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The Vaginal Microbiome
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Shahriar Mowla, Phillip R. Bennett, David A. MacIntyre
The vast majority of research on the pregnancy vaginal microbiome to date has been focused on understanding its relationship with preterm birth (110), which continues to be the leading cause of childhood mortality worldwide (111). Vaginal pathogen infection (112) or pathologies such as BV (113,114) and aerobic vaginitis (112) have long been recognized to increase preterm birth risk. As reviewed in detail elsewhere (110,115), recent application of metataxonomic profiling approaches in pregnancy have given new insights into the relationship between vaginal microbiota composition and preterm birth. Numerous studies across different global populations have now shown that in women of White ethnic backgrounds, there is a positive association between increased vaginal microbial diversity and risk of PTB (24,116–121). In contrast, studies of Black pregnant women have not shown any relationship between vaginal microbiota composition and preterm risk (122) or have reported decreased vaginal diversity in women who subsequently experience preterm birth (123,124). As mentioned earlier in this chapter, these findings suggest that the influence of ethnicity on the vaginal microbiota extends to its association with pathologies, including preterm birth.
Moxifloxacin
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
In a multicenter, prospective, randomized parallel-group study of 1156 women with uncomplicated pelvic inflammatory disease, 14 days of moxifloxacin (400 mg) was compared to ofloxacin (400 mg twice-daily) plus metronidazole (500 mg twice-daily). There were no differences in cure rates between both arms but drug-related adverse events were less in the moxifloxacin arm, as was cost, and compliance was higher with moxifloxacin (Asicioglu et al. 2013). In a recent small study of so-called aerobic vaginitis, a single 6-day course of moxifloxacin 400 mg daily was effective in most cases (Wang et al., 2016).
Cytolytic Vaginosis, Aerobic Vaginitis, and Desquamative Inflammatory Vaginitis
Published in William J. Ledger, Steven S. Witkin, Vulvovaginal Infections, 2017
William J. Ledger, Steven S. Witkin
Discussing three separate clinical syndromes—cytolytic vaginosis (CTV), aerobic vaginitis (AV), and desquamative inflammatory vaginitis (DIV)—in one chapter is an academic physician’s dream come true. These three entities are like peas in a pod, for they share the following characteristics: they all exhibit an abnormal overgrowth of vaginal bacteria, they are uncommon, and each mimics more familiar vaginal syndromes. Physician awareness of their existence will improve the medical care of women.
Miconazole for the treatment of vulvovaginal candidiasis. In vitro, in vivo and clinical results. Review of the literature
Published in Journal of Obstetrics and Gynaecology, 2023
Pedro Antonio Regidor, Manopchai Thamkhantho, Chenchit Chayachinda, Santiago Palacios
Dysbiosis of a vaginal ecosystem may lead to multiple concurrent diseases. Symptoms of vaginal candidiasis are also present in the more common bacterial vaginosis (Warren 2010). Aerobic vaginitis, an overgrowth of intravaginal aerobic flora causing severe inflammation, is distinct and should be excluded from the differential diagnosis (Donders et al.2002). In a 2002 study, only 33% of women who self-medicated for a yeast infection had such an infection, while most had bacterial vaginosis or a mixed-type infection (Ferris et al.2002).
Relationship between vaginal microecological changes and oncogene E6/E7 and high-risk human papillomavirus infection
Published in Journal of Obstetrics and Gynaecology, 2023
Jun Huang, Cunsi Yin, Junli Wang
Diagnostic criteria were as follows: (1) flora density: the number of bacteria in at least 10 visual fields was observed under the oil microscope, and observation results were documented as grades I (+) to grade IV (++++) according to the average number of bacteria in each visual field, which were 1–9, 10–99, more than 100, more than 1000 or covering all visual fields. (2) Flora diversity: the bacterial species in at least 10 visual fields were observed under the oil microscope, and the bacterial species in all visual fields were classified into grades I (+) to grade IV (++++), which were 1–3, 4–6, 7–9, and ≥10 species. (3) Pathogenic microorganisms: fungal mycelia, spores, trichomonas, and other pathogenic microorganisms were detected based on the microscope wet slide method. If any of the fungal spores and mycelia were identified, vulvovaginal candidiasis (VVC) could be subsequently diagnosed. Trichomonal vaginitis (TV) can be diagnosed if active trichomonas vaginalis is observed. The diagnosis of Aerobic vaginitis (AV) is determined using a wet mount microscopy, ideally by phase contrast (Donders et al. 2002). Based on parameters including inflammation presence, lactobacillary grade, toxic leucocyte proportion, microflora characteristics, and immature epithelial cell presence, the AV score is calculated (Donders et al. 2017). AV scoring criteria: 0–2 points for no AV, 3–4 points for mild AV, 5–6 points for moderate AV, and 7–10 points for severe AV (Vieira-Baptista et al. 2016). Bacterial vaginosis (BV): the BV was diagnosed by Gram staining Nugent score and was defined as normal (0–3 points), intermediate BV (4–6 points), and BV (≥7 points). All results were independently evaluated and the Nugent and AV scores were given by two experienced cell counting experts, and the final results were estimated by mutual agreement (Donders 2010).
Pharmacotherapy for the treatment of vaginal atrophy
Published in Expert Opinion on Pharmacotherapy, 2019
Gilbert G. G. Donders, Kateryna Ruban, Gert Bellen, Svitrigaile Grinceviciene
Diagnosing only based on patient-reported symptoms, however, can be misleading and more serious alternative diagnoses should be ruled out. Besides hypo-estrogenemia-related, other types of dyspareunia or vulvodynia may occur [56,57]. Vulvovaginal symptoms can indicate infections such as bacterial vaginosis (BV) or aerobic vaginitis (AV) [58]. Also, several important dermatoses or high-grade squamous intraepithelial or neoplastic lesions of the vulva could be missed, unless proper examination with or without biopsy is performed [49,59].