Differential PCR diagnosis of bacterial vaginosis, aerobic vaginitis and vulvovaginal candidiasis

Aim. To evaluate the effectiveness of PCR tests to diagnose common pathological conditions associated with vaginal discharge (i.e. bacterial vaginosis, aerobic vaginitis, and vulvovaginal candidiasis) in patients with and without complaints.

Materials and Methods. The study enrolled 240 women which flled out an original questionnaire on demographic, social, behavioral, and reproductive features and underwent a vaginal examination. Real-time PCR of vaginal smears was used to detect bacterial vaginosis, aerobic vaginitis, vulvovaginal candidiasis, and sexually transmitted infections (Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium).

Results. Sexually transmitted infections have not been detected in women included into the study. Almost half (46%) of the patients had gynecological complaints; these patients also had higher prevalence of vaginal dysbiosis. PCR analysis determined vaginal dysbiosis in > 45% of women with complaints. In around 25% women without any complaints, microorganisms prevailed over lactobacteria that suggested vaginal dysbiosis. Among the behavioural factors, only douching was signifcantly associated with vaginal dysbiosis.

Conclusion. PCR tests were able to defne vaginal dysbiosis in almost half of the patients and were effcient in patients both with or without complaints.

1. Sherrard J, Wilson J, Donders G, Mendling W, Jensen J. 2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge. Int J STD AIDS. 2018;29(13):1258-1272. https://doi.org/10.1177/0956462418785451

2. Dobrokhotova YUE, Bondarenko KR, Shadrova PA. Current view on infectious factor of early reproductive losses and possible pathogenetic mechanisms. Russian Journal of Human Reproduction. 2020;26(3):23-30 (In Russ). https://doi.org/10.17116/repro20202603123

3. Shipitsyna E, Khusnutdinova Т, Budilovskaya О, Krysanova А, Shalepo S, Savicheva А, Unemo M. Bacterial vaginosis-associated vaginal microbiota is an age-independent risk factor for Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis infections in low-risk women, St. Petersburg, Russia. Eur J ClinMicrobiol Infect Dis. 2020;39(7):1221-1230. https://doi.org/10.1007/s10096-020-03831-w

4. Workowski KA, Bolan GA. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2021. MMWR Recomm Rep. 2021;70(4):1-187. https://doi.org/10.15585/mmwr.rr7004a1

5. Klinicheskie rekomendatsii po diagnostike i lecheniyu zabolevaniy, soprovozhdayushchikhsya patologicheskimi vydeleniyami iz polovykh putey zhenshchin. Moscow: Rossiyskoe obshchestvo akusherov-ginekologov; 2019. 56. (In Russ).

6. Klinicheskie rekomendatsii. Bakterial'nyy vaginoz. Moscow: Rossiyskoe obshchestvo dermatovenerologov i kosmetologov; 2020. 25 s. (In Russ).

7. Savicheva AM, Tapilskaya NI, Shipitsyna EV, Vorobyeva NE. Bacterial vaginosis and aerobic vaginitis as major vaginal microfora balance disorders: Diagnostic and therapeutic characteristics. Obstetrics and Gynecology. 2017;5:24-31. (In Russ). https://doi.org/10.18565/aig.2017.5.24-31

8. Rumyantseva TA, Bellen G, Romanuk TN, Shipulina OI, Guschin AE, Shipulin GA, Donders GGG. Utility of microscopic techniques and quantitative real-time polymerase chain reaction for the diagnosis of vaginal microfora alterations. J Low Genit Tract Dis. 2015;19(2):124-128. https://doi.org/10.1097/LGT.0000000000000060

9. Rumyantseva TA, Bellen G, Savochkina YA, Guschin AE, Donders G. Diagnosis of aerobic vaginitis by quantitative real-time PCR. Arch Gynecol Obstet. 2016;294(1):109-114. https://doi.org/10.1007/s00404-015-4007-4

10. Savochkina YA, Rumyantseva TA, Dolgova TI, Guschin AE. The development of technique of diagnostic of vulvovaginal candidiasis based on quantitative multiplex polymerase chain reaction. Russian Clinical Laboratory Diagnostics. 2015;4:56-62. (In Russ).

11. Rumyantseva TA, Sursyakov VA, Khairullina GA, Chernyshova LA, Guschin AE. Vaginal discharge in gynecological patients: etiology and approaches to diagnosis. Obstetrics and Gynecology. 2015;8:96-101. (In Russ).

12. Froehle L, Ghanem KG, Page K, Hutton HE, Chander G, Hamill MM, Gilliams E, Tuddenham S. Bacterial Vaginosis and Alcohol Consumption: A Cross-Sectional Retrospective Study in Baltimore, Maryland. Sex Transm Dis. 2021;48(12):986-990. https://doi.org/10.1097/OLQ.0000000000001495

13. Smart S, Singa A, Minde A. Social and sexual risk factors for bacterial vaginosis. Sex Transm Infect. 2004;80(1):58-62. https://doi.org/10.1136/sti.2003.004978