Drug treatment shows microbiome changes in women with mixed vaginitis

       A study published in Frontiers in Cell and Infection Microbiology observed significant changes in the vaginal microbiome in patients with bacterial vaginosis (BV) plus vulvovaginal candidiasis (VVC) mixed vaginitis before and after drug treatment.
       The main pathogens are Gardnerella, Atopobium and Lactobacillus.In this study, oral metronidazole combined with clotrimazole was an effective treatment for BV+VVC mixed vaginitis.1
       However, the authors suggest that a more favorable prognosis for mixed BV+VVC vaginitis may be obtained by intensifying BV therapy.
       ”The abundance of lactobacilli in women with mixed vaginitis strongly influences the recovery and prognosis of the normal vaginal microbiota and should be aggressively recovered,” the authors wrote.
       The study included 48 symptomatic patients, ranging in age from 18 to 50 years (mean age, 32.92 years) with a clinical diagnosis of VVC complicated by BV, admitted to Peking University First Hospital in China from January 2017 to December 2020.
       Overall, 38 patients had a previous episode of VVC, of ​​which 24 had a history of recurrent VVC (RVVC).In addition, 3 patients had prior episodes of BV, while 9 patients had prior VVC and BV.
       All patients received oral metronidazole (400 mg orally twice daily for 7 days) in combination with topical clotrimazole (500 mg intravaginally on days 1, 4, and 7, once daily), followed by drug evaluation Efficacy and vaginal microbiota changes.and after treatment.
       Of 49 patients, 9 relapsed, defined as BV or VVC relapse after drug therapy
       Symptoms and signs of BV+VVC patients were significantly relieved after treatment, indicating that this treatment scheme can effectively relieve symptoms.
       The abundance of lactobacilli and dominant bacteria in vaginal samples varied with symptom relief.The vaginal pH value was lower than 4.5 after treatment, which was significantly lower than the pH value before treatment.
       Overall, the cure rate for BV was only 47.9% compared to 56.3% for VVC.This difference (P < 0.05) suggests that this treatment may be insufficient to combat bacterial vaginosis.
       Further analysis of BV treatment outcomes showed that Nugent scores increased in 4 patients, remained unchanged in 9 patients, and decreased in 35 patients; in other words, 72.9% of BV patients showed improvement.
       However, the authors were unable to identify the microecological changes that promote fungal recurrence at the microscopic level.
       The vaginal microbiomes of all patients were divided into four groups based on species-level correlations of microbiome members.
       The highest bacterial Shannon diversity index was found in cluster 3, which was mainly enriched for Prevotella, compared to cluster 1, which had the lowest diversity index and no enrichment of any single dominant genus.
       ”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,” the authors wrote.”Our results provide clues for improving cure rates and reducing relapses.”
       1. Xiao B, AD, Qin H, et al.Correlation analysis of vaginal microbiome changes with prognosis in bacterial vaginosis plus vulvovaginal candidiasis mixed vaginitis analysis of pre-cell infection with microorganisms.Published online March 8, 2022.doi:org/10.3389/fcimb.2022.860589

Post time: Jun-22-2022