Utility of Vaginal pH as Point of Care Test for Detection of Bacterial Vaginosis

Background & objectives: Bacterial vaginosis (BV) is a Reproduc?ve tract infec?on (RTI) among young sexually ac?ve women with high prevalence. It is associated with complica?ons related to pregnancy and an increased risk of acquiring STDs. This poses a need for cost-effec?ve detec?on of BV in low resource se?ngs. Hence, we propose to study the u?lity of vaginal pH determina?on for the detec?on of BV. Material & Methods: This is a single center, 1 year cross-sec?onal study. Swabs were collected from 250 non-pregnant women a?ending the out-pa?ent department of Obstetrics and Gynecology with vaginal discharge as a predominant symptom with or without backache and abdominal pain. Vaginal pH determina?on, Gram stain, wet mount, Whiff test, and Amsel’s criteria were used for BV detec?on. Results: 250 study par?cipants with vaginal discharge sugges?ve of BV were analyzed. Vaginal pH was significantly higher in women with BV with the mean pH being 6.2. Vaginal pH >4.5 had a sensi?vity of 85% and specificity of 66% to detect BV. The Whiff test had the least sensi?vity. Clue cells and Amsel’s criteria of ? 3 were significant for BV. A combina?on of pH and Whiff test performed be?er had high sensi?vity and specificity. Conclusions: A combina?on of pH determina?on and the Whiff test serves as a low-cost alterna?ve in resource-poor se?ngs for detec?on of BV. Though Clue cells and Amsel’s criteria ? 3 were most sensi?ve and specific, they cannot be used in low resource se?ngs. Vaginal pH alone can be used to detect BV in areas of low prevalence.

In -vitro Biofilm Formation of Vaginal Isolates of Streptococcus agalactiae; Effect of pH and Culture Media

Abstract Background: Streptococcus agalactiae (GBS), a major cause of neonatal morbidity and mortality, is transmitted from mother to neonate via placenta or during birth. Biofilm formation is an important factor in GBS pathogenesis. This study aimed to determine effects of pH, different culture media and nutritional composition on in vitro biofilm forming ability of GBS isolated from pregnant women. Methods: A total of 30 confirmed isolates of GBS from pregnant women were tested for biofilm formation in Todd Hewitt Broth (THB) at pH 4.5,6 and 7. Ten of these isolates were tested for biofilm formation in growth media THB, brain heart infusion broth, tryptic soy broth, Mueller Hinton broth and nutrient broth. Further they were tested for influence of glucose on biofilm formation using crystal violet and MTT assay. Results: Of 30 GBS isolates strong biofilm formation (SBF) was observed at pH 7 in 56.6 %(n=17) while 36.6%(n=11) isolates showed weak biofilm formation (WBF). At pH 4.5, 43.3% (n=13) were non biofilm formers. In THB without glucose, all 10 isolates were SBF while THB with 1% glucose, 3(30%) isolates were SBF, 5(50%) isolates were moderate biofilm producers and 2(20%) isolates were WBF. Ten isolates tested in 5 types of growth media did not show statistically significant difference in biofilm forming ability. Conclusion: All tested vaginal GBS isolates were able to produce biofilms, maximum biofilm formation of GBS was at pH 7.0. and pH 4.5 is not favorable, thus in normal vaginal pH (3.5 - 4.5), GBS finds it difficult to grow biofilms.

Evaluation of the vaginal microflora of women of reproductive age / Шинэ санаа Шинэ нээлт

Background@#The knowledge about the normal and abnormal vaginal microbiome has changed over the last years. The normal and the abnormal vaginal microbiota are complex ecosystems of more than 200 bacterial species influenced by genes, ethnic background and environmental and behavioral factors. Major changes in the vaginal physiology and microbiota over a woman’s lifetime are largely shaped by transitional periods such as puberty, menopause and pregnancy. Many studies have shown that bacterial vaginitis (BV) has an increased risk of preterm birth, miscarriage, premature rupture of membran, and postpartum uterine inflammation and sepsis. To assess different bacterial and epidemiological factors associations with increased vaginal pH in the women of reproductive age.@*Methods@#In the 1st Health center of Bayanzurkh district hospital, 100 non-pregnant women were randomly selected between 18-45 years of age. Women were submitted to an interview, vaginal examination and vaginal specimen collection for pH measurement and microscopy. Descriptive statistics are reported for the vaginal pH according to a specially designed survey card, the survey respondents assessed the status of the mother’s health.@*Results@#The non pregnant group studied herein were mostly young adults with ages in the age range 25-29 (32.0; 32%, mean±SD: 29.1±5.7) years. The vaginal pH mean in non-pregnant women was 4.5±0.5. Elevated vaginal pH was signicantly associated with bacterial vaginosis (p < 0.001), and bacterial vaginosis flora (p < 0.001). 162 of 200 women (81%) had an increased vaginal pH. 65,8% of participants in research were normal nugent score.@*Conclusion@#In non-pregnant women, the vaginal pH mean was 4.5 ± 0.5. Changes in vaginal pH are statistically significant with age, and clinical manifestations. /р<0.05/. The human vaginal ecosystem is a dynamic environment in which microbes can affect host physiology but also where host physiology can affect the composition and function of the vaginal microbiota.

Study of association of bacterial vaginosis in preterm labor and fetal outcome.

Background: Preterm labor has increasing evidence of infectious cause especially ascending infections from lower genital tract of late attention is being given to bacterial vaginosis. in many of the case control and prospective studies bacterial vaginosis has been associated with lat miscarriage, preterm labor, premature rupture of membranes, chorioamnionitis. Treating bacterial vaginosis can reduce the preventable cause of preterm birth. Aim: The association of bacterial vaginosis in preterm and its fetal outcome. Material and methods: A case control study of 120 pregnant women (study group-60 and controls 60 cases). Pregnant women with preterm labor, 28 weeks to 37 weeks were selected. vaginal discharge pH was measured. Sterile cotton swabs were used for vaginal smear preparation for gram staining and the organisms were scored based on Nugents scoring system. Clue cells were also noted on the smear. Diagnosis of bacterial vaginosis is done in women with pH above 4.5 and a score of 7 or more on gram staining of vaginal smear based on Nugents criteria. Outcome of delivery was observed. Results: 61.6% were < 34 weeks of gestation. High vaginal pH >4.5 is seen in 55%. Chi Square test and the P value 0.001 (99.9%) showed significance of the test. Gram staining revealed bacterial vaginosis infection 41.6% in study group and 16.6% in control group. This study was in aconcurrance with the study made by saifon Chawanpaiboon which showed an association between high vaginal pH, Amsels criteria and various stages of preterm labor. Neonatal complications were seen in women with preterm <34 weeks and positive for bacterial vaginosis. Conclusion: Association between bacterial vaginosis and preterm labor was established. Screening and treatment will reduce the incidence of preterm delivery.

Changes in Atrophic Symptoms, the Vaginal Maturation Index, and Vaginal pH in Postmenopausal Women Treated with Vaginal Estrogen Tablets / 대한폐경학회지

OBJECTIVES: The aim of this study was to assess atrophic symptoms, the vaginal maturation index (VMI), and vaginal pH in postmenopausal women after use of estriol vaginal tablets for the treatment of vaginal atrophy. METHODS: In a randomized prospective study, 67 postmenopausal women were treated with 500microg estriol tablets 3 times a week for 1 week in the 1-week treatment group (n = 40) and for 2 weeks in the 2-week treatment group (n = 27). The primary endpoints were changes in the VMI, vaginal pH, and improvement in participant-reported most bothersome symptom (MBS; vaginal dryness, irritation/itching, or dyspareunia). We compared three endpoints before and after treatment in each group and between the two treatment groups. The correlation between the vaginal pH and maturation value (MV) was assessed. RESULTS: A statistically significant increase in the MV, decrease in pH, and improvement in the MBS occurred for women treated with estriol vaginal tablets in the 1- (P = 0.000, P = 0.002, and P = 0.000, respectively) and 2-week treatment groups (P = 0.000, P = 0.000, and P = 0.000, respectively). There were no significant differences between the 1- and 2-week treatment groups with respect to improvement in the VMI, vaginal pH, or MBS. The correlation between the vaginal pH and MV showed a negative linear correlation at 0, 1, and 2 weeks (P = 0.000, P = 0.000, and P = 0.011, respectively). CONCLUSION: Treatment with 500microg estriol vaginal tablets thrice-weekly for 1 week was effective in improving. It is thought that the three primary endpoints (VMI, vaginal pH, and MBS) improved at the same time during treatment.

The Effect of Vitamin-C Vaginal Tablets (Vagi-C(R)) in Patients with Each Vaginitis in Pregnancy and in Normal Pregnant Women / 대한주산의학회잡지

OBJECTIVE: The purpose of this study is to evaluate the effect of Vitamin-C vaginal tablets on vaginal pH and vaginitis symptoms of pregnant women. METHODS: Ninety pregnant women who visited the antenatal clinic were included in this study after giving their informed consent. The treatment regimen of the vitamin-C vaginal tablets (250 mg, Vagi-C(R), Taurus Pharma GmbH, Germany) was one tablet given once a day for 6 consecutive days. Vaginal pH was measured the day before and the day after the Vit-C vaginal treatment. Ninety women of initial, ten failed to follow-up (participate). After routine screening using microscopic analysis of the vaginal smears, 31 of the 80 participating women fell into one of 3 pathologic groups (15 monilial infection, 10 bacterial vaginosis, 6 trichomonial infection) and leaving 49 pathogen-free pregnant women. 10 of the pathogen-free pregnant women were excluded during the study because they did not complete the treatment period due to vaginal irritation such as itching or burning sensations. The diagnosis of each vaginal infection was made by specific pathologic findings. RESULT: Mean vaginal pH values for the pathology group decreased significantly from 4.9 to 4.2. Pathologic findings of each infection were also improved without specific treatment. Bacterial vaginosis disappeared in 80.0% (8/10) of patients. The specific pathogens of the remained two vaginitis types were not detected in 33.3% (5/15) of monilial infection and 33.3% (2/6) trichomonial infection 1 week after discontinuation of Vitamin-C vaginal tablets. Although it is not significant, mean vaginal pH values decreased from 4.4 to 4.2 in the pathogen-free pregnant women. CONCLUSION: Vitamin-C, when vaginally applied, is effective in lowering vaginal pH and in the treatment of vaginitis in pregnant women.