Materiały źródłowe

• #1 Quantitative modeling predicts mechanistic links between pre-treatment microbiome composition and metronidazole efficacy in bacterial vaginosis | Nature Communications

  https://www.nature.com/articles/s41467-020-19880-w

  Bacterial vaginosis is a condition associated with adverse reproductive outcomes and characterized by a shift from a Lactobacillus-dominant vaginal microbiota to a polymicrobial microbiota, consistently colonized by strains of Gardnerella vaginalis. Metronidazole is the first-line treatment; however, treatment failure and recurrence rates remain high. […] Recurrence rates remain high, occurring in 57-90% of women who receive treatment. […] Overall results provide mechanistic insight into how personalized differences in microbial communities influence vaginal antibiotic efficacy. […] We validate this finding with in vitro co-cultures, and extend our analysis to more representative models which illustrate that this behavior is also expected in microbial environments with additional species, interspecies interactions, and strain variability.

• #2

  https://www.who.int/news-room/fact-sheets/detail/bacterial-vaginosis

  BV is treatable and curable. […] BV is a very common condition and does not usually cause serious complications. However, if untreated it could lead to: problems in pregnancy (for example, spontaneous abortion and preterm delivery) […] BV increases the risk of acquiring HIV, acquisition of and transmission of other STIs and if left untreated can lead to adverse effects of pregnancy. […] It is best treated with the antibiotic metronidazole but efficacy of treatments for BV is low if not combined with lifestyle/risk reduction advice. […] In 2024, WHO published Recommendations for the treatment of Trichomonas vaginalis, Mycoplasma genitalium, Candida albicans, bacterial vaginosis and human papillomavirus (anogenital warts) to provide evidence-informed clinical and practical recommendations on case management of BV.

• #3 Prognostic Indicators of Recurrence of Bacterial Vaginosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30842235/

  Following all forms of therapy for bacterial vaginosis (BV), recurrence rates are extremely high. […] Our goal was to determine which tests, and at what optimal times, have prognostic value in predicting recurrence. […] The qPCR-based LbRC (Lactobacillus Relative Composition) assay predicted BV recurrence when performed shortly after oral metronidazole treatment, with both 90% positive predictive values (PPV) and 74% negative predictive values (NPV); the Nugent scores had 93% PPV but poor NPV (57%). […] No test, at any other visit, was prognostic. […] Given the high recurrence rates of BV, prognostic tests that could influence individualized treatment alternatives are urgently needed.

• #4 Bacterial Vaginosis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/254342-overview

  Uncomplicated cases of bacterial vaginosis typically resolve after the standard antibiotic treatment. […] The prognosis for uncomplicated cases of bacterial vaginosis is generally excellent. Uncomplicated bacterial vaginosis that is assessed promptly typically resolves with standard antibiotic treatment. […] The prognosis for complicated cases of bacterial vaginosis leading to other infections varies depending on the particular infectious process. Note the following: Long-standing or untreated BV may lead to more serious sequelae, such as endometritis, salpingitis, pelvic inflammatory disease, or complications of pregnancy, including premature rupture of membranes, premature labor, chorioamnionitis, and postpartum endometritis. […] BV leads to an increased risk for acquiring HIV, and intravaginal practices are an important risk factor for developing BV.

• #5 Predictive value of the composition of the vaginal microbiota in bacterial vaginosis, a dynamic study to identify recurrence-related flora | Scientific Reports

  https://www.nature.com/articles/srep26674

  The high recurrence rate of BV after treatment with the currently recommended protocol of metronidazole and clindamycin is a major threat and seriously affects the lives of patients. […] This result indicates that the pattern of the microbiota can be used to evaluate the outcome of treatment. […] These results suggest that the composition of the microbiota at D7 has the ability to predict the final outcome of the disease. More importantly, these vaginal microbiota compositions detected using the deep sequencing method could be identified in low concentrations of bacteria after antibiotic treatment and were still able to be used to predict the prognosis. […] In conclusion, although patients with BV have a complete Nugent score and Amsels diagnostic criteria to categorize the disease condition by light microscopy, there are still some problems in precisely describing the composition of the bacterial community. Deep sequencing analysis provides a clearer picture of the bacteria community, which extends our understanding of the BV process and allows detection of recurrence and treatment failure, which may indicate bacterial resistance to metronidazole.

• #6 Bacterial Vaginosis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/254342-overview

  Bacterial vaginosis (BV) may lead to an increased risk of salpingitis and/or endometritis, postsurgical infections (eg, postcesarean endometritis, posthysterectomy vaginal cuff cellulitis), and adverse outcomes in pregnancy, including premature rupture of membranes, premature labor, chorioamnionitis, and postpartum endometritis.

• #7 Predicting risk of bacterial vaginosis: the role of race, smoking and corticotropin-releasing hormone-related genes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2734163/

  These data indicate that susceptibility to BV is affected by patterns of genetic variation in stress-related genes and smoking plays an important role. […] In white women, non-smokers with the CT genotype at CRH-BP + 17487 have lower Nugent scores than non-smokers with the TT genotype; whereas smokers with the CT genotype have higher Nugent scores than smokers with the TT genotype. […] In black women, the AG genotype at CRH + 3362 or CRH 1667 is associated with lower Nugent scores compared with the homozygous genotypes. […] These results indicate that smoking is an important factor in these models. […] In this study, we demonstrated that variation in stress-related genes is associated with BV and that these variants and association patterns differ by race.

• #8 Predicting risk of bacterial vaginosis: the role of race, smoking and corticotropin-releasing hormone-related genes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2734163/

  Bacterial vaginosis (BV) is one of the most prevalent vaginal disorders in adult women and is associated with adverse pregnancy outcomes such as pre-term birth. […] Approximately 10% of women with BV experience adverse pregnancy outcomes such as spontaneous pre-term delivery, premature rupture of membranes and amniotic fluid infection. […] One possible explanation for this disparity is that black women are exposed to significantly more physiological and psychological stressors than white women and this high level of chronic stress leads to an increased risk for BV. […] One study found that, after adjusting for maternal age, race, education, parity, douching, number of sexual partners, sexual practices and use of illicit drugs, women with high psychological stress were 2.2 times more likely to develop BV.

• #9 Hormonal Contraception Is Associated with a Reduced Risk of Bacterial Vaginosis: A Systematic Review and Meta-Analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0073055

  Hormonal contraceptive use was associated with a significant reduction in the odds of prevalent BV (pooled effect size by random-effects [reES]=0.68, 95%CI0.630.73), and in the relative risk (RR) of incident (reES=0.82, 95%CI:0.720.92), and recurrent (reES=0.69, 95%CI:0.590.91) BV. […] HC-use was associated with a significantly reduced risk of BV. This negative association was robust and present regardless of HC-type and evident across all three BV outcome measures. […] This meta-analysis provides compelling evidence that HC-use influences a woman’s risk of BV, with important implications for clinicians and researchers in the field.

• #10 Risks for Acquisition of Bacterial Vaginosis Among Women Who Report Sex with Women: A Cohort Study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0011139

  Vaginal detection of several BVAB in BV-negative women predicted subsequent BV, suggesting that changes in vaginal microbiota precede BV by weeks or months. […] Detection of Lactobacillus crispatus at enrollment conferred reduced risk for subsequent BV (HR 0.18 (0.080.4)). […] The significant association between detection of BVAB at enrollment and BV acquisition remained significant after adjusting for timing of examination relative to participants’ menstrual cycles and new sex partner with a history of BV. […] Our observation that detection of specific BVAB in vaginal fluid weeks to months prior to a diagnosis of BV suggests that changes in vaginal microbiota may precede the development of BV by a considerable time period. […] Our findings suggest that vaginal colonization with key BVABs among women with no BV is an independent risk factor for incident BV.

• #11 Quantitative modeling predicts mechanistic links between pre-treatment microbiome composition and metronidazole efficacy in bacterial vaginosis | Nature Communications

  https://www.nature.com/articles/s41467-020-19880-w

  We next evaluated whether the influence of initial BV:LB ratio on MNZ efficacy is observed clinically. […] Results resonated with model predictions where individuals who experienced recurrence had higher amounts of Lactobacillus spp. relative to BV-associated bacteria (lower BV:LB ratios, p=0.0366) at treatment initiation and tended to have higher abundances of Lactobacillus spp., particularly Li, but abundance of individual species were not statistically significant after adjustment for multiple comparisons. […] These results support both the in vitro experimental data and model results that predicted a lower efficacy of MNZ treatment when a lower ratio of Gv to Li was present pre-treatment.

• #12 Accuracy of a commercial multiplex PCR for the diagnosis of bacterial vaginosis | Microbiology Society

  https://www.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.000792?crawler=true

  Purpose. Bacterial vaginosis (BV) is a common clinical condition characterized by odorous vaginal discharge, vaginal itching and/or burning. […] The ATRiDA test is a sensitive method for the detection of BV but, given the high occurrence of asymptomatic vaginal dysbiosis, a positive test outcome should be interpreted together with clinical symptoms.

• #13 Predictive value of the composition of the vaginal microbiota in bacterial vaginosis, a dynamic study to identify recurrence-related flora | Scientific Reports

  https://www.nature.com/articles/srep26674

  Bacterial vaginosis (BV) is a highly prevalent disease in women and increases the risk of pelvic inflammatory disease. It has been given wide attention because of the high recurrence rate. […] The vaginal microbiota in deep-sequencing-view present a strong correlation to the final outcome. Thus, coupled with detailed individual bioinformatics analysis and deep-sequencing technology, we may illustrate a more accurate map of vaginal microbial to BV patients, which provide a new opportunity to reduce the rate of recurrence of BV. […] The bacterial microbiota composition pattern was not as expected tightly clustered into two groups associated with the FG and SG groups at D7, but was divided into three groups. However, 1 month after the patients had stopped taking the antibiotic (D30), they were separated obviously into two groups, which was consistent with the pre-defined groups based on the Nugent score. This showed the close relationship between the taxonomic categorization based on deep sequencing and the clinical features of BV, which validates the previous report of Sujatha et al.

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