Molecular Diagnosis of Vaginitis: Comparing Quantitative PCR and Microbiome Profiling Approaches to Current Microscopy Scoring

Lynch, Tarah; Peirano, Gisele; Lloyd, Tracie; Read, Ron; Carter, Julia; Chú, Ángel; Shaman, Jeffrey A.; Jarvis, Joseph P.; Diamond, Evan; Ijaz, Umer Zeeshan; Church, Deirdre L.

doi:10.1128/jcm.00300-19

Cited by 22 publications

(19 citation statements)

References 50 publications

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“…However, it was difficult to group participants according to the severity of AV in this study due to its retrospective nature. Escherichia coli was the most common pathogen of AV in our study, which is consistent with the results of previous studies (10,13,17). This also reveals that one of the main sources of vaginitis is the gastrointestinal tract.…”

Section: Discussionsupporting

confidence: 93%

Pathogen profile and risk factors of aerobic vaginitis in pregnant women: a retrospective cohort study

Li¹,

Yi²,

Chen³

2021

Ann Palliat Med

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Background: Vaginitis is one of the most common gynecological diseases in women and may severely affect the quality of life in patients. However, very few studies have investigated aerobic vaginitis (AV) in pregnant women, and our study was designed to identify the pathogen profile, clinical importance, and risk factors of AV in pregnancy.Methods: This was a retrospective cohort study enrolling 685 women who attended our hospital between July 2018 and June 2020. Based on the incidence of AV, enrolled women were divided into an AV group and healthy control group, and demographic and clinical characteristics were retrospectively collected by two independent investigators. Some pathogens of AV were tested using quantitative real-time polymerase chain reaction for higher accuracy. Pregnancy outcomes were also retrospectively collected. Univariable and multivariable logistic regression analysis was used to determine the risk factors of AV incidence and adverse pregnant outcomes.Results: Enrolled women were divided into an AV group of 182 women and healthy control group of 503 women. The proportions of women with a history of cesarean delivery and history of vaginal infection differed between the groups (P=0.002 and <0.001, respectively). The mean gestational week at diagnosis of AV was 22.3±8.6 weeks, and the most common pathogen of AV was Escherichia coli (28.6%). After adjustment using multivariable logistic regression, a history of vaginal infection acted as an important risk factor of AV incidence, while a history of cesarean delivery, college education or above, and being employed could protect pregnant women from AV. In addition, the incidences of preterm birth, premature rupture of membranes, neonatal jaundice, and neonatal infection were much higher in the AV group than in the control group, showing significant difference (P<0.001, <0.001, =0.007, and =0.025). After adjustment using multivariable logistic regression, the incidence of AV and older age were important risk factors of premature rupture of membranes and neonatal infection.Conclusions: Compared with healthy pregnant women, the presence of AV may increase the incidence of adverse outcomes. More attention should be paid to pregnant women with a history of vaginal infection.

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Section: Discussionsupporting

confidence: 93%

Pathogen profile and risk factors of aerobic vaginitis in pregnant women: a retrospective cohort study

Li¹,

Yi²,

Chen³

2021

Ann Palliat Med

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“…The quantification of the bacterial load is achieved using the qPCR, providing additional information that is not obtainable from the Gram staining. While taking into consideration that the total bacterial load may not consistently improve diagnostic accuracy, it could help the predictive values as it has been seen that elevated loads of G. vaginalis and A. vaginae are predictive of bacterial vaginosis [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Vaginal Dysbiosis and Partial Bacterial Vaginosis: The Interpretation of the “Grey Zones” of Clinical Practice

et al. 2021

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Bacterial vaginosis (BV) affects one-third of reproductive age women, increasing the risk of acquiring sexually transmitted infections (STIs) and posing a risk for reproductive health. The current diagnosis with Gram stain (Nugent Score) identifies a transitional stage named partial BV or intermediate microbiota, raising the problem of how to clinically handle it. We retrospectively analyzed cervicovaginal swabs from 985 immunocompetent non-pregnant symptomaticspp. women (vaginal discharge, burning, itching) by Nugent score and qPCR for BV, aerobic or fungal vaginitis, and STIs (Mycoplasmas spp., Chlamydia t., Trichomonas v., and Neisseria g.). Nugent scores 0–3 and 7–10 were confirmed in 99.3% and 89.7% cases, respectively, by qPCR. Among Nugent scores 4–6 (partial BV), qPCR identified 46.1% of BV cases, with 37.3% of cases negative for BV, and only 16.7% of partial BV. Gram staining and qPCR were discordant (p value = 0.0001) mainly in the partial BV. Among the qPCR BV cases, the presence of aerobic vaginitis and STIs was identified, with a significant association (p < 0.0001) between the STIs and partial BV/overt BV. qPCR is more informative and accurate, and its use as an alternative or in combination with Gram staining could help clinicians in having an overview of the complex vaginal microbiota and in the interpretation of partial BV that can correspond to vaginitis and/or STIs.

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“…However, the Nugent score usually cannot diagnose early-stage bacteria vaginitis. Also, the culture method may not be able to cover all species of pathogens [26]. Therefore, a large proportion of pregnant women who have been infected with anaerobic bacteria, mycoplasma, ureaplasma, etc.…”

Section: Discussionmentioning

confidence: 99%

Detection of Vaginal Metabolite Changes in Premature Rupture of Membrane Patients in Third Trimester Pregnancy: a Prospective Cohort Study

Liu

Chen

et al. 2020

Reprod. Sci.

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Premature rupture of membranes (PROM) is usually associated with pregnant and neonatal complications. Most of the PROM cases are caused by ascending asymptomatic genital infection. In China, PROM (15.3%) is more common than spontaneous preterm labor (7.3%) and leads to more adverse pregnancy outcomes. Here, we designed a prospective cohort study to measure the metabolomics changes in vaginal swab samples and explored their potential contribution to PROM. A total of 260 differentially expressed metabolites were identified and further analyzed. In the PROM group, N-acetyl-d-galactosamine and sucrose were downregulated (P = 0.0025, P = 0.0195, respectively), both of which are the upstream metabolites of the glycolysis pathway. Furthermore, estriol 3-sulfate 16-glucuronide (P = 0.0154) and 2-methoxy-17beta-estradiol 3-glucosiduronic acid (P = 0.004), two final metabolites in steroid hormone biosynthesis, were both downregulated in the PROM group. Finally, we found two catechin metabolites (epigallocatechin-7-glucuronide, P = 0.0009; 4′-methyl-epigallocatechin-7-glucuronide, P = 0.01) as well as DL-citrulline (P = 0.0393) were also significantly downregulated in the PROM group compared with the healthy control (HC) group, which are related to important antioxidant and anti-inflammatory activities in the human body. Altogether, metabolite changes in glycolysis, steroid hormone biosynthesis, and antioxidant/anti-inflammatory pathways may contribute to (or be a consequence of) vaginal dysbiosis and PROM. Metabolite pathway analysis is a new and promising approach to further investigate the mechanism of PROM and help prevent its unfavorable pregnant outcomes at a functional level. Trial registration number: ChiCTR2000034721

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Molecular Diagnosis of Vaginitis: Comparing Quantitative PCR and Microbiome Profiling Approaches to Current Microscopy Scoring

Cited by 22 publications

References 50 publications

Pathogen profile and risk factors of aerobic vaginitis in pregnant women: a retrospective cohort study

Pathogen profile and risk factors of aerobic vaginitis in pregnant women: a retrospective cohort study

Vaginal Dysbiosis and Partial Bacterial Vaginosis: The Interpretation of the “Grey Zones” of Clinical Practice

Detection of Vaginal Metabolite Changes in Premature Rupture of Membrane Patients in Third Trimester Pregnancy: a Prospective Cohort Study

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