Abnormal Vaginal Microbiota Research Articles

Investigating the impact of persistent HPV infection on recurrence of lesions post-surgery for early-stage cervical cancer and related influencing factors.

To explore the influencing factors of recurrence after surgical treatment for early-stage cervical cancer (stages IA1-IIA1) and to investigate the relationship between human papillomavirus (HPV) infection and postoperative recurrence of lesions. A retrospective analysis was conducted on the clinical data of 242 patients who underwent surgical treatment for early-stage cervical cancer (FIGO stages IA1-IIA1) at the Second Affiliated Hospital of Dalian Medical University between 2015 and 2022. Cox regression analysis was employed to evaluate the relationship between persistent postoperative HPV infection and lesion vaginal local recurrence while identifying the associated risk factors for persistent HPV infection following surgery. Within 12 months postoperatively, the HPV clearance rate was 88.11%. HPV infection persisted beyond 12 months in 19 patients (7.9%), with 3 cases demonstrating the same HPV genotypes (types 52, 58) as those identified preoperatively. Multivariate analysis identified persistent postoperative HPV infection (odds ratio [OR] 1.72, 95% confidence interval [CI] -1.14 to 5, p=0.001*) as an independent risk factor for recurrence. Additionally, smoking (OR 7.49, 95% CI 1.19 to 47.13, p=0.032), abnormal vaginal microbiota (OR 0.663, 95% CI 0.403 to 1.088, p=0.001*), and the type of surgical procedure (OR 0.32, 95% CI 0.11 to 0.91, p=0.033) were significantly associated with a higher rate of persistent HPV infection. Persistent HPV infection after surgery is an independent risk factor for postoperative recurrence in early-stage cervical cancer. Surgical approach, abnormal vaginal microbiota, and smoking are associated factors for persistent HPV infection after surgery.

In vitro evaluation of the immunomodulatory and antibacterial activities of calcitriol (1,25-dihydroxy-vitamin D3) as a potential application for aerobic vaginitis treatment - preliminary study results

BackgroundAerobic vaginitis (AV) is a state of abnormal vaginal microbiota, which is associated with increased numbers of aerobic, enteric bacteria and inflammation of the vaginal epithelium. Anti-microbial treatment combined with anti-inflammatory therapy could be useful in the treatment of this condition. It is known that calcitriol, the active form of vitamin D, plays an important role in modulating the immune response in several inflammatory diseases. The aim of this preliminary study was to evaluate in vitro the influence of calcitriol on the immune response of human vaginal epithelial cells to bacterial infection. Moreover, we assessed the anti-bacterial properties of calcitriol, as well as its synergistic activity with antibiotics that are used for the treatment of AV.ResultsHuman vaginal A431 epithelial cells were treated with calcitriol (100 nM) and then stimulated with thermally inactivated strains of AV-associated bacteria (Escherichia coli, Enterococcus faecalis, Streptococcus agalactiae), or first stimulated with heat-treated bacteria and then incubated with calcitriol (30 nM). After 24 h, 48 h, and 72 h post-infection, culture supernatants were collected, and levels of pro-inflammatory cytokines IL-6 and IL-1β were analyzed using enzyme-linked immunosorbent assays (ELISA). As it turned out, calcitriol treatment pre- or post-bacterial stimulation of vaginal epithelial cells significantly decreased the levels of IL-6 and IL-1β compared to cells stimulated only with bacteria. Downregulation of pro-inflammatory cytokines was more frequently significant when cells were pre-treated with calcitriol. Additionally, this study evaluated the anti-bacterial properties and synergistic activity of calcitriol with antibiotics by determining the Minimal Inhibitory Concentration (MIC) using colorimetric, Resazurin-based microdilution method detecting the active metabolism of bacteria. As a result, calcitriol by itself did not exhibit clinically relevant anti-bacterial activity; however, when combined with antibiotics, calcitriol significantly reduced the MIC values.ConclusionsThe results of this preliminary study confirm that calcitriol treatment influences cytokine-mediated immune response during infection and indicate that it can be effective in enhancing antibiotic activity. Such properties could be very useful in the treatment of inflammatory diseases. However, conclusions regarding the potential use of calcitriol in the treatment of AV require further confirmation in in vivo studies as well as in well-designed clinical trials.

Factors associated with Trichomonas vaginalis infection in reproductive-aged women attending cervical screening in southeast of Brazil.

Factors associated with Trichomonas vaginalis infection in reproductive-aged women attending cervical screening in southeast of Brazil.

P-439 Intimate hygiene practices and the correlation with abnormal vaginal microbiota in in vitro fertilization (IVF) patients – a cohort study in 1421 patients

Abstract Study question What are the intimate hygiene practices of women in IVF treatment and do they correlate with the vaginal microbiota? Summary answer Hygiene practices, in specific douching and use of intimate soap significantly increased the risk of abnormal vaginal microbiota (AVM). What is known already The normal vaginal microbiota acts as a defense system against infection. AVM is a molecularly defined vaginal dysbiosis, resembling bacterial vaginosis (BV) and is dominated by anaerobic bacteria such as Gardnerella vaginalis. Importantly, AVM is associated with an increased risk of genital tract infections, poor IVF outcomes, early miscarriage and preterm labor. The cause of AVM is multifactorial and hygiene practices may interrupt the normal microbiota. Previous small studies suggested vaginal douching to be associated with an increased risk of AVM. Few studies have investigated the possible correlation between intimate hygiene practices, menstrual practices and the vaginal microbiota. Study design, size, duration Observational cohort study, including a total of 1421 IVF patients from four Danish fertility centers. The inclusion period was from 2017 to January 2022. Participants/materials, setting, methods Patients aged 18-42 years and undergoing their first, second or third IVF stimulation cycle were eligible for inclusion. The intimate hygiene practices in terms of type of soap, menstrual protection, douching and probiotics, were reported in a structured questionnaire including a total of 40 questions. Vaginal swabs were obtained prior to ovarian stimulation and subsequently subjected to quantitative PCR testing, targeting DNA of dysbiotic bacteria. Main results and the role of chance AVM was present in a total of 34 % (479/1421) of women, and 20% (272/1384) reported vaginal douching, which significantly correlated with AVM (p < 0.01, OR = 1.62 [1.23-2.12]). Intimate soap was used by 39 % (535/1384) of patients, which also significantly increased the risk of AVM ( P = 0.04, OR = 1.35 [1.08-1.69]). Water only was used by 36% (492/1384), and regular soap was used by 27% (374/1384). No correlation between use of water only and regular soap and AVM was detected. For menstrual protection 40% (433/1078) used pads, followed by tampons alone 25% (265/1078) or a combination 21% (230/1078), and 14 % (148/1078) used a menstrual cup. A trend for an increased risk of AVM when using tampons, OR 1.21 [0.91-1.62] was seen whereas use of a menstrual cup seemed to lower the risk of AVM, OR 0.71 [0.48-1.04] Active smoking, higher BMI, drinking >7 units per week and previous chlamydia infection significantly correlated with AVM (p = 0.01, p = 0.01, p = 0.04 and p = 0.01). Finally, 84% (1190/1421) reported gynecological symptoms such as vaginal discharge, dyspareunia and fungal infection, but only fishy odor significantly correlated with AVM (p < 0.01). Limitations, reasons for caution To the best of our knowledge, this is the largest study investigating the intimate hygiene practice and its correlation with AVM in an IVF population. As these results describe the practices of a Scandinavian IVF population, results may differ from other settings and ethnicities. Wider implications of the findings Exploration of the cause-and-effect relations between intimate hygiene practices and AVM is needed, requiring intervention-based prospective studies. This would lead to evidence-based advice on intimate hygiene practices and AVM prevention, possibly increasing live birth rates. The unexpected high prevalence of douching in a Danish IVF population needs further exploration. Trial registration number NCT03420859

O-263 Effect of clindamycin and a live biotherapeutic containing lactobacilli on the reproductive outcomes of IVF patients with abnormal vaginal microbiota: a double-blind, placebo-controlled multicentre trial

Abstract Study question Does treatment of abnormal vaginal microbiota improve the reproductive outcomes of IVF patients? Summary answer Data is being analysed and will be presented at ESHRE 2023. What is known already An increasing number of studies reported an association between abnormal genital tract microbiota and adverse reproductive outcomes in IVF patients. One hypothesis could be that vaginal microbiota ascend to the endometrium where the microbiota hampers implantation. To the best of our knowledge, this is the first study powered to investigate causality between abnormal genital tract microbiota - in this study defined by a bacterial vaginosis like vaginal microbiota - and clinical pregnancy rate in IVF patients. Study design, size, duration Double-blind, placebo-controlled multicentre trial in IVF patients diagnosed with abnormal vaginal microbiota and subsequently randomised into three parallel groups 1:1:1. The first group received clindamycin 300 mg ×2 daily for 7 days followed by vaginal Lactobacillus crispatus until the clinical pregnancy scan. The second group received clindamycin and placebo, whereas the third group received placebo/placebo. A total of 1518 patients were screened, and 338 patients were randomised. The study duration was from 2017 to 2023. Participants/materials, setting, methods IVF patients with any cause of infertility embarking on their first, second or third IVF stimulation cycle or embryo transfer were approached for inclusion. At a minimum 12 days prior to embryo transfer, patients were screened for abnormal vaginal microbiota defined by a qPCR assay, targeting high quantitative loads of Fannyhessea vaginae and Gardnerella spp. Patients were excluded if they had intrauterine malformations like polyps, septum, and fibroma. Main results and the role of chance Data and safety monitoring board has decided not to open the randomization code yet. The final dataset is being completed. Data is being analysed and will be presented at ESHRE 2023. Limitations, reasons for caution Data is being analysed and will be presented at ESHRE 2023. Wider implications of the findings The present drug intervention study used clindamycin and a live biotherapeutic containing Lactobacillus crispatus. The results of the study could have a worldwide important clinical impact on daily IVF practice as currently there is no evidence that screening and treating IVF patients with abnormal vaginal microbiota improves the reproductive outcome. Trial registration number EudraCT 2016-002385-31

Association between monoaromatic hydrocarbons exposure and vaginal microbiota disorder in recurrent implantation failure

Association between monoaromatic hydrocarbons exposure and vaginal microbiota disorder in recurrent implantation failure

Vaginal microbiota in pregnant women with inflammatory rheumatic and inflammatory bowel disease: A matched case-control study.

BackgroundRheumatic diseases and vaginal infections both increase the risk of preterm birth. It is unclear whether pregnant women with rheumatic disease are more likely to experience vaginal infections, which might potentially accumulate modifiable risk factors.ObjectiveIn this study, we sought to evaluate the vaginal microbiota of pregnant women with inflammatory rheumatic and inflammatory bowel disease.MethodsA total of 539 asymptomatic women with singleton pregnancy were routinely screened for an abnormal vaginal microbiota between 10 + 0 and 16 + 0 gestational weeks. Vaginal smears were Gram‐stained and microscopically analysed. Those with inflammatory diseases (with or without immunomodulatory therapy) were assigned to the case group and matched in a 1:3 ratio to healthy pregnant controls.ResultsOverall, an abnormal vaginal microbiota occurred more frequently among women of the case group, compared with those of the control group (33.8% vs 15.6%; 95% CI: 1.78–4.27, p < .001). In particular, Candida colonisation (22.3% vs 9.2%; 95% CI: 1.69–4.75, p < .001), but also bacterial vaginosis (14.9% vs 7.2%; 95% CI: 1.25–4.1, p = .006), occurred more often in the case than in the control group. No significant difference was found with regard to the occurrence of an abnormal vaginal microbiota between subgroups with and without immunomodulatory treatment (37.0% vs 27.1%; 95% CI: 0.29–1.35, p = .232).ConclusionPregnant women with inflammatory rheumatic and inflammatory bowel disease are at risk for bacterial vaginosis and Candida colonisation, which might pose a risk for preterm birth. Prospective studies are needed to further evaluate the influence of autoimmune conditions and immunosuppressive therapy on the vaginal microbiota.

Placental inflammatory changes and their association with the vaginal microbiota before delivery

Hypothesis/aims of study: Infection of the amniotic cavity and placenta is one of the leading causes of adverse pregnancy outcomes. In the majority of cases, intra-amniotic infection is associated with the normal microbiota of the lower urogenital tract. The aim of the study was to explore the relationships between the placental inflammatory changes, vaginal microbiota and labor course.&#x0D; Study design, materials and methods: We examined 124 women at 37-41 weeks of gestation. The vaginal discharge at admission was taken for microbiological evaluation, with the delivered placenta sent for histological examination.&#x0D; Results: In 17.7% of cases, histological examination of the placenta revealed inflammatory changes. A statistically significant correlation was noted between the placental inflammatory changes and Staphylocossus spp. presence in the vaginal discharge at admission (р = 0.0004). The placental inflammatory changes were associated with the membrane rupture to delivery interval more than 6 hours (р = 0.01) and the labor duration more than 7 hours (р = 0.0004). Prelabor rupture of membranes did not significantly affect the placental inflammatory changes (p = 1.0).&#x0D; Conclusion: Predisposing factors for the development of ascending bacterial infection of the placenta are an abnormal vaginal microbiota with the presence of opportunistic bacteria before delivery, a long membrane rupture to delivery interval, and a prolonged labor.

Vaginal, Cervical and Uterine pH in Women with Normal and Abnormal Vaginal Microbiota.

Introduction: Healthy women of reproductive age have a vaginal pH around 4.5, whereas little is known about pH in the upper genital tract. A shift in the vaginal microbiota may result in an elevated pH in the upper genital tract. This might contribute to decreased fertility and increased risk of preterm birth. Therefore, we aimed to measure pH in different compartments of the female genital tract in both nonpregnant and pregnant women, stratifying into a normal and abnormal vaginal microbiota. Material and methods: In this descriptive study, we included 6 nonpregnant, 12 early-pregnant, and 8 term-pregnant women. A pH gradient was recorded with a flexible pH probe. An abnormal vaginal microbiota was diagnosed by a quantitative polymerase chain reaction technique for Atopobium vaginae; Sneathia sanguinegens; Leptotrichia amnionii; bacterial vaginosis-associated bacterium 1, 2, 3, and TM7; and Prevotella spp. among others. Results: In all participants we found the pH gradient in the lower reproductive canal to be most acidic in the lower vagina and most alkaline in the upper uterine cavity. Women with an abnormal vaginal microbiota had an increased pH in the lower vagina compared to the other groups. Conclusions: There is a pronounced pH gradient within the female genital tract. This gradient is not disrupted in women with an abnormal vaginal microbiota.

Aerobic Vaginitis-Underestimated Risk Factor for Cervical Intraepithelial Neoplasia.

The aim of this study is to analyse the association between vaginal microbiota and the histological finding of CIN. From July 2016 until June 2017, we included 110 consecutive patients with abnormal cervical cytology results referred for colposcopy to Riga East Clinical University Hospital Outpatient department in the study group. 118 women without cervical pathology were chosen as controls. Certified colposcopists performed interviews, gynaecological examinations and colposcopies for all participants. Material from the upper vaginal fornix was taken for pH measurement and wet-mount microscopy. Cervical biopsy samples were taken from all subjects in the study group and in case of a visual suspicion for CIN in the control group. Cervical pathology was more often associated with smoking (34.6% vs. 11.0%, p < 0.0001), low education level (47.2% vs. 25.5%, p = 0.001), increased vaginal pH (48.2% vs. 25.4%, p < 0.0001), abnormal vaginal microbiota (50% vs. 31.4%, p = 0.004) and moderate to severe aerobic vaginitis (msAV) (13.6% vs. 5.9%, p = 0.049) compared to controls. The most important independent risk factors associated with CIN2+ were smoking (OR 3.04 (95% CI 1.37–6.76), p = 0.006) and msAV (OR 3.18 (95% CI 1.13–8.93), p = 0.028). Bacterial vaginosis (BV) was found more often in CIN1 patients (8/31, 25.8%, p = 0.009) compared with healthy controls (8/118, 6.8%), or CIN2+ cases (8/79, 10.1%). In the current study msAV and smoking were the most significant factors in the development of CIN in HPV-infected women, especially high grade CIN. We suggest that AV changes are probably more important than the presence of BV in the pathogenesis of CIN and progression to cervix cancer and should not be ignored during the evaluation of the vaginal microbiota.

Community State Types of Vaginal Microbiota and Four Types of Abnormal Vaginal Microbiota in Pregnant Korean Women.

Abnormal vaginal microbiota (AVM), including bacterial vaginosis (BV), is caused by a microbiota imbalance. Nugent scoring is the gold standard for the laboratory diagnosis of BV; however, it is somewhat subjective to interpret, and challenging to distinguish bacteria. Hence, there is a need for improved technologies for the accurate diagnosis of AVM. To this end, next-generation sequencing (NGS) technology has been shown to yield comprehensive information on the pathophysiology of AVM. Hence, to evaluate the relationship between microbiota composition and the pathophysiology of AVM and its clinical significance, we characterized vaginal swab samples from 212 pregnant Korean women using both Nugent scoring and NGS analysis. Of these, the Nugent scoring identified 175 subjects (82.5%; 175/212) with normal flora (NF), 20 (9.4%; 20/212) with intermediate flora (IF), and 17 (8.0%; 17/212) with BV. NGS analysis followed by the characterization of vaginal microbiota composition, as represented by alpha and beta diversity, revealed the relative abundance of specific bacterial taxa at the genus and species level. Moreover, we identified all five predominant community state types (CSTs) along with three smaller CSTs. Analysis of the vaginal microbiota revealed the dominance of one or two Lactobacillus spp. in the NF group. Meanwhile, the IF and BV groups were dominated by the genera Gardnerella, Prevotella, and Atopobium. These two groups also showed higher alpha diversity than the NF group (p < 0.05). Principal coordinate analysis (PCoA) indicated that the NF group was significantly different from the AVM groups (p < 0.05), whereas no significant difference was observed between IF and BV groups (p = 0.25). Lastly, to investigate the characteristics of vaginal microbiota based on taxonomic composition, the IF and BV groups (AVM groups) were reclassified using the unweighted pair group method with arithmetic mean (UPGMA) clustering. Consequently, they were reclassified into BV1 (Lactobacillus iners-dominated), BV2-1 (Bifidobacterium breve-dominated), BV2-2 (Gardnerella vaginalis s1 or s2 and Atopobium vaginae-dominated), and BV3 [mixed population of G. vaginalis, L. iners, and other bacteria (p < 0.05)]. Collectively, these findings could serve to advance the current understanding regarding AVM pathophysiology.

Effect of clindamycin and a live biotherapeutic on the reproductive outcomes of IVF patients with abnormal vaginal microbiota: protocol for a double-blind, placebo-controlled multicentre trial

IntroductionRecent studies in in vitro fertilisation (IVF) patients have associated abnormal vaginal microbiota (AVM) with poor clinical pregnancy rates of 6%–9% per embryo transfer. The biological plausibility for this finding...

Relationship between Maternal and Perinatal Outcome with High Vaginal Swab Culture: A Cross-sectional Study

Introduction: Most of the pregnancies progress normally but unfortunately, few are prone to developing complications. Some antenatal and intra-partum conditions place the mother and the developing foetus or both at risk for complications and infections which undoubtedly play a major role in the same. Vaginal microbiome composition changes during pregnancy. This change is believed to inhibit pathogen growth through secretion of bacteriocins such as lactic acid that maintain acidic pH. Disturbed vaginal environment is associated with complications of pregnancy. Aim: To find the relationship between the microbiological study of High Vaginal Swab (HVS) in pregnancy at term with the maternal and foetal outcome. Materials and Methods: This cross-sectional study was conducted on 200 women who underwent vaginal swab culture during routine prenatal check-up from July 2019 to January 2020, in a hospital in Lucknow, Uttar Pradesh, India.The maternal and perinatal outcome and their relation with microbiological study of HVS were studied. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 11.5. Chi-square test was used for comparison of data for statistical significance. For descriptive statistics percentage, mean and Standard Deviation (SD) was calculated. Results:E.coli (18%) was the most common organism isolated from HVS cultures in this study. Maternal complications, rate of Lower Segment Caesarean Section (LSCS), low APGAR scores (Appearance, Pulse, Grimace, Activity and Respiration), need for neonatal resuscitation and Neonatal Intensive Care Unit (NICU) admission were more in the culture positive group. Conclusion: The study suggests that the abnormal vaginal microbiota is associated with adverse pregnancy outcomes. HVS cultures are simple and non-invasive screening tool which should be used as a routine procedure in all antenatal patients for preventing complications and improving the foeto-maternal outcome.

Prenatal Probiotics: The Way Forward in Prevention of Preterm Birth

Preterm birth (PTB) has presented a major challenge since decades among the obstetricians. Many premature born individuals have learning disabilities, visual and hearing problems. Abnormal vaginal microbiota and bacterial vaginosis (BV) are important risk factors for PTB and premature rupture of the membranes. In women with BV, there is a dramatic reduction of Lactobacillus and heavy colonization of the pathogenic bacteria. Administration of Lactobacillus rhamnosus GR1 and Lactobacillus reuteri RC14 in pregnant women restores the normal vaginal flora and acidic pH and interrupts the infectious/inflammatory process. Probiotics are preferred over tocolytic therapy to reduce the adverse maternal and fetal outcome. J Clin Gynecol Obstet. 2019;8(3):63-69 doi: https://doi.org/10.14740/jcgo571

Quantitation of all Four Gardnerella vaginalis Clades Detects Abnormal Vaginal Microbiota Characteristic of Bacterial Vaginosis More Accurately than Putative G.vaginalis SialidaseA Gene Count.

BackgroundBacterial vaginosis (BV) is a vaginal disorder characterized by a depletion of the normal lactobacillus-dominant microbiota and overgrowth of mainly anaerobic bacteria.ObjectivesThe study aimed to evaluate the distribution and abundance of the Gardnerella vaginalis clades and sialidase A gene in vaginal samples from Russian women, and investigate if the G. vaginalis sialidase A gene count detects an abnormal vaginal microbiota characteristic of BV more accurately than G. vaginalis load.MethodsVaginal samples from 299 non-pregnant patients of gynecological clinics were examined using Nugent scores and G. vaginalis clade and sialidase A gene quantitative real-time polymerase chain reactions (PCRs). Discriminatory power for BV microbiota was evaluated with receiver operating characteristic (ROC) analysis.ResultsThe vaginal microbiota was characterized by Nugent scores as normal, intermediate, and BV microbiota in 162, 58, and 79 women, respectively. G. vaginalis clades 1, 2, 3, 4, and the sialidase A gene were detected in 56% (51–62%), 40% (34–45%), 20% (16–25%), 94% (91–96%), and 70% (64–75%) of vaginal samples, respectively. The frequency and abundance of clades 1, 2, 4, and the sialidase A gene as well as clade multiplicity were significantly associated with abnormal microbiota. The sialidase A gene was present in all multi-clade samples, in all single-clade samples comprising clades 1, 2, and 3, and in four of 84 (5% [2–12%]) samples comprising clade 4 only. Total G. vaginalis load showed significantly higher discriminatory power for abnormal microbiota than sialidase A gene count (areas under ROC curves 0.933 vs. 0.881; p = 0.0306).ConclusionsQuantifying all four G. vaginalis clades discriminates between BV microbiota and normal microbiota more accurately than measuring G. vaginalis sialidase A gene. Clade 4 is strongly associated with BV microbiota, despite most clade 4 strains lacking the sialidase A gene.

Evaluation of an Orally Administered Multistrain Probiotic Supplement in Reducing Recurrences Rate of Bacterial Vaginosis: A Clinical and Microbiological Study

Background: Bacterial vaginosis (BV) is the most common urogenital disease in women, affecting about 19% - 24% of them in reproductive ages annually and after treatment, a single recurrence or more may occur in up to 58% of women within 12 months. Objective: The aim was to evaluate the effectiveness of a new orally administered food supplement, containing different probiotic strains, on women of childbearing age after the antibiotic treatment when compared with no probiotic intake. Methods: A prospective study was undertaken on 62 patients with BV. All patients were cured with metronidazole vaginal formulations (5 g of 0.75% gel once daily for 5 days or 500 mg ovules once daily for 7 days), then after was offered the option of using a new an orally administered food supplement containing: Lactobacillus plantarum PBS067, Lactobacillus rhamnosus LRH020 and Bifidobacterium animalis lactis BL050, with a total viability of 3 × 109 CFU/capsule (Intimique® Femme). Among these women, 50 accepted to use the new orally food supplement, while 25 patients decided to use only metronidazole (control group). Results: The recurrence rate of BV after treatment with Intimique® Femme was about 16%, compared to 40% in the control group. The incidence of abnormal vaginal microbiota decreased in both groups, but it was significantly higher in the Intimique® Femme group at the end of treatment. Conclusion: This study showed that, in case of BV diagnosis, the complementary treatment of a strain-specific probiotic complex after antibiotics prophylaxis, is mandatory to reduce potential recurrences and cyclic use of further antibiotics.

Evidence-based mixture containing Lactobacillus strains and lactoferrin to prevent recurrent bacterial vaginosis: a double blind, placebo controlled, randomised clinical trial.

Bacterial vaginosis (BV) is the most common cause of vaginal discomfort in women. It is characterised by abnormal vaginal microbiota with a depletion of lactobacilli and predominance of anaerobic microorganisms, mainly Gardnerella vaginalis and Atopobium vaginae. Although antibiotics represent an effective therapeutic option in the short-term, recurrent infections still remain a serious problem. Nowadays, evidence exists about the efficacy of probiotics for the management of BV. The aim of the current double blind, randomised clinical trial was to assess the efficacy of a probiotic mixture, including Lactobacillus acidophilus GLA-14 and Lactobacillus rhamnosus HN001, in combination with bovine lactoferrin, as adjuvant therapy to metronidazole in women with recurrent BV. In particular, normalisation of Nugent score, remission of symptoms and recurrences during a six-months follow-up were assessed. 48 adult women received metronidazole (500 mg twice daily) for 7 days and randomly assigned to take simultaneously either probiotics plus lactoferrin or placebo (2 capsules/day for 5 days followed by 1 capsule/day for 10 consecutive days; induction phase). The verum or placebo administration (1 capsule/day for 10 consecutive days) was repeated each month (maintenance phase) during the six months of follow-up starting the first day of menstrual cycle since the menstrual blood increases the vaginal pH and contributes to increase the risk of recurrences. The results showed that symptoms (vaginal discharge and itching), Nugent score and recurrence rate were significantly improved by probiotics mixture in association with lactoferrin. This alternative approach may represent a safe and effective remedy for the restoration of healthy vaginal microbiota in preventing recurrent BV.

Efficacy of dequalinium chloride vaginal tablets in treatment of bacterial vaginosis

Aim: to evaluate the efficacy and duration of the therapeutic effect of dequalinium chloride (in comparison with clindamycin) in treatment of vaginal dysbiosis. Materials and methods. A total of 73 fertile-aged women (18-35 years old) with abnormal vaginal microbiota were examined. The patients were randomized into two groups: Group 1 (main) included 37 women receiving dequalinium chloride; Group 2 (control) included 36 women under clindamycin therapy. The efficacy was assessed by analyzing patients’ complaints, by gynecological examinations, pH values of the vaginal fluid, the Amsel criteria, the microscopy results and the polymerase chain reaction (PCR). Results. Before the treatment, the Amsel criteria were positive in 36 patients (97.29%) in the main group and in 31 patients (93.93%) in the control group; all patients showed an increase in the pH values of the vaginal fluid by more than 4.5 units. The state of vaginal microbiocenosis as evaluated with RT-PCR diagnostics (Femoflor 16 analysis) identified a variety of gram-positive and gram-negative bacteria with a marked decrease in the number of Lactobacilli. During the treatment period, there were no complaints of adverse events; pH values were normal in all patients; the Femoflor 16 analysis showed a significant decrease in the amounts of pathogenic microorganisms. As assessed in 1 month after the treatment, the therapeutic effect persisted. Conclusion. The dequalinium chloride has antibacterial effect on bacterial vaginosis. The results of the study showed that dequalinium chloride had the efficacy comparable with that of clindamycin.

Vaginal, cervical and uterine pH in women with normal and abnormal vaginal microbiota

Vaginal, cervical and uterine pH in women with normal and abnormal vaginal microbiota

Reproductive outcome of patients undergoing in vitro fertilisation treatment and diagnosed with bacterial vaginosis or abnormal vaginal microbiota: a systematic PRISMA review and meta-analysis.

Despite recent efforts, the risks associated with bacterial vaginosis (BV) or abnormal vaginal microbiota in IVF patients are not well-established. We aimed to evaluate the risks associated with BV in IVF patients using meta-analysis. Following preliminary searches to find relevant keywords and MeSH terms, a systematic search was performed in PubMed (MEDLINE) in September 2017. The population was infertile women attending IVF treatment. The exposure was BV or abnormal vaginal microbiota. Outcomes included live birth rate, early spontaneous abortion rate and clinical pregnancy rate. Data were collected for each study and for each outcome using a summary of findings table. If appropriate, data were quantitatively assessed using meta-analysis, sensitivity analysis, funnel plots and GRADE evidence assessment were performed for the above-mentioned outcomes. A total of 12 studies were eligible, comprising a total of 2980 patients. The prevalence of BV was 16% (95% CI 15-18%) in the general study population and tubal factor infertility was highly prevalent in patients diagnosed with BV compared with normal vaginal microbiota patients (P = 0.001). Despite a significant association with early spontaneous abortion [relative risk (RR) 1.68, 95% CI 1.24-2.27], BV did not significantly impact the live birth rate (RR 1.47, 95% CI 0.96-1.57) or the clinical pregnancy rate (RR 0.93, 95% CI 0.75-1.15). BV is associated with tubal factor infertility and early spontaneous abortion. However, the quality of evidence was very low and the equivocal results justify the need for further research. Abnormal vaginal microbiota is associated with early spontaneous abortion in IVF patients.