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Bacterial vaginosis in pregnancy: Evidence-based approaches
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
James A. McGregor, Michael W. McCullough
Gram stains of vaginal fluid are used in research settings to identify the shift from predominance of Lactobacillus morphotypes to predominance of coccobacillary morphotypes and gram-negative rods characteristic of bacterial vaginosis. The Gram-stain diagnosis involves quantitative estimations of these types of bacteria in the vaginal fluid (70–72). Normal vaginal fluid is described by a predominance of large gram-positive rods, considered Lactobacillus morphotypes, with or without smaller gram-variable bacilli, considered Gardnerella morphotypes (Fig. 2) (73). A pattern of mixed vaginal flora, which includes Gardnerella morphotypes, gram-negative rods, fusiforms, curved rods, gram-positive cocci, and absent or reduced numbers of Lactobacillus morphotypes (less than five per high-power field), is consistent with bacterial vaginosis (Fig. 3) (73). The current laboratory “gold standard” incorporates Gram stain using a scoring system, the most prevalent being the “Nugent scoring” system with a sensitivity of 89% and a specificity of 83% when compared with Amsel’s criteria (Fig. 4).
Knowledge Area 10: Gynaecological Problems
Published in Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth, Get Through MRCOG Part 1, 2020
Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth
There is an increase in vaginal pH as it is associated with a decrease in lactobacilli (responsible for maintaining the acidic pH) in the vagina. Wet mount saline preparation with vaginal discharge shows clue cells (vaginal epithelial cells have a stippled appearance due to adherence of coccobacilli) under low- and high-power microscopy. The drug used for treatment is metronidazole (single dose of 2 g or 7-day course of oral dose – 500 mg bd for 7 days). Metronidazole is contraindicated during early pregnancy. Topical clindamycin and metronidazole are also useful in returning the vaginal flora to normal.
Contraception provision
Published in Hilary Curtis, Tony Hoolaghan, Carey Jewitt, Sexual Health Promotion in General Practice, 2018
Hilary Curtis, Tony Hoolaghan, Carey Jewitt
Problems/protection against STDs: Kills all common STD infections in vitro. Modifies vaginal flora, leading to an increased risk of candida. Heavy users may get vaginitis and minor ulceration, increasing the risk of STD.
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
The sample size of the study groups was calculated with a calculated sample size for two proportions. For a comparison requiring sample size; 40% was considered as a relevant disease effect of RM for the proportion of decreased Lactobacillus spp. in vaginal/cervical microbiota, assuming a power of 0.80 and an alpha error of 0.05. The required sample size was 23, and our final sample size was 25 per group with a drop-out rate of 10%. Women were excluded from the study to enhance the expected significances, if they had used douches, vaginal medications or suppositories, feminine sprays, genital wipes, or contraceptive spermicides in the last month; if they were under treatment with systemic drugs, such as corticosteroids, antibiotics, and probiotics; if they were immunocompromised; if they were applied any intrauterine device within last 3 months; if they had an endometrial cavity–related lesions, a previous history of thrombosis, autoimmune or endocrine diseases, systemic infection, recent major surgery or trauma, alcohol consumption, and cigarette smoking, BMI more than 40, or diabetes mellitus; or if they had sexual activity for 3 days before microbiota sampling. The study participants had to be free of subjective vaginal complaints, including vaginal discharge and vulvar itching, vaginal bleeding, and clinical signs of vaginal infection, and they had to have a microscopically normal vaginal flora with direct microscopy.
The effects of human immunodeficiency virus, human papillomavirus, herpes simplex virus-1 and -2, human herpesvirus-6 and -8, cytomegalovirus, and hepatitis B and C virus on female fertility and pregnancy
Published in British Journal of Biomedical Science, 2021
Higher incidence of PID and tubo-ovarian abscesses among HIV+ve is another risk factor for infertility that significantly increased the risk of tubal diseases and infertility [30,31]. Several studies have shown how certain endocrinological effects of HIV status can influence the ovarian function. HIV+ve women are more likely to have changes in the menstrual cycle function, protracted anovulation, and prolonged amenorrhoea, which implies impaired ovarian function, and could be considered as potential causes of pregnancy failure [32,33]. A direct effect of HIV leading to pituitary-gonadal failure has also been proposed [34]. The strong association between HIV acquisition and vaginal flora abnormalities is another risk factor [35]. Several studies have demonstrated the high prevalence of STDs in HIV+ve women [36], so this group could be at risk for tubal disease and infertility
The Impact of the Microbiome on Immunosenescence
Published in Immunological Investigations, 2018
Daniel Amsterdam, Barbara E. Ostrov
The human gut microbiome is in a continuous developmental cycle. From the time the neonate leaves the protective environment of the uterus, or even before that during in-utero exposure, there is contact with a vast array of microbial species. In essence, the bacterial communities of newborn children almost immediately reflect the microbial community of the vagina or skin, depending on whether the child is born vaginally or via Caesarian section. Vaginally delivered newborns have bacterial communities overshadowed by vaginal flora such as Lactobacillus species. The dominant microbiota of newborns delivered by Caesarian section demonstrate skin flora such as Staphylococcus in their microbiota (Dominguez-Bello et al., 2010). Over time, the infant gut microbiota becomes more diverse due to ingestion of food, reflected by an increase in the number of Bacteroidetes (Dominguez-Bello et al., 2010). Modulating factors on the developing gut microbiome of infants includes exposure to antibiotics, hospital stays, milk regimens (formula versus breast milk), and the timing and composition of solid foods. However, these differences fade over time and the overall gut microbiota become relatively stable by about 3 years of age when the composition of the gut microbiome approximates that found in adults (Dominguez-Bello et al., 2010).