1
|
Pagar R, Deshkar S, Mahore J, Patole V, Deshpande H, Gandham N, Mirza S, Junnarkar M, Nawani N. The microbial revolution: Unveiling the benefits of vaginal probiotics and prebiotics. Microbiol Res 2024; 286:127787. [PMID: 38851010 DOI: 10.1016/j.micres.2024.127787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/10/2024]
Abstract
Vaginal health is essential to a woman's overall well-being, as abnormalities in vaginal health can lead to a variety of gynaecological disorders, such as urinary tract infections, yeast infections, and bacterial vaginosis. The vaginal microbiome is essential for the prevention of these infections. Disruptions in this microbial ecosystem can significantly impact vaginal health. The concept of utilizing probiotics and prebiotics to stimulate the growth of protective vaginal microbiota has gathered substantial interest in recent years. Probiotics are live micro-organisms that strengthen and restore vaginal microbial balance by lowering pH levels, production of bacteriocins, biofilm disruption, modulation of immune response, and production of hydrogen peroxide (H2O2), consequently combating the development of pathogens. Prebiotics are oligosaccharides that encourage the development of probiotics such as lactobacilli species. Probiotics and prebiotics also have some broader implications for vaginal health, including their role in minimizing the incidence of premature birth, optimizing fertility, managing menopausal symptoms, and preventing vaginal infections. Synbiotics are a combination of probiotics and prebiotics that deliver additional benefits by encouraging the development and activity of beneficial microbes. Furthermore, postbiotics are bioactive compounds derived from probiotic bacteria during fermentation that have immunomodulatory actions and provide an additional layer of protection against vaginal infections. The present study highlights the most prevalent vaginal infections and limitations of existing therapies that influence the vaginal microbiota. The profound consequences of probiotics and prebiotics in women's health, including their role in minimizing the prevalence of vaginal infections and promoting overall vaginal health, as well as advanced therapeutic strategies such as synbiotics and postbiotics, are also discussed. The literature offers significant insights into the mechanism, efficacy, and safety of probiotics and prebiotics to healthcare providers and researchers.
Collapse
Affiliation(s)
- Roshani Pagar
- Department of Pharmaceutics, Dr. D. Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, India
| | - Sanjeevani Deshkar
- Department of Pharmaceutics, Dr. D. Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, India.
| | - Jayashri Mahore
- Department of Pharmaceutics, Dr. D. Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, India
| | - Vinita Patole
- Department of Pharmaceutics, Dr. D. Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, India
| | - Hemant Deshpande
- Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India
| | - Nageswari Gandham
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India
| | - Shahzad Mirza
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India
| | - Manisha Junnarkar
- Microbial Diversity Research Centre, Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Pune, India
| | - Neelu Nawani
- Microbial Diversity Research Centre, Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Pune, India
| |
Collapse
|
2
|
Wu S, Lin X, Hui KM, Yang S, Wu X, Tan Y, Li M, Qin AQ, Wang Q, Zhao Q, Ding P, Shi K, Li XJ. A Biochemiluminescent Sialidase Assay for Diagnosis of Bacterial Vaginosis. Sci Rep 2019; 9:20024. [PMID: 31882933 PMCID: PMC6934538 DOI: 10.1038/s41598-019-56371-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/07/2019] [Indexed: 12/25/2022] Open
Abstract
Bacterial vaginosis (BV) is a common condition among women of reproductive age. A sensitive, quantitative and rapid assay is needed for the diagnosis of and, particularly, therapy monitoring for BV. Bacterial sialidase appears to play an important role in bacterial biofilms on vaginal epithelium, a condition closely associated with BV. Here, we report a biochemiluminescent sialidase assay that uses a substrate derivatized with firefly luciferin. In the presence of sialidase in the reaction, the substrate is cleaved to release luciferin, which is subsequently oxidized by firefly luciferase to generate a light signal. Thus, the light signal intensity can be used to detect and measure the relative concentration of sialidase in a vaginal sample as a means of BV diagnosis. All reagents are present in a reagent bead and sample buffer, enabling essentially a one-step assay. The assay is highly sensitive and quantitative, with a sensitivity and specificity of 95.40% and 94.94%, respectively, compared to the Amsel method. Interestingly, only 27.6% of those with BV had high levels of sialidase activity with a signal to cutoff ratio of 10 or more. The assay may be used for diagnosis of BV, risk assessment of BV patients in terms of sialidase activity levels, and monitoring antibiotic therapy.
Collapse
Affiliation(s)
- Shengjun Wu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China.
| | - Xuexiang Lin
- Cellex (Shenzhen), Incorporated, Shenzhen, 518081, China
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Kwok Min Hui
- Cellex (Shenzhen), Incorporated, Shenzhen, 518081, China
- Cellex, Incorporated, Research Triangle Park, NC, 27709, United States
| | - Su Yang
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Xuanlan Wu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yichen Tan
- Cellex (Shenzhen), Incorporated, Shenzhen, 518081, China
| | - Meimei Li
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Ai-Qing Qin
- Cellex (Shenzhen), Incorporated, Shenzhen, 518081, China
| | - Qingxi Wang
- Jinan Central Hospital, Jinan, 250013, China
| | - Qi Zhao
- Yuhuangding Hospital, Yantai, 264000, China
| | - Pengfei Ding
- College of Automation, Hangzhou Danzi University, Hangzhou, 310018, China
| | - Kaisheng Shi
- Cellex (Shenzhen), Incorporated, Shenzhen, 518081, China
| | - X James Li
- Cellex (Shenzhen), Incorporated, Shenzhen, 518081, China.
- Cellex, Incorporated, Research Triangle Park, NC, 27709, United States.
| |
Collapse
|
3
|
Wang Y, Guo W, Wu X, Zhang Y, Mannion C, Brouchkov A, Man YG, Chen T. Oncolytic Bacteria and their potential role in bacterium-mediated tumour therapy: a conceptual analysis. J Cancer 2019; 10:4442-4454. [PMID: 31528208 PMCID: PMC6746139 DOI: 10.7150/jca.35648] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
As the human microbiota has been confirmed to be of great significance in maintaining health, the dominant bacteria in them have been applied as probiotics to treat various diseases. After the detection of bacteria in tumours, which had previously been considered a sterile region, these bacteria have been isolated and genetically modified for use in tumour therapy. In this review, we sum up the main types of bacteria used in tumour therapy and reveal the mechanisms of both wild type and engineered bacteria in eliminating tumour cells, providing potential possibilities for newly detected, genetically modified, tumour-associated bacteria in anti-tumour therapy.
Collapse
Affiliation(s)
- Yuqing Wang
- Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi 330031, PR China
| | - Wenxuan Guo
- Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi 330031, PR China
| | - XiaoLi Wu
- JiangXi university of traditional Chinese medicine, College of basic medicine, Nanchang 330000, PR China
| | - Ying Zhang
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ciaran Mannion
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Anatoli Brouchkov
- Lomonosov Moscow State University, Leninskie Gory, Moscow 119991, Russia.,Tyumen State University, Volodarskogo 6, Tyumen 625003, Russia
| | - Yan-Gao Man
- Department of Pathology, Hackensack Meridian Health-Hackensack University Medical Center, NJ, USA
| | - Tingtao Chen
- Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi 330031, PR China
| |
Collapse
|
4
|
Koppolu S, Wang L, Mathur A, Nigam JA, Dezzutti CS, Isaacs C, Meyn L, Bunge KE, Moncla BJ, Hillier SL, Rohan LC, Mahal LK. Vaginal Product Formulation Alters the Innate Antiviral Activity and Glycome of Cervicovaginal Fluids with Implications for Viral Susceptibility. ACS Infect Dis 2018; 4:1613-1622. [PMID: 30183260 DOI: 10.1021/acsinfecdis.8b00157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Glycosylated proteins (i.e., mucins, IgG) are important mediators of innate antiviral immunity in the vagina; however, our current knowledge of the role that glycan themselves play in genital immunity is relatively low. Herein, we evaluate the relationship between innate antiviral immunity and glycomic composition in cervicovaginal lavage fluid (CVL) collected as part of a Phase I clinical trial testing the impact of two distinct formulations of the antiretroviral drug dapivirine. Using lectin microarray technology, we discovered that formulation (hydrogel- versus film-based delivery) impacted the CVL glycome, with hydrogel formulations inducing more changes, including a loss of high-mannose. The loss of this epitope correlated to a loss of anti-HIV-1 activity. Glycoproteomic identification of high-mannose proteins revealed a cohort of antiproteases shown to be important in HIV-1 resistance, whose expression covaried with the high-mannose signature. Our data strongly suggests high-mannose as a marker for secreted proteins mediating innate antiviral immunity in vaginal fluids and that drug formulation may impact this activity as reflected in the glycome.
Collapse
Affiliation(s)
- Sujeethraj Koppolu
- Biomedical Chemistry Institute, Department of Chemistry, New York University, 100 Washington Square East, New York, New York 10003, United States
| | - Linlin Wang
- Biomedical Chemistry Institute, Department of Chemistry, New York University, 100 Washington Square East, New York, New York 10003, United States
| | - Ayushi Mathur
- Biomedical Chemistry Institute, Department of Chemistry, New York University, 100 Washington Square East, New York, New York 10003, United States
| | - Jayeshwar A. Nigam
- Biomedical Chemistry Institute, Department of Chemistry, New York University, 100 Washington Square East, New York, New York 10003, United States
| | - Charlene S. Dezzutti
- Magee-Womens Research Institute, 204 Craft Avenue, B511, Pittsburgh, Pennsylvania 15213, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, Pennsylvania 15213, United States
| | - Charles Isaacs
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, New York, New York 10314, United States
| | - Leslie Meyn
- Magee-Womens Research Institute, 204 Craft Avenue, B511, Pittsburgh, Pennsylvania 15213, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, Pennsylvania 15213, United States
| | - Katherine E. Bunge
- Magee-Womens Research Institute, 204 Craft Avenue, B511, Pittsburgh, Pennsylvania 15213, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, Pennsylvania 15213, United States
| | - Bernard J. Moncla
- Magee-Womens Research Institute, 204 Craft Avenue, B511, Pittsburgh, Pennsylvania 15213, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, Pennsylvania 15213, United States
| | - Sharon L. Hillier
- Magee-Womens Research Institute, 204 Craft Avenue, B511, Pittsburgh, Pennsylvania 15213, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, Pennsylvania 15213, United States
| | - Lisa C. Rohan
- Magee-Womens Research Institute, 204 Craft Avenue, B511, Pittsburgh, Pennsylvania 15213, United States
- Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
| | - Lara K. Mahal
- Biomedical Chemistry Institute, Department of Chemistry, New York University, 100 Washington Square East, New York, New York 10003, United States
| |
Collapse
|
5
|
Abstract
: Bacterial vaginosis, characterized by the replacement of the Lactobacillus-dominant microbiota with anaerobic bacteria and facultative Gram-negative rods, has been associated with adverse reproductive health outcomes including HIV acquisition. With the advent of newer molecular techniques, the vaginal microbiota can be investigated in more detail and the association with HIV examined more thoroughly. This review examines recent evidence suggesting that vaginal dysbiosis with increased microbial diversity, specific vaginal bacterial communities, and the presence and concentrations of some individual bacterial species, may increase HIV susceptibility. Potential mechanisms through which vaginal microbiota could impact HIV susceptibility are discussed. On the basis of the available data, this review finds that there is a modest, but growing, body of evidence linking vaginal microbiota to HIV susceptibility in women. The evidence could be strengthened through two main pathways. First, laboratory studies such as ex-vivo or animal experiments are needed to move from plausible mechanisms towards proven mechanisms that explain an effect of the vaginal microbiota on HIV susceptibility. Second, experimental evidence could directly test the hypothesis that sustaining optimal microbiota reduces HIV risk, though there are important obstacles to conducting such studies. Finally, this review examines strong evidence from a recent publication suggesting that deviations from an optimal vaginal microbiome, and particularly the presence of some bacterial communities with high relative abundance of Gardnerella vaginalis, reduces the efficacy of vaginal tenofovir-based microbicides.
Collapse
|
6
|
Alcendor DJ. Evaluation of Health Disparity in Bacterial Vaginosis and the Implications for HIV-1 Acquisition in African American Women. Am J Reprod Immunol 2016; 76:99-107. [PMID: 26847837 PMCID: PMC4942368 DOI: 10.1111/aji.12497] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/07/2016] [Indexed: 01/16/2023] Open
Abstract
There is a health disparity for both bacterial vaginosis (BV) and human immunodeficiency virus type 1 (HIV-1) infection in African American women that may be linked. The evidence that BV predisposes women to higher risk for HIV infection is well documented. The underlying mechanisms to support the epidemiological connections will require further investigations. This review explores the risk factors for BV disease with implications for HIV-1 acquisition in the context of race as a potential driver of the 20-fold increase in HIV-1 acquisition for African American women compared to white women. Specifically, it explores (i) disparities for BV in African American women, (ii) racial disparity for HIV-1 acquisition in African American women, (iii) common factors associated with BV and HIV acquisition in African American women, and (iv) potential mechanisms of the enhancement of HIV-1 transmission by BV.
Collapse
Affiliation(s)
- Donald J Alcendor
- Center for AIDS Health Disparities Research, Department of Microbiology and Immunology, Meharry Medical College, School of Medicine, Nashville, TN, USA
| |
Collapse
|
7
|
Thurman AR, Kimble T, Herold B, Mesquita PM, Fichorova RN, Dawood HY, Fashemi T, Chandra N, Rabe L, Cunningham TD, Anderson S, Schwartz J, Doncel G. Bacterial Vaginosis and Subclinical Markers of Genital Tract Inflammation and Mucosal Immunity. AIDS Res Hum Retroviruses 2015. [PMID: 26204200 DOI: 10.1089/aid.2015.0006] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Bacterial vaginosis (BV) has been linked to an increased risk of human immunodeficiency virus (HIV) acquisition and transmission in observational studies, but the underlying biological mechanisms are unknown. We measured biomarkers of subclinical vaginal inflammation, endogenous antimicrobial activity, and vaginal flora in women with BV and repeated sampling 1 week and 1 month after completion of metronidazole therapy. We also compared this cohort of women with BV to a healthy control cohort without BV. A longitudinal, open label study of 33 women with a Nugent score of 4 or higher was conducted. All women had genital swabs, cervicovaginal lavage (CVL) fluid, and cervicovaginal biopsies obtained at enrollment and received 7 days of metronidazole treatment. Repeat sampling was performed approximately 1 week and 1 month after completion of therapy. Participant's baseline samples were compared to a healthy, racially matched control group (n=13) without BV. The CVL from women with resolved BV (Nugent 0-3) had significantly higher anti-HIV activity, secretory leukocyte protease inhibitor (SLPI), and growth-related oncogene alpha (GRO-α) levels and their ectocervical tissues had significantly more CD8 cells in the epithelium. Women with persistent BV after treatment had significantly higher levels of interleukin-1β, tumor necrosis factor alpha (TNF-α), and intercellular adhesion molecule 1 (ICAM-1) in the CVL. At study entry, participants had significantly greater numbers of CCR5(+) immune cells and a higher CD4/CD8 ratio in ectocervical tissues prior to metronidazole treatment, compared to a racially matched cohort of women with a Nugent score of 0-3. These data indicate that BV is associated with changes in select soluble immune mediators, an increase in HIV target cells, and a reduction in endogenous antimicrobial activity, which may contribute to the increased risk of HIV acquisition.
Collapse
Affiliation(s)
| | - Thomas Kimble
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia
| | - Betsy Herold
- Albert Einstein College of Medicine, Bronx, New York
| | | | - Raina N. Fichorova
- Laboratory of Genital Tract Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hassan Y. Dawood
- Laboratory of Genital Tract Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Titilayo Fashemi
- Laboratory of Genital Tract Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Lorna Rabe
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | | | | | - Jill Schwartz
- CONRAD, Eastern Virginia Medical School, Arlington, Virginia
| | - Gustavo Doncel
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia
- CONRAD, Eastern Virginia Medical School, Arlington, Virginia
| |
Collapse
|
8
|
Impact of Hydroxychloroquine-Loaded Polyurethane Intravaginal Rings on Lactobacilli. Antimicrob Agents Chemother 2015; 59:7680-6. [PMID: 26416871 DOI: 10.1128/aac.01819-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/25/2015] [Indexed: 12/18/2022] Open
Abstract
The use of polymeric devices for controlled sustained delivery of drugs is a promising approach for the prevention of HIV-1 infection. Unfortunately, certain microbicides, when topically applied vaginally, may be cytotoxic to vaginal epithelial cells and the protective microflora present within the female genital tract. In this study, we evaluated the impact of hydroxychloroquine (HCQ)-loaded, reservoir-type, polyurethane intravaginal rings (IVRs) on the growth of Lactobacillus crispatus and Lactobacillus jensenii and on the viability of vaginal and ectocervical epithelial cells. The IVRs were fabricated using hot-melt injection molding and were capable of providing controlled release of HCQ for 24 days, with mean daily release rates of 17.01 ± 3.6 μg/ml in sodium acetate buffer (pH 4) and 29.45 ± 4.84 μg/ml in MRS broth (pH 6.2). Drug-free IVRs and the released HCQ had no significant effects on bacterial growth or the viability of vaginal or ectocervical epithelial cells. Furthermore, there was no significant impact on the integrity of vaginal epithelial cell monolayers, in comparison with controls, as measured by transepithelial electrical resistance. Overall, this is the first study to evaluate the effects of HCQ-loaded IVRs on the growth of vaginal flora and the integrity of vaginal epithelial cell monolayers.
Collapse
|
9
|
Wang L, Koppolu S, Chappell C, Moncla BJ, Hillier SL, Mahal LK. Studying the effects of reproductive hormones and bacterial vaginosis on the glycome of lavage samples from the cervicovaginal cavity. PLoS One 2015; 10:e0127021. [PMID: 25993513 PMCID: PMC4439148 DOI: 10.1371/journal.pone.0127021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/10/2015] [Indexed: 01/15/2023] Open
Abstract
The cervicovaginal fluid (CVF) coating the vaginal epithelium is an important immunological mediator, providing a barrier to infection. Glycosylation of CVF proteins, such as mucins, IgG and S-IgA, plays a critical role in their immunological functions. Although multiple factors, such as hormones and microflora, may influence glycosylation of the CVF, few studies have examined their impact on this important immunological fluid. Herein we analyzed the glycosylation of cervicovaginal lavage (CVL) samples collected from 165 women under different hormonal conditions including: (1) no contraceptive, post-menopausal, (2) no contraceptive, days 1-14 of the menstrual cycle, (3) no contraceptive, days 15-28 of the menstrual cycle, (4) combined-oral contraceptive pills for at least 6 months, (5) depo-medroxyprogesterone acetate (Depo-Provera) injections for at least 6 months, (6) levonorgestrel IUD for at least 1 month. Glycomic profiling was obtained using our lectin microarray system, a rapid method to analyze carbohydrate composition. Although some small effects were observed due to hormone levels, the major influence on the glycome was the presence of an altered bacterial cohort due to bacterial vaginosis (BV). Compared to normal women, samples from women with BV contained lower levels of sialic acid and high-mannose glycans in their CVL. The change in high mannose levels was unexpected and may be related to the increased risk of HIV-infection observed in women with BV, as high mannose receptors are a viral entry pathway. Changes in the glycome were also observed with hormonal contraceptive use, in a contraceptive-dependent manner. Overall, microflora had a greater impact on the glycome than hormonal levels, and both of these effects should be more closely examined in future studies given the importance of glycans in the innate immune system.
Collapse
Affiliation(s)
- Linlin Wang
- Biomedical Chemistry Institute, Department of Chemistry, New York University, New York, NY, 10003, United States of America
| | - Sujeethraj Koppolu
- Biomedical Chemistry Institute, Department of Chemistry, New York University, New York, NY, 10003, United States of America
| | - Catherine Chappell
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, United States of America
| | - Bernard J. Moncla
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, United States of America
- Magee-Womens Research Institute, Pittsburgh, PA, 15213, United States of America
| | - Sharon L. Hillier
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, United States of America
- Magee-Womens Research Institute, Pittsburgh, PA, 15213, United States of America
| | - Lara K. Mahal
- Biomedical Chemistry Institute, Department of Chemistry, New York University, New York, NY, 10003, United States of America
- * E-mail:
| |
Collapse
|
10
|
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]
|
11
|
Maternal vitamin D, folate, and polyunsaturated fatty acid status and bacterial vaginosis during pregnancy. Infect Dis Obstet Gynecol 2011; 2011:216217. [PMID: 22190843 PMCID: PMC3235789 DOI: 10.1155/2011/216217] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/25/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate associations among serum 25-hydroxy-vitamin D (25-OH-D), folate, omega-6/omega-3 fatty acid ratio and bacterial vaginosis (BV) during pregnancy. METHODS Biospecimens and data were derived from a random sample (N = 160) of women from the Nashville Birth Cohort. We compared mean plasma nutrient concentrations for women with and without BV during pregnancy (based on Nugent score ≥7) and assessed the odds of BV for those with 25-OH-D <12 ng/mL, folate <5 ug/L, and omega-6/omega-3 ratio >15. RESULTS The mean plasma 25-OH-D was significantly lower among women with BV during pregnancy (18.00±8.14 ng/mL versus 24.34±11.97 ng/mL, P = 0.044). The adjusted odds of BV were significantly increased among pregnant women with 25-OH-D <12 ng/mL (aOR 5.11, 95% CI: 1.19-21.97) and folate <5 ug/L (aOR 7.06, 95% CI: 1.07-54.05). CONCLUSION Vitamin D and folate deficiencies were strongly associated with BV (Nugent score ≥7) during pregnancy.
Collapse
|
12
|
Allsworth JE, Peipert JF. Severity of bacterial vaginosis and the risk of sexually transmitted infection. Am J Obstet Gynecol 2011; 205:113.e1-6. [PMID: 21514555 PMCID: PMC3156883 DOI: 10.1016/j.ajog.2011.02.060] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 01/11/2011] [Accepted: 02/17/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether the association between bacterial vaginosis (BV) and incident sexually transmitted infection (STI) varies with more extreme BV scores. STUDY DESIGN We analyzed the data from 535 women who were enrolled in a randomized trial to promote dual method contraceptive use. Incident STI was defined as any case of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, or pelvic inflammatory disease. BV was defined by Gram stain (Nugent score). STI risk was estimated with the use of proportional hazards regression. RESULTS Binary (0-6 vs 7-10) and 3-level (negative 0-3, intermediate 4-6, or BV 7-10) categorizations were not associated with time to STI; however, women with the highest Nugent scores (9-10) had a 2.1-fold increased risk of STI (95% confidence interval, 1.05-4.28), compared with women with normal flora. CONCLUSION Nugent score>8 is associated with incident STI. More accurate classification of BV will allow clinicians to identify those women who are at greatest risk of STI.
Collapse
Affiliation(s)
- Jenifer E Allsworth
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.
| | | |
Collapse
|
13
|
Thurman AR, Doncel GF. Innate immunity and inflammatory response to Trichomonas vaginalis and bacterial vaginosis: relationship to HIV acquisition. Am J Reprod Immunol 2011; 65:89-98. [PMID: 20678168 DOI: 10.1111/j.1600-0897.2010.00902.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Most women contract HIV-1 through sexual intercourse with an infected partner. Highly prevalent, unreported and often asymptomatic lower genital tract infections, including bacterial vaginosis (BV) and trichomoniasis (Trichomonas vaginalis- TV), increase a woman's susceptibility to HIV-1 genital infection, given an exposure. A review of the literature from 1989 to the present was conducted. This article will review potential mechanisms by which BV and TV serve as HIV-1-enhancing cofactors including (i) initiation of a clinical or subclinical mucosal inflammatory response, (ii) alteration of innate mucosal immunity, (iii) alteration of normal vaginal microflora and pH, and (iv) weakening or breach of intact cervico-vaginal mucosa. The transmission of HIV-1, in the absence of cofactors, is poorly efficient. Understanding the mechanisms by which these infections enhance HIV-1 acquisition is important to designing effective, safe and evidence-based prevention modalities.
Collapse
Affiliation(s)
- Andrea R Thurman
- Department of Obstetrics and Gynecology, CONRAD Clinical Research Center and CONRAD Microbicide Research Laboratory, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
| | | |
Collapse
|
14
|
|
15
|
Dobaria N, Mashru R. Design and in vitro evaluation of a novel bioadhesive vaginal drug delivery system for clindamycin phosphate. Pharm Dev Technol 2009; 15:405-14. [DOI: 10.3109/10837450903262058] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
Yoshimura K, Yoshimura M, Kobayashi T, Kubo T, Hachisuga T, Kashimura M. Can bacterial vaginosis help to find sexually transmitted diseases, especially chlamydial cervicitis? Int J STD AIDS 2009; 20:108-11. [PMID: 19182056 DOI: 10.1258/ijsa.2008.008249] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study was undertaken to establish reliable factors in order to identify chlamydial cervicitis among suspicious patients. Between January and December 2007, 406 patients who were suspected to have cervicitis due to clinical symptoms, were tested with polymerase chain reaction (PCR) for Chlamydia trachomatis (CT), vaginal pH and Nugent score (NS) in our University hospital and related clinics. During the same period, 67 patients who were diagnosed as having other sexually transmitted diseases (Neisseria gonorrhoeae (NG), Trichomonas vaginalis, Condyloma acuminatum and genital herpes) were also made to participate in this study. Eighty-nine women (22%) were positive for CT PCR. Bacterial vaginosis (BV)-positive women were tested positive for CT PCR (75/288), significantly higher than those without BV (6/66, P = 0.01). In addition, under 20-years old women were positive for CT PCR (24/57), significantly higher than those who were over 30 years old (16/113, P = 0.001). The proportion of patients with high NS (>7) in CT, NG and T. vaginalis cases were 75/89 (84.3%), 22/27 (81.5%) and 11/14 (78.6%), respectively. Whereas the high NS of the C. acuminatum and genital herpes groups were recorded at 7/14 (50%) and 4/12 (33.3%), respectively. Younger women with BV could be at a higher risk for STDs, especially for CT cervicitis.
Collapse
Affiliation(s)
- K Yoshimura
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | | | | | | | | | | |
Collapse
|
17
|
Viral Sexually Transmitted Infections and Bacterial Vaginosis: 2001–2004 National Health and Nutrition Examination Survey Data. Sex Transm Dis 2008; 35:791-6. [DOI: 10.1097/olq.0b013e3181788301] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Abstract
OBJECTIVES To assess and summarize the published literature on the extent to which bacterial vaginosis may increase the risk of HIV acquisition. DESIGN Meta-analysis of published studies. METHODS Medline and other electronic databases were systematically searched for eligible publications. The association between bacterial vaginosis and incident HIV was separately analyzed from that between bacterial vaginosis and prevalent HIV. The latter was further analyzed, stratified by bacterial vaginosis diagnostic method, HIV risk profile of the study population, and whether or not adjusted estimates were presented. RESULTS Twenty-three eligible publications were identified, including a total of 30,739 women. Bacterial vaginosis was associated with an increased risk of HIV acquisition in HIV-incidence studies (relative risk = 1.6, 95% confidence interval: 1.2, 2.1). All but one of 21 HIV-prevalence studies reported estimates above the null. The latter results were heterogeneous and showed some evidence of funnel plot asymmetry, precluding the estimation of a single summary measure. The association between bacterial vaginosis and HIV in prevalence studies appeared stronger for women without high-risk sexual behavior. CONCLUSION Bacterial vaginosis was consistently associated with an increased risk of HIV infection. High bacterial vaginosis prevalence may result in a high number of HIV infections being attributable to bacterial vaginosis. More prospective studies are needed to accurately evaluate the role of bacterial vaginosis in HIV acquisition in low-risk versus high-risk women. Furthermore, randomized clinical trials may be worth considering to determine the effect of bacterial vaginosis control measures on HIV acquisition.
Collapse
|
19
|
Abstract
Women are at significant risk of human immunodeficiency virus (HIV) and sexually transmitted infection (STI) acquisition with the genital mucosa serving as the main portal of infection. Exogenously supplied lactobacillus used as a probiotic may prove a cost-effective, female-initiated method to prevent HIV and STI infection in women. A probiotic may act indirectly through treating and preventing recurrent bacterial vaginosis or directly by secreting endogenous (e.g., hydrogen peroxide) and exogenous substances that block HIV and STI transmission. This review summarizes the preclinical and clinical studies that have been conducted so far to test probiotic bacteria for these purposes. Although significant progress has been made in this field, more fundamental research is required to better understand vaginal ecology to maximize probiotic formulations. Once identified, a suitable product will require testing in a well-designed, randomized, placebo-controlled trial to measure its effectiveness in augmenting antibiotic treatment to prevent bacterial vaginosis. If results from such a trial demonstrate efficacy, future studies should be designed to determine whether a probiotic can significantly lower the risk for HIV and STIs in at-risk female populations.
Collapse
|
20
|
Cole AM, Cole AL. Antimicrobial polypeptides are key anti-HIV-1 effector molecules of cervicovaginal host defense. Am J Reprod Immunol 2008; 59:27-34. [PMID: 18154593 DOI: 10.1111/j.1600-0897.2007.00561.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Mucosal surfaces of the cervix and vagina are portals for heterosexual transmission of human immunodeficiency virus type 1 (HIV-1) and, therefore, play a fundamental role in the pathogenesis of primary infection. Cationic antimicrobial polypeptides including defensins are the principal effector molecules of mucosal innate immunity against microbes and viruses such as HIV. In cervicovaginal secretions, antimicrobial polypeptides constitute the majority of the intrinsic anti-HIV-1 activity, synergism between cationic polypeptides is complex, and full anti-HIV-1 activity involves the complete complement of cationic polypeptides. Periods in which cationic antimicrobial polypeptide expression is reduced are likely associated with increased susceptibility to HIV-1 infection. This review provides an overview of the role of cationic antimicrobial polypeptides in innate cervicovaginal anti-HIV-1 host defense, and discusses how hormones and bacterial infections can regulate their expression. Emphasis is placed on the theta-defensin (retrocyclin) class of anti-HIV-1 peptides and their potential for development as topical microbicides to prevent HIV-1 transmission.
Collapse
Affiliation(s)
- Alexander M Cole
- Department of Molecular Biology and Microbiology, University of Central Florida, Orlando, FL, USA.
| | | |
Collapse
|
21
|
Schwebke JR, Desmond R. A randomized trial of metronidazole in asymptomatic bacterial vaginosis to prevent the acquisition of sexually transmitted diseases. Am J Obstet Gynecol 2007; 196:517.e1-6. [PMID: 17547876 PMCID: PMC1993882 DOI: 10.1016/j.ajog.2007.02.048] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 12/19/2006] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether treatment of bacterial vaginosis (BV) decreases the incidence of sexually transmitted diseases (STDs). STUDY DESIGN Women with asymptomatic BV were studied prospectively to determine the effect of treatment of BV for the prevention of STD. Women were assigned randomly to observation or treatment and prophylaxis with intravaginal metronidazole gel. Women were screened monthly for STDs. RESULTS Women who were assigned randomly to receive metronidazole gel had a significantly longer time to the development of STDs compared with women in the observation group (P = .02). The 6-month STD rate was 1.58 per person-year (95% CI, 1.29, 1.87) for women in the metronidazole gel group vs 2.29 per person-year (95% CI, 1.95, 2.63) for women in the observational group. The difference in STD rates was driven by a significant difference in the number of chlamydial infections (P = .013). CONCLUSION Treatment and twice-weekly prophylactic use of intravaginal metronidazole gel resulted in significantly fewer cases of chlamydia.
Collapse
Affiliation(s)
- Jane R. Schwebke
- *Corresponding Author (no reprints available), Jane R. Schwebke, M.D., University of Alabama at Birmingham, 703 19 Street, South, ZRB 239, Birmingham, AL 35294, 205-975-5665, 205-975-7764,
| | | |
Collapse
|
22
|
Allsworth JE, Peipert JF. Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey data. Obstet Gynecol 2007; 109:114-20. [PMID: 17197596 DOI: 10.1097/01.aog.0000247627.84791.91] [Citation(s) in RCA: 274] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the prevalence and correlates of bacterial vaginosis among women between the ages of 14 and 49 years in the United States. METHODS Data from the 2001-2001 and 2003-2004 National Health and Nutrition Examination Surveys were combined. Correlates of bacterial vaginosis evaluated included sociodemographic characteristics (age, race or ethnicity, education, poverty income ratio) and sexual history (age of first intercourse, number of sexual partners). Crude and adjusted odds ratios and 95% confidence intervals were estimated from logistic regression analyses. RESULTS Almost one third of women (29%) were positive for bacterial vaginosis. Bacterial vaginosis prevalence varied with age, race or ethnicity, education, and poverty. Black, non-Hispanic (odds ratio [OR] 3.13, 95% confidence interval [CI] 2.58-3.80) and Mexican-American (OR 1.29, 95% CI 0.99-1.69) women had higher odds of bacterial vaginosis than white, non-Hispanic women after adjustment for other sociodemographic characteristics. Douching in the past 6 months was also an important predictor of bacterial vaginosis prevalence (OR 1.93, 95% CI 1.54-2.40). CONCLUSION Bacterial vaginosis is a common condition among U.S. women, and the prevalence is similar to that in many treatment-seeking populations. Further studies are needed to disentangle the interactions between race or ethnicity and other sociodemographic characteristics. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Jenifer E Allsworth
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO 63110, USA.
| | | |
Collapse
|
23
|
Schwebke JR, Desmond RA. A randomized trial of the duration of therapy with metronidazole plus or minus azithromycin for treatment of symptomatic bacterial vaginosis. Clin Infect Dis 2006; 44:213-9. [PMID: 17173219 DOI: 10.1086/509577] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 07/31/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is the most common cause of vaginitis worldwide. Currently recommended treatments have poor efficacy and are associated with high rates of BV recurrence. We examined whether a longer duration of treatment with metronidazole or combination therapy with metronidazole and azithromycin would enhance the cure rates for BV. In addition, we examined factors other than drug therapy associated with cure. METHODS Women with symptomatic BV (defined by a modified Amsel criteria) were enrolled in a 4-arm study that compared metronidazole for 7 days versus 14 days, plus or minus azithromycin on days 1 and 3. Data regarding interim behaviors were also obtained, as were vaginal specimens for Gram staining. RESULTS At the first follow-up visit (7 days after the completion of therapy), there was a significant difference in cure rates among patients who received 7 days of metronidazole therapy, compared with those who received 14 days of therapy, combined across azithromycin therapy (P=.0003). There was no effect associated with azithromycin therapy. There were no differences in cure rates between any of the treatment groups at 21 days after completion of therapy. Abstinence or protected sex, refraining from douching, and a lower baseline Nugent score for the vaginal Gram stain were all significantly associated with cure. CONCLUSIONS Cure rates for BV were significantly improved by 14 days of metronidazole treatment (compared with 7 days of treatment), but the effects were not sustained, suggesting that relapse or reinfection occurred. Combination therapy with the addition of azithromycin had no benefit. Lower baseline Nugent scores--presumably reflecting less complex vaginal flora--were significantly associated with cure, as was refraining from unprotected sex and from douching.
Collapse
Affiliation(s)
- J R Schwebke
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | | |
Collapse
|
24
|
Watts DH, Springer G, Minkoff H, Hillier SL, Jacobson L, Moxley M, Justman J, Cejtin H, O'Connell C, Greenblatt RM. The Occurrence of Vaginal Infections Among HIV-Infected and High-Risk HIV-Uninfected Women. J Acquir Immune Defic Syndr 2006; 43:161-8. [PMID: 16951644 DOI: 10.1097/01.qai.0000242448.90026.13] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate changes over time in rates of bacterial vaginosis (BV), trichomoniasis (TV), and yeast vaginitis (YV) among HIV-infected and similar HIV-uninfected women. METHODS Two thousand fifty-six HIV-infected women and 554 HIV-uninfected women were evaluated semiannually from 1994 until March 2003 in a prospective cohort study. BV was diagnosed by Gram stain, TV by wet mount, and YV by symptoms with microscopically visible hyphae or positive culture. Trends were assessed using Poisson models. RESULTS At baseline, BV was present in 42.8% and 47.0% of HIV-infected and uninfected women (P = 0.21), TV in 6.1% and 7.8% (P = 0.17), and YV in 10.0% and 3.8% (P < 0.001). Over time, rates of BV and TV decreased significantly in both groups, whereas rates of YV declined only among HIV-infected women. Risk of BV was not associated with HIV status, whereas HIV-infected women had a lower risk of TV. Highly active antiretroviral therapy (HAART) use was associated with decreased risk of all 3 infections. CONCLUSIONS : Declines in BV, TV, and YV represent decreased morbidity for HIV-infected women and, potentially, decreased risk of transmission of HIV, because each has been associated with increased genital detection of HIV.
Collapse
Affiliation(s)
- D Heather Watts
- Pediatric, Adolescent, and Maternal AIDS Branch, Center for Research on Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
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
|
26
|
Myer L, Kuhn L, Stein ZA, Wright TC, Denny L. Intravaginal practices, bacterial vaginosis, and women's susceptibility to HIV infection: epidemiological evidence and biological mechanisms. THE LANCET. INFECTIOUS DISEASES 2005; 5:786-94. [PMID: 16310150 DOI: 10.1016/s1473-3099(05)70298-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intravaginal practices such as "dry sex" and douching have been suggested as a risk factor that may increase women's susceptibility to HIV infection. These behaviours appear common in different populations across sub-Saharan Africa, where practices include the use of antiseptic preparations, traditional medicines, or the insertion of fingers or cloths into the vagina. We systematically review the evidence for the association between women's intravaginal practices and HIV infection. Although a number of cross-sectional studies have shown that prevalent HIV infection is more common among women reporting intravaginal practices, the temporal nature of this association is unclear. Current evidence suggests that bacterial vaginosis, which is a likely risk factor for HIV infection, may be a mediator of the association between intravaginal practices and HIV. Although biologically plausible mechanisms exist, there is currently little epidemiological evidence suggesting that intravaginal practices increase women's susceptibility to HIV infection. Further research into factors that increase women's susceptibility to HIV will help to inform the design of vaginal microbicides and other HIV prevention interventions.
Collapse
Affiliation(s)
- Landon Myer
- Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | | | | | | | | |
Collapse
|
27
|
Verstraelen H, Delanghe J, Roelens K, Blot S, Claeys G, Temmerman M. Subclinical iron deficiency is a strong predictor of bacterial vaginosis in early pregnancy. BMC Infect Dis 2005; 5:55. [PMID: 16000177 PMCID: PMC1199597 DOI: 10.1186/1471-2334-5-55] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 07/06/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is the single most common vaginal infection in women of childbearing age and associated with a sizeable infectious disease burden among both non-pregnant and pregnant women, including a significantly elevated risk of adverse pregnancy outcome. Overall, little progress has been made in identifying causal factors involved in BV acquisition and persistence. We sought to evaluate maternal iron status in early pregnancy as a putative risk factor for BV, considering that micronutrients, and iron deficiency in particular, affect the host response against bacterial colonization, even in the setting of mild micronutrient deficiencies. METHODS In a nested case-control study, we compared maternal iron status at entry to prenatal care (mean gestational age 9.2 +/- 2.6 weeks) between eighty women with healthy vaginal microflora and eighteen women with vaginosis-like microflora. Vaginal microflora status was assessed by assigning a modified Nugent score to a Gram-stained vaginal smear. Maternal iron status was assayed by an array of conventional erythrocyte and serum indicators for iron status assessment, but also by more sensitive and more specific indicators of iron deficiency, including soluble transferrin receptors (sTfR) as an accurate measure of cellular and tissue iron deficiency and the iron deficiency log10[sTfR/ferritin] index as the presently most accurate measure of body storage iron available. RESULTS We found no statistically significant correlation between vaginal microflora status and routinely assessed iron parameters. In contrast, a highly significant difference between the healthy and vaginosis-like microflora groups of women was shown in mean values of sTfR concentrations (1.15 +/- 0.30 mg/L versus 1.37 +/- 0.38 mg/L, p = 0.008) and in mean iron deficiency log10[sTfR/ferritin] index values (1.57 +/- 0.30 versus 1.08 +/- 0.56, p = 0.003), indicating a strong association between iron deficiency and vaginosis-like microflora. An sTfR concentration > 1.45 mg/L was associated with a 3-fold increased risk (95%CI: 1.4-6.7) of vaginosis-like microflora and after controlling for maternal age, gestational length, body mass, parity, and smoking habits with an adjusted odds ratio of 4.5 (95%CI: 1.4-14.2). CONCLUSION We conclude that subclinical iron deficiency, presumably resulting from inadequate preconceptional iron supplies, is strongly and independently associated with vaginosis-like microflora during early pregnancy.
Collapse
Affiliation(s)
- Hans Verstraelen
- Department of Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Joris Delanghe
- Department of Clinical Chemistry, Microbiology and Immunology, Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Kristien Roelens
- Department of Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Stijn Blot
- Department of Intensive Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Geert Claeys
- Department of Clinical Chemistry, Microbiology and Immunology, Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Marleen Temmerman
- Department of Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| |
Collapse
|
28
|
Cohn JA, Hashemi FB, Camarca M, Kong F, Xu J, Beckner SK, Kovacs AA, Reichelderfer PS, Spear GT. HIV-Inducing Factor in Cervicovaginal Secretions Is Associated With Bacterial Vaginosis in HIV-1-Infected Women. J Acquir Immune Defic Syndr 2005; 39:340-6. [PMID: 15980696 PMCID: PMC3118994 DOI: 10.1097/01.qai.0000146599.47925.e0] [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: 11/26/2022]
Abstract
OBJECTIVE Certain cervicovaginal lavage (CVL) fluid samples obtained from HIV-1-infected and uninfected women stimulate in vitro HIV-1 replication. This activity, HIV-inducing factor (HIF), changes when CVL fluid is heated. We sought to confirm a previous observation that HIF was associated with bacterial vaginosis (BV). METHODS HIF was measured in unheated and heated CVL fluid obtained from HIV-1-infected women and compared with the presence of BV by Nugent scores, other genital tract conditions, and cervicovaginal HIV-1 shedding. RESULTS Among the 295 women studied, 54% of CVL samples had HIF activity and 21% showed heat-stable HIF activity. In adjusted logistic regression, heat-stable HIF was associated with BV (odds ratio [OR]=51.7, 95% confidence interval [CI]: 5.0, 530.7) and with intermediate flora (OR=43.3, 95% CI: 3.6, 521.1); heat-labile HIF was not associated with BV. Neither heat-stable nor heat-labile HIF was associated with other cervicovaginal conditions nor, after controlling for plasma viral load, with genital tract HIV-1 shedding. CONCLUSION We confirmed the association of HIF with BV and attribute it to the heat-stable component. Heat-stable activity is also associated, although less strongly, with intermediate vaginal flora. We propose that heat-stable HIF is a result of products of BV-associated bacteria.
Collapse
Affiliation(s)
- Jonathan A Cohn
- Division of Infectious Diseases, Department of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Bacterial vaginosis, vaginal flora patterns and vaginal hygiene practices in patients presenting with vaginal discharge syndrome in The Gambia, West Africa. BMC Infect Dis 2005; 5:12. [PMID: 15757510 PMCID: PMC1083415 DOI: 10.1186/1471-2334-5-12] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2004] [Accepted: 03/09/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) - a syndrome characterised by a shift in vaginal flora - appears to be particularly common in sub-Saharan Africa, but little is known of the pattern of vaginal flora associated with BV in Africa. We conducted a study aimed at determining the prevalence of BV and patterns of BV-associated vaginal micro-flora among women with vaginal discharge syndrome (VDS) in The Gambia, West Africa. METHODS We enrolled 227 women with VDS from a large genito-urinary medicine clinic in Fajara, The Gambia. BV was diagnosed by the Nugent's score and Amsel's clinical criteria. Vaginal swabs were collected for T vaginalis and vaginal flora microscopy, and for Lactobacillus spp, aerobic organisms, Candida spp and BV-associated bacteria (Gardnerella vaginalis, anaerobic bacteria, and Mycoplasma spp) cultures; and cervical swabs were collected for N gonorrhoeae culture and C trachomatis PCR. Sera were tested for HIV-1 and HIV-2 antibodies. Sexual health history including details on sexual hygiene were obtained by standardised questionnaire. RESULTS BV prevalence was 47.6% by Nugent's score and 30.8% by Amsel's clinical criteria. Lactobacillus spp were isolated in 37.8% of women, and 70% of the isolates were hydrogen-peroxide (H202)-producing strains. Prevalence of BV-associated bacteria were: G vaginalis 44.4%; Bacteroides 16.7%; Prevotella 15.2%; Peptostretococcus 1.5%; Mobiluncus 0%; other anaerobes 3.1%; and Mycoplasma hominis 21.4%. BV was positively associated with isolation of G vaginalis (odds-ratio [OR] 19.42, 95%CI 7.91 - 47.6) and anaerobes (P = 0.001 [OR] could not be calculated), but not with M hominis. BV was negatively associated with presence of Lactobacillus (OR 0.07, 95%CI 0.03 - 0.15), and H2O2-producing lactobacilli (OR 0.12, 95% CI 0.05 - 0.28). Presence of H2O2-producing lactobacilli was associated with significantly lower prevalence of G vaginalis, anaerobes and C trachomatis. HIV prevalence was 12.8%. Overall, there was no association between BV and HIV, and among micro-organisms associated with BV, only Bacteroides spp. and Prevotella spp. were associated with HIV. BV or vaginal flora patterns were not associated with any of the factors relating to sexual hygiene practices (vaginal douching, menstrual hygiene, female genital cutting). CONCLUSION In this population, BV prevalence was higher than in corresponding populations in industrialised countries, but the pattern of vaginal micro-flora associated with BV was similar. BV or vaginal flora patterns were not associated with HIV nor with any of the vaginal hygiene characteristics.
Collapse
|
30
|
Verbruggen BSM, Boon ME, van Schie MA, Wijsman-Grootendorst R, Kok LP. Dysbacteriosis in silver-stained cervical smears of Dutch-Moroccan immigrants: HPV infection and preneoplasia. Diagn Cytopathol 2005; 34:56-61. [PMID: 16355375 DOI: 10.1002/dc.20327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The vaginal/cervical smears of a group of Moroccan immigrants were used to compare vaginal dysbacteriosis (i.e., a bacterial population change with a decrease in lactobacilli and an increase of coccoid bacteria in vaginal/cervical smears) with Dutch women. From our archives, 779 smears from Moroccan immigrants were compared with 1,060 smears of age-matched Dutch women. For bacterial flora, Jones-Marres silver stains were used to define four groups. Koilocytosis and cervical intraepithelial neoplasia (CIN) were also recorded. The bacterial vaginal flora of Moroccan immigrants and Dutch women was different. The Moroccan women had a lower dysbacteriosis than Dutch women (3% vs. 24%). Koilocytosis and CIN were less frequent in the immigrant population. The possible synergy of a disturbed vaginal flora with human papillomavirus (HPV), HIV, or cervical preneoplasia indicates that vaginal hygiene and a normal flora may have positive effects on the uterine cervix.
Collapse
|
31
|
Abstract
BV is a prevalent sexually associated infection linked to several gynecologic complications and acquisition of STDs and acquisition and transmission of HIV. It seems that normalization of the vaginal flora may be effective for preventing short-term complications. The implications of screening and treating BV to prevent long-term complications are less clear and may depend on the availability of more effective treatment regimens.
Collapse
Affiliation(s)
- Jane R Schwebke
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 703 19th Street South, Zeigler Research Building #239, Birmingham, AL 35294-0007, USA.
| |
Collapse
|
32
|
West B, Morison L, Schim van der Loeff M, Gooding E, Awasana AA, Demba E, Mayaud P. Evaluation of a new rapid diagnostic kit (FemExam) for bacterial vaginosis in patients with vaginal discharge syndrome in The Gambia. Sex Transm Dis 2003; 30:483-9. [PMID: 12782948 DOI: 10.1097/00007435-200306000-00003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diagnosis of bacterial vaginosis (BV) in resource-poor primary health care settings is often overlooked; there is a need for a cheap, rapid, objective point-of-care diagnostic test. GOAL The goal was to determine the prevalence of BV and to evaluate the performance of a new commercial diagnostic test kit in a developing country environment. STUDY DESIGN Vaginal and cervical swabs were collected from 230 consecutive women attending a genitourinary medicine clinic with reported symptoms of vaginal discharge and/or itching. Etiological testing was carried out. BV was diagnosed on the basis of the Nugent score, the Amsel clinical criteria, and results of FemExam card tests. Card 1 is for pH and amines, and card 2 measures proline iminopeptidase (PIP) activity. RESULTS BV prevalence was 47.9% according to the Nugent score. When compared with the Nugent score, the Amsel clinical criteria had a sensitivity of 77.9% and specificity of 58.4%, FemExam card 1 had a sensitivity of 71.4% and specificity of 72.8%, FemExam card 2 had a sensitivity of 70% and specificity of 81.0%, and FemExam cards 1 and 2 combined had a sensitivity of 91.0% and specificity of 61.5%. Cost per patient and cost per true case detected ranged from US $0.74 and US $1.54, respectively, for Gram stain diagnosis, to US $8.32 and US $18.49 for the FemExam two-card method. CONCLUSIONS In a setting where BV was frequently associated with vaginal discharge, the FemExam test compared favorably with conventional clinical diagnosis, and it has the advantage of being rapid, less subjective, and easily performed. Cutting its cost would provide wider accessibility in developing countries.
Collapse
Affiliation(s)
- Beryl West
- MRC Laboratories, Fajara, PO Box 273, Banjul, The Gambia.
| | | | | | | | | | | | | |
Collapse
|
33
|
Antonio MAD, Hillier SL. DNA fingerprinting of Lactobacillus crispatus strain CTV-05 by repetitive element sequence-based PCR analysis in a pilot study of vaginal colonization. J Clin Microbiol 2003; 41:1881-7. [PMID: 12734221 PMCID: PMC154705 DOI: 10.1128/jcm.41.5.1881-1887.2003] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lactobacillus crispatus is one of the predominant hydrogen peroxide (H(2)O(2))-producing species found in the vagina and is under development as a probiotic for the treatment of bacterial vaginosis. In this study, we assessed whether DNA fingerprinting by repetitive element sequence-based PCR (rep-PCR) can be used to distinguish the capsule strain of L. crispatus (CTV-05) from other endogenous strains as well as other species of vaginal lactobacilli. Vaginal and rectal lactobacilli were identified to the species level by using whole-chromosome probe DNA hybridization. The DNAs from L. crispatus, L. jensenii, L. gasseri, and an as-yet-unnamed H(2)O(2)-negative Lactobacillus species designated 1086V were subjected to rep-PCR. The results of gel electrophoresis and ethidium bromide staining of the DNA fingerprints obtained were compared. L. crispatus CTV-05 had a unique DNA fingerprint compared to all other lactobacilli. DNA fingerprints for 27 production lots of L. crispatus sampled from 1994 through 2001 were identical to that of the original strain isolated in 1993, suggesting strain stability. In a pilot study of nine women, this DNA fingerprinting method distinguished CTV-05 from other endogenous vaginal lactobacilli prior to and after vaginal capsule use. rep-PCR DNA fingerprinting is useful for strain typing and for evaluating longitudinal loss or acquisition of vaginal lactobacilli used as probiotics.
Collapse
Affiliation(s)
- May A D Antonio
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
34
|
Politch JA, Anderson DJ. Use of assisted reproductive technology to prevent the transmission of HIV-1 in HIV-discordant couples desiring children. Immunol Allergy Clin North Am 2002. [DOI: 10.1016/s0889-8561(02)00020-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
35
|
Martino JL, Vermund SH. Vaginal douching: evidence for risks or benefits to women's health. Epidemiol Rev 2002; 24:109-24. [PMID: 12762087 PMCID: PMC2567125 DOI: 10.1093/epirev/mxf004] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jenny L Martino
- Schools of Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | |
Collapse
|
36
|
Abstract
This article describes the sexual behaviours of some pregnant women that contribute to vaginal and cervical infections, and describes their lack of awareness about the dangers associated with sexually transmitted infections during pregnancy. It presents a subanalysis of data from a principal epidemiological study of the association between preterm delivery and genital hygiene habits and sexual behaviour during pregnancy. One-hundred and nine postpartum women were questioned about high-risk sexual behaviours during their pregnancies, their partner's sexually transmitted disease status and their knowledge about the effect of sexually transmitted infections on their pregnancy. Global concerns about the prevalence, diagnosis and treatment of cervical and vaginal infection from sexually transmitted diseases are discussed. The dangers associated with high-risk sexual behaviours during pregnancy, and recommendations for clinicians, are included.
Collapse
Affiliation(s)
- J M Dwyer
- Department of Maternal/Child Health, Boston College School of Nursing, Boston, MA, USA.
| |
Collapse
|
37
|
|
38
|
Vermund SH, Sarr M, Murphy DA, Levin L, Abdalian SE, Ma Y, Crowley-Nowick PA, Wilson CM. Douching practices among HIV infected and uninfected adolescents in the United States. J Adolesc Health 2001; 29:80-6. [PMID: 11530307 DOI: 10.1016/s1054-139x(01)00284-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To characterize sexual behaviors and sociodemographic factors that are associated with douching among geographically diverse adolescent women with and without HIV infection. METHODS HIV infected subjects recruited preferentially and behaviorally comparable high-risk HIV uninfected subjects were enrolled in a prospective HIV study from 15 sites in 13 U.S. cities. Baseline interview data from 1996 to 1999 for females aged 12 to 19 years were analyzed using one-way analysis of variance and multiple logistic regression. RESULTS Among the 342 females/young women, 74.9% were black (non-Hispanic), 11.1% Hispanic/Latina, and 14.0% white or other race/ethnicity; 63.5% were HIV infected. Young women who had dropped out of high school comprised 23.4% of subjects. In the 3 months before the interview, 179 (52.3%) adolescents had douched at least once. In a multivariable logistic regression model, recent douching was more common among sexually active females (OR = 2.2; 95% CI: 1.2-4.2), Blacks (OR = 2.2; 95% CI: 1.2-4.1 vs. Hispanics/Whites/others), females who dropped out of high school (OR = 2.1; 95% CI: 1.2-3.7), and HIV infected females (OR = 1.7; 95% CI: 1.04-2.7). CONCLUSIONS In this nationwide study, adolescents who are sexually active, African-American, dropped out of high school, and HIV infected were most likely to douche. Interventions to discourage douching should pay special attention to these populations.
Collapse
Affiliation(s)
- S H Vermund
- University of Alabama at Birmingham, Birmingham, Alabama 35294-2170, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Affiliation(s)
- M Morris
- HIV & AIDS Division, Communicable Disease Surveillance Centre, London, UK
| | | | | | | | | |
Collapse
|
40
|
Morris M, Nicoll A, Simms I, Wilson J, Catchpole M. Bacterial vaginosis: a public health review. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0306-5456(00)00124-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
41
|
Abstract
BACKGROUND The cause of bacterial vaginosis remains poorly understood. Recent evidence strengthens the association between bacterial vaginosis and serious medical complications. GOAL To review the evidence linking bacterial vaginosis with adverse pregnancy outcomes, complications after gynecologic procedures, and HIV infection, and to identify prevention strategies. METHODS In March 1999, the Centers for Disease Control and Prevention organized a conference to accomplish this goal. RESULTS Better understanding is needed concerning the etiology, epidemiology, and natural history of bacterial vaginosis. More efficacious treatment of bacterial vaginosis and strategies to reduce maternal complications associated with bacterial vaginosis, such as premature rupture of the fetal membranes, chorioamnionitis, premature labor and delivery, postdelivery endometritis, and postpartum infant complications should be developed. Recent evidence shows that screening and treatment of bacterial vaginosis before abortion reduces postabortion pelvic inflammatory disease, and that anaerobic coverage during hysterectomy reduces postoperative complications. Better understanding concerning the relation of bacterial vaginosis to acquisition of sexually transmitted diseases and HIV infection are needed as well as possible prevention strategies. CONCLUSIONS A national prevention effort should be guided by the results of research that addresses current knowledge gaps.
Collapse
Affiliation(s)
- E H Koumans
- Division of STD Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | | |
Collapse
|
42
|
Abstract
Recent evidence has linked bacterial vaginosis with acquisition of sexually transmitted diseases, including HIV infection. Prospective data show that women with bacterial vaginosis are at a significantly higher risk for HIV infection than those without bacterial vaginosis. The hallmark of bacterial vaginosis is the shift in the microbiology of the vaginal flora away from a lactobacilli-predominant milieu. In particular, lactobacilli that produce hydrogen peroxide are notably absent. Hydrogen peroxide-producing lactobacilli have been shown in vitro to be virucidal to HIV. Thus, the lack of these apparently protective bacteria, along with other local changes resulting from the shift in microflora, is thought to represent a biological risk factor for HIV acquisition.
Collapse
Affiliation(s)
- Jane R. Schwebke
- University of Alabama at Birmingham, 703 South 19th Street, Zeigler Research Building, Room 239, Birmingham, AL 35294-0007, USA.
| |
Collapse
|
43
|
Warren D, Klein RS, Sobel J, Kieke B, Brown W, Schuman P, Anderson J, Cu-Uvin S, Mayer K, Jamieson DJ, Holmberg S, Duerr A. A multicenter study of bacterial vaginosis in women with or at risk for human immunodeficiency virus infection. Infect Dis Obstet Gynecol 2001; 9:133-41. [PMID: 11516061 PMCID: PMC1784649 DOI: 10.1155/s1064744901000242] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Bacterial vaginosis is a common gynecologic infection that has been associated with a variety of gynecologic and obstetric complications, including pelvic inflammatory disease, postabortal infection and premature delivery. Recent studies suggest that bacterial vaginosis may increase a woman's risk for human immunodeficiency virus (HIV). We undertook this study to assess whether the prevalence and characteristics of bacterial vaginosis differed according to HIV status in high-risk US women. METHODS Prevalence of bacterial vaginosis was assessed by Gram's stain and clinical criteria for 854 HIV-infected and 434 HIV-uninfected women enrolled in the HIV Epidemiology Research (HER) Study. Multiple logistic regression techniques were used to determine whether HIV infection independently predicted bacterial vaginosis. RESULTS Almost half (46%) the women had bacterial vaginosis by Gram's stain. The prevalence of bacterial vaginosis was 47% in the HIV-positive women compared with 44% in the HIV-negative women; this difference was not statistically significant (p = 0.36). After adjustment for other covariates, HIV-positive women were more likely than HIV-negative women to have bacterial vaginosis (odds ratio (OR) 1.31; 95% confidence interval (CI) 1.01-1.70) by Gram's stain but not by clinical criteria (OR 1.16; CI 0.87-1.55). Among HIV-positive women, use of antiretroviral drugs was associated with a lower prevalence of bacterial vaginosis (adjusted OR 0.54; Cl 0.38-0.77). CONCLUSIONS In this cross-sectional analysis of high-risk US women, HIV infection was positively correlated with bacterial vaginosis diagnosed by Gram's stain.
Collapse
Affiliation(s)
- Dora Warren
- Centers for Disease Control and Prevention AtlantaGAUSA
| | - Robert S. Klein
- Division of Infectious DiseasesDepartment of Medicine and the Department of Epidemiology and Social Medicine Montefiore Medical Center and Albert Einstein College of MedicineBronxNYUSA
| | - Jack Sobel
- Division of Infectious DiseasesWayne State University School of MedicineDepartment of MedicineDetroitMIUSA
| | - Burney Kieke
- Centers for Disease Control and Prevention AtlantaGAUSA
| | - William Brown
- Department of PathologyWayne State University School of MedicineDetroitMIUSA
| | - Paula Schuman
- Division of Infectious DiseasesWayne State University School of MedicineDepartment of MedicineDetroitMIUSA
| | - Jean Anderson
- Division of Obstetrics and GynecologyJohns Hopkins School of MedicineBaltimoreMDUSA
| | - Susan Cu-Uvin
- Division of Infectious DiseasesDepartment of MedicineMiriam and Memorial Hospitals and Brown University School of MedicineProvidenceRIUSA
| | - Kenneth Mayer
- Division of Infectious DiseasesDepartment of MedicineMiriam and Memorial Hospitals and Brown University School of MedicineProvidenceRIUSA
| | - Denise J. Jamieson
- Centers for Disease Control and Prevention AtlantaGAUSA
- 1600 Clifton Road, Mailstop E-45Division of HIV/AIDS PreventionNational Center for HIV, STD, TB PreventionCenters for Disease Control and PreventionAtlantaGA30333USA
| | | | - Ann Duerr
- Centers for Disease Control and Prevention AtlantaGAUSA
| |
Collapse
|
44
|
Coggins C, Blanchard K, Alvarez F, Brache V, Weisberg E, Kilmarx PH, Lacarra M, Massai R, Mishell D, Salvatierra A, Witwatwongwana P, Elias C, Ellertson C. Preliminary safety and acceptability of a carrageenan gel for possible use as a vaginal microbicide. Sex Transm Infect 2000; 76:480-3. [PMID: 11221133 PMCID: PMC1744249 DOI: 10.1136/sti.76.6.480] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We sought to determine the safety and acceptability of vaginal gel formulation PC-503 among low risk, abstinent women. The active ingredient was 2% pharmaceutical grade lambda carrageenan, a sulphated polymer that is generally recognised as safe by the US Food and Drug Administration. METHODS 35 women in five sites applied 5 ml of the PC-503 gel vaginally once a day for 7 days while abstaining from sexual intercourse. Visual vaginal examinations were performed on days 1, 4, and 8. STI testing and vaginal pool Gram stain preparations were done on days 1 and 8. Participants were asked about product acceptability. RESULTS 34 of the 35 women enrolled completed 7 days' use. Following product use, five reported mild symptoms including "bladder fullness," "genital warmth," or discomfort, and lower abdominal pain, and one had moderate pale yellow cervical discharge. Using the Nugent criteria, three women had bacterial vaginosis (BV) before and after use; three had BV before but not after, and two had BV after but not before. Most of the women found PC-503 to be pleasant or neutral in feel and smell and considered extra lubrication to be an advantage; however, one third found it to be messy. CONCLUSIONS Vaginal use of PC-503 gel did not cause significant adverse effects in a small number of low risk, sexually abstinent women. Further testing in larger numbers of sexually active women is planned. A smaller volume of gel may be more acceptable to some women.
Collapse
Affiliation(s)
- C Coggins
- Population Council, New York 10017, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Bachmann LH, Lewis I, Allen R, Schwebke JR, Leviton LC, Siegal HA, Hook EW. Risk and prevalence of treatable sexually transmitted diseases at a Birmingham substance abuse treatment facility. Am J Public Health 2000; 90:1615-8. [PMID: 11029998 PMCID: PMC1446369 DOI: 10.2105/ajph.90.10.1615] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the prevalence of gonorrhea, chlamydia, trichomoniasis, and syphilis in patients entering residential drug treatment. METHODS Data on sexual and substance abuse histories were collected. Participants provided specimens for chlamydia and gonorrhea ligase chain reaction testing. Trichomonas vaginalis culture, and syphilis serologic testing. RESULTS Of 311 patients, crack cocaine use was reported by 67% and multisubstance use was reported by 71%. Sexually transmitted disease (STD) risk behaviors were common. The prevalence of infection was as follows: Chlamydia trachomatis, 2.3%; Neisseria gonorrhoeae, 1.6%; trichomoniasis, 43%; and syphilis, 6%. CONCLUSIONS STD counseling and screening may be a useful adjunct to inpatient drug treatment.
Collapse
Affiliation(s)
- L H Bachmann
- Department of Medicine, University of Alabama at Birmingham 35924-0007, USA.
| | | | | | | | | | | | | |
Collapse
|
46
|
Stein MD, Cunningham WE, Nakazono T, Asch S, Turner BJ, Crystal S, Andersen RM, Zierler S, Bozzette SA, Shapiro MF. Care of vaginal symptoms among HIV-infected women. J Acquir Immune Defic Syndr 2000; 25:51-5. [PMID: 11064504 DOI: 10.1097/00042560-200009010-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Gynecologic disease is common in HIV-infected women. We examine the sociodemographic, clinical, and provider factors associated with the care of women with vaginal symptoms. METHODS Women enrolled in the HIV Cost and Services Utilization Study (HCSUS), a nationally representative probability sample of HIV-infected adults, were interviewed between January 1996 and April 1997. Women with vaginal symptoms who sought medical attention were asked, "Did your health care provider examine your vaginal area?" Women were also asked if they received medication for their symptoms. RESULTS Among 154 women with vaginal symptoms, 127 sought care for their symptoms. Of those who sought care, 48% saw a gynecologist and 52% sought care from nongynecologists, most often their usual HIV care provider. Women who saw a gynecologist for their symptoms were more likely to have received a pelvic examination (92% versus 76%; p =.06) and vaginal fluid collection (98% versus 88%; p =.06) than those who saw their regular HIV provider. Fifteen percent of women received medication for their symptoms without having a pelvic examination; gynecologists were less likely to prescribe without an examination (8% versus 21%; p =.12). CONCLUSION Gynecologists are more likely to provide adequate care of vaginal symptoms among HIV-infected women than nongynecologists who were HIV care providers. This specialty difference is consistent with quality of care studies for other medical conditions, but the potential gynecologic complications of inadequate evaluation and treatment warrants further investigation.
Collapse
Affiliation(s)
- M D Stein
- Division of General Medicine, Brown University, Providence, Rhode Island 02903, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
|