Our scientific group which specializes on STI studies has recently published tree articles on Florocenosis disorder syndromes.
The problem of vaginal microflora misbalance is one of the most important in gynecological practice. Changes in vaginal microflora can lead to vaginal discharges which takes 50% among patients who come to a gynecologist. The causes of these discharges may be bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), aerobic vaginitis (AV), sexually transmitted infections (STI) or other more rare disorders. Vaginal microflora misbalance is widely spread among women, for example, BV appears in 30-40% of female population and VVC in 20-45% of reproductive aged women. This microflora misbalance can lead to different inflammatory disorders, possible miscarrying and premature birth.
Pic.1 Gynecological disorders prevalence in women with symptoms of vaginal microbiota disorders.
Therapeutic approaches for mentioned disorders differ and it is very important to diagnose the patient correctly and select right treatment strategy. This is a challenging process as the symptoms might be similar and there are asymptomatic cases as well. This is why PCR-complex method AmpliSens Florocenosis is a very good solution for this problem.
What are AmpliSens Florocenosis series kits?
It is a complex test for women health screening and it consists of 4 kits intended for detection BV, VVC, AV syndromes as well as screening for conditional-pathogenic mycoplasmas. This set can be used together or separately and please note that STI multiplex kit should be the first step of gynecological analysis if patient has vaginal discharges.
Pic.2 AmpliSens Florocenosis series kits.
So here are presented three recent publications on different vaginal microbiota disorders by our scientific research groups.
«Quantitation of all four Gardnerella vaginalis clades detects abnormal vaginal microbiota characteristic of bacterial vaginosis more accurately than putative G. vaginalis sialidase A gene count»
E. Shipitsyna, A. Krysanova, G. Khayrullina, K. Shalepo, A. Savicheva, A. Guschin, M. Unemo
Bacterial vaginosis (BV) is a vaginal disorder characterized by a depletion of the normal lactobacillus-dominant microbiota and overgrowth of mainly anaerobic bacteria.
The study aimed to evaluate the distribution and abundance of the Gardnerella vaginalis clades and sialidase A gene in vaginal samples from Russian women, and investigate if the G. vaginalis sialidase A gene count detects an abnormal vaginal microbiota characteristic of BV more accurately than G. vaginalis load.
Vaginal samples from 299 non-pregnant patients of gynecological clinics were examined using Nugent scores and G. vaginalis clade and sialidase A gene quantitative real-time polymerase chain reactions (PCRs). Discriminatory power for BV microbiota was evaluated with receiver operating characteristic (ROC) analysis.
The vaginal microbiota was characterized by Nugent scores as normal, intermediate, and BV microbiota in 162, 58, and 79 women, respectively. G. vaginalis clades 1, 2, 3, 4, and the sialidase A gene were detected in 56% (51–62%), 40% (34–45%), 20% (16–25%), 94% (91–96%), and 70% (64–75%) of vaginal samples, respectively. The frequency and abundance of clades 1, 2, 4, and the sialidase A gene as well as clade multiplicity were significantly associated with abnormal microbiota. The sialidase A gene was present in all multi-clade samples, in all single-clade samples comprising clades 1, 2, and 3, and in four of 84 (5% [2–12%]) samples comprising clade 4 only. Total G. vaginalis load showed significantly higher discriminatory power for abnormal microbiota than sialidase A gene count (areas under ROC curves 0.933 vs. 0.881; p = 0.0306).
Quantifying all four G. vaginalis clades discriminates between BV microbiota and normal microbiota more accurately than measuring G. vaginalis sialidase A gene. Clade 4 is strongly associated with BV microbiota, despite most clade 4 strains lacking the sialidase A gene.
«Vulvovaginal candidiasis: histologic lesions are primarily polymicrobial and invasive and do not contain biofilms»
A. Swidsinski, A. Guschin, Q. Tang, Y. Dörffel, H. Verstraelen, A. Tertychnyy , G. Khayrullina, X. Luo, J.D. Sobel, X. Jiang
The recent demonstration of a vaginal biofilm in bacterial vaginosis and its postulated importance in the pathogenesis of recurrent bacterial vaginosis, including relative resistance to therapy, has led to the hypothesis that biofilms are crucial for the development of vulvovaginal candidiasis. The histopathology and microbial architecture of vulvovaginal candidiasis have not been previously defined; neither has Candida, containing biofilm been reported in situ. The present study aimed at clarifying the histopathology of vulvovaginal candidiasis including the presence or absence of vaginal biofilm.
In a cross-sectional study, vaginal tissue biopsies were obtained from 35 women with clinically, microscopically, and culture-proven vulvovaginal candidiasis and compared with specimens obtained from 25 healthy women and 30 women with active bacterial vaginosis. Vaginal Candida infection was visualized using fluorescent in situ hybridization with ribosomal gene–based probes.
Candida microorganisms were confirmed in 26 of 35 biopsies obtained from women with vulvovaginal candidiasis; however, Candida containing biofilm were not detected in any of the cases. Histopathological lesions were exclusively invasive and accompanied by co-invasion with Gardnerella or Lactobacillus species organisms.
Histopathological lesions of vulvovaginal candidiasis are primarily invasive in nature and polymicrobial and do not resemble biofilms. The clinical significance of Candida tissue invasion is unknown.
«Prevalence of Ureaplasma spp. and Mycoplasma hominis in healthy women and patients with flora alterations»
The objective was to estimate the prevalence of Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum in healthy women and patients with altered vaginal microflora. Vaginal samples from 2594 unselected female patients were divided into normal, bacterial vaginosis (BV), and aerobic vaginitis (AV) groups and tested for U. parvum, U. urealyticum and M. hominis. Normal flora was detected in 1773 patients (68.4%), BV in 754 patients (29.1%), and AV in 67 patients (2.6%). In the control group, 771 (43.5%) patients were U. parvum positive, 104 (5.9%) were U. urealyticum positive, and 158 (8.9%) were M. hominis positive. In the BV group, those bacteria were detected in 452 (59.9%), 102 (13.5%), and 202 (26.8%) patients, respectively (P < 0.001); in the AV group, those were detected in 16 (23.9%), 3 (4.5%), and 4 (6.0%) patients, respectively (P < 0.001; 0.63 and 0.40, respectively). This study demonstrated that mycoplasmas may be a marker or a symbiont of the BV flora but not AV flora.