Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review

Kalia, Namarta; Singh, Jatinder; Kaur, Manpreet

doi:10.1186/s12941-020-0347-4

Cited by 136 publications

(127 citation statements)

References 175 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…Out findings revealed statistically significant associations between pathological vaginal discharge and common vaginal infections i.e. bacterial vaginosis, vaginal candidiasis and trichomoniasis vaginalis, 21,22 which are commonly found in pregnant women with low education, underprivileged social and economic status and poor hygiene. 6 Most of women participants of our study were recruited during antenatal appointments in the outpatient obstetrics and gynaecology clinics, which are mostly attended by poor families in Pakistan.…”

Section: Common Causes Of Pathological Vaginal Dischargementioning

confidence: 91%

Is vaginal discharge a natural or pathological problem in pregnant women associated with adverse pregnancy outcomes?: A cross-sectional study

Khaskheli¹,

Baloch²,

Baloch³

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective: To differentiate between normal and pathological vaginal discharge (PVD) in pregnant women and to identify causes of and adverse pregnancy outcomes associated with PVD. Design: A cross-sectional study. Setting: Outpatient antenatal clinics. Population / Sample: Pregnant women, Convenience sample (N=85). Methods: Data were collected through history, clinical examination and laboratory investigations. Data analysed by frequencies, descriptive statistics and Chi-Squared tests. Main outcome measures: Vaginal discharge (VD), age, gestation, parity and adverse pregnancy outcomes. Results: Women's mean age was 27.4 (±4.67) years. Majority of women were 26-31 years old (40%), 28-35 weeks pregnant (34%) and primigravida (41%). Of 89% (n=76) women with VD, 32% (n=24) had normal VD and 68% (n=52) PVD. Normal VD was watery (100%) and odourless (96%) while PVD was yellowish curd like (33%) and foul smelling (52%). PVD was significantly associated with bacterial vaginosis (P < 0.0001), candidiasis (P = 0.005) and trichomoniasis (P = 0.018). A higher proportion of women with PVD reported irritation (P < 0.0001), pain (P < 0.0001), uterine contractions (P < 0.0001), premature membrane rupture (P < 0.0001), abortion (P < 0.042), pre-term delivery (P < 0.0001) and post-partum endometritis (P < 0.0001). PVD was also associated with low birth weight (P < 0.0001), low Apgar score at birth (P < 0.0001), respiratory distress syndrome (P < 0.0001), intensive neonatal care hospitalisation (P = 0.001) and early neonatal death (P = 0.002). Conclusions: Vaginal discharge in pregnancy requires early investigation to avoid any adverse fetomaternal outcomes associated with pathological vaginal discharge.

show abstract

Section: Common Causes Of Pathological Vaginal Dischargementioning

confidence: 91%

Is vaginal discharge a natural or pathological problem in pregnant women associated with adverse pregnancy outcomes?: A cross-sectional study

Khaskheli¹,

Baloch²,

Baloch³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…[51]. Interestingly, CST IV has been described in the literature as asymptomatic BV, albeit an ill-defined purported disease [58].…”

Section: Immuno-munibiome Model: a Conceptual Hypothesis Of Cervicovamentioning

confidence: 99%

Structure and regulation of the cervicovaginal microbiome in a cohort of Afro-Caribbean women

Roachford¹,

Alleyne²,

Kuelbs³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The cervicovaginal microbiome, with its well documented dynamic community state types (CSTs I-V) is known to interact with the host immune system in a complex regulatory ecosystem that guards against dysbiosis and invading pathogens. However, the regulatory mechanism of the cervicovaginal microbiome in vaginal eubiosis is not well understood. Therefore, we characterized the cervicovaginal microbiome in a cohort of Afro-Caribbean women to the species-strain taxonomic level using high-throughput targeted sequencing and shotgun metagenomics and conceptualized a hypothetical model that aids in understanding vaginal ecosystem regulation. Results Compared to targeted 16S rRNA V4 sequencing, whole genome shotgun (WGS) metagenomics offered greater species resolution of the cervicovaginal microbiome in the Afro-Caribbean women cohort. Community state type IV predominated in the microbiome of these women, with Prevotella (13.91%), Gardnerella (12.14%) and Lactobacillus (9.37%) being the three most abundant genera. For Prevotella and Lactobacillus the most abundant species-strains were P. timonensis DSM 22865 (5.0%) and L. iners DSM 13335 (7.0%), respectively. The less virulent strain of Gardnerella, G. vaginalis 409-05 (8.0%) was more abundant than G. vaginalis ATCC 14019 (4.0%). In the resistome, 2,753 antimicrobial resistance (AMR) genes consisting of 28 types (mostly tet and Emr; abundances 51% and 15%, respectively) which confer resistance to tetracyclines and the macrolide-lincosamide streptogramin B (MLSb phenotype) group were observed. Functional profiling showed a high abundance of biological processes (bacterial-type flagellum-dependent cell motility, cell adhesion, response to biotic stimulus and quorum sensing) associated with biofilm activity. Conclusions Characterized for the first time, the cervicovaginal microbiome in Afro-Caribbean women is predominantly CST IV with the three most abundant taxa consisting of bacterial strains P. timonensis DSM 22865, G. vaginalis 409-05 and L. iners DSM 13335. Its resistome had multiple AMR genes that confer resistance to antibiotics commonly used in the treatment of sexually transmitted infections (STIs) and bacterial vaginosis (BV). In this study, the occurrence of biofilm activity within the cervicovaginal microbiome suggested a possible regulatory role. We present a conceptual immuno-munibiome model that advances a mechanistic approach for the structure and regulation of the vaginal ecosystem in the Afro-Caribbean women cohort.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Most wet preps in the ED are performed in women of reproductive age whose vaginal potential of hydrogen (pH) typically ranges from about 4.0 to 5.0 [ 6 , 12 ]. The normal acidic vaginal environment helps inhibit the growth of some pathogenic organisms [ 12 ]. A disruption in the normal vaginal microbiome can result in vaginitis from STIs, antibiotic therapy, contraception, douching, foreign bodies [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…The normal acidic vaginal environment helps inhibit the growth of some pathogenic organisms [ 12 ]. A disruption in the normal vaginal microbiome can result in vaginitis from STIs, antibiotic therapy, contraception, douching, foreign bodies [ 12 , 13 ]. Vaginal pH greater than 4.5 can occur with BV or trichomoniasis; a pH of 4.0 to 4.5 can be seen with vulvovaginal candidiasis [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Frequency of Coinfection on the Vaginal Wet Preparation in the Emergency Department

Elkins

Cantillo-Campos

Sheele

2020

Cureus

View full text Add to dashboard Cite

Introduction Vaginal infections are common in the emergency department (ED) but the frequency of vaginal coinfections identified on wet preparation is unknown. Methods The study examined a data set of 75,000 ED patient encounters between April 18, 2014, and March 7, 2017, who had received testing for gonorrhea, chlamydia, or trichomonas or had received a urinalysis and urine culture during the ED encounter. From this data set we reviewed 16,484 patient encounters where a vaginal wet preparation was performed on women age 18 years and older. Findings from the vaginal wet preparation and ED discharge diagnoses were examined to evaluate the frequency of vaginal coinfections with vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis. Results Among the women who had wet preparations, 4,124 patient encounters (25.0%) had a diagnosis of bacterial vaginosis, 625 (3.8%) had a diagnosis of vulvovaginal candidiasis, and 1,802 (10.9%) were infected with Trichomonas vaginalis. Twenty encounters (0.1%) had a diagnosis of vulvovaginal candidiasis and trichomoniasis; 150 (0.9%), bacterial vaginosis and trichomoniasis; 136 (0.8%), vulvovaginal candidiasis and bacterial vaginosis; and 10 (0.1%), trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. On vaginal wet preparation, the mean white blood cell count was 13.0 per high-power field. Clue cells were found in 6,988 wet preparations (42.4%); 1,065 wet preparations (6.5%) had yeast and 1,377 (8.4%) had T. vaginalis. T. vaginalis was identified in 2.5% (266/10,542) of urinalyses and 8.4% (406/4,821) of nucleic acid amplification tests. Conclusions Vaginal coinfections were uncommon among women receiving a vaginal wet preparation in the emergency department. The most common vaginal coinfection was bacterial vaginosis and trichomonas.

show abstract

Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review

Cited by 136 publications

References 175 publications

Is vaginal discharge a natural or pathological problem in pregnant women associated with adverse pregnancy outcomes?: A cross-sectional study

Is vaginal discharge a natural or pathological problem in pregnant women associated with adverse pregnancy outcomes?: A cross-sectional study

Structure and regulation of the cervicovaginal microbiome in a cohort of Afro-Caribbean women

Frequency of Coinfection on the Vaginal Wet Preparation in the Emergency Department

Contact Info

Product

Resources

About