The characteristics and correlations of vaginal flora in women with cervical lesions / 中华肿瘤杂志

Objective: To explore the characteristics and correlations of vaginal flora in women with cervical lesions. Methods: A total of 132 women, including 41 women diagnosed with normal cervical (NC), 39 patients with low-grade cervical intraepithelial neoplasia (CIN 1), 37 patients with high-grade cervical intraepithelial neoplasia (CIN 2/3) and 15 patients with cervical squamous cell carcinoma (SCC), who came from the gynecological clinic of Second Hospital of Shanxi Medical University during January 2018 to June 2018, were enrolled in this study according to the inclusive and exclusive criteria strictly. The vaginal flora was detected by 16S rDNA sequencing technology. Co-occurrence network analysis was used to investigate the Spearman correlations between different genera of bacteria. Results: The dominant bacteria in NC, CIN 1 and CIN 2/3 groups were Lactobacillus [constituent ratios 79.4% (1 869 598/2 354 098), 63.6% (1 536 466/2 415 100) and 58.3% (1 342 896/2 301 536), respectively], while Peptophilus [20.4% (246 072/1 205 154) ] was the dominant bacteria in SCC group. With the aggravation of cervical lesions, the diversity of vaginal flora gradually increased (Shannon index: F=6.39, P=0.001; Simpson index: F=3.95, P=0.012). During the cervical lesion progress, the ratio of Lactobacillus gradually decreased, the ratio of other anaerobes such as Peptophilus, Sneathia, Prevotella and etc. gradually increased, and the differential bacteria (LDA score >3.5) gradually evolved from Lactobacillus to other anaerobes. The top 10 relative abundance bacteria, spearman correlation coefficient>0.4 and P<0.05 were selected. Co-occurrence network analysis showed that Prevotella, Peptophilus, Porphyrinomonas, Anaerococcus, Sneathia, Atopobium, Gardnerella and Streptococcus were positively correlated in different stages of cervical lesions, while Lactobacillus was negatively correlated with the above anaerobes. It was found that the relationship between vaginal floras in CIN 1 group was the most complex and only Peptophilus was significantly negatively correlated with Lactobacillus in SCC group. Conclusions: The increased diversity and changed correlations between vaginal floras are closely related to cervical lesions. Peptophilus is of great significance in the diagnosis, prediction and early warning of cervical carcinogenesis.

Lactobacilluscrispatus dominance in the vaginalmicrobiome reduces the occurrence of spontaneouspreterm birth in women with a short cervical length / Dominância de Lactobacillus crispatus no microbioma vaginal reduz a ocorrênciade parto prematuro espontâneo em mulheres com encurtamento do colo uterino

Introduction: The majority of pregnant women with a short cervix will deliver at term and, thus, may unnecessarily receive advanced monitoring and treatment. It is still necessary to define more accurately which sub-population of women with a short cervix is at elevated risk for early delivery. Objective: To determine if vaginal microbiome composition influenced the rate of spontaneous preterm birth in women with a short cervical length. Methods: In an exploratory, observational prospective study, vaginal secretions were obtained from 591 women at 21­24 week gestation. Vaginal microbiome composition was determined by analyzing the V1­V3 region of the bacterial 16S ribosomal RNA gene. Results: Lactobacillus crispatus was numerically dominant in the vagina in 41.7% of subjects, followed by L. iners in 32% and Gardnerella vaginalis in 12%. In women whose cervix was ≤25mm, the sensitivity to predict an spontaneous preterm birth was 11.8%. However, when L. crispatus was not the dominant vaginal bacterium, this sensitivity increased to 81.8%. Similarly, in women with a cervical length ≤30mm, the sensitivity to predict an spontaneous preterm birth increased from 21.7 to 78.3% when L. crispatus was not the dominant vaginal bacterium.In women with a prior spontaneous preterm birth and a cervix ≤25 or ≤30mm, L. crispatus dominance was also associated with a reduced rate of spontaneous preterm birth in the current pregnancy (p<0.001). Conclusion: In pregnant women with a cervix ≤25mm or ≤30mm, the risk for an spontaneous preterm birth is increased if L. crispatus is not dominant in the vagina.

Introdução: A maioria das mulheres grávidas com colo do útero curto dará à luz a termo e, portanto, pode receber desnecessariamente monitoramento e tratamento avançados. Permanece a necessidade de definir com mais precisão qual subpopulação de mulheres com colo do útero curto está em risco elevado de parto prematuro. Objetivo: Determinar se a composição do microbioma vaginal influenciou a taxa de parto prematuro espontâneo em mulheres com colo curto. Métodos: Em um estudo prospectivo exploratório observacional, os conteúdos vaginais foram obtidos de 591 mulheres com 21­24 semanas de gestação. A composição do microbioma vaginal foi determinada pela análise da região V1­V3 do gene de RNA ribossômico bacteriano 16S. Resultados: Lactobacilluscrispatus foi numericamente dominante na vagina em 41,7% dos indivíduos, seguido por L. iners em 32% e Gardnerella vaginalis em 12%. Em mulheres cujo colo do útero era <25 mm, a sensibilidade para prever uma taxa de parto prematuro espontâneo foi de 11,8%. No entanto, quando L. crispatus não era a bactéria vaginal dominante, essa sensibilidade aumentou para 81,8%. Da mesma forma, em mulheres com comprimento cervical <30 mm, a sensibilidade para prever uma taxa de parto prematuro espontâneo aumentou de 21,7 para 78,3% quando L. crispatus não era a bactéria vaginal dominante. Em mulheres com taxa de parto prematuro espontâneo anterior e colo do útero <25 ou <30 mm, a dominância de L. crispatus também foi associada a uma taxa reduzida de taxa de parto prematuro espontâneo na gravidez atual (p<0,001). Conclusão: Em mulheres grávidas com colo do útero <25 ou <30 mm, o risco de parto prematuro espontâneo é aumentado se L. crispatus não for dominante na vagina.

Association of genitourinary infections and cervical length with preterm childbirth

A prospective cohort study was conducted on a convenience sample of 1370 pregnant women with a gestational age of 20 to 25 weeks in the city of Ribeirão Preto. Data on obstetrical history, maternal age, parity, smoking habit, and a history of preterm delivery was collected with the application of a sociodemographic questionnaire. Cervical length was determined by endovaginal ultrasound, and urine and vaginal content samples were obtained to determine urinary tract infection (UTI) and bacterial vaginosis (BV), respectively. The aim of this study was to verify the association of cervical length and genitourinary infections with preterm birth (PTB). Ultrasound showed no association of UTI or BV with short cervical length. PTB rate was 9.63%. Among the women with PTB, 15 showed UTI (RR: 1.55, 95%CI: 0.93-2.58), 19 had BV (RR: 1.22, 95%CI: 0.77-1.94), and one had both UTI and BV (RR: 0.85, 95%CI: 0.13-5.62). Nineteen (14.4%) PTB occurred in women with a cervical length ≤2.5 cm (RR: 2.89, 95%CI: 1.89-4.43). Among the 75 patients with PTB stratified as spontaneous, 10 showed UTI (RR: 2.02, 95%CI: 1.05-3.86) and 14 had a diagnosis of BV (RR: 1.72, 95%CI: 0.97-3.04). A short cervical length between 20 and 25 weeks of pregnancy was associated with PTB, whereas UTI and BV determined at this age were not associated with short cervical length or with PTB, although UTI, even if asymptomatic, was related to spontaneous PTB.

What influence does vaginal microbiota have on human papillomavirus nfection? / Que influência a microbiota vaginal tem sobre a infecção por Papilomavírus humano?

Introduction: The human body is colonized by trillions of microbial cells, called the microbiota. The microbiome is defined as microbial cells and their genomes. Vaginal microbiota, especially lactic acid bacteria (mainly Lactobacillus sp.), seem to play a critical role in the prevention of various urogenital diseases such as bacterial vaginosis, fungal infections, sexually transmitted diseases, urinary tract infections, and human papillomaviridae (HPV) infections. Changes in the vaginal microbiome contribute to the development of precancerous cervical lesions. Objective: To evaluate studies associating the vaginal microbiota with HPV, including the risk and persistence of infection and evolution to squamous intraepithelial lesions of the cervix. Methods: A systematic review was conducted based on articles published between September 2011 and September 2019, using the following keyword combinations: "HPV [All Fields] AND "microbiota" [MeSH Terms] OR "microbiota" [All Fields] OR "microbiome" [All Fields])." The keyword search was performed in the MEDLINE, Latin American, and Caribbean Literature in Health Sciences (Lilacs), Cochrane Library, Highwire Stanford, and Embase databases. Results: In total, 239 original articles published between 2011 and 2019 were found in the researched databases on microbiome/microbiota and HPV. After exclusion, only six articles remained. Conclusion: There is a relationship between HPV and the cervicovaginal microbiota, but the mechanism of this influence cannot be specified.

Introdução: O corpo humano é colonizado por trilhões de células microbianas, denominadas microbiota. Microbioma é definida como células microbianas e seus genomas. A microbiota vaginal, especialmente as bactérias produtoras de ácido lático (principalmente Lactobacillus sp.), parece desempenhar um papel crítico na prevenção de várias doenças urogenitais, como a vaginose bacteriana, infecções fúngicas, doenças sexualmente transmissíveis, infecções do trato urinário e infecção pelo Papilomavírus humano (HPV). As alterações no microbioma vaginal parecem contribuir para o desenvolvimento de lesões cervicais pré-cancerosas. Objetivo: Avaliar estudos que associem a microbiota vaginal ao risco de infecção por HPV, sua persistência e evolução para lesões escamosas intraepiteliais do colo do útero. Métodos: Esta é uma revisão sistemática desenvolvida com base em artigos publicados entre setembro de 2011 e setembro de 2019, usando as seguintes combinações de palavras-chave: "HPV" [Todos os Campos] AND ("microbiota" [Termos MeSH] OU "microbiota" [Todos os Campos] OU "microbioma" [All Fields]) nas bases de dados MEDLINE, Latin American and Caribean Health Sciences Literature (Lilacs), Cochrane Library, Highwire Stanford e Embase. Resultados: Entre 2011 e 2019, foram encontrados 239 artigos originais nas bases de dados pesquisadas sobre microbioma/microbiota e HPV. Desse total, após o uso dos critérios de exclusão, restaram apenas seis artigos. Conclusão: Existe uma relação entre o HPV e a microbiota cervicovaginal, mas não foi possível especificar qual mecanismo está envolvido.

Prevalence of rectovaginal colonization by group B Streptococcus in pregnant women seen at prenatal care program of a health organization / Prevalência de colonização retovaginal por estreptococo do grupo B em gestantes de programa de atendimento pré-natal de instituição de saúde

ABSTRACT Objective To evaluate the prevalence of group B Streptococci in pregnant women of a corporate health program, as well as the epidemiological correlations. Methods This retrospective study used medical records of patients who participated of the prenatal care program at a private hospital in the city of São Paulo (SP), Brazil, from 2015 to 2016. Those who abandoned the program or had incomplete data in their medical records were excluded. Quantitative variables were described by means, standard deviations, median, minimal and maximal values. Parity and socioeconomic status were described by absolute frequency and percentages. We used logistic regression models in the software (SPSS) to analyze correlations of variables according to vaginal-rectal culture, considering a 95%CI and p-values. Variables were age, number of pregnancies, weight gain in pregnancy and gestational age at delivery. Results A total of 347 medical records were included, and after applying the exclusion criteria, 287 medical records composed the final sample. Patients' age ranged between 17 and 44 years. Mean age was 30.6 years, 67 patients had positive result for group B Streptococcus (prevalence of 23.3%; 95%CI: 18.7-28.5). Conclusion Considering the high prevalence of group B Streptococcus in our service, the antibiotic prophylaxis strategy based on rectovaginal culture screening approach seems to be cost-effective.

RESUMO Objetivo Identificar a prevalência de estreptococo do grupo B entre gestantes que frequentaram um programa de saúde corporativa, bem como as correlações com a colonização positiva. Métodos Estudo retrospectivo dos prontuários do pré-natal de um hospital privado em São Paulo, no período de 2015 a 2016. Foram excluídas as mulheres que abandonaram o programa ou apresentavam dados incompletos nos prontuários. As variáveis quantitativas foram descritas por média, desvios padrão, mediana, valores mínimos e máximos. A paridade e a condição socioeconômica foram descritos por frequência absoluta e percentagens. Utilizamos modelos de regressão logística no programa (SPSS) para analisar as correlações de variáveis de acordo com a cultura retovaginal, considerando IC95% e valores de p. As variáveis foram idade, número de gestações, peso ganho na gestação e idade gestacional no parto. Resultados Foram incluídos 347 prontuários e, após a aplicação dos critérios de exclusão, 287 prontuários compuseram a amostra final. A idade dos pacientes variou entre 17 e 44 anos. A média de idade foi de 30,6 anos, e 67 pacientes tiveram resultado positivo para o estreptococo do grupo B (prevalência de 23,3%; IC95%: 18,7-28,5). Conclusão Considerando a alta prevalência de estreptococos do grupo B em nosso serviço, existem evidências de que a estratégia de antibiótico profilaxia baseada na cultura retovaginal é custo-efetiva.

Antibiotic susceptibility patterns and prevalence of streptococcus agalactiae rectovaginal colonization among pregnant women in iran

Abstract Objective Streptococcus agalactiae is an important pathogen in neonates and pregnant women. Neonatal invasive infections due to S. agalactiae are life-threatening and preventive strategies for this challenge of human have become a concern. The aim of the present study was to determine the prevalence of rectovaginal colonization, related risk factors and antibiotic resistance pattern of S. agalactiae among pregnant women in Iran. Methods The present study was performed on 240 pregnant women. Vaginal and rectal swabs were obtained from all of the women and then were transferred to the laboratory. The isolation and identification of S. agalactiae was performed by standard microbiological tests and polymerase chain reaction (PCR) assay. The antimicrobial susceptibility patterns of the isolates were determined by the Kirby-Bauer disk diffusion. Polymerase chain reaction was used to detect ermB and mefA genes in erythromycin-nonsusceptible isolates. Results Out of 240 pregnant women, 16 cases (6.7%) were colonized by S. agalactiae. There is no significant association between demographic-obstetric factors and maternal S. agalactiae colonization in the pregnant women. Linezolid, vancomycin and ampicillin were the most effective antibiotics against S. agalactiae. The ermB gene was present in 6 (35.29%) S. agalactiae isolates. However, the mefA gene was not detected in any of the isolates. Conclusion Given the relatively significant prevalence of S. agalactiae colonization in the pregnant women in the present study and the risk of serious neonatal infections, the screening of pregnant mothers for the bacteria seems necessary. Our findings highlight the importance of appropriate antibiotic prophylaxis during pregnancy for the prevention of early onset S. agalactiae-neonatal infection and comorbidity.

Reactional changes in short-term levonorgestrel-releasing intrauterine system (lng-ius) use

SUMMARY OBJECTIVE: To evaluate endocervical and vaginal environment changes in women using a levonorgestrel-releasing intrauterine system (LNG-IUS). METHODS: A quasi-experimental study included sixty women who had an LNG-IUS inserted in the Family Planning Clinic of UNICAMP between April and November of 2016. Women in reproductive age, non-pregnant, without the use of antibiotics and contraceptives seeking for LNG-IUS insertion were selected for this study. All women were evaluated with regard to vaginal and endocervical pH, vaginal and endocervical Gram-stained bacterioscopy, and Pap-smear before and two months after LNG-IUS insertion. Clinical aspects such as cervical mucus, vaginal discharge, and cervical ectopy were also observed. RESULTS: After LNG-IUS insertion, there was an increase in the following parameters: endocervical pH>4.5 (p=0.02), endocervical neutrophil amount (p<0.0001), vaginal cytolysis (p=0.04). There was a decrease in vaginal discharge (p=0.01). No statistically significant changes were found in vaginal pH, neutrophils amount in the vaginal mucosa, vaginal discharge appearance, vaginal candidiasis, bacterial vaginosis, vaginal coccobacillary microbiota, cervical mucus appearance, or cervical ectopy size. CONCLUSIONS: Short-term LNG-IUS use did not increase vulvovaginal candidiasis or bacterial vaginosis, and led to diminished vaginal discharge. Notwithstanding, this device promoted reactional changes in the vaginal and endocervical environment, without modification on cervical ectopy size.

RESUMO OBJETIVO: Avaliar as alterações do ambiente endocervical e vaginal em mulheres usuárias de sistema intrauterino liberador de levonorgestrel (SIU-LNG). MÉTODOS: Um estudo quase-experimental incluiu 60 mulheres que inseriram o SIU-LNG na Clínica de Planejamento Familiar da UNICAMP entre abril e novembro de 2016. Mulheres em idade reprodutiva, não gestantes, sem uso de antibióticos e contraceptivos, em busca pela inserção do SIU-LNG, foram selecionadas para este estudo. Todas as mulheres foram avaliadas quanto ao pH vaginal e endocervical, bacterioscopia vaginal e endocervical por coloração de Gram, exame de Papanicolau antes e dois meses após a inserção de SIU-LNG. Aspectos clínicos como muco cervical, corrimento vaginal e ectopia cervical também foram observados. RESULTADOS: Após a inserção do SIU-LNG houve aumento nos seguintes parâmetros: pH endocervical >4,5 (p=0,02), quantidade de neutrófilos endocervicais (p<0,0001), citolise vaginal (p=0,04). Houve diminuição do conteúdo vaginal (p=0,01). Não foram encontradas alterações estatisticamente significativas no pH vaginal, na quantidade de neutrófilos na mucosa vaginal, apecto do corrimento vaginal, candidíase vaginal, vaginose bacteriana, microbiota cocobacilar vaginal, aparência de muco cervical ou tamanho da ectopia cervical. CONCLUSÃO: O uso do SIU-LNG em curto prazo não aumentou a candidíase vulvovaginal ou a vaginose bacteriana, levou à diminuição do conteúdo vaginal. No entanto, este dispositivo promoveu mudanças reacionais no ambiente vaginal e endocervical, sem modificação no tamanho da ectopia cervical.

Cribado de infecciones cervicales de transmisión sexual en mujeres embarazadas y su relación con la microbiota vaginal / Screening of cervical sexually transmitted infections in pregnant women and the relation with the vaginal microbiota

Resumen Introducción: La mujer embarazada está expuesta anumerosas infecciones de transmisión sexual (ITS), las que pueden producir aborto, enfermedad en el feto y/o en el recién nacido, además de alteraciones en el curso normal del embarazo. Objetivo: Realizar tamizaje de infección cervical asintomática en mujeres embarazadas y su relación con la microbiota. Pacientes y Métodos: Se enrolaron 85 mujeres embarazadas sin cervicitis clínica que consultaron en control de rutina de embarazo (47 pacientes) o que fueron derivadas a una unidad de ITS (38 pacientes). Se tomaron muestras de fondo de saco vaginal, que fueron analizadas por técnicas clásicas de microscopía y cultivo corriente y reacción de polimerasa en cadena para Neisseria gonorrhoeae, Trichomonas vaginalis y Chlamydia trachomatis. Resultados: Se encontró 12,9% de infección por C. trachomatis, 2,4% de T. vaginalis. En este estudio no se encontró N. gonorrhoeae. El 23,3% de pacientes con microbiota alterada (vaginosis bacteriana y microbiota intermedia) fue positiva para C. trachomatis. Conclusión: En este trabajo, encontramos una alta frecuencia de infección por C. trachomatis, que se relaciona en forma significativa con la presencia de microbiota alterada. Esta alta frecuencia debería promover estrategias preventivas en los controles de salud de la mujer embarazada.

Background: Pregnant woman is exposed to many sexual transmitted infections (STI). Many of these infections may produce diseases in the fetus and newborn, and also alteration in the normal course of the pregnancy. Aim: Screening of asymptomatic cervical infection in pregnant woman and its relationship with the vaginal microbiota. Patients and Methods: 85 pregnant women without clinical cervicitis who consult in the routine pregnant control (47 patients) and women derived from STI service (38 patients). The samples were obtained from the vaginal fund sac and were analyzed with optic microscopy, cultures and PCR of Neisseria gonorrhoeae, Trichomonas vaginalis and Chlamydia trachomatis. Results: 12,9% of the enrolled women were positive for C. trachomatis, 2,4% for T. vaginalis. In this study, we did not found N. gonorrhoeae. We observed 23,3% of patients with altered microbiota (bacterial vaginosis and intermediate microbiota) was positive for C. trachomatis. Conclusions: In this study, we found a high frequency of C. trachomatis infection, that correlates with the presence of altered microbiota. This high frequency would promote preventive strategies in the pregnant women routine controls.

Intervención educativa para incrementar el nivel de conocimientos sobre infección vaginal en gestantes / Intervenção educativa para aumentar o nível de conhecimento sobre a infecção vaginal em mulheres grávidas / Educational intervention to increase the level of knowledge about vaginal infection in pregnant women

Introducción: las infecciones vaginales afectan a mujeres de todas las edades, que en su mayoría han presentado la enfermedad en algún momento de su vida, no se refieren diferencias en relación con la raza u origen étnico. Objetivo: diseñar una intervención educativa que permita incrementar el nivel de conocimientos sobre infección vaginal en gestantes del consultorio médico "El Gremio No. 1", municipio Baracoa, Guantánamo, en el período de octubre de 2015 a mayo de 2017. Método: se realizó un estudio pre-experimental de intervención educativa en una muestra no probabilística intencionada de 16 gestantes. El estudio se realizó en tres etapas: etapa de diagnóstico, etapa de intervención y etapa de evaluación. El dato primario se obtuvo de la encuesta aplicada antes y después de la intervención. Los resultados se presentaron en tablas de contingencia y la medida de resumen el porcentaje. Se utilizó el porciento de variación para medir la efectividad de la intervención. Resultados: antes de la intervención se evidenció bajo conocimiento sobre los tipos de infección vaginal, factores de riesgos y métodos de prevención de la infección vaginal en el embarazo y aplicación de la técnica del aseo y el uso de agua hervida. El estudio permitió incrementar el nivel de conocimientos acerca de la infección vaginal después de la intervención. Conclusiones: se incrementó el nivel de conocimiento, aspecto que demuestra la efectividad de la propuesta de inter vención(AU)

Introduction: vaginal infections affect women of all ages, who have mostly presented the disease at some point in their lives; no differences are related to race or ethnic origin. Objective: to design an educational intervention that increase the level of knowledge about vaginal infection in pregnant women of the medical office "El Gremio No. 1", Baracoa, Guantanamo, from October 2015 to May 2017. Method: it was carried out a pre-experimental study of educational intervention in an intentional non-probabilistic sample of 16 pregnant women. The study was carried out in three stages: diagnostic stage, intervention stage and evaluation stage. The primary data was obtained from the survey applied before and after the intervention. The results were presented in contingency tables and the summary measure the percentage. The variation percentage was used to measure the effectiveness of the intervention. Results: before the intervention, there was evident knowledge about the types of vaginal infection, risk factors and methods of prevention of vaginal infection in pregnancy and application of the technique of cleanliness and the use of boiled water. The study permited to increase the level of knowledge about the infection after the intervention. Conclusions: the level of knowledge was increased, an aspect that demonstrates the effectiveness of the intervention proposal(AU)

Introdução: as infecções vaginais afetam mulheres de todas as idades, que em sua maioria apresentam a doença em algum momento de suas vidas, não havendo diferenças relacionadas à raça ou origem étnica. Objetivo: projetar uma intervenção educacional para aumentar o nível de conhecimento sobre a infecção vaginal no escritório do doutor generalista "El Gremio No. 1", município Baracoa, Guantanamo, no período de outubro de 2015 até maio de 2017. Método: foi realizado um estudo pré-experimental de intervenção educativa em uma amostra intencional não probabilística de 16 gestantes. O estudo foi realizado em três etapas: estágio de diagnóstico, estágio de intervenção e estágio de avaliação. Os dados primários foram obtidos a partir do inquérito aplicado antes e após a intervenção. Os resultados foram apresentados em tabelas de contingência e o resumo mede a porcentagem. A porcentagem de variação foi usada para medir a eficácia da intervenção. Resultados: antes da intervenção, não havia conhecimento evidente sobre os tipos de infecção vaginal, fatores de risco e métodos de prevenção da infecção vaginal na gravidez e aplicação da técnica de limpeza e uso de água fervida. O estudo permitiu aumentar o nível de conhecimento sobre a infecção após a intervenção. Conclusões: o nível de conhecimento foi aumentado, aspecto que demonstra a efetividade da proposta de intervenção(AU)

Prevalence of bacterial vaginosis and factors associated among women who have sex with women / Prevalência de vaginose bacteriana e fatores associados em mulheres que fazem sexo com mulheres / Prevalencia de vaginosis bacteriana y factores asociados en mujeres que tienen sexo con mujeres

ABSTRACT Objective: to describe the prevalence of bacterial vaginosis and factors associated among women who have sex with women. Method: cross-sectional, descriptive and analytical study with 150 women. The vaginal microbiota profile was analyzed by microscopic examination of vaginal swabs according to the Gram method. Endocervical samples were collected with cytobrush for the investigation of endocervicitis by Chlamydia trachomatis. The polymerase chain reaction was used to diagnosis Human Papillomavirus infection. Socio-demographic data, sexual behavior and clinical history were obtained through an interview. Logistic regression was performed to identify risk factors independently associated with bacterial vaginosis. Results: among the 150 participants, 71 (47.3%) presented some alteration in the vaginal microbiota, 54 (36.0%) bacterial vaginosis and 12 (8.0%) Flora II. The variable independently associated with bacterial vaginosis was the use of sexual accessories [2.37(1.13-4.97), p=0.022]. Conclusion: the high prevalence of bacterial vaginosis among women who have sex with women indicates the need for screening this population and association between use of sexual accessories and this disease suggests the possibility of transmission of sexual fluids between the partners during the sexual act, which demonstrates the need for educational actions on sexual and reproductive health.

RESUMO Objetivo: descrever a prevalência de vaginose bacteriana e fatores associados em mulheres que fazem sexo com mulheres. Método: trata-se de estudo transversal, descritivo e analítico com 150 mulheres. O padrão de microbiota vaginal foi analisado por microscopia do conteúdo vaginal corado pelo método de Gram. Amostras de secreção endocervical foram coletadas com cytobrush para a pesquisa de endocervicites por Chlamydia trachomatis e para infecção por Papilomavírus Humano por meio de reação em cadeia da polimerase. Dados sociodemográficos, de comportamento sexual e de história clínica foram obtidos por entrevista. Regressão logística foi realizada para identificar fatores de risco independentemente associados à vaginose bacteriana. Resultados: dentre as 150 participantes, 71 (47,3%) tinham alguma alteração da microbiota vaginal, 54 (36,0%) vaginose bacteriana e 12 (8,0%) Flora II. A variável independentemente associada com vaginose bacteriana foi o uso de acessórios sexuais [2,37(1,13-4,97), p=0,022]. Conclusão: a elevada prevalência de vaginose bacteriana entre mulheres que fazem sexo com mulheres aponta a necessidade de rastreio nessa população. O uso de acessórios sexuais associado a esse agravo sugere a possibilidade de transmissão de fluidos sexuais entre as parceiras durante o ato sexual, o que demonstra necessidade de ações de educação em saúde sexual e reprodutiva.

RESUMEN Objetivo: describir la prevalencia de la vaginosis bacteriana y los factores asociados en mujeres que tienen sexo con mujeres. Método: se trata de un estudio transversal, descriptivo y analítico realizado entre 150 mujeres. El patrón de microbiota vaginal se analizó por microscopía del contenido vaginal teñido por el método de Gram. Se recolectaron muestras de secreción endocervical con un citocepillo para investigar la endocervicitis por Chlamydia trachomatis y la infección por el Virus del Papiloma Humano mediante la reacción en cadena de la polimerasa. De la entrevista se obtuvieron datos sociodemográficos, de comportamiento sexual y del historial clínico. Se llevó a cabo una regresión logística para identificar factores de riesgo asociados independientemente a la vaginosis bacteriana. Resultados: entre las 150 participantes, el 71 (47,3%) tenía alteración de la microbiota vaginal, el 54 (36,0%), vaginosis bacteriana y el 12 (8,0%), Flora II. La variable asociada independientemente a la vaginosis bacteriana se debió al uso de accesorios sexuales [2,37(1,13-4,97), p=0,022]. Conclusión: la prevalencia elevada de vaginosis bacteriana entre mujeres que tienen sexo con mujeres señala la necesidad de estudiar dicha población, y el uso de accesorios sexuales asociado a este agravante sugiere la posibilidad de transmisión de fluidos sexuales entre las compañeras durante el acto sexual, razón por la cual deben llevarse a cabo acciones de educación en salud sexual y reproductiva.

Assessment of cow and farm level risk factors associated with Ureaplasma diversum in pasture-based dairy systems - A field study

ABSTRACT Potential risk factors for Ureaplasma diversum in the vaginal mucus of 1,238 dairy cows were included in a multivariate logistic regression model, based on the cow level (i.e., granular vulvovaginitis [+GVV], yearly milk production [4500 kg or more], pregnancy, predominance of Bos taurus [+Bos Taurus], score of corporal condition [at least 2.5], concomitant positivity for Escherichia coli [+E.coli]), and farm level i.e., milking room hygiene (-Milking room), dunghill location, and replacement female). Ureaplasma diversum was present in 41.1% of the samples. Independent risk factors for U. diversum were +GVV (odds ratio [OR], 1.31); +Mycoplasma spp (OR, 5.67); yearly milk production (4500 kg or more) (OR, 1.99); +Bos taurus (OR, 1.68); +E. coli (OR, 4.96); -milking room (OR, 2.31); and replacement females (OR, 1.89). Ureaplasma diversum vaginal colonization was strongly associated with Mycoplasma spp., E. coli, and number of pregnant cows.

Molecular characterization of ureaplasmas isolated from reproductive tract of goats and sheep from Brazil

Abstract Ovine/caprine ureaplasmas have not yet been assigned a species designation, but they have been classified into nine serotypes. Herein ureaplasmas were searched for in 120 samples of vulvo vaginal mucous from sheep and 98 samples from goats at 17 farms. In addition, semen samples were collected from 11 sheep and 23 goats. The recovered ureaplasma were from sheep and goats from animals without any reproductive disorder symptoms, but not all animals presented positive cultures. In sheep, 17 (68%) cultures of vulvovaginal mucous were positive for ureaplasma and 11 (27%) samples of semen presented positive cultures in animals with clinical signs of orchitis, balanoposthitis or low sperm motility. In goats four ureaplasma isolates were obtained from vulvovaginal mucus, but the semen samples were all negative. The isolates were submitted to Pulsed-field gel electrophoresis methodology and their 16S rRNA genes were sequenced. Fifty percent of ureaplasma recovered from sheep allowed for PFGE typing. Eleven isolates showed eight profiles genetically close to the bovine ureaplasmas. The 16S rRNA gene sequencing showed differences or similarities of isolates from sheep and goats, and the reference strains of bovine and human ureaplasma. Four clinical isolates from sheep were grouped separately. The studied ureaplasma isolates showed to be a diverse group of mollicutes.

Can the Pessary Use Modify the Vaginal Microbiological Flora? A Cross-sectional Study / O uso de pessário vaginal pode alterar a flora microbiológica? Um estudo transversal

Abstract Introduction Vaginal pessary is used as a conservative treatment for pelvic organ prolapse (POP). Some studies have shown that common complaints of its use may include vaginal discomfort and increased vaginal discharge. Scant information is available about the microflora status after using this device. Objective To determine if the usage of vaginal pessary can interfere with the vaginal environment. Methods A cross-sectional study was performed from March of 2014 to July of 2015 including 90 women with POP. The study group was composed of 45 women users of vaginal pessary and 45 nom-users. All enrolled women answered a standardized questionnaire and were subjected to a gynecological exam to collect vaginal samples for microbiological evaluation under optic microscopy. Clinical and microbiological data were compared between study and control groups. Results Vaginal discharge was confirmed in 84% of the study group versus 62.2% in the control group (p< 0.01); itching was reported in 20 and 2.2%, respectively (p< .05); genital ulcers were only found in the pessary group (20%). There was no difference with regard to the type of vaginal flora. Bacterial vaginosis was prevalent in the study group (31.1% study group versus 22.2% control group), (p=.34). Conclusion Women using vaginal pessaries for POP treatment presented more vaginal discharge, itching and genital ulcers than non-users.

Resumo Introdução O pessário vaginal é utilizado como tratamento conservador para o prolapso de órgãos pélvicos (POP). Alguns estudos demonstraram que as queixas mais comuns do seu uso são o desconforto vaginal e um aumento do fluxo vaginal. As informações são escassas a respeito do que ocorre com a microflora vaginal após o uso do pessário. Objetivo Determinar se o uso do pessário pode interferir com o ambiente vaginal. Métodos Um estudo transversal realizado de março de 2014 a julho de 2015 com 90 mulheres com POP; metade delas usaram pessário e a outra metade permaneceu como grupo controle. Todas preencheram um questionário e realizaram exame ginecológico para coleta de amostras vaginais para análise microbiológica. Dados clínicos e microbiológicos foram comparados entre os grupos de estudo e de controle. Resultados O fluxo vaginal foi confirmado em 84% das mulheres do grupo de estudo versus 62,2% do grupo de controle (p< 0,01); prurido foi encontrado em 20 e 2,2%, respectivamente (p< 0,05). As úlceras genitais foram somente encontradas no grupo pessário (20%). Não houve diferenças com relação ao tipo de flora vaginal. A vaginose bacteriana fora encontrada em 31,1% das mulheres do grupo de estudo versus 22,2% do grupo de controle (p= 0,34). Conclusão Mulheres usando pessários vaginais para tratamento do POP apresentaram maior fluxo vaginal, prurido e úlcera genital do que as não usuárias do dispositivo.

Group B Streptococcus detection in pregnant women via culture and PCR methods

Abstract INTRODUCTION: Group B Streptococcus (GBS), a source of neonatal infection, colonizes the gastrointestinal and genitourinary tracts of pregnant women. Routine screening for maternal GBS in late pregnancy and consequent intrapartum antibiotic prophylaxis have reduced the incidence of early-onset GBS neonatal infection. The aim of this study was to evaluate the performance of PCR, compared to culture (gold standard), in GBS colonization screening of pregnant women, and to establish the prevalence of GBS colonization among this population. METHODS: Vaginal introitus and perianal samples were collected from 204 pregnant women, between the 35th and 37th weeks of pregnancy, at the Obstetrics and Gynecology Unit of the University of Caxias do Sul General Hospital between June 2008 and September 2009. All samples were cultured after enrichment in a selective medium and then assayed by culture and PCR methods. RESULTS: The culture and PCR methods yielded detection rates of vaginal/perianal GBS colonization of 22.5% and 26%, respectively (sensitivity 100%; specificity 95.6%; positive and negative predictive values 86.8% and 100%, respectively). A higher prevalence of GBS colonization was detected in the combined vaginal and perianal samples by both culture and PCR assay analyses. CONCLUSIONS: PCR is a faster and more efficient method for GBS screening, allowing for optimal identification of women who should receive intrapartum antibiotic prophylaxis to prevent newborn infection.

Species distribution and antifungal susceptibility patterns of Candida isolates from a public tertiary teaching hospital in the Eastern Cape Province, South Africa

Candida species are the leading cause of invasive fungal infections, and over the past decade there has been an increased isolation of drug resistant Candida species. This study aimed to identify the species distribution of Candida isolates and to determine their unique antifungal susceptibility and resistance patterns. During a cross-sectional study, 209 Candida isolates (recovered from 206 clinical samples) were collected and their species distribution was determined using ChromAgar Candida. The Vitek-2 system (Biomerieux, South Africa) was used to determine minimum inhibitory concentrations (MICs) to azoles (fluconazole, voriconazole), echinocandins (caspofungin, micafungin), polyenes (amphotericin B) and flucytosine. Four species of Candida were isolated, of which C. albicans was the most frequent, isolated in 45.4% (95/209) of the isolates, followed by C. glabrata: 31.1% (65/209). The MICs of the different antifungal drugs varied amongst the species of Candida. From the 130 isolates tested for MICs, 90.77% (112/130) were susceptible to all antifungal drugs and 6.9% (9/130) of the isolates were multi-drug resistant. C. dubliniensis (n=2) isolates were susceptible to all the above mentioned antifungal drugs. There was no significant difference in species distribution amongst clinical specimens and between patients' genders (P>0.05). An increase in MIC values for fluconazole and flucytosine towards the resistance range was observed. To our knowledge, this is the first report on surveillance of Candida species distribution and antifungal susceptibility at a public tertiary teaching hospital in Eastern Cape, South Africa.

Identification of Vaginal Fluid Using Microbial Signatures / 法医学杂志

OBJECTIVES@#To investigate the specific microbial signatures in vaginal fluid.@*METHODS@#Vaginal fluid （16 samples）, saliva （16 samples）, feces （16 samples）, semen （8 samples）, peripheral blood （8 samples）, urine （5 samples）, and nasal secretion （4 samples） were collected respectively. The 16S rRNA genes of Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus jensenii, Lactobacillus iners, and Atopobium vaginae were amplified. PCR production was detected via a 3130xl Genetic Analyzer.@*RESULTS@#The detected number of Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus jensenii, Lactobacillus iners, and Atopobium vaginae were 15, 5, 8, 14, and 3 in all vaginal fluid samples, respectively. Lactobacillus crispatus and Lactobacillus jensenii existed specifically in vaginal fluid.@*CONCLUSIONS@#There is a potential application value to detect Lactobacillus crispatus and Lactobacillus jensenii for the identification of vaginal fluid.

Analysis of the Vaginal Microbiome by Next-Generation Sequencing and Evaluation of its Performance as a Clinical Diagnostic Tool in Vaginitis

BACKGROUND: Next-generation sequencing (NGS) can detect many more microorganisms of a microbiome than traditional methods. This study aimed to analyze the vaginal microbiomes of Korean women by using NGS that included bacteria and other microorganisms. The NGS results were compared with the results of other assays, and NGS was evaluated for its feasibility for predicting vaginitis. METHODS: In total, 89 vaginal swab specimens were collected. Microscopic examinations of Gram staining and microbiological cultures were conducted on 67 specimens. NGS was performed with GS junior system on all of the vaginal specimens for the 16S rRNA, internal transcribed spacer (ITS), and Tvk genes to detect bacteria, fungi, and Trichomonas vaginalis. In addition, DNA probe assays of the Candida spp., Gardnerella vaginalis, and Trichomonas vaginalis were performed. Various predictors of diversity that were obtained from the NGS data were analyzed to predict vaginitis. RESULTS: ITS sequences were obtained in most of the specimens (56.2%). The compositions of the intermediate and vaginitis Nugent score groups were similar to each other but differed from the composition of the normal score group. The fraction of the Lactobacillus spp. showed the highest area under the curve value (0.8559) in ROC curve analysis. The NGS and DNA probe assay results showed good agreement (range, 86.2-89.7%). CONCLUSIONS: Fungi as well as bacteria should be considered for the investigation of vaginal microbiome. The intermediate and vaginitis Nugent score groups were indistinguishable in NGS. NGS is a promising diagnostic tool of the vaginal microbiome and vaginitis, although some problems need to be resolved.

Bacterial vaginosis in pregnant adolescents: proinflammatory cytokine and bacterial sialidase profile. Cross-sectional study / Vaginose bacteriana em gestantes adolescentes: perfil de citocinas proinflamatórias e sialidases bacterianas. Estudo transversal

ABSTRACT CONTEXT AND OBJECTIVE: Bacterial vaginosis occurs frequently in pregnancy and increases susceptibility to sexually transmitted infections (STI). Considering that adolescents are disproportionally affected by STI, the aim of this study was to evaluate the cervicovaginal levels of interleukin (IL)-1 beta, IL-6, IL-8 and bacterial sialidase in pregnant adolescents with bacterial vaginosis. DESIGN AND SETTING: Cross-sectional study at mother and child referral units in Belém, Pará, Brazil. METHODS: Vaginal samples from 168 pregnant adolescents enrolled were tested for trichomoniasis and candidiasis. Their vaginal microbiota was classified according to the Nugent criteria (1991) as normal, intermediate or bacterial vaginosis. Cervical infection due to Chlamydia trachomatisand Neisseria gonorrhoeae was also assessed. Cytokine and sialidase levels were measured, respectively, using enzyme-linked immunosorbent assays and MUAN conversion in cervicovaginal lavages. Forty-eight adolescents (28.6%) were excluded because they tested positive for some of the infections investigated. The remaining 120 adolescents were grouped according to vaginal flora type: normal (n = 68) or bacterial vaginosis (n = 52). Their cytokine and sialidase levels were compared between the groups using the Mann-Whitney test (P < 0.05). RESULTS: The pregnant adolescents with bacterial vaginosis had higher levels of IL-1 beta, IL-6 and IL-8 (P < 0.05). Sialidase was solely detected in 35 adolescents (67.2%) with bacterial vaginosis. CONCLUSIONS: Not only IL-1 beta and sialidase levels, but also IL-6 and IL-8 levels are higher in pregnant adolescents with bacterial vaginosis, thus indicating that this condition elicits a more pronounced inflammatory response in this population, which potentially increases vulnerability to STI acquisition.

RESUMO CONTEXTO E OBJETIVO: A vaginose bacteriana é uma condição, comum em gestantes, que aumenta a susceptibilidade a infecções sexualmente transmissíveis (IST). Considerando que adolescentes são desproporcionalmente afetadas por IST, o objetivo deste estudo foi avaliar os níveis cervicovaginais de interleucina (IL)-1 beta, IL-6, IL-8 e sialidases bacterianas em gestantes adolescentes com vaginose bacteriana. DESENHO DO ESTUDO E LOCAL: Estudo transversal em Unidade de Referência Materno Infantil (UREMIA), Belém, Pará, Brasil. MÉTODOS: Amostras vaginais das 168 gestantes adolescentes incluídas foram testadas para tricomoníase e candidíase e a microbiota vaginal foi classificada em normal, intermediária e vaginose bacteriana, segundo os critérios de Nugent (1991). Infecções cervicais por Chlamydia trachomatis eNeisseria gonorrhoeae também foram avaliadas. Os níveis de citocinas e sialidades foram quantificados, respectivamente, por método imunoenzimático e pela conversão do MUAN nos lavados cervicovaginais. Foram excluídas 48 (28,6%) adolescentes positivas para alguma das infecções investigadas. As 120 gestantes remanescentes foram agrupadas de acordo com o padrão de flora vaginal em: normal (n = 68) e vaginose bacteriana (n = 52). Níveis de citocinas e sialidases foram comparados pelo teste de Mann-Whitney, P < 0,05. RESULTADOS: As gestantes adolescentes com vaginose bacteriana entre os grupos apresentaram níveis aumentados de IL-1 beta, IL-6 and IL-8 (P < 0,05). Sialidases foram exclusivamente detectadas em 35 (67,2%) adolescentes com vaginose bacteriana. CONCLUSÕES: Não apenas a IL-1 beta e as sialidases estão aumentadas em gestantes adolescentes com vaginose bacteriana, mas também IL-6 e IL-8, indicando resposta inflamatória mais pronunciada dessa alteração de microbiota nesta população, potencializando a vulnerabilidade à aquisição de IST.

Secreção vaginal anormal: Sensibilidade, especificidade e concordância entre o diagnóstico clínico e citológico / Abnormal vaginal secretion: sensitivity, specificity and concordance between clinical and cytological diagnosis

OBJETIVOS: Estimar a prevalência da vaginose bacteriana (VB), candidíase e tricomoníase e comparar os achados do exame físico da secreção vaginal com o diagnóstico microbiológico, obtido pelo estudo citológico do esfregaço vaginal, pelo do método de Papanicolaou. MÉTODOS: Estudo de corte transversal que incluiu 302 mulheres com idade entre 20 a 87 anos, submetidas à entrevista e exame ginecológico para avaliação da secreção vaginal e coleta de esfregaço citológico, no período de junho de 2012 a maio de 2013. Para avaliar a acurácia das características da secreção vaginal em relação ao diagnóstico microbiológico do esfregaço citológico foi empregado as análises de sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN), com seus respectivos IC95%. Para avaliar o grau de concordância entre as características clínicas da secreção vaginal e os achados microbiológicos no exame citológico, foi aplicado o índice kappa (k). RESULTADOS: A prevalência da VB, candidíase e tricomoníase foi de 25,5, 9,3 e 2,0%, respectivamente. A sensibilidade, especificidade, valor o VPP e o VPN das características clínicas da secreção vaginal para o diagnóstico citológico de VB foram de 74, 78,6, 54,3, e 89,9%, respectivamente. A sensibilidade, a especificidade, o VPP e o VPN das características clínicas da secreção vaginal para o diagnóstico citológico de candidíase foram de 46,4, 86,2, 25,5 e de 94%, respectivamente. O grau de concordância entre a avaliação clínica da secreção vaginal e o diagnóstico microbiológico de VB, candidíase e tricomoníase, avaliados pelo índice kappa foi de 0,47, 0,23 e 0,28, respectivamente. CONCLUSÃO: A causa mais frequente de secreção vaginal anormal foi VB. A avaliação clínica da secreção vaginal apresentou sensibilidade, VPP e grau de concordância moderado a fraco, comparado ao diagnóstico microbiológico, o que indica a necessidade de avaliação complementar do achado clínico de secreção vaginal anormal. .

PURPOSE: To estimate the prevalence of bacterial vaginosis (BV), candidiasis and trichomoniasis and compare the findings of physical examination of the vaginal secretion with the microbiological diagnosis obtained by cytology study of a vaginal smear using the Papanicolaou method. METHODS: A cross-sectional study of 302 women aged 20 to 87 years, interviewed and submitted to a gynecology test for the evaluation of vaginal secretion and collection of a cytology smear, from June 2012 to May 2013. Sensitivity analyses were carried out and specificity, positive predictive value (PPV) and negative predictive value (NPV) with their respective 95%CI were determined to assess the accuracy of the characteristics of vaginal secretion in relation to the microbiological diagnosis of the cytology smear . The kappa index (k) was used to assess the degree of agreement between the clinical features of vaginal secretion and the microbiological findings obtained by cytology. RESULTS The prevalence of BV, candidiasis and trichomoniasis was 25.5, 9.3 and 2.0%, respectively. The sensitivity, specificity, PPV and NPV of the clinical characteristics of vaginal secretion for the cytological diagnosis of BV were 74, 78.6, 54.3 and 89.9%, respectively. The sensitivity, specificity, PPV and the NPV of the clinical characteristics of vaginal secretion for the cytological diagnosis of candidiasis were 46.4, 86.2, 25.5 and 94%, respectively. The correlation between the clinical evaluation of vaginal secretion and the microbiological diagnosis of BV, candidiasis and trichomoniasis, assessed by the kappa index, was 0.47, 0.23 and 0.28, respectively. CONCLUSION The most common cause of abnormal vaginal secretion was BV. The clinical evaluation of vaginal secretion presented amoderate to weak agreement with the microbiological diagnosis, indicating the need for complementary investigation of the clinical findings of abnormal vaginal secretion. .