Screening For Bacterial Vaginosis Research Articles

Association between bacterial vaginosis, Chlamydia trachomatis infection and tubal factor infertility in Bukavu, Democratic Republic of Congo

BackgroundTubal factor infertility (TFI) is common in sub-Saharan Africa and often secondary to pelvic inflammatory disease (PID). Anaerobes associated with bacterial vaginosis (BV) are also found in PIDs widely dominated by Chlamydia trachomatis (C. trachomatis), whose role in TFI is better demonstrated than that of BV.ObjectivesTo determine the prevalence of BV and C. trachomatis and to investigate the association between BV, C. trachomatis and TFI.MethodsWe included 137 patients treated for infertility between January 2020 and November 2021. Cases were defined as women with infertility aged 18-45 years presenting with TFI (n = 52), and controls as infertile women in the same age groups without TFI (n = 85). Data on social habits, life style and infertility parameters were collected, and we performed screening for BV and C. trachomatis. Multiple regression was used to measure associations.ResultsThe prevalence of BV and C. trachomatis was 42.3% (58/137) and 23.4% (32/137), respectively. BV (61.5% vs 30.6%, p<0.001) and C. trachomatis (48.1 vs 8.2%, p<0.001) were more frequent in cases of TFI.BV and C. trachomatis increased the risk of TFI approximately 4-fold [aOR: 3.77 (1.61-8.83), p=0.002] and 14-fold [aOR: 13.77 (4.59-41.27), p<0.001], respectively.ConclusionBV and C. trachomatis infection are strongly associated with TFI in Bukavu. Prevention and screening should be implemented to reduce the risk of TFI.

Effectiveness and Costs of Molecular Screening and Treatment for Bacterial Vaginosis to Prevent Preterm Birth: The AuTop Randomized Clinical Trial

ABSTRACT One of the risk factors for preterm birth (PTB) is bacterial vaginosis (BV), a common, often asymptomatic, vaginal dysbiosis. The earlier BV is diagnosed based on gestational age, the higher the risk of PTB. The effectiveness of a screen-and-treat strategy for BV during pregnancy remains a source of debate. One meta-analyses, including 5 studies and 2346 patients, showed a benefit to screen and treat using clindamycin. Another, with 21 studies and 7847 patients, did not recommend BV screening but observed reductions in preterm delivery by 50% and miscarriages by 80%. In another systematic review, with 48 studies, there was varying accuracy across conventional screening tests for BV and suggested no or inconclusive efficacy in the treatment of asymptomatic BV in the general obstetric population and in those with a history of preterm delivery. Based on these studies, French and international organizations recommend against screening for BV with conventional diagnosis tools in low-risk populations. However, molecular diagnostic tools have been shown to be more accurate in identifying vaginal microbiota than conventional tools, such as clinical diagnosis based on Amsel or Nugent criteria. Molecular tools have been shown to provide an objective, reproducible, quantitative diagnosis of BV, identifying emergent pathogen species, such as Atopobium vaginae (now known as Fannyhessea vaginae). To date, no randomized studies have been conducted to assess the impact of molecular tools on a screen-and-treat intervention to BV. The aim of this study was to assess whether a screen-and-treat intervention using a molecular diagnostic tool is cost-effective in reducing the rate of PTB. The AuTop Trial was a prospective, open-label superiority trial conducted in 19 French maternity hospitals from March 9, 2015, to December 18, 2017. Included were adult women in early pregnancy (&lt;20 weeks of gestation), with no history of PTB or late abortion and no major risk factors for prematurity. Excluded were patients who had extrauterine pregnancy or nonprogressive pregnancy, or were treated with antibiotics a week before inclusion in the study. Women were randomly assigned 1:1 to undergo molecular screening and treatment (intervention group) or receive usual care (control group). The intervention group was asked to self-collect vaginal swabs and return them within 15 days of collection for each month until 28 weeks of gestation. If BV was detected, treatment with azithromycin (1 g repeated after 48 hours) or amoxicillin (2 g/d for 7 days) was provided within 48 hours. A molecular biology-based rapid diagnostic tool designed for point-of-care testing was developed using real-time polymerase chain reaction assays to quantify DNA levels of A. vaginae. The tool's specificity, sensitivity, positive predictive value, and negative predicative value of the tool were 99%, 95%, 95%, and 99%, respectively, compared with other diagnostic techniques. The control group received usual care with no systematic screening of BV. A total of 6671 women were randomly assigned 1:1 to the intervention group (n = 3333) or control group (n = 3338). At inclusion, a total of 3438 were nulliparous pregnancies, with 1671 in the intervention group and 1767 in the control group. In the intention-to-treat analysis, no reduction in the rate of PTB was observed between the intervention and control group (3.8% vs 4.6%, respectively; risk ratio, 0.83; 95% confidence interval [CI], 0.66–1.05; P = 0.12). The average cost of intervention per woman was €203.60 (US $218.00). No significant differences were observed in the total cost in the intervention group versus control group (€3344.30 [US $3580.50] vs €3272.90 [US $3504.10]). In addition, no evidence of superiority was observed for the intervention strategy compared with usual care. However, in the nulliparous subgroup, the number of PTBs was significantly lower in the intervention group (3.6%; 95% CI, 2.9–4.6) than the control group (5.9%, 95% CI, 4.8–7.2), and the cost was nonsignificant. In conclusion, the molecular diagnostic tool for screening and treating BV did not significantly reduce the risk of PTBs. Although no significant benefit was found in the overall population, the screen-and-treat strategy using a molecular tool was more effective than usual care in reducing PTBs among nulliparous pregnant women.

High-risk human papillomavirus prevalence among South African women diagnosed with other STIs and BV.

Human papillomavirus (HPV) infection is a leading cause of cervical cancer. Although this relies on infection and persistence of HPV in epithelial cells, often occurring in the context of other sexually transmitted infections (STIs) and bacterial vaginosis (BV), data on the relationships between these and their relative effects on epithelial barrier integrity in women remain sparse. This study describes the epidemiology of HPV combined with STI and/or BV prevalence and the relative impact on matrix metalloproteinases (MMPs) among South African women. Roche Linear Array was used for HPV genotyping in menstrual cup pellets of 243 HIV-negative women participating in the CAPRISA 083 cohort study. Vulvovaginal swabs were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis using Xpert® CT/NG assay and lateral flow assay, and Gram staining was performed to diagnose BV using Nugent scoring criteria. Concentrations of 5 MMPs were measured in menstrual cup supernatants by multiplexed ELISA. Fisher's exact tests, Mann-Whitney U tests, and multivariable regression models determined associations between HPV infection, STI and/or BV, and MMP concentrations. HPV was prevalent in 34% of women (83/243; median 23 years, interquartile range (IQR) 21-27 years). Low-risk (lr) (71%, 59/83) and high-risk (hr)-HPV infections (54.2%, 45/83) were common. Hr-HPV was frequently detected in STI and/or BV-positive women compared to women without STIs or BV (p = 0.029). In multivariable analysis, BV was associated with increased odds of hr-HPV detection (OR: 2.64, 95%CI: 1.02-6.87, p = 0.046). Furthermore, Gardasil®9 vaccine-type strains were more frequently detected in women diagnosed with STI and/or BV (55.2%, 32/58 vs 24%, 6/25; p = 0.009). Among STI and/or BV-positive women, HPV detection was significantly associated with increased MMP-10 concentrations (b = 0.55, 95% CI 0.79-1.01; p = 0.022). Most women with hr-HPV had another STI and/or BV, emphasizing an urgent need for STI and BV screening and intensive scale-up of cervical cancer screening and HPV vaccination programmes. Furthermore, the study highlights the need for more extensive research to confirm and understand the relationship between HPV infection and barrier integrity.

Effectiveness and Costs of Molecular Screening and Treatment for Bacterial Vaginosis to Prevent Preterm Birth

Bacterial vaginosis (BV) is a well-known risk factor for preterm birth. Molecular diagnosis of BV is now available. Its impact in the screening and treatment of BV during pregnancy on preterm births has not been evaluated to date. To evaluate the clinical and economic effects of point-of-care quantitative real-time polymerase chain reaction screen and treat for BV in low-risk pregnant women on preterm birth. The AuTop trial was a prospective, multicenter, parallel, individually randomized, open-label, superiority trial conducted in 19 French perinatal centers between March 9, 2015, and December 18, 2017. Low-risk pregnant women before 20 weeks' gestation without previous preterm births or late miscarriages were enrolled. Data were analyzed from October 2021 to November 2022. Participants were randomized 1:1 to BV screen and treat using self-collected vaginal swabs (n = 3333) or usual care (n = 3338). BV was defined as Atopobium vaginae (Fannyhessea vaginae) load of 108 copies/mL or greater and/or Gardnerella vaginalis load of 109 copies/mL or greater, using point-of-care quantitative real-time polymerase chain reaction assays. The control group received usual care with no screening of BV. Overall rate of preterm birth before 37 weeks' gestation and total costs were calculated in both groups. Secondary outcomes were related to treatment success as well as maternal and neonate health. Post hoc subgroup analyses were conducted. Among 6671 randomized women (mean [SD] age, 30.6 [5.0] years; mean [SD] gestational age, 15.5 [2.8] weeks), the intention-to-treat analysis of the primary clinical and economic outcomes showed no evidence of a reduction in the rate of preterm birth and total costs with the screen and treat strategy compared with usual care. The rate of preterm birth was 3.8% (127 of 3333) in the screen and treat group and 4.6% (153 of 3338) in the control group (risk ratio [RR], 0.83; 95% CI, 0.66-1.05; P = .12). On average, the cost of the intervention was €203.6 (US $218.0) per participant, and the total average cost was €3344.3 (US $3580.5) in the screen and treat group vs €3272.9 (US $3504.1) in the control group, with no significant differences being observed. In the subgroup of nulliparous women (n = 3438), screen and treat was significantly more effective than usual care (RR, 0.62; 95% CI, 0.45-0.84; P for interaction = .003), whereas no statistical difference was found in multiparous (RR, 1.30; 95% CI, 0.90-1.87). In this clinical trial of pregnant women at low risk of preterm birth, molecular screening and treatment for BV based on A vaginae (F vaginae) and/or G vaginalis quantification did not significantly reduce preterm birth rates. Post hoc analysis suggests a benefit of screen and treat in low-risk nulliparous women, warranting further evaluation in this group. ClinicalTrials.gov Identifier: NCT02288832.

O-019 Decreased Sperm Motility Associated With Bacterial Vaginosis Modeled in a Human Cervix Chip

Abstract Study question What is the underlying cause of infertility associated with bacterial vaginosis (BV)? Summary answer We provide the first evidence to suggest that BV-associated infertility could be the result of sperm dysfunction induced by exposure to poor cervical microbiome. What is known already Infertility is a global health concern, impacting 186 million individuals worldwide. In 25% of infertile couples the underlying cause remains unexplained. The complex interactions between the host mucosal epithelium, microbiome, and other microenvironmental factors play a significant role in health and disease of the reproductive tract. BV affects 30% of reproductive-aged women and is linked to overgrowth of pathogenic Gardnerella vaginalis bacteria. BV has a strong association with infertility, but it is not clear whether the resulting changes in the vaginal microbiome play a causal role, and as such BV screening is not currently included in infertility evaluation or treatment Study design, size, duration Female reproductive tract protective factors such as cervical mucus helps sperm retain their ability to fertilize for days compared to hours in suspension. We previously leveraged human organ-on-a-chip microfluidic culture technology to develop a physiological in vitro model of human cervix (Cervix Chip) that is lined with primary cervical epithelium interfaced with stromal fibroblasts. The epithelium forms a functional tissue barrier and produces mucus with compositional, biophysical, and hormone-responsive properties similar to the living cervix. Participants/materials, setting, methods We used 2D culture of sperm and bacteria as a screening and validated the effect of the identified bacteria on physiological in vitro Cervix Chip. A BV consortium containing E2 and E4 Gardnerella vaginalis bacteria was co-cultured with the Cervix Chip for 48 hours before adding human sperm samples. The motility of fluorescently labeled sperm was non-invasively evaluated in live chips using time-lapse imaging and quantitatively analyzed to obtain the percentage of motile sperm. Main results and the role of chance We initially analyzed the effects of bacterial co-cultur L. crispatus (optimal) or G. vaginalis (suboptimal) bacteria on sperm motility using a conventional 2D culture system. We observed a significant drop in sperm motility within 2 hours when exposed to G. vaginalis compared to L. crispatus or the control condition (no bacteria). We have established sperm staining and live tracking on Cervix Chip. Motile sperm was tracked on Cervix Chip for more than 7 days compared to 12 hours in suspension. We then tested this effect on-chip and observed that co-culture of live sperm with dysbiotic Cervix Chip (infected with G. vaginalis) resulted in a significant reduction in the sperm motility within 24 hours after exposure compared to the sperm exposed to the chips without bacteria. The dysbiotic Cervix Chip also exhibited a disease phenotype with elevated levels of proinflammatory cytokines including IL-1α, IL-1β, IL-6, IL-8, and TNF-α in the effluents of the chip's epithelial channel as well as significantly reduced thickness of the cervical mucus layer that correlated with reduced sperm motility. This finding is consistent with the observation that successful fertility is often associated with the quality of cervical mucus, which can be compromised in the BV dysbiotic condition. Limitations, reasons for caution Primary cervical epithelium cells used in the study were sourced from a single donor. Frozen sperm samples prepared for intrauterine insemination were used in the study Wider implications of the findings Our study suggests that infertility related to BV may be caused by sperm dysfunction, and BV screening should be considered in patients with unexplained infertility. We propose a model that can be used to identify dysbiotic conditions in the female reproductive tract that are unfavorable to sperm motility. Trial registration number N/A

Bacterial Vaginosis and Post-Operative Pelvic Infections.

Bacterial vaginosis (BV) represents a condition in which the normal protective Lactobacilli, especially those that produce H2O2, are replaced by high quantities of facultative anaerobes, leading to gynecologic and obstetric post-operative complications. BV is an important cause of obstetric and gynecological adverse sequelae and it could lead to an increased risk of contracting sexually transmitted infections such as gonorrhea, genital herpes, Chlamydia, Trichomonas, and human immunodeficiency virus. Herein, we reviewed bacterial vaginosis and its association with post-operative pelvic infections. In Obstetrics, BV has been associated with increased risk of preterm delivery, first-trimester miscarriage in women undergoing in vitro fertilization, preterm premature rupture of membranes, chorioamnionitis, amniotic fluid infections, postpartum and postabortal endomyometritis as well as postabortal pelvic inflammatory disease (PID). In gynecology, BV increases the risk of post-hysterectomy infections such as vaginal cuff cellulitis, pelvic cellulitis, pelvic abscess, and PID. BV is often asymptomatic, can resolve spontaneously, and often relapses with or without treatment. The American College of Obstetricians and Gynecologists recommends testing for BV in women having an increased risk for preterm delivery. Women with symptoms should be evaluated and treated. Women with BV undergoing gynecological surgeries must be treated to reduce the frequency of post-operative pelvic infections. Metronidazole and clindamycin are the mainstays of therapy. Currently, there is no consensus on pre-surgery screening for BV; decisions are made on a case-by-case basis.

Risk Factors Associated with Bacterial Vaginosis in Pregnant Women in Senegal

Background: Bacterial vaginosis (BV) is associated with a high risk of complications, particularly during pregnancy.&#x0D; Objectives: The aims of this study were to determine the prevalence of BV in pregnant women in Dakar, Senegal, and to identify its associated risk factors.&#x0D; Patients and Methods: This prospective cross-sectional study was conducted from July 2020 to March 2021 in pregnant women with 34 to 38 weeks of gestation and seen for their routine prenatal consultation at the Nabil Choucair health center in Dakar, Senegal. Vaginal swabs were taken and examined using the Nugent scoring system for the diagnosis of the BV. Data analysis on SPSS (version 25) was done using the chi-square test to measure the strength of association. A value of p ≤ 0.05 was considered statistically significant.&#x0D; Results: BV was found in 28.0% (112/400) of the screened women with a median age 24 (21-29) years. A pH &gt;4.5 predictive of BV was found in 80.4% (90/112) of samples. BV was associated with vaginal candidiasis in 49.1% (55/112) while Trichomonas vaginitis was found in 1.8% (02/112). In 80.4% (90/112) of affected women, BV was caused by Gardnerella vaginalis. Mobiluncus spp. was found in 19.6% (22/112) pregnant women in association with G. vaginalis. Symptoms characterized by episodes of pruritus, pelvic pain, burning and/or dyspareunia were seen among 59.8% (67/112) of these women with BV while 40.1% (45/112) of them reported no symptoms.&#x0D; Conclusion: In view of these results and in order to reduce gestational complications and adverse outcomes in the newborn, screening for BV in pregnant women should be favored in developing countries.

A Study of Bacterial Vaginosis and Associated Risk Factors among Married Women in Zakho City, Kurdistan Region, Iraq

Bacterial Vaginosis (BV) is a leading cause of reproductive tract problems, affecting mostly women of reproductive age group, worldwide. The aim of this study is to detect the infection rate of BV and then evaluate the risk factors associated with this bacterium among married women in Zakho city, Iraq. This cross-sectional study was performed among a 150-reproductive-age women's group from October 2021 till April 2022. The administered and structured questionnaire was designed to measure demographic, risk factors, and clinical characteristics. The vaginal swabs were collected from each subject and used for microscopical examination, including wet mount, vaginal pH, germ tube, and Gram stain methods to analyze the infection rate. The analysis of univariate regression analysis was applied to determine the relationships between BV and associated risk factors and clinical characteristics. The average age of participants was 32.64 years (±8.01 SD). The prevalence of BV was 41 (27.33%) among married women. About 12 (8%) and 1 (0.67%) of participants had mixed infections with Candida albicans and Trichomonas vaginalis, respectively. BV was found mostly among the age group less than 20 years (41.67) followed by age group of 40-50 years (37.93%). We found a higher infection rate among subjects from rural area (34.78%), but statistically not significant (p=0.17). Higher number of births was statistically associated to BV (OR 1.17, 1.006-1.37; p=0.003). BV was also highly associated among symptomatic patients with abnormal vaginal discharges (OR 4.18, 1.89-1.9.23; p=0.002), genital ulcer (OR 0.34, 0.13-0.84; p=0.01), and vaginal pH level more than 4.5 (OR 0.009, 0.002-0.043; p=0.001). BV is still prevalent among married women in our region. The higher infection rate was significantly associated with higher birth numbers, vaginal discharges, genital ulcers, and higher vaginal pH. There is an urgent requirement for regular screening for bacterial vaginosis among symptomatic women. Therefore, the early detection of risk factors associated with bacterial vaginal growth is critical to enhancing the health condition of married women, in order to prevent the risk of BV.

Screening for Low-Tract Genital Infections in Women with Threatened Preterm Labor: Which Role?

Objectives: The aim of this study was to evaluate the possible relationship between cultural specimens and preterm birth in women admitted for threatened preterm labor. Preterm birth is the leading cause of neonatal mortality and antenatal hospitalization; several risk factors including intrauterine infections have been identified, but its real causes remain poorly understood. Design: This is a retrospective, multicenter, cohort study including 250 women admitted for threatened preterm labor. Methods, Participants/Materials, Setting: All women admitted for threatened preterm labor, i.e., presenting with cervical changes and uterine activity before 37 weeks at the obstetrics unit of the hospitals of Modena, Monza, Carate, and Vimercate were included in the study. We excluded twin pregnancies and cases with preterm premature rupture of membranes at admission. Data about maternal history, pregnancy complications, cervical length, vaginal swabs, and urine culture at admission and gestational age at delivery were collected from clinical records in order to compare the incidence of preterm birth according to some known risk factors, cervical length, and microbiological test at admission. Results: 250 women were included in the study; preterm birth at less than 37 weeks occurred in 44.4% women admitted for threatened preterm labor. The incidence of preterm birth was not different between those with a positive or a negative vaginal swab (48.3 vs. 38.4%, p = 0.22) or positive versus negative urine culture (31.8 vs. 42.1%, p = 0.23) at admission. A shorter cervical length at admission was found in women with subsequent preterm birth (17 vs. 19.5 mm, p = 0.03). Cervical length <15 mm (OR 1.82, 95% CI: 1.03–3.23, p = 0.039) predicted the risk of preterm birth. Furthermore, only the history of a previous preterm birth (p = 0.02) and a previous uterine curettage (p = 0.045) was associated with preterm birth. Limitations: The observational and retrospective nature of the study and its small sample size are important limitations of the study. Moreover, women were not systematically or randomly assigned to the screening for vaginal or urinary infections. Conclusions: There is no evidence that the search for vaginal or urinary infections in women admitted for threatened preterm labor is helpful to identify those at increased risk of preterm birth. Although several studies have explored the role of screening for bacterial vaginosis in asymptomatic women and some studies evaluated vaginal or urinary infections in women with preterm birth, none of them focused on the possible role of microbiological specimens as a predictive tool in women admitted for threatened PTL. No association was found in our study, but prospective randomized controlled trials are required to confirm the results of this observation.

Assessment of vaginal health before and after treatment with vaginal suppository containing Lactiplantibacillus pentosus KCA1

Bacterial Vaginosis (BV) is a polymicrobial syndrome characterized by a shift in the vaginal flora from a predominant population of Lactobacilli to a replacement with anaerobes. Vaginal suppositories containing L. pentosus KCA1 were formulated using glycerol-gelatin base. A prospective and follow-up community-based study was done. Vaginal samples were collected from women of reproductive age (non-pregnant) between 18-45 years. A total of 360 women both symptomatic and asymptomatic provided High Vaginal Swabs (HVS) for BV screening using Nugent scoring method and 65 (18.1 %) participants were identified as having BV by microscopy with 45 (12.5 %) of them being consistent with BV (Nugent score of 7-10) and twenty (5.56 %) being intermediate with BV (Nugent score of 4-6). A baseline and intervention questionnaire were administered to the participants. Majority (81.5 %) of the participants affirmed that they have not heard about BV. Social burden reveals that 90.8 % affirmed that they feel frustrated, having BV symptoms recur after treatment and 83.1 % admitted that BV symptoms makes them feel embarrassed, ashamed and dirty. Majority (58.8 %) claimed that the state of their reproductive health is ‘very good’ four weeks after treatment, while 88.2 % of the participants rated their reproductive health after four weeks of treatment to be ‘somewhat better than now than a year ago’. In conclusion, it was revealed that BV has impact on the social status and quality of life of the participants except on their economic status. Knowledge on the awareness of BV among women of reproductive age is essential.

Differences in clinical practice regarding screening and treatment of infections associated with spontaneous preterm birth: An international survey

ObjectiveAn association between infections in pregnancy and increased risk of preterm birth (PTB) is described in the literature. We anticipated that differences may exist in screening and treatment approaches for infections associated with PTB, within and between European countries. The aim of this study was to examine and analyse these differences in clinical practice in greater detail. Study DesignWe created a descriptive survey examining the screening and treatment of infections in pregnancy. The survey was sent to European representatives of the International Spontaneous Preterm Birth Young Investigators (I-SPY) group in Europe, who sent it to their network. Finally, we had 50 respondents from ten European countries. ResultsWe found substantial differences in screening for bacterial vaginosis and asymptomatic bacteriuria, administration of antibiotics to women with preterm prelabour rupture of membranes (PPROM), and timing of induction of labour after PPROM. These differences in clinical practice were present both within, and between countries. ConclusionsApproaches for screening and treatment of infections associated with PTB differ between European countries. There is a lack of robust evidence, which is reflected in a lack of uniformity in international guidelines. International collaboration is paramount to enlarge sample sizes in obstetric studies and to facilitate the process of developing, updating, and implementing consistent guidelines across Europe and beyond.

Molecular Characterisation and Antibiogram of Vaginal Flora from Students Attending a Tertiary Institution in Port Harcourt, Rivers State, Nigeria

The microbiome of the vagina is characterized by a community bacteria playing important roles in the overall health status of the female genital tract. This study was conducted to isolate and characterize bacteria from the female genital tract and as well evaluate the antibiotics susceptibility pattern of the vaginal bacterial isolates. For this purpose, a total of fifty (50) vaginal swab samples were collected (using sterile swab sticks) from females attending a tertiary institution in Port Harcourt, Rivers State, Nigeria, and subjected to standard bacteriological analysis. Antibiotics sensitivity analysis was carried out using the modified Kirby Bauer disc diffusion method. A total of 160 bacterial isolates were obtained from the subjects of different age brackets in the study population. Molecular identification based on the nucleic acid sequence of the bacterial isolates revealed the isolates to be Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Bacillus flexus and Lysinibacillus macrolides. The result further showed that Escherichia coli was the most occurring bacterial isolate. Also, female subjects within the age bracket 21-23 years recorded the highest number of bacterial isolates (67) and 24-26 years had the least number of bacterial isolates (36). The antibiotic sensitivity analysis revealed that Escherichia coli and Staphylococcus aureus were resistant to 50% of the antibiotics tested, whereas Klebsiella pneumoniae was resistant to all (100% of) the antibiotics tested. The study has revealed that the vaginal microbiome of healthy female subjects is characterised by diverse species of bacteria, including opportunistic bacterial pathogens. The study therefore, recommended that regular screening for bacterial vaginosis as well as personal hygiene, sensitization programs to improve knowledge of women, should be encouraged.

Screening for Bacterial Vaginosis in Pregnant Persons to Prevent Preterm Delivery: US Preventive Services Task Force Recommendation Statement

(Abstracted from JAMA 2020;323(13):1286–1292) Bacterial vaginosis (BV) is a common vaginal condition, occurring in 5.8% to 19.3% of pregnant women. It is also associated with a 2-fold higher risk for preterm delivery, although it is unclear whether the condition is a cause of preterm birth.

An Attempt to Classify Gram-Stained Vaginal Smears with a Nugent Score of 4 into Four Bacterial Morphotypes at First Prenatal Visit

It is controversial whether universal screening for bacterial vaginosis (BV) should be done in the early stages of pregnancy in order to prevent preterm birth. In particular, whether the intermediate vaginal flora type should be included in the group to be treated for BV. This vaginal smear type is a mixture of Lactobacillus and Gardnerella or Bacteroides spp. We examined three vaginal flora types, excluding the mixed-type, with a Nugent Score of 4 and evaluated their significance in achieving term delivery. The subjects were pregnant women who were examined at our Hospital between June 2009 and December 2010. Their vaginal swabs were taken at their first prenatal visit and were studied by Gram staining. The resulting Nugent Score 4 organisms were further classified into the following four types: mixed-type, gram-positive cocci type, Bifidobacterium type, and non-bacterial type. The clinical courses for all the types except “mixed-type” were followed-up. Among the 566 pregnant women, 58 (10.2%) had a Nugent Score of 4. There were 38 cases of mixed-type (65.5%), 3 cases of gram-positive cocci type (5.2%), 10 cases of Bifidobacterium type (17.2%), and 7 cases of non-bacterial type (12.1%). The three women with the gram-positive cocci type attained successful term delivery despite two of them experiencing GBS infection and requiring treatment with penicillin and tocolytics. Among the 10 cases of Bifidobacterium type, 5 cases were term delivery with no therapy, 3 cases were term delivery with metronidazole treatment and 2 cases were preterm birth with maternal complications. Among the 7 cases of non-bacterial type, 6 cases were diagnosed with preterm PROM, and 5 of them resulted in preterm birth despite prophylactic antibiotic therapy. Classification of smears with a Nugent score of 4 into four bacterial morphotypes may be effective, for required treatment may vary depending on the morphotype.

The Vaginal Microbiome and Cervical Cancer Screening in Low- and Middle-Income Countries

PURPOSE Globally, cervical cancer affects more than a half-million women each year, with disproportionate incidence and mortality for women in low- and middle-income countries. Early detection through cervical cancer screening saves lives but is hampered by poor coverage, suboptimal detection accuracy, and lack of access to and delays in effective treatment. METHODS Emerging evidence that indicates how the vaginal microbiome can modify progression of human papillomavirus (HPV) infection and cervical cancer pathogenesis is surveyed. This presentation features a discussion of how the vaginal microbiome may affect cervical cancer screening and how cervical cancer screening may incorporate vaginal microbiome health in low- and middle-income countries. RESULTS Vaginal dysbiosis as a clinical syndrome may be called bacterial vaginosis (BV), a condition that represents a shift from a Lactobacillus-dominant vaginal microbiome to one that is polymicrobial and often associated with increased mucosal inflammation. Meta-analyses and prospective studies demonstrate an association between vaginal dysbiosis and increased risk of HPV incidence and persistence and high-grade lesions and cancer. Increasing vaginal microbiome diversity is associated with progression of cervical intraepithelial neoplasia. Vaginal microbiota that are associated with greater likelihood of HPV detection in molecular studies are also commonly associated with BV. There are numerous challenges to incorporating microbiome measurement in population-level cervical cancer screening and unanswered research questions on its immediate utility. BV may serve as a measure of vaginal microbiome health, although there are no guidelines or recommendations for regular BV screening and treatment. CONCLUSION Ongoing and planned longitudinal studies should evaluate BV screening in association with high-risk HPV, results of cervical cancer screening, and progression of cervical intraepithelial neoplasia to assess the utility of BV screening and treatment as an adjunct to cervical cancer screening and potential intervention.

Screening of Bacterial Vaginosis in Pregnant Women of Bundelkhand Region

Screening of Bacterial Vaginosis in Pregnant Women of Bundelkhand Region

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.

Development of a nomogram for individual preterm birth risk evaluation

ObjectiveThis study aimed to develop a new tool for personalised preterm birth risk evaluation in high-risk population. Study design813 high-risk asymptomatic pregnant women included in a French multicentric prospective study were analysed. Clinical and paraclinical variables, including screening for bacterial vaginosis with molecular biology, cervical length, have been used to create the nomogram, based on the logistic regression model. The validity was checked by bootstrap. A downloadable calculator was build. ResultsNine risk factors were included in this model: history of late miscarriage and/or preterm delivery, active smoking, ultrasound cervical length, term of pregnancy at screening, bacterial vaginosis, premature rupture of membranes, daily travel more than 30min. Discrimination and calibration of the nomogram revealed good predictive abilities. The area under the receiver operating characteristic curve was 0.77 (95% CI; 0.72–0.81). The mean absolute error was 0.018, which showed proper calibration. The optimal risk threshold was 23.2% with a sensitivity of 74%, a specificity of 72.7% and a predictive negative value of 90.6%. ConclusionThe nomogram can help to better define individual preterm birth risk in high-risk pregnancies.

Bacterial Vaginosis and C. Trachomatis as Risk Factors for First Trimester Miscarriage

Background: Miscarriage is the most common adverse outcome of pregnancy. Bacterial vaginosis (BV) is known as alteration of vaginal milieu. C. trachomatis is intracellular, sexually transmitted bacteria. Objectives: we aimed to investigating the role of BV and C. trachomatis in 1 st trimester miscarriage. Methodology: This study included 95 pregnant women with gestational age < 14 weeks. For each subject we investigate BV by Amsel's criteria and Nugent scoring. Anti chlamydial IgG antibodies were detected using qualitative ELISA. C. trachomatis DNA of cryptic plasmid were detected in urine sample by polymerase chain reaction. Results: BV was not risk factor for 1 st trimester miscarriage, however it was significantly associated with smoking ( P = 0.001), vaginal douching ( P = 0.001), intrauterine device ( P = 0.001) and history of preterm labor ( P = 0.002). C. trachomatis infection was significantly associated with 1 st trimester miscarriage (P = 0.001), hormonal contraception ( P = 0.03) and BV ( P = 0.004). Being older than 30 years was risk factor for miscarriage. Recommendations: We recommend screening of BV and C. trachomatis preconception and in pregnant women for early diagnosis and treatment and to prevent recurrent miscarriage or preter.

Screening for bacterial vaginosis before intrauterine device insertion at a family planning clinic in south-west Nigeria.

This study determined the prevalence of bacterial vaginosis (BV) among clients before insertion of intrauterine device (IUD) and compared the incidence of complications between participants who were positive and negative for BV. This was an observational cohort study that was performed between May 2014 and September 2014. A total of 360 women were recruited and followed up for 1 month. High vaginal swabs were obtained from each participant pre-insertion of the IUD and 1 month post-insertion. BV was diagnosed using Nugent's scoring. Data were collected, collated and analysed using frequency distributions and Chi-square test as appropriate. The level of statistical significance was P< 0.05. The prevalence of BV was 33.3%. The complication rate was 23.9% in which 30.5% complication rate was seen among participants positive for BV and 22.5% among participants negative for BV (P = 0.192). This was done with respect to four primary clinical outcomes. The incidence of BV one month after IUD insertion was 11.5%. The prevalence of BV was within the range reported in other populations. The complication rate appeared high; however, the differences in proportion between women positive and negative for BV were not statistically significant.