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Metronidazole
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Bacterial vaginosis is a complex vaginal syndrome characterized by decreased lactobacilli and the overgrowth of facultative and strictly anaerobic bacteria, including G. vaginalis, Prevotella spp., Bacteroides spp., Mobiluncus spp., anaerobic Gram-positive cocci, genital mycoplasmas, and, more recently recognized, Atopobium vaginae (Eschenbach et al., 1989; Thorsen et al., 1998; Ferris et al., 2004; Sobel, 2005). The treatment of bacterial vaginosis has been extensively reviewed by Koumans et al. (2002). Many studies have shown that oral metronidazole is effective for the treatment of bacterial vaginosis (Balsdon et al., 1980; Spiegel, 1987; Koumans et al., 2002). In randomized studies evaluating the use of oral metronidazole 400 mg two or three times daily for 5–7 days, or 500 mg two or three times daily for 7–10 days, cure rates of 80–92% were achieved (Koumans et al., 2002). The CDC recommend an oral regimen of 500 mg twice daily for 7 days, or metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once daily for 5 days, or clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days (Workowski and Bolan, 2015). Alternative regimes include oral tinidazole or oral clindamycin or intravaginal clindamycin ovules.
Tissue structure and physiology of the vulva*
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Miranda A. Farage, Howard I. Maibach
Culture-independent methods have recently been applied to characterize vulvar microbiota. A pilot study in five women found a diverse microbiota on the vulva, including populations known to be commensals of the microbiota of the skin, colon, and vagina (69). A greater diversity of microbes inhabited the labia majora compared with the labia minora, although both sites had appreciable numbers of lactobacilli and strict anaerobes. No single species was common to all women. A study in 10 Japanese women compared the microbiota on the labia minora before and during menstruation. Twenty-two genera were represented (70). The genus Lactobacillus predominated in 7 out of the 10 women and Atopobium vaginae and Gardnerella vaginalis predominated in two others. Six of 10 women exhibited a significantly different profile of vulvar microbiota during menstruation.
Bacterial Vaginosis
Published in William J. Ledger, Steven S. Witkin, Vulvovaginal Infections, 2017
William J. Ledger, Steven S. Witkin
A repeated truism is that the vaginal bacterial microbiota of healthy women is maintained by the presence of H2O2-producing Lactobacilli.4 This seems implausible on its face. Think about it: how can hydrogen peroxide be a major protective player against infection when the vaginal environment of healthy women is anaerobic, with anaerobic bacteria outnumbering aerobes 10–1? Additional studies further refute a role for H2O2 in vaginal well-being. Gene amplification studies of the vaginal bacterial microbiome of healthy asymptomatic women have demonstrated that Lactobacillus iners is the most frequently identified Lactobacillus; and this Lactobacillus does not produce H2O2.5 In addition, a study from Johns Hopkins showed that the microcidal activity of H2O2 was dramatically reduced by both cervical vaginal secretions and the male ejaculate, again strongly emphasizing the implausibility that H2O2 plays a major role in maintaining vaginal health.6 Finally, nonculture studies also show that between 15% and 20% of healthy asymptomatic women lack vaginal Lactobacilli.7 Instead, vaginal health is apparently maintained by the presence of other bacteria that produce lactic acid, a key element in preventing disturbances of the bacterial ecosystem of the vagina. Make no mistake: the presence of abundant numbers of Lactobacilli nearly always equates with vaginal health, but their absence is not necessarily a sign of infection. That is precisely the point where the flawed Nugent criteria for the diagnosis of BV, based upon an evaluation of the gram stain of vaginal secretions that has led clinicians astray by its emphasis upon the absence of Lactobacilli and the presence of short rods.8 The introduction of this diagnostic template into clinical practice has created a new patient entity, asymptomatic BV, and has grossly inflated the estimates of the percentage of American women with BV to 29%.4 This flies in the face of clinical reality. Atopobium vaginae and Lactobacillus iners, both producers of lactic acid and associated with vaginal health, are short rods, usually indistinguishable on gram stain from Gardnerella vaginalis. In too many instances, the gram stain diagnosis of asymptomatic BV is being applied to healthy women.
Comparison of microbial profiles and viral status along the vagina-cervix-endometrium continuum of infertile patients
Published in Systems Biology in Reproductive Medicine, 2023
Mark Jain, Elena Mladova, Anna Dobychina, Karina Kirillova, Anna Shichanina, Daniil Anokhin, Liya Scherbakova, Larisa Samokhodskaya, Olga Panina
A comparison of the detection rates of each analyzed group or species of microorganisms and viruses is presented in Figure 2. Such pathogenic agents as Mycoplasma genitalium, Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, and Herpes simplex virus 2 were completely absent in all samples. Moreover, among 31 analyzed taxa 14 were detected in none of the studied samples. Therefore, only the remaining 17 taxa were subjected to further analysis. Paired cervical and vaginal samples differed significantly in the detection rates of 8/17 microorganisms (p < 0.05). At the same time, endometrium exhibited a quite distinct microbiological profile, being different (negatively) in the detection rates of 14/17 taxa (p < 0.05), except Candida spp. in which case significant differences were observed only compared to vaginal samples. Due to the generally lower microbiological diversity of the uterus, the detection of a certain taxon in the endometrium, but not in the lower parts of the reproductive tract, is of particular interest. In total, there were six cases fitting the above description: Cytomegalovirus (CMV) – 3 patients; Candida spp. – 1 patient; CMV + Candida spp. – 1 patient, Atopobium vaginae – 1 patient.
Derangements of vaginal and cervical canal microbiota determined with real-time PCR in women with recurrent miscarriages
Published in Journal of Obstetrics and Gynaecology, 2022
Canan Soyer Caliskan, Nazan Yurtcu, Samettin Celik, Ozlem Sezer, Suleyman Sirri Kilic, Ali Cetin
Table 2 includes the state of Enterobacterium spp., Streptococcus spp., Staphylococcus spp., Eubacterium spp., Sneathia spp./Leptotrihia spp./Fusobacterium spp., Megasphaera spp./Veilonella spp./Dialister spp., Lachnobacterium spp./Clostridium spp., Mobiluncus spp./Corynebacterium spp., Peptostreptococcus spp., and Atopobium vaginae in vaginal and cervical specimens obtained from healthy women and women with RM. Analyses of data regarding facultative anaerobic microorganisms related to AV revealed the following: (1) The rate of 1–10 and 10–100% total microorganisms detected (TMD) of Enterobacterium spp. in the vaginal and cervical specimens were significantly higher in women with RM compared with healthy women (76 vs. 28 and 72 vs. 28%, respectively; p < .05). (2) The rates of 1–10 and 10–100% TMD of Streptococcus spp. in the vaginal and cervical specimens obtained from healthy women and women with RM were found to be similar (Streptococcus spp.: 4 vs. 4 and 4 vs. 8%, respectively; p > .05). (3) The rates of 1–10 and 10–100% TMD of Staphylococcus spp. in the cervical specimens were significantly higher in women with RM compared with healthy women (20 vs. 12%; p < .05). However, the rates of 1–10 and 10–100% TMD of Staphylococcus spp. in the vaginal specimens obtained from healthy women and women with RM were found to be similar (0 vs. 0%, respectively; p > .05).