دانلود رایگان ترجمه مقاله واژینوز باکتریال مرتبط با گاردنرلا واژيناليس در زنان بلغاری (نشریه الزویر 2013)

واژینوز باکتریال مرتبط با Gardnerella vaginalis در زنان بلغاری

Gardnerella vaginalis-associated bacterial vaginosis in Bulgarian women

Abstract

Background Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of reproductive age. The purpose of this study was to determine the frequency of BV in Bulgarian pregnant and nonpregnant women from several age ranges and to compare three different laboratory methods for Gardnerella vaginalis detection in patents suffering from BV.

Methods Between September 2011 and June 2012, 809 women of 16–40 years of age separated in two major groups: nonpregnant – 469 (355 with and 114 without symptoms) and pregnant – 340 (213 and 127 respectively) were enrolled for the study. The women underwent three different laboratory tests simultaneously: scoring of Gram staining of vaginal smear, culture, and polymerase chain reaction (PCR) assay for G. vaginalis.

Results The microscopic method detected high frequency of BV in symptomatic (57%) whereas only a minority of asymptomatic subjects (14%) were detected. G. vaginalis-associated BV was diagnosed in approximately equal proportions when evaluated with PCR and microscopic method for both pregnant and nonpregnant women. The comparative analysis of microscopic evaluation, culture and PCR assays demonstrated greater concurrence (about 90%) between Gram staining and PCR detection for BV, than both methods compared to culture. The combination of microscopy and PCR turned out to be very reliable and repeatable for detecting G. vaginalis-associated BV.

Conclusions This is the first comparative investigation on the epidemiology of G. vaginalis-associated BV in Bulgaria. The established highest frequency in the young Bulgarian women (21–30 years) is alarming and should be considered in prophylaxis and reproductive programmes.

1 Introduction

Bacterial vaginosis (BV) is the most common cause of unpleasant vaginal odor and discharge in women of reproductive age.1,2 It is induced by an imbalance in naturally occurring microflora. Any change in the resident flora including reduction of lactobacilli allows for different anaerobic bacteria to gain a foothold and multiply.3–7 Nevertheless the process is multifactorial and the initial mechanism of replacement of normal lactobacillary flora by opportunistic pathogens in vaginal ecosystem and the role of intrinsic host factors still remains unclear, requiring more research to be conducted.5–8 The essential participants in pathological polymicrobial associations, which could be used as markers for BV, are Gardnerella vaginalis (that grows under appropriate microaerophilic conditions) and anaerobic Atopobium vaginae.3–8 Other microorganisms involved in BV microbiota are very diverse and include anaerobes, such as Peptostreptococcus spp., Mobiluncus spp., Prevotella spp., Bacteroides spp., Fusobacterium spp., and facultative anaerobes.6–11 It is not clear yet if the BV is a sexually transmitted disease, but it is more common in promiscuous women with hazardous sexual behavior (with multiple and/or new sexual partners; or with female partners, sex during menses).12–18 BV can be an independent risk factor for acquisition of any other sexually transmitted infection.1,15,17 It has also been shown to be a cause for serious health problems as preterm birth, postpartum fever, development of endometritis, post-hysterectomy or postabortal sepsis, and pelvic inflammatory disease.19–21

The purpose of this study was to determine the frequency of BV and G. vaginalis-associated BV in Bulgarian pregnant and nonpregnant women from different age ranges and to compare three distinct laboratory methods for G. vaginalis detections in patients suffering from BV.