Abstract
Vaginal infection is a gynecological problem in women of reproductive age with multiple health outcomes. The most common forms of infection include bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and aerobic vaginitis (AV). Our main goals were to evaluate different types of vaginal infections in Ecuadorian women in a large urban area (Quito) and to characterize the vaginal microbiota colonization by opportunistic species. We collected vaginal swabs and epidemiological surveys from 414 women from June 2016 to July of 2017. We analyzed vaginal samples for the presence of any vaginal infection. The microbiological examination was done through Gram-stain, wet mount smears, and polymerase chain reaction (PCR) assays using primers for target genes, such as 16S rRNA (Atopobium vaginae, Mobiluncus mulieris, and Gardnerella species), ddl (Enterococcus faecalis), adk (Escherichia coli) and KER1 (Candida albicans) genes. Most women showed a healthy vaginal microbiota (66.7%). Nearly one-tenth (10.4%) of the participants had intermediate microbiota, and the remaining women (22.9%) had a single vaginal infection (BV, AV, or VC) or coinfections. From the 95 participants that had an infection, AV was the main diagnosed vaginal infection (51.6%), followed by BV (24.2%) and finally VC (7.4%). The remaining women (16.8%) showed coinfections, being BV and AV the most common coinfection. Using univariable logistic regression analyses we found an increased odds of healthy microbiota in women with a sexual partner (P = 0.02, OR = 1.64). Also, women in a free union relationship (P = 0.000, OR = 16.65) had an increased odds of having coinfections. On the other hand, the use of birth control (condom OR = 0.388 or other contraceptive method OR = 0.363) was associated with significantly lower odds of intermediate microbiota (P ≤ 0.05). We found no statistically significant differences between women with infection and a particular group age. Using multivariate logistic regression analyses we initially found an increased odds of having BV in women with M. mulieris (P = 0.020, OR = 4.98) and Gardnerella species (P = 0.010, OR = 4.16). Women with E. coli showed an increased odds of having AV (P = 0.009, OR = 2.81). The presence of C. albicans in women showed an increased odds of having VC (P = 0.007, OR = 17.94). Finally, women with M. mulieris showed a reverse odds of having healthy microbiota (P = 0.008, OR = 0.06). We found no statistically significant differences between women with symptomatic and asymptomatic infections or the presence of Enterococcus faecalis. We found using logistic regression analyses that M. mulieris was the most prevalent opportunistic pathogen among women with vaginal infection. Further studies should evaluate the possibility to use M. mulieris as a potential key predictor for vaginal infections.
Highlights
Vaginal infection is a gynecological problem in women of reproductive age with multiple health outcomes
When analyzing sociodemographic factors or behavioral variables simultaneously associated with all vaginal infections, we found that only unprofessional women (P = 0.048, OR = 2.33, 95% CI = 1.01–5.37) shared an increased odds of having any vaginal infection but lost its statistical significance after BH adjustment
To the authors’ knowledge, this is the first epidemiologic analysis done in Ecuador to evaluate the prevalence of key pathogens involved in the etiology of the different types of vaginal infections described in the literature
Summary
Vaginal infection is a gynecological problem in women of reproductive age with multiple health outcomes. Women with M. mulieris showed a reverse odds of having healthy microbiota (P = 0.008, OR = 0.06). Little is known about other types of vaginal microbiota in which Lactobacillus species do not dominate When this ecosystem gets disrupted, the vaginal epithelium is less protected, and vaginal infection sets in. Vaginal infections are characterized by a shift in microbial communities that include a progressive replacement of certain Lactobacillus species by pathogenic or opportunistic m icroorganisms[3,4] This microbial shift can lead to different vaginal infections such as bacterial vaginosis (BV) usually associated with several anaerobic or facultative bacteria, the most prevalent being: G. vaginalis; Atopobium sp.; Prevotella sp.; Bacteroides sp.; Peptostreptococcus sp.; Mobiluncus sp.; Sneathia sp.; Leptotrichia sp.; and genital Mycoplasma, such. Aerobic vaginitis (AV) can be frequently caused by E. coli, E. faecalis, among other aerobic b acteria[3]
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