Vaginal Dysbiosis and Partial Bacterial Vaginosis: The Interpretation of the “Grey Zones” of Clinical Practice

Bacterial vaginosis (BV) affects one-third of reproductive age women, increasing the risk of acquiring sexually transmitted infections (STIs) and posing a risk for reproductive health. The current diagnosis with Gram stain (Nugent Score) identifies a transitional stage named partial BV or intermediate microbiota, raising the problem of how to clinically handle it. We retrospectively analyzed cervicovaginal swabs from 985 immunocompetent non-pregnant symptomaticspp. women (vaginal discharge, burning, itching) by Nugent score and qPCR for BV, aerobic or fungal vaginitis, and STIs (Mycoplasmas spp., Chlamydia t., Trichomonas v., and Neisseria g.). Nugent scores 0–3 and 7–10 were confirmed in 99.3% and 89.7% cases, respectively, by qPCR. Among Nugent scores 4–6 (partial BV), qPCR identified 46.1% of BV cases, with 37.3% of cases negative for BV, and only 16.7% of partial BV. Gram staining and qPCR were discordant (p value = 0.0001) mainly in the partial BV. Among the qPCR BV cases, the presence of aerobic vaginitis and STIs was identified, with a significant association (p < 0.0001) between the STIs and partial BV/overt BV. qPCR is more informative and accurate, and its use as an alternative or in combination with Gram staining could help clinicians in having an overview of the complex vaginal microbiota and in the interpretation of partial BV that can correspond to vaginitis and/or STIs.

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Comparative study of pap smear and microbiological pattern in bacterial vaginosis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180888 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1039

Author(s):

Girishma J. ◽

Rupakala B. M. ◽

Sunil Chavan

Keyword(s):

Bacterial Vaginosis ◽

Vaginal Discharge ◽

Pap Smear ◽

Reproductive Age ◽

Gardnerella Vaginalis ◽

Pap Smears ◽

Gram Stain ◽

Medical College ◽

Gram Staining ◽

Gynecology And Obstetrics

Background: Bacterial vaginosis is the most common cause of vaginal discharge among women in reproductive age group. It is characterized by an increased vaginal pH and loss of normal lactobacilli and overgrowth of anaerobes like Gardnerella vaginalis and other gram-negative rods. Purpose of this study is to compare the characteristics of pap smear and microbiological pattern in patients with abnormal vaginal discharge.Methods: The study was conducted in the Department of Gynecology and Obstetrics of Rajarajeswari Medical College and Hospital (RRMCH) Bangalore, India. All patients with vaginal discharge were included in the study. Vaginal discharge samples were sent to gram staining, culture and pap smear examination.Results: Of the 52 patients, 18 patients (34.6%) showed positive for bacterial vaginosis according to Nugent’s score. Of the 18 patients with positive Gram stains, 8 of them were positive for bacterial vaginosis according to pap’s smear (44%) and 10 had negative pap smears. In our study, of the 18 patients with positive Gram stains, 14 (77%) of them were positive for bacterial vaginosis according to culture.Conclusions: In the present study we found out that correlation of gram stain and pap smear was 44% whereas correlation of gram stain and culture was 77%. Hence, we conclude that gram stain and culture are preferred for the diagnosis of bacterial vaginosis rather than the pap smear evaluation.

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Criteria for diagnosis of bacterial vaginosis using the test Femoflor-16

Journal of obstetrics and women s diseases ◽

10.17816/jowd66457-67 ◽

2017 ◽

Vol 66 (4) ◽

pp. 57-67 ◽

Cited By ~ 2

Author(s):

Veronika V. Nazarova ◽

Elena V. Shipitsyna ◽

Ekaterina N. Gerasimova ◽

Alevtina M. Savicheva

Keyword(s):

Bacterial Vaginosis ◽

Vaginal Discharge ◽

Bacterial Load ◽

Anaerobic Bacteria ◽

Microscopic Investigation ◽

Reproductive Age ◽

Gardnerella Vaginalis ◽

Nugent Score ◽

Adverse Pregnancy ◽

Amsel Criteria

Background. Bacterial vaginosis is disturbance of the balance of the vaginal microflora, associated with a number of infectious diseases of the urogenital tract and adverse pregnancy outcomes. In this country, for the detection of vaginal dysbiotic conditions, the test Femoflor-16 (DNA-Technology, Moscow) is widely used, however interpretation algorithms of this test do not include the category of BV. Aim. The study aimed to elaborate diagnostic criteria for the detection of BV using Femoflor-16 test. Materials and methods. Women of reproductive age addressing a gynecologist with vaginal discharge were enrolled in the study. For clinical diagnosis of BV, the Amsel criteria were used, laboratory analysis for BV was performed via microscopic investigation of vaginal discharge using the Nugent score. Samples of vaginal discharge from all women were analyzed with the test Femoflor-16, intended for characterizing vaginal microbiocenosis using multiplex quantitative real-time PCR. Results. A total of 280 women were included in the study. BV was diagnosed in 86 women (31%) using the Amsel criteria, and in 81 women (29%) using the Nugent score. All groups of anaerobic bacteria included in Femoflor-16 test were shown to be associated with BV, with the exception of bacteria of the genus Mobiluncus, which are detected together with phylogenetically related but not BV-associated bacteria of the genus Corynebacterium. A low amount of lactobacilli (< 10% of total bacterial load) coupled with an elevated amount of Gardnerella vaginalis/Prevotella bivia/Porphyromonas (> 1%) and/or Eubacterium (> 2%) and/or Sneathia/Leptotrichia/Fusobacterium (> 0.1%) and/or Megasphaera/Veillonella/Dialister (> 0.1%) and/or Lachnobacterium/Clostridium (> 0.1%) and/or Peptostreptococcus (> 0.1%) and/or Atopobium vaginae (> 0.2%) detected BV with a sensitivity of 99% and specificity of 93%. Conclusions. Criteria for BV diagnosis using the test Femoflor-16 have been elaborated, which enable to detect BV or exclude it with a sensitivity of 99% and specificity of 93%. These criteria for BV and criteria of the test manufacturers for severe anaerobic dysbiosis determine to a large extent the same category of the vaginal microbiocenosis.

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Rapid Detection of Bacterial Vaginosis (BV) by BVBlue test

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v4i1.8465 ◽

1970 ◽

Vol 4 (1) ◽

pp. 24-27

Author(s):

Shameem Akhter ◽

Humayun Satter ◽

Shirin Tarafder ◽

Ruhul Amin Miah ◽

Sohely Sharmin ◽

...

Keyword(s):

Bacterial Vaginosis ◽

Vaginal Discharge ◽

Vaginal Swab ◽

Reproductive Age ◽

Gram Stain ◽

Clinical Criteria ◽

Healthy Control ◽

History Of ◽

Study Population ◽

Abnormal Vaginal Discharge

Bacterial vaginosis is the commonest cause of abnormal vaginal discharge in women of reproductive age and require laboratory test for diagnosis . A total 200 women aged 15-45 years with history of abnormal vaginal discharge were included as study population. Fifty women without such history of discharge were taken as healthy control. Three vaginal swab samples were taken from each case and control. These swab samples were subjected to test by conventional methods such as Amsel clinical criteria, Gram stain Nugent method, culture and by newly developed BV Blue test. The results of the BVBlue test were compared with these methods to find out the efficacy of BVBlue test. Rate of detection of bacterial vaginosis (BV) cases was 21.5% by Amsel clinical criteria, 21.0% by Gram stain Nugent method, 21.0% by culture and 22% by BVBlue test among the study population. When comparing with the conventional test and culture, BVBlue test was 100% sensitive and 98% specific. It is rapid, technically simple and is suitable for screening large number of patient in short time where laboratory facilities are not developed. Key words: Bacterial Vaginosis, BVBlue test, Nugent method, Abnormal vaginal discharge. DOI: http://dx.doi.org/10.3329/bjmm.v4i1.8465 BJMM 2011; 4(1): 24-27

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BACTERIAL VAGINOSIS;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.02.520 ◽

2017 ◽

Vol 24 (02) ◽

pp. 252-257

Author(s):

Faiqa Saleem ◽

Munazza Malik ◽

Muhammad Sohaib Shahid ◽

Muhammad Tayyab

Keyword(s):

Bacterial Vaginosis ◽

Vaginal Discharge ◽

Reproductive Age ◽

P Value ◽

Vaginal Infections ◽

Vaginal Gel ◽

Vaginal Cream ◽

Significant Difference ◽

Group A ◽

Group B

In women of reproductive age bacterial vaginosis is a most common polymicrobialdisease and is the leading reason for vaginal discharge in this age group. Additionally itis further linked with sizeable disease burden of community problem in terms of infectiouscomplications. Clindamycin vaginal cream and metronidazole vaginal gel are effective in themanagement of vaginal infections caused by multi bacteria. Objectives: To compare thetherapeutic efficacy of Metronidazole vaginal gel and clindamycin vaginal cream as modality oftreatment for bacterial vaginosis. Study Design: Randomized control trial. Setting: Departmentof Obstetrics and Gynaecology, Unit-3 Jinnah Hospital Lahore. Period: Six months from 02-05-2011 to 01-11-2011. Material & Methods: A total of 300 patients were included in this study.They were divided into two groups. Group A received metronidazole vaginal gel (5 g dailyfor 7 days) while group B administered with clindamycin vaginal cream (5g daily for 7 days).Results: Mean age of the patient was observed 34.3+3.5 and 32.9+ 2.1 years in group –A andB respectively. Vaginal discharge was absent in 104 patients (69.3%) from group A and 127(84.7%) from group-B. Absence of clue cells on microscopy revealed in 112 patients (74.7%)from group A and 137 patients (91.3%) from group B. Absence of amine odour found in 116patients (77.3%) of group A and 134 patients (89.3%) of group B. Significant difference wasfound between two groups with p value of 0.006 in respect of efficacy. Conclusion: Clindamycinvaginal cream is more effective in comparison to Metronidazole vaginal gel for the treatment ofbacterial vaginosis.

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Isolation, identification and susceptibility pattern of Gardnerella vaginalis in bacterial vaginosis

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v5i1.15814 ◽

2013 ◽

Vol 5 (1) ◽

pp. 8-11 ◽

Cited By ~ 1

Author(s):

Shameem Akhter ◽

Humayun Sattar ◽

Ruhul Amin Miah ◽

Ahmed Abu Saleh ◽

Sharmeen Ahmed ◽

...

Keyword(s):

Bacterial Vaginosis ◽

Vaginal Discharge ◽

Vaginal Swab ◽

Reproductive Age ◽

Gardnerella Vaginalis ◽

Gram Stain ◽

Healthy Control ◽

History Of ◽

Abnormal Vaginal Discharge ◽

And Control

Bacterial vaginosis is the commonest cause of abnormal vaginal discharge in women of reproductive age. A total 200 women aged 15- 45 years with history of abnormal vaginal discharge were included as study population. Fifty women without such history of discharge were taken as healthy control. Two vaginal swab samples were taken from each case and control. These swab samples were subjected to test by Gram stain (Nugent method) and culture. 21.5 % of the cases were diagnosed as bacterial vaginosis by Gram stain (Nugent method) and 21 % by culture. Clindamycin was susceptible to G. vaginalis in (90.5%) followed by metronidazol (76.1 %), chloramphenicol (71.4 %) and erythromycin (66.7 %). Out of 50 cases of recurrent bacterial vaginosis, G. vaginalis was isolated from 15 (30 %) cases, of which 5 (33.3 %) were sensitive and 10 (66.7 %) were resistant to metronidazol, while all 15 cases were sensitive to clindamycin.DOI: http://dx.doi.org/10.3329/bjmm.v5i1.15814 Bangladesh J Med Microbiol 2011; 05 (01): 8-11

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PREVALENCE OF MICROBIOTA ASSOCIATED TO VAGINAL DISCHARGE AMONG REPRODUCTIVE AGE GROUP BASED ON SOCIOECONOMIC STATUS AND DEMOGRAPHIC BACKGROUND

10.36106/ijar/6011705 ◽

2021 ◽

pp. 49-50

Author(s):

Neha Yadav ◽

Sonu Panwar

Keyword(s):

Socioeconomic Status ◽

Bacterial Vaginosis ◽

Vaginal Discharge ◽

Demographic History ◽

Tertiary Care ◽

Reproductive Age ◽

Care Hospital ◽

Women Of Reproductive Age ◽

Biochemical Tests ◽

Gram Staining

In women of reproductive age, vaginal discharge is one of the most frequent signs. Vaginal discharge may be physiological or pathological; thus, this study was conducted to ascertain the microbial diversity of vaginal discharge cases in relation to socioeconomic status and demographic history among women of reproductive age attending a tertiary care hospital. To diagnose the organism, simple wet laboratory preparation, 10% KOH, Gram staining, and pH paper were used, while to classify and categorise the pathogens, various differential agar media such as CHROM agar, Blood agar, and Sabouraud Dextrose agar were used, followed by some biochemical tests and the use of the Nugent Score. The majority of the patients were between the ages of 22 and 28. The patients were all from the lower middle class 41. (37.61 percent ). Microbial diagnosis revealed that 45 percent of patients had Bacterial Vaginosis, 41 percent had Candidiasis, 5% had Trichomoniasis, and 9% had both Bacterial Vaginosis and Candidiasis..

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Clinical and microscopic correlation of abnormal vaginal discharge

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210706 ◽

2021 ◽

Vol 10 (3) ◽

pp. 909

Author(s):

Usharani N. ◽

Swetha D.

Keyword(s):

Bacterial Vaginosis ◽

Trichomonas Vaginalis ◽

Vaginal Discharge ◽

Reproductive Age ◽

Common Cause ◽

Gram Staining ◽

Gynecological Examination ◽

Three Samples ◽

Abnormal Vaginal Discharge ◽

Set Up

Background: Vaginal discharge in the reproductive age group is the most common complaint encountered everyday both by gynaecologists and general practitioners. The prevalence of vaginal discharge in India is estimated to be 30%. Bacterial vaginosis is the most common cause, followed by Candidiasis and Trichomonasis. Aims and objectives of the study were to correlate clinical and microscopic methods for diagnosing abnormal vaginal discharge and to find out the most common cause of abnormal vaginal discharge in our set up.Methods: The study was carried out in Gynaecological OPD of VIMS, Ballari. After thorough history and gynecological examination, three samples were collected from the posterior fornix of vagina using sterile cotton swabs. The first swab was used to detect trichomonas vaginalis using wet mount microscopy. The second swab was used to determine amine/fishy odour (Whiff test). The third swab was used for gram staining to diagnose Bacterial vaginosis and Candida. The Gram-stained slides was evaluated using Nugent’s scoring system for detection of BV.Results: Bacterial vaginosis constitutes the most common cause of vaginal discharge, followed by Candidiasis and then Trichomoniasis in our set up. The sensitivity of clinical diagnosis is 71.93%, 88.9%, and 33.3% and specificity are 54.65%, 92.15% and 99.49% for Bacterial vaginosis, Candidiasis, and Trichomoniasis respectively.Conclusions: The most ideal approach is the microbiological approach for the etiological diagnosis of symptomatic vaginal discharge. The most common cause of abnormal vaginal discharge is Bacterial vaginosis followed by Candidiasis and Trichomoniasis.

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Molecular Diagnosis of Bacterial Vaginosis: an Update

Journal of Clinical Microbiology ◽

10.1128/jcm.00342-18 ◽

2018 ◽

Vol 56 (9) ◽

Cited By ~ 22

Author(s):

Jenell S. Coleman ◽

Charlotte A. Gaydos

Keyword(s):

Bacterial Vaginosis ◽

Point Of Care ◽

The United States ◽

Reproductive Age ◽

Clinical Indicators ◽

Sexually Transmitted ◽

Reproductive Age Women ◽

Vaginal Swabs ◽

Diverse Community ◽

Point Of Care Tests

ABSTRACTBacterial vaginosis (BV) is the most common cause of vaginal discharge in reproductive-age women. BV has been associated with poor reproductive outcomes such as preterm delivery, the acquisition of sexually transmitted infections, including HIV, and pelvic inflammatory disease. BV represents the acquisition of a diverse community of anaerobic and facultative bacteria and a reduction in lactobacilli. It can be diagnosed using several tests ranging from clinical indicators, point-of-care tests, and molecular assays. Molecular technologies are objective, are able to detect fastidious bacteria, enable quantitation, and are ideal for self-collected vaginal swabs. This paper reviews the currently available BV diagnostic tests in the United States.

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The Profile of Bacterial Vaginosis in Academic Hospital Surabaya: A Retrospective Study

Berkala Ilmu Kesehatan Kulit dan Kelamin ◽

10.20473/bikk.v32.2.2020.141-148 ◽

2020 ◽

Vol 32 (2) ◽

pp. 141

Author(s):

Amanda Gracia Manuputty ◽

Sunarko Matodiharjo

Keyword(s):

Retrospective Study ◽

Bacterial Vaginosis ◽

Vaginal Discharge ◽

Vaginal Swab ◽

Reproductive Age ◽

Childbearing Age ◽

Genital Tract Infection ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Lower Genital Tract Infection

Background: Bacterial vaginosis (BV) is a lower genital tract infection, which occur as a result of vaginal microbiome dysbiosis. This vaginal infection can lead to symptoms such as vaginal discharge, malodor and irritation. It is the most common condition occurred in reproductive age but may give 50–75% of asymptomatic signs. Purpose: To overview new BV patients at the Sexually Transmitted Infection Division of Dermatology and Venereology Outpatient Clinic Dr. Soetomo General Hospital Surabaya in 2015–2017. Methods: A retrospective study was performed by evaluating medical records of new BV patients, including identity, history taking, examination, diagnosis, treatment, follow up and counselling. Result: The number of new BV cases was 35 (1,38%). The most infected age group was 25–44 years old (51%), and 65.7% of them were married. The most common chief complaint was vaginal discharge without subjective complaints (74.3%), the most common type of complaint was recurrence (48.6%), the most partner roles which affected by BV patients were husbands (51.4%), history of vaginal douching (34.2%), and the most vaginal discharges were severe (75.8%). The whiff test showed positive results and pH > 4.5 in 48.6% of patients. All microscopical preparations showed clue cells. The most prescribed drug was metronidazole. Conclusion: The overview new BV cases showed a small incidence with commonly occurred among women in childbearing age and were asymptomatic. A routine high vaginal swab helps the proper diagnosis and management to prevent the recurrence and complication of BV.

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Laboratory evaluation of the etiology of pathological vaginal dischurge

HEALTH OF WOMAN ◽

10.15574/hw.2019.140.64 ◽

2019 ◽

pp. 64-68

Author(s):

O.A. Burka ◽

◽

T.M. Tutchenko ◽

Keyword(s):

Bacterial Vaginosis ◽

Crucial Role ◽

Inflammatory Process ◽

Vaginal Discharge ◽

Vulvovaginal Candidiasis ◽

Diagnostic Methods ◽

Laboratory Evaluation ◽

Aerobic Vaginitis ◽

Laboratory Confirmation ◽

Vaginal Secretions

Pathological vaginal discharge is one of the most common complaints in women of all ages. Today, gynecologists are increasingly faced with a problem when, in the absence of laboratory confirmation of vulvovaginal candidiasis, bacterial vaginosis and STIs, women complain of discomfort caused by vaginal secretions. Causes of pathological vaginal discharge can be infectious and non-infectious processes and their combinations. The article analyzes the causes of the difficulties of diagnosing the of pathological vaginal discharge ethiology, demonstrates how the application of adequate volume of modern laboratory diagnostic methods in combination with understanding the multifaceted components of the inflammatory process plays crucial role in finding out the etiology of pathological vaginal secretions and the choice of optimal therapeutic tactics. Key words: pathological vaginal dischurge, vaginal microbiota, vulvovaginal candidiasis, bacterial vaginosis, aerobic vaginitis, cytolytic vaginosis.

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