Correlation Analysis of Vaginal Microbiome Changes and Bacterial Vaginosis Plus Vulvovaginal Candidiasis Mixed Vaginitis Prognosis

Abstract

Mixed vaginitis is the result of the simultaneous presence of different pathogenic processes mediated by at least two types of vaginal pathogens. Among the various types of mixed vaginitis presentations, bacterial vaginosis (BV) plus vulvovaginal candidiasis (VVC) presents to be the most prevalent form. Mixed vaginitis affects the health of women of all ages worldwide. However, few studies have focused on clinical manifestations, pathogenesis, diagnostic criteria, or therapy of mixed vaginitis. We recruited 48 symptomatic patients with clinical diagnoses of VVC complicated with BV, they were treated with oral metronidazole combined with local clotrimazole and followed to assess the drug efficacy and vaginal microbiome alterations before and after treatment. The vaginal microbiome in BV+VVC mixed vaginitis patients was altered significantly after the combined drug treatment within a unique form different from a simple overlay mode of BV and VVC, the key bacteria including Gardnerella and Atopobium, Lactobacillus. The combined drug therapy for the mixed vaginitis in this study was effective and enhanced treatment for BV may be more favorable because of more difficulty in dealing with BV according to the treatment outcome. The abundance of Lactobacillus in patients with mixed vaginitis affects the recovery of the vaginal microbiome as well as the prognosis, and the abundance should be actively restored. This is the first study to investigate the composition, diversity, and other characteristics of the vaginal microbiome in patients with BV+VVC mixed vaginitis before and after drug treatment, our results provide clues to improving the cure rate and reducing recurrences.

Interactions between microbiota and cervical epithelial, immune, and mucus barrier

“…Many studies also demonstrate that CVM is associated with disease treatment outcomes. For example, some studies reveal that low baseline Lactobacillus (Xiao et al, 2022), L.iners. (Zhou et al, 2022), high G.vaginalis and A. vaginae (Bradshaw et al, 2006;Ferreira et al, 2017) was associated with BV treatment failure and recurrence, although some reports show inconsistent effect.…”

Correlation analysis of vaginal microecology and different types of human papillomavirus infection: a study conducted at a hospital in northwest China

“…Nevertheless, the signs and symptoms of mixed vaginitis are often atypical, and treatment is complicated in contrast to single-type vaginitis ( 20 ). Owing to differences in race, region, detection technology, and methods, the incidence of mixed vaginitis is reported to vary greatly, from 4.44 to 35.06% ( 20 , 21 ); meanwhile, the result in our study was 14.37%, of which BV combined with AV was the most common type (66.37%). Currently, little is known about the vaginal pathophysiology of mixed vaginitis.…”

“…Currently, little is known about the vaginal pathophysiology of mixed vaginitis. Studies have found that there were synergistic effects between different pathogens, allowing them to form multi-strain biofilms and to further lead to refractory infections and recurrences ( 21 , 22 ). Bacteria and/or fungi can coexist within a host and influence each other via synergistic or antagonistic interactions ( 23 ).…”

In vitro biofilm formation of Gardnerella vaginalis and Escherichia coli associated with bacterial vaginosis and aerobic vaginitis

“…Mixed vaginitis is a group of vaginal infections caused by the coexistence of two or more vaginal pathogens, leading to abnormalities in the vaginal microenvironment and causing different signs and symptoms ( Paavonen and Brunham, 2018 ; Xiao et al., 2022 ). Depending on the vaginal pathogen, they can be further categorized into more than 10 types.…”