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Can bacterial vaginosis turn into chlamydia. Bacterial Vaginosis: Etiology, Prevalence, Risk Factors, and Relation to STIs

by alexxlab

What is bacterial vaginosis. How does it relate to chlamydia and gonorrhea. What are the risk factors for bacterial vaginosis. How is bacterial vaginosis diagnosed. What are the treatment options for bacterial vaginosis. Can bacterial vaginosis increase the risk of other infections. How can bacterial vaginosis be prevented.

Understanding Bacterial Vaginosis: A Common Vaginal Condition

Bacterial vaginosis (BV) is a prevalent vaginal condition that affects millions of women worldwide. It occurs when the delicate balance of bacteria in the vagina is disrupted, leading to an overgrowth of certain harmful bacteria. This imbalance can cause a range of uncomfortable symptoms and potentially increase the risk of other health issues.

Historically, the understanding of BV has evolved significantly. In the 1920s, Arthur Doderlein identified Lactobacillus acidophilus as the predominant bacteria in healthy vaginal flora. Later, in the 1950s, Hermann Gardner and Charles Dukes isolated a bacterium they named Haemophilus vaginalis, which was later reclassified as Gardnerella vaginalis and recognized as a key player in BV.

The Microbial Ecosystem of the Vagina

The vaginal microbiome is a complex ecosystem dominated by various species of Lactobacillus in healthy women. These beneficial bacteria produce lactic acid and hydrogen peroxide, maintaining an acidic environment that inhibits the growth of pathogenic microorganisms. In BV, this balance is disrupted, leading to an overgrowth of anaerobic bacteria such as Gardnerella vaginalis, Prevotella, and Mycoplasma hominis.

Prevalence and Risk Factors of Bacterial Vaginosis

BV is the most common vaginal condition in women of reproductive age. Its prevalence varies globally and among different populations. Factors that increase the risk of developing BV include:

  • Multiple or new sexual partners
  • Lack of condom use
  • Douching
  • Smoking
  • African American ethnicity
  • Use of intrauterine devices (IUDs)

Is BV a sexually transmitted infection? While BV is associated with sexual activity, it is not classified as a sexually transmitted infection (STI). However, sexual behaviors can influence the vaginal microbiome and contribute to the development of BV.

Diagnosis and Clinical Presentation of Bacterial Vaginosis

Diagnosing BV can be challenging as many women may be asymptomatic. When symptoms do occur, they typically include:

  • Thin, grayish-white vaginal discharge
  • Fishy odor, especially after sexual intercourse
  • Burning sensation during urination
  • Itching or irritation in the vaginal area

How is BV diagnosed clinically? Clinicians often use the Amsel criteria, which require at least three of the following four signs:

  1. Thin, homogeneous discharge
  2. Vaginal pH greater than 4.5
  3. Positive whiff test (fishy odor when potassium hydroxide is added to a sample of vaginal discharge)
  4. Presence of clue cells on microscopic examination

For research purposes and in some clinical settings, the Nugent scoring system is used. This method involves Gram staining of vaginal smears and assessing the relative abundance of different bacterial morphotypes.

The Relationship Between Bacterial Vaginosis and Sexually Transmitted Infections

While BV itself is not considered an STI, research has shown significant associations between BV and various sexually transmitted infections, including chlamydia and gonorrhea. Can BV increase the risk of acquiring STIs? Studies suggest that women with BV are at higher risk of acquiring STIs, including HIV. The altered vaginal environment in BV may make it easier for pathogens to establish infection.

BV and Chlamydia

Chlamydia trachomatis is one of the most common bacterial STIs worldwide. Research has shown a significant association between BV and chlamydial infection. Women with BV appear to be more susceptible to chlamydial infection, possibly due to the reduced protective effect of a healthy Lactobacillus-dominated vaginal flora.

BV and Gonorrhea

Similar to chlamydia, gonorrhea (caused by Neisseria gonorrhoeae) has been found to be more prevalent among women with BV. The altered vaginal environment may facilitate the growth and transmission of N. gonorrhoeae.

Does BV directly cause STIs? It’s important to note that while BV is associated with an increased risk of STIs, it does not directly cause these infections. Rather, the altered vaginal environment creates conditions that may be more favorable for pathogen growth and transmission.

Treatment Options for Bacterial Vaginosis

Effective treatment of BV is crucial not only for symptom relief but also to potentially reduce the risk of associated complications and STIs. What are the standard treatments for BV?

  • Metronidazole: This antibiotic can be administered orally or as a vaginal gel.
  • Clindamycin: Available as a vaginal cream or oral medication.
  • Tinidazole: An oral antibiotic that can be used as an alternative to metronidazole.

Treatment typically lasts 5-7 days, depending on the specific medication and formulation. It’s important to complete the full course of treatment, even if symptoms improve before finishing the medication.

Recurrent Bacterial Vaginosis

Recurrence of BV is common, with up to 50% of women experiencing a relapse within 12 months of treatment. For recurrent cases, extended or periodic suppressive therapy may be recommended. Some clinicians also explore the use of probiotics to help restore a healthy vaginal microbiome, although more research is needed to establish their efficacy.

Implications of Bacterial Vaginosis in Reproductive Health

Beyond its association with STIs, BV has been linked to various adverse reproductive health outcomes. How does BV affect pregnancy and fertility?

  • Increased risk of preterm birth
  • Higher rates of miscarriage
  • Potential link to pelvic inflammatory disease (PID)
  • Possible impact on fertility and IVF success rates

These associations underscore the importance of diagnosing and treating BV, especially in pregnant women or those planning to conceive.

Prevention Strategies and Future Directions in BV Research

Preventing BV involves maintaining a healthy vaginal microbiome. What steps can women take to reduce their risk of developing BV?

  • Practicing safe sex and limiting the number of sexual partners
  • Avoiding douching and other practices that disrupt the vaginal flora
  • Quitting smoking
  • Wearing breathable, cotton underwear
  • Maintaining good hygiene practices without using harsh soaps in the vaginal area

Future research in BV is focusing on several key areas:

  1. Development of more effective treatments to prevent recurrence
  2. Exploration of probiotics and prebiotics to maintain vaginal health
  3. Better understanding of the complex interactions within the vaginal microbiome
  4. Investigation of potential biomarkers for early detection and risk assessment
  5. Elucidation of the mechanisms linking BV to increased STI risk

As our understanding of the vaginal microbiome grows, so does the potential for developing targeted interventions to prevent and treat BV more effectively. This could have far-reaching implications for women’s reproductive health and the prevention of STIs.

The Role of Partner Treatment in Managing Bacterial Vaginosis

While BV is not classified as an STI, the question of partner treatment often arises. Should male partners be treated when a woman is diagnosed with BV? Current guidelines do not recommend routine treatment of male sexual partners. However, some studies have suggested that partner treatment might reduce recurrence rates in women.

The debate around partner treatment highlights the complex nature of BV and the need for further research into its transmission dynamics. It also underscores the importance of considering BV management within the broader context of sexual and reproductive health.

Emerging Therapies and Alternative Approaches

As research into BV continues, new treatment approaches are being explored. These include:

  • Biotherapeutic agents: Live bacteria or bacterial components designed to restore a healthy vaginal microbiome
  • Novel antimicrobial compounds: Targeting specific BV-associated bacteria while preserving beneficial flora
  • Antiseptic treatments: Such as boric acid suppositories, which may help maintain an acidic vaginal pH
  • Combination therapies: Using multiple treatment modalities to address different aspects of BV pathogenesis

While these approaches show promise, more research is needed to establish their efficacy and safety in clinical practice.

Public Health Implications of Bacterial Vaginosis

The high prevalence of BV and its association with various health risks make it a significant public health concern. How can public health strategies address the burden of BV?

  • Increasing awareness and education about BV and vaginal health
  • Improving access to diagnostic services and treatment
  • Integrating BV screening into routine gynecological care
  • Addressing socioeconomic factors that contribute to BV risk
  • Supporting research into prevention strategies and novel treatments

By addressing BV from a public health perspective, we can work towards reducing its prevalence and mitigating its impact on women’s health and well-being.

The Global Perspective on Bacterial Vaginosis

The prevalence and impact of BV vary across different regions and populations. In some parts of sub-Saharan Africa, for example, BV prevalence can exceed 50% among women of reproductive age. This high prevalence, combined with limited access to healthcare in many areas, contributes to the significant burden of BV-associated complications, including increased HIV transmission risk.

Understanding these global disparities is crucial for developing targeted interventions and allocating resources effectively. It also highlights the need for culturally appropriate education and prevention strategies that can be implemented in diverse settings.

Conclusion: The Complex Nature of Bacterial Vaginosis

Bacterial vaginosis remains a challenging condition to understand, prevent, and treat effectively. Its complex etiology, involving the disruption of the vaginal microbiome, underscores the delicate balance required for vaginal health. The association between BV and increased risk of STIs, including chlamydia and gonorrhea, highlights the interconnected nature of vaginal health and overall reproductive well-being.

As research continues to unravel the intricacies of the vaginal microbiome and its role in health and disease, new opportunities for prevention and treatment will likely emerge. In the meantime, promoting awareness, encouraging regular check-ups, and supporting healthy vaginal practices remain key strategies in managing the impact of BV on women’s health worldwide.

The journey to fully understanding and effectively managing bacterial vaginosis is ongoing. Each new discovery brings us closer to empowering women with the knowledge and tools they need to maintain optimal vaginal health throughout their lives.

Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections

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Association of Bacterial Vaginosis With Chlamydia and Gonorrhea Among Women in the U.

S. Army

. 2017 May;52(5):632-639.

doi: 10.1016/j.amepre.2016.09.016.

Epub 2016 Nov 3.

Christian T Bautista 
1
, Eyako K Wurapa 
2
, Warren B Sateren 
2
, Sara M Morris 
3
, Bruce P Hollingsworth 
3
, Jose L Sanchez 
4

Affiliations

Affiliations

  • 1 Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom. Electronic address: [email protected].
  • 2 Walter Reed Army Institute of Research, Silver Spring, Maryland.
  • 3 Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.
  • 4 Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, Maryland.

  • PMID:

    27816380

  • DOI:

    10.1016/j.amepre.2016.09.016

Free article

Christian T Bautista et al.

Am J Prev Med.

2017 May.

Free article

. 2017 May;52(5):632-639.

doi: 10.1016/j.amepre.2016.09.016.

Epub 2016 Nov 3.

Authors

Christian T Bautista 
1
, Eyako K Wurapa 
2
, Warren B Sateren 
2
, Sara M Morris 
3
, Bruce P Hollingsworth 
3
, Jose L Sanchez 
4

Affiliations

  • 1 Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom. Electronic address: [email protected].
  • 2 Walter Reed Army Institute of Research, Silver Spring, Maryland.
  • 3 Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.
  • 4 Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, Maryland.

  • PMID:

    27816380

  • DOI:

    10.1016/j.amepre.2016.09.016

Abstract


Introduction:

Bacterial vaginosis (BV) is a common vaginal condition in women of reproductive age, which has been associated with Chlamydia trachomatis and Neisseria gonorrhoeae among commercial sex workers and women attending sexually transmitted infection clinics. Pathogen-specific associations between BV and other sexually transmitted infections among U.S. military women have not been investigated.


Methods:

A population-based, nested case-control study was conducted of all incident chlamydia and gonorrhea cases reported to the Defense Medical Surveillance System during 2006-2012. Using a density sampling approach, for each chlamydia or gonorrhea case, 10 age-matched (±1 year) controls were randomly selected from those women who were never diagnosed with these infections. Incidence rate ratios were estimated using conditional logistic regression. Statistical analysis was carried out in December 2015.


Results:

A total of 37,149 chlamydia cases and 4,987 gonorrhea cases were identified during the study period. Antecedent BV was associated with an increased risk of subsequent chlamydia (adjusted incidence rate ratio=1.51; 95% CI=1.47, 1.55) and gonorrhea (adjusted incidence rate ratio=2.42; 95% CI=2.27, 2.57) infections. For every one additional episode of BV, the risk of acquiring chlamydia and gonorrhea infections increased by 13% and 26%, respectively. A monotonic dose-response relationship was also noted between antecedent BV and subsequent chlamydia and gonorrhea infection. In addition, an effect modification on the additive scale was found between BV and African-American race for gonorrhea, but not for chlamydia.


Conclusions:

Among U.S. Army women, antecedent BV is associated with an increased risk of subsequent chlamydia and gonorrhea infection.

Copyright © 2016 American Journal of Preventive Medicine. All rights reserved.

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MeSH terms

Vaginitis – symptoms, diagnosis and treatment of inflammation of the vagina

Vaginitis is an inflammation of the vaginal mucosa that can lead to discharge, itching and pain. The reason is usually: a change in the balance caused by the reproduction of opportunistic microflora; sexually transmitted infection; decrease in estrogen levels after menopause and some other diseases.

Most common types of vaginitis:

Bacterial vaginosis . Develops due to excessive growth of the opportunistic microflora of the vagina, which disrupts the natural balance.

Yeast colpitis (thrush, candidiasis). Inflammatory disease of the vaginal mucosa caused by the fungus Candida albicans.

Infectious vaginitis . Distinguish trichomonas, mycoplasma and other types of vaginitis. The causative agent in trichomoniasis is trichomonas vaginalis, usually transmitted sexually, can be transmitted from an infected mother to a child at birth.

Noninfectious vaginitis . Hygiene products may cause an allergic reaction or irritation leading to inflammation of the tissues of the vulva and vagina.

Atrophic vaginitis . Develops as a result of a decrease in estrogen levels after menopause or surgical removal of the ovaries.

Symptoms of vaginitis

Symptoms and signs of vaginitis may include:

    • Change in color, smell or amount of vaginal discharge
    • Vaginal itching or irritation
    • Pain during intercourse
    • Painful urination
  • Minor vaginal bleeding or spotting

If a woman has vaginal discharge, its characteristics may indicate a particular type of vaginitis. For example:

Bacterial vaginosis may present as a greyish-white discharge with an unpleasant odor. The odor, often described as “fishy”, may be more evident after intercourse.

Yeast infection. The main symptom is itching, but there may also be a thick white discharge resembling cottage cheese.

Trichomoniasis may be accompanied by a greenish-yellow, sometimes frothy discharge.

When to see a gynecologist

Seek medical attention if you experience vaginal discomfort, especially if:

— Vaginal odor, discharge or itching

– You have never had a vaginal infection. Seeing a doctor can help identify the cause and teach you to recognize the signs and symptoms

– You have had several sexual partners or have recently acquired a new partner. Symptoms may be a manifestation of a sexually transmitted infection, some of which have symptoms similar to thrush or bacterial vaginosis

– You have yourself been treated for yeast with over-the-counter drugs, but the symptoms persist

– You have fever, chills or pain in the pelvic area

You probably don’t need to see a doctor every time you experience vaginal irritation and discharge, especially if:

you’ve already been diagnosed with thrush (candidiasis) and your symptoms are the same as before

9000 2 – you are familiar with the symptoms of a yeast infection and are sure that this is what you have.

Causes of vaginitis

Bacterial vaginosis. This most common type of vaginitis results from an imbalance in the opportunistic microflora of the vagina. What causes the imbalance is unknown. Several microorganisms are involved in the occurrence of bacterial vaginosis, and not just gardnerella vaginalis, as previously thought. Normally, lactobacilli predominate in the vagina. With bacterial vaginosis, their number in the vagina decreases, while the number of vaginal gardnerella and other anaerobes increases (bacteroids, mobilincus, peptococci, ureaplasma and mycoplasma).

Bacterial vaginosis may be asymptomatic. This type of vaginitis appears to be related to, but not caused by, sex, especially if the woman has multiple sexual partners or a new sexual partner, but it also occurs in women who are not sexually active.

Yeast colpitis. This type of vaginitis is caused by a fungal growth in the vagina, usually Candida albicans. C. albicans also causes infections in other wet areas of the body, such as the mouth, skin folds, and nail beds. The fungus can also cause diaper rash.

Trichomonas. This common sexually transmitted infection is caused by a single-celled protozoan called Trichomonas vaginalis. In men, the microorganism usually affects the urinary tract, but is often asymptomatic. In women, trichomoniasis usually affects the vagina and can cause symptoms.

Noninfectious vaginitis. Vaginal sprays, douches, scented soaps, scented detergents and spermicides, toilet paper, tampons and pads may cause an allergic reaction or irritation leading to inflammation of the vulvar and vaginal tissues.

Atrophic vaginitis. Decreased estrogen levels after menopause or surgical removal of the ovaries can lead to thinning of the vaginal mucosa, sometimes resulting in vaginal irritation, burning, and dryness.

Factors that increase the risk of vaginitis include:

– Hormonal changes, such as those associated with pregnancy, birth control pills, or menopause

– Sexual activity

– Having a sexually transmitted infection

– Medications such as antibiotics and steroids

– Using spermicides for birth control

– Uncontrolled diabetes vaginal spray or vaginal deodorant

— Douching

— Wearing wet or tight clothing

— Using an intrauterine device (IUD)

Complications of vaginitis

Women with trichomoniasis or bacterial vaginosis are at greater risk of contracting sexually transmitted infections due to the inflammation caused by these diseases.

Inflammation can move to the cervix, which prevents bacteria and viruses from entering the uterus. When the cervix is ​​infected, there is an increased risk of infection reaching the uterus.

Diagnosis of vaginitis

Gynecologists diagnose vaginitis based on the history of the disease, symptoms, results of a gynecological examination (presence of inflammation, vaginal discharge). Gynecological examination, including using mirrors, is performed to examine the upper, lower and side walls of the vagina and cervix. On examination, hyperemia (redness) of the mucosa, its swelling, damage, and inflammatory discharge can be detected.

During a gynecological examination, the doctor may take samples of discharge from the vagina, urethra, and cervix. These samples are sent to the laboratory for bacterioscopic or bacteriological examination, PCR diagnostics to identify the pathogen and determine its sensitivity to antibiotics.

Treatment and prevention of vaginitis

Various organisms and conditions can cause vaginitis, so treatment is directed at the specific cause.

No treatment needed if vaginitis is caused by an allergic reaction to products such as spermicides or feminine hygiene products. A woman needs to pinpoint the source of irritation and avoid it. Possible sources include new soap, laundry detergent, sanitary napkins, tampons, etc.

If the cause of vaginitis is a sexually transmitted infection (STI), both you and your partner will need treatment, often with antibiotics. Antibiotics are prescribed for STIs such as gonorrhea, chlamydia, or bacterial infections, including bacterial vaginosis.

For trichomoniasis, the gynecologist may prescribe metronidazole (Flagyl) or tinidazole (Tindamax) tablets.

A doctor may recommend antiviral drugs for genital herpes in the vagina to help speed up the healing process, but there is no cure for herpes.

Yeast colpitis. An over-the-counter antifungal cream or suppository, such as miconazole, clotrimazole, butoconazole, or thioconazole, is commonly prescribed for thrush. Yeast infections can also be treated with prescription oral antifungals such as fluconazole (Diflucan).

The benefits of over-the-counter treatment are convenience, cost and no waiting to see a doctor. However, you may have something other than a yeast infection. Using the wrong medication can delay an accurate diagnosis and proper treatment.

Atrophic vaginitis. Estrogen – Vaginal creams, tablets, or rings can relieve this type of vaginitis. The treatment is prescribed by the doctor after considering the risk factors and possible complications.

Bacterial vaginosis. Antibiotics are the mainstay of treatment for bacterial vaginosis. Your doctor will usually prescribe metronidazole or clindamycin tablets or vaginal suppositories. Metronidazole can also be used as a vaginal gel. Therapy should be comprehensive in order to suppress all possible pathogens of bacterial vaginosis. Bacterial vaginosis may recur after treatment.

To reduce the risk of vaginitis from sexually transmitted infections, use condoms consistently and correctly every time you have sex. By being in a long-term relationship, you can reduce your chances of contracting an STI.

Proper hygiene can prevent some types of vaginitis from recurring:

– Avoid baths and hot tubs.

— Avoid irritants. These include scented tampons, pads, showers and scented soaps. Rinse the soap off the vulva after showering and dry it well to prevent irritation.

– Dry from front to back after going to the toilet. This will prevent the spread of fecal bacteria into the vagina.

– Avoid douching. The vagina does not require cleansing other than a regular shower. Repetitive douching destroys the beneficial microorganisms that live in the vagina and can increase the risk of a vaginal infection. Douching will not get rid of a vaginal infection.

– Wear cotton underwear. Also wear tights with a cotton crotch. Consider not wearing underwear to bed. Yeasts thrive in humid environments.

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Chlamydia | MTsRZ.RF

Sexually transmitted infections are not only unpleasant, but also quite dangerous. One of the most common of these is chlamydia. According to medical research, it is precisely this that is difficult to diagnose, therefore it is found when patients come to see a doctor for various reasons or for a preventive examination.

The causative agent of urogenital chlamydia is Chlamydia trachomatis. There are also Chlamydiapheumonia (causes pneumonia), Chlamydiapsittaci (causes chlamydia in animals and birds).

Once in the human body, chlamydia begin to actively multiply in the mucosa and after 10 hours penetrate into the cells and destroy them. Reproduction of chlamydia occurs by division, the microorganism has its own DNA and RNA. As a result, the cells of the human mucosa die. Chlamydia can travel through the lymphatic and blood vessels. This explains the infection of the joints, pharynx and other organs located at a distance from the reproductive system and abdominal cavity.

The main route of infection is sexual. Spermatozoa are carriers of chlamydia. Children can become infected with chlamydia at birth from a sick mother, as well as in utero during pregnancy (congenital blindness develops). Chlamydia may be accompanied by other urogenital infections, such as: trichomoniasis, mycoplasmosis, ureaplasmosis, candidiasis, gonorrhea, gardnerellosis (bacterial vaginosis), streptococci, staphylococci, etc.

Chlamydia lives inside a living cell, like a virus, but its structure is more like a bacterium.
In chlamydia, two stages of the life cycle are known – in the first it can exist outside the cell, and in the second stage it already lives in the cell, becoming an absolute cellular parasite.

Causes of chlamydia development are: