Objectives: To perform a comprehensive inventory of the number of samples, performance characteristics, and quality assurance of the laboratory diagnosis of Neisseria gonorrhoeae at five laboratories in St Petersburg and Leningradskaya Oblast, Russia, in 2004, and to recommend optimisations for an increased adherence to international evidence based recommendations of diagnostics. Methods: Surveillance data were obtained with questionnaire and site visits. For evaluation of the culture media utilised at the laboratories, N gonorrhoeae reference strains (n = 29) were used. Results: During 2004 the total numbers of N gonorrhoeae samples analysed at the five laboratories using microscopy of stained smears and culturing were 330 879 (407 positive) and 38 020 (420 positive), respectively. Four laboratories used a Russian non-selective culture medium-that is, Complegon, and one laboratory utilised Biocult-GC. Both media seemed suboptimal. Only two of the laboratories used any species confirmative assay. Antibiotic susceptibility testing of N gonorrhoeae was performed at only two of the laboratories and each year only occasional isolates were analysed. None of the laboratories comprised a complete laboratory quality assurance system. Conclusions: According to international recommendations, the diagnosis of N gonorrhoeae in St Petersburg and Leningradskaya Oblast, Russia, is suboptimal. More samples need to be analysed by culturing on a highly nutritious and selective medium and, furthermore, species confirmation and antibiotic susceptibility testing should be more frequently performed. In addition, the utilised methods for culturing and antibiotic susceptibility testing, including medium and interpretative criteria used, ought to be optimised, standardised, and quality assured using systematic internal and external quality controls.

The large majority of studies investigating associations between bacterial vaginosis (BV) and sexually transmitted infections (STIs) have been conducted among predominantly young women with high risk for STIs. Since a risky sexual behavior is a significant risk factor for both STIs and BV, this creates a bias toward an increased association between BV and STIs. This study evaluated associations between BV-associated vaginal microbiota and STIs (Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, and Neisseria gonorrhoeae) in a population of women with low risk for STIs and investigated STI outcomes depending on the dominating Lactobacillus species. Repository cervicovaginal samples collected from reproductive-age women from January 2014 to February 2019 were characterized for vaginal microbiota types and the STIs using multiplex real-time PCR assays. In total, 95 STI-positive and 91 STI-negative samples were included. A significant, age-independent association between BV-associated vaginal microbiota and the presence of C. trachomatis, M. genitalium, and T. vaginalis infections was identified (age-adjusted odds ratios 2.92 [95% confidence interval (CI) 1.24-7.03], 2.88 [95% CI 1.19-7.16], and 9.75 × 10 7 [95% CI 13.03-∞], respectively). Normal vaginal microbiota dominated by Lactobacillus crispatus, L. gasseri, or L. jensenii was a strong protective factor against C. trachomatis and/or M. genitalium infections, whereas L. iners-dominated microbiota was not significantly associated with C. trachomatis and/or M. genitalium positivity. The results of the present study confirm that STI prevention strategies should include interventions that also reduce the incidence of BV and promote a protective vaginal microbiota in both high-and low-risk women.

Introduction. Bacterial vaginosis (BV) is the primary cause of pathological vaginal discharge in women of reproductive age. Gardnerella vaginalis and Atopobium vaginae are considered key components of the vaginal microflora in BV. Etiology, pathogenesis and modes of transmission of BV are actively studied, however these questions still remain unanswered. Objective: investigate predictor factors of BV in women with vaginal discharge. Material and methods. In total, 318 women were included. As clinical material, vaginal samples were used. BV was diagnosed using the Nugent method. For quantitative determination of G. vaginalis and A. vaginae DNA, real-time PCR was used. Behavioral and anamnestic data were obtained from questionnaire filled out by the patients. Results. BV was diagnosed in 27 % of women. G. vaginalis and A. vaginae DNA was detected, respectively, in 93 % and 83 % of patients with BV, 73 % and 59 % - with intermediate microflora, 52 % and 38 % - with normal microflora. Difference between the three types of microflora in the frequency and concentrations of these microorganisms were statistically significant. Detection of G. vaginalis and A. vaginae were significant predictor factors of BV (OR 12.2; 95 % CI 5.1-29.4 and OR 7.9; 95 % CI 4.2-14.9, respectively), with chances to diagnose BV being manifold increased when clinically significant concentrations of these bacteria were detected (≥3×106 and ≥8×105 DNA copies/ml for G. vaginalis and A. vaginae, respectively). Detection of clue cells in Gram stained preparations was shown to be the strongest BV predictor (OR 765.6; 95 % CI 99.6-5883.2). Conclusions. BV is diagnosed in more than one fourth of women with vaginal discharge. Detection of G. vaginalis and A. vaginae, especially in clinically significant concentrations, and clue cells in Gram stained preparations are significant predictor factors of BV.

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Introduction. In healthy women of reproductive age, the vaginal microflora is represented mainly by lactobacilli. They provide a barrier function, preventing the propagation of opportunistic pathogens and the colonization of the vagina by pathogenic microorganisms. It is shown that the lactobacillary microflora of the vagina is very diverse, but not all species of lactobacilli can provide reliable protection of the female organism. Objective: to characterize the species and quantitative composition of vaginal lactobacilli of women of reproductive age in norm and in dysbiosis. Material and methods. The study involved 123 patients from polyclinic departments of the D.O. Ott Reasearch Institute of Obstetrics, Gynecology and Reproductology. For analysis of clinical material (vaginal discharge) for lactobacilli and other microorganisms, quantitative real-time PCR was used. Results. The most common types of lactobacilli are Lactobacillus jensenii, L. Iners, L. crispatus, L. vaginalis and L. gasseri. Species diversity of lactobacilli (detection of ≥2 species) is observed much more often in women with physiological microbiocenosis than in women with vaginal dysbiosis. Our study confirms that L. crispatus is the dominant species of the vaginal biotope of healthy women, while in dysbiosis the species L. gasseri and L. Iners are most often identified.

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ObjectivesAntimicrobial resistance in Mycoplasma genitalium (MG) is a poorly surveyed and controlled global health concern. We evaluated the first commercial dual resistance assay, AmpliSens M. genitalium-ML/FQ-Resist-FL assay, for detection of potential macrolide and quinolone resistance-associated mutations (MRAMs and QRAMs, respectively) and estimated the prevalence of these mutations in MG in St. Petersburg, Russia.MethodsUrogenital samples positive (n=145 from 2007 to 2020) and negative (n=56 from 2021) for MG in routine diagnostics were retrospectively analysed using the AmpliSens M. genitalium-ML/FQ-Resist-FL assay (Central Research Institute of Epidemiology, Moscow, Russia) and Sanger sequencing for validation.ResultsThe AmpliSens M. genitalium-ML/FQ-Resist-FL assay detected potential MRAMs and QRAMs with sensitivities of 100% (CI95% 83.9 to 100) and 92.3% (CI95% 66.7 to 99.6) and specificities of 99.2% (CI95% 95.6 to 100) and 100% (CI95% 97.2 to 100), respectively, in clinical specimens with ≥1000 MG geq/mL. In total, MRAMs were detected in 13.8% (CI95% 9.1 to 20.3) of samples, with 23S rRNA A2058G being the most prevalent mutation (45.0% (CI95% 25.8 to 65.8)). QRAMs were found in 9.0% (CI95% 5.3 to 14.7) of samples, with S83I the most frequent mutation (53.8% (CI95% 29.1 to 76.8)). Dual resistance was observed in 5.5% (CI95% 2.8 to 10.5) of samples. Potential MRAM and dual resistance rates significantly increased over time: from 0% in 2007–2008 to 25% (ptrend=0.0009) and 10% (ptrend=0.0447), respectively, in 2018–2020. QRAM rate appeared to increase (from 0% to 13%), but significance was not reached (ptrend=0.0605).ConclusionsThe rapid increase in MG antimicrobial resistance in St. Petersburg, especially prominent for MRAMs, necessitates implementation of macrolide resistance-guided therapy in Russia. The first commercial dual resistance assay, AmpliSens M. genitalium-ML/FQ-Resist-FL assay, was sensitive and specific for detection of potential MRAMs and QRAMs and could be valuable in macrolide resistance-guided therapies and possibly for surveillance of QRAMs. International surveillance of antimicrobial resistance-associated mutations in MG, further research into clinical relevance of several parC mutations and novel treatments are essential.

Hypothesis/aims of study. Miscarriage is a significant medical and social problem. The etiology of pregnancy losses is diverse and depends on many factors. It is believed that dysbiotic disorders of the vagina are one of the main causes of this pathology. While the etiopathogenesis of miscarriage is actively studied, many questions still remain open. The aim of the study was to investigate anamnestic and microbiological predictor factors of miscarriage. Study design, materials, and methods. In a prospective cohort study, 159 pregnant women were examined in the first trimester of pregnancy: the anamnesis, course of pregnancy, vaginal microflora, and present pregnancy outcome were studied. The vaginal microflora was analyzed using microscopic, bacteriological and quantitative real-time PCR methods. Depending on the present pregnancy outcome, the patients were divided into two groups: those delivered at term and women with early and late miscarriage. The analysis of predictors of miscarriage of the ongoing pregnancy was performed depending on the period of delivery. Results. The rate of miscarriage in women was 13%. The independent predictors of early miscarriage were chronic endometritis (OR 10.54; 95% CI 2.54 to 43.64), the dominance of Lactobacillus iners in the vaginal microflora (OR 8.52; 95% CI 2.07 to 35.05), and the prevalence of non-Lactobacillus species in microscopy of vaginal preparations (OR 4.50; 95% CI 1.02 to 19.69). The dominance of Lactobacillus crispatus was a significant protective factor of late miscarriage (OR 0.20; 95% CI 0.04 to 0.99). Conclusion. The undertaken analysis revealed significant associations of a number of anamnestic and microbiological predictor factors with miscarriage, which will enable to substantiate approaches for predicting pregnancy outcomes at different gestational age and to develop methods of pre-conception care and treatment in women with different risk of miscarriage.