bacterial vaginosis Archives - Revista Brasileira de Ginecologia e Obstetrícia
, , , , , Summary
Rev Bras Ginecol Obstet. 2022;44(2):169-177
, , , , , To evaluate genital hygiene among women with and without bacterial vaginosis (BV) and/or vulvovaginal candidiasis (VVC).
A cross-sectional study of reproductive-aged women who underwent gynecological and laboratory tests and fulfilled a genital hygiene questionnaire.
This study evaluated 166 healthy controls and 141 women diagnosed with either BV (n=72), VVC (n=61), or both (n=8). The use of intimate soap and moist wipes after urination was more frequent among healthy women (p=0.042 and 0.032, respectively). Compared to controls, bactericidal soap was more used by women with BV (p=0.05).
Some hygiene habits were associated to BV and/or VVC. Clinical trials should address this important issue in women’s health.
Summary
Rev Bras Ginecol Obstet. 2022;44(2):169-177
, , , , , To evaluate genital hygiene among women with and without bacterial vaginosis (BV) and/or vulvovaginal candidiasis (VVC).
A cross-sectional study of reproductive-aged women who underwent gynecological and laboratory tests and fulfilled a genital hygiene questionnaire.
This study evaluated 166 healthy controls and 141 women diagnosed with either BV (n=72), VVC (n=61), or both (n=8). The use of intimate soap and moist wipes after urination was more frequent among healthy women (p=0.042 and 0.032, respectively). Compared to controls, bactericidal soap was more used by women with BV (p=0.05).
Some hygiene habits were associated to BV and/or VVC. Clinical trials should address this important issue in women’s health.
, , , , , Summary
Rev Bras Ginecol Obstet. 2021;43(8):600-607
To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota.
Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women>18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis.
Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p=0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa=0.21; p=0.003) and candidiasis (Kappa=0.22; p=0.001), and slight for trichomoniasis (Kappa=0.14; p=0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests.
The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.
Summary
Rev Bras Ginecol Obstet. 2021;43(8):600-607
To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota.
Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women>18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis.
Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p=0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa=0.21; p=0.003) and candidiasis (Kappa=0.22; p=0.001), and slight for trichomoniasis (Kappa=0.14; p=0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests.
The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):437-441
DOI 10.1590/S0100-72031998000800002
Purpose:to compare the incidence of preterm labor and birth, premature rupture of membranes (PROM) and low birth-weight newborns (< 2,500 g) between two groups of pregnant women (with or without BV). To verify the adequacy of including a regular prenatal BV investigation. Methods:a total of 217 women between 28 and 32 weeks of pregnancy (35 with BV and 182 without BV) were studied. The diagnosis of BV was established according to Amsel's criteria. The data were analyzed by the chi² test, Fisher's test, Mann-Whitney test and the relative risk. Results:the incidence of preterm labor, preterm birth, PROM and low birth-weight was statistically higher in the group of women with BV than in the control group (29.4% vs. 3.8%; 28.6% vs. 3.3%; 22.9% vs. 10.4%; 20.0% vs. 3.3%; respectively). The means of gestational age and birth-weight were significantly lower in the newborns from mothers with BV (265.8 days vs. 279.9 days; 2,958 g vs. 3,294 g, respectively). Conclusion:all perinatal complications studied were significantly associated with the presence of untreated BV during pregnancy. Therefore, the diagnosis and adequate treatment should be included in the routine prenatal assistance at Brazilian Obstetrics Services. Such measure may be effective in the reduction of these perinatal complications.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):437-441
DOI 10.1590/S0100-72031998000800002
Purpose:to compare the incidence of preterm labor and birth, premature rupture of membranes (PROM) and low birth-weight newborns (< 2,500 g) between two groups of pregnant women (with or without BV). To verify the adequacy of including a regular prenatal BV investigation. Methods:a total of 217 women between 28 and 32 weeks of pregnancy (35 with BV and 182 without BV) were studied. The diagnosis of BV was established according to Amsel's criteria. The data were analyzed by the chi² test, Fisher's test, Mann-Whitney test and the relative risk. Results:the incidence of preterm labor, preterm birth, PROM and low birth-weight was statistically higher in the group of women with BV than in the control group (29.4% vs. 3.8%; 28.6% vs. 3.3%; 22.9% vs. 10.4%; 20.0% vs. 3.3%; respectively). The means of gestational age and birth-weight were significantly lower in the newborns from mothers with BV (265.8 days vs. 279.9 days; 2,958 g vs. 3,294 g, respectively). Conclusion:all perinatal complications studied were significantly associated with the presence of untreated BV during pregnancy. Therefore, the diagnosis and adequate treatment should be included in the routine prenatal assistance at Brazilian Obstetrics Services. Such measure may be effective in the reduction of these perinatal complications.
Summary
Rev Bras Ginecol Obstet. 2004;26(9):721-725
DOI 10.1590/S0100-72032004000900008
PURPOSE: to analyze the association between bacterial vaginosis (BV), high-risk HPV DNA, and Pap smear abnormalities in women submitted to diathermic conization for the treatment of high-grade cervical intraepithelial neoplasia (CIN 2 or 3). METHODS: a descriptive clinical study with 81 women submitted to diathermic conization for the treatment of CIN 2 or 3. Initial Pap smear was performed by the time of the biopsy and was also used to verify the presence of BV. Prior to conization, samples for the detection of high-risk HPV DNA through hybrid capture II (HC II) were collected. A control visit was scheduled for four months after the conization to repeat these tests. Twenty-seven women were found to have BV and 54 were not. Statistical analysis comprised odds ratios (OR) to assess the correlations between BV and HPV detection before and after diathermic conization and cytological abnormalities. All analyses were performed with a 95% confidence interval (95% CI). RESULTS: high-risk HPV DNA detection before conization was identical in both groups (89%). After conization, HPV DNA detection decreased to 26 and 18% in the groups with and without BV, respectively (OR=1.5; 95% CI 0.5 to 4.6). In addition, 41% of the women with BV and 20% without BV showed Pap smear abnormalities (OR=2.7; 95% CI 1.0 to 7.4). Regarding these 22 women with Pap smear abnormalities approximately four months after the diathermic conization, 83% of the BV group tested positive for HPV DNA compared with 50% in the group without BV (OR=5.0; IC 95% 0.5 a 52.9). CONCLUSION: women with BV presented more Pap smear abnormalities after conization when compared to the women without BV, although this was not statistically significant. This association was not related to high-risk HPV DNA.
Summary
Rev Bras Ginecol Obstet. 2004;26(9):721-725
DOI 10.1590/S0100-72032004000900008
PURPOSE: to analyze the association between bacterial vaginosis (BV), high-risk HPV DNA, and Pap smear abnormalities in women submitted to diathermic conization for the treatment of high-grade cervical intraepithelial neoplasia (CIN 2 or 3). METHODS: a descriptive clinical study with 81 women submitted to diathermic conization for the treatment of CIN 2 or 3. Initial Pap smear was performed by the time of the biopsy and was also used to verify the presence of BV. Prior to conization, samples for the detection of high-risk HPV DNA through hybrid capture II (HC II) were collected. A control visit was scheduled for four months after the conization to repeat these tests. Twenty-seven women were found to have BV and 54 were not. Statistical analysis comprised odds ratios (OR) to assess the correlations between BV and HPV detection before and after diathermic conization and cytological abnormalities. All analyses were performed with a 95% confidence interval (95% CI). RESULTS: high-risk HPV DNA detection before conization was identical in both groups (89%). After conization, HPV DNA detection decreased to 26 and 18% in the groups with and without BV, respectively (OR=1.5; 95% CI 0.5 to 4.6). In addition, 41% of the women with BV and 20% without BV showed Pap smear abnormalities (OR=2.7; 95% CI 1.0 to 7.4). Regarding these 22 women with Pap smear abnormalities approximately four months after the diathermic conization, 83% of the BV group tested positive for HPV DNA compared with 50% in the group without BV (OR=5.0; IC 95% 0.5 a 52.9). CONCLUSION: women with BV presented more Pap smear abnormalities after conization when compared to the women without BV, although this was not statistically significant. This association was not related to high-risk HPV DNA.
Summary
Rev Bras Ginecol Obstet. 2004;26(3):221-225
DOI 10.1590/S0100-72032004000300008
OBJECTIVE: to evaluate the presence of curved rods, suggesting Mobiluncus sp, and leukocytosis on Gram and Papanicolaou-stained vaginal smears in cases of bacterial vaginosis. METHODS: two hundred and five vaginal smears were studied by the Papanicolaou's method and other 205 vaginal smears, in the same patients, were evaluated by Gram staining. The diagnosis of bacterial vaginosis was made clinically by one of the authors (J.E.J.) using Amsel's criteria. In the Gram method stained smears the Nugent's score was calculated and the presence of curved rods was evaluated. In Papanicolaou's smears curved rods were searched as well the presence of leukocytes. The data were analyzed by Prism 3.0® with confidence interval of 95% using the Fisher exact test with modified Wald's method. RESULTS: on Pap smears the curved rods were present in 51.7% of the cases. The number of leukocytes varied, although the leukopenia was more frequent. In Gram-stained smears the curved rods were present in 46.8% of the cases and the Nugent's score was 8 in 48.3% of the cases. The finding of Mobiluncus sp in both methods occurred in 82%. When curved rods were observed leukocytosis occurred in 57.5% (p < 0.0001). In the same way, leukocytosis was more frequent in Nugent's scores 9 and 10. CONCLUSION: curved rods were observed in about 52% of bacterial vaginosis. Leukocytosis in Pap smears was more frequent when Mobiluncus sp were found with higher Nugent's scores.
Summary
Rev Bras Ginecol Obstet. 2004;26(3):221-225
DOI 10.1590/S0100-72032004000300008
OBJECTIVE: to evaluate the presence of curved rods, suggesting Mobiluncus sp, and leukocytosis on Gram and Papanicolaou-stained vaginal smears in cases of bacterial vaginosis. METHODS: two hundred and five vaginal smears were studied by the Papanicolaou's method and other 205 vaginal smears, in the same patients, were evaluated by Gram staining. The diagnosis of bacterial vaginosis was made clinically by one of the authors (J.E.J.) using Amsel's criteria. In the Gram method stained smears the Nugent's score was calculated and the presence of curved rods was evaluated. In Papanicolaou's smears curved rods were searched as well the presence of leukocytes. The data were analyzed by Prism 3.0® with confidence interval of 95% using the Fisher exact test with modified Wald's method. RESULTS: on Pap smears the curved rods were present in 51.7% of the cases. The number of leukocytes varied, although the leukopenia was more frequent. In Gram-stained smears the curved rods were present in 46.8% of the cases and the Nugent's score was 8 in 48.3% of the cases. The finding of Mobiluncus sp in both methods occurred in 82%. When curved rods were observed leukocytosis occurred in 57.5% (p < 0.0001). In the same way, leukocytosis was more frequent in Nugent's scores 9 and 10. CONCLUSION: curved rods were observed in about 52% of bacterial vaginosis. Leukocytosis in Pap smears was more frequent when Mobiluncus sp were found with higher Nugent's scores.
Summary
Rev Bras Ginecol Obstet. 2003;25(2):95-102
DOI 10.1590/S0100-72032003000200004
PURPOSE: to test the efficacy of and tolerance to Schinus terebinthifolius Raddi gel in the treatment of bacterial vaginosis. METHODS: forty-eight women with symptomatic bacterial vaginosis (according to Amsel's criteria) were enrolled in a randomized, double-blind, controlled trial comparing Schinus terebinthifolius Raddi gel (25 cases) with placebo (23 cases). The main outcome parameters were: rate of cure, presence of lactobacilli in Pap smear after treatment and side effects. Statistical analysis was performed using the chi2 and the Fisher exact test at 5% level of significance. RESULTS: using Amsel's clinical parameters of bacterial vaginosis, the cure rate was 84% in the Schinus group and 47.8% in the placebo group (p=0.008). A significant increase in the frequency of lactobacilli was observed in the Pap smear of the group treated with Schinus (43.5%) compared to the patient group (4.3%) (p=0.002). Treatment-related adverse events were not frequent in either group. CONCLUSIOS: the present study indicates that Schinus vaginal gel is effective and safe in the treatment of bacterial vaginosis. In addition, potential beneficial effects on the vaginal flora are suggested.
Summary
Rev Bras Ginecol Obstet. 2003;25(2):95-102
DOI 10.1590/S0100-72032003000200004
PURPOSE: to test the efficacy of and tolerance to Schinus terebinthifolius Raddi gel in the treatment of bacterial vaginosis. METHODS: forty-eight women with symptomatic bacterial vaginosis (according to Amsel's criteria) were enrolled in a randomized, double-blind, controlled trial comparing Schinus terebinthifolius Raddi gel (25 cases) with placebo (23 cases). The main outcome parameters were: rate of cure, presence of lactobacilli in Pap smear after treatment and side effects. Statistical analysis was performed using the chi2 and the Fisher exact test at 5% level of significance. RESULTS: using Amsel's clinical parameters of bacterial vaginosis, the cure rate was 84% in the Schinus group and 47.8% in the placebo group (p=0.008). A significant increase in the frequency of lactobacilli was observed in the Pap smear of the group treated with Schinus (43.5%) compared to the patient group (4.3%) (p=0.002). Treatment-related adverse events were not frequent in either group. CONCLUSIOS: the present study indicates that Schinus vaginal gel is effective and safe in the treatment of bacterial vaginosis. In addition, potential beneficial effects on the vaginal flora are suggested.
Summary
Rev Bras Ginecol Obstet. 2001;23(10):641-646
DOI 10.1590/S0100-72032001001000005
Purpose: to evaluate the prevalence of bacterial vaginosis (BV) in menopausal and in infertile outpatients and to analyze the current clinical diagnostic methods. Methods: we evaluated retrospectively 104 menopausal women and 86 with infertility. Characteristic vaginal discharge on gynecological examination, pH >4.5, positive KOH whiff test, and bacterial vaginosis by Gram test were considered positive. BV was established when at least 3 out of 4 criteria were found. Results: among the menopausal women, 29 patients (28.1%) were clinically positive for BV, 10 (9.6%) had positive whiff test, 68 (65.4%) vaginal pH >4.5, and 34 (32.7%) positive Gram test. For the infertile patients the figures were 20 (23.2%), 13 (15.1%), 61 (70.9%) and 26 (30.2%), respectively. According to our established criteria, BV was diagnosed in 14 menopausal (13.5%) and 15 infertile (17.4%) women. Conclusion: bacterial vaginosis prevalence was similar in both groups of patients. In addition, all diagnostic criteria should be followed in order to avoid underdiagnosing this pathology or treating an otherwise normal vaginal flora.
Summary
Rev Bras Ginecol Obstet. 2001;23(10):641-646
DOI 10.1590/S0100-72032001001000005
Purpose: to evaluate the prevalence of bacterial vaginosis (BV) in menopausal and in infertile outpatients and to analyze the current clinical diagnostic methods. Methods: we evaluated retrospectively 104 menopausal women and 86 with infertility. Characteristic vaginal discharge on gynecological examination, pH >4.5, positive KOH whiff test, and bacterial vaginosis by Gram test were considered positive. BV was established when at least 3 out of 4 criteria were found. Results: among the menopausal women, 29 patients (28.1%) were clinically positive for BV, 10 (9.6%) had positive whiff test, 68 (65.4%) vaginal pH >4.5, and 34 (32.7%) positive Gram test. For the infertile patients the figures were 20 (23.2%), 13 (15.1%), 61 (70.9%) and 26 (30.2%), respectively. According to our established criteria, BV was diagnosed in 14 menopausal (13.5%) and 15 infertile (17.4%) women. Conclusion: bacterial vaginosis prevalence was similar in both groups of patients. In addition, all diagnostic criteria should be followed in order to avoid underdiagnosing this pathology or treating an otherwise normal vaginal flora.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):529-533
DOI 10.1590/S0100-72032001000800008
Purpose: to evaluate the relationship between bacterial vaginosis (BV) and spontaneous preterm delivery. Method: a total of 611 pregnant women from the general antenatal clinic of the "Clínica Obstétrica do Hospital das Clínicas da Universidade de São Paulo" were enrolled in this study. All pregnancies were dated by an early scan. Iatrogenic preterm deliveries were excluded. The presence of bacterial vaginosis was evaluated between 23 and 24 weeks of pregnancy by a Gram stain of the vaginal smear collected from the posterior vaginal wall using a sterile swab. Vaginal pH was also assessed from the lateral vaginal wall by a Universal 0-14 pH strip produced by Merck. Result: a complete follow-up was obtained in 551 patients and bacterial vaginosis was diagnosed in 103 (19%) cases. Among the patients with BV in the vaginal smear, 9.7% delivered before 37 weeks against only 3.2% in the group with normal vaginal smear (p=0.008). The sensitivity, specificity, accuracy and false-positive rate for preterm delivery in the presence of bacterial vaginosis on Gram stain of the vaginal smear were 41.7, 82, 80.2 and 18%, respectively, with a relative risk of 1.8 for preterm delivery. The mean vaginal pH in the group of positive BV was 4.9 and in the group with normal smear it was 4.3 (p=0.0001). Conclusion: bacterial vaginosis during pregnancy increases the risk for spontaneous preterm delivery, with a relative risk of 1.8.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):529-533
DOI 10.1590/S0100-72032001000800008
Purpose: to evaluate the relationship between bacterial vaginosis (BV) and spontaneous preterm delivery. Method: a total of 611 pregnant women from the general antenatal clinic of the "Clínica Obstétrica do Hospital das Clínicas da Universidade de São Paulo" were enrolled in this study. All pregnancies were dated by an early scan. Iatrogenic preterm deliveries were excluded. The presence of bacterial vaginosis was evaluated between 23 and 24 weeks of pregnancy by a Gram stain of the vaginal smear collected from the posterior vaginal wall using a sterile swab. Vaginal pH was also assessed from the lateral vaginal wall by a Universal 0-14 pH strip produced by Merck. Result: a complete follow-up was obtained in 551 patients and bacterial vaginosis was diagnosed in 103 (19%) cases. Among the patients with BV in the vaginal smear, 9.7% delivered before 37 weeks against only 3.2% in the group with normal vaginal smear (p=0.008). The sensitivity, specificity, accuracy and false-positive rate for preterm delivery in the presence of bacterial vaginosis on Gram stain of the vaginal smear were 41.7, 82, 80.2 and 18%, respectively, with a relative risk of 1.8 for preterm delivery. The mean vaginal pH in the group of positive BV was 4.9 and in the group with normal smear it was 4.3 (p=0.0001). Conclusion: bacterial vaginosis during pregnancy increases the risk for spontaneous preterm delivery, with a relative risk of 1.8.
