Screening for abnormal vaginal microflora by self-assessed vaginal pH does not enable detection of sexually transmitted infections in Ugandan women

Donders, Gilbert; Donders, Francesca; Bellen, Gert; Depuydt, Christophe; Eggermont, Natalie; Michiels, Thirsa; Lule, John; Byamughisa, J.

doi:10.1016/j.diagmicrobio.2015.12.018

Cited by 6 publications

(7 citation statements)

References 41 publications

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“…Apart from BV, which is found to be highly prevalent in most sub-Saharan African countries [ 24 ], the prevalence of AVF and AV has not been intensively studied in Africa yet. In South Africa and Uganda, however, it was clearly shown that AVF and AV are more frequent than in other parts of the world [ 25 , 26 ] and presumably account for many of the potential side effects and STI transmission risk factors allegedly accounted to BV in several former studies [ 24 , 27 ]. We currently did not find a clear association between cytology/positive HR-HPV and disrupted flora types such as AV or BV as Jahic, Vieira-Baptista, and Donders found [ 28 , 29 ], but this can most likely be accounted to small numbers and pleas for more extensive research.…”

Section: Discussionmentioning

confidence: 99%

Genital Tract Infections in an Isolated Community: 100 Women of the Príncipe Island

Vieira‐Baptista

Grincevičienė

Bellen³

et al. 2017

Infectious Diseases in Obstetrics and Gynecology

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Objective To characterize the vaginal microbiome and the rate of sexually transmitted infections (STIs) in the women of Príncipe (São Tomé and Príncipe). Methods Cross-sectional study of 100 consecutive women, invited for a free appointment and cervical cancer screening. A vaginal slide (wet mount microscopy) and a cervical sample (ThinPrep®) (Pap test, high risk human papillomavirus [HR-HPV], N. gonorrhea [NG], T. vaginalis [TV], and C. trachomatis [CT]) were obtained. Results TV, NG, CT, and HIV were found in 8.0%, 2.0%, 3.0%, and 2.0%, respectively, and were more prevalent in younger women. HR-HPV was positive in 36.7%; 2 were positive for HPV18, but none for HPV16. Coinfection of HPV with other STIs was 8.3%. Prevalence of abnormal vaginal flora (AVF) was 82.5%, mostly bacterial vaginosis (BV) 54.6%, and moderate/severe aerobic vaginitis (msAV) 25.8%. HR-HPV was not related to BV (p = 0.67). The association of abnormal Pap test with msAV was not significant (p = 0.08). Conclusion The prevalence of NG, CT, TV, and HR-HPV was according to expected, while that of HR-AVF was higher. The surprisingly low prevalence of HPV16 and HPV18 must be considered in the design of programs for prevention and vaccination; this setting can be useful as a model for postvaccination scenarios.

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Section: Discussionmentioning

confidence: 99%

Genital Tract Infections in an Isolated Community: 100 Women of the Príncipe Island

Vieira‐Baptista

Grincevičienė

Bellen³

et al. 2017

Infectious Diseases in Obstetrics and Gynecology

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“…DNA from vaginal lavage was extracted, and PCR amplification and sequencing targeting the V4 regions of the 16S rRNA gene were performed on a HiSeq2500 (Illumina, San Diego, CA, USA). Bioinformatics analysis and results were already reported in a previous study [ 15 ].…”

Section: Methodsmentioning

confidence: 77%

“…However, several factors limit the broad application of wet-mount microscopy score. First, cells and bacteria can move on saline smears, the long-term preservation of wet-mount smears because repeated review by rehydration is less commonly practiced [ 15 , 16 ]. Second, the identification of aerobes requires a keen microscopist and a phase-contrast microscope, which may be obstacles to wide application in clinical practice in underdeveloped regions and the development of artificial intelligence (AI) interpretation systems.…”

Section: Introductionmentioning

confidence: 99%

Aerobic Vaginitis Diagnosis Criteria Combining Gram Stain with Clinical Features: An Establishment and Prospective Validation Study

Dong

Wang

et al. 2022

Diagnostics

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Wet-mount microscopy aerobic vaginitis (AV) diagnostic criteria need phase-contrast microscopy and keen microscopists, and the preservation of saline smears is less common in clinical practice. This research work developed new AV diagnostic criteria that combine Gram stain with clinical features. We enrolled 325 AV patients and 325 controls as a study population to develop new AV diagnostic criteria. Then, an independent group, which included 500 women, was used as a validation population. AV-related microscopic findings on Gram-stained and wet-mount smears from the same participants were compared. The accuracy of bacterial indicators from the two methods was verified by bacterial 16S rRNA V4 sequencing (n = 240). Logistic regression was used to analyse AV-related clinical features. The screened clinical features were combined with Gram-stain microscopic indicators to establish new AV diagnostic criteria. There were no significant differences in the leukocyte counts or the parabasal epitheliocytes (PBC) proportion between the Gram-stain and wet-mount methods (400×). Gram stain (1000×) satisfied the ability to identify bacteria as verified by 16S rRNA sequencing but failed to identify toxic leukocytes. The new criteria included: Lactobacillary grades (LBG) and background flora (Gram stain, 1000×), leukocytes count and PBC proportion (Gram stain, 400×), and clinical features (vaginal pH > 4.5, vagina hyperemia, and yellow discharge). These criteria satisfied the accuracy and reliability for AV diagnosis (Se = 86.79%, Sp = 95.97%, and Kendall’s W value = 0.899) in perspective validation. In summary, we proposed an alternative and valuable AV diagnostic criteria based on the Gram stain, which can make it possible to diagnose common vaginitis like AV, BV, VVC, and mixed infections on the same smear and can be available for artificial intelligence diagnosis in the future.

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“…oder Mycoplasma hominis, die weder durch eine mikroskopische Diagnostik noch durch eine pH-Wert-Bestimmung erfasst werden und einer gezielten Diagnostik bedürfen [43]. Ureaplasma urealyticum war in einer Kohorte von 126 Frauen mit vorzeitigen Wehen in über 60 % nachweisbar, wobei sich keine Unterschiede in der Häufigkeit zwischen Frauen mit und ohne nachfolgender Frühgeburt fanden [44].…”

Section: Diskussionunclassified

“…Trotzdem fehlt für die Durchführung von Abstrichkontrollen im vorliegendem Kontext jegliche Evidenz. Uneinheitlich waren die Meinungen zur Therapieindikation bei Nachweis intrazellulärer Erreger wie Ureaplasma urealyticum oder Mycoplasma hominis, die weder durch eine mikroskopische Diagnostik noch durch eine pH-Wert-Bestimmung erfasst werden und einer gezielten Diagnostik bedürfen [43]. Ureaplasma urealyticum war in einer Kohorte von 126 Frauen mit vorzeitigen Wehen in über 60 % nachweisbar, wobei sich keine Unterschiede in der Häufigkeit zwischen Frauen mit und ohne nachfolgender Frühgeburt fanden [44].…”

Section: Diskussionunclassified

Infektionsmanagement bei drohender Frühgeburt – eine Umfrage an deutschen Perinatalzentren

Pech

Gerber

Stubert

2021

Z Geburtshilfe Neonatol

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Zusammenfassung Einleitung Internationalen und nationalen Leitlinien fehlt es an detaillierten Empfehlungen zur Infektionsdiagnostik und -therapie bei drohender Frühgeburt. Ziel der Studie war es, Daten zur Versorgungssituation an deutschen Perinatalzentren zu erheben. Methoden Onlineumfrage zum Infektionsmanagement bei drohender Frühgeburt an allen 212 deutschen Perinatalzentren der Versorgungsstufen Level I und II. Ergebnisse Die Rücklaufquote betrug 31,6% (n=67). Bei drohender Frühgeburt unter 34 vollendeten SSW ohne Blasensprung verzichten 78,8% auf eine kalkulierte Antibiotikagabe. Von den verbleibenden vierzehn Zentren (21,2%) würde die Hälfte generell bei klinischen Zeichen einer drohenden Frühgeburt antibiotisch behandeln. Fast alle Zentren (94%) führen eine vaginale Erregerdiagnostik durch. Eine mikroskopische Abstrichbeurteilung mittels Nugent- oder Amsel-Score erfolgt in 37,3%. Abweichungen von der physiologischen vaginalen Mikrobiota werden mehrheitlich antibiotisch behandelt (bakterielle Vaginose 79,1%, n=53, Candida spp. 77,6%, n=52, Ureaplasma spp. 49,3%, n=33). Kontrollabstriche erfolgen in 70,1%. Konsens besteht hinsichtlich einer Antibiotikagabe bei frühem vorzeitigem Blasensprung. 72,6% bevorzugen eine Monotherapie mit einem β-Laktam-Antibiotikum. Uneinheitlich waren hier die Angaben zur Dauer der Therapie, wobei 58% der Zentren länger als sieben Tage behandeln. Schlussfolgerung An deutschen Perinatalzentren besteht eine hohe Bereitschaft zur Infektionsdiagnostik und -therapie bei drohender Frühgeburt. Das Infektionsmanagement ist jedoch uneinheitlich und partiell widersprüchlich zu den vorliegenden Leitlinien. Es besteht ein Bedarf an qualitativ hochwertigen Studien zu diesem Thema.

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Screening for abnormal vaginal microflora by self-assessed vaginal pH does not enable detection of sexually transmitted infections in Ugandan women

Abstract: Self-measured vaginal pH correlated well with markers of high-risk microflora types such as BV or aerobic vaginitis, but not with STIs. Hence, in a screening program addressing AVF in low-resource countries, extra specific tests are required to exclude STIs.

Cited by 6 publications

References 41 publications

Genital Tract Infections in an Isolated Community: 100 Women of the Príncipe Island

Genital Tract Infections in an Isolated Community: 100 Women of the Príncipe Island

Aerobic Vaginitis Diagnosis Criteria Combining Gram Stain with Clinical Features: An Establishment and Prospective Validation Study

Infektionsmanagement bei drohender Frühgeburt – eine Umfrage an deutschen Perinatalzentren

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