Markers Of Bacterial Vaginosis Research Articles

КОМПЛЕКСНЫЙ ПОДХОД К ЛЕЧЕНИЮ БАКТЕРИАЛЬНОГО ВАГИНОЗА У ПАЦИЕНТОК С СИНДРОМОМ ПОЛИКИСТОЗНЫХ ЯИЧНИКОВ

A two-stage complex method of therapy of bacterial vaginosis (BV) in 29 patients with polycystic ovary syndrome (PCOS) is proposed, consisting in the use of standard metronidazole therapy (vaginal suppositories of 500 mg 2 times a day for 7 days) at the first stage and therapy with Acylact DUO at the second stage (1 candle in the vagina per night of 10 days), effective in relieving clinical manifestations and preventing recurrence of vaginal dysbiosis. Intravaginal administration of metronidazole to patients with polycystic ovary syndrome (PCOS) and bacterial vaginosis (BV) significantly reduced the concentration of anaerobic microorganisms. The appointment with Acylact DUO stimulated the growth of its own lactobacilli and helped to reduce the number of relapses of the disease by increasing the protective properties in the vagina. Normalization of the vaginal microflora was noted in all patients included in the study. After three months, normal vaginal biocenosis was detected in 26 patients (89.6% of women) according to a control smear study to detect key cells as markers of bacterial vaginosis. Clinical manifestations of bacterial vaginosis (itching, burning, pathological discharge) were not detected in any patient. Thus, the conducted study showed high efficiency of complex two-stage treatment of bacterial vaginosis, consisting in the use of vaginal candles containing metronidazole at the first stage, followed by the drug Acylact DUO in patients with polycystic ovary syndrome, provided timely correction of hormonal and metabolic disorders in them.

TACTICS OF DENTAL EXAMINATION OF WOMEN WITH PERIODONTAL DISEASE AGAINST THE BACKGROUND OF BACTERIAL VAGINOSIS AND THEIR SEXUAL PARTNERS

Numerous studies have proved that periodontal pathology is an issue that requires a comprehensive and multidisciplinary approach in diagnosis, treatment and prevention, as most periodontal diseases are syndromic manifestations of somatic and psycho-somatic diseases, but there are little data on the periodontal status in patients with disturbance of the genital microflora. The aim of the study was to provide the grounds for the tactics of dental examination of child-bearing women with bacterial vaginosis and their sexual partners and to compare the results of different sex groups. Materials and methods. 28 heterosexual couples aged 18-45 years were examined. Objective periodontal examination included the calculation of Green-Vermilion oral hygiene index, papillary-marginal-alveolar index, complex periodontal index by P.A. Leus, Svrakov's iodine number. Amino test of oral fluid, assessment of oral fluid pH, identification of bacterial vaginosis pathogens, and in particular, Gardnerella vaginalis and Atopobium vaginae, in the oral cavity of the patients by polymerase chain reaction-diagnostics and bacterioscopically. Results. Chronic generalized catarrhal gingivitis was detected in 10.71% of the women, chronic generalized periodontitis in the initial stage was found out in 64.29% of the women, and chronic generalized periodontitis of the first degree in 25% of the female patients. Men, who were carriers of bacterial vaginosis, chronic generalized catarrhal gingivitis, made up 7.14%; chronic generalized periodontitis in the initial stage was found in 60.71% of the men and chronic generalized periodontitis was found in 32.14%. The values ​​of periodontal indices did not really differ between the indicators of different sex groups. Amino tests of the oral fluid in the women and men showed a positive result those points out the presence of volatile amines. The oral fluid pH is reduced in patients of both groups that indicate an inflammatory process in the oral cavity. All the patients have "key cells", which are exfoliated epitheliocytes with Atopobium vaginae and Gardnerella vaginalis adhered to them. This is one of the main markers of bacterial vaginosis. Conclusions. Summing up the results of the performed clinical and laboratory observations, it should be noted that when collecting the history of bearing aged women, the dentist should pay attention to the presence of diseases of the genital tract, and in particular, bacterial vaginosis. To detect inflammatory and inflammatory-dystrophic periodontal diseases in women of childbearing age, amino tests of oral fluid not only in women but also in their sexual partners for rapid diagnosis of pathogens such as bacterial vaginosis and vaginal vaginal vagina can be very informative.

Relationship between nugent score and vaginal epithelial exfoliation.

ObjectiveClue cells characteristic of bacterial vaginosis (BV) are thought to arise due to exfoliation of the vaginal epithelium; however, there is little published data connecting total numbers of epithelial cells to markers of BV. The purpose of this study was to enumerate exfoliated epithelial cells (independent of clue cells) and examine the relationship to Nugent score.Study designWe conducted a cross-sectional sub-study of the Contraceptive CHOICE Project cohort. Vaginal swabs were used to create vaginal smears for Gram staining and these smears were later scored using the Nugent method, and then two blinded observers used microscopy to enumerate exfoliated epithelial cells. The degree of epithelial cell exfoliation was compared between women diagnosed as BV-negative (Nugent score 0–3), BV-intermediate (Nugent score 4–6), and BV-positive (Nugent score 7–10). BV specimens (Nugent 7–10) were randomly matched to specimens in the two other groups (Nugent low and Nugent-intermediate), in order to avoid comparing groups of women with potentially confounding baseline demographics.ResultsExfoliated epithelial cell counts were higher in the vaginal smears from BV-positive women compared with BV-negative women. Higher levels of epithelial exfoliation were also evident in BV-intermediate women compared to those with low Nugent scores. After adjustment for clustering introduced by matching, the incidence ratio of increased epithelial cell counts was 2.09 (95% CI 1.50–2.90) for the BV-intermediate women and 1.71 (95% CI 1.23–2.38) for the BV positive women.ConclusionA vaginal epithelial exfoliation phenotype was measured in both Nugent-defined BV-positive and BV-intermediate women. Bacterial vaginosis and intermediate status (Nugent score >3) was associated with significantly more vaginal epithelial exfoliation compared to women with Lactobacillus-dominated microbiotas (Nugent 0–3).

Reducing infection-related preterm birth.

A myriad of research papers have indicated that abnormal vaginal flora is a risk factor for preterm delivery. The most favored hypothesis for the mechanism is through ascending infection from the vagina, causing deciduitis and chorioamnionitis, inducing the cytokine and prostaglandin cascade and hence cervical weakening and contractions. In his contribution, Steve Witkin points to the matrix metalloproteinase (MMP)-8 and its inducer extracellular MMP inducer (EMMPRIN) as a key trigger to weaken the cervix and allow ascending commensal or potential pathogenic microorganisms, most often associated with bacterial vaginosis (BV), to cause intra-amniotic infection to occur. In conjunction with the l-lactate producing vaginal epithelium, the presence of Lactobacillus crispatus, Lactobacillus jenseni, and Lactobacillus gasseri, but not the BV-associated Lactobacillus iners, contributes to the protection of the vagina against this EMMPRIN activity by producing d-lactate, which decreases its release by the epithelium. This point is well taken and his suggestion to replace antibiotic therapy by lactic acid gel application to the vagina in women living in areas with poor resources and women with signs of disturbed flora could work. However, a few details may matter. That the production of vaginal lactic acid is closely correlated with the proportional level of other bacteria replacing the lactobilli (lactobacillary grades) has been known for decades, as well as the association of the latter with vaginal pro-inflammatory cytokine production, which fluctuates along the course of pregnancy. The results of Hoyme's original observational study of self-measuring vaginal pH, followed by treatment without proper diagnostic workout may have suggested a benefit in reducing preterm births, but this was not confirmed in a subsequent population-based controlled trial following 149 048 pregnant women in the same region (Bitzer et al. Dtsch Arztebl Int 2011;108:81–6). Analysing self-measurements of vaginal pH, although well accepted in poor resource countries such as Uganda, did not reflect the presence of BV in these women, as only 34% of women with increased pH had BV, the others having aerobic vaginitis (AV), endogeneous lack of lactobacilli or other conditions influencing pH (G.G.G Donders, F. Donders, G. Bellen, C. Depuydt, N. Eggermont, T. Michiels, J. Lule, J. Byamughisa, data on file). In this study the transitional state between normal flora and BV, called partial BV, had the same increased vaginal pH as full blown BV, whereas the so-called intermediate flora, representing a Nugent score 4–6 on gram-stained specimens, was found equally frequently in all pH groups. As this ‘intermediate flora’ according to Nugent represents not only partial BV, but also AV and other abnormalities, it is not surprising that it should also be considered a risk factor for preterm labour, as AV as well as partial BV may pose a greater risk for the pregnancy than full blown BV (Donders et al. BJOG 2009;116:1315–24). Hence it does not come as a surprise that meta-analyses have failed to show that metronidazole prevents preterm birth, as mentioned in the paper. Besides L. iners and Gardnerella vaginalis being general surrogate markers markers of BV, Mobiluncus and Atopobium vaginae are even stronger indicators of full-blown BV (Nugent score above 8), and are, remarkably, not responsive to metronidazole. Although they are notorious lactic acid producers, both organisms are independently linked to an increased preterm birth risk (Foxman et al. AJOG 2014;210:226–7). As reasoned by Dr Witkin, treatment with lactic acid in cases with a disturbed lactate d over lactate l ratio could be an option to help prevent preterm birth that requires further attention. However, preventive or curative non-antibiotic treatment options are not limited to the use of lactic acid gel and/or glycogen. Antiseptics, pH-lowering devices such as vitamin C, or probiotic agents can also restore resistant vaginal flora (Donders et al. Expert Opin Pharmacother 2014;15:645–57) and are currently being studied in low resource countries. None. Wrote the paper. Not applicable. None. None.

Correlation of Atopobium vaginae Amount With Bacterial Vaginosis Markers

The purpose of this study was to test the correlation of the amount of Atopobium vaginae with the most commonly used markers for bacterial vaginosis (BV). We enrolled 103 nonpregnant and premenopausal women that were positive for BV by Amsel criteria and with a Nugent score higher than 3. All women were negative for yeast, Chlamydia trachomatis, Trichomonas vaginalis, and Neisseria gonorrhoeae. A. vaginae concentration was determined by quantitative polymerase chain reaction from samples of vaginal rinsings with 2 mL of sterile saline. There was no difference in the median values of A. vaginae concentration when comparing samples with presence or absence of each individual Amsel criterion. In the case of a higher pH cutoff value of 4.9, greater amounts of this microorganism (p = .02) were found. In addition, correlation tests showed that A. vaginae concentration is positively correlated with pH (p < .001) and with Nugent scores (p = .003). The quantification of A. vaginae is useful for identification of the most severe cases of BV.