Vaginosis Research Articles

Temporal dynamics of the vaginal microbiome and host immune markers before, during, and after metronidazole treatment for bacterial vaginosis.

This study analyzed metagenomic and immune marker profiles of seven individuals before, during, and after a 7-day course of metronidazole treatment for bacterial vaginosis (BV). Treatment reduced BV-associated bacteria and immune marker levels, with distinct early (days 1-4) and late (days 5-7) phases. Post-treatment variability in microbial and immune marker profiles demonstrated a rapid resurgence of certain BV-associated bacteria, highlighting the need for additional strategies like probiotics to maintain a healthy vaginal microbiome. The study found significant host and microbial influences on immune response variance, with IP-10 and sEcad highly correlated with the vaginal microbiome. The findings identify the optimal timing for administering live biotherapeutics to restore D-lactic acid-producing Lactobacillus species dominance and underscore the complexity of BV infection and treatment response among different people.IMPORTANCEBacterial vaginosis (BV), a common condition associated with an increased risk of preterm birth and sexually transmitted infections, among others, is characterized by a dysbiotic vaginal microbiome associated with the predominance of a diverse assortment of anaerobic bacterial species. Metronidazole is the first-line treatment recommended by the CDC for BV when patients report symptoms. Despite treatment, BV recurrence is common. There is limited data regarding the effects of oral metronidazole on the vaginal microbiome starting at the initiation of treatment, as most studies have compared measurements taken before and after treatment completion. This study utilized metagenomic sequencing, pan-bacterial qPCR, and immune marker measurements to analyze the longitudinal dynamics of the vaginal microbiome and host immune response before, during, and after metronidazole treatment.

Lactobacilli and bacterial vaginosis. Species typing and analysis of content levels in the microbiome

Objective. To examine changes in lactobacilli composition in the vaginal microbiocenosis associated with bacterial vaginosis (BV) and to assess the frequency of individual species. Material and methods. The study included 40 patients who presented with pathological discharge from the genital tract and had a confirmed diagnosis of BV based on the Amsel criteria. Quantitative assessment and typing of lactobacilli were performed using real-time PCR. Results. All women with BV were found to have lactobacilli present in quantities ranging from 0.01% to 100% of the total bacterial content. Analysis of the distribution of the lactobacilli index (LI), which indicates the proportion of lactobacilli in the total bacterial content, revealed three peaks corresponding to samples with low, intermediate, and high values. During the typing, all four species of lactobacilli characteristic of the vaginal microbiocenosis were identified: L. iners, L. crispatus, L. jensenii, and L. gasseri/L. johnsonii. No samples were found that lacked at least one of these species; L. crispatus and L. iners were the most frequently detected. Despite a general trend toward decreased LI levels in BV, patients were categorized into three subgroups based on their LI values: high, moderately reduced, and low. Conclusion. The positive correlation observed for L. iners and the negative correlation for L. crispatus with the degree of dysbiosis do not, in our opinion, reflect direct cause-and-effect relationships regarding BV, as these correlations are more closely associated with lactobacilli content than with clinical manifestations of the disease. A significant proportion of BV cases with the preservation of lactobacilli dominance suggests the existence of at least two forms of this syndrome. One of them, despite the presence of clinical symptoms, is not associated with a decrease in the number of lactobacilli in the vaginal microbiome.

Cervical cancer pathology and vaginal and gut microbiota: conception of the association.

The role of gut and vaginal microbiota has been examined as potential markers in the progression of cervical cancer and inspired heightened attention. We attempted to identify the current status, the influence of changing trends in the gut and vaginal microbiota, and their impact on cervical cancer. All publications were searched in online databases such as PubMed, Scopus, Medline, and Google Scholar using the keywords "cervical cancer," "vaginal microbiota," "gut microbiota," "dysbiosis," "cervical intraepithelial neoplasia," and "HPV." Growing evidence that gut microbiota dysbiosis is involved in many diseases has attracted many researchers. The vaginal microbiome is a micro-ecosystem complex that undergoes continuous fluctuations throughout a woman's life. Decrease in Lactobacilli spp. Levels can lead to an overgrowth of anaerobic bacteria, resulting in bacterial vaginosis that accounts for adverse health outcomes, including increased susceptibility to sexually transmitted infections, including human papillomavirus, and cervical intraepithelial neoplasia, leading to cervical cancer. Thus, dysbiosis, characterized by an imbalance of beneficial and harmful bacteria, can negatively affect health. Understanding the intricate interactions between the microbiota and cervical cancer can provide valuable insights into potential therapeutic strategies and the development of preventive measures.

Bacterial vaginosis: modern views

Bacterial vaginosis (BV) is attributed by some researchers to inflammatory syndrome with subclinical course due to the presence of individual inflammatory clinical signs and detection of proinflammatory cytokines in vaginal discharge produced by T-helper type 1 cells (Th1). This is a common vaginal disease in women of reproductive age. The analytical review discusses modern aspects of this disease. It is considered that the disease occurs when predominant species of healthy vaginal flora (Lactobacillus spp.) replace anaerobic bacteria, mostly Gardnerella vaginalis, although the etiology of BV is still unknown. There is an increasing evidence confirming the hypothesis that BV raises the risk of sexually transmitted infections (including chlamydial, gonococcal, as well as human papilloma virus and human immunodeficiency virus) in women and their sexual partners. G. vaginalis has a proven ability to form microbial biofilm on the surface of the vaginal mucosa. The modern conceptual model of BV pathogenesis includes the transmission of G. vaginalis virulent strains through sexual intercourse and the initiation of microbial biofilm formation. Microorganisms acquire new properties being a part of biofilm including a significant reduction of sensitivity to causal treatment of BV-associated bacteria. It’s important to note that biofilm formation is one of the causes of antibiotic resistance, low therapy effectiveness and BV relapses.

The vaginal microbiota and preterm birth: A systematic review.

The vaginal microbiota and preterm birth: A systematic review.

Impact of prophages on gut microbiota and disease associations.

Impact of prophages on gut microbiota and disease associations.

The role of intimate hygiene in women’s health maintenance

Hygiene skills are an essential part of a human healthy lifestyle. COVID-19 pandemic updated the importance of adhering to basic hygiene rules that reduce the risk of infectious diseases transmission. Intimate hygiene is also an integral part of human modern life. Vaginal microbiome is a dynamic biosystem consisting of different microorganisms colonising the vagina. Currently, it is considered that the sign of a “healthy” vaginal microbiome is the dominance of Lactobacillus spp. which acidify the vaginal medium and protect it against pathogenic infection. The reduction of lactobacilli proportion in vaginal microbiome due to various factors can lead to adverse consequences for woman’s reproductive health, for example to bacterial vaginosis, increased risk of sexually transmitted infections occurrence and preterm birth. Inadequate intimate hygiene with the use of aggressive alkaline agents, as well as vaginal douching can contribute to the vaginal dysbiosis predisposing to pelvic inflammatory diseases. This review presents an analysis of scientific studies devoted to the impact of intimate hygiene on women’s health. It should be noted that adequate and regular intimate hygiene decrease the risk of developing sexually transmitted infections, vaginosis and vaginitis.

The Association Between Adenomyotic Abnormal Bleeding and Prevalence of Bacterial Vaginosis.

Background: Bacterial vaginosis (BV) is one of the most common vaginal conditions and is associated with significant obstetric and gynecological risks. Previous studies have demonstrated an association between menses and the vaginal dysbiosis underlying the development of BV. Given this association, we hypothesized that increased vaginal bleeding, such as abnormal uterine bleeding (AUB) caused by adenomyosis, might increase the risk of developing BV. Objective: This study assesses whether AUB in patients with adenomyosis was associated with BV diagnoses. Methods: We performed a retrospective study of 372 patients diagnosed with adenomyosis between 2016 and 2020 at a tertiary care center. Characteristics of patients who developed BV within 3 years of adenomyosis diagnosis were compared to patients without subsequent BV diagnoses. Results: The prevalence of BV in patients diagnosed with adenomyosis between 2016 and 2020 was 19.4%. Patients who developed BV following their diagnosis of adenomyosis had higher rates of menorrhagia than those who did not develop BV (p < 0.01). While patients with BV were primarily diagnosed with adenomyosis by radiological findings, patients without BV were mostly diagnosed with adenomyosis by post-hysterectomy histopathologic evaluation. Treatment of adenomyosis-related symptoms was significantly different between the two study groups. There was also a positive association between the prevalence of menorrhagia and the number of BV episodes, demonstrating a relationship between AUB and BV. Conclusions: This study provides evidence for an association between the menorrhagia caused by adenomyosis and a diagnosis of BV. Based on these findings, prospective studies are needed to assess the contribution of abnormal uterine bleeding pathologies to the development of BV.

Assessing urinary microbiota in chronic cystitis based on midstream urine sample.

This study aims to compare the urinary microbiota of healthy women, women with a predisposition to UTIs and patients with chronic recurrent cystitis using real-time PCR as well as identify diagnostic markers for urinary diseases. The study enrolled three groups of patients: healthy control group, patients with chronic recurrent cystitis and patients with a risk of developing UTIs. Urine samples were analyzed by multiplex real-time PCR reagent kits Femoflor®16 and BacScreen OM. Chronic recurrent cystitis is associated with an increase in total bacterial mass (TBM), genomic DNA and relative predominance of facultative anaerobic microorganisms. The most prevalent bacterial species found in chronic cystitis was E. coli in conjunction with other Enterobacteriaceae, most commonly, Serratia marcescens. An increased amount of genomic DNA and both facultative and obligate anaerobic microorganisms was observed in patients with a risk of developing UTIs. A relative decrease in Lactobacillus spp. was noted in both groups, with the chronic cystitis group showing a more pronounced reduction. In summary, the levels of genomic DNA, TBM and relative values of Lactobacillus spp. can be used as molecular diagnostics markers for chronic cystitis and a variety of other conditions, including micronephrolithiasis and bacterial vaginosis.

Syntrophic bacterial and host–microbe interactions in bacterial vaginosis

Bacterial vaginosis (BV) is a common, polymicrobial condition of the vaginal microbiota that is associated with symptoms such as malodor and excessive discharge, along with increased risk of various adverse sequelae. Host–bacteria and bacteria–bacteria interactions are thought to contribute to the condition, but many of these functions have yet to be elucidated. Using untargeted metaproteomics, we identified 1068 host and 1418 bacterial proteins in a set of cervicovaginal lavage samples collected from 20 participants with BV and 9 who were negative for the condition. We identified Dialister micraerophilus as a major producer of malodorous polyamines and identified a syntrophic interaction between this organism and Fannyhessea vaginae that leads to increased production of putrescine, a metabolite characteristic of BV. Although formate synthesis has not previously been noted in BV, we discovered diverse bacteria associated with the condition express pyruvate formate-lyase enzymes in vivo and confirm these organisms secrete formic acid in vitro. Sodium hypophosphite efficiently inhibited this function in multiple taxa. We also found that the fastidious organism Coriobacteriales bacterium DNF00809 can metabolize formic acid secreted by Gardnerella vaginalis, representing another syntrophic interaction. We noted an increased abundance of the host epithelial repair protein transglutaminase 3 in the metaproteomic data, which we confirmed by enzyme-linked immunosorbent assay. Other proteins identified in our samples implicate Finegoldia magna and Parvimonas micra in the production of malodorous trimethylamine. Some bacterial proteins identified represent novel targets for future therapeutics to disrupt BV communities and promote vaginal colonization by commensal lactobacilli.

High Prevalence of Vaginal Candidiasis and Absence of Trichomonas vaginalis Among Female Patients in Da Nang, Vietnam

Vaginitis is a major health concern among women, with inadequate treatment potentially leading to reproductive complications. This study aimed to assess vaginitis prevalence, identify predominant pathogens, and evaluate associated risk factors among female patients at Da Nang Dermato-Venereology Hospital. A prospective study of 796 female patients undergoing physical examinations was conducted, with demographic, clinical, and microbiological data collected. Vaginitis was diagnosed in 180 (22.6%) of 796 female patients, predominantly caused by Candida spp. (66.1%) and bacterial pathogens (31.7%), with no Trichomonas vaginalis detected, and was most prevalent in women aged 20–30 years. Poor hygiene practices, including infrequent sanitary pad changes (OR = 5.01, p &lt; 0.001) and routine vaginal douching (OR = 6.77, p &lt; 0.001), were significantly associated with vaginitis. The Amsel criteria showed high specificity (99.1%) for bacterial vaginosis diagnosis. The absence of T. vaginalis suggests a potential shift in the epidemiology of vaginal infections. The Amsel criteria are a practical diagnostic tool in resource-limited settings. Our findings highlight the need for targeted hygiene education to reduce vaginitis prevalence in Vietnam.

Association of Dysbiotic Vaginal Flora with Oncogenic Human Papillomavirus Infection, Bacterial Vaginosis and Pap Smear Abnormalities: Indian Context

PurposeBacterial vaginosis (BV) is reported to be the most common cause of dysbiotic vaginal flora with frequent relapses among women. It increases the susceptibility to other genital infections resulting in cervicitis. Cervicitis can potentially modulate the progression of the oncogenic Human Papilloma virus infection. The current study addresses the gaps in literature regarding the prevalence and association of HPV, co-burden of HPV with BV infection among women with cervicitis in Indian context.MethodsTotally, 508 eligible women, 254 with cervicitis (case arm) and 254 asymptomatic women with healthy cervix (control arm), attending a tertiary cancer hospital for cervical cancer screening were enrolled in the study. All enrolled women, irrespective of the study arm underwent Gram-stained smears for diagnosing Bacterial Vaginosis (BV), Hybrid Capture-2 test to diagnose oncogenic Human Papilloma Virus infection (HPV) and Pap smears to demonstrate epithelial cell abnormalities (ECA).ResultsThe odds ratio of having BV infection (OR 18, 95% CI 9.62–36.99), ECA (OR 4.1, 95% CI 2.21–8.29) and HPV infection (OR 2.8, 95% CI 2.71–3.14) among women in case arm were significantly higher as compared to the control arm. Women in the case arm were also at significantly increased risk of co-infections of HPV with BV (OR 1.6, 95% CI 1.42–1.52).ConclusionStrong association of BV and HPV infection with increased ECA demonstrated in our study warrants prompt and effective treatment of BV. Genital infections are known modulators of persistent HPV infection. More longitudinal studies may lend better understanding of vaginal microbiome and its interplay between BV and HPV infections.

Dynamic changes of vaginal microbiota in healthy Chinese women from pre-pregnancy to the postpartum period.

Dynamic changes of vaginal microbiota in healthy Chinese women from pre-pregnancy to the postpartum period.

Bacterial vaginosis.

Bacterial vaginosis (BV) is a vaginal microbiome disorder that is associated with preterm birth and spontaneous abortion, increased risk of HIV infection and sexually transmitted infections, and has negative effects on quality of life. BV affects one in four women globally, with the highest burden in resource-limited settings. Marked alterations in vaginal microbiome composition, in pro-inflammatory cytokines and chemokines, and in the proteome and metabolome characterize BV and contribute to adverse sequelae. Despite its prevalence, the exact aetiologic agent of BV is unknown and its pathophysiology is poorly understood. These knowledge gaps impede diagnostic and management approaches, with recommended treatment strategies resulting in recurrence that exceeds 50% over 3-6 months. New data on the sexual transmission of BV, including evidence that male-partner treatment improves cure, have improved our understanding of its aetiology and pathogenesis, and provide opportunities for developing optimal diagnostic, treatment and prevention strategies. Other factors probably also contribute to the low efficacy of current treatments, including biofilm and/or antimicrobial resistance, and failure to recolonize a favourable vaginal microbiome after treatment. The complex pathophysiology of BV highlights that individualized and multifaceted management approaches will be required to manage the refractory and adverse sequelae of BV.

Bacterial vaginosis.

Bacterial vaginosis.

Gynecological health: A missing link in comprehensive treatment monitoring for multiple sclerosis.

Safety monitoring of disease-modifying therapies (DMTs) used to treat multiple sclerosis (MS) has largely overlooked the domain of gynecological health. This topical review aims to provide MS clinicians with an overview of the three categories of complications described to date, as well as risk mitigation strategies. These are increased risk of human papilloma virus (HPV) positivity and related cervical dysplasia/cancers; inflammatory and infectious vaginitis and susceptibility to bacterial vaginosis (BV); and herpesvirus infections, including genital Herpes Simplex Virus (HSV). Current knowledge may be biased due to limited studies and lack of gynecological focus in neurological encounters. Risk mitigation strategies include promoting HPV vaccination, following guidance for immune compromised individuals relating to cervical cancer screening and antiviral suppression, and proactive communication with patients about gynecological health when starting DMTs. Together, these might improve gynecological health and thereby quality of life in females with neuroinflammatory diseases.

Three-year impact of COVID-19 pandemic on hospitalized twin pregnancies: evaluation of characteristics and changes in antibiotic prescribing.

The COVID-19 pandemic has significantly impacted healthcare systems worldwide, including obstetric care. However, the long-term effects on twin pregnancies remain unclear. This study investigates the impact of COVID-19 on the clinical characteristics and antibiotic prescribing patterns in hospitalized twin pregnancies. A retrospective cohort study was conducted at Women and Children's Hospital of Chongqing Medical University, Chongqing, China, involving 3,827 twin pregnancies with live deliveries between 1 January 2017 and 31 December 2022. The pre-pandemic group included 1,707 patients, and the pandemic group included 2,120. Sociodemographic and clinical data were analyzed using general linear models with SPSS and R software. During the pandemic, twin pregnancy admissions increased by 24.19%. Patients in the pandemic group have less gestational weight gain (17.00 vs. 16.08 kg, P < 0.001), had higher rates of assisted reproductive technology use (73.2% vs. 68.7%, P = 0.002), and experienced more complications. Neonates showed higher rates of pneumonia (5.7% vs. 3.8%, P < 0.001) and NICU admissions (43.7% vs. 13.9%, P < 0.001). Longer hospital stays were observed in the pandemic group (P = 0.004). Antibiotic prescriptions, especially non-repeat prescriptions, increased for older patients, those with higher BMI, and premature deliveries. The rate of repeated antibiotic prescriptions for bacterial vaginosis increased 1.68 times. COVID-19 influenced twin pregnancy admissions, clinical characteristics, and antibiotic use. The study highlights the need for rational antibiotic use and improved healthcare resource management in future crises.

IL-33 Participates in G. Vaginalis-Induced Bacterial Vaginosis: Involvement of Intravaginal IgA

IntroductionBacterial vaginosis (BV) is a common gynecological disease characterized by an abnormal increase in vaginal secretions, odor and itching. The pathogenesis of BV is not fully understood, but it is believed that the disruption of the mucosal immune system plays a key role. We investigated the role of IL-33 in preventing BV and explored the mechanism by which IL-33 regulates intravaginal IgA.MethodsProtein levels of IL-33 and IgA, and the pH value of vaginal secretions in healthy donors and patients with BV (14 vs 14) were determined by ELISA. G. vaginalis-induced bacterial vaginosis mouse model was established using wild-type (WT) and IL-33 knockout (KO) mice. Protein levels of IL-33, IgA and TGF-β, the pH value of vaginal secretions, and Gram-staining were measured in vivo and in vitro to investigate the role of IL-33 in BV progression.ResultsIL-33 and IgA were significantly decreased in vaginal secretions of patients with BV. IL-33 deficiency aggravated BV induced by G. vaginalis in a mouse model, while IL-33 supplementation prevented it. IL-33 modulated intravaginal IgA expression through the TGF-β signaling pathway in B cells.ConclusionIL-33 prevents G. vaginalis-induced BV by modulating intravaginal IgA expression through the TGF-β signaling pathway in B cells.

Factors associated with Nugent-bacterial vaginosis in pregnancy and postpartum among women in rural northwestern Bangladesh.

Community-based longitudinal data on factors linked to bacterial vaginosis (BV) during and after pregnancy in Bangladesh are limited. Using data from a rural randomized trial of vitamin A and β-carotene supplementation, we examined factors associated with Nugent-score-assessed BV. Self-collected vaginal swabs from 1,812 participants were obtained in early pregnancy, late pregnancy, and 3 months postpartum for Nugent scoring. We analyzed associations between participant factors and Nugent-BV (scores 7-10 vs. 0-6; 4-10 vs. 0-3) at eachtime point. Bivariate associations were tested using chi-square and t-tests, and multivariable log-binomial regression was used to estimate adjusted prevalence ratios with 95% confidence intervals. In early pregnancy, consistent soap use during bathing (vs. never/sometimes) was associated with a decreased risk of Nugent-BV 7-10 (adjusted prevalence ratio (aPR): 0.64, 95% CI: 0.43, 0.96). In late pregnancy, Hindu religion (vs. Muslim) (aPR: 2.68, 95% CI: 1.52, 4.72) and higher gestational age (aPR: 1.18, 95% CI: 1.04, 1.35) were associated with increased risk of Nugent-BV 7-10 and 4-10. Furthermore, maternal underweight (BMI < 18.5 kg/m² vs. ≥ 18.5) (aPR: 0.62, 95% CI: 0.44, 0.87) and having ≥1 antenatal care visit (vs. none) (aPR: 0.59, 95% CI: 0.38, 0.91) were associated with reduced risk of Nugent-BV 4-10. Among multiparous individuals, a longer pregnancy interval of ≥18 months (vs. < 18 months) was protective against Nugent-BV 7-10 (aPR: 0.34, 95% CI: 0.14, 0.81). At 3-months postpartum, vitamin A supplementation (vs. placebo) was associated with a decreased risk of Nugent-BV 7-10, consistent with prior trial findings. Our findings indicate that Nugent-BV during pregnancy and postpartum is linked to modifiable factors, including hygiene, nutrition, birth spacing, and healthcare access. Rigorous randomized trials are needed to evaluate their ability to reduce BV, promote long-term vaginal health, and lower the risk of adverse pregnancy outcomes.

Nanoparticle-Driven Modulation of Mucosal Immunity and Interplay with the Microbiome.

Mucosal surfaces are dynamic immunological interfaces that play a critical role in maintaining host defense and microbial homeostasis. Disruptions in the interaction between the mucosal immune system and its commensal microbiota have been associated with the onset of several diseases, including inflammatory bowel disease, asthma, and bacterial vaginosis. This review examines recent advances in nanoparticle (NP)-based strategies aimed at modulating mucosal immunity and restructuring microbial communities. It highlights how organic and inorganic NPs such as polysaccharide-based carriers, lipid NPs, and metallic nanomaterials enhance the delivery and stability of probiotics, prebiotics, and synbiotics, and facilitate targeted immunomodulation across gastrointestinal, respiratory, and female reproductive mucosal tissues. NP-based strategies are particularly emphasized for their ability to penetrate mucus barriers, facilitate microbial colonization, modulate cytokine activity, and enhance the restoration of epithelial barrier function. Disease-specific applications, including NP-based therapies for colitis, respiratory inflammation, and vaginal dysbiosis, are also discussed. In addition, this review outlines current challenges related to biosafety, targeting specificity, and clinical translation, and suggests future directions for research. Altogether, NP platforms offer a promising avenue for the precise modulation of mucosal immunity and microbiota, with significant potential in the prevention and treatment of mucosal-associated diseases.