproductive health outcomes, such as pre-term birth and sexually transmitted infections including HIV. However, its etiology, diagnosis and treatment remain poorly defined. We evaluated flow cytometry as a tool to quantify total bacterial cells in vaginal specimens self-collected longitudinally by adolescents. BV was diagnosed by Gram-stain (criteria of Hay and Ison). Average flow cytometric counts of bacterial cell-units (BCU) was log(10) 8.04 per gram sample and was found to correlate with sample weight (p<0.0001). BV was frequently observed in this group, with 22 of 32 participants (69%) diagnosed with BV for at least one timepoint. Surprisingly, increased BCU was associated with normal Hay-Ison score (p=0.0003), even when adjusting for sample weight (p=0.02). Since presence and quantity of Lactobacillus defines normal vaginal microbiology (ie. absence of BV), this result indicates a possible bias towards dominance of Lactobacillus cells in measurements of "total" BCU. Increased BCU per gram was associated in multivariate analysis with longer self-reported time since last menstruation (p=0.004) and last sexual intercourse (p=0.007). Sperm was detected in 3 samples provided by those reporting sexual intercourse in the previous 24 h. Light-scattering profiles of bacteria and vaginal cells in samples collected over time from an individual were often identical and distinct from other individuals. To our knowledge, this is the first description of flow cytometry for analysis of commensal bacteria in vaginal specimens. Further development may help to illuminate the complex dynamics of vaginal microbial communities underlying BV.
Collapse
Affiliation(s)
- John Schellenberg
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | | | | | | | | |
Collapse
|
41
|
Riordan T. Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre's syndrome. Clin Microbiol Rev 2007; 20:622-59. [PMID: 17934077 PMCID: PMC2176048 DOI: 10.1128/cmr.00011-07] [Citation(s) in RCA: 351] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Human infection with Fusobacterium necrophorum usually involves F. necrophorum subsp. funduliforme rather than F. necrophorum subsp. necrophorum, which is a common pathogen in animals. Lemierre's syndrome, or postanginal sepsis, is the most common life-threatening manifestation. Tonsillitis is followed by septic thrombophlebitis of the internal jugular vein and then a septicemia with septic emboli in lungs and other sites. Recent evidence suggests that F. necrophorum can be limited to the throat and cause persistent or recurrent tonsillitis. F. necrophorum is unique among non-spore-forming anaerobes, first for its virulence and association with Lemierre's syndrome as a monomicrobial infection and second because it seems probable that it is an exogenously acquired infection. The source of infection is unclear; suggestions include acquisition from animals or human-to-human transmission. Approximately 10% of published cases are associated with infectious mononucleosis, which may facilitate invasion. Recent work suggests that underlying thrombophilia may predispose to internal jugular vein thrombophlebitis. Lemierre's syndrome was relatively common in the preantibiotic era but seemed to virtually disappear with widespread use of antibiotics for upper respiratory tract infection. In the last 15 years there has been a rise in incidence, possibly related to restriction in antibiotic use for sore throat.
Collapse
Affiliation(s)
- Terry Riordan
- Microbiology Department, Royal Devon & Exeter Foundation Trust, Exeter, United Kingdom.
| |
Collapse
|
42
|
Nyirjesy P, McIntosh MJ, Gattermeir DJ, Schumacher RJ, Steinmetz JI, Joffrion JL. The effects of intravaginal clindamycin and metronidazole therapy on vaginal lactobacilli in patients with bacterial vaginosis. Am J Obstet Gynecol 2006; 194:1277-82. [PMID: 16647910 DOI: 10.1016/j.ajog.2005.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2005] [Revised: 10/23/2005] [Accepted: 11/04/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effects of 3 intravaginal antibacterial treatments on vaginal lactobacilli in patients with bacterial vaginosis (BV). STUDY DESIGN Retrospective analyses were performed on Lactobacillus scores from 3 similar studies evaluating 2 2% clindamycin vaginal creams and 0.75% metronidazole gel at baseline and at 21 to 30 days in 408 patients with BV. Scores were compared using a 1-way global F test and McNemar's test. RESULTS All groups had similar mean Lactobacillus scores at baseline (P = 0.37) and at 21 to 30 days (P = .71). The 3 groups were also comparable at both visits with respect to the distributions of scores within each group. In all groups, there was significant improvement in the percentages of patients with no lactobacilli present at 21 to 30 days compared with baseline (P < .0001 for all comparisons). CONCLUSION Clindamycin and metronidazole promoted similar levels of restoration of vaginal lactobacilli at 21 to 30 days.
Collapse
Affiliation(s)
- Paul Nyirjesy
- Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA 19102, USA.
| | | | | | | | | | | |
Collapse
|
43
|
Decena DCD, Co JT, Manalastas RM, Palaypayon EP, Padolina CS, Sison JM, Dancel LA, Lelis MA. Metronidazole with Lactacyd vaginal gel in bacterial vaginosis. J Obstet Gynaecol Res 2006; 32:243-51. [PMID: 16594932 DOI: 10.1111/j.1447-0756.2006.00383.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIM To assess the efficacy and tolerability of lactic acid (Lactacyd vaginal gel; LVG) when given as an adjunct to metronidazole in the treatment of bacterial vaginosis (BV) among Filipino patients. METHODS A multicenter, open-labeled, controlled, randomized, three-arm comparative study on 90 women aged 18 years or over with clinically and microbiologically proven BV. RESULTS The lactobacilli colony count significantly increased over time in all three arms. At day 14, growth of lactobacilli was significantly higher among patients in the lactic acid gel and combination treatment arms. Significant reduction of malodorous vaginal discharge (whiff test) and lowest recurrence of BV were noted in the metronidazole plus lactic acid gel arm. Regarding disappearance of signs of BV, there was significant decrease in the pH level and frequency of clue cell positive patients across time but was not significantly different across treatment groups. Only one patient (3%, 1/60) among those who received lactic acid gel complained of increased curd-like discharge. Six patients (10%, 6/60) who received metronidazole complained of epigastric pain/discomfort, dizziness and dyspnea. CONCLUSIONS Lactic acid gel (LVG) is safe and as efficacious as metronidazole in the treatment of BV. There is evidence that LVG when combined with metronidazole is superior to metronidazole alone in promoting lactobacilli colonization. LVG as an adjunct to metronidazole, having the least number of recurrent BV, appears to result in better long-term treatment effect on bacterial vaginosis.
Collapse
|
44
|
Coolen MJL, Post E, Davis CC, Forney LJ. Characterization of microbial communities found in the human vagina by analysis of terminal restriction fragment length polymorphisms of 16S rRNA genes. Appl Environ Microbiol 2006; 71:8729-37. [PMID: 16332868 PMCID: PMC1317315 DOI: 10.1128/aem.71.12.8729-8737.2005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To define and monitor the structure of microbial communities found in the human vagina, a cultivation-independent approach based on analyses of terminal restriction fragment length polymorphisms (T-RFLP) of 16S rRNA genes was developed and validated. Sixteen bacterial strains commonly found in the human vagina were used to construct model communities that were subsequently used to develop efficient means for the isolation of genomic DNA and an optimal strategy for T-RFLP analyses. The various genera in the model community could best be resolved by digesting amplicons made using bacterial primers 8f and 926r with HaeIII; fewer strains could be resolved using other primer-enzyme combinations, and no combination successfully distinguished certain species of the same genus. To demonstrate the utility of the approach, samples from five women that had been collected over a 2-month period were analyzed. Differences and similarities among the vaginal microbial communities of the women were readily apparent. The T-RFLP data suggest that the communities of three women were dominated by a single phylotype, most likely species of Lactobacillus. In contrast, the communities of two other women included numerically abundant populations that differed from Lactobacillus strains whose 16S rRNA genes had been previously determined. The T-RFLP profiles of samples from all the women were largely invariant over time, indicating that the kinds and abundances of the numerically dominant populations were relatively stable throughout two menstrual cycles. These findings show that T-RFLP of 16S rRNA genes can be used to compare vaginal microbial communities and gain information about the numerically dominant populations that are present.
Collapse
Affiliation(s)
- Marco J L Coolen
- Laboratory of Microbial Ecology, Center for Ecological and Evolutionary Studies, University of Groningen, Haren, The Netherlands
| | | | | | | |
Collapse
|
45
|
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.
Collapse
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.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Genç MR, Karaşahin E, Onderdonk AB, Bongiovanni AM, Delaney ML, Witkin SS. Association between vaginal 70-kd heat shock protein, interleukin-1 receptor antagonist, and microbial flora in mid trimester pregnant women. Am J Obstet Gynecol 2005; 192:916-21. [PMID: 15746691 DOI: 10.1016/j.ajog.2004.09.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study investigated the association among the inducible 70-kd heat shock protein, cytokines, and microbial flora in the vagina in mid trimester pregnant women and subsequent preterm delivery. STUDY DESIGN Vaginal samples from 205 pregnant women, which were collected at 18 to 22 weeks of gestation, were analyzed for qualitative and quantitative vaginal microflora and for 70-kd heat shock protein, interleukin-1beta, interleukin-1 receptor antagonist, and tumor necrosis factor-alpha by enzyme-linked immunosorbent assay. Pregnancy outcome data were obtained subsequently. RESULTS The 70-kd heat shock protein was detected in 38 vaginal samples (18.5%). Its presence was associated with elevated vaginal pH, a diagnosis of bacterial vaginosis, and elevated interleukin-1 receptor antagonist levels (P < .001). Among women with bacterial vaginosis, 70-kd heat shock protein-positive subjects had a >80% increase in median vaginal concentration of interleukin-1 receptor antagonist (P < .05). CONCLUSION Vaginal 70-kd heat shock protein expression is associated with the down-regulation of the proinflammatory immune response to abnormal vaginal flora in mid trimester pregnant women.
Collapse
Affiliation(s)
- Mehmet R Genç
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital, Harvard Medical School, Boston, Mass, USA
| | | | | | | | | | | |
Collapse
|
47
|
De Martino SJ, Mahoudeau I, Brettes JP, Piemont Y, Monteil H, Jaulhac B. Peripartum bacteremias due to Leptotrichia amnionii and Sneathia sanguinegens, rare causes of fever during and after delivery. J Clin Microbiol 2005; 42:5940-3. [PMID: 15583348 PMCID: PMC535221 DOI: 10.1128/jcm.42.12.5940-5943.2004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report three cases of delivery and postpartum bacteremia due to unusual anaerobic bacteria in healthy young women. Leptotrichia amnionii bacteremia occurred during delivery in two mothers and was associated with fetal distress during labor. Conversely, Sneathia sanguinegens bacteremia occurred postpartum, 2 days after delivery, without consequence for the neonate.
Collapse
Affiliation(s)
- S J De Martino
- Institute of Bacteriology, Faculty of Medicine, Louis Pasteur University and Strasbourg University Hopsital, Strasbourg, France.
| | | | | | | | | | | |
Collapse
|
48
|
Genc MR, Onderdonk AB, Vardhana S, Delaney ML, Norwitz ER, Tuomala RE, Paraskevas LR, Witkin SS. Polymorphism in intron 2 of the interleukin-1 receptor antagonist gene, local midtrimester cytokine response to vaginal flora, and subsequent preterm birth. Am J Obstet Gynecol 2004; 191:1324-30. [PMID: 15507961 DOI: 10.1016/j.ajog.2004.05.074] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigated the association between polymorphism in intron 2 of the interleukin-1 receptor antagonist gene, midtrimester vaginal microflora, vaginal interleukin receptor antagonist and interleukin-1beta levels and subsequent spontaneous preterm birth. STUDY DESIGN Vaginal samples from 212 women, collected at 18-22 weeks' gestation, were analyzed for the polymorphism in intron 2 of the interleukin-1 receptor antagonist gene by polymerase chain reaction, qualitative and quantitative vaginal microflora, and interleukin-1beta and interleukin-1ra concentrations by enzyme-linked immunosorbent assay. Pregnancy outcome data were subsequently obtained. RESULTS Carriage of intron 2 of the interleukin-1 receptor antagonist allele 2 (IL1RN * 2) was associated with an elevated vaginal pH in black ( P < .001) and white ( P = .005) women, a reduced interleukin-1beta response to anaerobic Gram-negative rods and/or Gardnerella vaginalis ( P < .01), and a decreased rate of spontaneous preterm deliveries (6% versus 18%, P = .02). In black women, IL1RN * 2 carriage was associated with increased anaerobic Gram-negative rods, Mycoplasma, and Peptostreptococci and decreased Lactobacilli colonization. CONCLUSION IL1RN * 2 carriage was associated with a blunted proinflammatory interleukin-1beta response to abnormal vaginal flora. This property may decrease susceptibility to infection-related preterm birth.
Collapse
Affiliation(s)
- Mehmet R Genc
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Genc MR, Vardhana S, Delaney ML, Onderdonk A, Tuomala R, Norwitz E, Witkin SS. Relationship between a toll-like receptor-4 gene polymorphism, bacterial vaginosis-related flora and vaginal cytokine responses in pregnant women. Eur J Obstet Gynecol Reprod Biol 2004; 116:152-6. [PMID: 15358455 DOI: 10.1016/j.ejogrb.2004.02.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Revised: 12/19/2003] [Accepted: 02/04/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The relationship between a single nucleotide polymorphism (TLR4 896 A > G) in the toll-like receptor-4 (TLR4) gene, qualitative and quantitative changes in vaginal micro-flora and vaginal interleukin (IL)-1beta and IL-1 receptor antagonist (IL-1ra) concentrations in pregnant women were evaluated. STUDY DESIGN Qualitative and quantitative microbial methods were used to characterize vaginal micro-flora of 238 women at 18-22 weeks gestation. Polymerase chain reaction was used to determine TLR4 genotype. IL-1beta and IL-1ra concentrations in vaginal lavage samples were measured by ELISA. RESULTS The TLR4 variant was identified in 10.3% of women. Carriage of this variant was associated with a median increase in vaginal pH (P = 0.05), a greater than 10-fold increase in vaginal Gardnerella vaginalis levels (P < 0.0001) and a 10-fold increase in the vaginal concentration of three species of anaerobic Gram-negative rods, Prevotella, Bacteroides, and Porphyromonas (P = 0.08 ). Colonization with G. vaginalis and/or the anaerobic Gram-negative rods resulted in elevated vaginal IL-1 (P = 0.01) and IL-1ra (P < 0.0002) concentrations in women who were TLR4 896A homozygotes, but not in TLR4 896G carriers. CONCLUSION The TLR4 896 A > G polymorphism contributes to inter-individual differences in the vaginal immune defense against G. vaginalis and anaerobic Gram-negative rods.
Collapse
Affiliation(s)
- Mehmet R Genc
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | |
Collapse
|
50
|
Genc MR, Witkin SS, Delaney ML, Paraskevas LR, Tuomala RE, Norwitz ER, Onderdonk AB. A disproportionate increase in IL-1beta over IL-1ra in the cervicovaginal secretions of pregnant women with altered vaginal microflora correlates with preterm birth. Am J Obstet Gynecol 2004; 190:1191-7. [PMID: 15167817 DOI: 10.1016/j.ajog.2003.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This purpose of this study was to investigate the association between vaginal microflora, concentrations of interleukin-1beta (IL-1beta), and its natural receptor antagonist (IL-1ra) in the cervicovaginal discharge, and spontaneous preterm birth. Study design Vaginal samples collected at 18 to 22 weeks' gestation from 207 women were analyzed to study qualitative and quantitative microbiologic aspects of vaginal microflora and IL-1beta and IL-1ra concentrations. RESULTS Among women colonized with anaerobic Gram-negative rods and/or Gardnerella vaginalis, an elevated IL-1beta concentration, or a diminished IL-1ra:IL-1beta ratio were associated with preterm delivery. A cut-off IL-1ra:IL-1beta ratio of <8632:1 optimally discriminated the subjects with subsequent spontaneous preterm deliveries from subjects who delivered at term, with a sensitivity of 78%, specificity of 51%, positive predictive value of 21%, and negative predictive value of 95%. CONCLUSION A disproportionate increase in IL-1beta over IL-1ra in response to vaginal colonization with anaerobic Gram-negative rods and/or G. vaginalis at 18 to 22 weeks' gestation is associated with spontaneous preterm delivery.
Collapse
Affiliation(s)
- Mehmet R Genc
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | |
Collapse
|