This study aims to systematically evaluate the clinical efficacy and safety of Kushen Gelatum combined with antibiotics for treating bacterial vaginosis. The randomized controlled trial(RCT) of Kushen Gelatum for treating bacterial vaginosis were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, and Cochrane Library with the time interval from inception to January 2023. Data were extracted from the included RCT by 2 investigators, including the sample size, characteristics of patients, interventions and controls, outcome indicators, and adverse effects. The Cochrane collaboration network's bias risk assessment tool was used for methodolo-gical quality evaluation of the included trials. RevMan 5.4 was employed to perform the Meta-analysis. A total of 19 RCTs were inclu-ded, involving 1 980 patients with bacterial vaginosis. Meta-analysis showed that, compared with nitroimidazoles alone, Kushen Gelatum + nitroimidazoles improved the total response rates in terms of clinical symptoms and laboratory tests(RR=1.24, 95%CI[1.13, 1.36], P<0.000 01), laboratory tests(RR=1.16, 95%CI[1.06, 1.26], P=0.000 9), and clinical symptoms(RR=1.26, 95%CI[1.08, 1.46], P=0.003), and reduced the leukocyte esterase positive rate(RR=0.29, 95%CI[0.17, 0.48], P<0.000 01) and the recurrence rate(RR=0.37, 95%CI[0.23, 0.58], P<0.000 1). Compared with lincomycin antibiotics(clindamycin) alone, Kushen Gelatum + lincomycin antibiotics(clindamycin) improved the total response rates in terms of clinical symptoms and laboratory tests(RR=1.18, 95%CI[1.06, 1.31], P=0.003) and laboratory tests(RR=1.27, 95%CI[1.04, 1.54], P=0.02), reduced the recurrence rate(RR=0.20, 95%CI[0.05, 0.75], P=0.02), and shortened the time to relief of burning sensation(MD=-1.70, 95%CI[-2.15,-1.26], P<0.000 01), vaginal itching(MD=-0.82, 95%CI[-1.30,-0.34], P=0.000 8), and abnormal leucorrhea(MD=-1.52, 95%CI[-1.98,-1.06], P<0.000 01). Compared with nitroimidazoles + probiotics, Kushen Gelatum + nitroimidazoles + probiotics improved the total response rate in terms of clinical symptoms and laboratory tests(RR=1.18, 95%CI[1.02, 1.36], P=0.03) and reduced the recurrence rate(RR=0.27, 95%CI[0.09, 0.76], P=0.01). Kushen Gelatum combined with antibiotics demonstrates a potential therapeutic effect on bacterial vaginosis, whereas the number and quality of the relevant clinical studies remain to be improved. The process of clinical trial should be standardized to improve the quality of evidence, so as to provide strong evidence to guide the application of Kushen Gelatum in clinical practice.
Female ; Humans ; Anti-Bacterial Agents/adverse effects* ; Clindamycin/adverse effects* ; Vaginosis, Bacterial/chemically induced* ; Nitroimidazoles/adverse effects*

OBJECTIVES: Human papillomavirus (HPV) is a kind of spherical DNA virus, which is related to many factors such as immune status and pregnancy. Due to the decrease of immunity, pregnant women are more likely to have HPV infection, which causes serious imbalance of vaginal microecology and is not beneficial to pregnancy outcome. Therefore, this study focuses on the impact of HPV infection on vaginal microecology and maternal and neonatal outcomes. METHODS: A total of 140 pregnant women with HPV infection during pregnancy, who received obstetric examination in the First Affiliated Hospital of Hainan Medical College from November 2017 to July 2019, were selected as a HPV infection group, and 150 normal pregnant women with HPV negative in the same period were selected as a control group. Vaginal secretions were collected from all the pregnant women at 28-34 weeks of gestation to evaluate vaginal pH, cleanliness and microecological status, and to record pregnancy outcomes for all pregnant women. RESULTS: The proportions of vaginal pH>4.5, constituent ratio of flora density and diversity of I-II, positive detection rate of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) in HPV infected pregnant women were significantly higher than those in the control group (all CONCLUSIONS Pregnant women with HPV infection during pregnancy are more likely to have vaginal microecological disorders, and can increase the risk of adverse pregnancy outcomes such as premature delivery and chorioamnionitis.
Candidiasis, Vulvovaginal ; Cesarean Section ; Female ; Humans ; Infant, Newborn ; Papillomavirus Infections/epidemiology* ; Pregnancy ; Vaginosis, Bacterial

Bacterial vaginosis (BV) is a disease caused by vaginal microbiota dysbiosis. The conventional antibiotic treatment can aggravate microbial dysbiosis, alter the acid environment of the vagina and lead to drug resistance, thus shows low cure rate and high recurrence rate. This poses significant physiological and psychological burden to the BV patients. Vaginal microbiota transplantation (VMT) is a novel live biotherapeutic approach. It directly engrafts the whole vaginal microbiota from healthy women to the vaginal tract of patients to rapidly reconstruct the vaginal microbiota environment and restore the vaginal health. This article summarizes the development, present challenges, and future directions of using VMT, with the aim to explore new strategies for treatment of BV and promote the clinical use of VMT.
Dysbiosis/therapy* ; Female ; Humans ; Microbiota ; Vagina ; Vaginosis, Bacterial/therapy*

Candidiasis, Vulvovaginal ; microbiology ; Communicable Diseases ; microbiology ; Female ; Humans ; Microbiota ; physiology ; Vagina ; microbiology ; Vaginitis ; microbiology ; Vaginosis, Bacterial ; microbiology

Bacterial vaginosis (BV) and complicated vulvovaginal candidiasis (VVC) are frequently occurring vaginal infections in postmenopausal women, caused by an imbalance in vaginal microflora. Postmenopausal women suffer from decreased ovarian hormones estrogen and progesterone. A normal, healthy vaginal microflora mainly comprises Lactobacillus species (spp.), which act beneficially as a bacterial barrier in the vagina, interfering with uropathogens. During premenopausal period, estrogen promotes vaginal colonization by lactobacilli that metabolizing glycogen and producing lactic acid, and maintains intravaginal health by lowering the intravaginal pH level. A lower vaginal pH inhibits uropathogen growth, preventing vaginal infections. Decreased estrogen secretion in postmenopausal women depletes lactobacilli and increases intravaginal pH, resulting in increased vaginal colonization by harmful microorganisms (e.g., Enterobacter, Escherichia coli, Candida, and Gardnerella). Probiotics positively effects on vaginal microflora composition by promoting the proliferation of beneficial microorganisms, alters the intravaginal microbiota composition, prevents vaginal infections in postmenopausal. Probiotics also reduce the symptoms of vaginal infections (e.g., vaginal discharge, odor, etc.), and are thus helpful for the treatment and prevention of BV and VVC. In this review article, we provide information on the intravaginal mechanism of postmenopausal vaginal infections, and describes the effectiveness of probiotics in the treatment and prevention of BV and VVC.
Candida ; Candidiasis, Vulvovaginal ; Colon ; Enterobacter ; Escherichia coli ; Estrogens ; Female ; Glycogen ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid ; Lactobacillus ; Microbiota ; Odors ; Postmenopause ; Premenopause ; Probiotics* ; Progesterone ; Vagina ; Vaginal Discharge ; Vaginal Diseases ; Vaginosis, Bacterial

Aims: This study aims to investigate the phylogroups, antibiotics susceptibility and biofilm formation among CVEC isolated from female with bacterial vaginosis. Methodology and results: High vaginal swab from girl with age (18-60 years) were collected and cultured on MacConkey agar, EMB agar and UTI chromogenic medium to recover CVEC and only the confirmed Escherichia coli will pass through rest of the assays like phylogrouping (by PCR), antibiotics susceptibility test and biofilm formation. The results revealed that only 32 (20.38%) of CVEC were recovered and among them only 3 (9.375%) of CVEC belong to intestinal subgroup A1 and the rest 29 (90.625%) assigned to extraintestinal phylogenetic group B2. CVEC isolates belong to B1 and D groups not reported. Antibiotics resistance results shown that, 32 (100%) for cefazolin, cephalothin, cefoxitin and metronidazole, 31 (96.9%) for erythromycin, 24 (75%) for fosfomycin, 20 (62.5%) for cefotaxime, 16 (50%) for ceftazidime, 14 (43.75%) for cefepeim, (28.1%) for aztreonam, 7 (21.9%) for streptomycin, 6 (18.75%) for meropenem, 5 (15.6%) for both imipenem and gentamicin, 2 (6.25%) for both ciprofloxacin and norfloxacin, amikacin 1 (3.1%) and no resistance stated for nitrofurantion (0.00%). TCP methods results display that 12 (37.5%) of CVEC were biofilm former while 20 (62.5%) were non biofilm former. Conclusion, significance and impact of study: This study concluded that, most of the CVEC belong to highly virulent phylogroup B2 and have the ability to resist multiple antibiotics and the ciprofloxacin, norfloxacin, amikacin and nitrofurantion still the best choice for treatment and CVEC have the ability to form biofilm which make the infection ruthless and hard to cure.
Vaginosis, Bacterial

BACKGROUND: Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginitis. In the Philippines, prevalence of BV is at 28.16%. The mainstay for the treatment of BV is Metronidazole. Although antibiotic therapy has been shown to eliminate BV associated organisms, there is extremely high recurrence rate.
OBJECTIVE: To compare the efficacy of metronidazole and metronidazole plus lactobacilli tablet in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary medical center.
METHODOLOGY: The population included non-pregnant women ages 15 t0 44 years old, with bacterial vaginosis diagnosed by Amsel's criteria and Nugent's scoring. The participants were randomly assigned to their treatment group, one is Metronidazole only and other received Metronidazole plus Lactobacillus tablet. All participants followed up on day 8,15,22 and 56 from initiation of treatment resolution or persistence of symptoms and collection of vaginal specimen for gram stain and inquire on adverse effects.
RESULTS: On day 8 treatment, there were significantly more participant in the metronidazole plus probiotic arm with an estimated lactobacilli count of more than 30/hpf as comapred to metronidazole alone. On day 15 post treatment, there was no statistically significant difference with the estimated Gardnerella vaginalis count, lactobacilli count, presence or absence of malodorous vaginal discharge between the metronidazole plus probiotic and the metronidazole alone arm. With metronidazole plus probiotic group, the proportion of women with less than 30 per hpf Gardnella vaginalis count and absent foul smelling vaginal discharge were accounted among 100% of the participants from day 8 to 56 post treatment. The early reduction in the causative agent and symptoms can be attributed to an increase in the estimated lactobacilli count sustained until 56 days post treatment metronidazole plus probiotic. However, from day 15 to 22 and 56 post- treatment, the proportion of participants who had a nugent's score of less than 4 were greater for both the metronidazole plus probiotic (100%) and metronidazole alone (95%) arm, when compared to day 8 post-treatment. This finding for the metronidazole plus probiotic group is due to sustained reduction in the Gardnella vaginalis count and increase in lactobacilli counts. Potentially , the metronidazole plus probiotic treatment was found to be more favorable in sustaining the normal flora and probiotic can be used as an adjunct may enhance the efficacy of metronidazole in the treatment of BV.
CONCLUSION: Metronidazole plus probiotic and metronidazole only treatment are comparable in treating bacterial vaginosis. In terms of restoring and maintaining the normal flora, metronidazole plus probiotic appears to be more significantly efficacious. Probiotic in the form of lactobacilli is a promising adjunct to enhance the efficacy of metronidazole in the treatment of bacterial vaginosis.

Human ; Female ; Adult ; Adolescent ; Gardnerella Vaginalis ; Vaginosis, Bacterial ; Metronidazole ; Lactobacillus ; Gardnerella ; Probiotics ; Vaginal Discharge ; Gentian Violet ; Phenazines ; Tablets ; Anti-bacterial Agents

BACKGROUND: Bacterial vaginosis (BV) is a very common gynecologic infection associated with a vast number of complications both in gynecologic and obstetric patients. One of the major concerns in its treatment is a high recurrence rate which was multifactorial and the choice of the suitable antimicrobial is important to decrease the treatment failure.

METHODS: All gynecologic patients aged 18 years old and above in a tertiary hospital diagnosed with bacterial vaginosis according to Amsel's criteria. A total of 80 patients were randomly assigned into two groups; one group to receive oral Probiotics (Protexin) while the other group to receive Metronidazole. The patients will be followed up accordingly on Days 1, 3, 7 and 30 and will be graded according to Amsel's criteria. The primary endpoint of the study is the treatment of bacterial vaginosis based on the mentioned criteria. (Anukam, 2006)

RESULTS: The results showed that there was a significant improvement in the character of the vaginal discharge based on the Amsels criteria on Day 1 of treatment for the Metronidazole group (0/40; 100%, p value <0.001) and Day 3 for Oral Lactobacillus arms. (7/40; 20%, p value 0.01). The Metronidazole arm showed a significant improvement in the fishy odor on vaginal examination with addition of 10% KOH on day 1 (0/40; 100%, p value <0.001) and Day 3 for oral Lactobacilus (0/40; 100%, p value 1.00). Then vaginal pH was noted to be more acidic in the Metronidazole compared to the Protexin arm on Day 1 of treatment (0/40; 0% and 40/40; 100% p value

CONCLUSION: The Metronidazole remains to be the standard treatment for Bacterial vaginosis. There was also faster recovery and clinical improvement in the character of the vaginal discharge, amount and smell based on the Amsel's criteria as early as Day 1 of follow-up; however, there was a small number of population with poor compliance resulting to higher recurrence rate which was evident on the 30 th day of follow-up. The oral lactobacillus rhamnosus showed advantage over Metronidazole due to lower recurrence rate of BV as noted on Day 30 of follow up.

Human ; Female ; Aged ; Middle Aged ; Adult ; Pregnancy ; Vaginosis, Bacterial ; Lactobacillus Rhamnosus ; Metronidazole ; Lactobacillus ; Probiotics ; Anti-infective Agents ; Gynecological Examination ; Odorants ; Smell ; Vaginal Discharge

BACKGROUND: Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginitis. In the Philippines, prevalence of BV is at 28.16%. The mainstay for the treatment of BV is Metronidazole. Although antibiotic therapy has been shown to eliminate BV associated organisms, there is extremely high recurrence rate.

OBJECTIVE: To compare the efficacy of metronidazole and metronidazole plus lactobacilli tablet in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary medical center.

METHODOLOGY: The population included non-pregnant women ages 15 t0 44 years old, with bacterial vaginosis diagnosed by Amsel's criteria and Nugent's scoring. The participants were randomly assigned to their treatment group, one is Metronidazole only and other received Metronidazole plus Lactobacillus tablet. All participants followed up on day 8,15,22 and 56 from initiation of treatment resolution or persistence of symptoms and collection of vaginal specimen for gram stain and inquire on adverse effects.

RESULTS: On day 8 treatment, there were significantly more participant in the metronidazole plus probiotic arm with an estimated lactobacilli count of more than 30/hpf as comapred to metronidazole alone. On day 15 post treatment, there was no statistically significant difference with the estimated Gardnerella vaginalis count, lactobacilli count, presence or absence of malodorous vaginal discharge between the metronidazole plus probiotic and the metronidazole alone arm. With metronidazole plus probiotic group, the proportion of women with less than 30 per hpf Gardnella vaginalis count and absent foul smelling vaginal discharge were accounted among 100% of the participants from day 8 to 56 post treatment. The early reduction in the causative agent and symptoms can be attributed to an increase in the estimated lactobacilli count sustained until 56 days post treatment metronidazole plus probiotic. However, from day 15 to 22 and 56 post- treatment, the proportion of participants who had a nugent's score of less than 4 were greater for both the metronidazole plus probiotic (100%) and metronidazole alone (95%) arm, when compared to day 8 post-treatment. This finding for the metronidazole plus probiotic group is due to sustained reduction in the Gardnella vaginalis count and increase in lactobacilli counts. Potentially , the metronidazole plus probiotic treatment was found to be more favorable in sustaining the normal flora and probiotic can be used as an adjunct may enhance the efficacy of metronidazole in the treatment of BV.

CONCLUSION: Metronidazole plus probiotic and metronidazole only treatment are comparable in treating bacterial vaginosis. In terms of restoring and maintaining the normal flora, metronidazole plus probiotic appears to be more significantly efficacious. Probiotic in the form of lactobacilli is a promising adjunct to enhance the efficacy of metronidazole in the treatment of bacterial vaginosis.

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Adolescent (a Person 13-18 Years Of Age) ; Gardnerella Vaginalis ; Vaginosis, Bacterial ; Metronidazole ; Lactobacillus ; Gardnerella ; Probiotics ; Vaginal Discharge ; Gentian Violet ; Phenazines ; Tablets ; Anti-bacterial Agents

BACKGROUND: Bacterial vaginosis (BV) is a very common gynecologic infection associated with a vast number of complications both in gynecologic and obstetric patients. One of the major concerns in its treatment is a high recurrence rate which was multifactorial and the choice of the suitable antimicrobial is important to decrease the treatment failure.

METHODS: All gynecologic patients aged 18 years old and above in a tertiary hospital diagnosed with bacterial vaginosis according to Amsel's criteria. A total of 80 patients were randomly assigned into two groups; one group to receive oral Probiotics (Protexin) while the other group to receive Metronidazole. The patients will be followed up accordingly on Days 1, 3, 7 and 30 and will be graded according to Amsel's criteria. The primary endpoint of the study is the treatment of bacterial vaginosis based on the mentioned criteria. (Anukam, 2006)

RESULTS: The results showed that there was a significant improvement in the character of the vaginal discharge based on the Amsels criteria on Day 1 of treatment for the Metronidazole group (0/40; 100%, p value <0.001) and Day 3 for Oral Lactobacillus arms. (7/40; 20%, p value 0.01). The Metronidazole arm showed a significant improvement in the fishy odor on vaginal examination with addition of 10% KOH on day 1 (0/40; 100%, p value <0.001) and Day 3 for oral Lactobacilus (0/40; 100%, p value 1.00). Then vaginal pH was noted to be more acidic in the Metronidazole compared to the Protexin arm on Day 1 of treatment (0/40; 0% and 40/40; 100% p value

CONCLUSION: The Metronidazole remains to be the standard treatment for Bacterial vaginosis. There was also faster recovery and clinical improvement in the character of the vaginal discharge, amount and smell based on the Amsel's criteria as early as Day 1 of follow-up; however, there was a small number of population with poor compliance resulting to higher recurrence rate which was evident on the 30 th day of follow-up. The oral lactobacillus rhamnosus showed advantage over Metronidazole due to lower recurrence rate of BV as noted on Day 30 of follow up.

Human ; Female ; Aged ; Middle Aged ; Adult ; Pregnancy ; Vaginosis, Bacterial ; Lactobacillus Rhamnosus ; Metronidazole ; Lactobacillus ; Probiotics ; Anti-infective Agents ; Gynecological Examination ; Odorants ; Smell ; Vaginal Discharge