Bacterial vaginosis and disturbances of vaginal flora

Taha, Taha E.; Hoover, Donald R.; Dallabetta, Gina; Kumwenda, Newton; Mtimavalye, Laban A.R.; Yang, Li Ping; Liomba, George N.; Broadhead, Robin L.; Chiphangwi, John D.; Miotti, Paolo

doi:10.1097/00002030-199813000-00019

Cited by 552 publications

(129 citation statements)

References 29 publications

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“…The higher prevalence rate of BV in pregnant women compared with non pregnant women may be due to the fact that pregnant women are known to be immunosuppressed and this implies that such pregnant women may be more prone to obstetric infection. "Reference [21] showed that there was a significant trend of increased risk of HIV with increasing severity of vaginal disturbances among pregnant women". However, the high prevalence of BV in HIV positive patients observed in this study is not statistically significant (p = 0.1) Although a previous study found that BV prevalence increased with age [18], the age related increase in this study was not significant.…”

Section: Discussionmentioning

confidence: 99%

Nugent Scores of Pregnant Women in a Tertiary Institution in Nigeria

Ajani¹,

Oduyebo²,

Haruna³

et al. 2012

AiM

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Background: Bacterial Vaginosis (BV) is an imbalance of the vaginal normal flora, and it is asymptomatic in most women. Therefore, one of the major ways of diagnosing BV is demonstration of an abnormal flora in the vagina. This can be achieved through various methods including Nugent score. In view of the association of BV with obstetric/gynaecological complications and high rate of HIV transmission, it is desirable to know the prevalence of BV in pregnant women. Knowledge of risk factors will also help to design preventive measures. Methodology: A prospective study was performed to determine the prevalence of BV among pregnant women. High vaginal swabs (HVS) were collected and smears made were Gram stained and scored by the Nugent method. A predesigned questionnaire was also used to obtain information on possible risk factors. Associations between categorical variables were assessed using chi square test and fisher's exact test as appropriate. Result: Three hundred married women aged between 18 and 45 years were studied. The prevalence of BV was 64.3%, 25% had intermediate and 10.7% had negative Nugent scores. BV rates were high across all age groups, educational background, ethnicity, parity, HIV status, and occupation. The occurrence of BV was higher (75.5%) among gestational age group ≤ 30 weeks (p < 0.05), in women who had sex more than twice within a week (p < 0.05) and in women who engaged in unskilled labour (p < 0.05). Conclusion: Bacterial vaginosis is a very common condition among the studied population. This high prevalence may necessitate routine screening and treatment during antenatal care in preventing the associated adverse effects of BV during pregnancy and childbirth.

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Section: Discussionmentioning

confidence: 99%

Nugent Scores of Pregnant Women in a Tertiary Institution in Nigeria

Ajani¹,

Oduyebo²,

Haruna³

et al. 2012

AiM

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“…We reported, in studies in Malawi, Africa, that disturbances of vaginal flora were common and associated with HIV-1 infection [10,11]. Identifying a simple treatment regimen for these vaginal disturbances is a priority.…”

Section: Introductionmentioning

confidence: 99%

Intermittent Intravaginal Antibiotic Treatment of Bacterial Vaginosis in HIV-Uninfected and -Infected Women: A Randomized Clinical Trial

et al. 2007

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Objective:Assess efficacy of intermittent intravaginal metronidazole gel treatment in reducing frequency of bacterial vaginosis (BV).Design:Randomized, double-masked, placebo-controlled phase 3 trial.Setting:Postnatal and family planning clinics of the Queen Elizabeth Central Hospital and two health centers in Blantyre, Malawi.Participants:Nonpregnant HIV-uninfected and -infected women.Intervention:Intravaginal metronidazole treatment and placebo gels provided at baseline and every 3 mo for 1 y.Outcome measures:Primary: Cross-sectional and longitudinal comparisons of BV frequency at baseline, 1 mo after product dispensation (post-treatment evaluation [PTE]), and every quarterly visit. Secondary: Effect of treatment on BV clearance and recurrence.Results:Baseline: 842 HIV-uninfected and 844 HIV-infected women were enrolled. The frequency of BV at baseline in treatment and placebo arms, respectively, was 45.9% and 46.8% among HIV-uninfected women, and 60.5% and 56.9% among HIV-infected women. Primary outcomes: At the PTEs the prevalence of BV was consistently lower in treatment than placebo arms irrespective of HIV status. The differences were statistically significant mainly in HIV-uninfected women. Prevalence of BV was also reduced over time in both treatment and placebo arms. In a multivariable analysis that controlled for other covariates, the effect of intravaginal metronidazole treatment gel compared with placebo was not substantial: adjusted relative risk (RR) 0.90, 95% confidence interval (CI) 0.83–0.97 in HIV-uninfected women and adjusted RR 0.95, 95% CI 0.89–1.01 in HIV-infected women. Secondary outcomes: Intravaginal metronidazole treatment gel significantly increased BV clearance (adjusted hazard ratio [HR] 1.34, 95% CI 1.07–1.67 among HIV-uninfected women and adjusted HR 1.29, 95% CI 1.06–1.58 among HIV-infected women) but was not associated with decreased BV recurrence. Safety: No serious adverse events were related to use of intravaginal gels.Conclusion:Intermittent microbicide treatment with intravaginal gels is an innovative approach that can reduce the frequency of vaginal infections such as BV.

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“…It is important to evaluate the safety of topical PrEP products, as any breach to the integral mucosal barrier and the associated inflammation promote the recruitment of local CD4 T cells and facilitate HIV infection (68). The PrEP product should not alter the innate vaginal microbial milieu, as altered microbial states may increase the risk of HIV acquisition (69)(70)(71). Vaginal facultative and anaerobic bacteria remained stable throughout the study with both the IQP-0528NP and IQP-0528 film formulations (Fig.…”

Section: Discussionmentioning

confidence: 99%

Safety and Pharmacokinetics of Quick-Dissolving Polymeric Vaginal Films Delivering the Antiretroviral IQP-0528 for Preexposure Prophylaxis

Srinivasan

Zhang

Martin

et al. 2016

Antimicrob Agents Chemother

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dFor human immunodeficiency virus (HIV) prevention, microbicides or drugs delivered as quick-dissolving films may be more acceptable to women than gels because of their compact size, minimal waste, lack of an applicator, and easier storage and transport. This has the potential to improve adherence to promising products for preexposure prophylaxis. Vaginal films containing IQP-0528, a nonnucleoside reverse transcriptase inhibitor, were evaluated for their pharmacokinetics in pigtailed macaques. Polymeric films (22 by 44 by 0.1 mm; providing 75% of a human dose) containing IQP-0528 (1.5%, wt/wt) with and without poly(lactic-co-glycolic acid) (PLGA) nanoparticle encapsulation were inserted vaginally into pigtailed macaques in a crossover study design (n ‫؍‬ 6). With unencapsulated drug, the median ( In the absence of an effective vaccine, preexposure prophylaxis (PrEP) with antiretroviral (ARV) drugs is currently a very promising biomedical intervention to control the human immunodeficiency virus (HIV) epidemic (1, 2). PrEP involves the use of ARV by high-risk HIV-negative individuals to prevent HIV acquisition. Many ARVs that have traditionally been used for HIV treatment have advanced as PrEP agents due to their safety and potency profiles (1,(3)(4)(5). Of the available ARVs, tenofovir disoproxil fumarate (TDF), a nucleoside reverse transcriptase inhibitor (NRTI) used widely in HIV treatment, has been studied extensively in animals and humans as a PrEP agent (3, 5). The success with oral TDF and Truvada, TDF in combination with emtricitabine (FTC), in inhibiting HIV infection in nonhuman primates led to the clinical trials in humans with TDF and Truvada (1, 6-11). In stark contrast to the success of TDF and Truvada in clinical trials in men who have sex with men and heterosexual HIV-discordant couples, two large clinical trials in women with oral Truvada, VOICE and FEM-PrEP, have demonstrated no protection due to a lack of adherence (12, 13).Providing optimal dosage forms of potent HIV PrEP agents for women has the potential to improve product adherence (14,15). Topical dosage forms can be effective in reducing HIV infection, as demonstrated by the CAPRISA 004 vaginal 1% tenofovir (TFV) gel trial, where per-protocol use of the gel before and after sex with no more than 2 doses in 24 h (BAT-24) reduced HIV acquisition by 39% (2). As observed in the oral PrEP trials, greater efficacy was reported among the high adherers in CAPRISA 004 (54% versus 28% in the low adherers) (2). Subsequent trials with 1% TFV gel, such as FACTS 001, employing the BAT-24 regimen used in CAPRISA-004, and the VOICE trial, with a daily application of 1% TFV gel, were not effective in protecting women against HIV acquisition (12, 16). It was estimated based on the returned used applicators that only 13% of the FACTS 001 trial participants were able to use the gel in Ն80% of sex acts per month (16). Neither the noncoital daily application of the TFV gel with VOICE nor the pericoital vaginal dosing regimen with FACTS 001 demonstrated effecti...

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Bacterial vaginosis and disturbances of vaginal flora

Abstract: This prospective study suggests that progressively greater disturbances of vaginal flora, increase HIV acquisition during pregnancy and postnatally. The screening and treating of women with BV could restore normal flora and reduce their susceptibility to HIV.

Cited by 552 publications

References 29 publications

Nugent Scores of Pregnant Women in a Tertiary Institution in Nigeria

Nugent Scores of Pregnant Women in a Tertiary Institution in Nigeria

Intermittent Intravaginal Antibiotic Treatment of Bacterial Vaginosis in HIV-Uninfected and -Infected Women: A Randomized Clinical Trial

Safety and Pharmacokinetics of Quick-Dissolving Polymeric Vaginal Films Delivering the Antiretroviral IQP-0528 for Preexposure Prophylaxis

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