Van Gerwen Olivia T, Smith Sarah E, Muzny Christina A
Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Obstetrics and Gynecology, Emory University, Atlanta, GA, USA.
Curr Infect Dis Rep. 2023 Jan;25(1):7-15. doi: 10.1007/s11908-022-00794-1. Epub 2022 Dec 15.
Bacterial vaginosis (BV) is the most common vaginal infection worldwide, but most research has been conducted in premenopausal women. After menopause, endogenous estrogen production decreases, often leading to the genitourinary syndrome of menopause (GSM), characterized by vulvovaginal dryness and irritation. The estrogen-deficient postmenopausal state results in an elevated vaginal pH and depletion of vaginal lactobacilli. Use of traditional BV diagnostics (Amsel criteria, Nugent score) is difficult in post-menopausal women, especially those not on estrogen replacement therapy, as these methods were originally developed in premenopausal women. In this review, we discuss recent clinical data on BV in postmenopausal women, difficulties in diagnosis using traditional methods, the role of BV molecular diagnostics, and our current expert opinion for managing BV in this population.
BV prevalence has been found to range between 2%-57% among postmenopausal women per Amsel and Nugent criteria. This is likely an over-estimate of the true prevalence due to limitations in these criteria which were only validated in pre-menopausal women. Despite increasing diagnostic options for BV in recent years, including highly sensitive and specific BV nucleic acid amplification tests (NAATs), the physiologic changes of menopause and limited inclusion of postmenopausal women in clinical studies, diagnosis is difficult in this population. Recent studies utilizing 16s rRNA gene sequencing suggest that the vaginal microbiota of premenopausal and postmenopausal women is quite different, even if BV is not present. Data also suggest that obese postmenopausal women have significantly lower rates of BV compared to non-obese postmenopausal women, although further research is needed in this area. Multiple treatment options exist for vaginal atrophy and BV in this population.
Data are limited regarding optimal diagnostic approaches for BV in postmenopausal women; BV NAATs and 16s rRNA gene sequencing may have a role for diagnosing BV in symptomatic women although further studies are needed. Menopausal women with characteristic vaginal symptoms and an elevated vaginal pH should be initially treated for estrogen deficiency prior to considering a diagnosis of BV; subsequent treatment for BV should be driven by symptoms.
细菌性阴道病（BV）是全球最常见的阴道感染，但大多数研究是在绝经前女性中进行的。绝经后，内源性雌激素分泌减少，常导致绝经后泌尿生殖综合征（GSM），其特征为外阴阴道干燥和瘙痒。雌激素缺乏的绝经后状态会导致阴道pH值升高和阴道乳酸杆菌减少。在绝经后女性中，尤其是未接受雌激素替代治疗的女性，使用传统的BV诊断方法（阿姆塞尔标准、纽金特评分）存在困难，因为这些方法最初是在绝经前女性中开发的。在本综述中，我们讨论了绝经后女性BV的最新临床数据、使用传统方法诊断的困难、BV分子诊断的作用以及我们目前对该人群BV管理的专家意见。
根据阿姆塞尔和纽金特标准，绝经后女性中BV的患病率在2%至57%之间。由于这些标准仅在绝经前女性中得到验证，存在局限性，这可能高估了实际患病率。尽管近年来BV的诊断选择不断增加，包括高度敏感和特异的BV核酸扩增试验（NAATs），但由于绝经的生理变化以及临床研究中绝经后女性纳入有限，该人群的诊断仍然困难。最近利用16s rRNA基因测序的研究表明，即使没有BV，绝经前和绝经后女性的阴道微生物群也有很大差异。数据还表明，肥胖的绝经后女性BV发生率明显低于非肥胖的绝经后女性，尽管该领域还需要进一步研究。该人群中阴道萎缩和BV有多种治疗选择。
关于绝经后女性BV的最佳诊断方法的数据有限；BV NAATs和16s rRNA基因测序可能有助于诊断有症状女性的BV，尽管还需要进一步研究。有特征性阴道症状且阴道pH值升高的绝经女性，在考虑诊断BV之前应首先治疗雌激素缺乏；随后的BV治疗应根据症状进行。
