Vaginal Flora Research Articles

The influence and association of blood on transfer catheter and vaginal microbiota on pregnancy outcomes in frozen-embryo transfer cycles.

The influence and association of blood on transfer catheter and vaginal microbiota on pregnancy outcomes in frozen-embryo transfer cycles.

Anti-candida activity of Lacticaseibacillus rhamnosus R-2002 and its possible application in candidiasis prevention

Background and Objectives: Probiotics are used for the treatment of yeast infections, they restore the balance in vaginal microbiome, adhere to epithelial cells, compete against pathogenic bacteria, acidify the environment, produce bacteriocins and modulate the immunity. The aim of the study was to investigate the anti-yeast activity (AYA) of the strain Lacticaseiba- cillus rhamnosus R-2002 against different Candida species. Materials and Methods: From 20 strains of lactic acid bacteria examined, only L. rhamnosus R-2002 strain demonstrated beneficial properties against yeast. The effects of temperature and pH on AYA and its relation to cell wall were revealed by bi-layer agar assay. The connection of AYA to the cell wall was determined with the sonicated cells. Results: R-2002 inhibited the growth of C. albicans ATCC 10291, C. tropicalis G 31 and C. albicans G4 (both isolated from vaginal samples). R-2002 maintained its AYA between a wide range of pH and its anti-yeast component/s are extracellular. The tested strain demonstrated stability against the high concentrations of progesterone and metronidazole, making it a suit- able candidate for the mitigation of vaginitis. Conclusion: The present study summarizes all the positive features of the strain R-2002 and its potential as a therapeutic agent in the treatment of candidiasis.

Probiotics in pregnancy and group B streptococcus colonization: A multicentric, randomized, placebo-controlled, double-blind study with a focus on vaginal microbioma.

To evaluate the feasibility and effects of the use of probiotics in pregnancy, starting in the third trimester, on rectovaginal colonization of group B streptococcus (GBS) in women at low obstetric risk. A multicentre, randomized, placebo-controlled, double-blind, parallel-group study was conducted in three tertiary hospitals in northern Italy and included low-risk pregnant women. The intervention consisted of oral administration of two capsules of probiotics or placebo from 30weeks of pregnancy until 37weeks of pregnancy. The primary outcome was GBS colonization, evaluated with rectovaginal swabs. In a subgroup, selected at random, changes in the vaginal microbiome after treatment administration were evaluated using 16S Metagenomic Sequencing Library Preparation sequencing and analysis. In total, 267 pregnant women were randomized to receive probiotics (n=133) or placebo (n=134). The two groups were similar at baseline. After treatment, no differences were found in the rates of positive rectovaginal swabs (p=0.24) and antibiotic administration (p=0.27). Only one case of postpartum fever (>38°C) was found in the placebo group. Labour and delivery outcomes and neonatal outcomes were similar in both groups. Analysis of the vaginal microbiota showed that the relative abundance of Lactobacillus spp. was not modified significantly by the probiotics, but the relative abundance of Gardnerella spp. decreased significantly (3.6±7.9 vs 5.5±10.2; p=0.03). Interestingly, the relative abundance of Lactobacillus spp. reduced significantly in women who subsequently presented with partial rupture of membranes (46.9±43.6 vs 77.7±24.9; p=0.02). Although the clinical outcomes were unaffected, administration of probiotics led to favourable changes in vaginal microbiota. It remains to be established how this effect could be translated into clinical advantage.

Comparison of efficacy of ALA-PDT and CO2 laser in the treatment of vaginal intraepithelial neoplasia II (VaIN II).

Comparison of efficacy of ALA-PDT and CO2 laser in the treatment of vaginal intraepithelial neoplasia II (VaIN II).

Characterization of the vaginal microbiota in women of childbearing age with different Nugent scores.

Characterization of the vaginal microbiota in women of childbearing age with different Nugent scores.

Alterations to the vaginal microbiota and their correlation with serum pro-inflammatory cytokines in post-weaning sows with endometritis.

Alterations to the vaginal microbiota and their correlation with serum pro-inflammatory cytokines in post-weaning sows with endometritis.

Metabarcoding analysis of the microbiota in flocks naturally infected by Coxiella burnetii: First description of the global microbiota in domestic small ruminants.

This study investigates Q fever in sheep and goats, key reservoirs for human infection, by metabarcoding and comparing it with q-PCR and serology. Samples from 26 small ruminants (aborted and normal-delivery) and six males across three Q fever-affected herds were analyzed. In sheep herds, seropositivity was 50 and 80% respectively, with Coxiella (C.) burnetii shedding detected vaginally in the second herd. In goats, 100% seropositivity and 90% C. burnetii detection were observed, with nasal and vaginal samples showing the highest detection rates. Metabarcoding revealed significant differences in alpha diversity, with greater richness in blood and evenness in milk from normal-delivery sheep and higher evenness in faeces from aborted sheep. Beta diversity showed distinct vaginal microbiota in normal-delivery females compared to aborted ones. Firmicutes was the most abundant phylum observed. Dominant genera included: Moraxella (nasal), Mycoplasma (blood), Streptococcus (milk), Ureaplasma (vaginal and preputial), Rikenellaceae RC9 gut group (faeces). Significant differences in bacterial composition, including infertility-linked vaginal pathogens, were found across female groups in all herds in the anatomical locations studied, revealing new species and tropisms. Moreover, taxonomic analysis identified C. burnetii in vaginal, milk and environmental samples. This first report of C. burnetii in the caprine nasal cavity suggests an underestimated tropism that may improve Q fever diagnosis. These findings underscore the need for herd-wide Q fever control measures, including males and normal-delivery females. Our findings contribute to new insights into the pathogen's impact on small ruminant microbiota and a novel approach to studying infectious diseases in this sector.

Association between lifestyle factors, traditional Chinese medicine constitution types and vaginal microbiota health in women: A case-control study

Association between lifestyle factors, traditional Chinese medicine constitution types and vaginal microbiota health in women: A case-control study

Metagenomic analysis reveals the novel role of vaginal Lactobacillus iners in Chinese healthy pregnant women

This study investigated the relationship between vaginal microbiota and women’s health conditions in 95 Chinese pregnant women in their third trimester. We conducted vaginal metagenomic analysis, examining species, functional pathways, and genes, and utilized correlation and LEfSe analyses to link microbiota to health conditions. Results revealed that healthy participants exhibited higher levels of Lactobacillus iners, with its abundance associated with tetrahydrofolate biosynthesis pathways. They also possessed more glycosyltransferase and ErmB antibiotic resistance genes compared to women with diagnosed conditions. Comparative genomics demonstrated that L. iners strains linked to bacterial vaginosis (BV) possessed more genes encoding biofilm-associated YhgE/Pip domain-containing proteins than healthy-associated strains. Notably, three BV-associated L. iners strains exhibited stronger biofilm formation abilities than four healthy-associated strains isolated in this study. Also, four out of seven L. iners strains inhibited the growth of Gardnerella vaginalis. Overall, L. iners may help maintain vaginal ecosystem stability in Chinese pregnant women.

Toward accurate vaginal microbiome profiling: protocol, bioinformatics, and core microbiota characterisation.

Rising demand for assisted reproductive technologies (ART) with limited improvements in success rates has driven interest in the impact of the vaginal microbiome on fertility outcomes. In order to fully examine the relationship between the vaginal microbiome and fertility outcomes, methodologies and technological developments must be standardised and benchmarked to provide the most accurate assessment of microbial population representation. This study sought to investigate the utility of 16S sequencing and bioinformatic approaches using nanopore sequencing to characterize core vaginal microbiota in a healthy Australian cohort of reproductive-age women. Optimisation and comparison of different PCR strategies for whole 16S amplification was undertaken, along with the generation of bioinformatic analysis strategies. Initial qPCR identified the 27F-YM (MIX) primer as the most sensitive for C. trachomatis. However, nanopore sequencing revealed no detectable C. trachomatis across all six samples. Among the bioinformatic tools, Porechop with NanoCLUST most accurately identified microbial presence. Community state type (CST) I-characterised by Lactobacillus crispatus dominance-was identified as the most common CST (66%), aligning with patterns of a healthy vaginal microbiome. The findings highlight a Lactobacillus-rich microbiome as the most common among healthy females; however, further refinement-potentially through a metagenomics approach-is recommended to address 16S rRNA primer limitations to enable improved accuracy of microbial detection for the vaginal microbiome.

Ligilactobacillus salivarius CECT5713 Increases Term Pregnancies in Women with Infertility of Unknown Origin: A Randomized, Triple-Blind, Placebo-Controlled Trial

Background/Objectives: Unexplained infertility is a worldwide problem affecting a significant proportion of couples of reproductive age. Recent studies suggest that alterations in the vaginal microbiota are related to female infertility, while supplementation with some probiotic strains has been shown to improve pregnancy rates in couples experiencing this problem. This study aimed to evaluate the impact of oral administration of Ligilactobacillus salivarius CECT5713 on pregnancy success rates in couples with unexplained infertility prior to in vitro fertilization (IVF). Methods: Seventy couples were randomized to receive either a placebo or a probiotic intervention (one capsule per day containing an excipient only or 3 × 109 viable cells of L. salivarius CECT5713 plus an excipient, respectively); 57 couples completed the study. Baseline data on demographics, health status (including gynecological and reproductive history), and lifestyle habits were collected. Vaginal swabs and semen samples were obtained from each couple before the intervention and immediately prior to IVF or upon confirmed pregnancy and were analyzed for microbiological (using both culture-dependent and -independent methods) and immunological profiles. Results: Oral administration of L. salivarius CECT5713 in couples with unexplained infertility scheduled for IVF resulted in a significantly higher pregnancy success rate (48.1%) compared to the placebo group (20.0%) (one-tailed Chi-square test; p < 0.024). The probiotic intervention improved both vaginal and semen immunological profiles, with no substantial changes observed in their microbial composition. Conclusions: These preliminary findings support the potential of L. salivarius CECT5713 supplementation to enhance fertility outcomes in couples with unexplained infertility.

Ureasil-polyether hybrid polymer-based vaginal ovules for combination therapy in the treatment of vulvovaginal candidiasis.

The aim of this research was to develop, characterize and evaluate the biocompatibility of ureasil-poly(propylene oxide) (U-PPO400) vaginal ovules for the modified release of a natural polyphenolic compound and an azole agent in the treatment of vulvovaginal candidiasis (VVC) caused by Candida albicans and non-albicans (NAC). The ovules were produced with a hydrophobic and low molecular weight ureasil-polyether through the sol-gel process. 1H NMR confirmed that the organic-inorganic molecule was obtained. X-ray diffraction (XRD) and scanning electron microscopy (SEM) showed the presence of drug crystals in the ovules. Miconazole (MCZ) and curcumin (CUR) were released by 60.95% and 12.06% in six days, respectively. The synergistic and additive effect of the antifungals was confirmed in NAC strains, with minimum inhibitory concentrations of CUR and MCZ being reduced up to 16 and 8 times. Biocompatibility tests showed that MCZ concentrations higher than 90µg/mL can negatively affect the vaginal microbiota. U-PPO400 had no impact on the growth of Lactobacillus jensenii. The cytotoxicity of the drugs on VK2/E6E7 vaginal epithelial cells was observed at concentrations equal to or greater than 5.94µg/mL for MCZ and 256µg/mL for CUR. No cytotoxic or inflammatory effects were observed after elution of the blank U-PPO400 ovules. This study demonstrated the biocompatibility and potential of the U-PPO400 base to promote controlled release of drugs and to reduce the frequency of use of vaginal ovules. The antifungal efficacy of the CUR/MCZ combination, especially against NAC strains, points to a promising alternative to improve the efficacy of the treatment of VVC.

Antibiotics or Antiseptics: What to Choose for the Treatment of Bacterial Vaginosis?

BACKGROUND: Bacterial vaginosis is an imbalance of the vaginal microbiome that is characterized by a decrease in lactobacilli and an overgrowth of opportunistic anaerobic bacteria. Given the high prevalence of bacterial vaginosis and the problem of antibiotic resistance, there is a need to develop new treatment methods and optimize the use of existing drugs. AIM: The aim of this study was to evaluate the efficacy and tolerability of the sequential use of lactic acid with clindamycin or dequalinium chloride in the treatment of bacterial vaginosis in women of reproductive age. METHODS: This study involved 127 women aged 18 to 45 years and diagnosed with bacterial vaginosis based on the Amsel criteria. The patients were randomly divided into four groups: Group 1 (34 women) received lactic acid; Group 2 (31 women) received clindamycin and lactic acid; Group 3 (32 women) received dequalinium chloride and lactic acid; and Group 4 (30 women) received clindamycin only. The effectiveness of treatment was assessed after 14 days based on the Amsel criteria. Three months post-treatment, complaints, vaginal discharge pH, amine tests and smears were analyzed if two or more Amsel criteria were present. RESULTS: Two weeks after treatment, bacterial vaginosis symptoms persisted in 14.7% of women in Group 1, 3.2% of women in Group 2, and 13.3% of women in Group 4. Additionally, two weeks after therapy, vulvovaginal candidiasis was diagnosed in one woman (3.2%) in Group 3. Bacterial vaginosis recurrences three months after treatment were recorded in 6.9% of patients in Group 1, 3.3% of patients in Group 2, 6.5% of patients in Group 3, and 11.5% of patients in Group 4. In Group 2, one case of vulvovaginal candidiasis (3.3%) was also documented. The efficacy of lactic acid was 85.3% after 14 days and 93.1% after three months, while clindamycin demonstrated an efficacy of 86.7% after 14 days and 88.5% after three months. Combination therapy with clindamycin and lactic acid demonstrated an efficacy of 96.8% after 14 days and 96.7% after three months. Treatment with dequalinium chloride and lactic acid demonstrated an efficacy of 100% after 14 days and 93.5% after three months. CONCLUSION: The data obtained confirm the high efficacy of the two-stage therapy using clindamycin with lactic acid and dequalinium chloride with lactic acid. This treatment method provides superior outcomes in terms of both cure rates and tolerability compared to traditional treatments. Given the growing resistance of microorganisms to antibiotics, the introduction of safe alternatives is particularly important, while offering new prospects for improving the treatment of bacterial vaginosis and enhancing the quality of life for patients.

Association Between Vaginal Microbiota and Infertility: A Systematic Review

The aim of this systematic review was to synthesize the available evidence on the relationship between vaginal microbiota and infertility, highlighting key microbial factors and their impact on reproductive outcomes. A comprehensive search of four databases identified 1,216 relevant publications. After duplicate removal using Rayyan QCRI and relevance screening, 605 full-text articles were reviewed, with nine studies ultimately meeting inclusion criteria. The included nine studies involving 1,768 women with vaginal infections. A significant microbial imbalance was observed in infertile women compared to non-infertile women, with a decrease in Lactobacillus and an increase in pathogenic bacteria such as Gardnerella and Mycoplasma. These findings support the inclusion of microbial assessments in infertility evaluations and highlight the potential benefits of managing bacterial imbalances to improve fertility outcomes. We conclude that vaginal microbial imbalance is associated with infertility, suggesting that targeted microbial interventions could benefit fertility treatments. Further researches are needed to explore these relationships in greater depth and apply them clinically.

Associations of Atopobium, Garderella, Megasphaera, Prevotella, Sneathia, and Streptococcus with human papillomavirus infection, cervical intraepithelial neoplasia, and cancer: a systematic review and meta-analysis

BackgroundLactobacillus spp. depleted and high diversity of vaginal microbiota is closely related to human papillomavirus infection and cervical cancer. However, the role of other microbial communities in human papillomavirus infection and cervical cancer is still unclear.ObjectiveThis study aims to systematically review the existing literature and perform a meta-analysis to statistically evaluate the relationship between vaginal microbiota, human papillomavirus infection, cervical intraepithelial neoplasia, and cervical cancer at the genus level.MethodsA comprehensive search of PubMed, Web of Science, and Embase databases was conducted to identify relevant studies. We synthesized data on the relative abundance of specific bacterial species associated with human papillomavirus status and cervical lesions. SPSS 25.0 was used to compare relative abundance among multiple groups.ResultsThe meta-analysis included 17 observational studies published between 2019 and 2023, involving 2014 participants from Asia, North America, and Africa. We found that specific vaginal microorganisms, such as Gardnerella, Prevotella, Sneathia, and Streptococcus, showed increased relative abundance with the severity of cervical lesions in human papillomavirus-negative, human papillomavirus-positive, cervical intraepithelial neoplasia, and cervical cancer patients. However, no statistically significant differences were found in that regard. Notably, Prevotella was significantly more abundant in cervical cancer patients compared to human papillomavirus-negative individuals. Sneathia was also found to be more abundant in cervical intraepithelial neoplasia and cervical cancer patients.ConclusionsThe specific vaginal microbial species are associated with human papillomavirus infection status and the severity of cervical lesions that may have significant implications for the prevention and treatment strategies of cervical cancer.

Microbial imbalances linked to early pregnancy loss: a comparative analysis of vaginal microbiota

Objective To explore the role and related functions of vaginal microbiota in early pregnancy loss. Methods This study was a case-control study with a comparison group (reference group). We recruited 178 women, including 73 who had experienced at least one early clinical pregnancy loss and 105 patients with one live birth and no history of pregnancy loss. Data on demographics, disease history, menstrual and reproductive history was collected. The case group patients were sampled immediately upon presenting with pregnancy loss at their first visit. The reference group patients underwent samples when they chose to participate voluntarily. All vaginal discharge was performed DNA Preparation and Metagenomics Sequencing. DNA extraction was performed using the phenol/trichloromethane method and the DNA fragments were then size-selected to 300–700 bp using magnetic beads. The selected fragments were repaired and ligated with indexed adaptors. The captured DNA was amplified again by PCR and circularized to create a single-stranded circular (ssCir) library. The ssCir library was subsequently amplified through rolling circle amplification (RCA) to produce DNA nanoballs (DNBs). The DNBs were then loaded onto a flow cell and sequenced using the DNBSEQ Platform. Nonparametric tests, including Kruskal–Wallis and Wilcoxon tests, were employed. Relative abundance between groups was compared, and differential species selection was performed using the LEfSe software with linear discriminant analysis. Results 1. PCoA analysis based on Bray–Curtis distances at the species level revealed a difference between the groups (p = 0.011). At the genus level, α-diversity, assessed using the Shannon, Simpson, and Inverse Simpson indices, indicated higher bacterial richness and diversity in the control group (Shannon: mean 0.554 vs. 0.383, p = 0.0044; Simpson: mean 0.254 vs. 0.179, p = 0.0043; Inverse Simpson: mean 1.636 vs. 1.414, p = 0.0043); At the genus level, 107 microbial genera were identified, 18 of which displayed statistically significant differences. At the species level, 23 microbial species showed significant differences between the two groups. 2. We analyzed the differences in the most abundant phyla, genera, and species, with a particular focus on the top 20 most abundant genera and species. Firmicutes and Proteobacteria were significantly more prevalent among patients with pregnancy loss (PL). Among the top 20 most abundant genera, Streptococcus and Porphyromonas were significantly more abundant in patients with PL, whereas Bifidobacterium was significantly more prevalent in the reference group. Among the 20 most abundant species, Lactobacillus crispatus was significantly more prevalent in patients with PL, whereas common in the control group. 3. Principal Coordinates Analysis (PCoA) of Bray-Curtis distances, highlight their distinct clustering patterns, suggesting a notable difference between the metabolic pathways of the two groups. Key pathways with a negative correlation to PL include those related to amino acid biosynthesis, lipid metabolism, and nucleotide biosynthesis. Conclusion Our study highlights the association between vaginal microbiota dysbiosis and EPL, identifying specific microbial taxa that may contribute to pregnancy loss. These findings underscore the importance of the vaginal microbiome in reproductive health and open up new avenues for research into microbiome-based diagnostics and therapies. By integrating microbial, immune, and environmental data, future research has the potential to uncover the mechanisms underlying EPL and develop targeted interventions to improve pregnancy outcomes.

The role of uterine and vaginal microbiome affecting the outcomes of assisted reproductive technologies

Infertility is a high-priority medical and social issue, which prevalence reaches 15 % according to the World Health Organization. One of the methods for infertility treatment, which is often resorted to by sub-fertile couples, is the use of assisted reproductive technologies (ART). It is known that the microbiome of the uterine cavity and vagina can affect ART-related fertility potential. The normal vaginal microbiome is characterized by the dominance of Lactobacillus spp. representatives, which ensure the maintenance of optimal pH values and prevent pathogenic microbial penetration and multiplication. It is assumed that the normal endometrial microbiome is characterized by predominance of Lactobacillus spp., but relevant studies are prominently heterogeneous. According to the current hypothesis, the dominance of Lactobacillus spp. and, particularly, Lactobacillus crispatus, in the vagina and uterine cavity is associated with favorable reproductive outcomes in ART programs. Recurrent implantation failures are related to spreading of opportunistic microflora in such niches. Nevertheless, some authors have reported no direct correlation between Lactobacillus spp. level, presence of opportunistic microorganisms and favorable outcomes of ART programs, which underlies a need to conduct further large-scale studies.

WHAT IS THE IMPACT OF IATROGENIC MENOPAUSE ON VAGINAL HEALTH AND SEXUALITY? (PRELIMINARY) RESULTS OF “VOLUPTA”; THE MENOPAUSE MICROBIOME STUDY

Abstract Objectives Genitourinary symptoms of menopause (GSM) are common in women with a history of breast cancer (BC). When GSM occurs these symptoms are likely to be moderate to severe. Little is known about the timing of onset of vaginal changes during BC-treatment and the relation of these changes towards sexual function. It is not known whether vaginal symptoms related to GSM may be caused by changes in the vaginal microbiome. This study explores vaginal microbiomes when iatrogenic menopause occurs due to BC-treatment. This first in time study collects longitudinal samples of vaginal microbiome samples are collected during the menopausal transition. Before menopause, the vaginal microbiome is usually Lactobacillus spp. dominated in Western countries. Methods This longitudinal prospective trial investigates vaginal microbiome samples (eNAT®, COPAN) during iatrogenic menopause in function of BC-treatment. We measured the vaginal pH and analyzed the microbiome using 16S rRNA gene sequencing and quantitative real-time polymerase chain reaction (qPCR) at baseline(V1) and after 3-and 6 months BC-treatment(V2-V3). We determined menopausal status using serum-estrogen and performed a clinical examination using validated tools; the vaginal &vulvar assessment scale. Results We recruited 60 premenopausal BCpatients (median age 42.9y, SD 6.8y). At this moment we completed data on all timepoints for 17 participants. All participants except p15 became menopausal due to ovarian function suppression. After V1 no participant had a vaginal pH below 5.0. The vaginal microbiomes are more diverse after induction of menopause. We observe a decrease of Lactobacillus species and increase of Gram-negative bacteria such as Prevotella. Clinically, we noticed that signs of vaginal- and vulvar atrophy are already present after 3 months of menopause, resulting in an increase of vaginal and vulvar composite scores at V2 and V3. Conclusions After induction BC-treatment, we determine less Lactobacillus spp. dominance, indicating an increase in vaginal microbiome diversity after iatrogenic menopause with a quick and lasting effect. Signs of vaginal and vulvar atrophy were visible after 3 months of menopause. In the future, we aspire to identify oncological safe measures to safeguard patients from discomfort associated with GSM when iatrogenic menopause occurs. Conflicts of Interest none.

The Effect of Probiotics on Preterm Birth Rates in Pregnant Women After a Threatened Preterm Birth Episode (The PROPEV Trial).

Introduction: Preterm birth is the leading cause of perinatal mortality worldwide, with prevalence rates showing little reduction. Although mortality rates have decreased, morbidity rates remain concerningly high. In recent years, there has been a surge in studies examining the etiology, risk factors, and management of preterm birth. The use of vaginal probiotics in pregnant women at risk of preterm birth has garnered attention as a potential approach for improving perinatal outcomes and modulating the vaginal microbiota. However, the efficacy of this intervention remains unclear. Therefore, this study explored the impact of vaginal probiotics on perinatal outcomes and vaginal microbiota composition in pregnant women at risk of preterm birth. Materials and Methods: This was a randomized, prospective, longitudinal, double-blind, placebo-controlled, multicentric trial conducted across seven maternities in Spain from October 2017 to August 2022 in pregnant women at risk of preterm birth. Participants were randomly assigned to receive vaginal probiotics containing four lactobacilli strains or a placebo. The primary outcome was to explore a potential correlation between probiotic use among pregnant women at risk of preterm birth and the actual rate of preterm birth before 37 gestational weeks. Secondary outcomes included an evaluation of preterm birth rates, neonatal morbidity, the vaginal microbiota, and changes in the vaginal microbiota after receiving probiotics. Other secondary outcomes were identifying vaginal microbiota patterns associated with preterm birth and exploring potential therapeutic mechanisms involving probiotics. Trial registration: Clinicaltrials.gov, identifier: NCT03689166. Results: A total of 200 participants were included. Of those, birth data were obtained for 181 women. Demographics were similar between both groups. An analysis of perinatal outcomes found no significant differences in preterm birth rates, prematurity rates, gestational weeks at delivery, neonatal complications, time to birth, or latency time to delivery. Microbiota analysis showed no significant differences in vaginal microbiota changes between groups. No serious or unexpected adverse reactions were reported. Conclusions: There were no statistically significant differences for spontaneous preterm birth between pregnant women receiving probiotics and pregnant women receiving the placebo.

Antifungal Resistance in Vaginal Candidiasis Among Reproductive-age Women: A Review.

Candida is a type of fungus that can cause infections in humans. Sometimes, these infections become tough to treat because the Candida fungus resists antifungal drugs. This resistance depends on both the specific type of Candida and how it interacts with the human body. For instance, Candida can change its genetic makeup or produce proteins that pump out the drugs, making them less effective. Additionally, Candida can form a protective layer called a biofilm, which shields it from the drugs. Candida can cause a variety of diseases, and vaginal candidiasis is among the most troublesome. Nearly every woman experiences this infection at least once in her lifetime. Higher rates of treatment failures and recurrent infections result from the developing issue of antifungal resistance, underscoring the need for a more thorough understanding of resistance mechanisms. Changes in hormonal levels and immune responses can significantly influence the effectiveness of antifungal treatments. Hormonal fluctuations can alter vaginal pH and immune functions, which in turn affects Candida colonization and persistence. Moreover, an imbalance in the vaginal microbiome can lead to an overgrowth of Candida and lead to the drug resistance candidiasis. This review delves into the molecular pathways that contribute to the resistance of vaginal candidiasis to antifungal treatments, focusing on both acquired and intrinsic resistance mechanisms. Acquired resistance develops due to genetic alterations following antifungal exposure, including mutations in genes encoding drug targets, overexpression of efflux pumps, and increased biofilm formation. In contrast, intrinsic resistance refers to the innate traits of the Candida species that inherently reduce the efficacy of antifungal agents. These characteristics include changes in membrane sterols, genetic mutations in target enzymes, and the presence of efflux pumps that remove antifungal medications. Understanding these complex mechanisms can inform future therapeutic strategies and improve clinical outcomes.