1887

Journal of Medical Microbiology logo

Volume 66, Issue 8

Treatment failure of bacterial vaginosis is not associated with higher loads of and Free

Abstract

Cervicovaginal and are strongly associated with bacterial vaginosis (BV) and are the main components of vaginal biofilms. The low efficacy of BV treatment with metronidazole may be due to the presence of such biofilms. Thus, the aim of this study was to compare the pretreatment cervicovaginal loads of and for women who restored normal flora and those who persisted with BV after a full course of oral metronidazole.

In this cross-sectional study, 309 reproductive-aged women were recruited in a primary health care service in Botucatu, Brazil. Cervicovaginal samples were tested for genital tract infections, microscopic classification of local microbiota and molecular quantification of and .

All the participants with concurrent cervicovaginal infections (=64) were excluded. A total of 84 out of 245 (34.3 %) women had BV at enrolment and 43 (51.2 %) of them completed the treatment and returned for follow-up. Evaluation of the vaginal microbiota at follow-up showed that 29 (67.4 %) women restored normal vaginal flora, while 14 (32.6 %) still had BV. The pretreatment loads of were lower in women with treatment failure (=0.001) compared to those who successfully restored normal flora. The loads of did not differ between the groups.

Although produces several virulence factors and its loads correlate positively with those of , higher cervicovaginal quantities of these bacteria are not associated with treatment failure of BV after oral metronidazole.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): Atopobium vaginae , bacterial vaginosis , Gardnerella vaginalis and metronidazole
© 2017 The Authors
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000561
2017-08-01
2024-04-18
Loading full text...

Full text loading...

/deliver/fulltext/jmm/66/8/1217.html?itemId=/content/journal/jmm/10.1099/jmm.0.000561&mimeType=html&fmt=ahah

References

  1. Spiegel CA. Bacterial vaginosis. Clin Microbiol Rev 1991; 4:485–502 [View Article][PubMed]
     [Google Scholar]
  2. Marconi C, Duarte MT, Silva DC, Silva MG. Prevalence of and risk factors for bacterial vaginosis among women of reproductive age attending cervical screening in Southeastern Brazil. Int J Gynaecol Obstet 2015; 131:137–141 [View Article][PubMed]
     [Google Scholar]
  3. Sobel JD. Bacterial vaginosis. Annu Rev Med 2000; 51:349–356 [View Article][PubMed]
     [Google Scholar]
  4. Pereira L, Culhane J, Mccollum K, Agnew K, Nyirjesy P. Variation in microbiologic profiles among pregnant women with bacterial vaginosis. Am J Obstet Gynecol 2005; 193:746–751 [View Article][PubMed]
     [Google Scholar]
  5. Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SSK et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci USA 2011; 108:4680–4687 [View Article]
     [Google Scholar]
  6. Sewankambo N, Gray RH, Wawer MJ, Paxton L, Mcnaim D et al. HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet 1997; 350:546–550 [View Article][PubMed]
     [Google Scholar]
  7. Wiesenfeld HC, Hillier SL, Krohn MA, Landers DV, Sweet RL. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis 2003; 36:663–668 [View Article][PubMed]
     [Google Scholar]
  8. Myer L, Denny L, Telerant R, Souza M, Wright TC et al. Bacterial vaginosis and susceptibility to HIV infection in South African women: a nested case-control study. J Infect Dis 2005; 192:1372–1380 [View Article][PubMed]
     [Google Scholar]
  9. Marconi C, Cruciani F, Vitali B, Donders GG. Correlation of Atopobium vaginae amount with bacterial vaginosis markers. J Low Genit Tract Dis 2012; 16:127–132 [View Article][PubMed]
     [Google Scholar]
  10. Bretelle F, Rozenberg P, Pascal A, Favre R, Bohec C et al. High Atopobium vaginae and Gardnerella vaginalis vaginal loads are associated with preterm birth. Clin Infect Dis 2015; 60:860–867 [View Article][PubMed]
     [Google Scholar]
  11. Marconi C, Donders GG, Parada CM, Giraldo PC, Da Silva MG. Do Atopobium vaginae, Megasphaera sp. and Leptotrichia sp. change the local innate immune response and sialidase activity in bacterial vaginosis?. Sex Transm Infect 2013; 89:167–173 [View Article][PubMed]
     [Google Scholar]
  12. Bradshaw CS, Tabrizi SN, Fairley CK, Morton AN, Rudland E et al. The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy. J Infect Dis 2006; 194:828–836 [View Article][PubMed]
     [Google Scholar]
  13. Srinivasan S, Liu C, Mitchell CM, Fiedler TL, Thomas KK et al. Temporal variability of human vaginal bacteria and relationship with bacterial vaginosis. PLoS One 2010; 5:e10197 [View Article][PubMed]
     [Google Scholar]
  14. Schwebke JR, Muzny CA, Josey WE. Role of Gardnerella vaginalis in the pathogenesis of bacterial vaginosis: a conceptual model. J Infect Dis 2014; 210:338–343 [View Article][PubMed]
     [Google Scholar]
  15. Cauci S, Driussi S, Monte R, Lanzafame P, Pitzus E et al. Immunoglobulin a response against Gardnerella vaginalis hemolysin and sialidase activity in bacterial vaginosis. Am J Obstet Gynecol 1998; 178:511–515 [View Article][PubMed]
     [Google Scholar]
  16. Swidsinski A, Mendling W, Loening-Baucke V, Ladhoff A, Swidsinski S et al. Adherent biofilms in bacterial vaginosis. Obstet Gynecol 2005; 106:1013–1023 [View Article][PubMed]
     [Google Scholar]
  17. Swidsinski A, Mendling W, Loening-Baucke V, Swidsinski S, Dörffel Y et al. An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole. Am J Obstet Gynecol 2008; 198:97.e1–97.e6 [View Article][PubMed]
     [Google Scholar]
  18. Patterson JL, Stull-Lane A, Girerd PH, Jefferson KK. Analysis of adherence, biofilm formation and cytotoxicity suggests a greater virulence potential of Gardnerella vaginalis relative to other bacterial-vaginosis-associated anaerobes. Microbiology 2010; 156:392–399 [View Article][PubMed]
     [Google Scholar]
  19. Santiago GL, Deschaght P, El Aila N, Kiama TN, Verstraelen H et al. Gardnerella vaginalis comprises three distinct genotypes of which only two produce sialidase. Am J Obstet Gynecol 2011; 204:450.e1–450.e7 [View Article][PubMed]
     [Google Scholar]
  20. Hardy L, Jespers V, Dahchour N, Mwambarangwe L, Musengamana V et al. Unravelling the bacterial vaginosis-associated biofilm: a multiplex Gardnerella vaginalis and Atopobium vaginae fluorescence in Situ hybridization assay using peptide nucleic acid probes. PLoS One 2015; 10:e0136658 [View Article][PubMed]
     [Google Scholar]
  21. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1–137[PubMed] [CrossRef]
     [Google Scholar]
  22. Larsson PG, Forsum U. Bacterial vaginosis-a disturbed bacterial Flora and treatment enigma. APMIS 2005; 113:305–316 [View Article][PubMed]
     [Google Scholar]
  23. Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB et al. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis 2006; 193:1478–1486 [View Article][PubMed]
     [Google Scholar]
  24. Watnick P, Kolter R. Biofilm, city of microbes. J Bacteriol 2000; 182:2675–2679 [View Article][PubMed]
     [Google Scholar]
  25. Ravel J, Brotman RM, Gajer P, Ma B, Nandy M et al. Daily temporal dynamics of vaginal Microbiota before, during and after episodes of bacterial vaginosis. Microbiome 2013; 1:29 [View Article][PubMed]
     [Google Scholar]
  26. Bostwick DG, Woody J, Hunt C, Budd W. Antimicrobial resistance genes and modeling of treatment failure in bacterial vaginosis: clinical study of 289 symptomatic women. J Med Microbiol 2016; 65:377–386 [View Article][PubMed]
     [Google Scholar]
  27. Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G et al. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG 2002; 109:34–43 [View Article][PubMed]
     [Google Scholar]
  28. Donders GG. The prevalence of bacterial vaginosis and aerobic vaginitis in young finish women. APMIS 2011; 119:224–225 [View Article][PubMed]
     [Google Scholar]
  29. Rezeberga D, Lazdane G, Kroica J, Sokolova L, Donders GG. Placental histological inflammation and reproductive tract infections in a low risk pregnant population in Latvia. Acta Obstet Gynecol Scand 2008; 87:360–365 [View Article][PubMed]
     [Google Scholar]
  30. Vieira-Baptista P, Lima-Silva J, Pinto C, Saldanha C, Beires J et al. Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities. Eur J Clin Microbiol Infect Dis 2016; 35:657–664 [View Article][PubMed]
     [Google Scholar]
  31. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991; 29:297–301[PubMed]
     [Google Scholar]
  32. Marconi C, Donders GG, Martin LF, Ramos BR, Duarte MT et al. Chlamydial infection in a high risk population: association with vaginal flora patterns. Arch Gynecol Obstet 2012; 285:1013–1018 [View Article][PubMed]
     [Google Scholar]
  33. Ho BS, Feng WG, Wong BK, Egglestone SI. Polymerase chain reaction for the detection of Neisseria gonorrhoeae in clinical samples. J Clin Pathol 1992; 45:439–442[PubMed] [CrossRef]
     [Google Scholar]
  34. Dezzutti CS, Hendrix CW, Marrazzo JM, Pan Z, Wang L et al. Performance of swabs, lavage, and diluents to quantify biomarkers of female genital tract soluble mucosal mediators. PLoS One 2011; 6:e23136 [View Article][PubMed]
     [Google Scholar]
  35. Spear GT, Kendrick SR, Chen HY, Thomas TT, Bahk M et al. Multiplex immunoassay of lower genital tract mucosal fluid from women attending an urban STD clinic shows broadly increased IL1ß and lactoferrin. PLoS One 2011; 6:e19560 [View Article][PubMed]
     [Google Scholar]
  36. Menard JP, Fenollar F, Henry M, Bretelle F, Raoult D. Molecular quantification of Gardnerella vaginalis and Atopobium vaginae loads to predict bacterial vaginosis. Clin Infect Dis 2008; 47:33–43 [View Article][PubMed]
     [Google Scholar]
  37. Kusters JG, Reuland EA, Bouter S, Koenig P, Dorigo-Zetsma JW. A multiplex real-time PCR assay for routine diagnosis of bacterial vaginosis. Eur J Clin Microbiol Infect Dis 2015; 34:1779–1785 [View Article][PubMed]
     [Google Scholar]
  38. Fredricks DN, Fiedler TL, Thomas KK, Oakley BB, Marrazzo JM. Targeted PCR for detection of vaginal bacteria associated with bacterial vaginosis. J Clin Microbiol 2007; 45:3270–3276 [View Article][PubMed]
     [Google Scholar]
  39. Mendes-Soares H, Krishnan V, Settles ML, Ravel J, Brown CJ et al. Fine-scale analysis of 16S rRNA sequences reveals a high level of taxonomic diversity among vaginal Atopobium spp. Pathog Dis 2015; 73:ftv020 [View Article][PubMed]
     [Google Scholar]
  40. Srinivasan S, Hoffman NG, Morgan MT, Matsen FA, Fiedler TL et al. Bacterial communities in women with bacterial vaginosis: high resolution phylogenetic analyses reveal relationships of Microbiota to clinical criteria. PLoS One 2012; 7:e37818 [View Article][PubMed]
     [Google Scholar]
  41. de Backer E, Verhelst R, Verstraelen H, Alqumber MA, Burton JP et al. Quantitative determination by real-time PCR of four vaginal Lactobacillus species, Gardnerella vaginalis and Atopobium vaginae indicates an inverse relationship between L. gasseri and L. iners. BMC Microbiol 2007; 7:115 [View Article][PubMed]
     [Google Scholar]
  42. Donders GG. Definition and classification of abnormal vaginal flora. Best Pract Res Clin Obstet Gynaecol 2007; 21:355–373 [View Article][PubMed]
     [Google Scholar]
  43. Catlin BW. Gardnerella vaginalis: characteristics, clinical considerations, and controversies. Clin Microbiol Rev 1992; 5:213–237 [View Article][PubMed]
     [Google Scholar]
  44. Donders GG, Zodzika J, Rezeberga D. Treatment of bacterial vaginosis: what we have and what we miss. Expert Opin Pharmacother 2014; 15:645–657 [View Article][PubMed]
     [Google Scholar]
  45. Marrazzo JM, Thomas KK, Fiedler TL, Ringwood K, Fredricks DN. Relationship of specific vaginal bacteria and bacterial vaginosis treatment failure in women who have sex with women. Ann Intern Med 2008; 149:20–28 [View Article][PubMed]
     [Google Scholar]
  46. Skarin A, Holst E, Mårdh PA. Antimicrobial susceptibility of comma-shaped bacteria isolated from the vagina. Scand J Infect Dis Suppl 1983; 40:81–84[PubMed]
     [Google Scholar]
  47. Spiegel CA, Eschenbach DA, Amsel R, Holmes KK. Curved anaerobic bacteria in bacterial (nonspecific) vaginosis and their response to antimicrobial therapy. J Infect Dis 1983; 148:817–822 [View Article][PubMed]
     [Google Scholar]
  48. Luchiari HR, Ferreira CS, Golim MA, Silva MG, Marconi C. Cervicovaginal bacterial count and failure of metronidazole therapy for bacterial vaginosis. Int J Gynaecol Obstet 2016; 132:297–301 [View Article][PubMed]
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000561
Loading
Treatment failure of bacterial vaginosis is not associated with higher loads of Atopobium vaginae and Gardnerella vaginalis
J. Med. Microbiol. 66, 1217 (2017); https://doi.org/10.1099/jmm.0.000561
/content/journal/jmm/10.1099/jmm.0.000561
/content/journal/jmm/10.1099/jmm.0.000561
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error