Clinical variability of bacterial vaginosis and trichomoniasis

Bacterial vaginosis and trichomoniasis are two of the most commonly encountered vaginal diseases. Although risk factors for both vaginal conditions have been identified, there continues to be lack of knowledge in regard to their role in association with other sexually transmitted diseases. Vaginal pH is an essential ingredient in the defense and control of the vaginal environment. The alteration of pH with the sequelae of such pregnancy complications as preterm delivery, preterm labor and premature rupture of the membranes; amniotic fluid infection; postpartum endometritis and surgical infections; and the role of bacterial vaginosis are discussed. Treatment modalities in both the nonpregnant and pregnant woman, as well as treatment of resistant cases of both vaginal conditions, are recommended.     

An epidemiological survey of bacterial vaginosis,vulvovaginal candidiasis and trichomoniasis in the Tibetan area of Sichuan Province,China

Objective

To determine the prevalence and risk factors of vaginitis in the Tibetan area of Sichuan Province in China.

Study design

Between September and October 2007, 397 women were surveyed with a questionnaire and diagnosed with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomoniasis by Gram stain and microscopy of vaginal swabs.

Results

The prevalence of BV, VVC, and trichomoniasis was 51.6%, 6.5%, and 2.5%, respectively. Multivariate logistic modeling showed that risk factors associated with having vaginitis due to any of the three infections were older age and Tibetan ethnicity.

Conclusion

BV appears to be the predominant cause of vaginitis, followed by VVC, and trichomoniasis. Risk factors for vaginitis include being more than 49 years old and of Tibetan ethnicity.     

Longitudinal trajectory of vulvovaginal candidiasis,trichomoniasis, and bacterial vaginosis during pregnancy as well as the impact on pregnancy outcomes: a preliminary study

Objectives: The aims of this study were to describe the course of vulvovaginal candidiasis (VVC), trichomoniasis, and bacterial vaginosis (BV) in pregnancy and to explore the association between these longitudinal changes and pregnancy outcomes.

Methods: A total of 793 pregnant women were enrolled at the first trimester of pregnancy and were followed prospectively twice at the second and third trimester. VVC, trichomoniasis, and BV were evaluated at each trimester of pregnancy. Results were evaluated for trends of these three diseases and the association between these changes of trends and pregnancy outcomes.

Results: The trend of negative at all three time points was dominant for all three diseases compared with trend of positive throughout pregnancy was the most rare. In addition, for VVC, a trend toward positive can’t be ignored (7.5%). However, for BV, the distribution of other three trends (trend negative, trend positive, status random) were basically the same. Different trends of these three diseases were not associated with adverse pregnancy outcomes, with the exception of women who had a trend of BV positive throughout pregnancy were more likely to suffer from amniotic fluid infection (AFI) compared with women who were negative at all three time points (p?=?.016, OR: 17.29, 95% CI: 1.70–175.54).

Conclusions: In this population, the trend of negative throughout pregnancy was dominant for all three diseases compared with few women were positive across their pregnancy. BV may be associated with AFI during pregnancy.     

Mannose-binding lectin gene polymorphism, vulvovaginal candidiasis, and bacterial vaginosis

OBJECTIVE: To evaluate associations between polymorphisms in the gene coding for mannose-binding lectin (MBL) and the diagnosis of acute or recurrent vulvovaginal candidiasis and bacterial vaginosis METHODS: Women at two outpatient clinics in Brazil filled out a questionnaire and were examined for the presence of vulvovaginal candidiasis or bacterial vaginosis. A buccal swab was blindly tested for codons 54 and 57 MBL2 gene polymorphisms by polymerase chain reaction and endonuclease digestion. RESULTS: A total of 177 women were enrolled. Vulvovaginal candidiasis was identified in 78 (44.1%) women, 33 (18.6%) had bacterial vaginosis, and 66 (37.3%) were normal controls. Recurrent vulvovaginal candidiasis was present in 50 (64.1%) of the women with vulvovaginal candidiasis; 20 (60.6%) of the bacterial vaginosis patients had recurrent disease. Vulvovaginal candidiasis was associated with white race (P=.007), bacterial vaginosis was associated with nonwhite race (P=.05), and both were associated with a history of allergy (P< or =.02) and having sexual intercourse at least three times a week (P<.001). Carriage of the variant MBL2 codon 54 allele B was more frequent in women with recurrent vulvovaginal candidiasis (25.0%) than in the women with acute vulvovaginal candidiasis (17.9%) or controls (10.6%) (P=.004). Allele B was also more prevalent in women with recurrent bacterial vaginosis (22.5%) than in those with acute bacterial vaginosis (0%) (P=.009). The MBL2 codon 57 polymorphism was infrequent and not associated with vulvovaginal candidiasis or bacterial vaginosis. CONCLUSION: The incidence of vulvovaginal candidiasis and bacterial vaginosis differs by ethnicity in Brazilian women. The MBL2 codon 54 gene polymorphism is associated with both recurrent vulvovaginal candidiasis and recurrent bacterial vaginosis.     

Clinical and laboratory findings in women with bacterial vaginosis and trichomoniasis versus controls

We report comprehensively on the clinical and laboratory findings in 30 women with bacterial vaginosis (BV), 30 with vaginal trichomoniasis and 30 with normal secretions. Women with trichomoniasis were more often divorced (chi 2 test, p much less than 0.001), more often complained of dyspareunia (chi 2 test, p less than 0.05), frequently had discharge present in the vaginal vestibule, and showed one or more signs of vaginitis in half the cases. A 'moth-eaten' cervix was seen in only four women (13%) with trichomoniasis, but can be considered pathognomonic of the condition. While the main characteristics of vaginal secretions, i.e. amount, consistency, colour, absence or presence of gas and odour, are only poorly discriminative between BV and trichomoniasis, they can be of much help in distinguishing between 'abnormal' and--probably--normal secretions. Parabasal cells were found in the wet mount of 19 women (73%) with trichomoniasis. Epithelial cell clusters were a prominent finding in controls but were virtually absent in the other two groups. We detected curved rods in 15 women (50%) with BV, but in none of the women with trichomoniasis or normal secretions. There were only minor differences in the results of bacterial cultures in cases of BV and trichomoniasis. Bacteroides and Peptostreptococcus species were the predominant anaerobes in both groups. Gardnerella vaginalis was significantly more often isolated from women with BV than from controls (chi 2 test for trend, p less than 0.001). Gas-liquid chromatography showed the presence of succinate in only two cases of BV. Lactate was found in all controls but one. Ethylation of vaginal samples probably reduces the risk of over-emphasizing the presence of succinate and lactate. It is concluded that BV and trichomoniasis are both characterized by the overgrowth of anaerobic bacteria and that there is a considerable overlap in clinical and laboratory findings. Microscopy of the wet mount should be considered the most powerful diagnostic tool.     

Evaluation of clinical methods for diagnosing bacterial vaginosis

OBJECTIVE: To determine whether the current clinical criteria for diagnosing bacterial vaginosis can be simplified by using 2 clinical criteria rather than the standard 3 of 4 criteria (Amsel's criteria). METHODS: This was a prospective observational study of 269 women undergoing a vaginal examination in the Women's Primary Care Center, Division of Research, or Colposcopy Clinic at Women & Infants Hospital. All 4 clinical criteria for diagnosing bacterial vaginosis were collected, and Gram stain was used as the gold standard. Sensitivity and specificity were calculated for each individual criterion, combinations of criteria, and a colorimetric pH and amine card. Receiver operating characteristic curve was generated to estimate the preferred pH and percentage of clue cells for diagnosing bacterial vaginosis. RESULTS: The prevalence of bacterial vaginosis in our study population was 38.7%. Vaginal pH was the most sensitive of all the criteria, at 89%, and a positive amine odor was the individual criteria with the highest specificity, at 93%. Similar specificity was seen with combinations of 2 criteria and Amsel's criteria. Receiver operating characteristic curve analysis yielded a preferred pH and percentage of clue cells of 5.0 and 20%, respectively. However, a pH of 4.5 or greater improves sensitivity with minimal loss of specificity. CONCLUSION: The clinical criteria for diagnosing bacterial vaginosis can be simplified to 2 clinical criteria without loss of sensitivity and specificity.     

Bacterial vaginosis and trichomoniasis: epidemiology and management of recurrent disease

Effective therapies exist for the treatment of both vaginal trichomoniasis and bacterial vaginosis (BV). Recurrent trichomonas infection is uncommon, and significant metronidazole resistance remains rare. The management of metronidazole-resistant trichomoniasis is dependent on susceptibility studies, which can be used to guide higher doses of metronidazole therapy. Recurrent BV is common. A mechanism for reestablishing the normal vaginal flora with H(2)O(2)-producing lactobacilli remains elusive. The management of this recurrent infection is based upon a longer duration of therapy with currently available antibiotic regimens and documentation of a clinical response using composite clinical criteria and Gram's stain of the vaginal secretions.     

A multicenter,double-blind,randomized, placebo-controlled study of rifaximin for the treatment of bacterial vaginosis

ObjectiveTo compare efficacy and tolerability between different regimens of rifaximin vaginal tablets and a placebo for treatment of bacterial vaginosis.MethodsIn a prospective study carried out at 13 sites in 3 European countries between August 2009 and October 2010, White, non-pregnant, premenopausal women with bacterial vaginosis were randomly assigned to receive rifaximin at 100 mg for 5 days (100 mg/5 days), 25 mg/5 days, or 100 mg/2 days, or placebo. Women were assessed at 7–10 and 28–35 days. Diagnosis and cure were based on Amsel criteria and Nugent score. Fisher exact test was used to compare cure rates.ResultsAmong 114 women recruited, 103 were evaluable for drug efficacy. Therapeutic cure rate at first follow-up was higher in the rifaximin 25 mg/5 days (48%, P = 0.04), 100 mg/2 days (36.0%), and 100 mg/5 days (25.9%) groups than in the placebo group (19.0%). At second follow-up, therapeutic cure rate was 28.0%, 14.8%, and 4.0% in the respective groups versus 7.7% in the placebo group. No difference in adverse events was observed.ConclusionRifaximin at 25 mg/5 days showed better therapeutic cure rates and maintenance of therapeutic cure after 1 month versus placebo. All treatment regimens were well tolerated.EudraCT number: 2009-011826-32.     

Psychosocial factors influencing teenage sexual activity, use of contraception and unplanned pregnancy

Objective: to compare teenagers who become unintentionally pregnant and teenagers who have never been pregnant but are using contraception on matters related to family/partner stability, and communication with a parent or stable sexual partner about sexual matters.Design: survey utilising self-completed questionnaire.Setting: a hospital antenatal clinic and community-based family planning clinic.Participants: 30 teenagers with an unplanned pregnancy and 31 ‘never-pregnant’ teenagers using contraception.Findings: the two groups were similar on demographic factors, mean age at which sexual intercourse was first experienced, total number of sexual partnerships, the number of teenagers having a current, regular boyfriend and mean length of the interval between when the teenagers first started going out with their boyfriend and when first sexual intercourse took place. Teenagers in the family planning clinic group were more likely to be living with both natural parents and to be still at school or in higher education. The mean length of time pregnant teenagers had been going out with their boyfriend was longer, they were more likely to be cohabiting with him and to be unemployed. Participants from the antenatal clinic group communicated more with their mothers about sexual matters than those in the family planning clinic group, who were more likely to seek this information from books. The family planning clinic participants were more likely to discuss personal rules and values with friends than those in the antenatal clinic group.Implications for practice: to develop understanding of factors predisposing to unplanned pregnancy during adolescence and to implement measures to counter them, further studies to examine the influence of teenagers' perceptions of family relationships and future life prospects on contraception use and unplanned pregnancy were identified.     

A clinical and microbiological study of bacterial vaginosis and vaginitis in pregnant women

Infectious complications in pregnancy and delivery are still y serious problem in obstetrical, gynecological and neonatological practice. The main part of them are caused from the anaerobic organisms associated with bacterial vaginosis as well from sexually transmitted pathogens. In this study we present data about the frequency of spreading of bacterial vaginosis and vaginitis in pregnant women at different stages of pregnancy. We held y study of 106 pregnant women aged between 15 and 35, registrated at the Pregnancy Consultation Office in eleven. About half of the women did not have data for genital discharge and the microbiological analysis showed normal vaginal flora. Two thirds of the rest investigated women had data for candidiasis, bacterial vaginosis, or both. Only one case of Trichomonas vaginalis-vaginitis was detected. The results from the microscopic examination of the specimens from 10 (9.4%) of the women were suspected for N. gonorrhoeae and/or Chlamydia trachomatis-cervicitis. Group B streptococci in significant quantity was found in five cases. These results showed high frequency of spreading of bacterial vaginosis and cervico-vaginitis in pregnant women.     

Risk of bacterial vaginosis,Trichomonas vaginalis and Candida albicans infection among new users of combined hormonal contraception vs LNG-IUS

Objective: The study assessed the risk of bacterial vaginosis, Trichomonas vaginalis and Candida albicans infection among new users of either a combined oral contraceptive pill (COC) or the levonorgestrel-releasing intrauterine system (LNG-IUS).

Methods: This prospective observational study included 430 women, without active vaginitis at inclusion, who were divided into two groups according to their chosen method of contraception: COC group (n?=?236) and LNG-IUS group (n?=?194). Participants were examined for bacterial vaginosis, T. vaginalis and C. albicans infection initially and then at 6 weeks, 6 months and 12 months after the start of contraceptive use. Data were collected and statistically analysed.

Results: The rates of acquisition of bacterial vaginosis, T. vaginalis and C. albicans infection during follow-up were significantly increased and comparable between the groups (p?p?p?25?kg/m², history of bacterial vaginosis, history of sexually transmitted infection, vaginal douching more than five times per week and coital frequency more than five times per week were strong risk factors for acquisition of bacterial vaginosis during the follow-up period (p?Conclusions: The use of COCs and LNG-IUS is associated with an increased, comparable risk of acquisition of bacterial vaginosis, T. vaginalis and C. albicans infections, which is greatest during initial use of the method but which improves over time.     

Comparative study of intravaginal metronidazole and triple-sulfa therapy for bacterial vaginosis

Objective: We sought to compare the efficacy of metronidazole gel vs. triple-sulfa cream in the treatment of bacterial vaginosis (BV).Methods: In a double-blinded study, 247 women with symptomatic BV were randomly assigned to receive either 5 g of 0.75% metronidazole gel twice daily for 5 days or triple-sulfa cream twice daily for 5 days. There were 205 (96 treated with metronidazole and 109 treated with triple-sulfa) evaluable patients to compare efficacy at the final visit. Approximately 60% of these patients had been previously treated for BV, reflecting the recurrent nature of the disease in this patient population.Results: At the first (12-16 days) return visit, 81/103 (79%) patients in the metronidazole group were cured compared with 80/113 (71%) patients in the triple-sulfa cream group (P = 0.333). At the final (28-35 days) return visit, 63/96 (66%) in the 96 metronidazole group remained cured compared with only 51/109 (47%) in the triple-sulfa group (P = 0.02). An intent-to-treat analysis similarly showed that the cure rate with metronidazole was superior to triple-sulfa (P 相似文献   

Exposure to chronic stress and ethnic differences in rates of bacterial vaginosis among pregnant women

OBJECTIVE: The purpose of this study was to assess the contribution of chronic social stressors to race/ethnic differences in the rate of bacterial vaginosis among pregnant women in the inner-city area. STUDY DESIGN: We conducted a cross-sectional clinical prevalence study in a sample of 2304 women at the first prenatal visit (14.8 +/- 0.2 weeks of gestation). Bacterial vaginosis was diagnosed by Nugent's method. Stress was measured at the individual and community levels with the use of interviews and administrative records. Logistic regression was used to assess the effects of stress on the odds of bacterial vaginosis occurrence, after adjustment for demographic and behavioral risk. RESULTS: Black women had significantly higher rates of bacterial vaginosis (64%) compared with white women (35%). Exposure to chronic stressors at the individual level differed by race (eg, 32% of the black women reported threats to personal safety compared with 13% of white women). There were significant racial differences in exposure to stress at the community level (eg, 63% of the black women lived in neighborhoods with aggravated assault rates that were above the citywide mean compared with 25% of the white women). After the adjustment for sociodemographic, behavioral risk, and perceived stress, the odds of the occurrence of bacterial vaginosis that was associated with the community level stressor of "homelessness" was significant (odds ratio, 6.7; 95% CI, 1.6-27.8). Inclusion of both individual and community level stressors reduced the black/white bacterial vaginosis odds ratio by 27%. CONCLUSION: Stressful exposures are associated positively with bacterial vaginosis in pregnancy in a sample of women of low income in the inner city. The measurement of stressors at multiple levels explained a significant proportion of the racial disparity in the rates of occurrence of bacterial vaginosis.     

Self-collected vaginal swabs to diagnosis bacterial vaginosis during pregnancy: A pilot study

OBJECTIVE: To study the feasibility of a screening for bacterial vaginosis by a self-collected vaginal swab during pregnancy. To measure bacterial vaginosis prevalence in a non-representative sample of women. PATIENTS AND METHODS: A self-collected swab was suggested to 398 women who consulted between 15 and 33 weeks of gestation in three different centres. Gram stain evaluation using Nugent criteria was used for the diagnosis of bacterial vaginosis. RESULTS: Three hundred and forty-one women agreed to take part in the study (86%). The quality of the swabs was satisfactory in 93% of the cases. Concerning the 15 non-interpretable slides, the cellular and bacterial density was too poor, owing to a poor quality or a low vaginal flora. Thirty-one women (9%) had a bacterial vaginosis--Nugent score included between 7 and 10--and this frequency did not vary according to the centre. Thirty-five women (10%) had an intermediate flora--score between 4 and 6--and this result varied from 2 to 12% depending on the centre, but the difference was not significant. DISCUSSION AND CONCLUSION: Self-collected swabs to detect bacterial vaginosis are well accepted by most of pregnant women, and the quality of the swabs seems to be satisfactory. In case vaginal flora is intermediate--between 4 and 6--the interpretation of the slides could be difficult.     

Diagnosis and clinical manifestations of bacterial vaginosis

Among 640 randomly selected women who were attending a sexually transmitted disease clinic and did not have trichomoniasis, 33% had bacterial vaginosis as defined by a composite of four clinical criteria: (1) Vaginal discharge was homogeneous; (2) vaginal discharge had a pH greater than or equal to 4.7; (3) vaginal discharge had an amine-like odor when mixed with 10% potassium hydroxide; (4) vaginal discharge contained clue cells representing greater than or equal to 20% of vaginal epithelial cells. Previously published Gram stain criteria for bacterial vaginosis correlated better than results of semiquantitative cultures for Gardnerella vaginalis with presence or absence of clue cells and with composite clinical criteria. Of 293 women with bacterial vaginosis by Gram stain criteria, 65% had symptoms of increased vaginal discharge and/or vaginal malodor, while 74% had signs of characteristic homogeneous vaginal discharge or amine-like odor. Elevated vaginal pH was the least specific and amine-like odor the least sensitive sign of bacterial vaginosis. Gram stain criteria for bacterial vaginosis were not associated with the concentrations of endocervical or vaginal inflammatory cells but were significantly associated with a clinical diagnosis of pelvic inflammatory disease. After adjusting for coinfection, sexual behavior, and other variables, bacterial vaginosis remained associated with adnexal tenderness (odds ratio = 9.2, p = 0.04). Bacterial vaginosis, previously implicated as a risk factor for obstetric infections, may be a risk factor for pelvic inflammatory disease.