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Sharon L. Hillier - One of the best experts on this subject based on the ideXlab platform.
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suppressive antiBacterial therapy with 0 75 metronidazole vaginal gel to prevent recurrent Bacterial Vaginosis
American Journal of Obstetrics and Gynecology, 2006Co-Authors: Jack D Sobel, Harold C. Wiesenfeld, Jane R. Schwebke, Jeffrey F Peipert, David E Soper, Daron G Ferris, Paul Nyirjesy, Suzanne E Ohmit, Sharon L. HillierAbstract:Objective Efficacy study of suppressive vaginal metronidazole in reducing recurrent symptomatic episodes of Bacterial Vaginosis. Study design Multicenter prospective study with initial 10-day open-label metronidazole gel in which asymptomatic responders randomly assigned to receive twice weekly metronidazole vaginal gel or placebo for 16 weeks and off therapy for 12 weeks. Results Of 157 eligible women with recurrent Bacterial Vaginosis, 112 of 127 returning evaluable women (88.2%) responded clinically and were randomly assigned. During suppressive therapy, recurrent Bacterial Vaginosis occurred in 13 women (25.5%) receiving metronidazole and 26 (59.1%) receiving placebo (MITT analysis, relative risk [RR] 0.43, CI=0.25-0.73, P = .001). During the entire 28-week follow-up, recurrence occurred in 26 (51.0%) on treatment compared with 33 (75%) on placebo (RR 0.68, CI=0.49-0.93, P = .02). Probability for remaining cured was 70% for metronidazole compared with 39% on placebo, which declined to 34% and 18%, respectively, by 28 weeks follow-up. Adverse effects were uncommon; however, secondary vaginal candidiasis occurred significantly more often in metronidazole-treated women ( P = .02). Conclusion Suppressive therapy with twice-weekly metronidazole gel achieves a significant reduction in the recurrence rate of Bacterial Vaginosis; however, secondary vaginal candidiasis is common.
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Bacterial Vaginosis and anaerobic bacteria are associated with endometritis
Clinical Infectious Diseases, 2004Co-Authors: Catherine L Haggerty, Sharon L. Hillier, Roberta B Ness, Debra C Bass, Pid EvaluationAbstract:Background. Chlamydia trachomatis and/or Neisseria gonorrhoeae account for approximately one-third to one-half of pelvic inflammatory disease (PID) cases. Thus, up to 70% of cases have an unknown, nongonococcal/ nonchlamydial microbial etiology. Methods. We investigated the associations of N. gonorrhoeae, C. trachomatis, Bacterial Vaginosis, anaerobic bacteria, facultative bacteria, and lactobacilli with endometritis among 278 women with complete endometrial histology and culture from the PID Evaluation and Clinical Health Study. Results. Women with acute endometritis were less likely to have H 2 O 2 -producing Lactobacillus species (odds ratio [OR], 0.1; 95% confidence interval [CI], 0.01-0.8) and more likely to be infected with C. trachomatis (OR, 16.2; 95% CI, 4.6-56.6), N. gonorrhoeae (OR, 11.6; 95% CI, 4.5-29.9), diphtheroids (OR, 5.0; 95% CI, 2.1-12.2), black-pigmented gram-negative rods (OR, 3.1; 95% CI, 1.4-7.0), and anaerobic gram-positive cocci (OR, 2.1; 95% CI, 1.0-4.3) and to have Bacterial Vaginosis (OR, 2.4; 95% CI, 1.3-4.3). Conclusions. We conclude that Bacterial Vaginosis-associated organisms are frequent among women with PID. Because these organisms were strongly associated with endometritis, we recommend that all women with PID be treated with regimens that include metronidazole.
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antimicrobial resistance associated with the treatment of Bacterial Vaginosis
American Journal of Obstetrics and Gynecology, 2004Co-Authors: Richard H Beigi, Marijane A. Krohn, Michele N Austin, Leslie A Meyn, Sharon L. HillierAbstract:Objective This study was undertaken to evaluate antimicrobial susceptibility of vaginal anaerobic bacteria before and after treatment of Bacterial Vaginosis. Study design A randomized clinical trial of 119 nonpregnant women with Bacterial Vaginosis receiving either intravaginal metronidazole for 5 days or clindamycin for 3 days was performed. Women had 1 baseline and 3 follow-up visits at which quantitative vaginal cultures were performed. Anaerobic isolates underwent antimicrobial susceptibility testing. Results Complete susceptibility data was available on 95 women (47 metronidazole and 48 clindamycin). Of 1059 anaerobic Bacterial isolates, less than 1% demonstrated resistance to metronidazole. In contrast, 17% demonstrated baseline clindamycin resistance, and 53% demonstrated resistance to clindamycin after therapy. Women exposed to clindamycin (but not metronidazole) had high frequencies (80%) of clindamycin-resistant anaerobic bacteria that persisted for 90 days after treatment. Conclusion Treatment of Bacterial Vaginosis with clindamycin is associated with marked evidence of antimicrobial resistance among vaginal anaerobic bacteria. This may increase the vaginal reservoir of macrolide-resistant bacteria.
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Bacterial Vaginosis and risk of pelvic inflammatory disease
Obstetrics & Gynecology, 2004Co-Authors: Roberta B Ness, Richard L. Sweet, Sharon L. Hillier, David E Soper, James A Mcgregor, Carol A Stamm, Debra C Bass, Peter A Rice, Kevin E Kip, Holly E RichterAbstract:This multicenter study was conducted to investigate the association of pelvic inflammatory disease (PID) and Bacterial Vaginosis. Participants were recruited from women who were attending family planning, health, gynecology, and sexually transmitted disease (STD clinics in 5 medical centers. Eligible patients were women not seeking care for STD, but who were considered at high risk for acquiring STDs according to an algorithm that weighed age, race parity, number of sexual partners, habit of douching, and a history. The vaginal swabs were self-collected. Participating patients were instructed in the use of a cotton swab to collect their vaginal specimens. At intervals of 6 to 12 months, the self-obtained specimens were examined for the characteristics of Bacterial Vaginosis. A vaginal microflora gram stain score of 7 to 10 was considered Bacterial Vaginosis. Women who developed pelvic pain or who were positive for Neisseria gonorrhoeae or Chlamydia trachomatis underwent a clinical examination and endometrial biopsy for detection of PID. A diagnosis of PID required the presence of histologic endometritis and/or pelvic pain and tenderness accompanied by either a fever of 101° F or higher, sedimentary rate greater than 15 mm/hr, elevated white blood count, or leukorrhea, mucopus, N. gonorrhea, or C. trachomatis in the lower genital tract. There were 1179 patients included in the analysis. The average follow up was 4 years. At the initial examination, 428 women had normal vaginal flora (36%), 280 had intermediate flora (29%), and 471 had Bacterial Vaginosis (40%). The baseline diagnosis was not associated with the rate of detection of PID over the 4 years of follow up. Nor was the development of PID significantly associated with age, race, education, income, smoking, sex during menses, condom use, or a history of STD or PID. Analyses according to various subgroups of patients (younger/older women, black/white women, women with/without a history of PID, with/without baseline gonococcal or chlamydia genital infection) found that only women who had a baseline report of 2 or more sexual partners in the previous 2 months and who had a baseline diagnosis of Bacterial Vaginosis were significantly more likely to have PID. An absence of hydrogen peroxide-producing lactobacillus was not associated with PID, even among the various subgroups. A baseline diagnosis of G. vaginalis or Gram-negative rod growth above 4 had no association with PID except in the subgroup of women who reported 2 or more sexual partners in the previous 2 months. Women with baseline diagnoses of N. gonorrhea or C. trachomatis were more likely to have PID.
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Bacterial Vaginosis Is a Strong Predictor of Neisseria Gonorrhoeae and Chlamydia Trachomatis Infection
Clinical Infectious Diseases, 2003Co-Authors: Harold C. Wiesenfeld, Daniel V. Landers, Marijane A. Krohn, Sharon L. Hillier, Richard L. SweetAbstract:To evaluate whether Bacterial Vaginosis predicts the acquisition of sexually transmitted diseases (STDs), we studied 255 nonpregnant female subjects aged 15-30 who reported recent sexual contact with a male partner in whom either gonococcal or chlamydial urethritis or nongonococcal urethritis was diagnosed. Compared to subjects with normal vaginal flora, subjects with Bacterial Vaginosis were more likely to test positive for Neisseria gonorrhoeae (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.7-9.7) and Chlamydia trachomatis (OR, 3.4; 95% CI, 1.5-7.8). Subjects colonized vaginally by hydrogen peroxide-producing lactobacilli were less likely to receive a diagnosis of chlamydial infection or gonorrhea than subjects without such lactobacilli. Bacterial Vaginosis was a strong predictor of gonorrhea and chlamydial infection among subjects who reported recent exposure to a male partner with urethritis. These data support the importance of vaginal flora in the defense against STD acquisition.
Franco Quadrifoglio - One of the best experts on this subject based on the ideXlab platform.
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prevalence of Bacterial Vaginosis and vaginal flora changes in peri and postmenopausal women
Journal of Clinical Microbiology, 2002Co-Authors: Sabina Cauci, Paola Penacchioni, Teresa Iannicelli, Davide Di Santo, Francesco De Seta, Domenico De Aloysio, Silvia Driussi, Paolo Lanzafame, Franco Quadrifoglio, Secondo GuaschinoAbstract:Our aim was to evaluate the prevalence of Bacterial Vaginosis and decrease in lactobacillus colonization in women 40 years old or older in relation to menopausal status by evaluation of Gram-stained smears. A total of 1,486 smears from Italian Caucasian women aged 40 to 79 years were examined. Women were classified as follows: fertile (regular cycles) (n = 328), perimenopausal (irregular cycles) (n = 237), and postmenopausal (n = 921), including 331 women on estroprogestinic hormone replacement therapy (HRT). The prevalences of Bacterial Vaginosis (assessed as a Nugent score of ≥7) in fertile (9.8%) and perimenopausal (11.0%) women were not statistically different, whereas the prevalence was significantly lower overall in postmenopausal women (6.0%) (P = 0.02). Specifically, 6.3% of postmenopausal women without HRT and 5.4% of postmenopausal women with HRT were positive for Bacterial Vaginosis. The Nugent score system was not adequate for evaluating the normal and intermediate vaginal flora in women over the age of 40 years. High numbers of peri- and postmenopausal women had no lactobacilli and no Bacterial-Vaginosis-associated microorganisms. This nonpathological absence of lactobacilli in women with a Nugent score of 4 was scored as 4∗, and this group was considered separately from the intermediate flora group. A score of 4∗ was obtained for 2.1% of fertile women, 11.4% of perimenopausal women, 44.1% of postmenopausal women without HRT, and 6.9% of postmenopausal women with HRT. The physiological reduction in lactobacillus colonization of the vagina in postmenopausal women does not cause an increase in Bacterial-Vaginosis prevalence. Reversion of lactobacillus flora to premenopausal levels due to HRT does not increase the prevalence of Bacterial Vaginosis in postmenopausal women.
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correlation of local interleukin 1beta levels with specific iga response against gardnerella vaginalis cytolysin in women with Bacterial Vaginosis
American Journal of Reproductive Immunology, 2002Co-Authors: Sabina Cauci, Silvia Driussi, Secondo Guaschino, Miriam Isola, Franco QuadrifoglioAbstract:PROBLEM: Mucosal immune system activation may represent a critical determinant of adverse sequelae correlated with Bacterial Vaginosis, as HIV sexual transmission, upper genital tract infections, cervicitis, endometritis, postsurgical infections, and adverse pregnancy outcomes as preterm delivery (PTD), low birth weight (LBW). METHOD OF STUDY: Levels of interleukin-1beta (IL-1beta), anti-Gardnerella vaginalis hemolysin (Gvh) IgA, pH, Nugent score, and number of leukocytes were measured in vaginal fluids of 60 fertile women with Bacterial Vaginosis and of 64 healthy controls. RESULTS: Vaginal IL-1beta levels were nearly 13-fold higher in women with Bacterial Vaginosis (BV) and were associated with anti-Gvh IgA response. IL-1beta was positively correlated with leukocyte counts in the smear both in healthy and Bacterial Vaginosis positive women. CONCLUSIONS: Induction of the proinflammatory cytokine IL-1beta may be a necessary event to elicit an innate immune response to control anaerobic genital tract infections. High levels of vaginal IL-1beta are associated with mounting of an antigen-specific mucosal immune response in women with Bacterial Vaginosis. Parallel induction of innate and adaptive immune response may be associated with protection from ascent of micro-organisms to the upper genital tract, and from acquiring viral infection through the vaginal tract.
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immunoglobulin a response against gardnerella vaginalis hemolysin and sialidase activity in Bacterial Vaginosis
Journal of Lower Genital Tract Disease, 1998Co-Authors: Sabina Cauci, Silvia Driussi, Rossella Monte, Paolo Lanzafame, Emanuele Pitzus, Franco QuadrifoglioAbstract:Abstract Objective: The aim of this study was to investigate the correlation between the immunoglobulin A immune response to Gardnerella vaginalis hemolysin and sialidase activity in vaginal fluids from patients with Bacterial Vaginosis. Study Design: Nonpregnant women who were examined at a gynecologic clinic, in an age range of 18 to 62 years, were enrolled. The study population comprised 131 healthy volunteers, 32 women with Bacterial Vaginosis that was positive for immunoglobulin A to Gardnerella vaginalis hemolysin, 40 women with Bacterial Vaginosis that was negative for immunoglobulin A to Gardnerella vaginalis hemolysin, and 19 women with Candida vaginitis. Bacterial Vaginosis was diagnosed by clinical criteria and Gram stain. Results: Sialidase activity was present in 75% (54/72) of patients with Bacterial Vaginosis. Women having Bacterial Vaginosis and lacking a specific immunoglobulin A response had a significantly higher level of sialidase activity than patients who had an immune response against Gardnerella vaginalis hemolysin. Sialidase activity was detected in 87% (35/40) of the former subgroup of patients with Bacterial Vaginosis and in 59% (19/32) of women of the latter subgroup. No sialidase activity was measured in patients with candidiasis. Specificity of the assay for healthy controls was 95% (124/131 women without sialidase activity). Conclusions: Sialidases produced by Prevotella bivia and other microorganisms present in the microflora of patients with Bacterial Vaginosis are very likely a virulence factor not only by destroying the mucins and enhancing adherence of bacteria but also by impairing a specific immunoglobulin A immune response against other virulence factors such as cytotoxin from Gardnerella vaginalis . (Am J Obstet Gynecol 1998;178:511-5.)
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immunoglobulin a response against gardnerella vaginalis hemolysin and sialidase activity in Bacterial Vaginosis
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Sabina Cauci, Silvia Driussi, Rossella Monte, Paolo Lanzafame, Emanuele Pitzus, Franco QuadrifoglioAbstract:OBJECTIVE: The aim of this study was to investigate the correlation between the immunoglobulin A immune response to Gardnerella vaginalis hemolysin and sialidase activity in vaginal fluids from patients with Bacterial Vaginosis. STUDY DESIGN: Nonpregnant women who were examined at a gynecologic clinic, in an age range of 18 to 62 years, were enrolled. The study population comprised 131 healthy volunteers, 32 women with Bacterial Vaginosis that was positive for immunoglobulin A to Gardnerella vaginalis hemolysin, 40 women with Bacterial Vaginosis that was negative for immunoglobulin A to Gardnerella vaginalis hemolysin, and 19 women with Candida vaginitis. Bacterial Vaginosis was diagnosed by clinical criteria and Gram stain. RESULTS: Sialidase activity was present in 75% (54/72) of patients with Bacterial Vaginosis. Women having Bacterial Vaginosis and lacking a specific immunoglobulin A response had a significantly higher level of sialidase activity than patients who had an immune response against Gardnerella vaginalis hemolysin. Sialidase activity was detected in 87% (35/40) of the former subgroup of patients with Bacterial Vaginosis and in 59% (19/32) of women of the latter subgroup. No sialidase activity was measured in patients with candidiasis. Specificity of the assay for healthy controls was 95% (124/131 women without sialidase activity). CONCLUSIONS: Sialidases produced by Prevotella bivia and other microorganisms present in the microflora of patients with Bacterial Vaginosis are very likely a virulence factor not only by destroying the mucins and enhancing adherence of bacteria but also by impairing a specific immunoglobulin A immune response against other virulence factors such as cytotoxin from Gardnerella vaginalis.
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specific immune response against gardnerella vaginalis hemolysin in patients with Bacterial Vaginosis
American Journal of Obstetrics and Gynecology, 1996Co-Authors: Sabina Cauci, Silvia Driussi, Rossella Monte, Federica Scrimin, Sandro Ceccone, Loris Fant, Franco QuadrifoglioAbstract:Abstract OBJECTIVE: Our goal was to study the mucosal host response in Bacterial Vaginosis by evaluating the presence of a specific immune response elicited against the Gardnerella vaginalis hemolysin in vaginal fluids of patients and by verifying its correlation with usual criteria adopted to diagnose Bacterial Vaginosis. STUDY DESIGN: A total of 123 white women attending the gynecologic care unit for urogenital complaints or for screening of uterine malignancies (Papanicolaou test) aged from 20 to 60 years, nonmenstruating, were enrolled. Bacterial Vaginosis was diagnosed by clinical criteria and a Gram stain score >6. RESULTS: We performed the determination of the antibody response in vaginal fluid against the hemolysin produced by G. vaginalis , a common agent present in Bacterial Vaginosis. The purified G. vaginalis toxin was a suitable antigen for detecting the presence of an immune response in the vaginal fluids of patients with Bacterial Vaginosis regardless of the strain of G. vaginalis present. A specific immunoglobulin A response was detected in 60% of women with overt Bacterial Vaginosis (Gram stain score >6) and in 18.5% of women with intermediate vaginal flora (Gram stain score 4 to 6). The specificity of the test was 91%. CONCLUSIONS: We found a correlation between the specific local immune response to G. vaginalis toxin and Bacterial Vaginosis. The highly purified form of the toxin is able to discriminate disorders from the opportunistic colonization by G. vaginalis . (Am J Obstet Gynecol 1996;175:1601-5.)
Sabina Cauci - One of the best experts on this subject based on the ideXlab platform.
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prevalence of Bacterial Vaginosis and vaginal flora changes in peri and postmenopausal women
Journal of Clinical Microbiology, 2002Co-Authors: Sabina Cauci, Paola Penacchioni, Teresa Iannicelli, Davide Di Santo, Francesco De Seta, Domenico De Aloysio, Silvia Driussi, Paolo Lanzafame, Franco Quadrifoglio, Secondo GuaschinoAbstract:Our aim was to evaluate the prevalence of Bacterial Vaginosis and decrease in lactobacillus colonization in women 40 years old or older in relation to menopausal status by evaluation of Gram-stained smears. A total of 1,486 smears from Italian Caucasian women aged 40 to 79 years were examined. Women were classified as follows: fertile (regular cycles) (n = 328), perimenopausal (irregular cycles) (n = 237), and postmenopausal (n = 921), including 331 women on estroprogestinic hormone replacement therapy (HRT). The prevalences of Bacterial Vaginosis (assessed as a Nugent score of ≥7) in fertile (9.8%) and perimenopausal (11.0%) women were not statistically different, whereas the prevalence was significantly lower overall in postmenopausal women (6.0%) (P = 0.02). Specifically, 6.3% of postmenopausal women without HRT and 5.4% of postmenopausal women with HRT were positive for Bacterial Vaginosis. The Nugent score system was not adequate for evaluating the normal and intermediate vaginal flora in women over the age of 40 years. High numbers of peri- and postmenopausal women had no lactobacilli and no Bacterial-Vaginosis-associated microorganisms. This nonpathological absence of lactobacilli in women with a Nugent score of 4 was scored as 4∗, and this group was considered separately from the intermediate flora group. A score of 4∗ was obtained for 2.1% of fertile women, 11.4% of perimenopausal women, 44.1% of postmenopausal women without HRT, and 6.9% of postmenopausal women with HRT. The physiological reduction in lactobacillus colonization of the vagina in postmenopausal women does not cause an increase in Bacterial-Vaginosis prevalence. Reversion of lactobacillus flora to premenopausal levels due to HRT does not increase the prevalence of Bacterial Vaginosis in postmenopausal women.
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correlation of local interleukin 1beta levels with specific iga response against gardnerella vaginalis cytolysin in women with Bacterial Vaginosis
American Journal of Reproductive Immunology, 2002Co-Authors: Sabina Cauci, Silvia Driussi, Secondo Guaschino, Miriam Isola, Franco QuadrifoglioAbstract:PROBLEM: Mucosal immune system activation may represent a critical determinant of adverse sequelae correlated with Bacterial Vaginosis, as HIV sexual transmission, upper genital tract infections, cervicitis, endometritis, postsurgical infections, and adverse pregnancy outcomes as preterm delivery (PTD), low birth weight (LBW). METHOD OF STUDY: Levels of interleukin-1beta (IL-1beta), anti-Gardnerella vaginalis hemolysin (Gvh) IgA, pH, Nugent score, and number of leukocytes were measured in vaginal fluids of 60 fertile women with Bacterial Vaginosis and of 64 healthy controls. RESULTS: Vaginal IL-1beta levels were nearly 13-fold higher in women with Bacterial Vaginosis (BV) and were associated with anti-Gvh IgA response. IL-1beta was positively correlated with leukocyte counts in the smear both in healthy and Bacterial Vaginosis positive women. CONCLUSIONS: Induction of the proinflammatory cytokine IL-1beta may be a necessary event to elicit an innate immune response to control anaerobic genital tract infections. High levels of vaginal IL-1beta are associated with mounting of an antigen-specific mucosal immune response in women with Bacterial Vaginosis. Parallel induction of innate and adaptive immune response may be associated with protection from ascent of micro-organisms to the upper genital tract, and from acquiring viral infection through the vaginal tract.
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immunoglobulin a response against gardnerella vaginalis hemolysin and sialidase activity in Bacterial Vaginosis
Journal of Lower Genital Tract Disease, 1998Co-Authors: Sabina Cauci, Silvia Driussi, Rossella Monte, Paolo Lanzafame, Emanuele Pitzus, Franco QuadrifoglioAbstract:Abstract Objective: The aim of this study was to investigate the correlation between the immunoglobulin A immune response to Gardnerella vaginalis hemolysin and sialidase activity in vaginal fluids from patients with Bacterial Vaginosis. Study Design: Nonpregnant women who were examined at a gynecologic clinic, in an age range of 18 to 62 years, were enrolled. The study population comprised 131 healthy volunteers, 32 women with Bacterial Vaginosis that was positive for immunoglobulin A to Gardnerella vaginalis hemolysin, 40 women with Bacterial Vaginosis that was negative for immunoglobulin A to Gardnerella vaginalis hemolysin, and 19 women with Candida vaginitis. Bacterial Vaginosis was diagnosed by clinical criteria and Gram stain. Results: Sialidase activity was present in 75% (54/72) of patients with Bacterial Vaginosis. Women having Bacterial Vaginosis and lacking a specific immunoglobulin A response had a significantly higher level of sialidase activity than patients who had an immune response against Gardnerella vaginalis hemolysin. Sialidase activity was detected in 87% (35/40) of the former subgroup of patients with Bacterial Vaginosis and in 59% (19/32) of women of the latter subgroup. No sialidase activity was measured in patients with candidiasis. Specificity of the assay for healthy controls was 95% (124/131 women without sialidase activity). Conclusions: Sialidases produced by Prevotella bivia and other microorganisms present in the microflora of patients with Bacterial Vaginosis are very likely a virulence factor not only by destroying the mucins and enhancing adherence of bacteria but also by impairing a specific immunoglobulin A immune response against other virulence factors such as cytotoxin from Gardnerella vaginalis . (Am J Obstet Gynecol 1998;178:511-5.)
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immunoglobulin a response against gardnerella vaginalis hemolysin and sialidase activity in Bacterial Vaginosis
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Sabina Cauci, Silvia Driussi, Rossella Monte, Paolo Lanzafame, Emanuele Pitzus, Franco QuadrifoglioAbstract:OBJECTIVE: The aim of this study was to investigate the correlation between the immunoglobulin A immune response to Gardnerella vaginalis hemolysin and sialidase activity in vaginal fluids from patients with Bacterial Vaginosis. STUDY DESIGN: Nonpregnant women who were examined at a gynecologic clinic, in an age range of 18 to 62 years, were enrolled. The study population comprised 131 healthy volunteers, 32 women with Bacterial Vaginosis that was positive for immunoglobulin A to Gardnerella vaginalis hemolysin, 40 women with Bacterial Vaginosis that was negative for immunoglobulin A to Gardnerella vaginalis hemolysin, and 19 women with Candida vaginitis. Bacterial Vaginosis was diagnosed by clinical criteria and Gram stain. RESULTS: Sialidase activity was present in 75% (54/72) of patients with Bacterial Vaginosis. Women having Bacterial Vaginosis and lacking a specific immunoglobulin A response had a significantly higher level of sialidase activity than patients who had an immune response against Gardnerella vaginalis hemolysin. Sialidase activity was detected in 87% (35/40) of the former subgroup of patients with Bacterial Vaginosis and in 59% (19/32) of women of the latter subgroup. No sialidase activity was measured in patients with candidiasis. Specificity of the assay for healthy controls was 95% (124/131 women without sialidase activity). CONCLUSIONS: Sialidases produced by Prevotella bivia and other microorganisms present in the microflora of patients with Bacterial Vaginosis are very likely a virulence factor not only by destroying the mucins and enhancing adherence of bacteria but also by impairing a specific immunoglobulin A immune response against other virulence factors such as cytotoxin from Gardnerella vaginalis.
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specific immune response against gardnerella vaginalis hemolysin in patients with Bacterial Vaginosis
American Journal of Obstetrics and Gynecology, 1996Co-Authors: Sabina Cauci, Silvia Driussi, Rossella Monte, Federica Scrimin, Sandro Ceccone, Loris Fant, Franco QuadrifoglioAbstract:Abstract OBJECTIVE: Our goal was to study the mucosal host response in Bacterial Vaginosis by evaluating the presence of a specific immune response elicited against the Gardnerella vaginalis hemolysin in vaginal fluids of patients and by verifying its correlation with usual criteria adopted to diagnose Bacterial Vaginosis. STUDY DESIGN: A total of 123 white women attending the gynecologic care unit for urogenital complaints or for screening of uterine malignancies (Papanicolaou test) aged from 20 to 60 years, nonmenstruating, were enrolled. Bacterial Vaginosis was diagnosed by clinical criteria and a Gram stain score >6. RESULTS: We performed the determination of the antibody response in vaginal fluid against the hemolysin produced by G. vaginalis , a common agent present in Bacterial Vaginosis. The purified G. vaginalis toxin was a suitable antigen for detecting the presence of an immune response in the vaginal fluids of patients with Bacterial Vaginosis regardless of the strain of G. vaginalis present. A specific immunoglobulin A response was detected in 60% of women with overt Bacterial Vaginosis (Gram stain score >6) and in 18.5% of women with intermediate vaginal flora (Gram stain score 4 to 6). The specificity of the test was 91%. CONCLUSIONS: We found a correlation between the specific local immune response to G. vaginalis toxin and Bacterial Vaginosis. The highly purified form of the toxin is able to discriminate disorders from the opportunistic colonization by G. vaginalis . (Am J Obstet Gynecol 1996;175:1601-5.)
Silvia Driussi - One of the best experts on this subject based on the ideXlab platform.
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prevalence of Bacterial Vaginosis and vaginal flora changes in peri and postmenopausal women
Journal of Clinical Microbiology, 2002Co-Authors: Sabina Cauci, Paola Penacchioni, Teresa Iannicelli, Davide Di Santo, Francesco De Seta, Domenico De Aloysio, Silvia Driussi, Paolo Lanzafame, Franco Quadrifoglio, Secondo GuaschinoAbstract:Our aim was to evaluate the prevalence of Bacterial Vaginosis and decrease in lactobacillus colonization in women 40 years old or older in relation to menopausal status by evaluation of Gram-stained smears. A total of 1,486 smears from Italian Caucasian women aged 40 to 79 years were examined. Women were classified as follows: fertile (regular cycles) (n = 328), perimenopausal (irregular cycles) (n = 237), and postmenopausal (n = 921), including 331 women on estroprogestinic hormone replacement therapy (HRT). The prevalences of Bacterial Vaginosis (assessed as a Nugent score of ≥7) in fertile (9.8%) and perimenopausal (11.0%) women were not statistically different, whereas the prevalence was significantly lower overall in postmenopausal women (6.0%) (P = 0.02). Specifically, 6.3% of postmenopausal women without HRT and 5.4% of postmenopausal women with HRT were positive for Bacterial Vaginosis. The Nugent score system was not adequate for evaluating the normal and intermediate vaginal flora in women over the age of 40 years. High numbers of peri- and postmenopausal women had no lactobacilli and no Bacterial-Vaginosis-associated microorganisms. This nonpathological absence of lactobacilli in women with a Nugent score of 4 was scored as 4∗, and this group was considered separately from the intermediate flora group. A score of 4∗ was obtained for 2.1% of fertile women, 11.4% of perimenopausal women, 44.1% of postmenopausal women without HRT, and 6.9% of postmenopausal women with HRT. The physiological reduction in lactobacillus colonization of the vagina in postmenopausal women does not cause an increase in Bacterial-Vaginosis prevalence. Reversion of lactobacillus flora to premenopausal levels due to HRT does not increase the prevalence of Bacterial Vaginosis in postmenopausal women.
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correlation of local interleukin 1beta levels with specific iga response against gardnerella vaginalis cytolysin in women with Bacterial Vaginosis
American Journal of Reproductive Immunology, 2002Co-Authors: Sabina Cauci, Silvia Driussi, Secondo Guaschino, Miriam Isola, Franco QuadrifoglioAbstract:PROBLEM: Mucosal immune system activation may represent a critical determinant of adverse sequelae correlated with Bacterial Vaginosis, as HIV sexual transmission, upper genital tract infections, cervicitis, endometritis, postsurgical infections, and adverse pregnancy outcomes as preterm delivery (PTD), low birth weight (LBW). METHOD OF STUDY: Levels of interleukin-1beta (IL-1beta), anti-Gardnerella vaginalis hemolysin (Gvh) IgA, pH, Nugent score, and number of leukocytes were measured in vaginal fluids of 60 fertile women with Bacterial Vaginosis and of 64 healthy controls. RESULTS: Vaginal IL-1beta levels were nearly 13-fold higher in women with Bacterial Vaginosis (BV) and were associated with anti-Gvh IgA response. IL-1beta was positively correlated with leukocyte counts in the smear both in healthy and Bacterial Vaginosis positive women. CONCLUSIONS: Induction of the proinflammatory cytokine IL-1beta may be a necessary event to elicit an innate immune response to control anaerobic genital tract infections. High levels of vaginal IL-1beta are associated with mounting of an antigen-specific mucosal immune response in women with Bacterial Vaginosis. Parallel induction of innate and adaptive immune response may be associated with protection from ascent of micro-organisms to the upper genital tract, and from acquiring viral infection through the vaginal tract.
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immunoglobulin a response against gardnerella vaginalis hemolysin and sialidase activity in Bacterial Vaginosis
Journal of Lower Genital Tract Disease, 1998Co-Authors: Sabina Cauci, Silvia Driussi, Rossella Monte, Paolo Lanzafame, Emanuele Pitzus, Franco QuadrifoglioAbstract:Abstract Objective: The aim of this study was to investigate the correlation between the immunoglobulin A immune response to Gardnerella vaginalis hemolysin and sialidase activity in vaginal fluids from patients with Bacterial Vaginosis. Study Design: Nonpregnant women who were examined at a gynecologic clinic, in an age range of 18 to 62 years, were enrolled. The study population comprised 131 healthy volunteers, 32 women with Bacterial Vaginosis that was positive for immunoglobulin A to Gardnerella vaginalis hemolysin, 40 women with Bacterial Vaginosis that was negative for immunoglobulin A to Gardnerella vaginalis hemolysin, and 19 women with Candida vaginitis. Bacterial Vaginosis was diagnosed by clinical criteria and Gram stain. Results: Sialidase activity was present in 75% (54/72) of patients with Bacterial Vaginosis. Women having Bacterial Vaginosis and lacking a specific immunoglobulin A response had a significantly higher level of sialidase activity than patients who had an immune response against Gardnerella vaginalis hemolysin. Sialidase activity was detected in 87% (35/40) of the former subgroup of patients with Bacterial Vaginosis and in 59% (19/32) of women of the latter subgroup. No sialidase activity was measured in patients with candidiasis. Specificity of the assay for healthy controls was 95% (124/131 women without sialidase activity). Conclusions: Sialidases produced by Prevotella bivia and other microorganisms present in the microflora of patients with Bacterial Vaginosis are very likely a virulence factor not only by destroying the mucins and enhancing adherence of bacteria but also by impairing a specific immunoglobulin A immune response against other virulence factors such as cytotoxin from Gardnerella vaginalis . (Am J Obstet Gynecol 1998;178:511-5.)
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immunoglobulin a response against gardnerella vaginalis hemolysin and sialidase activity in Bacterial Vaginosis
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Sabina Cauci, Silvia Driussi, Rossella Monte, Paolo Lanzafame, Emanuele Pitzus, Franco QuadrifoglioAbstract:OBJECTIVE: The aim of this study was to investigate the correlation between the immunoglobulin A immune response to Gardnerella vaginalis hemolysin and sialidase activity in vaginal fluids from patients with Bacterial Vaginosis. STUDY DESIGN: Nonpregnant women who were examined at a gynecologic clinic, in an age range of 18 to 62 years, were enrolled. The study population comprised 131 healthy volunteers, 32 women with Bacterial Vaginosis that was positive for immunoglobulin A to Gardnerella vaginalis hemolysin, 40 women with Bacterial Vaginosis that was negative for immunoglobulin A to Gardnerella vaginalis hemolysin, and 19 women with Candida vaginitis. Bacterial Vaginosis was diagnosed by clinical criteria and Gram stain. RESULTS: Sialidase activity was present in 75% (54/72) of patients with Bacterial Vaginosis. Women having Bacterial Vaginosis and lacking a specific immunoglobulin A response had a significantly higher level of sialidase activity than patients who had an immune response against Gardnerella vaginalis hemolysin. Sialidase activity was detected in 87% (35/40) of the former subgroup of patients with Bacterial Vaginosis and in 59% (19/32) of women of the latter subgroup. No sialidase activity was measured in patients with candidiasis. Specificity of the assay for healthy controls was 95% (124/131 women without sialidase activity). CONCLUSIONS: Sialidases produced by Prevotella bivia and other microorganisms present in the microflora of patients with Bacterial Vaginosis are very likely a virulence factor not only by destroying the mucins and enhancing adherence of bacteria but also by impairing a specific immunoglobulin A immune response against other virulence factors such as cytotoxin from Gardnerella vaginalis.
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specific immune response against gardnerella vaginalis hemolysin in patients with Bacterial Vaginosis
American Journal of Obstetrics and Gynecology, 1996Co-Authors: Sabina Cauci, Silvia Driussi, Rossella Monte, Federica Scrimin, Sandro Ceccone, Loris Fant, Franco QuadrifoglioAbstract:Abstract OBJECTIVE: Our goal was to study the mucosal host response in Bacterial Vaginosis by evaluating the presence of a specific immune response elicited against the Gardnerella vaginalis hemolysin in vaginal fluids of patients and by verifying its correlation with usual criteria adopted to diagnose Bacterial Vaginosis. STUDY DESIGN: A total of 123 white women attending the gynecologic care unit for urogenital complaints or for screening of uterine malignancies (Papanicolaou test) aged from 20 to 60 years, nonmenstruating, were enrolled. Bacterial Vaginosis was diagnosed by clinical criteria and a Gram stain score >6. RESULTS: We performed the determination of the antibody response in vaginal fluid against the hemolysin produced by G. vaginalis , a common agent present in Bacterial Vaginosis. The purified G. vaginalis toxin was a suitable antigen for detecting the presence of an immune response in the vaginal fluids of patients with Bacterial Vaginosis regardless of the strain of G. vaginalis present. A specific immunoglobulin A response was detected in 60% of women with overt Bacterial Vaginosis (Gram stain score >6) and in 18.5% of women with intermediate vaginal flora (Gram stain score 4 to 6). The specificity of the test was 91%. CONCLUSIONS: We found a correlation between the specific local immune response to G. vaginalis toxin and Bacterial Vaginosis. The highly purified form of the toxin is able to discriminate disorders from the opportunistic colonization by G. vaginalis . (Am J Obstet Gynecol 1996;175:1601-5.)
Paolo Lanzafame - One of the best experts on this subject based on the ideXlab platform.
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prevalence of Bacterial Vaginosis and vaginal flora changes in peri and postmenopausal women
Journal of Clinical Microbiology, 2002Co-Authors: Sabina Cauci, Paola Penacchioni, Teresa Iannicelli, Davide Di Santo, Francesco De Seta, Domenico De Aloysio, Silvia Driussi, Paolo Lanzafame, Franco Quadrifoglio, Secondo GuaschinoAbstract:Our aim was to evaluate the prevalence of Bacterial Vaginosis and decrease in lactobacillus colonization in women 40 years old or older in relation to menopausal status by evaluation of Gram-stained smears. A total of 1,486 smears from Italian Caucasian women aged 40 to 79 years were examined. Women were classified as follows: fertile (regular cycles) (n = 328), perimenopausal (irregular cycles) (n = 237), and postmenopausal (n = 921), including 331 women on estroprogestinic hormone replacement therapy (HRT). The prevalences of Bacterial Vaginosis (assessed as a Nugent score of ≥7) in fertile (9.8%) and perimenopausal (11.0%) women were not statistically different, whereas the prevalence was significantly lower overall in postmenopausal women (6.0%) (P = 0.02). Specifically, 6.3% of postmenopausal women without HRT and 5.4% of postmenopausal women with HRT were positive for Bacterial Vaginosis. The Nugent score system was not adequate for evaluating the normal and intermediate vaginal flora in women over the age of 40 years. High numbers of peri- and postmenopausal women had no lactobacilli and no Bacterial-Vaginosis-associated microorganisms. This nonpathological absence of lactobacilli in women with a Nugent score of 4 was scored as 4∗, and this group was considered separately from the intermediate flora group. A score of 4∗ was obtained for 2.1% of fertile women, 11.4% of perimenopausal women, 44.1% of postmenopausal women without HRT, and 6.9% of postmenopausal women with HRT. The physiological reduction in lactobacillus colonization of the vagina in postmenopausal women does not cause an increase in Bacterial-Vaginosis prevalence. Reversion of lactobacillus flora to premenopausal levels due to HRT does not increase the prevalence of Bacterial Vaginosis in postmenopausal women.
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immunoglobulin a response against gardnerella vaginalis hemolysin and sialidase activity in Bacterial Vaginosis
Journal of Lower Genital Tract Disease, 1998Co-Authors: Sabina Cauci, Silvia Driussi, Rossella Monte, Paolo Lanzafame, Emanuele Pitzus, Franco QuadrifoglioAbstract:Abstract Objective: The aim of this study was to investigate the correlation between the immunoglobulin A immune response to Gardnerella vaginalis hemolysin and sialidase activity in vaginal fluids from patients with Bacterial Vaginosis. Study Design: Nonpregnant women who were examined at a gynecologic clinic, in an age range of 18 to 62 years, were enrolled. The study population comprised 131 healthy volunteers, 32 women with Bacterial Vaginosis that was positive for immunoglobulin A to Gardnerella vaginalis hemolysin, 40 women with Bacterial Vaginosis that was negative for immunoglobulin A to Gardnerella vaginalis hemolysin, and 19 women with Candida vaginitis. Bacterial Vaginosis was diagnosed by clinical criteria and Gram stain. Results: Sialidase activity was present in 75% (54/72) of patients with Bacterial Vaginosis. Women having Bacterial Vaginosis and lacking a specific immunoglobulin A response had a significantly higher level of sialidase activity than patients who had an immune response against Gardnerella vaginalis hemolysin. Sialidase activity was detected in 87% (35/40) of the former subgroup of patients with Bacterial Vaginosis and in 59% (19/32) of women of the latter subgroup. No sialidase activity was measured in patients with candidiasis. Specificity of the assay for healthy controls was 95% (124/131 women without sialidase activity). Conclusions: Sialidases produced by Prevotella bivia and other microorganisms present in the microflora of patients with Bacterial Vaginosis are very likely a virulence factor not only by destroying the mucins and enhancing adherence of bacteria but also by impairing a specific immunoglobulin A immune response against other virulence factors such as cytotoxin from Gardnerella vaginalis . (Am J Obstet Gynecol 1998;178:511-5.)
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immunoglobulin a response against gardnerella vaginalis hemolysin and sialidase activity in Bacterial Vaginosis
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Sabina Cauci, Silvia Driussi, Rossella Monte, Paolo Lanzafame, Emanuele Pitzus, Franco QuadrifoglioAbstract:OBJECTIVE: The aim of this study was to investigate the correlation between the immunoglobulin A immune response to Gardnerella vaginalis hemolysin and sialidase activity in vaginal fluids from patients with Bacterial Vaginosis. STUDY DESIGN: Nonpregnant women who were examined at a gynecologic clinic, in an age range of 18 to 62 years, were enrolled. The study population comprised 131 healthy volunteers, 32 women with Bacterial Vaginosis that was positive for immunoglobulin A to Gardnerella vaginalis hemolysin, 40 women with Bacterial Vaginosis that was negative for immunoglobulin A to Gardnerella vaginalis hemolysin, and 19 women with Candida vaginitis. Bacterial Vaginosis was diagnosed by clinical criteria and Gram stain. RESULTS: Sialidase activity was present in 75% (54/72) of patients with Bacterial Vaginosis. Women having Bacterial Vaginosis and lacking a specific immunoglobulin A response had a significantly higher level of sialidase activity than patients who had an immune response against Gardnerella vaginalis hemolysin. Sialidase activity was detected in 87% (35/40) of the former subgroup of patients with Bacterial Vaginosis and in 59% (19/32) of women of the latter subgroup. No sialidase activity was measured in patients with candidiasis. Specificity of the assay for healthy controls was 95% (124/131 women without sialidase activity). CONCLUSIONS: Sialidases produced by Prevotella bivia and other microorganisms present in the microflora of patients with Bacterial Vaginosis are very likely a virulence factor not only by destroying the mucins and enhancing adherence of bacteria but also by impairing a specific immunoglobulin A immune response against other virulence factors such as cytotoxin from Gardnerella vaginalis.
