西非冈比亚阴道分泌物综合征患者的细菌性阴道病、阴道菌群模式及阴道卫生习惯

Bacterial vaginosis, vaginal flora patterns and vaginal hygiene practices in patients presenting with vaginal discharge syndrome in The Gambia, West Africa.

作者信息

Demba Edward, Morison Linda, van der Loeff Maarten Schim, Awasana Akum A, Gooding Euphemia, Bailey Robin, Mayaud Philippe, West Beryl

机构信息

Medical Research Council Laboratories, Fajara, The Gambia.

出版信息

BMC Infect Dis. 2005 Mar 9;5:12. doi: 10.1186/1471-2334-5-12.

DOI:10.1186/1471-2334-5-12

PMID:15757510

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1083415/

Abstract

BACKGROUND

Bacterial vaginosis (BV) - a syndrome characterised by a shift in vaginal flora - appears to be particularly common in sub-Saharan Africa, but little is known of the pattern of vaginal flora associated with BV in Africa. We conducted a study aimed at determining the prevalence of BV and patterns of BV-associated vaginal micro-flora among women with vaginal discharge syndrome (VDS) in The Gambia, West Africa.

METHODS

We enrolled 227 women with VDS from a large genito-urinary medicine clinic in Fajara, The Gambia. BV was diagnosed by the Nugent's score and Amsel's clinical criteria. Vaginal swabs were collected for T vaginalis and vaginal flora microscopy, and for Lactobacillus spp, aerobic organisms, Candida spp and BV-associated bacteria (Gardnerella vaginalis, anaerobic bacteria, and Mycoplasma spp) cultures; and cervical swabs were collected for N gonorrhoeae culture and C trachomatis PCR. Sera were tested for HIV-1 and HIV-2 antibodies. Sexual health history including details on sexual hygiene were obtained by standardised questionnaire.

RESULTS

BV prevalence was 47.6% by Nugent's score and 30.8% by Amsel's clinical criteria. Lactobacillus spp were isolated in 37.8% of women, and 70% of the isolates were hydrogen-peroxide (H202)-producing strains. Prevalence of BV-associated bacteria were: G vaginalis 44.4%; Bacteroides 16.7%; Prevotella 15.2%; Peptostretococcus 1.5%; Mobiluncus 0%; other anaerobes 3.1%; and Mycoplasma hominis 21.4%. BV was positively associated with isolation of G vaginalis (odds-ratio [OR] 19.42, 95%CI 7.91 - 47.6) and anaerobes (P = 0.001 [OR] could not be calculated), but not with M hominis. BV was negatively associated with presence of Lactobacillus (OR 0.07, 95%CI 0.03 - 0.15), and H2O2-producing lactobacilli (OR 0.12, 95% CI 0.05 - 0.28). Presence of H2O2-producing lactobacilli was associated with significantly lower prevalence of G vaginalis, anaerobes and C trachomatis. HIV prevalence was 12.8%. Overall, there was no association between BV and HIV, and among micro-organisms associated with BV, only Bacteroides spp. and Prevotella spp. were associated with HIV. BV or vaginal flora patterns were not associated with any of the factors relating to sexual hygiene practices (vaginal douching, menstrual hygiene, female genital cutting).

CONCLUSION

In this population, BV prevalence was higher than in corresponding populations in industrialised countries, but the pattern of vaginal micro-flora associated with BV was similar. BV or vaginal flora patterns were not associated with HIV nor with any of the vaginal hygiene characteristics.

摘要

背景

细菌性阴道病（BV）——一种以阴道菌群改变为特征的综合征——在撒哈拉以南非洲似乎尤为常见，但对于非洲与BV相关的阴道菌群模式了解甚少。我们开展了一项研究，旨在确定西非冈比亚阴道分泌物综合征（VDS）女性中BV的患病率以及与BV相关的阴道微生物群模式。

方法

我们从冈比亚法贾拉一家大型生殖泌尿医学诊所招募了227名患有VDS的女性。通过Nugent评分和Amsel临床标准诊断BV。采集阴道拭子用于阴道毛滴虫和阴道菌群显微镜检查，以及乳酸杆菌属、需氧菌、念珠菌属和与BV相关细菌（阴道加德纳菌、厌氧菌和支原体属）培养；采集宫颈拭子用于淋病奈瑟菌培养和沙眼衣原体PCR检测。检测血清中的HIV-1和HIV-2抗体。通过标准化问卷获取性健康史，包括性卫生细节。

结果

根据Nugent评分，BV患病率为47.6%，根据Amsel临床标准为30.8%。37.8%的女性分离出乳酸杆菌属，其中70%的分离株为产过氧化氢（H2O2）菌株。与BV相关细菌的患病率分别为：阴道加德纳菌44.4%；拟杆菌属16.7%；普雷沃菌属15.2%；消化链球菌属1.5%；动弯杆菌属0%；其他厌氧菌3.1%；人型支原体21.4%。BV与阴道加德纳菌分离呈正相关（优势比[OR]19.42，95%可信区间7.91 - 47.6），与厌氧菌呈正相关（P = 0.001，无法计算[OR]），但与人型支原体无关。BV与乳酸杆菌的存在呈负相关（OR 0.07，95%可信区间0.03 - 0.15），与产H2O2的乳酸杆菌呈负相关（OR 0.12，95%可信区间0.05 - 0.28）。产H2O2的乳酸杆菌的存在与阴道加德纳菌、厌氧菌和沙眼衣原体的患病率显著降低相关。HIV患病率为12.8%。总体而言，BV与HIV之间无关联，在与BV相关的微生物中，只有拟杆菌属和普雷沃菌属与HIV相关。BV或阴道菌群模式与任何性卫生习惯因素（阴道灌洗、经期卫生、女性割礼）均无关联。