History Of Bacterial Vaginosis Research Articles

Molecular Diagnosis of Vaginal Microbiota Associated with Spontaneous Abortion in Women

Spontaneous abortion (SA) is a sever disease in which a women losses her foetus usually before 24 weeks of the pregnancy. About 10% -50% of pregnancy cases are run out with SA for reasons related with women's age and health. This condition occurrence may increases if the patient has a history of bacterial vaginosis. This study aimed at the characterization and isolation of vaginal microbiota generally and highlight on commensal bacteria becoming opportunistic when circumstances are favourable. From October to December 2022, about 100 samples were collected, 50 specimens from women with SA and 50 specimens from healthy pregnant outcomes (control). The high vaginal swabs samples were collected from Babylon Teaching Hospital for Maternity and Children and Imam Sadiq Teaching Hospital in Babylon, Iraq. To culture the samples, they were transported by media swab to laboratory. The culture of bacteria was done on 4 types of agar media: UTI chromogenic agar, MRS agar, MacConkey agar and blood agar. The first identification of bacteria was based on phenotypic traits of colonies, using manual biochemical tests and gram stain. Finally, the diagnosis was confirmed genetically by extracting bacterial genomic DNA for 20 of bacterial isolates under study and using PCR technique for 16S rRNA Loci gene and sequencing. The current study results showed difference in bacterial genera in women with SA compared with healthy women. It was also noted that embroilment of Enterococcus faecalis occurred in most cases of SA with an estimated percentage of 56% (28/50), thus defeating Escherichia coli by 32% (16/50) and 4% (2/50) for Klebsiella pneumonia and 4% (2/50) for Enterococcus gallinarum. In this study, some very rare bacteria species were identified including Acinetobacter junii at 2% (1/50) and Corynebacterium coyleae at 2% (1/50). While the percentage of bacteria associated with healthy women was: 30% (15/50) for E. faecalis, 26% (13/50) for E. coli, 18% (9/50) for K. pneumonia, 24% (12/50) for Staphylococcus epidermidis, and 2% (1/50) for Metabacillus niabensis (which was diagnosed for the first time in Iraq as well as the rest of the world in a clinical sample).

The association between dietary phytochemical index and bacterial vaginosis risk: secondary analysis of case-control study

IntroductionBy studying the dietary habits of patients with bacterial vaginosis (BV) and the controls, we aim to find out whether the dietary intakes of phytochemicals could reduce the odds of BV. To the best of our knowledge, no study has ever examined the matter before. Therefore, we decided to conduct this secondary analysis of case-control study to examine the association between dietary phytochemicals and BV.MethodThis case-control study was conducted at the gynecological clinic of Imam Hossein Hospital using a convenience sampling method from November 2020 to June 2021. To diagnose BV, all participants underwent examination by a gynecologist, assessing the presence of 3 or 4 criteria from the Amsel criteria. A validated semi-quantitative food frequency questionnaire was used. The phytochemical index was determined using McCarty’s method. To assess the association between dietary phytochemical intake and the odds of BV, binary logistic regression was utilized.ResultsAfter adjusting for potential confounders, the association between phytochemical index and BV remained significant (odds ratio (OR) = 0.349, 95% confidence interval (CI): 0.176–0.695, p-value = 0.003). Furthermore, each unit increase in fat intake was associated with higher odds of BV (OR = 1.008, 95% CI: 1.002–1.014, p-value = 0.006), and a positive family history of BV continued to show significantly increased odds of BV (OR = 3.442, 95% CI: 2.068–5.728, p-value < 0.001).ConclusionIn summary, the findings of this study indicate that increased consumption of dietary phytochemicals is associated with a reduced risk of BV among Iranian women of reproductive age. Additional research, especially longitudinal dietary studies, is required to explore the potential impact of dietary modifications on BV.

Vaginal carriage of Haemophilus influenzae in a non-pregnant reproductive-age population

BackgroundHaemophilus influenzae (Hi) is an emerging cause of early onset neonatal sepsis, but mechanisms of transmission are not well understood. We aimed to determine the prevalence of vaginal carriage of Hi in reproductive age women and to examine behavioral and demographic characteristics associated with its carriage.MethodsWe performed a secondary analysis of stored vaginal lavage specimens from a prospective cohort study of nonpregnant reproductive-age women. After extraction of bacterial genomic DNA, samples were tested for the presence of the gene encoding Haemophilus protein d (hpd) by quantitative real-time polymerase chain reaction (PCR) using validated primers and probe. PCR for the V3-V4 region of the 16 S rRNA gene (positive control) assessed sample quality. Samples with cycle threshold (CT) value < 35 were defined as positive. Sanger sequencing confirmed the presence of hpd. Behavioral and demographic characteristics associated with vaginal carriage of Hi were examined.Results415 samples were available. 315 (75.9%) had sufficient bacterial DNA and were included. 14 (4.4%) were positive for hpd. There were no demographic or behavioral differences between the women with Hi vaginal carriage and those without. There was no difference in history of bacterial vaginosis, vaginal microbiome community state type, or presence of Group B Streptococcus in women with and without vaginal carriage of Hi.ConclusionHi was present in vaginal lavage specimens of 4.4% of this cohort. Hi presence was unrelated to clinical or demographic characteristics, though the relatively small number of positive samples may have limited power to detect such differences.

Genital Herpes Simplex Virus Type 2 Suppression With Valacyclovir Is Not Associated With Changes in Nugent Score or Absolute Abundance of Key Vaginal Bacteria.

In women, genital herpes simplex virus type 2 (HSV-2) infection is associated with increased risk for recurrent bacterial vaginosis (BV), but causal relationships are unclear. Women with a self-reported history of BV and HSV-2 seropositivity self-collected vaginal and anogenital swabs for 2 nonconsecutive 28-day periods, in the absence or presence of valacyclovir suppressive therapy (500 mg daily). HSV polymerase chain reaction was performed on anogenital swabs; vaginal swabs were used for assessment of BV by Nugent score and quantification of vaginal microbiota. Days with BV, defined by Nugent score ≥7, were compared during the observational period and valacyclovir treatment. Forty-one women collected swabs for a median of 28 days (range, 20-32 days) each study period. The HSV-2 shedding rate decreased from 109 of 1126 days (9.7%) presuppression to 6 of 1125 days (0.05%) during valacyclovir (rate ratio [RR], 0.06 [95% confidence interval {CI}, .02-.13]). BV occurred on 343 of 1103 days (31.1%) during observation and 302 of 1091 days (27.7%) during valacyclovir (RR, 0.90 [95% CI, .68-1.20]). The median per-person Nugent score was 3.8 during observation and 4.0 during valacyclovir. Average log10 concentrations of vaginal bacterial species did not change significantly during valacyclovir treatment. Short-term HSV-2 suppression with valacyclovir did not significantly affect the Nugent score or the vaginal microbiome despite potent suppression of HSV-2 shedding.

Natural progress history of asymptomatic bacterial vaginosis in Chinese Han women and associated risk factors

ABSTRACT Objective Asymptomatic bacterial vaginosis (aBV) is prevalent in the general population, while a previous study only investigated the natural history of aBV in women at high-risk. This stage study was to investigate the natural history of aBV in Chinese Han women at general risk and examine risk factors associated with different outcomes. Methods Women of reproductive age with aBV were enrolled and prospectively followed up with for four months. Participants were classified into one of three outcomes: progress, self-cure or no-change. Univariate and multivariate analyses were used to determine the association between potential risk factors and outcomes. Results A total of 3420 subjects were screened and 1014 women with aBV were enrolled. Eventually, 984 participants completed the study, with 30 patients dropped out. Among the 984 cases, 42 cases self-cured spontaneously, while 433 cases progressed and 509 cases did not change significantly. Of the 433 cases that progressed, several types of mixed infections were observed in addition to 196 symptomatic bacterial vaginosis. According to univariate analysis, frequent travel (OR, 95% CI, 2.73 [2.09 ~ 3.55]) and history of bacterial vaginosis (BV) (5.47, [4.15 ~ 7.21]) exhibited significant associations with aBV progression, while condom contraception (0.46 [0.36 ~ 0.61]) and lower Nugent score (0.49, [0.37 ~ 0.64]) demonstrated protective effects for self-cure. According to multivariate regression analysis, the risk factors for aBV progression were history of BV (6.67, [4.86 ~ 9.15]) and frequent travel (3.57, 2.59 ~ 4.92). Condom contraception (0.36, 0.26 ~ 0.49) exhibited a protective effect against aBV progression. Conclusion Without intervention, a large proportion of aBV would progress, compared to the very few patients whose aBV self-cured spontaneously. It is necessary to clinically intervene aBV patients. Condom utilization can be used as an effective method to improve the outcome of aBV.

613 Vaginal carriage of haemophilus influenzae in a non-pregnant reproductive-age population

Haemophilus influenzae (Hi) is an emerging cause of early onset neonatal sepsis, but mechanisms of transmission are not well understood. We aimed to evaluate the prevalence of vaginal carriage of Hi in reproductive age women as a first step in assessing the role of peripartum vertical transmission in neonatal Hi disease. We performed a secondary analysis of stored vaginal lavage specimens from nonpregnant reproductive-age women. After extraction of bacterial genomic DNA, samples were tested for the presence of the gene encoding Haemophilus protein d (hpd) by quantitative real-time polymerase chain reaction (PCR) using validated primers and probe. PCR for the V3-V4 region of the 16S rRNA gene was performed as a positive control to assess sample quality. Samples with a cycle threshold (CT) value < 35 were defined as positive. Sanger sequencing confirmed the presence of hpd. We compared demographic and behavioral characteristics of women with and without vaginal carriage of Hi. Chi-square, Fisher’s exact, Mann-Whitney and t-test were used with p<0.05 set as the level of statistical significance. 415 samples were available for analysis. 315 (75.9%) had sufficient bacterial DNA present and were included in the analysis. Of these, 14 (4.4%) were positive for hpd. There were no demographic or behavioral differences between the women with Hi vaginal carriage and those without (Table 1). There was no difference in history of bacterial vaginosis, vaginal microbiome community state type, or presence of Group B Streptococcus (GBS) in women with and without vaginal carriage of Hi (Table 2). Haemophilus influenzae was present in vaginal lavage specimens of 4.4% of this cohort. Hi presence was unrelated to clinical or demographic characteristics, though the relatively small number of positive samples may have limited power to detect such differences. Further studies should assess for the presence of this possible perinatal pathogen in pregnant women and the rate of transmission to neonates.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Papillomaviral infection and cervical diseases in pregnant women. Risk factors of social status, reproductive and contraceptive behavior

Aim. To determine the risk factors for human papillomavirus of high carcinogenic risk (HPV HCR) and cervical diseases (CD) in pregnant women associated with the social status, reproductive and contraceptive behavior.&#x0D; Materials and methods. Design: open-label comparative non-interventional cohort study in parallel groups. The total number of patients 330 people, of whom 148 women were negative for HPV and 182 women were positive. They were divided into 4 groups depending on the presence or absence of CD. Methods: analysis of anamnesis data, general clinical, test Kvant-21 to determine HPV, cytological examination, extended colposcopy.&#x0D; Results. The most significant risk factors for HPV HRS infection were identified: history of mycoplasma infection (OR 5.9) and BV (OR 5.3), alcohol consumption (OR 4.0). A history of STIs (trichomoniasis and chlamydial infection), as well as more than 3 sexual partners (OR 2.7) were also significant. The most significant risk factors for CD in HPV-infected women were: age over 35 years (OR 3.8), a history of bacterial vaginosis (OR 3.0), and lack of regular screening (OR 2.4). The coitarche earlier than 16 years old (OR 2.2) also mattered. There were also found factors indicating a low risk of HPV infection the use of condoms (OR 0.3), and a low risk of CD was indicated by age under 25 years (OR 0.2) and regular screening (OR 0.3).&#x0D; Conclusion. HPV infection with HRS and the prevalence of CMC in pregnant women against the background of HPV infection is associated mainly with social risk factors, to a lesser extent with factors of reproductive and contraceptive behavior.

Cervical diseases in pregnant women. Socio-demographic and clinical-anamnestic risk factors

Introduction. To study the prevalence of human papillomavirus infection, the frequency and structure of cervical diseases in pregnant women and determine the risk factors for their development. Material and methods . Screening for HPV was carried out among 2620 pregnant women. Of these, 682 (29%) had HPV. 182 pregnant women with HPV and 148 without HPV were included in the additional study program and were divided into groups depending on the presence or absence of cervical disease (CWD). The research methods were used: general clinical, the Kvant-21 test to determine HPV and STIs, microscopy of the vaginal discharge, determination of the composition of the vaginal microbiota by the Femoflor 16 method, cytological examination, extended colposcopy. We used the method of logit-regression models to identify risk factors. Results. The prevalence of diseases of the cervix (DC) in HPV carriers was 89.4%. 72.1% of them had inflammatory DC compared to 21.4% in patients without HPV (p < 0.0001). The incidence of intraepithelial lesions was 17.4% versus 2.6%, respectively (p = 0.005). The most significant risk factors for developing DC in pregnant women, in addition to HPV infection of high carcinogenic risk, are: Lack of regular screening for cervical cancer before pregnancy (OR = 34.8), a history of bacterial vaginosis (OR = 15.9), the practice of interrupted sexual intercourse during sexual contacts (OR = 14.6). Factors indicating a low risk of these diseases are: participation in the annual screening of cervical cancer, stable partnerships (one sexual partner, marriage), age under 25, and condom use (OR less than 0.25). Conclusion. The prevalence of DC in pregnant women against the background of HPV infection is high, predominantly inflammatory in nature and associated with certain socio-demographic and clinical-anamnestic risk factors.

Sex is associated with the persistence of non-optimal vaginal microbiota following treatment for bacterial vaginosis: a prospective cohort study.

Determine the associations between factors and sexual practices and the composition of the vaginal microbiome (VM) of women treated for bacterial vaginosis (BV). Prospective cohort study. The Melbourne Sexual Health Centre, Melbourne, Australia. Seventy-five reproductive-age women diagnosed with clinical BV, treated with first-line antibiotics and followed for up to 6 months. Women self-collected vaginal swabs and completed questionnaires at enrolment, the day following antibiotics and monthly for up to 6months until BV recurrence or no BV recurrence (n=430 specimens). Bacterial composition was determined using 16S rRNA gene amplicon sequencing. The effects of ongoing factors on VM composition (utilising 291 monthly specimens) were assessed using generalised estimating equations population-averaged models, which accounted for repeated measures within individuals. The relative abundance of vaginal bacterial taxa. Women who reported ongoing sex with a regular sexual partner (RSP) had a VM comprised of increased relative abundance of non-optimal BV-associated bacteria (Adjusted co-efficient[Adjusted co-eff] =11.91, 95% CI 3.39to20.43, P=0.006) and a decreased relative abundance of optimal, Lactobacillus species (Adjusted co-eff=-12.76, 95% CI -23.03 to -2.49, P=0.015). A history of BV was also associated with a decreased relative abundance of Lactobacillus spp. (Adjusted co-eff=-12.35, 95% CI -22.68, P=0.019). The relative abundance of Gardnerella, Atopobium and Sneathia spp. increased following sex with an RSP. Sex with an untreated RSP after BV treatment was associated with a VM comprised of non-optimal BV-associated bacteria. BV treatment approaches may need to include partner treatment if they are to achieve a sustained optimal VM associated with improved health outcomes. Sex drives a return to a 'non-optimal' vaginal microbiota after antibiotics for bacterial vaginosis.

Bacterial vaginosis: prevalence, risk profile and association with sexually transmitted infections

Background and Objectives: Bacterial vaginosis (BV) is the most common cause of vaginal discharge in the world. The study aimed to estimate the prevalence and to identify risk factors associated with bacterial vaginosis. Methods: A cross-sectional study was conducted in Ouro Preto, Brazil, between February and December 2017. Three hundred and forty-one women aged 18 years or older, users of the Brazilian Unified Health System, participated in this study. Women who used oral or topical antibiotics in the four weeks prior to the sample collection and women who had undergone a total hysterectomy were excluded from the study. After signing the Informed Consent Form and filling out a questionnaire containing sociodemographic, behavioral and sexual data, the participants were directed to the collection room, where the nurse collected the samples for the preventive examination of the cervix and also two vaginal swabs. Vaginal swabs and cervical samples were analyzed for cytological abnormalities and BV using Gram staining and cytology. Pathogens causing sexually transmitted infections (STIs) were identified by Polymerase Chain Reaction (PCR). For the analysis of the data, statistical package STATA version 10.0 was used. This study was approved by the Research Ethics Committee of the Federal University of Ouro Preto (UFOP). Results: During the study, 341 women were evaluated. The prevalence of BV using Gram staining (32.5% [CI95% 27.7=37.7%]) and cytology (27.7% [CI95% 23.0=32.8%]) was similar, however, the sensitivity of cytology was lower (77.8%). Risk factors associated with BV were smoking (IRR 1.5[CI95%: 1.1 = 2.1]), use of an intrauterine device (IRR 2.8 [CI95%: 1.2 = 6.5]), and past medical history of BV (IRR 1.5 [CI95%: 1.1 = 2.1]). Correlation between the presence of BV and Trichomonas vaginalis (TV) infection (r=0.24) was observed. Conclusion: The prevalence of BV was affected by life habits and was prevalent in women with TV. Thus, behavioral and social prevention approaches to women with diverse risk profiles may help mitigate TV/BV prevalence and recurrence of BV.

Genitourinary Side Effects With the Vaginal pH Regulator: Results From AMPOWER [19I

INTRODUCTION: The investigational vaginal pH regulator (VPRTM) is a non-hormonal, woman-controlled contraceptive vaginal gel. The objectives of the current analysis are to report on genitourinary (GU) side effects with VPR based on the phase 3 AMPOWER trial. METHODS: AMPOWER was a single-arm, open-label, IRB-approved, multi-center trial based in the United States (NCT03243305). Women, aged 18-35 years, administered VPR intravaginally up to 1 hour before each episode of vaginal intercourse. The primary study objective was contraceptive efficacy over 7 cycles of use. Safety was assessed through adverse event reporting. RESULTS: In 1,330 women included in the safety analysis, the most common adverse events (10% or greater) were vaginal burning (20.0%) and itching (11.2%). Rates of vaginal burning and itching generally decreased over time (burning: Cycle 0=11.2%, Cycle 3=4.2%, Cycle 7=1.4%; itching: 4.5%, 1.1%, and 0.3%, respectively). Rates of burning and itching by act of intercourse were lower when VPR was used once/day (2.1% and 0.7%, respectively) compared to 2 or more times/day (4.6% and 1.0%, respectively). In women who had GU infections on-study (n=77), rates of burning (32.5%) and itching (22.1%) were higher than in the general study population. Women with a history of bacterial vaginosis (n=245) had similar rates of burning (21.6%) and itching (12.7%) compared to the general study population. Overall, 1% [13/1330] of women discontinued due to GU symptoms. CONCLUSION: In the phase 3 AMPOWER trial, rates of GU symptoms with VPR decreased substantially over time, with higher rates reported in women with existing GU infections compared to the general study population.

Association Analysis on Recurrence of Bacterial Vaginosis Revealed Microbes and Clinical Variables Important for Treatment Outcome.

To investigate the parameters associated with post-treatment recurrence of bacterial vaginosis (BV), clinical factors and vaginal microbiota were examined and analyzed for BV patients who received standard metronidazole therapy. The variables associated with BV recurrence included clinical factors of past BV history, use of intravaginal device, and D7 Nugent score as well as many microbial genera, with Lactobacillus, Enterococcus, Ureaplasma, and Aerococcus being the top contributors. Co-occurrence network analysis showed that whereas overwhelming majority of interbacterial interactions were positive, negative interactions were present and connected mostly to Lactobacillus, Enterococcus, and to a less extent Ureaplasma, suggesting the importance of interbacterial antagonism for treatment outcome. The patients who were cured and recurrent also exhibited clear differences in the species composition of Lactobacillus: although L. iners remained the dominant species at all time points, L. crispatus, L. gasseri, and L. jensenii displayed apparent differences in relative abundance between the cure and recurrent groups. Based on these results, we developed a 5-component panel comprising Enterococcus, L. crispatus, Ureaplasma, Aerococcus, and L. jensenii for predicting recurrence using D7 data and showed that it generated the specificity, sensitivity, and AUC values of 0.80, 0.66, and 0.73 for the discovery cohort and 0.80, 0.67, and 0.69 for the validation cohort. Our findings highlighted key microbial components for BV recurrence and suggested that they could be used to monitor the treatment outcome.

Factors Associated with Bacterial Vaginosis among Women Who Have Sex with Women: A Systematic Review.

BackgroundWomen who have sex with women (WSW) have a higher burden of bacterial vaginosis (BV) than heterosexual women; studies of risk factors specific to this population are limited. We summarised current knowledge regarding risk factors for BV among WSW by systematic review.MethodsThis systematic review was conducted according to the PRISMA statement. PUBMED, EMBASE, Web of Science and The Cochrane Library were searched to 31st December, 2014. Inclusion criteria: 1) WSW included in the study population; 2) accepted BV diagnostic method; 3) investigated or could extrapolate factors(s) associated with BV acquisition, persistence or transmission in WSW specifically by comparing BV positive to BV negative women. Search was limited to English-language publications.ResultsA limited number of studies have investigated BV in WSW. Of 71 unique references, 18 full-text articles were assessed and 14 studies fulfilled inclusion criteria. BV was positively associated with higher numbers of female partners, both lifetime and in the three months prior to diagnosis, and confirmed BV in a female partner, but inconsistently associated with partners’ BV history or symptoms. BV was not associated with ethnicity, vaginal douching or hormonal contraception. The impact of specific sexual activities, male sexual contact, smoking and the menstrual cycle varied considerably between study populations.ConclusionBV in WSW is associated with increased numbers of recent and past female partners and confirmed BV in a female partner. There are limited studies of BV in WSW populations, and research is needed to further elucidate risk factors for BV among WSW. However these data provide epidemiological evidence that BV risk in women is directly related to exposure to other female partners and a partner with BV, providing support for the concept that BV is likely to be transmitted between women.Systematic Review Registration NumberCRD42014009536 (PROSPERO)

Molecular analysis of the relationship between specific vaginal bacteria and bacterial vaginosis metronidazole therapy failure.

Bacterial vaginosis frequently persists, even after treatment. The role of some strains of bacteria associated with bacterial vaginosis treatment failure remains poorly defined. The aim of our study was to define the risk of bacterial vaginosis treatment failure, including pre-treatment detection of specific vaginal bacteria. Bacterial vaginosis is present when the Nugent score is ≥7 and the modified Amsel criteria is positive. Women with bacterial vaginosis were treated with intravaginal metronidazole gel nightly for 5 nights. The 454 pyrosequencing method was used to detect bacteria in vaginal fluid. By univariate analysis, a history of bacterial vaginosis, intrauterine device use and the presence of Facklamia, Corynebacterium and Veillonella were significantly associated with bacterial vaginosis treatment failure. Lactobacillus crispatus, Lactobacillus pentosus and Megasphaera were significantly associated with curing bacterial vaginosis. After logistic regression analysis and detection of these bacteria for test-of-cure, we found that women who had a history of bacterial vaginosis had a higher incidence of bacterial vaginosis treatment failure, whereas women with L. crispatus had a lower incidence of treatment failure. Post-treatment sexual activity was not associated with the treatment effect. Our data suggested that treatment failure may be not caused by drug resistance. Rather, it has a closer relationship with the failed restoration of lactobacilli.

Daily temporal dynamics of vaginal microbiota before, during and after episodes of bacterial vaginosis

BackgroundBacterial vaginosis (BV) is a common gynecologic diagnosis characterized by dysbiosis of the vaginal microbiota. It is often accompanied by vaginal symptoms such as odor and discharge, but can be asymptomatic. Despite over 50 years of research, the etiology of BV is not well understood, which is a major impediment to treatment and prevention of BV.ResultsHere we report on the temporal dynamics of 25 vaginal communities over a 10 week period using samples collected daily from women who were diagnosed with symptomatic BV (15 women), asymptomatic BV (6 women), and women who did not have BV (4 women).ConclusionThis unique resource of samples and data will contribute to a better understanding of the role that the vaginal microbes have in the natural history of BV and lead to improved diagnosis and treatment.

P3.362 Microbicide Use During Pregnancy: Acceptability For Prevention/Treatment and the Role of Partners

ObjectivesTo explore pregnant women’s acceptance of microbicides for reproductive tract infections (RTIs).MethodsTo date, we have analysed interview transcripts of 15 women in their third trimester who participated in a qualitative...

Cost Effectiveness of Local vs. Oral Antibiotic in Non-Pregnant Women with Vaginal Discharge Suggestive of Bacterial Vaginosis

Objective: To estimate the cost-effectiveness of local vs. oral antibiotic in non-pregnant women with vaginal discharge suggestive of bacterial vaginosis.Methods: We compared four combinations of antibiotics for the first option and for the treatment of clinical failure: vaginal clindamycin and tinidazol PO, single dose; vaginal clindamycin and secnidazol PO, single dose; tinidazol PO, single dose y vaginal clindamycin; secnidazol PO, single dose, and vaginal clindamycin. A Markov model was built in TreeAge® to represent the natural history of bacterial vaginosis. Treatment changes in the face of recurrence without adverse events where modeled separately as a decision tree. The perspective was that of the health system, including all direct costs. All monetary amounts were expressed in Colombian pesos of 2010. The outcome was clinical improvement. Effectiveness, security, persistence and recurrence data were extracted from the literature. The incremental cost-effectiveness ratio was calculated; univariate and probabilistic sensitivity analyses were performed.Results: Both for the general and the particular cases, treatment with vaginal clindamycin as the first choice and tinidazole PO, single dose, to treat recurrence and persistence with adverse events is a dominant strategy because it is less costly and more effective than the other treatment regimes evaluated. Per 1.000 patients, the cost of the dominant alternative is $ 16.795.411 COP with 985,6 clinical improvements in the general case and $ $ 23.979.230 COP with 903,4 clinical improvements in the particular case.Conclusion: Vaginal clindamycin as the first choice for treatment of bacterial vaginosis and tinidazole PO, single dose, to treat recurrence and persistence with adverse events of clindamycin is cost effective in Colombia. The results were robust to variations in the parameters of the model.

An Evaluation of the Natural History of Bacterial Vaginosis Using Transition Models

The natural history of bacterial vaginosis (BV) is complex given the variability across and within women over time. This article considers 3 different transition models for analyzing longitudinal BV data. Data from the Longitudinal Study of Vaginal Flora were used to evaluate 3 transition modeling strategies: (1) a Markov regression, (2) a Markov regression with random effects, and (3) a mover-stayer model. The effect of covariates on the transition process of BV, defined as a Nugent score of 7 to 10, was estimated using a logistic regression parameterization. Models were compared using various model assessment techniques. We analyzed a subset of women completing all 5 visits (n = 1731) as well as the complete data (n = 3626), in which 1 or more visit measurements were missing. The Markov regression model had a poor fit to the data. A random-effects or mover-stayer model accounted for additional unexplained heterogeneity and had a better fit to the data. Across all models, douching was significantly associated with BV fluctuation. In the mover-stayer model, both douching and number of sexual partners were associated with persisting with (λ11 = 0.90, P < 0.001; λ12 = -0.41, P < 0.03, respectively) or without (λ01 = -0.73, P < 0.001; λ02 = -0.33, P = 0.023, respectively) BV across all visits. Using a random-effects model, we demonstrated that an individual propensity to initiate BV was positively associated with their propensity to resolve BV. Transition models that account for additional heterogeneity provide an attractive approach for describing the effect of covariates on the natural history of BV.

Bacterial vaginosis: what is physiological in vaginal bacteriology? An update and opinion

Bacterial vaginosis (BV) was originally described as a sexually transmitted infection caused by a single microbe. The prevailing concept describes BV as a polymicrobial coitus-associated disease of uncertain origin. In this overview the natural history of BV as a monobacterial and polymicrobial entity is examined with respect to the physiological concept of BV in relation to sexual behavior before and after introduction of the hormonal contraceptive pill. Bacterial vaginosis, characterized by low vaginal acidity (elevated pH) and replacement of vaginal Lactobacillus by Gardnerella vaginalis flora, could be caused by unprotected intercourse when a low pH changes through the neutralizing power of male ejaculate, vaginal coital transudate and vaginal neurogenic transudate. A monobacterial form, G. vaginalis vaginitis, could be a physiological post-coital condition for protection of ejaculated spermatozoa, characterized by 'pure'Gardnerella flora and elevated pH as an immediate result of an incidental unprotected coital act through neutralization of vaginal acid and replacement of Lactobacillus by Gardnerella flora. A polymicrobial form of BV could be autoinfection of the post-coital physiological G. vaginalis flora, characterized by a mixture of G. vaginalis, Mycoplasma hominis and anaerobic bacteria at lower vaginal acidity, possibly resulting from suppression of normal vaginal acidity through repeated sexual acts, with a resultant higher pH and transfer of enteric bacteria from the perianal region. Monobacterial and polymicrobial auto-infectious forms of BV may be clinically distinct and share a common origin. The understanding of BV as a basic physiological entity could influence the prophylaxis and treatment of the largely therapy-resistant polymicrobial BV.

O3-S5.06 Double-blind randomised placebo controlled trial of oral metronidazole in combination with either vaginal clindamycin or an oestrogen-containing vaginal probiotic for the treatment of bacterial vaginosis

BackgroundTo determine if addition of vaginal clindamycin or an oestrogen-containing vaginal probiotic, to current recommended therapy for bacterial vaginosis (BV), oral metronidazole for 7 days, reduces 6 month recurrence rates.MethodsThree...