The Threat of Aerobic Vaginitis to Pregnancy and Neonatal Morbidity

Abstract

Aerobic vaginitis (AV) is an endogenous opportunistic infection brought about by the disruption of the normal vaginal microbiota. Its early diagnosis and treatment during pregnancy may reduce the risk of negative pregnancy outcomes. The aim of this review was to report on the aerobic bacteria most prevalent in AV and to provide evidence of the threat of untreated AV on pregnancy outcomes. More than 300 papers on preterm delivery were extracted from several research domains and filtered to include only AV-associated bacteria such as Staphylococcus aureus, Enterococcus faecalis, Escherichia coli and Group B streptococci and their association with adverse pregnancy outcomes. Due to the diverse sample groups, study techniques and outcomes, a meta-analysis was not conducted. The review revealed that the association of AV with adverse pregnancy outcomes has not been as widely researched as bacterial vaginosis (BV) and needs further investigation. Furthermore, the frequent misdiagnosis of AV coupled with the emerging antimicrobial resistance associated with bacteria implicated in AV and neonatal nosocomial infections pose a problem for prophylaxis and treatment to reduce the risk of maternal and neonatal morbidity and mortality. (Afr J Reprod Health 2017; 21[2]: 109-118). Keywords: Aerobic vaginitis; pregnancy risks; antimicrobial resistance RésuméLa vaginite aérobie (VA) est une infection opportuniste endogène provoquée par la perturbation du microbiota vaginal normal. Son diagnostic précoce et son traitement pendant la grossesse peuvent réduire le risque de résultats négatifs de grossesse. L'objectif de cette revue était de faire un rapport sur les bactéries aérobies les plus répandues en VA et de prouver la menace de la VA non traitée sur les résultats de la grossesse. Plus de 300 articles sur l'accouchement prématuré ont été tirés de plusieurs domaines de recherche et filtrés pour inclure uniquement des bactéries associées à la VA telles que Staphylococcus aureus, Enterococcus faecalis, Escherichia coli et streptocoques du groupe B et leur association avec des résultats de grossesse indésirables. En raison des divers groupes d'échantillons, des techniques d'étude et des résultats, une méta-analyse n'a pas été menée. L'examen a révélé que l'association de la VA avec les résultats de grossesse défavorisés n'a pas été aussi largement étudiée que la vaginose bactérienne (VB) et doit faire l'objet d'une enquête plus approfondie. En outre, le diagnostic erroné de la VA y compris la résistance antimicrobienne émergente associée à une bactérie impliquée dans les infections à vent et nonnéomatologiques constitue un problème pour la prophylaxie et le traitement afin de réduire le risque de morbidité et de mortalité maternelle et néonatale. (Afr J Reprod Health 2017; 21[2]: 109-118).

Does Aerobic Vaginitis Have Adverse Pregnancy Outcomes? Prospective Observational Study

“…Han et al found that pregnant women with AV were associated with a higher frequency for PROM (p < 0:05) [28]. Besides, a recent review article by Kaambo and Africa stated that even when asymptomatic, aerobic vaginitis may represent a risk factor for preterm delivery and PROM, ascending chorioamnionitis, and a neonatal mortality rate of 25%-90% because of congenital neonatal sepsis [29].…”

Vaginal Microbiomes Associated With Aerobic Vaginitis and Bacterial Vaginosis

“…Currently, GBS is considered to be the leading cause of early-onset sepsis worldwide ( 37 , 38 ). In addition, GBS and E. faecalis are associated with preterm birth, very low birth weight delivery, and puerperal sepsis, which cause substantial morbidity and mortality in sub-Saharan Africa ( 4 , 37 , 39 ).…”

“…Human vaginal infections are associated with significantly increased risk of preterm birth in women ( 3 , 4 ). If untreated, they can lead to pelvic inflammatory diseases (PID), which can cause tubal infertility, ectopic pregnancy, reproductive dysfunction, and adverse pregnancy outcomes (including preterm delivery and low birth weight) ( 3 , 4 ).…”

“…Human vaginal infections are associated with significantly increased risk of preterm birth in women ( 3 , 4 ). If untreated, they can lead to pelvic inflammatory diseases (PID), which can cause tubal infertility, ectopic pregnancy, reproductive dysfunction, and adverse pregnancy outcomes (including preterm delivery and low birth weight) ( 3 , 4 ). Vaginal infections may contribute to the progression of cervical dysplasia, increased risk of post-delivery infections, HIV, and herpes simplex virus-2 (HSV-2) acquisition and transmission ( 3 , 5 , 6 ).…”

Saccharomyces cerevisiae-Based Probiotics as Novel Antimicrobial Agents to Prevent and Treat Vaginal Infections

“…It is estimated that vaginal infections account for more than 10 million doctors' visits per year, and that 70% of episodes of vaginitis in premenopausal women are caused by bacterial vaginosis (BV) or vulvovaginal candidiasis (VVC; Anderson et al, 2004). Especially if untreated, these infections may cause serious complications of the upper genital tract (e.g., endometritis, salpingitis, and pelvic inflammatory disease) leading to tubal scarring, infertility, or ectopic pregnancies (Mulu et al, 2015;Kaambo and Africa, 2017). During pregnancy, they can increase the risk of preterm labor and low birth weight in the newborn (Guaschino et al, 2006).…”