Amsel Criteria Research Articles

Combined vaginal administration of nystatin, diiodohydroxyquin, and benzalkonium chloride versus oral metronidazole for the treatment of bacterial vaginosis.

To compare combined vaginal administration of nystatin, diiodohydroxyquin, and benzalkonium chloride versus oral metronidazole for the treatment of bacterial vaginosis (BV). A randomized controlled trial was conducted among women diagnosed with BV using the Amsel criteria (n=90) at a university hospital in Khon Kaen, Thailand, between June 27, 2017, and April 30, 2018. The oral metronidazole group (n=44) received 400mg of metronidazole, administered three times per day. The combined vaginal tablet group (n=46) received a vaginal suppository once daily, which comprised nystatin (100000U), diiodohydroxyquin (100mg), and benzalkonium chloride (7mg). Treatment was administered for 7days in both groups. Follow-up visits at 14 and 42days assessed treatment outcomes and adverse effects. Remission of BV occurred among 41 (93%) women in the oral metronidazole group and 39 (85%) women in the combined vaginal tablet group. The adjusted relative risk was 0.92 (95% confidence interval 0.80-1.06). The rate of nausea and/or vomiting was significantly higher in the oral metronidazole group than that in the combined vaginal tablet group. Treatment efficacy of the combined vaginal tablet versus oral metronidazole was equivalent. TCTR20170627001 (www.clinicaltrials.in.th).

Efficacy of metronidazole and lactobacillus in the treatment of bacterial vaginosis- A comparative study

Efficacy of metronidazole and lactobacillus in the treatment of bacterial vaginosis- A comparative study - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/2581-4729.2019.0004, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

Clinico-microbiological retrospective study of abnormal vaginal discharge in women coming to obstetrics and gynecology out patient department at a tertiary care hospital

Introduction: Vaginal discharge is a normal physiological discharge which is usually white or clear, non-offensive and varies with menstrual cycle. Abnormal vaginal discharge if untreated can lead to cervicitis, pelvic inflammatory disease, urinary tract infection and also infertility. As abnormal vaginal discharge presents vaguely in a clinical set up, diagnosis is made by laboratory confirmation for rapid identification of causative pathogens and appropriate treatment. Materials and Methods: This is a retrospective study where records of clinically suspected vaginitis/cervicitis cases from Jan 2016 till June 2018 were studied. History, general examination findings, per speculum and pelvic examination findings, investigations performed and treatment given were collected for these cases and the data was analyzed. The amount, odor, color, pH and consistency of vaginal discharge were noted. Three high vaginal swabs were taken from every patient using sterile swab sticks and labeled. The tests include: saline wet mount, KOH mount and Grams stain. Bacterial vaginosis was diagnosed using the Amsel's clinical criteria and standard microbiological techniques. The collected samples were also cultured on MacConkey’s agar, Blood agar and Sabouraud’s Dextrose agar for aerobic bacterial and fungal cultures respectively. The antibiotic sensitivity testing of all isolates was performed by Kirby Bauer’s disc diffusion method on Muller Hinton agar and interpreted as per CLSI guidelines. Results: This is a retrospective study where records of clinically suspected vaginitis/cervicitis cases were studied. A total of 1680 clinically suspected vaginitis/cervicitis case records were collected in this study. Out of 1680 cases, only 475 (28.27%) cases were positive for growth of a pathogen and the remaining 1205 (71.72%) cases either showed no growth or no pathogens were isolated. Bacterial vaginosis was diagnosed in 120 (7.14%) cases and trichomoniasis was diagnosed in 51 (3.03%) cases. Out of the 475 samples positive for growth, most common isolate was Escherichia coli (195, 41.05%), followed by Coagulase negative staphylococcus (130, 27.36%). Conclusion: Escherichia coli was the most common organism causing infection in our study population followed by Coagulase negative staphylococcus. Clinical diagnosis along with complete microbiological evaluation is necessary to determine the causative agents of vaginal infections for appropriate management. Keywords: Abnormal vaginal discharge, Vaginitis, Cervicitis, High vaginal swabs.

Identification of Gardnerella vaginalis and Atopobium vaginae in Women With Bacterial Vaginosis in Northern Iran

Background Bacterial vaginosis is the most common lower genital tract infection among women of reproductive age. Its causative agent is often the bacterium Gardnerella vaginalis, which exists in synergism with other mostly anaerobic bacteria such as Atopobium vaginae, Mobiluncus curtisii, and Megasphaera type I. Methods A total of 211 women, who referred to obstetrics and gynecology clinics in Rasht City for suspected vaginal infections, were tested for possible bacterial vaginosis. The presence of G. vaginalis and A. vaginae was verified by 5 different laboratory methods based on the Amsel criteria. These methods included determination of pH, whiff test, and observation of clue cells in a direct smear. Polymerase chain reaction using specific primers was performed on the extracted DNA from the vaginal specimens. Results Sixty cases of bacterial vaginosis, of the 211 women tested for suspected vaginal infections, were confirmed using Amsel criteria. In 44% (29/66) and 29% (19/66) of these bacterial vaginosis cases, the presence of G. vaginalis and A. vaginae was confirmed by polymerase chain reaction, respectively. Conclusions Gardnerella vaginalis had a very high prevalence in the 18- to 35-year-old women suffering from bacterial vaginosis in this region of Iran. Presumably, these cases were recommended for appropriate treatment, but the wider issue is about prevention in this age group and appropriate public health messages to raise awareness.

Screening for bacterial vaginosis before and after intrauterine device insertion

Objective To screen for bacterial vaginosis (BV) before and after insertion of intrauterine device (IUD), screen for complications of IUD, and evaluate the relation between BV and complication of IUD. Background IUD is one of the most prevalent and effective reversible methods of contraception worldwide. Users of the IUD may be at increased risk for BV, pelvic inflammatory diseases, and other complications. Patients and methods An observational cohort study was done for 147 women who came for IUD insertion. Complete history was taken, questionnaire was filled out, and vaginal swabs were taken from the posterior vaginal fornix before insertion of IUD and at 1 and 2 months after insertion of IUD. Complications of IUD were recorded. BV was diagnosed using Amsel's criteria and Nugent scoring methods. Results The prevalence of BV was 27.2% before IUD insertion and 9.5% after insertion (fresh diagnosis) at 1 month. The commonest complications of IUD were pelvic pain, vaginal bleeding, followed by abnormal vaginal discharge and dyspareunia. These complications were significantly higher in Gram stain-positive group than Gram stain-negative group. Conclusion The prevalence of BV is within the range of BV found among women of reproductive age group worldwide. The current standard of care does not require screening for BV before IUD insertion. The complication rate appeared significantly higher in patients with BV than those without.

Prevalence of bacterial vaginosis among antenatal attendees with abnormal vaginal discharge in a secondary health facility in Delta State, Nigeria

Introduction: Bacterial vaginosis (BV) is the most common lower genital tract syndrome among women of reproductive age with significant adverse outcome in pregnancy. Routine screening of antenatal patients for BV is not recommended, however, it is important to determine its prevalence especially in pregnant women who complain of abnormal vaginal discharge. Methods: This was a cross-sectional study of 340 antenatal attendees who complained of an abnormal vaginal discharge. The high vaginal swab was collected from each woman and subjected to wet film and Gram reaction. The diagnosis of BV was made using the Amsel's clinical criteria. Data were analyzed using the EPI-INFO statistical package and the results were presented as percentages and proportions. Results: BV was detected in 105 pregnant women with abnormal vaginal discharge, therefore, giving a prevalence rate of 30.4%. Positive correlates of BV included multiple sexual partners (P = 0.0001) and cigarette smoking (P = 0.008). Conclusion: BV is a prevalent disorder in pregnant women with abnormal vaginal discharge.

Novel Non-Antibiotic Treatment of Bacterial Infections of the Vagina, A Proof of Concept Study using Single Dose and Triple Dose Regimen

The effect of a novel treatment principle for bacterial vaginosis has been investigated in an open clinical study. 10 patients received a single dose while 20 patients received three applications every third day. The formulation is in the form of vaginal foam, containing lactic acid, hydrogen peroxide and an antimicrobial lipid. The intention of using the foam form for delivery is to avoid the creation of untreated areas, as is the case for other local formulations. Clinical signs, symptom and microbial effects have been studied using strict Amsel criteria and modified Hay/Ison for inclusion and modified Hay/Ison to monitor clinical efficacy pre- and post- menstruation. Therapeutic parameters as pH, malodor, abnormal discharge, itch and pain were monitored during the study. The microbiological was monitored by PCR being able to detect 6 pathogens and Lactobacilli.

Vaginal microbiome variances in sample groups categorized by clinical criteria of bacterial vaginosis

BackgroundOne of the most common and recurrent vaginal infections is bacterial vaginosis (BV). The diagnosis is based on changes to the “normal” vaginal microbiome; however, the normal microbiome appears to differ according to reproductive status and ethnicity, and even among individuals within these groups. The Amsel criteria and Nugent score test are widely used for diagnosing BV; however, these tests are based on different criteria, and so may indicate distinct changes in the vaginal microbial community. Nevertheless, few studies have compared the results of these test against metagenomics analysis.MethodsVaginal flora samples from 77 participants were classified according to the Amsel criteria and Nugent score test. The microbiota composition was analyzed using 16S ribosome RNA gene amplicon sequencing. Bioinformatics analysis and multivariate statistical analysis were used to evaluate the microbial diversity and function.ResultsOnly 3 % of the participants diagnosed BV negative using the Amsel criteria (A−) were BV-positive according to the Nugent score test (N+), while over half of the BV-positive patients using the Amsel criteria (A+) were BV-negative according to the Nugent score test (N−). Thirteen genera showed significant differences in distribution among BV status defined by BV tests (e.g., A − N−, A + N− and A + N+). Variations in the four most abundant taxa, Lactobacillus, Gardnerella, Prevotella, and Escherichia, were responsible for most of this dissimilarity. Furthermore, vaginal microbial diversity differed significantly among the three groups classified by the Nugent score test (N−, N+, and intermediate flora), but not between the Amsel criteria groups. Numerous predictive microbial functions, such as bacterial chemotaxis and bacterial invasion of epithelial cells, differed significantly among multiple BV test, but not between the A− and A+ groups.ConclusionsMetagenomics analysis can greatly expand our current understanding of vaginal microbial diversity in health and disease. Metagenomics profiling may also provide more reliable diagnostic criteria for BV testing.

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.

Comparing the effect of sucrose gel and metronidazole gel in treatment of clinical symptoms of bacterial vaginosis: a randomized controlled trial

BackgroundLactobacilli, as normal vaginal flora, have a central role in controlling body environment and preventing the growth of pathogens. Sucrose, by promoting the growth of Lactobacilli, accelerates the suppression of pathogenic bacteria. The aim of this research was to compare the effects of sucrose gel with those of metronidazole gel in treating women with bacterial vaginosis (BV).MethodsThis triple-blind clinical trial (IRCT2016112631105N1) was conducted with 70 sexually active, premenopausal women diagnosed with bacterial vaginosis through meeting at least three out of four Amsel criteria. The subjects were randomly divided into two groups of 35 patients, one group treated with sucrose vaginal gel, and the other with metronidazole vaginal gel. The treatment period was 14 days for each group. At the end of the treatment period, the status of each woman’s improvement was determined by elimination at least three out of four Amsel criteria (homogeneous vaginal discharge, presence of clue cells > 20%, positive whiff test and vaginal pH value > 4.5), and clinical complaints and reported side effects of medication were recorded for the patients. Data were analyzed using the t test, chi-squared test and McNemar’s test).ResultsThe sucrose vaginal gel and metronidazole vaginal gel were not significantly different in reducing patients’ clinical complaints or in elimination at least three out of four of the Amsel criteria that were positive before treatment. With an 85.7% improvement rate with sucrose gel and an 88.5% improvement rate with metronidazole gel, the differences in therapeutic response were not significant, and neither was statistically different in improving the disease (p = 0.389).ConclusionIt seems that sucrose vaginal gel might be considered a possible alternative to metronidazole vaginal gel in the treatment of bacterial vaginosis.Trial registrationIranian Registry of Clinical Trials, IRCT2016112631105N1. Registered on 27 December 2016.

Frequency and diagnosis of bacterial vaginosis.

To determine the frequency of bacterial vaginosis (BV) in women with vaginal discharge, and to compare different diagnostic tests for its diagnosis. Cross-sectional study. The Aga Khan University Hospital from June 1998 to May 2000. All women attending the Obstetrics and Gynecology clinics at The Aga Khan University Hospital, with the complaints of vaginal discharge, were examined with the help of a speculum. The vaginal pH was measured, samples for bacterial cultures were obtained. A slide was prepared for the gram's stain and Whiff-test was also performed. BV was diagnosed, when the vaginal discharge fulfilled at least three of the composite clinical criteria (Amsel's criteria), a standard method for the diagnosis of bacterial vaginosis: homogenous (pasty) discharge, pH more than 4.5, positive Whiff-test and the presence of clue cells. The frequency of BV was observed to be 16.1% . The culture for Gardnerella vaginalis was compared with the composite clinical criteria. The sensitivity, specificity, positive and negative predictive values of the culture, calculated for the diagnosis of BV were 93.8%, 70%, 37.7% and 98% respectively. The use of laboratory tests in conjunction with clinical findings is necessary for diagnosis of BV. The composite clinical criteria for the diagnosis of BV are rapid, reliable and inexpensive method.

Effect of vaginal suppository on bacterial vaginitis based on Persian medicine (Iranian traditional medicine): a randomised double blind clinical study

This trial was conducted on 127 women aged 18–50 years with bacterial vaginosis to compare the vaginal suppository of metronidazole with Forzejeh, a vaginal suppository of herbal Persian medicine combination of Tribulus terrestris, Myrtus commuis, Foeniculum vulgare and Tamarindus indica. The patients (63 in metronidazole group and 64 in Forzejeh group) received the medications for 1 week. Their symptoms including the amount and odour of discharge and cervical pain were assessed using a questionnaire. Cervical inflammation and Amsel criteria (pH of vaginal discharge, whiff test, presence of clue cells and Gram staining) were investigated at the beginning of the study and 14 days after treatment. The amount and odour of discharge, Amsel criteria, pelvic pain and cervical inflammation significantly decreased in Forzejeh and metronidazole groups (p = <.001). There was no statistically significant difference between the metronidazole and Fozejeh groups with respect to any of the clinical symptoms or the laboratory assessments. This study showed that Forzejeh, which is an herbal Persian medicine preparation, has a therapeutic effect the same as metronidazole in bacterial vaginosis.Impact statementWhat is already known on this subject? Bacterial vaginosis (BV) is a common problem in women. Common antibiotics for the treatment of BV include: metronidazole, tinidazole and clindamycin. Unfortunately, treatments often occur with a recurrence and failure. Therefore, alternative treatments are necessary. Many natural treatments are recommended for this condition in Persian Traditional Medicine sources. One of them is the vaginal suppository “Forzejeh” which is the combination of Tribulus terrestris, Myrtus commuis, Foeniculum vulgare and Tamarindus indica. These plants have antimicrobial activities. Forzejeh has been used for the treatment of BV in folk medicine for many years and has been formulated and standardised recently.What do the results of this study add? This study showed that the therapeutic effect of Forzejeh on bacterial vaginosis is similar to metronidazole.What are the implications of these findings for clinical practice and/or further research? A clinical study with a longer follow-up time is suggested for assessing the recurrence of BV after treatment with Forzejeh metronidazole.

Multicenter study establishing the clinical validity of a nucleic-acid amplification–based assay for the diagnosis of bacterial vaginosis

The present study sought to validate the clinical performance of a previously described PCR-based assay for the diagnosis of bacterial vaginosis (BV). A total of 1579 patients were enrolled in 5 locations; samples were classified as BV positive (n=538) or negative (n=1,041) based on an algorithm utilizing quantitative Gram-stain analysis of vaginal discharge and clinical evaluation (Amsel criteria); a next-generation sequencing (NGS) approach to determining diversity of vaginal microbiota was used to resolve discordant results between BV-PCR and Nugent/Amsel. BV-PCR demonstrated a sensitivity of 96.0% (483/503) and a specificity of 90.2% (885/981) when measured against the conventional test standard, with 95 samples (6.0%) being classified as indeterminate. After resolution of discordant results by NGS, including elimination of the PCR indeterminate category, the resolved sensitivity, specificity, and positive and negative predictive values of the BV-PCR assay were 98.7%, 95.9%, 92.9%, and 96.9%, respectively. The results of this study conclusively demonstrate that a relatively simple, 3-biomarker, molecular amplification construct can effectively diagnose BV in symptomatic women. Results generated using this assay were congruent with those obtained using conventional and molecular reference methods.

Identification of Key Bacteria Involved in the Induction of Incident Bacterial Vaginosis: A Prospective Study.

The sequence of events preceding incident bacterial vaginosis (iBV) is unclear. African American women who have sex with women, who had no Amsel criteria and Nugent scores of 0-3, were followed for 90 days to detect iBV (defined as a Nugent score of 7-10 on at least 2-3 consecutive days), using self-collected vaginal swab specimens. For women with iBV (cases) and women maintaining normal vaginal flora (healthy women), 16S ribosomal RNA gene sequencing targeting V4 was performed. Longitudinal vaginal microbiome data were analyzed. Of 204 women screened, 42 enrolled; of these, 45% developed iBV. Sequencing was performed on 448 specimens from 14 cases and 8 healthy women. Among healthy women, Lactobacillus crispatus dominated the vaginal microbiota in 75%. In contrast, prior to iBV, the vaginal microbiota in 79% of cases was dominated by Lactobacillus iners and/or Lactobacillus jensenii/Lactobacillus gasseri. The mean relative abundance of Prevotella bivia, Gardnerella vaginalis, Atopobium vaginae, and Megasphaera type I became significantly higher in cases 4 days before (P. bivia), 3 days before (G. vaginalis), and on the day of (A. vaginae and Megasphaera type I) iBV onset. The mean relative abundance of Sneathia sanguinegens, Finegoldia magna, BV-associated bacteria 1-3, and L. iners was not significantly different between groups before onset of iBV. G. vaginalis, P. bivia, A. vaginae, and Megasphaera type I may play significant roles in iBV.

The stimulation of the vaginal immune system with short-term administration of a vaginal gel containing fraction of Propionibacterium acnes, hyaluronic acid and polycarbophil is efficacious in vaginal infections dependent on disorders in the vaginal ecosystem

The vaginal immune system (VIS) is the first defense against antigens recognized as foreign. Substances capable of locally activating the VIS could be a valid strategy to treat vulvo-vaginal infections (VVI), caused by changes in the vaginal ecosystem, such as bacterial vaginosis (BV), vulvo-vaginal candidiasis (CA), and mixed vaginitis (MV). Bacterial lysates, obtained by crushing bacterial cultures, exert immuno-modulatory activities. The parietal fraction from Propionibacterium acnes is a patent of Depofarma (MoglianoVeneto, Italy). The preparation that associates such fraction to hyaluronic acid and polycarbophil is a registered trademark, commercially available in Italy as vaginal gel, Immunovag®. The study aimed to evaluate whether a 5-day-treatment with Immunovag® improves the symptoms and signs of VVI, in 60 women with Gardnerella vaginalis (GV), 154 with CA, 95 with MV, diagnosed with vulvar vaginal swab (VVS), and in 283 with BV, diagnosed with the Amsel criteria. At the end of the treatment (visit 2), the symptoms and signs of VVI disappeared in a significant number of subjects (χ2p < .02 vs pre-treatment) in all VVI groups, and their intensity was significantly (p < .0002) reduced in the subjects in which they were still present. Immunovag® represents a valid treatment of VVI induced by changes in the vaginal ecosystem.

The Effect of Prangos Ferulacea Vaginal Cream on Accelerating the Recovery of Bacterial Vaginosis: A Randomized Controlled Clinical Trial.

The present study was conducted on the effect of prangos ferulacea vaginal cream on accelerating the recovery of bacterial vaginosis. This randomized controlled clinical trial was conducted on 100 non-pregnant women referring to health centers affiliated to Lorestan University of Medical Sciences in 2016 with the diagnosis of bacterial vaginosis based on the patient's complaints, Amsel's clinical criteria, and the Nugent microscopic criteria. The women were randomly divided into two groups of 50. One group was treated with oral metronidazole plus Prangos ferulacea vaginal cream and the other with oral metronidazole plus a placebo vaginal cream for seven days. The patient's complaints, Amsel's clinical criteria and the Nugent microscopic criteria were assessed seven days after treatment. The data were analyzed using SPSS, version 20, with a significance level of 0.05. The response to oral metronidazole plus Prangos ferulacea vaginal cream treatment was 94% according to Amsel's clinical criteria and 88% according to the Nugent microscopic criteria. The response to oral metronidazole plus placebo vaginal cream treatment was 94% according to Amsel's criteria and 86% according to the Nugent criteria. The analysis of the patients' complaints, Amsel's clinical criteria and the Nugent microscopic criteria showed significant differences in each group before and after the treatment. This trial showed that Prangos ferulacea vaginal cream accelerated the recovery of bacterial vaginosis of patients with bacterial vaginosis. It can be used effectively as a complementary treatment with oral metronidazole in cases of medication resistance and also in people wishing to use herbal remedies Trial Registration Number: IRCT2016042327534N1.

CLINICAL AND LABORATORY EFFICIENCY OF TREATMENT OF WOMEN WITH PERIODONTAL DISEASES ON THE BACKGROUND OF BACTERIAL VAGINOSIS

Introduction. There is currently no tactic for dental examination and treatment of women suffering from bacterial vaginosis (BV), although chronic catarrhal gingivitis, periodontitis of initial and first degree of severity in patients with this pathology has been proven. The frequency of detection of BV in modern women aged 18-45 is 67-89%. The main pathogens of BV are Gardnerella vaginalis and Atopobium vaginae.&#x0D; Aim. To determine clinical and laboratory effectiveness of the treatment scheme for women with periodontal diseases on the background of bacterial vaginosis.&#x0D; Materials and methods. Diagnosis of BV was established by an obstetrician-gynaecologist based on the Amsel criteria. 54 women aged 18-45 were examined. The examined women were divided into two groups, depending on the intended scheme of integrated treatment. Determination of the degree of inflammation of the periodontal period was carried out according to the PMA indices (modified by S. Parma), KPI by Leus. The quality control of the treatment was performed by PCR method, the presence of Gardnerella vaginalis and Atopobium vagina, the amino test of oral liquid, the quantitative activity of alpha amylase and the concentration of sIgA in saliva. Representatives of the first control group (26 women) were prescribed the common course of treatment, namely: local treatment therapy (oral baths of the solution of the medicine “Stomatophyte” after morning and evening hygiene procedures, application of “Mergagil-denta” (7 days); general therapy (metronidazole 250 mg every 8 hours for every 7 days, probiotic “Symbiter acidophilic concentrate” for 21 days). Women of the second experimental group (28 patients) were treated according to the scheme we patented. Their local treatment included: oral baths with the medicine “Stomatophyte” after morning and evening hygiene procedures (7 days), tablets for resuscitation “Lizak” for 1 tab. every 6 hours (5 days), application of “Metrogil-denta” for 20 minutes twice a day. After using “Stomatophyte” (10 days), use “Symbiter omega” for 21 days in silicone caps for the night after the completion of the use of “Metrogil-Denta”. General medicines for patients in the 2nd group: clindamycin 150 mg every 6 hours (7 days), probiotic “Symbiter acidophilic concentrate” per unit (21 days). Evaluation of the treatment results was carried out 14 days, 3, 6 and 12 months after the end of the course treatment.&#x0D; Results. In the examined two groups, there was a disorder in the condition of periodontal tissues. In women of the first group chronic catarrhal gingivitis was registered in 11.5%, chronic generalized periodontitis of initial degree - in 57.69%, chronic generalized periodontitis - in 30.77%; in patients of the 2nd group – in 10.71%, 64.29% and 25% respectively. None of the 54 patients had clinically intact periodontal disease. The PMA and Leish KPI indices in women of the 1st group after the treatment did not have a significant difference with the initial results, while the rates of patients in the second group decreased significantly, indicating a decrease in inflammation in the periodontal tissues. The concentration of sIgA after the end of the treatment course was higher in women of the 2nd group, which suggests a higher efficacy of the proposed method of treatment.&#x0D; Conclusions. Comparing the conventional and patented treatment regimen, it has been determined that traditional treatment is significantly less effective. Clinical methods of examination are insufficient to control the quality of treatment of women with BV and manifestations of periodontal disease, since a specific microflora appears in the oral cavity of this contingent of patients. In order to objectify clinical results, it is advisable to use a study of local immunity factors, such as saliva alpha-amylase and sIgA. To control the presence of IB pathogens as an express method, an amino test should be used, and in the case of its positive result, PCR should be used to detect Gardnerella vaginalis and Atopobium vaginae.

Use of copper intrauterine device is not associated with higher bacterial vaginosis prevalence in Thai HIV-positive women

ABSTRACTThe study assessed and compared bacterial vaginosis (BV) prevalence in Thai women in reproductive age in four study groups – group 1, HIV-positive with copper intrauterine device (Cu-IUD); group 2, HIV-positive without Cu-IUD; group 3, HIV-negative with Cu-IUD; and group 4, HIV-negative without Cu-IUD. We conducted a cross-sectional study. BV prevalence was assessed by Nugent score and Amsel criteria. Descriptive statistics was used to present baseline characteristics; kwallis rank test – to compare variables between the four groups; logistic regression – to assess factors, related to BV prevalence. The analysis included 137 women in the four study groups with a median age of 39 years. Median BV prevalence by Nugent score was 45%, intermediate vaginal flora – 7% and normal vaginal flora – 48%. There was no statistically significant difference in the BV prevalence between the four study groups, p = 0.711. Threefold lower BV prevalence was found, assessed by Amsel criteria compared to Nugent score. Women with body mass index (BMI) < 20 had higher probability to have BV or intermediate vaginal flora, OR = 3.11, 95% CI (1.2–8.6), p = 0.025. The study found a high BV prevalence in the four study groups, related neither to HIV status, nor to Cu-IUD use. BV prevalence was associated only with low BMI. Thus, Cu-IUD could be a good contraceptive choice for HIV-positive women. Research in defining normal vaginal microbiota and improve diagnostic methods for BV should continue.

Combined oral and topical antimicrobial therapy for male partners of women with bacterial vaginosis: Acceptability, tolerability and impact on the genital microbiota of couples - A pilot study

ObjectivesRecurrence following recommended treatment for bacterial vaginosis is unacceptably high. While the pathogenesis of recurrence is not well understood, recent evidence indicates re-infection from sexual partners is likely to play a role. The aim of this study was to assess the acceptability and tolerability of topical and oral antimicrobial therapy in male partners of women with bacterial vaginosis (BV), and to investigate the impact of dual-partner treatment on the vaginal and penile microbiota.MethodsWomen with symptomatic BV (Nugent Score of 4–10 and ≥3 Amsel criteria) and their regular male sexual partner were recruited from Melbourne Sexual Health Centre, Melbourne, Australia. Women received oral metronidazole 400mg twice daily (or intra-vaginal 2% clindamycin cream, if contraindicated) for 7-days. Male partners received oral metronidazole 400mg twice daily and 2% clindamycin cream topically to the penile skin twice daily for 7-days. Couples provided self-collected genital specimens and completed questionnaires at enrolment and then weekly for 4-weeks. Genital microbiota composition was determined by 16S rRNA gene sequencing. Changes in genital microbiota composition were assessed by Bray-Curtis index. Bacterial diversity was measured by the Shannon Diversity Index.ResultsTwenty-two couples were recruited. Sixteen couples (76%) completed all study procedures. Adherence was high; most participants took >90% of prescribed medication. Medication, and particularly topical clindamycin in males, was well tolerated. Dual-partner treatment had an immediate and sustained effect on the composition of vaginal microbiota (median Bray-Curtis score day 0 versus day 8 = 0.03 [IQR 0–0.15], day 0 vs day 28 = 0.03 [0.02–0.11]). We observed a reduction in bacterial diversity of the vaginal microbiota and a decrease in the prevalence and abundance of BV-associated bacteria following treatment. Treatment had an immediate effect on the composition of the cutaneous penile microbiota (median Bray-Curtis score day 0 vs day 8 = 0.09 [0.04–0.17]), however this was not as pronounced at day 28 (median Bray-Curtis score day 0 vs day 28 = 0.38 [0.11–0.59]). A decrease in the prevalence and abundance of BV-associated bacteria in the cutaneous penile microbiota was observed immediately following treatment at day 8.ConclusionCombined oral and topical treatment of male partners of women with BV is acceptable and well tolerated. The combined acceptability and microbiological data presented in this paper supports the need for larger studies with longer follow up to characterize the sustained effect of dual partner treatment on the genital microbiota of couples and assess the impact on BV recurrence.

Anaerobic bacteriological profile of leukorrhea in reproductive age group women

INTRODUCTION: Leukorrhea is one of the most common complaints of women in their reproductive age group attending the OBG OPD and Bacterial Vaginosis (BV) is its most common cause. AIM: of the study was to isolate and identify the anaerobic bacteria causing leukorrhea. MATERIALS AND METHODS: This was a cross sectional study conducted in a medical college and tertiary care hospital, on 250 married women in their reproductive age group attending the OBG OPD with complaints of leukorrhea. High vaginal swabs were collected from these women and BV was diagnosed using Amsel's clinical composite criteria. Anaerobic bacteria were isolated from the samples using standard operative procedure. RESULTS: Out of 250 women, 220 (88%) had a thin, grey, homogenous discharge and 30 (12%) had thick, white non offensive discharge, indicating vaginal candidiasis. Out of the 220 women, 123 (55.9%) were diagnosed to have BV by Amsel's criteria and 42 (19%) of them were culture positive for anaerobic bacteria. Porphyromonas spp. (55%) was the most common bacteria isolated, followed by Peptostreptococcus spp. (17%) and Bacteroides spp. (14%). CONCLUSION: Anaerobic bacteria are important pathogens in the causation of bacterial vaginosis along with other aerobic organisms.