Screening for bacterial vaginosis in pregnancy21Reprints are available from the AHRQ Web site at www.ahrq.gov/clinic/uspstfix.htm, through the National Guideline Clearinghouse (www.guideline.gov), or in print through the AHRQ Clearinghouse (1-800-358-9295).22The U.S. Preventive Services Task Force recommendations based on this evidence review can be found in Screening for Bacterial Vaginosis in Pregnancy: Recommendations and Rationale, available elsewhere in this supplement, and from the AHRQ Web site and

Guíse, Jeanne Marie; Mahon, Susan M.; Aickin, Mikel; Helfand, Mark; Peipert, Jeffrey F.; Westhoff, Carolyn

doi:10.1016/s0749-3797(01)00256-2

Cited by 101 publications

(12 citation statements)

References 32 publications

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“…Whether or not screening for BV, prevents PTB remains to be debated [155,156,157]. While some recommend that treatment of BV reduces the risk of PTB, others report an increase in PTB following treatment for BV [158].…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, BVAB3 an anerobe prevalent in BV, was found to decrease the risk for PTB [133], a finding which may explain why come cases of BV may be involved in PTB and others not. Inconsistencies in clinical and laboratory detection methods used for the monitoring of treatment have a direct impact on success rates [76,83,155,159] thus complicating a comparison between the presence/absence of BV in PTB and full-term birth (FTB) [156]. Because different bacteria have different associations with Amsel diagnostic criteria, this may explain discrepancies often reported between Amsel criteria and microscopy [34].…”

Section: Discussionmentioning

confidence: 99%

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Anaerobes and Bacterial Vaginosis in Pregnancy: Virulence Factors Contributing to Vaginal Colonisation

Africa

Nel

Stemmet

2014

IJERPH

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The aetiology and pathogenesis of bacterial vaginosis (BV) is unclear but it appears to be associated with factors that disrupt the normal acidity of the vagina thus altering the equilibrium between the normal vaginal microbiota. BV has serious implications for female morbidity, including reports of pelvic inflammatory disease, adverse pregnancy outcomes, increased susceptibility to sexually transmitted infections and infertility. This paper reviewed new available information regarding possible factors contributing to the establishment of the BV vaginal biofilm, examined the proposed role of anaerobic microbial species recently detected by new culture-independent methods and discusses developments related to the effects of BV on human pregnancy. The literature search included Pubmed (NLM), LISTA (EBSCO), and Web of Science. Because of the complexity and diversity of population groups, diagnosis and methodology used, no meta-analysis was performed. Several anaerobic microbial species previously missed in the laboratory diagnosis of BV have been revealed while taking cognisance of newly proposed theories of infection, thereby improving our understanding and knowledge of the complex aetiology and pathogenesis of BV and its perceived role in adverse pregnancy outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anaerobes and Bacterial Vaginosis in Pregnancy: Virulence Factors Contributing to Vaginal Colonisation

Africa

Nel

Stemmet

2014

IJERPH

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“…(121), wherein three of the following four symptoms must be evident: 1) a homogenous, white, non-inflammatory discharge that smoothly coats the vaginal walls; 2) the presence of “clue” cells on microscopic examination (squamous epithelial cells covered with adherent bacteria); 3) a vaginal fluid pH over 4.5; and 4) a fishy odor of vaginal discharge before or after addition of 10% KOH (121). The reliability of the Amsel criteria have been subject to debate, particularly in reference to pregnancy given the increased vaginal discharge that is often experienced by pregnant women, and the variation of pH depending on how and where samples are taken (41). However, not all symptoms are observed in every case (56), and because the diagnosis is subjective, controversy persists about the definition of BV.…”

Section: Bacterial Vaginosismentioning

confidence: 99%

“…While the Nugent criteria are commonly used to assess BV, the scoring of specimens can be subjective. Nonetheless with a sensitivity of 89% and specificity of 83% (93) compared to Amsel criteria, the Nugent Gram-stain test remains the preferred diagnostic tool (41; 59) and it can be performed on self-collected vaginal smears (74), thus facilitating longitudinal field-based studies (14; 94). Interestingly, as much as 50% of all women with BV (as defined by Nugent score) are asymptomatic (4), which led to the use of the term “Nugent-score BV” (85).…”

Section: Bacterial Vaginosismentioning

confidence: 99%

Vaginal Microbiome: Rethinking Health and Disease

Forney

Ravel

2012

Annu. Rev. Microbiol.

589

484

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Vaginal microbiota form a mutually beneficial relationship with their host and have a major impact on health and disease. In recent years our understanding of vaginal bacterial community composition and structure has significantly broadened as a result of investigators using cultivation-independent methods based on the analysis of 16S ribosomal RNA (rRNA) gene sequences. In asymptomatic, otherwise healthy women, several kinds of vaginal microbiota exist, the majority often dominated by species of Lactobacillus, while others are composed of a diverse array of anaerobic microorganisms. Bacterial vaginosis is the most common vaginal condition and is vaguely characterized as the disruption of the equilibrium of the normal vaginal microbiota. A better understanding of normal and healthy vaginal ecosystems that is based on their true function and not simply on their composition would help better define health and further improve disease diagnostics as well as the development of more personalized regimens to promote health and treat diseases.

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“…124–133 Such efforts need to be revisited to focus both on clindamycin and early treatment. 86,87,134 …”

mentioning

confidence: 99%

Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis

Lamont¹,

Nhan-Chang²,

Sobel³

et al. 2011

American Journal of Obstetrics and Gynecology

161

139

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The purpose of this study was to determine whether the administration of clindamycin to women with abnormal vaginal flora at <22 weeks of gestation reduces the risk of preterm birth and late miscarriage. We conducted a systematic review and metaanalysis of randomized controlled trials of the early administration of clindamycin to women with abnormal vaginal flora at <22 weeks of gestation. Five trials that comprised 2346 women were included. Clindamycin that was administered at <22 weeks of gestation was associated with a significantly reduced risk of preterm birth at <37 weeks of gestation and late miscarriage. There were no overall differences in the risk of preterm birth at <33 weeks of gestation, low birthweight, very low birthweight, admission to neonatal intensive care unit, stillbirth, peripartum infection, and adverse effects. Clindamycin in early pregnancy in women with abnormal vaginal flora reduces the risk of spontaneous preterm birth at <37 weeks of gestation and late miscarriage. There is evidence to justify further randomized controlled trials of clindamycin for the prevention of preterm birth. However, a deeper understanding of the vaginal microbiome, mucosal immunity, and the biology of bacterial vaginosis will be needed to inform the design of such trials.

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Cited by 101 publications

References 32 publications

Anaerobes and Bacterial Vaginosis in Pregnancy: Virulence Factors Contributing to Vaginal Colonisation

Anaerobes and Bacterial Vaginosis in Pregnancy: Virulence Factors Contributing to Vaginal Colonisation

Vaginal Microbiome: Rethinking Health and Disease

Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis

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