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Bacterial vaginosis is one of the most common reproductive health problems in women. Lactobacillus spp. play a leading role in the vaginal biocenosis and provide local antimicrobial defense, but not all species are equally capable of protecting the vaginal ecosystem from pathogens. Diagnostic methods in practical healthcare do not allow identification of Lactobacillus spp. species, which limits the ability to comprehensively assess the status of the vaginal biocenosis. We conducted a study in which we compared microscopy data of the examined smear with the detection of Lactobacillus spp. and other microorganisms. The aim of the study was to evaluate the species composition of Lactobacillus spp. from the vagina depending on morphologic characteristics and composition of associated flora. The study included 64 conditionally healthy women of reproductive age from 18 to 35 years old. The study of species composition of the vaginal biocenosis and typing of lactobacilli was carried out by real-time PCR methods. The obtained results were processed using generally accepted methods of descriptive and ordinal statistics. During the study, it was found that the vaginal biocenosis was dominated by species of Lactobacillus spp. L. crispatus, L. vaginalis, L. iners and L. jensenii. L. johnsonii was rarely found, and L. acidophilus was not detected. Typing results showed that the vagina was more frequently colonized by more than one species of Lactobacillus spp. while a single species of Lactobacillus spp. was detected less frequently. A correlation was found between Lactobacillus spp. species and bacilli thickness. If thick bacilli are detected in gynecological smear microscopy, they belong to the species L. crispatus, which has high colonization resistance and is a factor in the stability of the vaginal biocenosis. If smear microscopy reveals thin bacilli, then these are species of L. iners and L. jensenii. These representatives of Lactobacillus spp. are not directly related to the dysbiotic state of the vagina, but may indicate the possible development of dysbiosis in the future.

Dysbiosis of the vaginal microbiome poses a serious risk for sexual human immunodeficiency virus type 1 (HIV-1) transmission. Prevotella spp are abundant during vaginal dysbiosis and associated with enhanced HIV-1 susceptibility; however, underlying mechanisms remain unclear. Here, we investigated the direct effect of vaginal bacteria on HIV-1 susceptibility of vaginal CD4+ T cells. Notably, pre-exposure to Prevotella timonensis enhanced HIV-1 uptake by vaginal T cells, leading to increased viral fusion and enhanced virus production. Pre-exposure to antiretroviral inhibitors abolished P timonensis –enhanced infection. Our study shows that the vaginal microbiome directly affects mucosal CD4+ T-cell susceptibility, emphasizing importance of vaginal dysbiosis diagnosis and treatment. [ABSTRACT FROM AUTHOR]

The vaginal microbiota can be classified into five major community state types (CSTs) based on the bacterial content. However, the link between different CST subtypes and vaginal infection remains unclear. Here, we analyzed 2017 vaginal microbiota samples from women of a reproductive age with vaginal infections that were published in the last decade. We found that L. iners was the most dominant in 34.8% of the vaginal samples, followed by L. crispatus (21.2%). CST I was common in healthy individuals, whereas CST III and IV were associated with dysbiosis and infection. CST III-B, IV-A, IV-B, and IV-C0 were prevalent in patients with bacterial vaginosis (BV). Based on the relative abundance of bacteria at the (sub)genus level, a random forest classifier was developed to predict vaginal infections with an area under the curve of 0.83. We further identified four modules of co-occurring bacterial taxa: L. crispatus, Gardnerella, Prevotella, and Bacteroides. The functional prediction revealed that nucleotide biosynthesis pathways were upregulated in patients with human papilloma virus, and carbohydrate degradation pathways were downregulated in patients with BV. Overall, our study identified the bacterial signatures of healthy and infected vaginal microbiota, providing unique insights into the clinical diagnosis and health status prediction of women of a reproductive age. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is a sexually transmitted virus, which infects approximately 80% of all men and women at some time in their lives. Usually, the infection is resolved successfully by the body's immune system. Persistent infection with high-risk HPV (hrHPV) is necessary but not sufficient for cervical cancer development, and additional factors, such as the vaginal microbiome (vaginome), are thought to be involved. The aim of this study is to investigate whether either vaginal dysbiosis (imbalance in vaginal bacterial composition) or sexually transmitted pathogens, e.g., Chlamydia trachomatis (CT), are possible cofactors for hrHPV infection and HPV-induced cervical dysplasia in asymptomatic women attending the Dutch Cervical Cancer Screening Program. In this study, 492 hrHPV-positive and 500 hrHPV-negative cervical smears from women attending the Screening Program were included. Age and cytology were known for the hrHPV-positive samples. All cervical smears were diluted in Aptima® specimen transfer medium and tested with Aptima® transcription-mediated amplification assays targeting CT, Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), Candida spp. (CS), C. glabrata (CG), Trichomonas vaginalis (TV), and bacterial vaginosis (BV). The prevalences of CT, NG, MG, CS, CG, TV, and BV in this cohort were found to be 1.9%, 0.0%, 1.7%, 5.4%, 1.4%, 0.1%, and 27.2%, respectively. When comparing HPV groups, it was found that CT, MG, and BV had a significantly higher prevalence in hrHPV-positive smears as compared with hrHPV-negative samples (for all p < 0.001). No significant differences were found when comparing different age groups and cytology outcomes. In conclusion, vaginal dysbiosis seems associated with hrHPV infection in women attending the Dutch Cervical Cancer Screening Program. [ABSTRACT FROM AUTHOR]

Bacterial vaginosis (BV) is an infection of the genital tract characterized by disturbance of the normally Lactobacilli-dominated vaginal flora due to the overgrowth of Gardnerella and other anaerobic bacteria. Gardnerella vaginalis, an anaerobic pathogen and the major pathogen of BV, produces sialidases that cleave terminal sialic acid residues off of human glycans. By desialylation, sialidases not only alter the function of sialic acid-containing glycoconjugates but also play a vital role in the attachment, colonization and spread of many other vaginal pathogens. With known pathogenic effects, excellent performance of sialidase-based diagnostic tests, and promising therapeutic potentials of sialidase inhibitors, sialidases could be used as a biomarker of BV. This review explores the sources of sialidases and their role in vaginal dysbiosis, in aims to better understand their participation in the pathogenesis of BV and their value in the diagnosis and treatment of BV. [ABSTRACT FROM AUTHOR]

The article presents literary data on the morphology and types of vaginal lactobacilli, pathological changes in the vaginal environment, as well as modern possibilities of restoring the vaginal microflora of a woman’s organism. Certain regularities regarding the connection of bacterial vaginosis with intestinal dysbiosis have been observed, which indicates a single dysbiotic process in the organism with a dominant manifestation either in the sexual or digestive system. A review of scientific publications of recent years shows the significant influence of intestinal dysbiosis, infectious and inflammatory diseases of the stomach and intestines, as well as the oral use of antibacterial drugs on the quantitative and qualitative composition of the vaginal microflora in women. It was found that an increased number of opportunistic microorganisms (85%) and a decreased number of lactobacilli and bifidobacteria (less than 70%) in the intestine are associated with a rise in the content of opportunistic microorganisms in the vaginal biota in women with infectious and inflammatory diseases of the reproductive system. This is explained by the ability of saprophytes and opportunistic microorganisms to penetrate into the reproductive organs of women by increasing the permeability of the mucous membrane of the intestinal wall, as well as into the vascular bed, which can be observed, for example, on the background of antibiotic use. The antibiotic use in a number of cases leads to a closed circle, when the need for antibacterial therapy to eliminate one infection leads to a deepening of dysbiosis and an increased number of other pathogens. Numerous studies have demonstrated the effectiveness of selective decontamination (selective elimination of pathogens) in combination with a probiotic, prebiotic or synbiotic to restore vaginal microbiocenosis. Our experience of using an oral synbiotic (1 capsule contains 5 billion colony-forming units of Lactobacillus plantarum lyophilizate pcs. 8Р-AZ, Lactobacillus fermentum pcs. 90Т-С4 and prebiotic inulin, once a day 30 minutes before meal for 7–10 days) in a complex therapy of bacterial vaginosis in non-pregnant women of reproductive age indicates faster elimination of systemic dysbiosis and restoration of normal intravaginal flora. Thus, regression of complaints and normalization of objective data was determined on average for 2.9 days versus 4.7 days in women who were not administered the drug. The obtained data show that a systemic synbiotic containing a lyophilized microbial mass of probiotic lactobacteria, products of their metabolism and inulin (prebiotic) creates an additional effect in restoring normal biocenosis and the immune mechanism of ensuring colonization resistance of the body’s mucous membranes. [ABSTRACT FROM AUTHOR]

To date, probiotic medicinal products have a significant number of clinical studies, which is the basis for the formation of an evidence base and their inclusion in modern treatment standards. However, ideas about the optimal composition of a probiotic preparation and effective dosage remain problematic issues in modern medicine. Choosing an effective probiotic in gynecological practice is a particularly difficult and important issue. Objective of the review: to analyze the available clinical studies aimed at identifying strains of beneficial bacteria, their dosage, possible combinations in order to choose the optimal composition of a probiotic agent for the treatment of dysbiosis, including vaginal. Materials and methods. Modern methods recommended for theoretical analytical research were used: method of analysis, method of synthesis, method of induction. An electronic search was conducted in bibliographic databases, including PubMed, CENTRAL, MEDLINE, Embase, and CINAHL. 58 scientific publications were analyzed. Inclusion criteria were the following keywords: probiotics, optimal dosage, optimal composition, dysbiosis. Results. The most important probiotic microorganisms for restoring health in women are Lactobacillus acidophilus, L. crispatus, L. jensenii, L. gasseri, L. rhamnosus. Each of these lactobacilli maintains the normal vaginal pH, produces hydrogen peroxide, suppresses growth and prevents the reproduction of obligate anaerobes and opportunistic microorganisms when interacting with the peroxidase of cervical mucus. The mechanism of action of the above-mentioned probiotic microorganisms was analyzed. It was established that the effective dose of each of the components should not be less than 1-2 billion colony forming units. Conclusions. The analysis of scientific publications in the bibliographic databases was sufficient to establish that the oral use of probiotics in the treatment of gynecological patients is effective. The optimal components of the probiotic agent, which are effective for the therapy of vaginal dysbiosis, are L. crispatus, L. gasseri, L. jensenii, L. rhamnosus, L. acidophilus.

At concentrations achieved following systemic administration, the primary effect of imidazoles and triazoles on fungi is inhibition of 14-α-sterol demethylase, a microsomal cytochrome P450 (CYP) enzyme. Imidazoles and triazoles impair the biosynthesis of ergosterol for the cytoplasmic membrane and lead to the accumulation of 14-α-methyl sterols. The synthetic imidazole miconazole is additionally able to increase intracellular reactive oxygen species, at least in part through inhibition of fungal catalase and peroxidase. This unique feature of miconazole is probably the basis for its fungicidal activity in C. albicans, in addition to the fungistatic mode of action. Studies show that miconazole is superior to nystatin treatment and demonstrate its impact as one of the best options in managing vulvovaginal candidiasis. Regarding recurrent vulvovaginal candidiasis, several new drugs are currently developed to ensure effective treatment also for this group of patients. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is a sexually transmitted virus, which infects approximately 80% of all men and women at some time in their lives. Usually, the infection is resolved successfully by the body’s immune system. Persistent infection with high-risk HPV (hrHPV) is necessary but not sufficient for cervical cancer development, and additional factors, such as the vaginal microbiome (vaginome), are thought to be involved. The aim of this study is to investigate whether either vaginal dysbiosis (imbalance in vaginal bacterial composition) or sexually transmitted pathogens, e.g., Chlamydia trachomatis (CT), are possible cofactors for hrHPV infection and HPV-induced cervical dysplasia in asymptomatic women attending the Dutch Cervical Cancer Screening Program. In this study, 492 hrHPV-positive and 500 hrHPV-negative cervical smears from women attending the Screening Program were included. Age and cytology were known for the hrHPV-positive samples. All cervical smears were diluted in Aptima® specimen transfer medium and tested with Aptima® transcription-mediated amplification assays targeting CT, Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), Candida spp. (CS), C. glabrata (CG), Trichomonas vaginalis (TV), and bacterial vaginosis (BV). The prevalences of CT, NG, MG, CS, CG, TV, and BV in this cohort were found to be 1.9%, 0.0%, 1.7%, 5.4%, 1.4%, 0.1%, and 27.2%, respectively. When comparing HPV groups, it was found that CT, MG, and BV had a significantly higher prevalence in hrHPV-positive smears as compared with hrHPV-negative samples (for all p < 0.001). No significant differences were found when comparing different age groups and cytology outcomes. In conclusion, vaginal dysbiosis seems associated with hrHPV infection in women attending the Dutch Cervical Cancer Screening Program.

The vaginal microbiota can be classified into five major community state types (CSTs) based on the bacterial content. However, the link between different CST subtypes and vaginal infection remains unclear. Here, we analyzed 2017 vaginal microbiota samples from women of a reproductive age with vaginal infections that were published in the last decade. We found that L. iners was the most dominant in 34.8% of the vaginal samples, followed by L. crispatus (21.2%). CST I was common in healthy individuals, whereas CST III and IV were associated with dysbiosis and infection. CST III-B, IV-A, IV-B, and IV-C0 were prevalent in patients with bacterial vaginosis (BV). Based on the relative abundance of bacteria at the (sub)genus level, a random forest classifier was developed to predict vaginal infections with an area under the curve of 0.83. We further identified four modules of co-occurring bacterial taxa: L. crispatus, Gardnerella, Prevotella, and Bacteroides. The functional prediction revealed that nucleotide biosynthesis pathways were upregulated in patients with human papilloma virus, and carbohydrate degradation pathways were downregulated in patients with BV. Overall, our study identified the bacterial signatures of healthy and infected vaginal microbiota, providing unique insights into the clinical diagnosis and health status prediction of women of a reproductive age.

At concentrations achieved following systemic administration, the primary effect of imidazoles and triazoles on fungi is inhibition of 14-α-sterol demethylase, a microsomal cytochrome P450 (CYP) enzyme. Imidazoles and triazoles impair the biosynthesis of ergosterol for the cytoplasmic membrane and lead to the accumulation of 14-α-methyl sterols. The synthetic imidazole miconazole is additionally able to increase intracellular reactive oxygen species, at least in part through inhibition of fungal catalase and peroxidase. This unique feature of miconazole is probably the basis for its fungicidal activity in C. albicans, in addition to the fungistatic mode of action. Studies show that miconazole is superior to nystatin treatment and demonstrate its impact as one of the best options in managing vulvovaginal candidiasis. Regarding recurrent vulvovaginal candidiasis, several new drugs are currently developed to ensure effective treatment also for this group of patients.

Miscarriage is a devastating pregnancy loss that affects many women worldwide. It is characterized as a spontaneous miscarriage that occurs before 20 weeks of gestation which affects more than 25% of pregnancies. While the causes of miscarriage are complex and multifactorial, recent research has suggested a potential role of the vaginal microbiota. The vaginal microbiome is a dynamic ecosystem of microbes that are essential for preserving vaginal health and avoiding infections. Vaginal dysbiosis has been accompanied with numerous adverse pregnancy complications, such as preterm birth. However, the effect of the vaginal microbiome in miscarriage is not fully understood. This review aims to investigate the link between vaginal microbiota and miscarriage. Also, we investigate the various mechanisms through which the vaginal microbiota may affect miscarriage. Additionally, we examine the implications of these research findings, specifically the possibility of vaginal microbiome screening and targeted interventions to prevent miscarriage. [ABSTRACT FROM AUTHOR]

Introduction. It is known that women are significantly more likely to suffer from lower urinary tract infections (LUTIs) than men. Nowadays, there is growing evidence to demonstrate the impact of vaginal microbiota on the development of recurrent LUTIs.Objectives. To demonstrate the impact of vaginal microbiota disorders on the development of recurrent lower urinary tract infections.Materials & methods. Seventy-five women with recurrent LUTIs 19 – 76 years old were enrolled in this study. The examination was performed according to the algorithm developed in the Department of Urology and Surgical Andrology, Russian Medical Academy of Continuous Professional Education. Real-time PCR of vaginal epithelial cell scrapings (Femoflor 16) was performed to comprehensively evaluate the vaginal microbiota.Results. Vaginal dysbiosis was detected in 47/75 (62.7%) women with recurrent UTIs: moderate vaginal dysbiosis was detected in 25/75 (33.3%) women and severe dysbiosis — in 22/75 (29.3%) women. A moderate correlation between the presence/absence of vaginal dysbiosis and the number of LUTI recurrences over 6 months was found (r = 0.310; p = 0.007). Vaginal dysbiosis was significantly more common among peri- and postmenopausal women with recurrent LUTIs than reproductive women (OR = 4.85; 95% CI = 1.45 – 16.17).Conclusion. Vaginal dysbiosis contributes to the development of recurrent LUTIs with more relapses. Vaginal microbiota disorders and, consequently, recurrent LUTIs are more common in peri- and postmenopausal women than reproductive women.

Objective: to evaluate the clinical tolerability, effectiveness and stability of the therapeutic result when using different regimens for the treatment of recurrent bacterial vaginosis (BV) in women of reproductive age. Materials and methods. 105 women of reproductive age with diagnosed recurrent symptomatic BV participated in the study. The participants were randomized into three comparable groups of 35 women each. A ten-day primary decontamination of the vaginal tract was carried out in all groups: intravaginal administration of the drug Tergynan for group 1 and Femiril suppositories in groups 2 and 3. After the initial treatment patients of group 3 received the vaginal probiotic suppositories Alactel Femi for 15 days, after that they used it twice a week No. 10. The effectiveness of BV therapy was evaluated immediately after the antibacterial course and after a 6-month follow-up period based on the results of clinical examination and determination of vaginal pH. Results. Subjective and objective signs of bacterial infection were not detected in all participants after the course of vaginal decontamination. The pH of vaginal secretion was within the normal range and did not differ statistically between the groups. After 6 month, according to the results of a gynecological examination and pH test, one recurrence of BV was confirmed in group 1 and 2. The patients of group 3 had no complaints about manifestations of reinfection, which, in combination with the data of pH-metry, allowed confirming the absence of BV recurrences in them. Additional use of a probiotic in a complex with lactic acid in group 3 was associated with a stable normalization of the acid-alkaline balance of the vaginal secretion: 4.43 ± 0.12 and 4.39 ± 0.14 in groups 1 and 2, respectively, against 4.02 ± 0 ,12 in the 3rd group (p < 0.05). Conclusions. Obtained results indicate a more stable anti-relapse effectiveness and safety of the local use of Femiril, followed by the restoration of the physiological parameters of the vaginal biotope with a complex of probiotics and lactic acid in the Alactel femi. The effectiveness of this approach consists in combining the antibacterial effect of phytoextracts with the successive restoration of vaginal immunity and metabolism through persistent colonization of the mucous membrane with living lactobacilli of eubiotic origin.

Miscarriage is a devastating pregnancy loss that affects many women worldwide. It is characterized as a spontaneous miscarriage that occurs before 20 weeks of gestation which affects more than 25% of pregnancies. While the causes of miscarriage are complex and multifactorial, recent research has suggested a potential role of the vaginal microbiota. The vaginal microbiome is a dynamic ecosystem of microbes that are essential for preserving vaginal health and avoiding infections. Vaginal dysbiosis has been accompanied with numerous adverse pregnancy complications, such as preterm birth. However, the effect of the vaginal microbiome in miscarriage is not fully understood. This review aims to investigate the link between vaginal microbiota and miscarriage. Also, we investigate the various mechanisms through which the vaginal microbiota may affect miscarriage. Additionally, we examine the implications of these research findings, specifically the possibility of vaginal microbiome screening and targeted interventions to prevent miscarriage.

Background: The thesis on which this paper is based intended to investigate whether the result of the microbiological vaginal swab has an influence on the outcome of the fertility treatment. Methods: The microbiological vaginal swabs of patients who received fertility treatment at Saarland University Hospital were evaluated. Depending on the microorganisms detected, the swab result was classified as inconspicuous, intermediate, or conspicuous. The SPSS software was used to determine the correlation between the swab result and the outcome of the fertility treatment. Results: Dysbiosis was associated with a worse outcome of fertility treatment. The pregnancy rate with a conspicuous swab was 8.6%, whereas it was 13.4% with an inconspicuous swab. However, this association was not statistically significant. Furthermore, an association of endometriosis with dysbiosis was found. Endometriosis was more frequent with a conspicuous swab result than with an inconspicuous result (21.1% vs. 17.7%), yet the correlation was not statistically significant. However, the absence of lactobacilli was significantly associated with endometriosis (p = 0.021). The association between endometriosis and a lower pregnancy rate was also statistically significant (p = 0.006). Conclusion: The microbiological vaginal and cervical swabs can be used as predictors for the success of fertility treatments. Further studies are needed to assess the impact of transforming a dysbiotic flora into a eubiotic environment on the success of fertility treatments. [ABSTRACT FROM AUTHOR]

In the modern world it is important to understand the interaction of macro- and microorganisms in normal conditions and during illness. It is the biotope of the vagina that plays an extremely important role in a woman’s organism and it reflects the general state of woman’s health. Urogenital endogenous microflora is not static, it is a constantly changing macropopulation. In this population the number of specific types of microorganisms fluctuates within the limits of changes in the conditions of their environment. The microflora of the vagina changes during different periods of a woman’s life, namely during perinatal, late neonatal, prepubertal, pubertal, reproductive and postmenopausal periods, as well as the menstrual cycle, daily and hourly. The ability of commensal microorganisms to protect the region from the invasion of their own microflora from other cavities and the microflora of the sexual partner is unique. Considering the general global trend towards the increase in prevalence, virulence and resistance of microorganisms to traditional methods of antiseptic therapy, as well as the appearance of new types of microorganisms, a steady trend towards an increase in infectious diseases, including sexually transmitted infections, is determined. Dysbiosis is considered qualitative and quantitative violations of the corresponding biotope of the normal flora. According to official statistics, the prevalence of bacterial vaginosis is 10-35% among all patients with pathological vaginal discharge. The variability of the vaginal microbiome is widely studied in the world and depends on many factors, namely the hormonal background of a woman’s organism, her diet, the characteristics of urination and defecation, menstruation, hygienic procedures and infections. One of the key links in the pathogenesis of vaginal infectious diseases is the ability of bacteria to form biofilms, which are microbial associations. Infections caused by film-forming strains of pathogenic and opportunistic microorganisms are characterized by an atypical course, insufficient effectiveness of antibiotic therapy, and often transition to a chronic form or carriage. Therefore, understanding the mechanisms of formation, structure and regulation of vital activities of biofilms helps in solving problems related to human health. The World Health Organization recommends evaluating the vaginal microbiome according to the Hay – Ison criteria. Determining the pH of vaginal secretions also helps to establish the type of vaginal dysbiosis. Clinical therapy includes two main stages of treatment: antiseptic measures and restoration of one’s own vaginal microbiome. Often, these two stages of therapy are carried out simultaneously. Correcting the pH of the vaginal secretion is also important. [ABSTRACT FROM AUTHOR]

Vaginal dysbiosis can lead to serious infections in asymptomatic women. Lactobacillus probiotics (LBPs) are being investigated as a promising therapy for reversing vaginal microbiota dysbiosis. This study aimed to investigate whether administering LBPs could improve vaginal dysbiosis and facilitate the colonization of Lactobacillus species in asymptomatic women. 36 asymptomatic women were classified based on the Nugent score as Low-NS (n = 26) and High-NS (n = 10) groups. A combination of Lactobacillus acidophilus CBT LA1, Lactobacillus rhamnosus CBT LR5, and Lactobacillus reuteri CBT LU4 was administered orally for 6 weeks. The study found that among women with a High-NS, 60% showed improved vaginal dysbiosis with a Low-NS after LBP intake, while four retained a High-NS. Among women with a Low-NS, 11.5 % switched to a High-NS. Genera associated with vaginal dysbiosis were positively correlated with the alpha diversity or NS, while a negative correlation was observed between Lactobacillus and the alpha diversity and with the NS. Vaginal dysbiosis in asymptomatic women with an HNS improved after 6 weeks of LBP intake, and qRT-PCR revealed the colonization of Lactobacillus spp. in the vagina. These results suggested that oral administration of this LBP could improve vaginal health in asymptomatic women with an HNS. [ABSTRACT FROM AUTHOR]

The human microbiota influences physiology, disease, and metabolic reproduction. The origin of uterine bacteria is controversial. The main assumption is that the germs enter the uterine cavity from the vagina through the cervical canal, bloodstream, fallopian tubes, and gynecological surgical channels. Understanding the microbiota at various anatomical sites is critical to the female reproductive system and pregnancy. Today's study focuses on the role of uterine bacteria in pregnancy and embryo implantation. According to our findings, the uterine microbiome influences embryo implantation and pregnancy outcome. Pregnancy is a natural, evolutionarily selected approach to human reproduction. During pregnancy, the microbiota of the reproductive tract changes, facilitating the maintenance of pregnancy, and the human immune system undergoes a series of changes that recognize and adapt to the non-self. From the beginning of pregnancy, a non-self fetus must establish a placenta of embryonic origin to protect itself and promote growth; the VMB tends to be more stable and lactobacillusdominated in late gestation than in early gestation. Any material that disrupts this connection, such as microbial changes, is associated with a higher risk of poor health and poor pregnancy outcomes in women (eclampsia). The presence of any material that disrupts this connection, such as microbial changes, is associated with a higher risk of poor health and poor pregnancy outcomes (preeclampsia, preterm birth, gestational diabetes, etc.). In this work, we review the last decade of relevant research to improve our understanding of the mechanisms by which the microbiota of the female reproductive tract influences female reproductive health. This work discusses the mechanisms associated with the reproductive tract microbiota and pregnancy immunity, aswell as the impact of an abnormal microbiota on adverse pregnancy outcomes. Emphasis is placed on the characteristics and sources of the female vaginal, uterine, and placental microbiota and the importance of a well-stabilized local human microbiota and immune system for embryo implantation, placental development, fetal growth, and pregnancy outcome. [ABSTRACT FROM AUTHOR]

A healthy vaginal microbiota is Lactobacillus-dominated. Several factors can interfere with the state of balance leading to dysbiosis, such as vaginal infections caused by bacteria and Candida species. The present single-arm, uncontrolled open-label study aimed to evaluate the ability of the SYNBIO® probiotic combination, taken as an oral formulation, to contribute to vaginal health. Thirty pre-menopausal participants were included in the study. Participants were instructed for daily oral intake of SYNBIO® probiotic capsules for 15 days. Vaginal swabs were collected at baseline (T0), 15 days after the start of the treatment (T1), and 7 days after the end of the treatment (T2). Amsel criteria, Nugent score, and vaginal pH were evaluated at each sampling time. In addition, the participants' quality of life was assessed by the WHOQOL-BREF questionnaire. The administration of SYNBIO® once daily for 15 days resulted in a substantial improvement in the vaginal flora in terms of an increase in lactobacilli and a decrease in enterococci, staphylococci, Gardnerella spp., and Candida spp. According to the results, statistically significant changes in leucorrhoea, itching, and vulvo-vaginal erythema/edema as well as a decrease in all the Amsel criteria were recorded. The oral consumption of SYNBIO® demonstrated enhanced benefits for vaginal health. [ABSTRACT FROM AUTHOR]

Purpose of Review: To highlight recent literature that discusses the association of overweight and obesity with vaginal dysbiosis and symptomatic vulvovaginitis among non-pregnant women. Recent Findings: Literature search on vaginitis showed varying results regarding associations between obesity, vaginal dysbiosis, yeast vulvovaginitis, and vulvar disorders. There was no convincing relationship between obesity and vulvovaginal candidiasis. However, majority of the results in vaginal dysbiosis do show important associations with obesity. Summary: Lactobacillus, especially L. crispatus and L. iners, play an important role in the vaginal microbiome of obese women. While women with obesity may have a higher prevalence of vaginal dysbiosis, this does not appear to increase the risk for clinical bacterial vaginosis or vulvovaginal candidiasis. Obesity may increase the risk for atopic dermatitis or atopic eczema due to chronic inflammation from induced immune dysfunction and hypersensitivity. These findings should be considered in future research to further understand the direct role of overweight/obesity in recurrent vulvovaginal symptoms and to have a better understanding of its impact on treatment efficacy. [ABSTRACT FROM AUTHOR]

Trauma to the perineum during childbirth is still a common obstetric problem. The question of etiology and risk factors is still extremely debatable. The high risk of long-term consequences of perineal injuries creates the need for timely prediction and effective prevention of this complication of childbirth, which seems to be the main reserve for reducing future pelvic floor insufficiency and associated pathological conditions. Background. Perineal trauma during childbirth is still a common problem in obstetrics. Also, a high percentage of long-term consequences of perineal injuries creates the need for timely prediction and effective prevention of perineal trauma during childbirth, which is relevant today. Aim. To identify the main predictors of the risk of developing obstetric perineal injury. Materials and methods. We conducted a prospective randomized study between September 2020 and January 2022, which included 110 pregnant women. The observation of the patients began from the day of the first visit to the antenatal clinic and throughout pregnancy and the postpartum period, much attention was paid to a comprehensive perineological examination. Results. In group 1, a large number of grade I and II tears (n=37, 33% and n=24, 29%) were noted, and grade III tears were completely absent. In group 2, there were grade III perineal tears, the frequency was (n=5, 2.1%), but still their number was inferior to grade I and II tears (n=10, 26% and n=15, 14%). In group 3, the analysis showed a low frequency of perineal tears of I and II degrees (n=8, 11% and n=17, 18%) and a number of tears of degree III comparable to group 2 (n=8, 2.6%). Episiotomy in all groups was carried out in the range from 7 to 9%, strictly according to obstetric indications. Conclusion. According to the data obtained, the most significant clinical and anamnestic predictors of obstetric perineal trauma were: frequent abortions in anamnesis, chronic diseases of the ENT organs and the urinary system, vaginal dysbiosis (nonspecific vaginitis, bacterial vaginosis), changes in the pH of the vaginal environment, low tone of the perineum, the presence of scar on the perineum.

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In China, premature rupture of membranes (PROM) counts as a major pregnancy complication in China and usually results into adverse pregnancy outcomes. We analysed the vagina microbiome composition using 16S rDNA V3–V4 amplicon sequencing technology, in this prospective study of 441 women in their third trimester of pregnancy. We first divided all subjects into PROM and HC (healthy control) groups, in order to investigate the correlation of vagina microbiome composition and the development of PROM. We found that seven pathogens were higher in the PROM group as compared to the HC group with statistical significance. We also split all subjects into three groups based on Lactobacillus abundance-dominant (Lactobacillus > 90%), intermediate (Lactobacillus 30–90%) and depleted (Lactobacillus < 30%) groups, and explored nine pathogenic genera that were higher in the depleted group than the intermediate and dominant groups having statistical significance. Finally, using integrated analysis and logistics regression modelling, we discovered that Lactobacillus (coeff = −0.09, p = 0.04) was linked to the decreased risk of PROM, while Gardnerella (coeff = 0.04, p = 0.02), Prevotella (coeff = 0.11, p = 0.02), Megasphaera (coeff = 0.04, p = 0.01), Ureaplasma (coeff = 0.004, p = 0.01) and Dialister (coeff = 0.001, p = 0.04) were associated with the increased risk of PROM. Further study on how these pathogens interact with vaginal microbiota and the host would result in a better understanding of PROM development. [ABSTRACT FROM AUTHOR]

Introduction: The Nugent score, limited by subjectivity and personnel requirements, lacks accuracy. Establishing a precise and simple molecular test is therefore essential for detecting vaginal microbiota compositions and evaluating vaginal health., Methods: We evaluated the vaginal health of Chinese women using quantitative polymerase chain reaction (qPCR) to target Lactobacillus crispatus ( L. crispatus) , L. iners , Gardnerella vaginalis ( G. vaginalis) , Atopobium vaginae ( A. vaginae) , and Megasphaera phylotype1 . bacterial vaginosis (BV)-related bacteria shared a fluorescent channel. Using 16S rDNA sequencing as a reference standard, we evaluated and validated the diagnostic accuracy of the qPCR assay., Results: Both qPCR and 16S rDNA sequencing demonstrated 90.5% concordance in segregating vaginal community state type (CST), as visualized through heatmaps and PCoA. Spearman's correlation analysis revealed strong correlations between the two methods in calculating the RA of L. crispatus (CST I), L. iners (CST III), and BV-related bacteria (CST IV), with coefficients of 0.865, 0.837, and 0.827, respectively. Receiver operating characteristic analysis showed that qPCR had significant diagnostic accuracy for CST I, CST III, and CST IV (molecular BV), with area under the curve values of 0.967, 0.815, and 0.950, respectively, indicating strong predictive power., Discussions: Vaginal health can be evaluated using a single qPCR amplification experiment, making the multiplex qPCR assay a highly accurate tool for this purpose., Competing Interests: No conflicts of interest., (Copyright and License information: Editorial Office of CCDCW, Chinese Center for Disease Control and Prevention 2024.)

Abstract Background The vaginal microbiota (VMB) are the set of microorganisms residing in the human vagina. During pregnancy, their composition is Lactobacillus-dominant in most Caucasian women. Previous studies suggest that the VMB of women with African ancestry is more likely to be non-Lactobacillus dominant (dysbiotic) compared to other populations, and possibly relate to the high incidence of pregnancy complications, such as preterm birth. This work reviewed the literature on VMB composition in pregnant women from sub-Saharan Africa. Methods A search was conducted in PubMed and Embase databases following PRISMA guidelines. Observational and intervention studies analysing VMB communities from sub-Saharan African pregnant women using molecular techniques were included. Results Ten studies performed in seven sub-Saharan African countries were identified. They independently showed that Lactobacillus-dominant VMB (particularly L. iners or L. crispatus) or VMB containing Lactobacilli are the most prevalent, followed by a more diverse anaerobe-dominant VMB, in the studied populations. The majority of pregnant women with a sexually-transmitted infection had a Lactobacillus-dominant VMB, but with a significantly higher presence of anaerobic species. Conclusion In agreement with studies performed in other populations, Lactobacillus species are the most prevalent VMB species during pregnancy in sub-Saharan African women. The frequency of diverse anaerobe-dominant VMB is high in these populations. In Africa, studies on VMB in pregnancy are scant, heterogeneous in methodology, and knowledge remains limited. More insights on VMB composition and their possible sequalae among these populations is needed.

Background: The thesis on which this paper is based intended to investigate whether the result of the microbiological vaginal swab has an influence on the outcome of the fertility treatment. Methods: The microbiological vaginal swabs of patients who received fertility treatment at Saarland University Hospital were evaluated. Depending on the microorganisms detected, the swab result was classified as inconspicuous, intermediate, or conspicuous. The SPSS software was used to determine the correlation between the swab result and the outcome of the fertility treatment. Results: Dysbiosis was associated with a worse outcome of fertility treatment. The pregnancy rate with a conspicuous swab was 8.6%, whereas it was 13.4% with an inconspicuous swab. However, this association was not statistically significant. Furthermore, an association of endometriosis with dysbiosis was found. Endometriosis was more frequent with a conspicuous swab result than with an inconspicuous result (21.1% vs. 17.7%), yet the correlation was not statistically significant. However, the absence of lactobacilli was significantly associated with endometriosis (p = 0.021). The association between endometriosis and a lower pregnancy rate was also statistically significant (p = 0.006). Conclusion: The microbiological vaginal and cervical swabs can be used as predictors for the success of fertility treatments. Further studies are needed to assess the impact of transforming a dysbiotic flora into a eubiotic environment on the success of fertility treatments.

Objective: Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes and is an independent risk factor for vaginal dysbiosis. Understanding the vaginal microbiota in health and disease is essential to screen, detect, and manage complications of pregnancy. Therefore, the aims of the present study were to assess and compare vaginal dysbiosis in pregnancy in women with and without GDM and examine its impact on perinatal outcomes in our population. Methods: The present study was a prospective cohort study recruiting pregnant women. The subjects were divided into two groups (GDM and non-GDM) and were followed until delivery to assess fetomaternal outcomes. Vaginal samples were collected at 24-28 weeks and 34-38 weeks for Nugent scoring and determination of bacterial and fungal species. Results: The study recruited 502 pregnant women, with a final assessment of 320 mother-infant pairs (GDM n = 134; non-GDM n = 186). We found a significant association of vaginal dysbiosis with GDM and adverse perinatal outcomes. Significant differences were also seen in status of infection and its trimester-wise changes in relation to hyperglycemia. Conclusion: By defining an association of vaginal dysbiosis with GDM and its correlation with perinatal outcomes, the present study calls for exploitation of this potential association as a new target in the prevention and treatment of GDM and in alleviating their undesired maternal and infant outcomes. [ABSTRACT FROM AUTHOR]

"Unity in strength" is a notion that can be exploited to characterize biofilms as they bestow microbes with protection to live freely, escalate their virulence, confer high resistance to therapeutic agents, and provide active grounds for the production of biofilms after dispersal. Naturally, fungal biofilms are inherently resistant to many conventional antifungals, possibly owing to virulence factors as their ammunitions that persistently express amid planktonic transition to matured biofilm state. These ammunitions include the ability to form polymicrobial biofilms, emergence of persister cells post-antifungal treatment and acquisition of resistance genes. One of the major disorders affecting vaginal health is vulvovaginal candidiasis (VVC) and its reoccurrence is termed recurrent VVC (RVVC). It is caused by the Candida species which include Candida albicans and Candida glabrata. The aforementioned Candida species, notably C. albicans is a biofilm producing pathogen and habitually forms part of the vaginal microbiota of healthy women. Latest research has implicated the role of fungal biofilms in VVC, particularly in the setting of treatment failure and RVVC. Consequently, a plethora of studies have advocated the utilization of probiotics in addressing these infections. Specifically, the excreted or released compounds of probiotics which are also known as postbiotics are being actively researched with vast potential to be used as therapeutic options for the treatment and prevention of VVC and RVVC. These potential sources of postbiotics are harnessed due to their proven antifungal and antibiofilm. Hence, this review discusses the role of Candida biofilm formation in VVC and RVVC. In addition, we discuss the application of pro-, pre-, post-, and synbiotics either individually or in combined regimen to counteract the abovementioned problems. A clear understanding of the role of biofilms in VVC and RVVC will provide proper footing for further research in devising novel remedies for prevention and treatment of vaginal fungal infections. [ABSTRACT FROM AUTHOR]

Vaginal dysbiosis can lead to serious infections in asymptomatic women. Lactobacillus probiotics (LBPs) are being investigated as a promising therapy for reversing vaginal microbiota dysbiosis. This study aimed to investigate whether administering LBPs could improve vaginal dysbiosis and facilitate the colonization of Lactobacillus species in asymptomatic women. 36 asymptomatic women were classified based on the Nugent score as Low-NS (n = 26) and High-NS (n = 10) groups. A combination of Lactobacillus acidophilus CBT LA1, Lactobacillus rhamnosus CBT LR5, and Lactobacillus reuteri CBT LU4 was administered orally for 6 weeks. The study found that among women with a High-NS, 60% showed improved vaginal dysbiosis with a Low-NS after LBP intake, while four retained a High-NS. Among women with a Low-NS, 11.5 % switched to a High-NS. Genera associated with vaginal dysbiosis were positively correlated with the alpha diversity or NS, while a negative correlation was observed between Lactobacillus and the alpha diversity and with the NS. Vaginal dysbiosis in asymptomatic women with an HNS improved after 6 weeks of LBP intake, and qRT-PCR revealed the colonization of Lactobacillus spp. in the vagina. These results suggested that oral administration of this LBP could improve vaginal health in asymptomatic women with an HNS.

The cervicovaginal microbiome plays an important role in protecting women from dysbiosis and infection caused by pathogenic microorganisms. In healthy reproductive-age women the cervicovaginal microbiome is predominantly colonized by protective Lactobacillus spp. The loss of these protective bacteria leads to colonization of the cervicovaginal microenvironment by pathogenic microorganisms resulting in dysbiosis and bacterial vaginosis (BV). Mobiluncus mulieris and Eggerthella sp. are two of the many anaerobes that can contribute to BV, a condition associated with multiple adverse obstetric and gynecological outcomes. M. mulieris has been linked to high Nugent scores (relating to BV morphotypes) and preterm birth (PTB), whilst some bacterial members of the Eggerthellaceae family are highly prevalent in BV, and identified in ~85-95% of cases. The functional impact of M. mulieris and Eggerthella sp. in BV is still poorly understood. To determine the individual immunometabolic contributions of Eggerthella sp. and M. mulieris within the cervicovaginal microenvironment, we utilized our well-characterized human three-dimensional (3-D) cervical epithelial cell model in combination with multiplex immunoassays and global untargeted metabolomics approaches to identify key immune mediators and metabolites related to M. mulieris and Eggerthella sp. infections. We found that infection with M. mulieris significantly elevated multiple proinflammatory markers (IL-6, IL-8, TNF-α and MCP-1) and altered metabolites related to energy metabolism (nicotinamide and succinate) and oxidative stress (cysteinylglycine, cysteinylglycine disulfide and 2-hydroxygluatrate). Eggerthella sp. infection significantly elevated multiple sphingolipids and glycerolipids related to epithelial barrier function, and biogenic amines (putrescine and cadaverine) associated with elevated vaginal pH, vaginal amine odor and vaginal discharge. Our study elucidated that M. mulieris elevated multiple proinflammatory markers relating to PTB and STI acquisition, as well as altered energy metabolism and oxidative stress, whilst Eggerthella sp. upregulated multiple biogenic amines associated with the clinical diagnostic criteria of BV. Future studies are needed to evaluate how these bacteria interact with other BV-associated bacteria within the cervicovaginal microenvironment. [ABSTRACT FROM AUTHOR]

A modern probiotic preparation should include an effective combination of microorganisms with proven probiotic properties, i.e. produce lactic acid, hydrogen peroxide and bactericins, have the ability to grow and colonize, allowing them to become temporary for the period of treatment, or permanent inhabitants of vagina or other micro-ecologies. The World Health Organization (WHO) has outlined certain guidelines for a bacterial strain to be used as a probiotic: it must be capable of survival during passage through the stomach and intestines (for oral forms), resistant to the effects of antibiotics, tested for side effects and adverse effects in humans. Currently, there are only a few recognized lactobacilli or bifidobacterial strains which meet WHO criteria. The main indication for the probiotics use in gynecology is the treatment of bacterial vaginosis, candidiasis and recurrent infections of the urinary tract. Numerous studies have shown the clinical efficacy of introducing probiotics into treatment regimens for these diseases. Probiotics are able to adhere to vaginal epithelial cells and form a protective layer (biofilm) that provides a barrier against infectious pathogens. Vaginal biocenosis disorders often lead to complicated pregnancy, miscarriage, development of placental insufficiency, premature birth and intrauterine infection of the fetus, various pathologies in the newborn (impaired immunity, allergic diseases, etc.). Therefore, the condition of the vaginal microflora of woman is important for health of her child. Its correction is needed at the stage of preconceptional preparation, as well as during pregnancy. At the same time, probiotics are not only beneficial, but also safe for pregnant and lactating women. Vaginal suppositories Florica showed effectiveness and tolerability in maintaining the normal vaginal microbiota balance and prevent recurrence of bacterial vaginosis and vaginal dysbiosis whereas in the absence of its use, the frequency of diseases recurrence was 35% within 6 months

Introduction: to investigate the possibility of using clindamycin and butaconazole in local therapy of moderate and severe dysbiosis in patients during the menopausal transition (early and late).Materials and methods: 107 women were examined. They were divided into two groups depending on their complains: the patients of group 1 (49.5%) had an early transition to menopause (44.7 ± 2.3 years); the patients of group 2 (50.5%) corresponded to a late transition to menopause (49.1 ± 1.5 years). The complains were evaluated. The levels of hormones (FSH, AMH, Inhibin B, estradiol) were determined. A study of the vaginal biotope was conducted by PCR ‘Femoflor 8. Statistical studies were conducted in the environment of STATISTICA 10 package (Tibco, USA). The difference in average values was considered statistically significant for p

Introduction. Vaginal infections of nonspecific etiology caused by microbiocenosis disorder is one of the leading aspects of gynecological morbidity in recent times. According to research statistics, the incidence of such disease varies from 30 to 80% among all inflammatory lower genital tract diseases in women. Aim of the study: to present the experience of preparation for ART in patients with chronic endometritis against the background of mixed forms of vaginal dysbiosis. Material and methods. The results of treatment with a drug containing metronidazole and miconazole nitrate (vaginal suppositories once a day at bedtime for 7 days) were studied in combination with natural micronized progesterone in 36 women with infertility caused by endometrial receptivity disorder due to chronic endometritis against the background of vaginal dysbiosis, in whom pre-implantation preparation with embryo transfer was carried out after the end of the therapy. The following were used: assessment of microbiota status of urogenital tract – PCR (femoflor-16), measurement of vaginal environment pH, Hay/Ison criteria, endometrial pipelle biopsy and endometrial immunohistochemical evaluation of endometrial receptivity (LIF, LIF-R) on the 3rd and 7th days after LH peak. Conclusion. The presented experience of complex local therapy of women diagnosed with “Infertility against the background of chronic endometritis and vaginal dysbiosis“ using a drug containing metronidazole and miconazole and natural micronized progesterone in the form of vaginal gel can be useful for practicing obstetricians-gynecologists and other interested specialists.

Purpose of the study. To investigate the efficiency and safety of combined treatment and prevention of bacterial vaginosis recurrence in women of reproductive age. Materials and methods. 78 women of reproductive age with diagnosed bacterial vaginosis were examined. 50 women are included in the main group, 28 women are included in the comparison group. Women in the main group were offered complex therapy: Samitol (secnidazole 500 mg) 1 g 2 times a day per os for 3 days, Gynex Forte (1 vaginal suppository contains metronidazole 750 mg, miconazole nitrate 200 mg) 1 time a day (overnight) for 7 days, Serrata (serratiopeptidase tablets) 1 tablet (10 mg) 3 times a day for 20 days. After Gynex Forte treatment women received a probiotic per vaginum for 7 days. Comparison group received standard two-step therapy. Results. Clinical effect of treatments was achieved in 49 (98%) patients of the main group in contrast to the comparison group where the effectiveness of treatment was 12 (42.9%). A direct positive treatment effect on 15th day in the main group was reported in 33 cases (66%) compared with control group – 9 (32.1%). 6 months after treatment main group did not have recurrence of bacterial vaginosis, while in the comparison group recurrence was diagnosed in 8 (28.6%) women. Conclusions. The results showed the high efficacy and safety of complex therapy, which included drug Samitol (secnidazole), vaginal suppositories Gynex Forte (a combination of metronidazole and miconazole) and proteolytic drug Serrata (serratiopeptidase tablets) in women of reproductive age in the bacterial vaginosis treatment. The results of this clinical study suggest the recommended treatment of bacterial vaginosis in women of reproductive age for common use in gynecological practice

The cervicovaginal microbiome plays an important role in protecting women from dysbiosis and infection caused by pathogenic microorganisms. In healthy reproductive-age women the cervicovaginal microbiome is predominantly colonized by protective Lactobacillus spp. The loss of these protective bacteria leads to colonization of the cervicovaginal microenvironment by pathogenic microorganisms resulting in dysbiosis and bacterial vaginosis (BV). Mobiluncus mulieris and Eggerthella sp. are two of the many anaerobes that can contribute to BV, a condition associated with multiple adverse obstetric and gynecological outcomes. M. mulieris has been linked to high Nugent scores (relating to BV morphotypes) and preterm birth (PTB), whilst some bacterial members of the Eggerthellaceae family are highly prevalent in BV, and identified in ~85-95% of cases. The functional impact of M. mulieris and Eggerthella sp. in BV is still poorly understood. To determine the individual immunometabolic contributions of Eggerthella sp. and M. mulieris within the cervicovaginal microenvironment, we utilized our well-characterized human three-dimensional (3-D) cervical epithelial cell model in combination with multiplex immunoassays and global untargeted metabolomics approaches to identify key immune mediators and metabolites related to M. mulieris and Eggerthella sp. infections. We found that infection with M. mulieris significantly elevated multiple proinflammatory markers (IL-6, IL-8, TNF-α and MCP-1) and altered metabolites related to energy metabolism (nicotinamide and succinate) and oxidative stress (cysteinylglycine, cysteinylglycine disulfide and 2-hydroxygluatrate). Eggerthella sp. infection significantly elevated multiple sphingolipids and glycerolipids related to epithelial barrier function, and biogenic amines (putrescine and cadaverine) associated with elevated vaginal pH, vaginal amine odor and vaginal discharge. Our study elucidated that M. mulieris elevated multiple proinflammatory markers relating to PTB and STI acquisition, as well as altered energy metabolism and oxidative stress, whilst Eggerthella sp. upregulated multiple biogenic amines associated with the clinical diagnostic criteria of BV. Future studies are needed to evaluate how these bacteria interact with other BV-associated bacteria within the cervicovaginal microenvironment.

Dysbiosis of the vaginal microbiome poses a serious risk for sexual human immunodeficiency virus type 1 (HIV-1) transmission. Prevotella spp are abundant during vaginal dysbiosis and associated with enhanced HIV-1 susceptibility; however, underlying mechanisms remain unclear. Here, we investigated the direct effect of vaginal bacteria on HIV-1 susceptibility of vaginal CD4+ T cells. Notably, pre-exposure to Prevotella timonensis enhanced HIV-1 uptake by vaginal T cells, leading to increased viral fusion and enhanced virus production. Pre-exposure to antiretroviral inhibitors abolished P timonensis-enhanced infection. Our study shows that the vaginal microbiome directly affects mucosal CD4+ T-cell susceptibility, emphasizing importance of vaginal dysbiosis diagnosis and treatment., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

The aim of this scoping review was to explore the potential relationship between vaginal microbiome dysbiosis and polycystic ovarian syndrome (PCOS). Four databases were utilized to identify primary literature based on a pre-determined exclusion and inclusion criteria. The electronic databases searched include MEDLINE, Embase, Cochrane Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. After an initial double-blind screening and removal of duplicates, 81 articles remained. Articles were included based on preselected inclusion and exclusion criteria, type of study, and date of publishing. Specifically, primary literature that focused on subjects that were diagnosed with PCOS and that discussed PCOS in relation to the vaginal microbiome was included. Literature reviews, studies with animal subjects, and studies that did not discuss PCOS and the vaginal microbiome were excluded. Current data from the five articles included in this review suggests that there is a relationship between PCOS and vaginal microbiome dysbiosis. Specifically, dysbiosis of the vaginal flora may be due to vaginal pH alterations secondary to decreased vaginal Lactobacillus species and elevated pathogenic species including Streptococcus, Actinomyces, Prevotella, Gardnerella , and Mycoplasma species. The manifestation of this vaginal microbiome dysbiosis is often bacterial and fungal vaginitis. Therefore, more studies are needed to explore the possibility of treating PCOS with probiotics designed to reestablish a healthy Lactobacillus -dominant vaginal microbiome. In addition, further studies on the microbial composition of the vaginal microbiota in PCOS patients could identify microbial biomarkers for diagnosing PCOS., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Pereira et al.)

Background: The vaginal microbiota (VMB) are the set of microorganisms residing in the human vagina. During pregnancy, their composition is Lactobacillus-dominant in most Caucasian women. Previous studies suggest that the VMB of women with African ancestry is more likely to be non-Lactobacillus dominant (dysbiotic) compared to other populations, and possibly relate to the high incidence of pregnancy complications, such as preterm birth. This work reviewed the literature on VMB composition in pregnant women from sub-Saharan Africa.Methods: A search was conducted in PubMed and Embase databases following PRISMA guidelines. Observational and intervention studies analysing VMB communities from sub-Saharan African pregnant women using molecular techniques were included.Results: Ten studies performed in seven sub-Saharan African countries were identified. They independently showed that Lactobacillus-dominant VMB (particularly L. iners or L. crispatus) or VMB containing Lactobacilli are the most prevalent, followed by a more diverse anaerobe-dominant VMB, in the studied populations. The majority of pregnant women with a sexually-transmitted infection had a Lactobacillus-dominant VMB, but with a significantly higher presence of anaerobic species.Conclusion: In agreement with studies performed in other populations, Lactobacillus species are the most prevalent VMB species during pregnancy in sub-Saharan African women. The frequency of diverse anaerobe-dominant VMB is high in these populations. In Africa, studies on VMB in pregnancy are scant, heterogeneous in methodology, and knowledge remains limited. More insights on VMB composition and their possible sequalae among these populations is needed. [ABSTRACT FROM AUTHOR]

It has been long understood that the vaginal microflora is crucial in maintaining a normal physiological environment for the host and its involvement is deemed indispensable for reproductive success. A global concept of normalcy vs. dysbiosis of vaginal microbiome is debatable as women of different races have a unique vaginal microflora with regional variations. Vaginal microflora is a dynamic microenvironment affected by gestational status, menstrual cycle, sexual activity, age, and contraceptive use. Normal vaginal flora is dominated by lactobacilli especially in women of European descent vs. African American women. These microbes confer the host vagina protection from potentially pathogenic microbes that may lead to urinary tract infections and sexually transmitted diseases. Changes in the vaginal microbiota including reduced lactobacilli abundance and increased facultative and anaerobic organism populations result in bacterial vaginosis, that predisposes the host to several conditions like low birth weight and increased risk of contracting bacterial infections. On the other hand, the vaginal microbiome is also reshaped during pregnancy, with less microbial diversity with a dominance of Lactobacillus species. However, an altered vaginal microbiota with low lactobacilli abundance especially during pregnancy may result in induction of excessive inflammation and pre-term labor. Since the vaginal microbiome plays an important role during embryo implantation, it is not surprising that bacterial vaginosis is more common in infertile women and associated with reduced rates of conception. Probiotic has great success in treating bacterial vaginosis and restoring the normal microbiome in recent. This report, reviewed the relationships between the vaginal microbiome and women's reproductive health. [ABSTRACT FROM AUTHOR]

Vulvovaginal candidiasis (VVC), considered the second cause of genital infection among women, has pathogenic mechanisms still to be elucidated and unknown risk factors. Prevalence studies with laboratory diagnosis (at first diagnosis and recurrence) are uncommon, especially using MALDI TOF, used in this clinical, epidemiological, and laboratory study for evaluating candidiasis, and identifying unknown risk factors. To obtain clinical and epidemiological data, patients were questioned, and there was material collection. Samples collected were identified by using phenotypic and presumptive methods and confirmed by MALDI TOF. This study analyzed 278 patients, divided into symptomatic (n = 173) and asymptomatic (n = 105) groups. Regarding the main candidiasis symptoms (discharge, itching, and burning), only 50.3% of patients described these concomitant symptoms, showing a positive predictive value of 67.8%. Regarding the risk factors investigated, there was a statistical correlation between candidiasis and dairy products, gut transit, contraceptive use, respiratory allergy, and panty liners, describing new risk factors related to intestinal and vaginal dysbiosis. After Candida species analysis and confirmation, the primary prevalence was 80.9% (Candida albicans), 15.2% (non-albicans), 1% (Rhodotorula mucilaginosa), and 1.9% (unidentified species). In recurrence, the prevalence was 66.7% (C. albicans) and 33.3% (non-albicans). The presence of symptoms has low positive predictive value for the diagnosis of candidiasis, even when considering the classic triad of symptoms. Laboratory identification of yeast species is essential for correct treatment, preventing the resistance to antifungals and the high recurrence. In addition, dairy products and bowel habits, both related to intestinal and vaginal dysbiosis, may be associated with VVC. [ABSTRACT FROM AUTHOR]

Background: Preterm prelabor rupture of membranes (PPROM) is a major cause of morbidity and mortality for both the mother and the newborn. The vaginal germ profile in PPROM is poorly known, particularly regarding the risk of early-onset neonatal infection (EONI).Objective: To determine microbiological risk factors for EONI in case of PPROM before 34 weeks of gestation (WG).Study Design: A retrospective single-center cohort of patients with PPROM before 34 W G from 2008 to 2016. Vaginal swabs were obtained at admission and at delivery as per usual care and were analyzed by Gram stain and culture for vaginal dysbiosisi.e lactobacilli depletion and/or presence of potential pathogens.Results: Among 268 cases of PPROM, 39 neonates had EONI 14.55 %; (95 %CI 0.11 - 0.19) Overall, vaginal samples culture was positive in 16.67 % (95 %CI 11.95 %-22.32 %) at the time of rupture and 24.76 % (95 %CI 19.02 %-31.23 %) at delivery, with no significant differences between EONI and no-EONI groups (p = 0.797 and 0.486, respectively), including for Group B Streptococci (GBS) and Escherichia coli. EONI was significantly associated with dysbiosis at the time of rupture (23.94 % versus 10.35 % in the absence of dysbiosis, p = 0.009) and at delivery (19.70 % versus 3.90 % if no dysbiosis, p < 0.001). Clinical intra-uterine infection was present in 78.5 % (n = 31) of the EONI group versus 37.2 % (n = 85) in the non-EONI group (p < 0.001) and chorioamnionitis and/or funisitis were found in 97.3 % and 91.9 %, respectively in the EONI group, versus 56.11 % and 53.96 %, respectively, in the non-EONI group (p < 0.001).Conclusion: Dysbiosis following rupture and at delivery, but not the presence of pathogens in the VS culture, was associated with the risk of EONI in case of PPROM. [ABSTRACT FROM AUTHOR]

The urgency of the problem of vaginal infection is determined by its highest prevalence in the structure of obstetric-gynecological morbidity. Currently, the share of diseases of the lower genital tract associated with quantitative unbalance conditionally pathogenic microorganisms of bacterial and fungal origin vagina, which occur in 40-65% of pregnant women. Carried out a sufficient number of studies showing the role of vaginal microbiocenosis dysbiotic violations in the development of pathology of pregnancy, childbirth and postpartum infectious complications. It is known, that for vaginal infections and dysbiosis significantly more often increases the risk of chronic placental insufficiency, premature birth, low birth weight and postpartum endometritis, wound infection. In connection with the above, it is important to timely diagnose microflora disorders using clinical and laboratory research methods, followed by adequate etiotropic therapy. Timely and effective treatment of vaginal dysbiosis in pregnant women before delivery reduces the risk of postpartum infectious complications.

In China, premature rupture of membranes (PROM) counts as a major pregnancy complication in China and usually results into adverse pregnancy outcomes. We analysed the vagina microbiome composition using 16S rDNA V3–V4 amplicon sequencing technology, in this prospective study of 441 women in their third trimester of pregnancy. We first divided all subjects into PROM and HC (healthy control) groups, in order to investigate the correlation of vagina microbiome composition and the development of PROM. We found that seven pathogens were higher in the PROM group as compared to the HC group with statistical significance. We also split all subjects into three groups based on Lactobacillus abundance-dominant (Lactobacillus > 90%), intermediate (Lactobacillus 30–90%) and depleted (Lactobacillus < 30%) groups, and explored nine pathogenic genera that were higher in the depleted group than the intermediate and dominant groups having statistical significance. Finally, using integrated analysis and logistics regression modelling, we discovered that Lactobacillus (coeff = −0.09, p = 0.04) was linked to the decreased risk of PROM, while Gardnerella (coeff = 0.04, p = 0.02), Prevotella (coeff = 0.11, p = 0.02), Megasphaera (coeff = 0.04, p = 0.01), Ureaplasma (coeff = 0.004, p = 0.01) and Dialister (coeff = 0.001, p = 0.04) were associated with the increased risk of PROM. Further study on how these pathogens interact with vaginal microbiota and the host would result in a better understanding of PROM development.

Human papillomavirus (HPV) is a proven cause of precancer and cervical cancer. Violation of the vaginal microbiota in women with HPV-associated cervical pathology may contribute to the development of carcinogenesis. Deficiency of lactobacillus contributes to the growth and development of opportunistic microorganisms, reducing the synthesis of bactericidal and antifungal substances. The study of the clinical efficacy of the vaginal Lactoginal® (strain Lactobacillus rhamnosus LCR35), in the complex treatment of HPV-associated cervical pathology at the vaginal dysbiosis background’s. The results of the study showed a significant decrease in cases of vaginal dysbiosis, an increase in the number of lactobacilli in the vaginal secretion, a decrease in the microbial associations of relative pathogenic flora, an improvement in local immunity and complete elimination of HPV with the addition of the Lactoginal® to the basic therapy. The results obtained allow us to recommend the Lactoginal® for treatment of precancerous diseases of the cervix.

Premature rupture of membranes (PROM) is usually associated with pregnant and neonatal complications. Most of the PROM cases are caused by ascending asymptomatic genital infection. In China, PROM (15.3%) is more common than spontaneous preterm labor (7.3%) and leads to more adverse pregnancy outcomes. Here, we designed a prospective cohort study to measure the metabolomics changes in vaginal swab samples and explored their potential contribution to PROM. A total of 260 differentially expressed metabolites were identified and further analyzed. In the PROM group, N-acetyl-d-galactosamine and sucrose were downregulated (P = 0.0025, P = 0.0195, respectively), both of which are the upstream metabolites of the glycolysis pathway. Furthermore, estriol 3-sulfate 16-glucuronide (P = 0.0154) and 2-methoxy-17beta-estradiol 3-glucosiduronic acid (P = 0.004), two final metabolites in steroid hormone biosynthesis, were both downregulated in the PROM group. Finally, we found two catechin metabolites (epigallocatechin-7-glucuronide, P = 0.0009; 4′-methyl-epigallocatechin-7-glucuronide, P = 0.01) as well as DL-citrulline (P = 0.0393) were also significantly downregulated in the PROM group compared with the healthy control (HC) group, which are related to important antioxidant and anti-inflammatory activities in the human body. Altogether, metabolite changes in glycolysis, steroid hormone biosynthesis, and antioxidant/anti-inflammatory pathways may contribute to (or be a consequence of) vaginal dysbiosis and PROM. Metabolite pathway analysis is a new and promising approach to further investigate the mechanism of PROM and help prevent its unfavorable pregnant outcomes at a functional level. Trial registration number: ChiCTR2000034721 [ABSTRACT FROM AUTHOR]