Vaginitis Research Articles

EFEKTIVITAS EKSTRAK DAUN SIRIH MERAH TERHADAP JUMLAH KOLONI BAKTERI PADA REMAJA PEREMPUAN YANG MENGALAMI KEPUTIHAN

Leukorrhea, or vaginal discharge, is a common issue faced by adolescent girls during puberty. The Indonesian Adolescent Reproductive Health Survey reports that 31.8% of young women experience this condition, indicating their increased vulnerability to vaginal infections. Bacterial growth is a primary cause of leukorrhea, particularly in adolescent girls whose thin vaginal mucosa provides a favorable environment for bacterial proliferation, resulting in excessive fluid production and discomfort. Red betel leaf extract, containing natural antiseptics and antibiotics, offers an effective treatment for leukorrhea. The research sought to examine how extract from Piper crocatum (red betel leaf) impacts the growth of bacteria responsible for leukorrhea in young female adolescents. The research employed the Total Plate Count method to measure aerobic bacterial colony numbers in the participants' leukorrhea samples The research employed a quasi-experimental methodology, utilizing a single group pre-post test design and sequential sampling. Results demonstrated a notable impact of red betel leaf extract on the quantity of bacterial colonies in teenage girls. The statistical evaluation produced a p-value below 0.05 (specifically, 0.02), validating the extract's effectiveness. The research concludes that red betel leaf extract, a readily available natural remedy, can serve as an effective therapy to reduce bacterial colonies responsible for leukorrhea in adolescent girls. This herbal treatment's accessibility makes it a practical option for community use.

Vaginal Ecological Profile and Characteristic of Vaginal Infection of the Genital Tract of Pregnant Women followed at the Laboratory of the Inter-Army Medical Center Senegal

Introduction: Female genital tract infections are a public health problem. Initial treatment of vaginal infections is most often probabilistic. The benignity of the condition and the safety of topical medications allow for immediate management, even empirical. Hence this study, which aims to evaluate the vaginal microecological profile and vaginal infections in pregnant women followed at the laboratory of the Inter Army Medical Center. Methodology: We carried out a descriptive retrospective study over a period of 8 years, from 2012 to 2020, conducted by the laboratory of the Inter Army Medical Center., on pregnant women. After the collection of sociodemographic data, each woman was subjected to a vaginal swab in accordance with good laboratory practices. A macroscopic and microscopic examination and culture were carried out on each sample. Results: During the study period, 3221 pregnant women were included with an average age of 29.91years. 59.05% of these had normal vaginal cleanliness. 1634 women had type IV flora. The direct examination showed that 210 pregnant women were carriers of Gardnerella vaginalis. The prevalence of Candida albicans and Trichomonas vaginalis infections was 10.90% and 1.06%. There was statistically significant difference of the type of flora, bacterial vaginosis in pregnant women of different age groups. Conclusion: The microecological state of the pregnant women was mostly normal. Low rates of vaginal trichomoniasis infections were found in our study. There was a significant difference between the type of flora and the incidence of bacterial vaginosis in pregnant women of different age groups.

Development of Novel Women's Friendly Antifungal Microemulsion Loaded Gel for Vulvovaginal Infections

Aim: The research was carried out to develop the microemulsion-loaded gel of curcu-min, alkylpolyglucoside, and tea tree oil to treat vulvovaginal candidiasis infection. Methods: Screening of oils, surfactants, and co-surfactants was done based on solubility studies and the construction of pseudo-ternary phase diagrams with curcumin. The microemulsion was characterized for globule size, zeta potential, viscosity, and thermodynamic stability. Ex-vivo studies were carried out using Franz diffusion cells. The antifungal activity of microemulsion-loaded hydrogel was evaluated using the cup plate method using Candida albicans ATCC 10231 in glucose yeast agar medium. Results: The selected micro-emulsion consisted of curcumin 35μg/mL, IPM+TTO (1:1) 0.1 mL, Milcoside 100 + Acconon MC 8-2 EP NF 0.6-0.3 mL, phosphate buffer pH 4 160 mL showed maximum thermodynamic stability and exhibited lowest particle size and highest intensity. The viscosity of microemulsion-loaded gel was 11.2 pa.s. The surface tension of the microemulsion was measured by tensiometer and was found to be 26.07 mN/m. Antimicrobial susceptibility test-ing assay was done according to NCCLs assay protocol, and the EC50 value of our formulation was found to be 0.4465 μg/mL. In-vitro drug release and ex-vivo permeation studies showed 67.9% release in 420 minutes and 83.02% release in 360 minutes, respectively. An in-vitro irrita-tion study concluded that there was no redness or irritation on goat mucosa. Conclusion: The texture analysis test showed adhesiveness at -172.46 g s at - 4.60 adhesive force, and the peak load was 13.40 g. The microemulsion-loaded gel formulation can be a promis-ing alternative to the marketed formulations available for vaginal yeast infections.

Etiology, Epidemiology and Pathophysiology of Vaginitis

Vaginitis is a common condition that affects women; it is an inflammation of the vagina, an infection that creates abnormal discharge followed by irritations and itching. Being aware of the etiology and epidemiology of vaginitis is very crucial for successful diagnosis, treatment, and public health intervention. These are the three most common types of infections responsible for vaginitis-bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Therefore, this review of literature tries to consolidate findings of research already done on vaginitis epidemiology, pinpoints areas where more research might be needed due to lack of information.

Microbiological Profile of Vaginal Swabs from Infertile Women in the Cities of Ngaoundere and Garoua, Cameroon

Genital infections are a real public health problem in developed countries. They have serious consequences such as ectopic pregnancy (EP), chronic pelvic pain, premature delivery, miscarriage, cervical cancer and even infertility. The objective of this study was to determine the epidemiological and microbiological profile of genital infections among infertile women in the cities of Ngaoundéré and Garoua. This descriptive study was carried out in the Protestant and regional hospitals, as well as the military and regional hospitals serving the cities of Ngaoundéré and Garoua, over a period of five months, from August 2020 to January 2021. Women of reproductive age (15 to 45 years) who met the inclusion criteria, gave their informed consent, and had at least one consultation in the gynecology department of the aforementioned hospitals for infertility made up our population. Thus, the study included 100 women, or 50 women per city. A pre-tested questionnaire was employed to get data from the subjects. Blood samples were taken for chlamydia testing, and cervical-vaginal samples were taken for microbiological analysis (PCV+ATB and mycoplasma testing). The gathered information. SphinxPlus. V5 was the program used to analyze the data that were collected. Ninety-six percent of the 100 women who participated in this study had a vaginal infection. The infertile women's modal age range was 26–35 years old, with a mean age of 29. Of the women, 54% were housewives, 33% had completed their elementary; education, and 55 were in monogamous marriages. At 65%, secondary infertility was the most prevalent type. 5.15 years was the average length of infertility. Abortions accounted for 41% of the patients' histories, whereas genital infections made up 69%. When the infertile women's vaginal pH was analyzed, the majority (69%) had a pH > 4.5. Chlamydia trachomatis (28.41%), Ureaplasma urealyticum (22.63%), Candidas albicans (20.58%), Gardnerella vaginalis (14.40%), Mycoplasma hominis (9.46%), Candidas spp (1.65%), Staphylococcus (1.64%), Trichomonas vaginalis (0.82%), and Neisseria gonorrhoeae (0.41%) were among the microbiological analyses of the samples. The etiological identification of genital infections and infertility of infectious or tubal origin, which can be avoided with early intervention, is greatly aided by microbiology.

Performance of deep learning models in predicting the nugent score to diagnose bacterial vaginosis.

The Nugent score is a commonly used diagnostic tool for bacterial vaginosis. However, its accuracy depends on the skills of laboratory technicians. This study aimed to evaluate the performance of deep learning models in predicting the Nugent score to improve diagnostic consistency and accuracy. In total, 1,510 vaginal smear images collected from a hospital in Japan between 2021 and 2023 were assessed. Each image was annotated by laboratory technicians into one of four categories based on the Nugent score-normal vaginal flora, no vaginal flora, altered vaginal flora, or bacterial vaginosis. Deep learning models were developed to predict these categories, and their performance was compared to that of technician annotations. The deep learning models demonstrated 84% accuracy at 400× magnification and 89% at 1,000× magnification. The 1,000× model was further optimized and tested on an independent set of 106 images. After optimization, the advanced model achieved 94% accuracy, outperforming the average 92% accuracy of the technicians. The agreement between the advanced model predictions and technicians was 92% for normal vaginal flora, 100% for no vaginal flora, 91% for altered vaginal flora, and 100% for bacterial vaginosis. Overall, our findings suggest that deep learning models have the potential to diagnose bacterial vaginosis with an accuracy comparable to that of laboratory technicians.IMPORTANCEBacterial vaginosis is a global health issue affecting women, causing symptoms such as abnormal vaginal discharge and discomfort. The Nugent score is a standard method for diagnosing bacterial vaginosis and is based on the manual interpretation of Gram-stained vaginal smears. However, this method relies on the skill and experience of trained professionals, leading to variability in results and poses significant challenges for settings with limited access to experienced technicians. The results of this study indicate that deep learning models can predict the Nugent score with high accuracy, offering the potential to standardize the diagnosis of bacterial vaginosis. By reducing observer variability, these models can facilitate reliable diagnoses, even in settings where experienced personnel are scarce. Although validation is needed on a larger scale, our results suggest that deep learning models may represent a new approach for diagnosing bacterial vaginosis.

The level of pregnancy and childbirth complications among the residents of front-line city of Kharkiv

Background. The city of Kharkiv has been located in the area of armed conflict or the front-line zone since the beginning of the invasion of Russian troops. A part of the female reproductive-aged population constantly remains in Kharkiv which determines the possible negative impact of wartime stress. The purpose – of the work was to study the level of pregnancy and childbirth complications among women living in Kharkiv. Materials and Methods. A retrospective observational study was conducted based on the materials of the municipal non-commercial enterprise «Municipal Perinatal Center» of the Kharkiv City Council. All the examined contingent was divided into three groups. 2914 women who gave birth in 2021 were included in Group I. There were 956 patients in Group II whose pregnancies were completed in term via childbirth in 2022. Group III included 1288 women who gave birth in 2023. The study was conducted by studying the cards of pregnant women in the computer-automated system of the perinatal center Results. The level of thyroid diseases was likely to increase in 2022 compared to the prior level. In 2023, the upward trend continued. A probable increase in the incidence of diabetes mellitus in pregnant women in 2023 compared to the data of 2021 was detected. Interestingly, the level of anemia and cardiovascular diseases remained stable. However, a significant increase in the urinary system’s infectious processes was established in 2023 compared to previous years. Unfortunately, a substantial increase in the level of maternal trauma during childbirth has been established. This was especially true concern on vaginal and cervical tears. Therefore, sanitation of the urogenital system can be the key to reducing maternal trauma during childbirth. Conclusions. During the military operations, an increase in the level of medical complications among pregnant women in the city of Kharkiv was noted due to a rise in some endocrine diseases and urinary tract infections. The increase in the prevalence of vaginal infections has led to a rise in the rate of vaginal and perineal ruptures. This requires an emphasis on infection monitoring and timely sanitation of the birth canal. The use of preventive measures made it possible to keep the level of major obstetric syndromes such as premature births, and pre-eclampsia, as well as the level of childbirth complications quite stable. The established features should become the basis for further work in the direction of reducing the negative consequences of military aggression on the health of pregnant women in the city of Kharkiv.

Photodynamic inactivation strategies for maximizing antifungal effect against Sporothrix spp. and Candida albicans in an in vitro investigation.

Sporotrichosis is a zoonotic disease caused by the dimorphic fungus Sporothrix spp., leading to skin lesions that can, in some cases, progress and result in the death of infected individuals. Candida albicans is another fungus involved in several skin, oral, and vaginal mucosal infections. Fungal diseases are concerning due to increasing incidence and the limited variety of antifungal classes available for treatment. Furthermore, antifungal medications can cause various side effects, exacerbated by their prolonged use during infection treatment. There is a need to explore alternatives to conventional drugs that are effective, fast, and safe in combating sporotrichosis. This study aimed to achieve in vitro elimination of the fungi Sporothrix brasiliensis and Sporothrix schenckii through Photodynamic Inactivation (PDI), using curcumin as a photosensitizer and in combination with antifungal agents used in the treatment of sporotrichosis. Yeasts of Candida albicans, Sporothrix brasiliensis, and Sporothrix schenckii were subjected to Photodynamic Inactivation (PDI) using light at a wavelength of 450 ± 10 nm, irradiance of 35 mW/cm2, delivering a fluence of 31.5 J/cm2, with curcumin as the photosensitizer at doses ranging from 0.75 to 150 μg/mL. After determining the Minimum Inhibitory Concentration (MIC) values of the antifungal drugs itraconazole, ketoconazole, and potassium iodide, sub-MIC doses of these antifungals were combined with sub-MIC doses of curcumin in a new PDI session. Photodynamic inactivation is a promising technique in the treatment of sporotrichosis, as well as its combination with antifungals. The combination of curcumin in concentrations ranging from 0.75 g/mL a 7.5 g/mL with sub-MIC concentrations of itraconazole, ketoconazole, and potassium iodide was able to completely inactivate the fungi C. albicans, S. brasiliensis and S. schenckii, indicating that PDI may increase the effectiveness of antifungals. However, further studies are needed to establish protocols for future clinical applications.

Effect of Some Factors on Vaginal Infection in Postmenopausal Women from Al Rifi City

Effect of Some Factors on Vaginal Infection in Postmenopausal Women from Al Rifi City

The role of probiotics in maintaining vaginal ecosystem

A disturbed vaginal ecosystem is characterized by reduced or non-existing lactobacillary flora and damaged vaginal epithelium. It may not always be apparent whether alterations of the vaginal epithelium or pathogenic microorganisms are the primary cause of a disturbed vaginal ecosystem. Estriol plays a key role in developing and maintaining a healthy vaginal epithelium, stimulating cell growth and differentiation, increases epithelial thickness, and also promotes glycogen synthesis, which is required to maintain an acidic environment. Estriol deficiency results in the vulvovaginal atrophy and the development of atrophic vaginitis. In turn, Lactobacillus acidophilus maintains a healthy microbiome, protecting against infections and creating an acidic environment unfavourable for the growth of pathogens. In recent years, an increasing interest has been developed in probiotics with the belief that probiotics could be able to restore the vaginal microbiota health. A review of scientific articles on the use of an ultra-low-dose vaginal estriol 0.03 mg in combination with Lactobacillus acidophilus to normalize the vaginal microbiota and treat vaginal infections has been conducted. An analysis of published clinical studies and meta-analyses on the use of probiotics in vaginal infections showed the mechanisms of action of probiotics, their biological role and clinical effects. The integration of probiotics into the treatment and prevention of bacterial vaginosis is growing more urgent. The results of numerous studies and meta-analyses confirmed their high efficacy and safety. The supplementation of standard antibiotic therapy with probiotics improves cure rates, restores normal vaginal microflora and reduces the risk of relapse. Therefore, further studies on the use of probiotics to develop more effective and personalized treatment strategies providing long-term results are needed. The publication of new evidence will make it possible to introduce best practices into clinical practice and ensure a healthier future for patients worldwide.

Effective correction of manifestations of vaginal microflora disorders

Pathological vaginal discharge is one of the main reasons for visiting gynecologists. Despite the abundance of drugs, not all are compliant and quickly effective for pronounced itching and swelling in the introitus area. One of the most common causes of pathological leukemia is vaginal infections, which are represented by three main clinical forms: bacterial vaginosis (BV) – up to 50% of all cases; vulvovaginal candidiasis (CVV) – 20–25% and trichomonas vaginitis (TV) – 15–20% of cases, respectively. In this regard, retrospective analysis shows that patients with BV, KV, TV most often actively turn to a gynecologist or venereologist However, the fact that the cause of pathological whites in more than 30% of cases can be a mixed infection creates problems in treatment with the use of monodrugs (many relapses up to 40% or more). Therefore, for their treatment, it is considered rational to use the concept of the etiotropic approach, based on the local effect of combined vaginal drugs. The role of a combined topical drug, including those with a rapid anesthetic effect, was evaluated. Neo-Penotran Forte L is a logical combination of antibacterial agents and a local anesthetic used to treat manifest forms of vaginal infections and provide rapid relief of intolerable symptoms.

Features of the vaginal microbiota in women with relapsing-remitting multiple sclerosis

Introduction. Multiple sclerosis (MS) is a chronic disease of the central nervous system predominantly affecting women of reproductive age. It is known that there is a high incidence of low urinary tract infections in MS. However, information about microbiology of the genital tract in women with MS is extremely limited.Aim. To study the qualitative and quantitative composition of the vaginal microflora in patients with MS.Materials and methods. 19 patients with relapsing-remitting MS of the main group and 19 healthy women of the control group, the qualitative and quantitative composition of the microflora in the vaginal secretion was determined using the polymerase chain reaction method in real time (a set of reagents was used to study the biocenosis of the urogenital tract in women, Femoflor 16, DNA-Technology, Moscow), a gynecological smear from the vagina was performed. The neurological status was assessed using the EDSS scale and The questionnaire on pelvic organ function. The following statistical indicators were determined: frequency, spread, average and χ² test.Results. A status of normocenosis was observed in the majority of women with MS (14 subjects, 73.7%), Lactobacillus bacteria were found in 16 subjects (84.2%), and an increased number of facultative anaerobes was identified in 7 subjects (37.4%), there were no significant differences with the comparator group. Bacteriological examination findings from vaginal smears did not show any signs of inflammation in either group. A high incidence of vaginal infections in anamnesis was reported in women with neurogenic lower urinary tract dysfunction (16 subjects, 84.2%).Conclusion. Data on the state of the vaginal biocenosis of women with MS has been presented for the first time. It was found the preservation of normocenosis with a tendency to shift the balance towards dysbiotic processes in the vagina.

Natural Antimicrobial Monoterpenes as Potential Therapeutic Agents in Vaginal Infections: A Review

The recurrence and relapse of vaginal infections in women is a major issue and a challenging pathway to identify and develop new approaches to treatment. In the case of antibiotic therapy, contraceptives, and dietary changes, the recurrence of vaginitis is more common these days. Anaerobic bacteria, Candida spp., and trichomonas in the vaginal microflora cause both symptomatic and asymptomatic vaginitis, which includes vaginal inflammation. It changes the vaginal microbiota and decreases Lactobacilli spp. growth, which is maintaining the vaginal pH (3.5-4.5) through lactic acid production, antimicrobial peptides, bacteriocin, and bacteriocin-like inhibitory substances. The remarkable antimicrobial activity of plant’s producing metabolites like alkaloids, tannins, phenolic compounds, flavonoids and terpenoids for several vaginal infections have been reported in previous studies. Presented review focuses on the pivotal role of monoterpenes, providing a detailed description of thymol, geraniol, limonene, eugenol, eucalyptol, and α-terpineol as antimicrobial molecules in the treatment of vaginal infections. These monoterpenes are very good at killing E. coli, Staphylococcus aureus, Pseudomonas aeruginosa, Aspergillus niger, Trichomonas vaginalis and Candida albicans which are the main microbes that cause vaginitis. Future research could explore the latent combinations of such monoterpenes as synergistic antimicrobial agents to treat bacterial and fungal vaginal infections, trichomoniasis, among other conditions.

NET-EN treatment leads to delayed HSV-2 infection, enhanced mucin and T cell functions in the female genital tract when compared to DMPA in a preclinical mouse model.

Depot-medroxyprogesterone acetate (DMPA) and Norethisterone Enanthate (NET-EN) are progestin-only injectable contraceptives widely used by women in sub-Sharan Africa, where incidence of HIV-1 and HSV-2 infection remains high. Studies indicate that DMPA usage can increase the risk of HSV-2 infection, but limited data indicate no increased risk with use of NET-EN. We therefore investigated the effects of NET-EN and DMPA on susceptibility to vaginal HSV-2 infection in ovariectomized (OVX) mice and effects on immune responses, particularly in the vaginal tract (VT). OVX mice, when treated with NET-EN and infected intravaginally, had delayed genital pathology, decreased viral shedding, and extended survival compared to DMPA- or untreated OVX mice. CD4+ T cells isolated from VT showed no significant change in frequency with either contraceptive. However, DMPA significantly decreased the total number of VT CD4+ and CD8+ T cells and the number of IFN-γ producing CD4 and CD8 T cells and increased the percentage of CD4 and CD8 T cells producing TNF-α compared to untreated mice. In contrast, NET-EN significantly enhanced percentages of CD8+ T cells compared to DMPA treated mice, and frequencies of IFN-γ+ CD4 and CD8 T cells in the VT compared to untreated mice. Comparative analysis of splenic lymphocytes indicated that DMPA treatment resulted in reduction of CD4+ T cell frequency, but enhanced TNF-α+ CD4 T cells compared to untreated mice. NET-EN enhanced the frequency of CD8 T cells, as well as IFN-γ+ and TNF-α+ CD4, and IFN-γ+ CD8 T cells in the spleen compared to untreated mice. Importantly, we found DMPA treatment that significantly reduced mucin production, whereas NET-EN enhanced expression of cell-associated mucin in VT. High levels of mucin in NET-EN mice were associated with lower levels of HSV-2 virus detected in the vaginal tract. This study provides the first evidence that NET-EN treatment can delay HSV-2 infection compared to DMPA.

Prevalence of vaginal and cervical HPV infection among 35-year age cohort ever-married women in Kalutara district of Sri Lanka and the validity of vaginal HPV/DNA specimen as a cervical cancer screening tool: a cross-sectional study.

Cervical cancer is the 2nd most common female cancer among Sri Lankan females and is almost associated with sexually transmitted cervicovaginal human papillomavirus (HPV) infection. The study objectives were to determine the prevalence of vaginal and cervical HPV infection among 35year old ever-married women and assess the validity of primary healthcare provider-collected vaginal HPV/DNA specimens as a cervical cancer screening tool to improve the coverage of the programme. A descriptive cross-sectional study was carried out from the 1st of September 2018 to the 31st of January 2019. Ever-married women 35 years of age in Kalutara district were the study population. Two women from each Public Health Midwife area (n = 413) were selected randomly from the relevant area eligible families register/s. HPV/DNA cervical specimen and vaginal specimen collection (n = 621) were carried out. Specimens were screened by the Cobas 4800 HPV/DNA automated Polymerase Chain Reaction (PCR) machine. Participants' profiles were recorded by the research assistants using an interviewer-administered questionnaire. The overall prevalence of vaginal and cervical HPV infection was 7.08% (95% CI; 5.2-9.4%) and 6.12% (95% CI; 4.26-8.3%) respectively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and the kappa coefficient of the vaginal HPV/DNA screening method vs. cervical HPV/DNA screening method were 100%, 98.9%, 86.4%, 100%, 99% and 0.92 respectively. Vaginal HPV/DNA specimen screening method can be used as a cervical cancer screening tool due to its high validity. Pilots of the feasibility should be set up before the regional or national rollout of vaginal sampling strategies.

Development of a nomogram for predicting postoperative recurrence of cervical intraepithelial neoplasia using immunohistochemical and clinical parameters

ABSTRACT Background We aimed to develop a nomogram to predict abnormal follow-up results of co-testing for cytology and human papillomavirus (HPV) in cervical intraepithelial neoplasia (CIN) patients after conization. Research design and methods Two hundred sixty-three patients initially diagnosed as CIN2+ were recruited. Data on immunohistochemical (IHC) staining scores, along with demographic and clinical information were collected. Using least absolute shrinkage and selection operator (LASSO) regression analysis, variables were identified for inclusion. A predict model and nomogram were developed through multi-factor logistic regression. The goodness-of-fit test was applied across different cohorts to construct the calibration curve of the model, and the predictive effect was evaluated by the receiver operating characteristic curve. Decision curve analysis was performed to determine the net benefit. Results Five predictor variables, including protein expression score, vaginal infection, HPV coinfection, and cone height were screened and plotted as a nomogram. The calibration curves showed a good fit. The area under the curve of the model was 0.835 for the training cohort and 0.728 for the internal test cohort. The decision curve analysis indicated that the nomogram provides significant net advantages for clinical use. Conclusion A practical nomogram predict model was developed to predict abnormal follow-up outcomes in CINs after conization.

Practical Guidance on the Use of Vaginal Laser Therapy: Focus on Genitourinary Syndrome and Other Symptoms.

Genitourinary syndrome of the menopause (GSM) is a chronic, often progressive condition, characterised by symptoms relating to oestrogen deficiency including; vaginal dryness, burning, itching, dyspareunia, dysuria, urinary urgency and recurrent urinary tract infections. GSM affects up to 70% of breast cancer survivors with a tendency to particularly severe symptoms, owing to the effects of iatrogenic menopause and endocrine therapy. Patients and clinicians can be reluctant to replace oestrogen vaginally due to fear of cancer recurrence. Vaginal laser is a novel therapy, which may become a valuable nonhormonal alternative in GSM treatment. There are currently 6 published studies regarding Erbium:YAG laser treatment for GSM, 41 studies regarding CO2 laser treatment for GSM and 28 studies regarding vaginal laser treatment for GSM in breast cancer survivors. Number of participants ranges from 12 to 645. The majority of studies describe a course of 3 treatments, but some report outcomes after 5. Significant improvements were reported in vaginal dryness, burning, dyspareunia, itch, Vaginal Health Index Scores (VHIS), Quality of Life, and FSFI (Female Sexual Function Index). Most studies reported outcomes at short-term follow-up from 30 days to 12 months post-treatment. Few studies report longer-term outcomes with conflicting results. Whilst some studies suggest improvements are sustained up to 24 months, others report a drop-off in symptom improvement at 12-18 months. Patient satisfaction ranged from 52% to 90% and deteriorated with increasing time post-procedure in one study. The findings in this review must be validated in robust randomised sham-controlled trials of adequate power. There remain a number of unanswered questions in terms of which laser medium to use, optimal device settings, ideal interval between treatments, pre-treatment vaginal preparation, as well as safety and efficacy of repeated treatments long term. These issues could be addressed most efficiently with a mandatory registry of vaginal laser procedures.

Bioinspired gelated cell sheet-supported lactobacillus biofilm for aerobic vaginitis diagnosis and treatment.

Aerobic vaginitis (AV) is a long-standing inflammatory disease that affects female patients. The use of antibiotics is a common means for AV treatment, but it will indiscriminately kill both pathogenic bacteria and beneficial strains, which easily causes vaginal dysbacteriosis and infection recurrence. Herein, we describe a bioinspired strategy for fabricating gelated cell sheet-supported lactobacillus biofilms (GCS-LBs) for AV treatment. Compared with common planktonic probiotic formulations, probiotic biofilms forming on a robust GCS exhibit enhanced stress tolerance and better colonization capacity in the mouse vagina. Moreover, DNA nanodevices are decorated on the GCS and dynamically report the microenvironment change of biofilms for timely evaluating bacterium activity, both in vitro and in vivo. Consequently, GCS-LBs are used for treating AV in an Escherichia coli-infected mouse model, which shows enhanced therapeutic efficacy compared with conventional antibiotic or lactobacillus monotherapy. Overall, the GCS-LB shows promise as a potent multifunctional tool to combat bacterial infection.

Evaluation of the Efficacy of Medicinal Plants in Treating Bacterial Vaginosis: A Comprehensive Systematic Review of Interventional Studies

Background: Bacterial Vaginosis (BV) is the most prevalent cause of vaginal infection among women. This study aimed to summarize the evidence related to the effectiveness of medicinal plants as an alternative therapy for the management of BV. Materials and Methods: PubMed, Scopus, Cochrane Library, Web of Science, and Medline PubMed were systematically searched. Moreover, we searched Google Scholar to explore the possible effects of herbal treatments on BV in women of childbearing age up to 2022. All randomized clinical trials investigating the effects of medicinal plants as oral or vaginal monotherapy or in combination for BV treatment in women of childbearing age were included in this systematic review. Results: In total, 20 studies comprising 2685 participants were included in our review. The results show that combinations of herbal medicines such as Prangos ferulacea, Berberis vulgaris, Myrtus communis, and Quercus Brantii with metronidazole can have better results in the treatment of BV. Moreover, the main results show that some medicinal plant products alone such as Forzejehe (Tribulus terrestris + Myrtus communis + Foeniculum vulgare + Tamarindus indica), Zataria multiflora, and Calendula officinalis had therapeutic effects similar to metronidazole. Propolis and Brazilian pepper tree (Schinus) were effective in the treatment of BV, but they have less therapeutic effect than metronidazole. Conclusions: To reduce the complications caused by chemical treatments and also the resistance of patients to these treatments, it seems necessary to use supportive treatments along with chemical drugs after the necessary approvals have been obtained.

Vaginal Microbiome and the Risk of Preterm Birth in Women Living With HIV: A Scoping Review.

There are sparse data on the role of thevaginal microbiome (VMB) in pregnancy among pregnant women living with HIV (PWLWH) and its association with spontaneous preterm birth (sPTB). We conducted a scoping review to assess associations between vaginal microbiota and sPTB among PWLWH. Three studies were included, representing a total of 180 PWLWH out of 652 total pregnancies. All studies used modern DNA sequencing methods (16S rRNA amplification, metagenomics, or metatranscriptomics). PWLWH had higher VMB richness and diversity compared to HIV-uninfected pregnant women and higher sPTB rates in two of three studies. A higher proportion of sPTB among PWLWH was observed in those with Lactobacillus-deficient, anaerobe-dominant vaginal microbiota. In two of three studies, higher concentrations of vaginal inflammation markers were associated with increased VMB richness and diversity. HIV status was independently associated with sPTB. It is unclear if increased vaginal microbial diversity among PWLWH or increased vaginal inflammation contributes more to PTB, but HIV does appear to alter the VMB in pregnant individuals and may also affect PTB rates in microbiome-independent pathways. Given the limited number of studies, heterogeneity in sample size, sample collection methods, and inconsistent results it is difficult to causally link HIV, VMB, inflammatory cytokines, and sPTB.