State of the Art for Diagnosis of Bacterial Vaginosis

Muzny, Christina A.; Cerca, Nuno; Elnaggar, Jacob H.; Taylor, Christopher M.; Sobel, Jack D.; Pol, Barbara Van Der

doi:10.1128/jcm.00837-22

Cited by 11 publications

(16 citation statements)

References 95 publications

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“…We also cannot draw any inferences about the transmasculine BV positivity rate (22.2%) relative to cisgender women's rate (74.5%) since only 1.9% of transmasculine patients were tested compared to 17.3% of cisgender women. The low rate of testing for transmasculine patients may also be due asymptomatic presentation per the BV testing protocol; further, BV molecular diagnostic tests are only recommended for use in symptomatic females ( 1 ). Due to variable EHR documentation and lack of full criteria for definitive BV diagnostic approaches, we relied on molecular test orders and results as they were most frequently conducted and consistently reported.…”

Section: Discussionmentioning

confidence: 99%

“…Bacterial vaginosis (BV) is one of the most common reproductive tract infections, associated with non-optimal changes in the vaginal microbiome (VMB). It is characterized by a dominance of anaerobic bacteria and a reduction in Lactobacillus crispatus , which dominates an optimal VMB ( 1 ). Decreasing levels of endogenous estrogen are associated with BV ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

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Bacterial vaginosis testing gaps for transmasculine patients may exacerbate health disparities

Thompson,

Rusie,

Schneider

et al. 2024

Front. Reprod. Health

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IntroductionBacterial vaginosis (BV) is associated with non-optimal changes in the vaginal microbiome and increased susceptibility to STIs and HIV in cisgender women. Much less is known about the sexual health of transmasculine people and susceptibility to BV, STIs, and HIV. This study's objective was to assess BV testing and outcomes of transmasculine and cisgender women patient populations at a large, LGBTQ + federally qualified health center.MethodsRetrospective electronic health record data were extracted for eligible patients having at least one primary care visit between January 1, 2021, and December 31, 2021. Transmasculine patients were limited to those with a testosterone prescription in 2021. We conducted log binomial regression analysis to determine the probability of receiving a BV test based on gender identity, adjusting for sociodemographic characteristics.ResultsDuring 2021, 4,903 cisgender women patients and 1,867 transmasculine patients had at least one primary care visit. Compared to cisgender women, transmasculine patients were disproportionately young, White, queer, privately insured, living outside Chicago, and had a lower rate of BV testing (1.9% v. 17.3%, p < 0.001). Controlling for sociodemographics, transmasculine patients were less likely to receive a BV test [Prevalence Ratio = 0.19 (95% CI 0.13–0.27)].DiscussionThe low rate of BV testing among transmasculine patients may contribute to disparities in reproductive health outcomes. Prospective community- and provider-engaged research is needed to better understand the multifactorial determinants for sexual healthcare and gender-affirming care for transmasculine patients. In particular, the impact of exogenous testosterone on the vaginal microbiome should also be determined.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bacterial vaginosis testing gaps for transmasculine patients may exacerbate health disparities

Thompson,

Rusie,

Schneider

et al. 2024

Front. Reprod. Health

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“…More recently, a molecular diagnosis of BV has become available through the use of multiple commercially available nucleic acid amplification tests (NAATs) in symptomatic women, 41 all of which have excellent sensitivity and specificity. 42 However, more traditional methods of BV diagnosis (ie, Amsel criteria) remain useful due to their lower cost and ability to provide a rapid diagnosis. 41 Nevertheless, BV NAATs and even quantitative molecular methods (ie, quantitative polymerase chain reaction [qPCR]) have not yet facilitated or enhanced the clinical management of patients with recurrent BV as they are unable to predict prognosis in the symptomatic pre-treatment patient nor in the post-treatment asymptomatic patient.…”

Section: Diagnosismentioning

confidence: 99%

Understanding and Preventing Recurring Bacterial Vaginosis: Important Considerations for Clinicians

Muzny¹,

Sobel²

2023

IJWH

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Bacterial vaginosis (BV) is the most common vaginal infection worldwide. It is associated with an increased risk of acquisition of HIV and other sexually transmitted infections (STIs) as well as pelvic inflammatory disease and adverse birth outcomes. During BV, a polymicrobial biofilm forms on the surface of the vaginal mucosa. However, the exact etiology of BV remains controversial which has impeded significant advances in diagnosis, treatment, and prevention. Despite 30-day cure rates approaching 80% in BV-infected women treated with 7 days of oral metronidazole, recurrence within 12 months is common. This article provides a current review of the epidemiology, pathogenesis, diagnosis, and treatment of recurrent BV for practicing clinicians who commonly see women with this recurrent vaginal infection. Regarding management, we focus primarily on antimicrobial measures that may be effective. Future areas of research in this field are also discussed.

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“…5 Bacterial vaginosis can also be diagnosed using the Nugent score, a microscopic assessment of a Gram staining of the vaginal discharge, rarely performed at the point of care because it requires more time, trained personnel, and specialized equipment. 6,7 First-line treatments for BV are metronidazole and clindamycin. [8][9][10][11] Their 1-to 4-week cure rate is 55% to 90%, [12][13][14][15] but the recurrence rate within 6 months is 30% to 70%.…”

Section: Introductionmentioning

confidence: 99%

“…The clinical diagnosis of BV is based on the presence of at least 3 Amsel criteria: characteristic vaginal discharge; “fishy” smell, clue cells; and vaginal pH greater than 4.5 . Bacterial vaginosis can also be diagnosed using the Nugent score, a microscopic assessment of a Gram staining of the vaginal discharge, rarely performed at the point of care because it requires more time, trained personnel, and specialized equipment …”

Section: Introductionmentioning

confidence: 99%

Efficacy of Dequalinium Chloride vs Metronidazole for the Treatment of Bacterial Vaginosis

Raba,

Ďurkech,

Malík

et al. 2024

JAMA Netw Open

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ImportanceBacterial vaginosis (BV) is a common cause of vaginal infection. First-line treatments of BV are metronidazole and clindamycin. Due to the increase in antibiotic resistance, effective nonantibiotic treatments for BV are needed.ObjectiveTo examine whether dequalinium chloride, a broad-spectrum antiseptic, is noninferior to oral metronidazole for the treatment of BV.Design, Setting, and ParticipantsThis phase 4, multicenter, triple-blind, double-dummy, parallel, noninferiority randomized clinical trial was conducted from July 29, 2021, to August 25, 2022, with a 1-month follow-up. Participants were premenopausal women 18 years or older with BV from 11 gynecologic practices and 1 hospital in Poland, Slovakia, and the Czech.InterventionPatients were randomized to treatment with dequalinium chloride vaginal tablets (10 mg once daily for 6 days) or oral metronidazole (500 mg twice daily for 7 days). Double-dummy medication kits contained vaginal and oral tablets with placebo and active medication.Main Outcomes and MeasuresThe main outcome was the noninferiority margin (of 15 percentage points) in the absolute difference in clinical cure rates between dequalinium chloride and metronidazole 7 to 11 days after start of treatment (visit 1). Noninferiority was met if the lower 95% CI for the difference in clinical cure rate was less than 15 percentage points at visit 1.ResultsA total of 147 women (mean [SD] age, 36.7 [9.0] years) were treated with dequalinium chloride (n = 72) or metronidazole (n = 75). The clinical cure rates at visit 1 were 64 of 69 (92.8%) for dequalinium chloride vs 69 of 74 (93.2%) for metronidazole in the intention-to-treat population, whereas in the per-protocol population, cure rates were 54 of 58 (93.1%) for dequalinium chloride vs 48 of 53 (90.6%) for metronidazole. The treatment differences of −0.5 percentage points (95% CI, −10.8 to 9.8 percentage points; P = .002) in the intention-to-treat population and 2.5 percentage points (95% CI, −9.4 to 14.4 percentage points; P = .001) in the per-protocol population confirmed the noninferiority of dequalinium chloride. The tolerability of dequalinium chloride was rated as very good by 30 of 50 patients (60.0%) but only by 21 of 54 (38.9%) for metronidazole. Three patients in the metronidazole group suspended treatment due to an adverse event.Conclusions and RelevanceThis randomized clinical trial showed that dequalinium chloride was not inferior to metronidazole for the treatment of BV. Dequalinium chloride had a similarly high cure rate but with better tolerability and fewer adverse events. With a similar efficacy to metronidazole and clindamycin, dequalinium chloride warrants consideration as first-line treatment for BV to help reduce antibiotic consumption.Trial RegistrationEudraCT: 2020-002489-15

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State of the Art for Diagnosis of Bacterial Vaginosis

Cited by 11 publications

References 95 publications

Bacterial vaginosis testing gaps for transmasculine patients may exacerbate health disparities

Bacterial vaginosis testing gaps for transmasculine patients may exacerbate health disparities

Understanding and Preventing Recurring Bacterial Vaginosis: Important Considerations for Clinicians

Efficacy of Dequalinium Chloride vs Metronidazole for the Treatment of Bacterial Vaginosis

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