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BackgroundGardnerella is a key pathogen in bacterial vaginosis (BV), but the role of the different Gardnerella species remains unclear. We investigated the role of four Gardnerella species, as well as Fannyhessea vaginae, Lactobacillus crispatus and L. iners in BV.MethodsFrom 331 pregnant women from the Democratic Republic of the Congo, BV was diagnosed using Nugent scoring and a cervicovaginal lavage was used to quantify G. leopoldii, G. piotii, G. swidsinskii, G. vaginalis, F. vaginae, L. crispatus and L. iners by qPCR. Univariate associations between these species and clinical outcomes were assessed. A logistic regression model and ROC curves were calculated to determine the best diagnostic marker for BV.ResultsHere, L. iners (75.8%) was the most prevalent species and G. vaginalis (36.0%) the most common Gardnerella species. All investigated Gardnerella spp. were prevalent (50.9-57.9%) in women with (asymptomatic) BV. Univariate analysis revealed no significant associations with clinical symptoms of BV, while F. vaginae (positive Whiff test, high pH), G. vaginalis (high pH) and L. crispatus (low pH) were associated with signs of BV. G. piotii was associated with markers of urinary tract infection. Women with L. iners had higher odds of delivering preterm. ROC analyses showed that F. vaginae was the best marker for BV (AUC 0.81), and the combined model further increased the diagnostic performance (AUC 0.90).ConclusionAll Gardnerella species were involved in BV, although none were associated with the most important clinical symptoms of BV and none emerged as a superior molecular marker for BV. more...

BackgroundBacterial vaginosis (BV) is the most common gynecological condition in women of reproductive age and associated with adverse pregnancy outcomes. In the Democratic Republic of the Congo (DRC), neonatal mortality rate is as high as 2.8 percent with preterm birth (PTB) and low birth weight (LBW) as leading causes. Because no studies have addressed BV in DRC, we aimed to investigate the prevalence of BV, the risk factors and the association between BV and adverse pregnancy outcomes in a population of pregnant women from Bukavu, DRC.MethodsA total of 533 pregnant women in the second trimester of pregnancy were recruited in the Provincial Reference Hospital of Bukavu, DRC, between January and October 2017, and followed until delivery. Clinical and sociodemographic data of mother and newborn, and data on (vaginal) hygiene practices, sexual behavior and reproductive history were collected. BV was diagnosed by Nugent scoring of Gram-stained vaginal smears. Two multivariate regression models were built to identify risk factors for BV and to investigate BV as a risk factor for adverse pregnancy outcomes.ResultsThe prevalence of BV was 26.3% and approximately half of the women with BV were asymptomatic. Independent risk factors for BV were the use of alternatives to water for intravaginal washing, concurrent partners, unemployed status, the presence of vaginal Candida and clay consumption. BV was independently associated with both LBW and PTB of an infant with LBW.ConclusionThe prevalence of BV in Bukavu is high but in line with the global average. BV was associated with adverse pregnancy outcomes in our study population. Hence, research on modifiable risk factor-based interventions to reduce the prevalence of BV, and on screening/treatment of BV during antenatal care should be explored to reduce neonatal mortality and morbidity. more...