Objectives: High prevalence of bacterial vaginosis (BV) has been reported in lesbians but most studies were based in sexually transmitted infection clinic settings; therefore, we wished to determine the prevalence and risk factors of BV in lesbians and heterosexual women in a community setting in the UK. Methods: A cross-sectional study recruiting lesbian women volunteers from community groups, events, clubs and bars. Heterosexual women were recruited from a community family planning clinic. They self-swabbed to create a vaginal smear, which was Gram-stained and categorised as BV, intermediate or normal flora. They completed a questionnaire about age, ethnic group, smoking, genital hygiene practices and sexual history. Results: Of 189 heterosexuals and 171 lesbians recruited, 354 had gradeable flora. BV was identified in 43 (25.7%) lesbians and 27 (14.4%) heterosexuals (adjusted OR 2.45, 95% CI 1.25 to 4.82; p¿=¿0.009). Concordance of vaginal flora within lesbian partnerships was significantly greater than expected (27/31 (87%) couples, ¿¿=¿0.63; p<0.001). Smoking significantly increased the risk of BV regardless of sexuality (adjusted OR 2.65; p¿=¿0.001) and showed substantial concordance in lesbian partnerships but less than for concordance of flora. Conclusions: Women who identified as lesbians have a 2.5-fold increased likelihood of BV compared with heterosexual women. The prevalence is slightly lower than clinic-based studies and as volunteers were recruited in community settings, this figure may be more representative of lesbians who attend gay venues. Higher concordance of vaginal flora within lesbian partnerships may support the hypothesis of a sexually transmissible factor or reflect common risk factors such as smoking.

Preterm birth remains a major challenge in obstetrics. It complicates up to 13% of all pregnancies and accounts for approximately 80% of neonatal mortality and morbidity. Bacterial Vaginosis (BV) is associated with a 1.4-fold increased risk of preterm birth. Due to ineffectiveness of antibiotics in preventing preterm labour, probiotics have been proposed to serve as an alternative for treatment of BV and prevention of preterm birth. The objectives of this thesis were to determine 1) the effect of Lactobacillus rhamnosus GR-1 (L. rhamnosus GR-1) supernatant on cytokine profile and prostaglandin (PG)-regulating enzyme expression in lipopolysaccharide (LPS)-stimulated human chorion and placental trophoblast cells from human placentae, 2) the potential signaling pathways through which lactobacilli act and 3) the potential role of immune and placental trophoblast cells in initiating a response to LPS and L. rhamnosus GR-1 treatments. Primary cultures of human placental trophoblast cells were pre-treated with lactobacilli supernatant and then with LPS. In addition, immune cells were removed from cell suspensions using a magnetic purification technique to determine their role in modulating cytokine levels. The expression of pro- and anti-inflammatory cytokines and prostaglandin-regulating enzymes was then determined. We found sex-specific differences in the ability of LPS to increase the output of TNF-α, IL-10, and PTGS2. We also showed that L. rhamnosus GR-1 is able to act through the JAK/STAT and MAPK pathways to increase IL-10 and G-CSF, and independently down-regulates PTGS2 and TNF-α and up-regulates PGDH. The increase in G-CSF and PGDH were only observed in women carrying a female fetus. L. rhamnosus GR-1 may serve as an alternative to antibiotics in preventing some infection/inflammation-mediated cases of preterm birth.

Preterm birth, birth prior to 37 weeks gestation, is the leading cause of neonatal mortality and morbidity worldwide. While the uterine cavity and amniotic fluid largely remain sterile throughout gestation, bacterial infections can occur and are associated with preterm birth and/or preterm premature rupture of the fetal membranes (PPROM). Sneathia amnii can be detected as a component of the vaginal flora in healthy women; however, it’s also associated with bacterial vaginosis and preterm birth. Sn35, an isolate of S.amnii, was identified and sequenced through the Vaginal Human Microbiome Project at VCU. Our objective was to classify potential virulence determinants in Sn35 and we successfully identified a putative zinc endopeptidase. The zinc endopeptidase appeared to cleave itself in a site-specific manner under calcium-depleted conditions, resulting in a truncated protein. The truncated protein did have collagenase activity and bacteriolytic activity as well.

Preterm birth, defined at birth before 37 weeks gestation, affects millions of newborns worldwide every year. Preterm birth is a leading cause of infant morbidity and mortality. One major cause of preterm birth is preterm premature rupture of membranes (PPROM), which can be triggered by bacterial infection and inflammation. A bacterial species that has been implicated in preterm birth and other obstetric complications is Sneathia amnii. The goals of this study were to observe cytopathogenic effects caused by S. amnii strain Sn35 and identify putative virulence factors causing those effects. Sn35 was able to adhere to, invade, and damage/kill various host cell lines. We characterized these virulence attributes. A putative virulence determinant was identified, and a fragment of the protein was expressed for polyclonal antiserum production. Antiserum was used to characterize the expression and subcellular localization of the protein in Sn35. However, antiserum was unable to prevent cytopathogenic effects.

acase@tulane.edu

<p>Risk factors such as intrauterine and vaginal infection put pregnant women at risk for delivering preterm. Bacterial vaginosis (BV) is a polymicrobial clinical syndrome commonly diagnosed in women of reproductive age, with women of African descent with low socioeconomic status and previous preterm delivery at high risk. Although frequently isolated from healthy women,&nbsp / Gardnerella vaginalis has been most frequently associated with BV. There is limited data available on the prevalence of BV in Southern Africa / therefore, we embarked on a study to determine the&nbsp / prevalence of BV and G. vaginalis in predominantly black communities in the Western Cape, in order to establish the role of G. vaginalis in BV. Women attending various Maternity and Obstetrics&nbsp / units (MOU) in the Cape Peninsula with and without a history of pre-term delivery (PTD) were invited to participate in the study. Several factors were statistically associated with pregnancy history,&nbsp / including location of study population, parity, smoking and presence of clinical symptoms. The presence of G. vaginalis was determined by culture in 51.7% of the preterm delivery group (PTDG)&nbsp / and 44% of the full-term delivery group (FTDG) women. BV was detected in 31.13% of PTDG and 23.67% of FTDG by Gram stained analysis according to Nugent scoring criteria, with age and HIV&nbsp / status posing as risk factors. When comparing PTDG and FTDG for an association between the presence of G. vaginalis and BV, a stronger association was observed in the PTDG but it was not statistically significant. In both PTDG and FTDG, G. vaginalis was isolated significantly more often in women diagnosed with BV at 24.5% (p &lt / 0.05). Antibiogram studies revealed both Metronidazole and Clindamycin resistant strains of G. vaginalis. G. vaginalis Biotype 7 is specifically associated with BV, while Biotype 2 appears to be associated with BV in women with a history&nbsp / of PTD. Accuracy of diagnostic tools were tested and it was determined that Nugent scoring is more sensitive in diagnosing BV (76.04%), but culture for G. vaginalis is more specific (83.21%). Although this study was limited in that we were unable to follow-up pregnancy outcomes, we were able to confirm the perceived role of G. vaginalis in BV.&nbsp / </p>

Source: Masters Abstracts International, Volume: 47-06, page: 3500. Adviser: Kim Waller. Includes bibliographical references.

<p>Risk factors such as intrauterine and vaginal infection put pregnant women at risk for delivering preterm. Bacterial vaginosis (BV) is a polymicrobial clinical syndrome commonly diagnosed in women of reproductive age, with women of African descent with low socioeconomic status and previous preterm delivery at high risk. Although frequently isolated from healthy women,&nbsp / Gardnerella vaginalis has been most frequently associated with BV. There is limited data available on the prevalence of BV in Southern Africa / therefore, we embarked on a study to determine the&nbsp / prevalence of BV and G. vaginalis in predominantly black communities in the Western Cape, in order to establish the role of G. vaginalis in BV. Women attending various Maternity and Obstetrics&nbsp / units (MOU) in the Cape Peninsula with and without a history of pre-term delivery (PTD) were invited to participate in the study. Several factors were statistically associated with pregnancy history,&nbsp / including location of study population, parity, smoking and presence of clinical symptoms. The presence of G. vaginalis was determined by culture in 51.7% of the preterm delivery group (PTDG)&nbsp / and 44% of the full-term delivery group (FTDG) women. BV was detected in 31.13% of PTDG and 23.67% of FTDG by Gram stained analysis according to Nugent scoring criteria, with age and HIV&nbsp / status posing as risk factors. When comparing PTDG and FTDG for an association between the presence of G. vaginalis and BV, a stronger association was observed in the PTDG but it was not statistically significant. In both PTDG and FTDG, G. vaginalis was isolated significantly more often in women diagnosed with BV at 24.5% (p &lt / 0.05). Antibiogram studies revealed both Metronidazole and Clindamycin resistant strains of G. vaginalis. G. vaginalis Biotype 7 is specifically associated with BV, while Biotype 2 appears to be associated with BV in women with a history&nbsp / of PTD. Accuracy of diagnostic tools were tested and it was determined that Nugent scoring is more sensitive in diagnosing BV (76.04%), but culture for G. vaginalis is more specific (83.21%). Although this study was limited in that we were unable to follow-up pregnancy outcomes, we were able to confirm the perceived role of G. vaginalis in BV.&nbsp / </p>

Immune activation is increasingly recognized as a critical element of HIV infection and pathogenesis, causing expansion of virus founder populations at the mucosal port of entry and eventual exhaustion of cellular immune effectors. A cohort of HIV-resistant (HIV-R) commercial sex workers (CSW) in Nairobi, Kenya, have increased levels of anti- inflammatory factors in vaginal secretions and reduced peripheral immune activation ("immune quiescence"). The mucosal immune micro-environment underlying HIV susceptibility is well-known to be influenced by concurrent sexually transmitted infections, however the role of commensal microbiota is poorly characterized. Bacterial vaginosis (BV), characterized by a shift from Lactobacillus to Gardnerella and Prevotella as dominant members of vaginal microbiota, is a risk factor for HIV acquisition in studies worldwide. However, the etiology and ecological dynamics of BV remain enigmatic, and the mechanisms by which BV increases HIV susceptibility are not fully defined. Protective functional characteristics of Lactobacillus microbiota, including acid and hydrogen peroxide (H2O2) production, may reinforce physicochemical defences of vaginal mucus, stimulate innate epithelial defences and/or modulate activation status of HIV target cells. Therefore, the goal of this study was to determine if reduced BV and increased Lactobacillus colonization are the basis for resistance to HIV in this cohort. Vaginal specimens from a group of 242 CSW were examined, including microscopic diagnosis of BV, culture-based functional analyses and phylogenetic profiling by ultra-deep sequencing. HIV-R individuals were just as likely to have BV compared to other HIV- negative (HIV-N) individuals, and no more likely to be colonized with acid- or H2O2- ii producing bacteria, however two BV-related phylotypes identified by deep sequencing were significantly more likely to be observed in HIV-N individuals (p=0.0002 and p=0.006). HIV+ individuals were significantly more likely than HIV– individuals to have E. coli detected by deep sequencing (p<0.0001) and less likely to have Lactobacillus crispatus (p=0.0006). A coherent set of differences in culture-based and culture- independent characteristics were observed in individuals with BV diagnoses compared to BV– individuals. This study has generated an unprecedented amount of information regarding the composition, structure and function of the vaginal microbiota in African CSW, fundamentally defining many aspects of BV microbiology. Elucidation of the relationship between complex microbial communities and protective mucosal responses against HIV infection should be a priority for future research.

Immune activation is increasingly recognized as a critical element of HIV infection and pathogenesis, causing expansion of virus founder populations at the mucosal port of entry and eventual exhaustion of cellular immune effectors. A cohort of HIV-resistant (HIV-R) commercial sex workers (CSW) in Nairobi, Kenya, have increased levels of anti- inflammatory factors in vaginal secretions and reduced peripheral immune activation ("immune quiescence"). The mucosal immune micro-environment underlying HIV susceptibility is well-known to be influenced by concurrent sexually transmitted infections, however the role of commensal microbiota is poorly characterized. Bacterial vaginosis (BV), characterized by a shift from Lactobacillus to Gardnerella and Prevotella as dominant members of vaginal microbiota, is a risk factor for HIV acquisition in studies worldwide. However, the etiology and ecological dynamics of BV remain enigmatic, and the mechanisms by which BV increases HIV susceptibility are not fully defined. Protective functional characteristics of Lactobacillus microbiota, including acid and hydrogen peroxide (H2O2) production, may reinforce physicochemical defences of vaginal mucus, stimulate innate epithelial defences and/or modulate activation status of HIV target cells. Therefore, the goal of this study was to determine if reduced BV and increased Lactobacillus colonization are the basis for resistance to HIV in this cohort. Vaginal specimens from a group of 242 CSW were examined, including microscopic diagnosis of BV, culture-based functional analyses and phylogenetic profiling by ultra-deep sequencing. HIV-R individuals were just as likely to have BV compared to other HIV- negative (HIV-N) individuals, and no more likely to be colonized with acid- or H2O2- ii producing bacteria, however two BV-related phylotypes identified by deep sequencing were significantly more likely to be observed in HIV-N individuals (p=0.0002 and p=0.006). HIV+ individuals were significantly more likely than HIV– individuals to have E. coli detected by deep sequencing (p<0.0001) and less likely to have Lactobacillus crispatus (p=0.0006). A coherent set of differences in culture-based and culture- independent characteristics were observed in individuals with BV diagnoses compared to BV– individuals. This study has generated an unprecedented amount of information regarding the composition, structure and function of the vaginal microbiota in African CSW, fundamentally defining many aspects of BV microbiology. Elucidation of the relationship between complex microbial communities and protective mucosal responses against HIV infection should be a priority for future research.