Aerobic Vaginitis Diagnosis Criteria Combining Gram Stain with Clinical Features: An Establishment and Prospective Validation Study

Wet-mount microscopy aerobic vaginitis (AV) diagnostic criteria need phase-contrast microscopy and keen microscopists, and the preservation of saline smears is less common in clinical practice. This research work developed new AV diagnostic criteria that combine Gram stain with clinical features. We enrolled 325 AV patients and 325 controls as a study population to develop new AV diagnostic criteria. Then, an independent group, which included 500 women, was used as a validation population. AV-related microscopic findings on Gram-stained and wet-mount smears from the same participants were compared. The accuracy of bacterial indicators from the two methods was verified by bacterial 16S rRNA V4 sequencing (n = 240). Logistic regression was used to analyse AV-related clinical features. The screened clinical features were combined with Gram-stain microscopic indicators to establish new AV diagnostic criteria. There were no significant differences in the leukocyte counts or the parabasal epitheliocytes (PBC) proportion between the Gram-stain and wet-mount methods (400×). Gram stain (1000×) satisfied the ability to identify bacteria as verified by 16S rRNA sequencing but failed to identify toxic leukocytes. The new criteria included: Lactobacillary grades (LBG) and background flora (Gram stain, 1000×), leukocytes count and PBC proportion (Gram stain, 400×), and clinical features (vaginal pH > 4.5, vagina hyperemia, and yellow discharge). These criteria satisfied the accuracy and reliability for AV diagnosis (Se = 86.79%, Sp = 95.97%, and Kendall’s W value = 0.899) in perspective validation. In summary, we proposed an alternative and valuable AV diagnostic criteria based on the Gram stain, which can make it possible to diagnose common vaginitis like AV, BV, VVC, and mixed infections on the same smear and can be available for artificial intelligence diagnosis in the future.

Azoximer bromide-modulated immune response in aerobic vaginitis

Aim: to evaluate the efficacy of azoximer bromide along with a combined antimicrobial drug in treatment of patients with aerobic vaginitis (AV).Materials and Methods. There was conducted a prospective, randomized, parallel group study with enrolled 60 patients diagnosed with AV and 10 apparently healthy women (control group III). Group I (n = 30) received azoximer bromide (10 vaginal insertion according to the scheme, course of 10 days) and a combined antimicrobial drug, while Group II (n = 30) received only antimicrobial drug (course of 10 days). Microscopy of vaginal discharge smears, polymerase chain reaction method was used, detection of cytokines – interleukins (IL) and tumor necrosis factor-alpha (TNF-α) in vaginal washings was performed by ELISA. The study of neutrophil extracellular traps (NETs) was performed by ELISA, and DNA-containing strands ejected by neutrophils were determined by fluorescence method.Results. Recovery from disease was found in 100 % (30/30) and 86.7 % (26/30) in group I and group II, respectively. After treatment, serum level of IL-8 was revealed to decline in group I from 35.2 to 5.5 pg/ml (p = 0.05), in group II – from 33.4 to 5.3 pg/ml (p = 0.04), also not differ (p > 0.05) from the control values (5.2 pg/ml). The level of IL-1β also decreased after treatment in group I from 51.5 to 15.1 pg/ml (p = 0.002), in group II – from 57.9 to 20.1 pg/ml (p = 0.03), which also did not differ (p > 0.05) from the control values (16.7 pg/ml). The IL-10 level in both main groups decreased slightly (from 0.26 and 0.24 to 0.16 pg/ml in both groups), which was higher by 1.8-fold than in the control group (0.09 pg/ml; p < 0.001). The number of ejected NETs in both main groups decreased significantly after treatment, reaching control level. No side effects were observed, compliance and acceptability were 100 % in both groups. The frequency of AV relapses within 3 months was observed in 3.3 % (1/30) and 14.3 % (4/28) patients, after 6 months – in 14.3 % (4/28) and in 20.0 % (5/25) patients in groups I and II, respectively. Using the logit regression model, demonstrated that AV relapse might occur with a 50 %-probability at TNF-α level < 0.1 pg/ml after treatment (sensitivity – 67 %, specificity – 79 %). The risk of relapses in group I, in contrast to group II, showed a downward trend.Conclusions. The use of azoximer bromide and a combined broad-spectrum antimicrobial drug is effective in AV treatment, exerts a modulating effect on immune response parameters contributes to lowering relapse rate.

Practical approaches to examination of women with abnormal vaginal discharge: a review of evidence-based recommendations 2021

Abnormal vaginal discharge (AVD) is a syndrome that combines conditions of different origin (microbial/non-microbial) and of different anatomical localization (limited to vagina and exocervix/spreading from the endocervix to the pelvic organs) that cause discomfort and changes in the characteristics of vaginal discharge.Review objective: to systematize modern approaches to the diagnosis of the most common causes of AVD – bacterial vaginosis (BV), trichomoniasis, aerobic vaginitis (AV), vulvovaginal candidiasis (VVC) – in a practical context. Laboratory component of diagnosing the AVD causes should be complex due to the not fully understood mechanisms of regulation of vaginal biocenosis and changes in the virulence of opportunistic and pathogenic flora, leading to an increase in the frequency of mixed forms of vaginosis and their atypical course. The tasks of laboratory tests in AVD are determination of the sexually transmitted infections (gonorrhea, chlamydia, Mycoplasma genitalium) more often as a concomitant asymptomatic infection in combination with BV or another cause of AVD; confirmation of the suspected cause of AVD (BV, trichomoniasis, AV, VVC); differential diagnosis with more rare microbial causes (cytolytic vaginosis) and non-microbial causes.Vaginal pH and microscopy of vaginal discharge with an assessment according to the diagnostic criteria for dysbiosis are first line of available diagnostic tests of BV, AV and VVC. They make it possible to differentiate typical AVD causes from non-microbial AVD causes and rare causes of microbial AVD. Additionally, complex modern molecular methods for assessing the vaginal biocenosis can be used. Cultural methods play an important role in the diagnosis and treatment of recurrent/complicated VVC and AV. PCR for chlamydia, gonorrhea, trichomoniasis and Mycoplasma genitalium is a mandatory component of a comprehensive test in patients with suspected BV, AV or mixed dysbiosis. Patients diagnosed with BV or trichomoniasis has to be tested for HIV and sexually transmitted infections.

1354. Antibiotic Resistance and Coinfections Among Women with Sexually Transmitted Infections

Background Sexually transmitted infections (STIs) represent a growing epidemic, particularly among America’s youth. Traditional single or dual organism STI testing is limited in its utility compared to PCR panel-based vaginitis testing. PCR panel testing can identify up to 99% of vaginitis associated organisms, while simultaneously providing information about antibiotic resistance. Methods We analyzed 10,011 vaginosis panel cases released between April 2020 and May 2021. The PCR-based vaginosis panel consists of organisms associated with bacterial vaginosis, aerobic vaginitis, yeast infections, STIs, and Lactobacillus species. This panel simultaneously detects evidence of antibiotic resistance for nine classes of drugs. Results Of 9405 cases from vaginal swabs, 618 (6.8%) were positive for at least one STI including Chlamydia trachomatis (CT), Haemophilus ducreyi, Herpes Simplex Virus 1 or 2 (HSV2), Neisseria gonorrhoeae (NG), and/or Trichomonas vaginalis. Of 603 urine samples, 7.6% were positive for at least one STI and represented a younger population. Patients younger than age 25 (33% of the cohort) were disproportionately affected by STIs, consistent with CDC findings. About 50% of all positive STI cases were in patients under 25. Evidence of bacterial vaginosis was also present in 89% of CT and NG cases, and 75% of HSV2 cases. Strikingly, we found the presence of an antibiotic resistant marker(s) to first line treatment in 76.2% of CT and 19.3% of NG cases. Conclusion Our data illustrates the advantages of utilizing a PCR-panel approach to STI detection over a targeted approach for individual organisms. Coinfections with bacterial vaginosis were common and if left unidentified, patients may receive incomplete treatment. Additionally, our data suggests that antibiotic resistance testing is imperative for effective treatment planning and antibiotic stewardship in suspected STI cases. Disclosures Brittany L. Carpenter, PhD, NxGen MDx (Employee) Jacqueline D. Peacock, PhD, MB(ASCP)CM, NxGen MDx (Employee) Kyle Dubiak, PhD, NxGen MDx (Employee) Heather Fecteau, MS, LCGC, NxGen MDx (Employee) Robert Carlson, MD, FCAP, NxGen MDx (Employee)

Therapeutic effects of silver nanoparticle and L-carnitine on aerobic vaginitis in mice: an experimental study

Introduction: Aerobic vaginitis (AV) is a type of vaginal infection that occurs at the reproductive age of women. In this study, we aimed to study the possible anti-AV therapeutic effects of silver nanoparticles (AgNPs) and L-carnitine (LC) in the mouse model. Methods: AV model was established by intra-vaginal inoculation of 108 CFU/mL Staphylococcus aureus and Escherichia coli (1:1) in adult NMRI mice. Susceptibilities of the bacteria were examined against AgNPs by inhibitory concentration (IC-50 and IC-90) and minimum biofilm inhibitory concentration (MBIC- 90) methods. The regimens therapy was intra-vaginal inoculation of AgNPs at MBIC- 90 and a daily injection of 250 mg/kg LC for two weeks. Mice were classified into healthy (control) and AV groups and then treated by LC, AgNPs, and AgNPs + LC. The vaginal smears were taken daily and tissue sections were prepared using the hematoxylin and eosin (H & E) method. Results: Minimum inhibitory concentrations (MICs) of AgNPs for E. coli, S. aureus, and their mixture were 250, 125, and 500 ppm, and their MBIC-90% were 500, 250, and 1000 ppm, respectively. The estrus cycle of mice treated with co-administration of AgNPs and LC was similar to the control group (P < 0.05). The results of histology also showed that infected mice were treated with AgNPs and LC, simultaneously. Conclusion: Single bacteria are more sensitive than their mixed model to these NPs. Co-administration of AgNPs as an antibacterial agent and LC as an antioxidant agent can treat AV in the infected mice.

Evaluation of the effectiveness of dequalinium chloride vaginal tablets in aerobic vaginitis: A placebo-controlled study

Background: Aerobic vaginitis is a disturbance of vaginal homeostasis caused by the colonization of enteric bacteria. They are not clinically well-defined and do not have standard treatment regimes. Hence, the present study was conducted to evaluate the effectiveness of dequalinium chloride topical vaginal administration in aerobic vaginitis in a placebo-controlled manner. Materials and Methods: This study was conducted in a placebo-controlled manner to demonstrate the effectiveness of vaginal 10 mg dequalinium chloride. A total of 30 patients with different vaginal infections were included in the study. The patients included in the study were divided between the drug group and the placebo group and were treated with one vaginal tablet daily for 6 days. The total symptom score, which consists of the assessment of discharge, itching, and burning sensation, and the lactobacillus grade evaluated microscopically, was determined. Results: It was found that the effectiveness of dequalinium chloride was very high compared to placebo (92% vs. 0%). The reproduction frequency in the first visit was statistically significantly lower in the drug group compared to the placebo group (P < 0.001). Conclusion: It was found that dequalinium chloride is effective for the treatment of aerobic vaginitis. However, studies containing a larger sample group, including the long-term effects (efficacy and side effects) of the drug, should be conducted to prove our conclusion.

Antimicrobial Sensitivity Pattern and Incidence of Streptococcus agalactiae and Other Pathogenic Microbial Organism from Pregnant Women at Tertiary Care Centre, Kanpur

This study was conducted in Rama Medical College Hospital & Research Centre. The inclusion and exclusion criteria were applied. The study was conducted from January 2016 to December 2016. A total 50 high vaginal swabs were collected from pregnant women admitted to the labour room after gestation. Vaginal swabs collected from high vagina using sterile cotton swabs (Himedia, Mumbai) and transported to the laboratory and inoculated into enrichment broth, (Todd Hewitt Broth) and incubated at 370 C for 18-24 hours. After incubation sample were plated onto Blood agar and MacConkey agar (Himedia, Mumbai) and incubated aerobically at 370 C for 18-24 hours. The isolates were identified based on colony appearance, gram stain, and standard biochemical test obtained from (Himedia, Mumbai). Out of 50 women, 16 (32%) were primigravida 34 (68%) were multigravida. Number of pathogenic growth were 31 (62%). The maximum number of aerobic vaginitis cases fell in the age group of 20-25 years followed by 26-30 and 30-35. The common pathogenic isolates in this study Candida, Escherichia coli, Klebsiella species, Coagulase negative Staphylococcus and Enterococcus species. The results of present study showed a high occurrence of Candida among pregnant women. There was a high prevalence of vaginal candidiasis among multigravida, women at the third trimester and those between age group 20 to 25 and 3 samples of aerobic vaginitis with polymicrobial growth. This study did not show any Group B Streptococcus. In this study were found most common sensitive drugs among all microbes– Gentamycin, Amikacin, Netilmicin, Amoxycillin/clavulanic acid, Piperacillin/tazobactam, Imipenem, Meropenem, Tigecycline, Colistin, Polymyxin B. Cotrimoxazole, Ceftriaxone, Ceftazidime, Cefoxitine, Teicoplanin, Levofloxacin, Vancomycin, Ampicillin, Penicillin, Tetracyclin, Aztreonam.

Bacterial Profile and Antimicrobial Susceptibility Pattern of Aerobic Vaginal Pathogens in Gynae Patients Visiting to Khyber Teaching Hospital Peshawar

OBJECTIVES: The aim of this study was to determine the prevalent aerobic vaginal bacteria and their antibiogram to commonly prescribed antibiotics for the treatment of aerobic vaginitis (AV). METHODOLOGY: A total of 200 high vaginal swabs (HVS) samples were collected from different AV suspected patients visiting Khyber Teaching Hospital (KTH) and processed for identification of bacterial isolates followed by antibiotic susceptibility patterns as per CLSI protocols. RESULTS: Out of 200 clinical samples, 70 (35%) HVS isolates yielded bacterial growth. Of the isolates, E.coli was the common pathogen 36 (51.4%) followed by S.aureus 20 (28.5%), Enterobacter spp 08 (11.4%), Pseudomonas spp 04 (5.7%) and Citrobacter spp 02 (2.8%). The highest prevalence was observed in the age group of 21-35 years (31.4%) followed by age groups 16-20 years (25.7%) and 26-30 years. S.aureus isolates (n=20) were resistant to ciprofloxacin (90%), cephradine (70%), erythromycin (70%), gentamicin (50%) and cefotaxime (40%) while 1 (5%) of each isolate was resistant to methicillin and vancomycin. Majority of the gram-negative isolates (n=50) were resistant to cotrimoxazole, cephalosporins, quinolones, aminoglycosides and susceptible to carbapenems, tigecycline, sulbactam and tazobactam. CONCLUSION: Aerobic vaginitis should be treated very selectively in order not to kill the beneficial bacteria. Before treating AV, the causative agents should be accurately identified and tested for drug susceptibility patterns and empirical antibiotic therapy should be avoided.