2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge

Sherrard, Jackie; Wilson, Janet; Donders, Gilbert; Mendling, Werner; Jensen, Jørgen Skov

doi:10.1177/0956462418785451

Cited by 215 publications

(232 citation statements)

References 119 publications

(150 reference statements)

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“…The emergence and spread of human immunodeficiency virus (HIV) have made the prevention and management of RVVI even more important and urgent. World Health Organization (WHO), IUSTI/WHO and centres for diseases control (CDC) have provided guidelines on vaginal discharge management [2][3][4]. However, despite of these efforts, the cases of RVVI are still persisting and emerging, probably owing to misdiagnosis and wrong treatment.…”

mentioning

confidence: 99%

Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review

Kalia

Singh

Kaur

2020

Ann Clin Microbiol Antimicrob

176

139

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Recurrent vulvovaginal infections (RVVI) has not only become an epidemiological and clinical problem but also include large social and psychological consequences. Understanding the mechanisms of both commensalism and pathogenesis are necessary for the development of efficient diagnosis and treatment strategies for these enigmatic vaginal infections. Through this review, an attempt has been made to analyze vaginal microbiota (VMB) from scratch and to provide an update on its current understanding in relation to health and common RVVI i.e. bacterial vaginosis, vulvovaginal candidiaisis and Trichomoniasis, making the present review first of its kind. For this, potentially relevant studies were retrieved from data sources and critical analysis of the literature was made. Though, culture-independent methods have greatly unfolded the mystery regarding vaginal bacterial microbiome, there are only a few studies regarding the composition and diversity of vaginal mycobiome and different Trichomonas vaginalis strains. This scenario suggests a need of further studies based on comparative genomics of RVVI pathogens to improve our perceptive of RVVI pathogenesis that is still not clear (Fig. 5). Besides this, the review details the rationale for Lactobacilli dominance and changes that occur in healthy VMB throughout a women's life. Moreover, the list of possible agents continues to expand and new species recognised in both health and VVI are updated in this review. The review concludes with the controversies challenging the widely accepted dogma i.e. "VMB dominated with Lactobacilli is healthier than a diverse VMB". These controversies, over the past decade, have complicated the definition of vaginal health and vaginal infections with no definite conclusion. Thus, further studies on newly recognised microbial agents may reveal answers to these controversies. Conversely, VMB of women could be an answer but it is not enough to just look at the microbiology. We have to look at the woman itself, as VMB which is fine for one woman may be troublesome for others. These differences in women's response to the same VMB may be determined by a permutation of behavioural, cultural, genetic and various other anonymous factors, exploration of which may lead to proper definition of vaginal health and disease.

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mentioning

confidence: 99%

Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review

Kalia

Singh

Kaur

2020

Ann Clin Microbiol Antimicrob

176

139

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“…Основное направление в лечении БВ -элиминация повышенного количества анаэробных микроорганизмов, что достигается применением метронидазола или клиндамицина (интравагинально или внутрь) или тинидазола (внутрь) [1,6,7]. При КВВ используют клотримазол, миконазол, итраконазол, бутоконазол или натамицин интравагинально или флуконазол либо итраконазол (внутрь) [1,6,7].…”

Section: Discussionunclassified

“…Самые частые инфекционные заболевания влагалища -БВ и КВВ, которые в совокупности отвечают за большинство случаев патологических вагинальных выделений [1]. БВэто полимикробный клинический синдром, для которого характерно замещение физиологической лактобациллярной микрофлоры влагалища другими микроорганизмами, главным образом анаэробными.…”

Section: In Vitro Sensitivity Of Vaginal Microorganisms To a Combinatunclassified

In vitro Sensitivity of Vaginal Microorganisms to a Combination Intravaginal Antimicrobial Preparation Based on Metronidazole and Clotrimazole

Савичева¹,

Shipitsyna²,

Spasibova³

2019

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Цель исследования: определение in vitro чувствительности микроорганизмов, выделенных из влагалища женщин репродуктивного возраста, к комбинированному препарату местного действия на основе метронидазола и клотримазола. Дизайн: экспериментальное исследование. Материалы и методы. Всего протестировали 421 изолят микроорганизмов влагалища: дрожжеподобных грибов рода Candida (C. albicans, C. glabrata); бактерий, ассоциированных с бактериальным вагинозом (БВ) (Gardnerella vaginalis, Atopobium vaginae); грамотрицательных бактерий (Escherichia coli, Klebsiella pneumoniae, Enterobacter spp.), грамположительных бактерий (Streptococcus agalactiae, Enterococcus spp.), лактобацилл (Lactobacillus iners, L. jensenii, L. gasseri, L. crispatus). Для определения чувствительности микроорганизмов к препарату использовали агар Мюллера-Хинтона, препарат наносили калиброванной петлей объемом 10 мкл, учет результатов проводили визуально, замеряя диаметр зоны задержки роста после инкубации в течение 24 ч при температуре 37°С. Результаты. Все протестированные изоляты двух видов рода Candida, а также изоляты G. vaginalis и A. vaginae были чувствительны к исследуемому препарату. Показатели чувствительности разных видов лактобацилл существенно варьировали. Все изоляты грамотрицательных и грамположительных бактерий были резистентны к препарату. Заключение. Интравагинальный антимикробный препарат на основе метронидазола и клотримазола обладает высокой антимикробной in vitro активностью в отношении ключевых микроорганизмов, задействованных в развитии БВ (G. vaginalis и A. vaginae) и кандидозного вульвовагинита (C. albicans и C. glabrata), и не действует на основные виды лактобацилл-L. crispatus и L. iners. Ключевые слова: микробиоценоз влагалища, бактериальный вагиноз, кандидозный вульвовагинит, метронидазол/клотримазол, in vitro чувствительность микроорганизмов.

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“…The outcomes of interest were women, who have experienced either at least one episode of any of the common vaginal infections (VVI) or its repeated episodes (RVVI) as per the original definitions. For VVI, the standard clinical symptoms and laboratory based diagnosis positive for BV, VVC and TV should be in consistent with European (IUSTI/WHO) guidelines on vaginal discharge management 25 . Whereas, the condition of RVVI is defined as the repetition rates as high as 30-50% within 3 months for recurrent BV (RBV), while ≥4 repetitive episodes of VVC in 12 months for recurrent VVC (RVVC) 2 .…”

Section: Methodsmentioning

confidence: 98%

A meta-analysis of mannose-binding lectin gene polymorphisms with the risk of recurrent vulvovaginal infections

Kalia

Singh

Rauniyar

et al. 2020

Sci Rep

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the genetic variants of Mannose-Binding Lectin, a vital component of innate immunity have been studied with acute/recurrent vaginal infections ((R)VVI) and presented inconclusive findings. Therefore, a systematic review and meta-analysis of published data were conducted to assess the possible role of these variations in (R)VVI. A comprehensive search was made using PubMed, Web of Science and Google scholar till June 18, 2019. A total of 12 studies met the specified criteria and were included in the analysis. Different comparisons were made on the basis of the outcome of interest that resulted in the filtering of studies for the pooled analysis to find an association using the standard genetic models. Odds ratio (OR) with 95% confidence interval (CI) was chosen as the effect measure for the data synthesis. The trim and fill technique was applied to adjust the publication bias. The meta-analysis revealed the significant association (p < 0.05) of rs1800450 polymorphism with RVVI risk (OR ≥ 3.5) in all the genetic models. The subgroup analysis identified the same association in Caucasian and Mixed ethnicity. Quantitative synthesis based on RVVC showed>3.5 fold risk of disease development accredited to rs1800450. A combined evaluation of Exon1 variants showed no association with (R)VVI. This meta-analysis suggests rs1800450 polymorphism as a genetic predisposing factor for RVVI, but to reinforce, further studies with a larger sample size are warranted. Vulvovaginal infections (VVI) account for a huge fraction of gynaecological outpatient visits by woman of childbearing age and include about 10 to 20% of consultations only. Bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomoniasis (TV) are the frequently encountered VVI in clinical practice 1. However, the important issues are their high recurrence rates (RVVI) and the associated severe pregnancy outcomes as well as infectious diseases 2. High proportion of opportunistic pathogens, which are either normally dwelling or transmitted sexually have been suggested as the reason behind the development of VVI and RVVI, collectively abbreviated in this study as (R)VVI 2. Nevertheless, universal presence of asymptomatic cases implies that the shared risk factors of (R)VVI including excessive sexual activity, antibiotics/contraceptives use and ethnicity are simply responsible for increasing the vaginal colonisation of potentially dangerous microbial species but not disease 3. Hence, the presence of symptomatic/asymptomatic (R)VVI cases are mainly accredited to the differences in women's immunity, conferred partially or wholly by genetic variations 1. Therefore, genetic exploration of immune mediators that ultimately decides the host susceptibility to symptomatic (R)VVI is necessary. One such important mediator is human Mannose-Binding Lectin (MBL), which is a vital component of systemic as well as mucosal innate immunity 4. It's a multimeric soluble protein encoded by MBL2 mapped to 10q21.1. Evidences have been provided regarding MBL binding to the molecular pa...

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2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge

Cited by 215 publications

References 119 publications

Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review

Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review

In vitro Sensitivity of Vaginal Microorganisms to a Combination Intravaginal Antimicrobial Preparation Based on Metronidazole and Clotrimazole

A meta-analysis of mannose-binding lectin gene polymorphisms with the risk of recurrent vulvovaginal infections

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