Bacterial Vaginosis In Nonpregnant Women Research Articles

Modern approaches to restoring vaginal microbiocenosis

The article presents literary data on the morphology and types of vaginal lactobacilli, pathological changes in the vaginal environment, as well as modern possibilities of restoring the vaginal microflora of a woman’s organism. Certain regularities regarding the connection of bacterial vaginosis with intestinal dysbiosis have been observed, which indicates a single dysbiotic process in the organism with a dominant manifestation either in the sexual or digestive system.A review of scientific publications of recent years shows the significant influence of intestinal dysbiosis, infectious and inflammatory diseases of the stomach and intestines, as well as the oral use of antibacterial drugs on the quantitative and qualitative composition of the vaginal microflora in women. It was found that an increased number of opportunistic microorganisms (85%) and a decreased number of lactobacilli and bifidobacteria (less than 70%) in the intestine are associated with a rise in the content of opportunistic microorganisms in the vaginal biota in women with infectious and inflammatory diseases of the reproductive system. This is explained by the ability of saprophytes and opportunistic microorganisms to penetrate into the reproductive organs of women by increasing the permeability of the mucous membrane of the intestinal wall, as well as into the vascular bed, which can be observed, for example, on the background of antibiotic use. The antibiotic use in a number of cases leads to a closed circle, when the need for antibacterial therapy to eliminate one infection leads to a deepening of dysbiosis and an increased number of other pathogens.Numerous studies have demonstrated the effectiveness of selective decontamination (selective elimination of pathogens) in combination with a probiotic, prebiotic or synbiotic to restore vaginal microbiocenosis.Our experience of using an oral synbiotic (1 capsule contains 5 billion colony-forming units of Lactobacillus plantarum lyophilizate pcs. 8Р-AZ, Lactobacillus fermentum pcs. 90Т-С4 and prebiotic inulin, once a day 30 minutes before meal for 7–10 days) in a complex therapy of bacterial vaginosis in non-pregnant women of reproductive age indicates faster elimination of systemic dysbiosis and restoration of normal intravaginal flora. Thus, regression of complaintsand normalization of objective data was determined on average for 2.9 days versus 4.7 days in women who were not administered the drug.The obtained data show that a systemic synbiotic containing a lyophilized microbial mass of probiotic lactobacteria, products of their metabolism and inulin (prebiotic) creates an additional effect in restoring normal biocenosis and the immune mechanism of ensuring colonization resistance of the body’s mucous membranes.

Bacterial Vaginosis: A Clinical Update with a Focus on Complementary and Alternative Therapies.

Bacterial vaginosis is a prevalent vaginal infection that affects women of all ages. Presenting symptoms include a vaginal discharge that is thin and white and has a fishy odor. This infection is associated with the acquisition of other sexually transmitted infections as well as premature labor and preterm birth. Recurrence rates after treatment are high, and medication adverse effects are common, leading many women to seek alternative therapies to manage and prevent recurrence. Many of these treatments are searchable online, and ingredients are easily obtainable. The purpose of this article is to review the state of the science regarding the safety and efficacy of alternative therapies for the treatment of bacterial vaginosis in nonpregnant women.

Prevalence of bacterial vaginosis in pregnant and non-pregnant Iranian women: a systematic review and meta-analysis.

Bacterial vaginosis (BV) is a vaginal disorder which occurs either symptomatic or asymptomatic because of an imbalance between H2O2-producing Lactobacillus and Gardnerella vaginalis in the vagina. This systematic review and meta-analysis is the first to determine the prevalence of BV in pregnant and non-pregnant women in Iran. We used national (SID, Irandoc, Iranmedex and Magiran) and international (PubMed, Scopus, Google Scholar and ISI web of knowledge) electronic databases to systematically search and collect available studies using related keywords (up to 1 December 2017). Inclusion and exclusion criteria were defined to select eligible studies. The overall prevalence of BV among Iranian women was 18.9% (95% CI 14-25). Gardnerella vaginalis was the most prevalent isolated bacteria. The prevalence of BV in non-pregnant women was 28% (95% CI 15.1-45.9) which was higher compared with pregnant women who had a prevalence of 16.5% (95% CI 12.5-21.6). The present review revealed a high prevalence of BV in non-pregnant women. Given that BV is associated with a series of reproductive complications such as infertility, taking preventive measures such as awareness of patients as well as monitoring and controlling of syndrome are essential.

Serum vitamin D status and bacterial vaginosis prevalence and incidence in Zimbabwean women

Bacterial vaginosis, a highly prevalent vaginal condition, is correlated with many adverse reproductive outcomes. In some studies, low vitamin D status (measured as serum 25-hydroxyvitamin D, 25[OH]D) has been associated with increased prevalence of bacterial vaginosis. We examined the cross-sectional association between vitamin D status and prevalence of bacterial vaginosis, separately for pregnant and nonpregnant women. Using prospectively collected data, we also characterized the effect of time-varying vitamin D status on incident bacterial vaginosis. We quantified 25(OH)D in stored sera collected quarterly from 571 Zimbabwean women participating in the Hormonal Contraception and Risk of HIV Acquisition Study. The analysis was restricted to women not using hormonal contraception. We characterized associations between vitamin D insufficiency (defined as 25[OH]D ≤ 30 ng/mL vs > 30 ng/mL) and prevalence of bacterial vaginosis among nonpregnant women at the enrollment visit and among pregnant women at the first follow-up visit that pregnancy was detected. Among women who were negative for bacterial vaginosis at enrollment (n= 380), we also assessed the effect of time-varying vitamin D status on incident bacterial vaginosis. We used the Liaison 25(OH)D total assay to measure 25(OH)D. Bacterial vaginosis was diagnosed via Nugent score. At enrollment, the prevalence of bacterial vaginosis was 31% and overall median 25(OH)D was 29.80 ng/mL (interquartile range, 24.70-34.30 ng/mL): 29.75 ng/mL (interquartile range, 25.15-33.95 ng/mL) among women with bacterial vaginosis, and 29.90 ng/mL (interquartile range, 24.70-34.50 ng/mL) among women without bacterial vaginosis. Among pregnant women, the prevalence of bacterial vaginosis was 27% and overall median 25(OH)D was 29.90 ng/mL (interquartile range, 24.10-34.00 ng/mL): 30.80 ng/mL (interquartile range, 26.10-36.90 ng/mL) among women with bacterial vaginosis, and 29.10 ng/mL (interquartile range, 23.80-33.45 ng/mL) among women without bacterial vaginosis. Vitamin D levels ≤ 30 ng/mL were not associated with a prevalence of bacterial vaginosis in nonpregnant women (adjusted prevalence ratio, 1.04; 95% confidence interval, 0.81-1.34) or pregnant women (adjusted prevalence ratio, 0.88, 95% confidence interval, 0.51-1.54). Vitamin D levels ≤ 30 ng/mL were similarly not associated with incident bacterial vaginosis (adjusted hazard ratio, 0.98, 95% confidence interval, 0.73-1.31). Our findings were robust to alternative specifications of vitamin D status including using a cut point for vitamin D deficiency of < 20 ng/mL vs ≥ 20 ng/mL and modeling 25(OH)D as a continuous variable. Among reproductive-age Zimbabwean women, insufficient vitamin D was not associated with increased bacterial vaginosis prevalence or incidence. Given established associations between bacterial vaginosis and poor reproductive outcomes, identification of factors leading to high bacterial vaginosis prevalence is urgently needed.

Factor Associated to Bacterial Vaginosis in Non-pregnant Women of North Indian Population

Bacterial vaginosis is currently the most prevalent cause of vaginal infection and vaginal discharge among the sexually active women. Bacterial vaginosis is a complex microbiological disease. Therefore, we aimed to determine the association of risk factors for bacterial vaginosis patients. In the prospective study, we enrolled a total of 300 nonpregnant women. One hundred and twenty six women were positive for bacterial vaginosis, confirmed by Amsel's criteria and Nugent's scoring. One hundred and seventy four women were unrelated control. Frequency of intrauterine contraceptive device differed significantly between bacterial vaginosis and healthy individuals (29.4% versus 17.2%, p=0.017; OR=1.70). Individuals with a sexual transmitted disease in partners was conferred significantly higher risk for bacterial vaginosis (p=0.001, OR=8.28). However, use of contraception, vaginal douching, and use of condom did not modulate the risk of bacterial vaginosis. Individuals with the use of intrauterine contraceptive device and presence of sexual transmitted disease in partners conferred a higher risk for bacterial vaginosis.

Pregnancy-specific association of vitamin D deficiency and bacterial vaginosis

Recent data suggest vitamin D deficiency (VDD) is associated with bacterial vaginosis (BV) during pregnancy. We hypothesized that VDD is a risk factor for BV in nonpregnant women. Using National Health and Nutrition Examination Survey data, we conducted multivariable logistic regression analyses stratified by pregnancy. VDD was associated with BV only in pregnant women (adjusted odds ratio [AOR], 2.87; 95% confidence interval [CI], 1.13-7.28). Among nonpregnant women, douching (AOR, 1.72; 95% CI, 1.25-2.37), smoking (AOR, 1.66; 95% CI, 1.23-2.24), and black race (AOR, 2.41; 95% CI, 1.67-3.47) were associated with BV; oral contraceptive use was inversely associated with BV (AOR, 0.60; 95% CI, 0.40-0.90). VDD moderated the association between smoking and BV in nonpregnant women. Risk factors for BV differ by pregnancy status. VDD was a modifiable risk factor for BV among pregnant women; evaluation of vitamin D supplementation for prevention or adjunct therapy of BV in pregnancy is warranted.

The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women

Bacterial vaginosis (BV) is a very common cause of vaginitis that has been associated with a high incidence of obstetric and gynaecologic complications and increased risk of HIV-1 transmission. This has led to renewed research interest in its treatment. To assess the effects of antimicrobial agents on BV in non-pregnant women. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, LILACS, and African Healthline (December 2007); and proceedings of relevant international conferences (from 1981 to date). Randomised controlled trials comparing any two or more antimicrobial agents, or antimicrobial agents with placebo or no treatment, in women with clinical or Gram-stain criteria of BV. Two authors independently assessed trial quality and extracted data from the original publications while the third author cross checked the data. Twenty-four trials involving 4422 participants were reviewed. Most examined symptomatic women only. Only seven trials analysed results by intention to treat; we re-analysed the remainder.Compared with placebo, clindamycin showed a lower rate of treatment failure (relative risk (RR) 0.25, 95% confidence interval (CI) 0.16 to 0.37). Clindamycin and metronidazole showed identical rates of treatment failure, irrespective of regimen type, at two and four-week follow up (RR 1.01, 95% CI 0.69 to 1.46; RR 0.91, 95% CI 0.70 to 1.18, respectively). Clindamycin tended to cause a lower rate of adverse events (RR 0.75, 95% CI 0.56 to 1.02); metallic taste, and nausea and vomiting were more common in the metronidazole group (RR 0.08, 95% CI 0.1 to 0.59; RR 0.23, 95% CI 0.10 to 0.51, respectively). Given intravaginally as gelatin tablets, lactobacillus was more effective than oral metronidazole (RR 0.20, 95% CI 0.05 to 0.08). Similarly, oral lactobacillus combined with metronidazole was more effective than metronidazole alone (RR 0.33, 95% CI 0.14 to 0.77). Clindamycin showed a lower rate of clinical failure than triple sulfonamide cream (RR 0.46, 95% CI 0.29 to 0.72). Hydrogen peroxide douche showed a higher rate of clinical failure (RR 1.75, 95% CI 1.02 to 3.00) and adverse events (RR 2.33, 95% CI 1.21 to 4.52) than a single 2 g dose of metronidazole. Clindamycin preparations, oral metronidazole, and oral and intravaginal tablets of lactobacillus were effective for bacterial vaginosis. Hydrogen peroxide douche and triple sulphonamide cream were ineffective. Metronidazole caused metallic taste, nausea and vomiting. We need better-designed trials with larger sample sizes to test the effectiveness of promising drugs.

Vaginal microflora associated with bacterial vaginosis in nonpregnant women: reliability of sialidase detection.

Objective: To determine the prevalence of Gardnerella vaginalis, anaerobic bacteria and Mycoplasma hominis in vaginal specimens of women with and without bacterial vaginosis (BV) as well as to determine the sensitivity and specificity of the direct sialidase assay of vaginal fluid as a rapid test for diagnosing this syndrome. Methods: Vaginal cultures were obtained from 109 nonpregnant women (mean age 33 ± 7.1 years), 47 of them with clinical signs of BV (BV+) and 62 of them without BV (BV- ). In addition, we determined the vaginal sialidase activity in both groups, which may serve as a feature of this syndrome. Results: Anaerobic bacteria were isolated in 91% and 18% of the BV+and BV- groups, respectively (p < 0.001). Peptostreptococcus spp., Prevotella bivia and Porphyromonas spp. were strongly associated with BV. P. bivia and Prevotella spp. represented 44% of all the anaerobes isolated in the BV+ group. All the isolated P. bivia strains presented sialidase activity. G. vaginalis and M. hominis were isolated in 76% and 42% of the BV+ and 1% and 0% of the BV- women, respectively (p < 0.001). Mobiluncus morphotypeswere observed in 34% of the BV+and 0% of BV- women. Sensitivity, specificity, positive predictive value and negative predictive value of sialidase activity were 81%, 94%, 90% and 86%, respectively. Conclusions: Our data demonstrate a strong association between G. vaginalis, M. hominis, and P. bivia and BV. Sialidase activity and Gram stain of vaginal fluid represent accurate methods for diagnosing BV.

Bacterial vaginosis: a threat to reproductive health? Historical perspectives, current knowledge, controversies and research demands

Bacterial vaginosis is a change in flora, the cause of which is still unknown in the vast majority of instances. Bacterial vaginosis has generally been used to represent any change in vaginal flora resulting in an assumed loss of lactobacilli. However, whether such a flora represents the genetically normal state of some women is poorly defined. The present ‘crude’ diagnosis of bacterial vaginosis ought to be refined. The proposed impact of bacterial vaginosis on adverse pregnancy outcome is contradicted by therapeutic studies involving pregnant women that result in a change in flora to a lactobacillus-dominated vaginal flora, but have no influence on the course of pregnancy. Most therapies recommended for bacterial vaginosis in non-pregnant women are often successful in the short term, but usually unsuccessful if the follow-up period after finishing therapy is prolonged. Although bacterial vaginosis is generally believed to be an endogenous condition, a number of behavioral factors are involved, such as the use of contraceptive and intimate hygiene products and smoking habits. Although bacterial vaginosis is not considered a true sexually transmitted infection, it is correlated to sexual activities. The current review elaborates on these matters and on the vaginal microbial ecology.

Bacterial vaginosis-associated microflora and effects of topical intravaginal clindamycin

The goals of this study were as follows: (1) to further define the microbiologic characteristics of bacterial vaginosis in nonpregnant women, (2) to evaluate the in vivo activity of topical intravaginal clindamycin and reference this activity to clinical cure, and (3) to evaluate for clindamycin-related emergence of species. Vaginal microflora was identified and quantified from 33 women with bacterial vaginosis at enrollment and 4 to 7 days after treatment with placebo or three different dosages of clindamycin administered twice daily for 5 days in a double-blind, randomized trial. Clindamycin eradicated and/or decreased counts of major bacterial vaginosis-associated microflora such as Gardnerella, gram-negative and gram-positive anaerobes, and Mycoplasma hominis; this was correlated with cure in 22 of 24 (92%) women. Altered flora (nonlactobacilli) among some of the women who received clindamycin appeared to be transient and without apparent adverse effects. Microbial (and clinical) results support use of clindamycin as effective treatment of bacterial vaginosis.

Use of oral metronidazole in pregnancy: Risks, benefits, and practice guidelines

Metronidazole is the recommended treatment for trichomoniasis and bacterial vaginosis in nonpregnant women. Reluctance to use this drug in pregnancy is related to concerns about possible adverse effects on the fetus. However, recent literature suggests associations between these infections during pregnancy and risk of preterm delivery; if such associations are causal and preterm birth is shown to be prevented by effective treatment, the risk-benefit equation may be altered. This article reviews the literature on the carcinogenic and teratogenic potential of metronidazole and discusses the evidence that associates trichomoniasis and bacterial vaginosis with perinatal outcomes. Current practice recommendations are summarized.