Bacterial vaginosis

Last updated

Bacterial vaginosis
Other namesAnaerobic vaginositis, non-specific vaginitis, vaginal bacteriosis, Gardnerella vaginitis [1]
Normal vaginal flora versus bacterial vaginosis on Pap stain.jpg
Vaginal squamous cell with normal vaginal flora versus bacterial vaginosis on Pap stain. Normal vaginal flora (left) is predominantly rod-shaped Lactobacilli whereas in bacterial vaginosis (right) there is an overgrowth of bacteria which can be of multiple species.
Specialty Gynecology, infectious disease
Symptoms Vaginal discharge that often smells like fish, burning with urination [2]
Complications Early delivery among pregnant women [3]
CausesImbalance of the naturally occurring bacteria in the vagina [4] [5]
Risk factors Douching, new or multiple sex partners, antibiotics, using an intrauterine device [5]
Diagnostic method Testing the vaginal discharge [6]
Differential diagnosis Vaginal yeast infection, infection with Trichomonas [7]
Prevention Probiotics [6]
Medication Clindamycin or metronidazole [6]
Frequency~ 5% to 70% of women [8]

Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria. [6] [9] Common symptoms include increased vaginal discharge that often smells like fish. [2] The discharge is usually white or gray in color. [2] Burning with urination may occur. [2] Itching is uncommon. [2] [6] Occasionally, there may be no symptoms. [2] Having BV approximately doubles the risk of infection by a number of sexually transmitted infections, including HIV/AIDS. [8] [10] It also increases the risk of early delivery among pregnant women. [3] [11]

Contents

BV is caused by an imbalance of the naturally occurring bacteria in the vagina. [4] [5] There is a change in the most common type of bacteria and a hundred to thousand fold increase in total numbers of bacteria present. [6] Typically, bacteria other than Lactobacilli become more common. [12] Risk factors include douching, new or multiple sex partners, antibiotics, and using an intrauterine device, among others. [5] However, it is not considered a sexually transmitted infection and, unlike gonorrhoea and chlamydia, sexual partners are not treated. [13] Diagnosis is suspected based on the symptoms, and may be verified by testing the vaginal discharge and finding a higher than normal vaginal pH, and large numbers of bacteria. [6] BV is often confused with a vaginal yeast infection or infection with Trichomonas. [7]

Usually treatment is with an antibiotic, such as clindamycin or metronidazole. [6] These medications may also be used in the second or third trimesters of pregnancy. [6] However, the condition often recurs following treatment. [6] Probiotics may help prevent re-occurrence. [6] It is unclear if the use of probiotics or antibiotics affects pregnancy outcomes. [6] [14]

BV is the most common vaginal infection in women of reproductive age. [5] The percentage of women affected at any given time varies between 5% and 70%. [8] BV is most common in parts of Africa and least common in Asia and Europe. [8] In the United States about 30% of women between the ages of 14 and 49 are affected. [15] Rates vary considerably between ethnic groups within a country. [8] While BV-like symptoms have been described for much of recorded history, the first clearly documented case occurred in 1894. [1]

Signs and symptoms

Although about 50% of women with BV are asymptomatic, [16] common symptoms include increased vaginal discharge that usually smells like fish. The discharge is often white or gray in color. There may be burning with urination. Occasionally, there may be no symptoms. [2]

The discharge coats the walls of the vagina, and is usually without significant irritation, pain, or erythema (redness), although mild itching can sometimes occur. By contrast, the normal vaginal discharge will vary in consistency and amount throughout the menstrual cycle and is at its clearest at ovulation—about two weeks before the period starts. Some practitioners claim that BV can be asymptomatic in almost half of affected women, [17] though others argue that this is often a misdiagnosis. [18]

Complications

Although previously considered a mere nuisance infection, untreated bacterial vaginosis may cause increased susceptibility to sexually transmitted infections, including HIV, and pregnancy complications. [19] [20]

It has been shown that HIV-infected women with bacterial vaginosis (BV) are more likely to transmit HIV to their sexual partners than those without BV. [10] There is evidence of an association between BV and increased rates of sexually transmitted infections such as HIV/AIDS. [19] BV is associated with up to a six-fold increase in HIV shedding. BV is a risk factor for viral shedding and herpes simplex virus type 2 infection. BV may increase the risk of infection with or reactivation of human papillomavirus (HPV). [19] [21]

In addition, bacterial vaginosis as either pre-existing, or acquired, may increase the risk of pregnancy complications, most notably premature birth or miscarriage. [22] [23] Pregnant women with BV have a higher risk of chorioamnionitis, miscarriage, preterm birth, premature rupture of membranes, and postpartum endometritis. [24] Women with BV who are treated with in vitro fertilization have a lower implantation rate and higher rates of early pregnancy loss. [19] [21]

Causes

Healthy vaginal microbiota consists of species that neither cause symptoms or infections, nor negatively affect pregnancy. It is dominated mainly by Lactobacillus species. [12] [25] BV is defined by the disequilibrium in the vaginal microbiota, with decline in the number of lactobacilli. While the infection involves a number of bacteria, it is believed that most infections start with Gardnerella vaginalis creating a biofilm, which allows other opportunistic bacteria, such as Prevotella and Bacteroides , to thrive. [26] [9] [27]

One of the main risks for developing BV is douching, which alters the vaginal microbiota and predisposes women to developing BV. [28] Douching is strongly discouraged by the U.S. Department of Health and Human Services and various medical authorities, for this and other reasons. [28]

BV is a risk factor for pelvic inflammatory disease, HIV, sexually transmitted infections (STIs), endometriosis, and reproductive and obstetric disorders or negative outcomes. Although BV can be associated with sexual activity, there is no clear evidence of sexual transmission. [26] [29] [30] It is possible for sexually inactive persons to develop bacterial vaginosis. [29] [9]

Also, subclinical iron deficiency may correlate with bacterial vaginosis in early pregnancy. [31] A longitudinal study published in February 2006, in the American Journal of Obstetrics and Gynecology, showed a link between psychosocial stress and bacterial vaginosis persisted even when other risk factors were taken into account. [32] Exposure to the spermicide nonoxynol-9 does not affect the risk of developing bacterial vaginosis. [33]

Diagnosis

Phase contrast microscopy of clue cells in a vaginal swab Clue cells in bacterial vaginosis.jpg
Phase contrast microscopy of clue cells in a vaginal swab
A pH indicator to detect vaginal alkalinization (here showing approximately pH 8), and a microscope slide to microscopically detect clue cells Bacterial vaginosis workup.jpg
A pH indicator to detect vaginal alkalinization (here showing approximately pH 8), and a microscope slide to microscopically detect clue cells
Gram stain of cells from the vagina (the same magnification) with normal bacterial flora (top) and the bacteria that cause vaginosis (bottom). Normal and BV flora.jpg
Gram stain of cells from the vagina (the same magnification) with normal bacterial flora (top) and the bacteria that cause vaginosis (bottom).

To make a diagnosis of bacterial vaginosis, a swab from inside the vagina should be obtained. These swabs can be tested for:

Differential diagnosis for bacterial vaginosis includes the following: [35]

The Center for Disease Control (CDC) defines STIs as "a variety of clinical syndromes and infections caused by pathogens that can be acquired and transmitted through sexual activity." [37] But the CDC does not specifically identify BV as sexually transmitted infection. [13]

Amsel criteria

In clinical practice BV can be diagnosed using the Amsel criteria: [38]

  1. Thin, white, yellow, homogeneous discharge
  2. Clue cells on microscopy
  3. pH of vaginal fluid >4.5
  4. Release of a fishy odor on adding alkali—10% potassium hydroxide (KOH) solution.

At least three of the four criteria should be present for a confirmed diagnosis. [39] A modification of the Amsel criteria accepts the presence of two instead of three factors and is considered equally diagnostic. [40]

Gram stain

An alternative is to use a Gram-stained vaginal smear, with the Hay/Ison [41] criteria or the Nugent [24] criteria. The Hay/Ison criteria are defined as follows: [39]

Gardnerella vaginalis is the main culprit in BV. Gardnerella vaginalis is a short, Gram-variable rod (coccobacillus). Hence, the presence of clue cells and gram variable coccobacilli are indicative or diagnostic of bacterial vaginosis. [42]

Nugent score

The Nugent score is now rarely used by physicians due to the time it takes to read the slides and requires the use of a trained microscopist. [4] A score of 0–10 is generated from combining three other scores. The scores are as follows: [24]

At least 10–20 high power (1000× oil immersion) fields are counted and an average determined. [43]

Lactobacillus morphotypes – average per high powered (1000× oil immersion) field. View multiple fields.

Gardnerella / Bacteroides morphotypes – average per high powered (1000× oil immersion) field. View multiple fields.

Curved Gram variable rods – average per high powered (1000× oil immersion) field. View multiple fields (note that this factor is less important – scores of only 0–2 are possible)

  • Score 0 for >30
  • Score 1 for 15–30
  • Score 2 for 14
  • Score 3 for <1 (this is an average, so results can be >0, yet <1)
  • Score 4 for 0
  • Score 0 for 0
  • Score 1 for <1 (this is an average, so results can be >0, yet <1)
  • Score 2 for 1–4
  • Score 3 for 5–30
  • Score 4 for >30

DNA hybridization testing with Affirm VPIII was compared to the Gram stain using the Nugent criteria. [44] The Affirm VPIII test may be used for the rapid diagnosis of BV in symptomatic women but uses expensive proprietary equipment to read results, and does not detect other pathogens that cause BV, including Prevotella spp, Bacteroides spp, and Mobiluncus spp. [45] The cervicovaginal microbiome measured using 16S rRNA sequencing has the capacity to increase throughput of the Nugent Score and has demonstrate to be directly comparable to clinical Nugent Score measurement. [46]

Screening

Screening during pregnancy is not recommended in the United States as of 2020 because " the US Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for bacterial vaginosis in pregnant persons at increased risk for preterm delivery". [47]

Prevention

Some steps suggested to lower the risk include: not douching, avoiding sex, or limiting the number of sex partners. [48]

One review concluded that probiotics may help prevent re-occurrence. [6] Another review found that, while there is tentative evidence, it is not strong enough to recommend their use for this purpose. [49]

Early evidence suggested that antibiotic treatment of male partners could re-establish the normal microbiota of the male urogenital tract and prevent the recurrence of infection. [19] However, a 2016 Cochrane review found high-quality evidence that treating the sexual partners of women with bacterial vaginosis had no effect on symptoms, clinical outcomes, or recurrence in the affected women. It also found that such treatment may lead treated sexual partners to report increased adverse events. [19]

Treatment

Antibiotics

Treatment is typically with the antibiotics metronidazole or clindamycin. [50] They can be either given by mouth or applied inside the vagina with similar efficacy. [16] [50] About 10% to 15% of people, however, do not improve with the first course of antibiotics and recurrence rates of up to 80% have been documented. [21] Recurrence rates are increased with sexual activity with the same pre-/posttreatment partner and inconsistent condom use although estrogen-containing contraceptives decrease recurrence. [51] When clindamycin is given to pregnant women symptomatic with BV before 22 weeks of gestation the risk of pre-term birth before 37 weeks of gestation is lower. [52]

Other antibiotics that may work include macrolides, lincosamides, nitroimidazoles, and penicillins. [19]

Bacterial vaginosis is not considered a sexually transmitted infection, and treatment of a male sexual partner of a woman with bacterial vaginosis is not recommended. [53] [54]

Probiotics

A 2009 Cochrane review found tentative but insufficient evidence for probiotics as a treatment for BV. [21] A 2014 review reached the same conclusion. [55] A 2013 review found some evidence supporting the use of probiotics during pregnancy. [56] The preferred probiotics for BV are those containing high doses of lactobacilli (around 109 CFUs Tooltip Colony-forming units) given in the vagina. [57] Intravaginal administration is preferred to taking them by mouth. [57] Prolonged repetitive courses of treatment appear to be more promising than short courses. [57]

The lack of effectiveness of commercially available Lactobacillus probiotics may be because most do not actually contain vaginal lactobacilli strains. [58] LACTIN-V is a live biopharmaceutical medication containing the vaginally important Lactobacillus crispatus which is under development for the treatment of bacterial vaginosis and recurrent urinary tract infections. [58] [59] [60] It has shown initial effectiveness in considerably reducing recurrence of bacterial vaginosis following antibiotic treatment. [58] [60] LACTIN-V is not yet Food and Drug Administration (FDA)-approved or commercially available. [60] [59]

Antiseptics

Topical antiseptics, for example dequalinium chloride, policresulen, hexetidine or povidone-iodine vaginal suppositories may be applied, if the risk of ascending infections is low (outside of pregnancy and in immunocompetent people without histories of upper genital tract infections). [61] One study found that vaginal irrigations with hydrogen peroxide (3%) resulted in a slight improvement but this was much less than with the use of oral metronidazole. [62] Intravaginal boric acid in conjunction with other medications may be helpful in the treatment of recurrent BV. [60] [63] TOL-463, a formulation of boric acid enhanced with ethylenediaminetetraacetic acid (EDTA), is under development as an intravaginal medication for the treatment of BV and has shown preliminary effectiveness. [64] [63] [65] [66]

Epidemiology

BV is the most common infection of the vagina in women of reproductive age. [5] The percentage of women affected at any given time varies between 5% and 70%. [8] BV is most common in parts of Africa, and least common in Asia and Europe. [8] In the United States, about 30% of those between the ages of 14 and 49 are affected. [15] Rates vary considerably between ethnic groups within a country. [8]

Related Research Articles

<span class="mw-page-title-main">Pelvic inflammatory disease</span> Infection of uterus, fallopian tubes, ovaries or the inner surface of pelvis

Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

<span class="mw-page-title-main">Trichomoniasis</span> Medical condition

Trichomoniasis (trich) is an infectious disease caused by the parasite Trichomonas vaginalis. About 70% of affected people do not have symptoms when infected. When symptoms occur, they typically begin 5 to 28 days after exposure. Symptoms can include itching in the genital area, a bad smelling thin vaginal discharge, burning with urination, and pain with sex. Having trichomoniasis increases the risk of getting HIV/AIDS. It may also cause complications during pregnancy.

<i>Gardnerella vaginalis</i> Species of bacterium

Gardnerella vaginalis is a species of Gram-variable-staining facultative anaerobic bacteria. The organisms are small non-spore-forming, nonmotile coccobacilli.

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.

<span class="mw-page-title-main">Vaginal discharge</span> Medical condition

Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain. While most discharge is considered physiologic or represents normal functioning of the body, some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections, bacterial vaginosis, and sexually transmitted infections. The characteristics of abnormal vaginal discharge vary depending on the cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse.

<span class="mw-page-title-main">Clue cell</span> Epithelial cell of the human vagina that is covered with bacteria

Clue cells are epithelial cells of the vagina that get their distinctive stippled appearance by being covered with bacteria. The etymology behind the term "clue" cell derives from the original research article from Gardner and Dukes describing the characteristic cells. The name was chosen for its brevity in describing the sine qua non of bacterial vaginosis.

<span class="mw-page-title-main">Aposymbiosis</span>

Aposymbiosis occurs when symbiotic organisms live apart from one another. Studies have shown that the lifecycles of both the host and the symbiont are affected in some way, usually negative, and that for obligate symbiosis the effects can be drastic. Aposymbiosis is distinct from exsymbiosis, which occurs when organisms are recently separated from a symbiotic association. Because symbionts can be vertically transmitted from parent to offspring or horizontally transmitted from the environment, the presence of an aposymbiotic state suggests that transmission of the symbiont is horizontal. A classical example of a symbiotic relationship with an aposymbiotic state is the Hawaiian bobtail squid Euprymna scolopes and the bioluminescent bacteria Vibrio fischeri. While the nocturnal squid hunts, the bacteria emit light of similar intensity of the moon which camouflages the squid from predators. Juveniles are colonized within hours of hatching and Vibrio must outcompete other bacteria in the seawater through a system of recognition and infection.

<span class="mw-page-title-main">Vaginal flora</span> Microorganisms present in the vagina

Vaginal flora, vaginal microbiota or vaginal microbiome are the microorganisms that colonize the vagina. They were discovered by the German gynecologist Albert Döderlein in 1892 and are part of the overall human flora. The amount and type of bacteria present have significant implications for an individual's overall health. The primary colonizing bacteria of a healthy individual are of the genus Lactobacillus, such as L. crispatus, and the lactic acid they produce is thought to protect against infection by pathogenic species.

A vaginal disease is a pathological condition that affects part or all of the vagina.

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

<span class="mw-page-title-main">Vaginal yeast infection</span> Medical condition

Vaginal yeast infection, also known as candidal vulvovaginitis and vaginal thrush, is excessive growth of yeast in the vagina that results in irritation. The most common symptom is vaginal itching, which may be severe. Other symptoms include burning with urination, a thick, white vaginal discharge that typically does not smell bad, pain during sex, and redness around the vagina. Symptoms often worsen just before a woman's period.

Lactobacillus crispatus is a common, rod-shaped species of genus Lactobacillus and is a hydrogen peroxide (H2O2) producing beneficial microbiota species located in both the vagina, through vaginal discharge, and the vertebrate gastrointestinal tract. The strain CTV-05 is used as a probiotic that can be used by premenopausal and postmenopausal women that experience recurrent urinary tract infections. It is being evaluated specifically for the prevention and treatment of bacterial vaginosis, which is characterized by the absence of Lactobacillus flora necessary to protect the host from infection.

The vaginal flora in pregnancy, or vaginal microbiota in pregnancy, is different from the vaginal flora before sexual maturity, during reproductive years, and after menopause. A description of the vaginal flora of pregnant women who are immunocompromised is not covered in this article. The composition of the vaginal flora significantly differs in pregnancy. Bacteria or viruses that are infectious most often have no symptoms.

<span class="mw-page-title-main">Aerobic vaginitis</span> Medical condition

Aerobic vaginitis (AV) is a form of vaginitis first described by Donders et al. in 2002. It is characterized by a more or less severe disruption of the lactobacillary flora, along with inflammation, atrophy, and the presence of a predominantly aerobic microflora, composed of enteric commensals or pathogens.

<span class="mw-page-title-main">Lactobacillus vaccine</span> Vaccine using an inactivated strain of Lactobacillus

Lactobacillus vaccines are used in the therapy and prophylaxis of non-specific bacterial vaginitis and trichomoniasis. The vaccines consist of specific inactivated strains of Lactobacilli, called "aberrant" strains in the relevant literature dating from the 1980s. These strains were isolated from the vaginal secretions of patients with acute colpitis. The lactobacilli in question are polymorphic, often shortened or coccoid in shape and do not produce an acidic, anti-pathogenic vaginal environment. A colonization with aberrant lactobacilli has been associated with an increased susceptibility to vaginal infections and a high rate of relapse following antimicrobial treatment. Intramuscular administration of inactivated aberrant lactobacilli provokes a humoral immune response. The production of specific antibodies both in serum and in the vaginal secretion has been demonstrated. As a result of the immune stimulation, the abnormal lactobacilli are inhibited, the population of normal, rod-shaped lactobacilli can grow and exert its defense functions against pathogenic microorganisms.

Limosilactobacillus vaginalis is a lactic acid bacterium that is a normal, but infrequent part of the vaginal microbiome.

LACTIN-V, also known as CTV-05 or as Lactobacillus crispatus CTV-05, is a live biopharmaceutical medication containing a strain of Lactobacillus crispatus (L. crispatus) which is under development for the treatment of urinary tract infections (UTIs) and bacterial vaginosis (BV). It is administered intravaginally and is described as the first vaginal microbiome (VMB)-based live biotherapeutic product (LBP). Depletion of hydrogen peroxide (H2O2)-producing Lactobacillus strains such as Lactobacillus crispatus in the vagina has been strongly associated with BV and UTIs. Most commercially available probiotic Lactobacillus strains are not vaginal strains and do not appear to improve vaginal or urinary health outcomes. The Centers for Disease Control and Prevention (CDC)'s Sexually Transmitted Infections Treatment Guidelines (2021) noted that intravaginal LACTIN-V produced a considerably lower recurrence of BV following initial antibiotic treatment with metronidazole in a randomized controlled trial. However, the guidelines also noted that LACTIN-V is not yet Food and Drug Administration (FDA)-approved or commercially available. As of December 2021, LACTIN-V is in phase 2/3 clinical trials for the treatment of UTIs and is in phase 2 trials for the treatment of BV. It was originated by GyneLogix and is under development by Osel Inc., the National Institute of Allergy and Infectious Diseases, and other organizations.

<span class="mw-page-title-main">TOL-463</span> Combination drug

TOL-463 is an anti-infective medication which is under development for the treatment of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC). It is a boric acid-based vaginal anti-infective enhanced with ethylenediaminetetraacetic acid (EDTA) which was designed to have improved activity against vaginal bacterial and fungal biofilms while sparing protective lactobacilli. EDTA enhances the antimicrobial activity of boric acid and improves its efficacy against relevant biofilms. In a small phase 2 randomized controlled trial, TOL-463 as an insert or gel achieved clinical cure rates of 50–59% against BV and 81–92% against VVC in women who had one or both conditions. It was effective and safe in the study, though it was without indication of superiority over other antifungal medications for VVC. The cure rates against BV with TOL-463 were said to be comparable to those with recently approved antibiotic treatments like single-dose oral secnidazole (58%) and single-dose metronidazole vaginal gel (41%). As of May 2019, TOL-463 is in phase 2 clinical trials for the treatment of BV and VVC. It was originated by Toltec Pharmaceuticals and is under development by Toltec Pharmaceuticals and the National Institute of Allergy and Infectious Diseases.

References

  1. 1 2 Borchardt KA (1997). Sexually transmitted diseases: epidemiology, pathology, diagnosis, and treatment. Boca Raton [u.a.]: CRC Press. p. 4. ISBN   9780849394768. Archived from the original on 10 September 2017.
  2. 1 2 3 4 5 6 7 "What are the symptoms of bacterial vaginosis?". 21 May 2013. Archived from the original on 2 April 2015. Retrieved 3 March 2015.
  3. 1 2 Queena JT, Spong CY, Lockwood CJ, eds. (2012). Queenan's management of high-risk pregnancy: an evidence-based approach (6th ed.). Chichester, West Sussex: Willey-Blackwell. p. 262. ISBN   9780470655764.
  4. 1 2 3 Bennett J (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN   9781455748013.
  5. 1 2 3 4 5 6 "Bacterial Vaginosis (BV): Condition Information". National Institute of Child Health and Human Development. 21 May 2013. Archived from the original on 2 April 2015. Retrieved 3 March 2015.
  6. 1 2 3 4 5 6 7 8 9 10 11 12 13 Donders GG, Zodzika J, Rezeberga D (April 2014). "Treatment of bacterial vaginosis: what we have and what we miss". Expert Opinion on Pharmacotherapy. 15 (5): 645–57. doi:10.1517/14656566.2014.881800. PMID   24579850. S2CID   19241611.
  7. 1 2 Mashburn J (2006). "Etiology, diagnosis, and management of vaginitis". Journal of Midwifery & Women's Health. 51 (6): 423–30. doi: 10.1016/j.jmwh.2006.07.005 . PMID   17081932.
  8. 1 2 3 4 5 6 7 8 Kenyon C, Colebunders R, Crucitti T (December 2013). "The global epidemiology of bacterial vaginosis: a systematic review". American Journal of Obstetrics and Gynecology. 209 (6): 505–23. doi:10.1016/j.ajog.2013.05.006. PMID   23659989.
  9. 1 2 3 Sharma H, Tal R, Clark NA, Segars JH (January 2014). "Microbiota and pelvic inflammatory disease". Seminars in Reproductive Medicine. 32 (1): 43–9. doi:10.1055/s-0033-1361822. PMC   4148456 . PMID   24390920.
  10. 1 2 Bradshaw CS, Brotman RM (July 2015). "Making inroads into improving treatment of bacterial vaginosis - striving for long-term cure". BMC Infectious Diseases. 15: 292. doi: 10.1186/s12879-015-1027-4 . PMC   4518586 . PMID   26219949.
  11. ↑ "What are the treatments for bacterial vaginosis (BV)?". National Institute of Child Health and Human Development. 15 July 2013. Archived from the original on 2 April 2015. Retrieved 4 March 2015.
  12. 1 2 Nardis C, Mosca L, Mastromarino P (September–October 2013). "Vaginal microbiota and viral sexually transmitted diseases". Annali di Igiene. 25 (5): 443–56. doi:10.7416/ai.2013.1946. PMID   24048183.
  13. 1 2 "Bacterial Vaginosis – CDC Fact Sheet". Centers for Disease Control and Prevention. 11 March 2014. Archived from the original on 28 February 2015. Retrieved 2 March 2015.
  14. ↑ Othman M, Neilson JP, Alfirevic Z (January 2007). "Probiotics for preventing preterm labour". The Cochrane Database of Systematic Reviews. 2012 (1): CD005941. doi:10.1002/14651858.CD005941.pub2. PMC   9006117 . PMID   17253567.
  15. 1 2 "Bacterial Vaginosis (BV) Statistics Prevalence". cdc.gov. 14 September 2010. Archived from the original on 22 February 2015. Retrieved 3 March 2015.
  16. 1 2 Tidbury FD, Langhart A, Weidlinger S, Stute P (January 2021). "Non-antibiotic treatment of bacterial vaginosis-a systematic review". Archives of Gynecology and Obstetrics. 303 (1): 37–45. doi:10.1007/s00404-020-05821-x. PMID   33025086. S2CID   222149236.
  17. ↑ Schwebke JR (December 2000). "Asymptomatic bacterial vaginosis: response to therapy". American Journal of Obstetrics and Gynecology. 183 (6): 1434–9. doi:10.1067/mob.2000.107735. PMID   11120507.
  18. ↑ Forney LJ, Foster JA, Ledger W (November 2006). "The vaginal flora of healthy women is not always dominated by Lactobacillus species". The Journal of Infectious Diseases. 194 (10): 1468–9, author reply 1469–70. doi: 10.1086/508497 . PMID   17054080.
  19. 1 2 3 4 5 6 7 Amaya-Guio J, Viveros-Carreño DA, Sierra-Barrios EM, Martinez-Velasquez MY, Grillo-Ardila CF (October 2016). "Antibiotic treatment for the sexual partners of women with bacterial vaginosis". The Cochrane Database of Systematic Reviews. 2016 (10): CD011701. doi:10.1002/14651858.CD011701.pub2. PMC   6458027 . PMID   27696372.
  20. ↑ "STD Facts — Bacterial Vaginosis (BV)". CDC. Archived from the original on 3 December 2007. Retrieved 4 December 2007.
  21. 1 2 3 4 Senok AC, Verstraelen H, Temmerman M, Botta GA (October 2009). "Probiotics for the treatment of bacterial vaginosis". The Cochrane Database of Systematic Reviews (4): CD006289. doi:10.1002/14651858.CD006289.pub2. PMID   19821358.
  22. ↑ "Bacterial vaginosis". National Health Service, UK. Archived from the original on 9 February 2014. Retrieved 3 October 2013.
  23. ↑ Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, Martin DH, et al. (December 1995). "Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group". The New England Journal of Medicine. 333 (26): 1737–42. doi: 10.1056/NEJM199512283332604 . PMID   7491137.
  24. 1 2 3 Nugent RP, Krohn MA, Hillier SL (February 1991). "Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation". Journal of Clinical Microbiology. 29 (2): 297–301. doi:10.1128/JCM.29.2.297-301.1991. PMC   269757 . PMID   1706728.
  25. ↑ Petrova MI, Lievens E, Malik S, Imholz N, Lebeer S (2015). "Lactobacillus species as biomarkers and agents that can promote various aspects of vaginal health". Frontiers in Physiology. 6: 81. doi: 10.3389/fphys.2015.00081 . PMC   4373506 . PMID   25859220.
  26. 1 2 Jiang I, Yong PJ, Allaire C, Bedaiwy MA (May 2021). "Intricate Connections between the Microbiota and Endometriosis". International Journal of Molecular Sciences. 22 (11): 5644. doi: 10.3390/ijms22115644 . PMC   8198999 . PMID   34073257.
  27. ↑ Patterson JL, Stull-Lane A, Girerd PH, Jefferson KK (February 2010). "Analysis of adherence, biofilm formation and cytotoxicity suggests a greater virulence potential of Gardnerella vaginalis relative to other bacterial-vaginosis-associated anaerobes". Microbiology. 156 (Pt 2): 392–399. doi: 10.1099/mic.0.034280-0 . PMC   2890091 . PMID   19910411.
  28. 1 2 Cottrell BH (2010). "An updated review of evidence to discourage douching". MCN: The American Journal of Maternal/Child Nursing. 35 (2): 102–7, quiz 108–9. doi:10.1097/NMC.0b013e3181cae9da. PMID   20215951. S2CID   46715131.
  29. 1 2 Ali A, Jørgensen JS, Lamont RF (2022). "The contribution of bacteriophages to the aetiology and treatment of the bacterial vaginosis syndrome". Faculty Reviews. 11: 8. doi: 10.12703/r/11-8 . PMC   9022730 . PMID   35509673.
  30. ↑ Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB, Moss LM, Horvath LB, Kuzevska I, Fairley CK (2006). "High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence". J. Infect. Dis. 193 (11): 1478–86. doi: 10.1086/503780 . PMID   16652274. S2CID   24440932.
  31. ↑ Verstraelen H, Delanghe J, Roelens K, Blot S, Claeys G, Temmerman M (July 2005). "Subclinical iron deficiency is a strong predictor of bacterial vaginosis in early pregnancy". BMC Infectious Diseases. 5 (1): 55. doi: 10.1186/1471-2334-5-55 . PMC   1199597 . PMID   16000177.
  32. ↑ Nansel TR, Riggs MA, Yu KF, Andrews WW, Schwebke JR, Klebanoff MA (February 2006). "The association of psychosocial stress and bacterial vaginosis in a longitudinal cohort". American Journal of Obstetrics and Gynecology. 194 (2): 381–6. doi:10.1016/j.ajog.2005.07.047. PMC   2367104 . PMID   16458633.
  33. ↑ Wilkinson D, Ramjee G, Tholandi M, Rutherford G (2002). "Nonoxynol-9 for preventing vaginal acquisition of sexually transmitted infections by women from men". The Cochrane Database of Systematic Reviews (4): CD003939. doi:10.1002/14651858.CD003939. PMID   12519623.
  34. ↑ Muzny CA, Kardas P (July 2020). "A Narrative Review of Current Challenges in the Diagnosis and Management of Bacterial Vaginosis". Sexually Transmitted Diseases. 47 (7): 441–446. doi:10.1097/OLQ.0000000000001178. PMC   7294746 . PMID   32235174.
  35. ↑ "Diseases Characterized by Vaginal Discharge". cdc.gov. Centers for Disease Control and Prevention. Archived from the original on 11 July 2017.
  36. ↑ Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B (January 2002). "Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis". BJOG. 109 (1): 34–43. doi:10.1111/j.1471-0528.2002.00432.x. hdl: 10067/1033820151162165141 . PMID   11845812. S2CID   8304009.
  37. ↑ Workowski KA, Bolan GA (June 2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and Reports. 64 (RR-03): 1–137. PMC   5885289 . PMID   26042815.
  38. ↑ Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK (January 1983). "Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations". The American Journal of Medicine. 74 (1): 14–22. doi:10.1016/0002-9343(83)91112-9. PMID   6600371.
  39. 1 2 "National guideline for the management of bacterial vaginosis (2006)". Clinical Effectiveness Group, British Association for Sexual Health and HIV (BASHH). Archived from the original on 3 November 2008. Retrieved 16 August 2008.
  40. ↑ Mittal V, Jain A, Pradeep Y (May 2012). "Development of modified diagnostic criteria for bacterial vaginosis at peripheral health centres in developing countries". Journal of Infection in Developing Countries. 6 (5): 373–377. doi: 10.3855/jidc.1625 . PMID   22610702.
  41. ↑ Ison CA, Hay PE (December 2002). "Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics". Sexually Transmitted Infections. 78 (6): 413–5. doi:10.1136/sti.78.6.413. PMC   1758337 . PMID   12473800.
  42. ↑ Paladine, H. L.; Desai, U. A. (2018). "Vaginitis: Diagnosis and Treatment". American Family Physician. 97 (5): 321–329. PMID   29671516.
  43. ↑ Kamga YM, Ngunde JP, Akoachere JK (May 2019). "Prevalence of bacterial vaginosis and associated risk factors in pregnant women receiving antenatal care at the Kumba Health District (KHD), Cameroon". BMC Pregnancy and Childbirth. 19 (1): 166. doi: 10.1186/s12884-019-2312-9 . PMC   6511194 . PMID   31077161.
  44. ↑ Gazi H, Degerli K, Kurt O, Teker A, Uyar Y, Caglar H, et al. (November 2006). "Use of DNA hybridization test for diagnosing bacterial vaginosis in women with symptoms suggestive of infection". APMIS. 114 (11): 784–787. doi:10.1111/j.1600-0463.2006.apm_485.x. PMID   17078859. S2CID   36677972.
  45. ↑ Brown HL, Fuller DD, Jasper LT, Davis TE, Wright JD (2004). "Clinical evaluation of affirm VPIII in the detection and identification of Trichomonas vaginalis, Gardnerella vaginalis, and Candida species in vaginitis/vaginosis". Infectious Diseases in Obstetrics and Gynecology. 12 (1): 17–21. doi:10.1080/1064744042000210375. PMC   1784585 . PMID   15460191.
  46. ↑ Usyk M, Schlecht NF, Pickering S, Williams L, Sollecito CC, Gradissimo A, et al. (January 2022). "molBV reveals immune landscape of bacterial vaginosis and predicts human papillomavirus infection natural history". Nature Communications. 13 (1): 233. Bibcode:2022NatCo..13..233U. doi:10.1038/s41467-021-27628-3. PMC   8752746 . PMID   35017496.
  47. ↑ Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, et al. (April 2020). "Screening for Bacterial Vaginosis in Pregnant Persons to Prevent Preterm Delivery: US Preventive Services Task Force Recommendation Statement". JAMA. 323 (13): 1286–1292. doi: 10.1001/jama.2020.2684 . PMID   32259236. S2CID   215408782.
  48. ↑ "Bacterial Vaginosis – CDC Fact Sheet". Centers for Disease Control and Prevention. 11 March 2014. Archived from the original on 7 May 2015. Retrieved 6 May 2015.
  49. ↑ Mastromarino P, Vitali B, Mosca L (July 2013). "Bacterial vaginosis: a review on clinical trials with probiotics" (PDF). The New Microbiologica. 36 (3): 229–38. PMID   23912864. Archived (PDF) from the original on 18 May 2015.
  50. 1 2 Oduyebo OO, Anorlu RI, Ogunsola FT (July 2009). Oduyebo OO (ed.). "The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women". The Cochrane Database of Systematic Reviews (3): CD006055. doi:10.1002/14651858.CD006055.pub2. PMID   19588379.
  51. ↑ Bradshaw CS, Vodstrcil LA, Hocking JS, Law M, Pirotta M, Garland SM, et al. (March 2013). "Recurrence of bacterial vaginosis is significantly associated with posttreatment sexual activities and hormonal contraceptive use". Clinical Infectious Diseases. 56 (6): 777–86. doi:10.1093/cid/cis1030. PMID   23243173.
  52. ↑ Lamont RF, Nhan-Chang CL, Sobel JD, Workowski K, Conde-Agudelo A, Romero R (September 2011). "Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis". American Journal of Obstetrics and Gynecology. 205 (3): 177–90. doi:10.1016/j.ajog.2011.03.047. PMC   3217181 . PMID   22071048.
  53. ↑ Mehta SD (October 2012). "Systematic review of randomized trials of treatment of male sexual partners for improved bacteria vaginosis outcomes in women". Sexually Transmitted Diseases. 39 (10): 822–30. doi: 10.1097/OLQ.0b013e3182631d89 . PMID   23007709. S2CID   36148239.
  54. ↑ Potter J (November 1999). "Should sexual partners of women with bacterial vaginosis receive treatment?". The British Journal of General Practice. 49 (448): 913–8. PMC   1313567 . PMID   10818662.
  55. ↑ Huang H, Song L, Zhao W (June 2014). "Effects of probiotics for the treatment of bacterial vaginosis in adult women: a meta-analysis of randomized clinical trials". Archives of Gynecology and Obstetrics. 289 (6): 1225–34. doi:10.1007/s00404-013-3117-0. PMID   24318276. S2CID   9696920.
  56. ↑ VandeVusse L, Hanson L, Safdar N (2013). "Perinatal outcomes of prenatal probiotic and prebiotic administration: an integrative review". The Journal of Perinatal & Neonatal Nursing. 27 (4): 288–301, quiz E1-2. doi:10.1097/jpn.0b013e3182a1e15d. PMID   24164813. S2CID   205728750.
  57. 1 2 3 Mastromarino P, Vitali B, Mosca L (July 2013). "Bacterial vaginosis: a review on clinical trials with probiotics". The New Microbiologica. 36 (3): 229–38. PMID   23912864.
  58. 1 2 3 Lagenaur LA, Hemmerling A, Chiu C, Miller S, Lee PP, Cohen CR, Parks TP (June 2021). "Connecting the Dots: Translating the Vaginal Microbiome Into a Drug". J Infect Dis. 223 (12 Suppl 2): S296–S306. doi:10.1093/infdis/jiaa676. PMC   8502429 . PMID   33330916.
  59. 1 2 "CTV 05". AdisInsight. Springer Nature Switzerland AG.
  60. 1 2 3 4 "Bacterial Vaginosis - STI Treatment Guidelines". Centers for Disease Control and Prevention. 19 July 2021.
  61. ↑ Schaefer C, Spielmann H, Vetter K, eds. (January 2006). "Spezielle Arzneimitteltherapie in der Schwangerschaft" [Special medicamentous therapies in pregnancy]. Arzneiverordnung in Schwangerschaft und Stillzeit (in German) (7th ed.). Urban & Fischer. pp. 33–557. doi:10.1016/B978-343721332-8.50004-1. ISBN   978-3-437-21332-8. PMC   7271219 .
  62. ↑ Verstraelen H, Verhelst R, Roelens K, Temmerman M (June 2012). "Antiseptics and disinfectants for the treatment of bacterial vaginosis: a systematic review". BMC Infectious Diseases. 12: 148. doi: 10.1186/1471-2334-12-148 . PMC   3458956 . PMID   22742642.
  63. 1 2 Sobel JD (28 November 2022). Marrazzo J, Barbieri RL, Eckler K (eds.). "Bacterial vaginosis: Initial treatment". UpToDate.
  64. ↑ "TOL 463". AdisInsight. Springer Nature Switzerland AG.
  65. ↑ Sobel JD, Sobel R (August 2021). "Current and emerging pharmacotherapy for recurrent bacterial vaginosis". Expert Opin Pharmacother. 22 (12): 1593–1600. doi:10.1080/14656566.2021.1904890. PMID   33750246. S2CID   232325625.
  66. ↑ Marrazzo JM, Dombrowski JC, Wierzbicki MR, Perlowski C, Pontius A, Dithmer D, Schwebke J (February 2019). "Safety and Efficacy of a Novel Vaginal Anti-infective, TOL-463, in the Treatment of Bacterial Vaginosis and Vulvovaginal Candidiasis: A Randomized, Single-blind, Phase 2, Controlled Trial". Clin Infect Dis. 68 (5): 803–809. doi:10.1093/cid/ciy554. PMC   6376090 . PMID   30184181.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.