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admin | Get Rid Of Bv | 22.05.2015
Our aim is to be a definitive source for people seeking, information, help, advice, and real treatment options for BV, as recommended by the CDC, FDA of America and the UK department of Health for STD's. Bacterial Vaginosis (BV) is the name of a condition in women where the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria.
Bacterial vaginosis (BV) is the most common vaginal infection in women of childbearing age.
At the present time it is not 100% fully understood what causes bacterial vaginosis, it is belived that an imbalance in the bacteria that are normally found in a woman's vagina is the main reason. A health care provider must examine the vagina for signs of BV and perform laboratory tests on a sample of vaginal fluid to look for bacteria associated with BV.
Although BV will sometimes clear up without treatment, all women with symptoms of BV should be treated to avoid complications. Some physicians recommend that all women undergoing a hysterectomy or abortion be treated for BV prior to the procedure, regardless of symptoms, to reduce their risk of developing an infection. We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you.
Polymicrobial etiologies of disease: models and perspectives on basic and clinical research.
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Bacterial vaginosis (BV) is the most common genital tract infection in women during their reproductive years and it has been associated with serious health complications, such as preterm delivery and acquisition or transmission of several sexually transmitted agents.
The healthy vaginal microflora has been described as being constituted mainly by Gram-positive bacilli of the genus Lactobacillus, being L. Among genital infections, bacterial vaginosis (BV) is the leading vaginal disorder in women of childbearing age, contributing to more than 60% of all vulvovaginal infections (Sobel, 2000).
Despite the most recent discoveries related to the etiology of BV, current treatment is still directed toward alleviation of symptoms through reduction of BV-associated bacteria overgrowth and restoration of normal vaginal flora (Pirotta et al., 2009).
Presently, metronidazole is considered to be the drug of choice for BV treatment (Centers for Disease Control and Prevention, 2015). Despite the high cure rates achieved in some studies, very high BV recurrence rates and some relevant treatment side effects have been reported. The low efficacy of antibiotics in preventing recurrences is thought to be due to their inability to fully eradicate BV vaginal biofilms-associated bacteria.
The increasing evidence that BV is a biofilm-mediated infection sparked the interest of the scientific community in exploring agents aimed to disrupting biofilms. An alternative approach to deal with BV is by modulating the vaginal microbiota, for example, by using probiotics.
It has also been proposed that prebiotics, nutritional substances that stimulate the growth of probiotics, could be used as alternative to treat BV (Roberfroid, 2007). The use of plant-derived compounds in the treatment of genital infections is another therapy on the rise (Palmeira-de-Oliveira et al., 2013). Natural antimicrobials, mainly bacteriocins, have also been studied as potential therapeutic alternatives against BV. An innovative approach to disrupt BV biofilms consists in the use of DNase which targets extracellular DNA. Another strategy involves the use of retrocyclin 101, a synthetic cyclic antimicrobial peptide with antiviral activity (Cole et al., 2007). However, some activities or behaviors can upset the normal balance of bacteria in the vagina and put women at increased risk including: Having a new sex partner or multiple sex partners. All pregnant women who have ever had a premature delivery or low birth weight baby should be considered for a BV examination, regardless of symptoms, and should be treated if they have BV.
Two different antibiotics are recommended as treatment for BV: metronidazole or clindamycin.
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This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. BV is characterized by a reduction of beneficial lactobacilli and a significant increase in number of anaerobic bacteria, including Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp., Bacteroides spp.


The Centers for Disease Control and Prevention (CDC) recommends that all symptomatic women should be treated, since it recognizes several benefits of therapy, including the relief of the symptoms and signs of infection (Centers for Disease Control and Prevention, 2015) and the reduction in the risk of acquiring sexually transmitted diseases (Brotman et al., 2010). It is a first generation nitroimidazole, which was initially indicated for the management of trichomoniasis (Moffett and Mcgill, 1960) but was then shown to be effective against anaerobic microorganisms (Tally et al., 1975).
In fact, Swidsinski and colleagues investigated the influence of oral metronidazole therapy on G. Thus, in recent years, studies of anti-BV agents started to include biofilm disruptor candidates, such as DNases, retrocyclins, probiotics, antiseptics, natural antimicrobials, and plant-derived compounds (see Table 2). They have an antibacterial activity against a broad spectrum of bacteria, acting by nonspecifically disrupting their cell membrane (Lachapelle et al., 2013).
Probiotics are live microorganisms which confer a health benefit to the host, when administered in suitable amounts (Food Agriculture Organization of the United Nations World Health Organization, 2001). Interestingly, Rousseau and colleagues demonstrated that prebiotic preparations containing oligosaccharides were able to promote the growth of beneficial lactobacilli strains but not of the pathogenic microorganisms often found in urogenital infections including G.
One of the earliest reports on this topic dates back from 1991, when Blackwell described the first therapeutic success of using plants extracts to treat BV (Blackwell, 1991). Retrocyclin 101 and has been shown to inhibit the cytolytic activity of vaginolysin, a toxin produced by G.
Douching, and using an intrauterine device (IUD) for contraception Hot weather (sweating in the vaginal area) Poor hygeine Sex with someone who has unclean hands or penis .
Douching, and using an intrauterine device (IUD) for contraception Hot weather (sweating in the vaginal area) Poor hygeine Sex with someone who has unclean hands or penis. Either can be used with non-pregnant or pregnant women, but the recommended dosages differ. Clinically, a profuse vaginal discharge and a rotten fish vaginal odor are characteristic symptoms, although some women with BV remain asymptomatic (Koumans et al., 2007). Conventionally, BV is treated with metronidazole, clindamycin or tinidazole (Centers for Disease Control and Prevention, 2015).
Recently, Bahamondes and colleagues verified that a soap containing lactic acid and lactoserum could be used for external intimate hygiene, reducing BV recurrence after treatment with oral metronidazole (Bahamondes et al., 2011). Women with BV who are HIV-positive should receive the same treatment as those who are HIV-negative. Microbiologically, this condition is characterized by a dramatic shift of vaginal microflora which involves the loss of beneficial bacteria (lactobacilli) and a simultaneous proliferation of anaerobic bacteria including G. Later, Alves and colleagues determined the in vitro susceptibility of 30 BV-associated biofilm forming bacteria to metronidazole, tinidazole, and clindamycin and showed that all tested bacteria tested were resistant to metronidazole and tinidazole and 67% to clindamycin (Alves et al., 2014). However, a recent systematic review verified that most studies addressing the use of antiseptics for BV treatment are somehow methodologically weak since follow-up studies were very limited and their safety and excipients composition was poorly investigated (Verstraelen et al., 2012).
Surprisingly, up to now only one study evaluated the capability of plant-derived compound to eradicate BV biofilms.
Due to this important advantage, natural antimicrobials have also been proposed as a valuable therapeutic alternative to eradicate BV-biofilms.
Interestingly, vitamin C, when coated with silicon, allowed the constant release of the active agent, resulting in a long-lasting vaginal low pH and prevention of vaginal irritation (Polatti et al., 2006). In a series of in vitro studies, they showed that enzymatic disruption of extracellular DNA not only inhibited the formation of new biofilms but also destroyed the already formed ones (Hymes et al., 2013). However, it is certain that BV involves the presence of a thick vaginal multi-species biofilm, where G. In addition, other anaerobic bacteria were positively associated with BV and this lead researchers to conclude that BV was a polymicrobial infection (Sobel, 2000).
It is a lincosamide that is available in various pharmaceutical formulations including vaginal dosage forms and oral (systemic) pills(Menard, 2011). In this sense, novel antimicrobials agents, with the ability to selectively target vaginal pathogens and their biofilms, are urgently required.
Nevertheless, the potential of antiseptics against BV biofilms was recently highlighted when Swidsinski and colleagues reported high initial cure rates when using octenidine. In contrast, despite their therapeutic potential, some clinical trials have not detected a significant improvement in BV management (Falagas et al., 2007). In that study, the prebiotic gel displayed a similar therapeutic cure rate to metronidazole, having a major advantage of quicker restoration of the normal vaginal microflora.


Interestingly, Braga and colleagues showed that thymol, a molecule present in thyme essential oil, had an inhibitory effect upon both newly formed and mature G.
In addition, DNase liberates bacteria from biofilms into the supernatant fractions and so potentiates the effect of metronidazole. However, a major conceptual problem with this later hypothesis is its inconsistency with epidemiological data, which suggests that BV is a sexual transmitted disease and therefore, most likely to be caused by a single agent (Josey and Schwebke, 2008). However, when applied topically, clindamycin might weaken latex products such as condoms (Rosen and Rosen, 1999) and may even cause pseudomembranous colitis (Trexler et al., 1997). However, the efficacy of prolonged and repeated treatment was lower than expected and bacterial resistance emerged in a considerable subset of women (Swidsinski et al., 2015).
Recently, Coste and colleagues evaluated the efficacy and safety of another prebiotic gel, applied as adjuvant therapy, in women treated for BV and showed an improved recovery of the normal vaginal flora, reducing the risk of recurrences (Coste et al., 2012). Additionally, the regular use of vitamin C during 6 days per month, for 6 months after successful BV treatment, was shown to decrease the risk of BV recurrence (Krasnopolsky et al., 2013). Similar to what happens in many other biofilm-related infections, standard antibiotics, like metronidazole, are unable to fully eradicate the vaginal biofilm, which can explain the high recurrence rates of BV. Importantly, lactobacilli play a pivotal role in maintaining the female genital tract health while preventing genitourinary infections (Borges et al., 2014).
Its high prevalence and the associated complications make BV an important public health issue. Currently, is consensual that BV involves the presence of a dense, structured and polymicrobial biofilm, primarily constituted by G. Tinidazole was the most recently approved antimicrobial agent for BV treatment, by the Food and Drug Administration (Dickey et al., 2009) and it is considered an alternative antimicrobial agent for BV treatment particularly whenever metronidazole and clindamycin are unavailable or not tolerated (Centers for Disease Control and Prevention, 2015).
Using a series of in vitro assays, these researchers demonstrated that LAE had the strongest bactericidal effect against G. Furthermore, antibiotic therapy can also cause a negative impact on the healthy vaginal microflora. However, due to the great diversity and complexity of microorganisms involved, the BV etiopathogenesis is not yet fully understood and is still a matter of controversy (Schwebke et al., 2014). Being a second generation nitroimidazole with a longer half-life than metronidazole (Wood and Monro, 1975) it requires lower dosages, to be taken less frequently than metronidazole (Dickey et al., 2009). Polycarbophil is a weak poly-acid that it is able to adhere to vaginal epithelial cells, acting as a buffer in the vaginal secretions (Milani et al., 2000).
Later, Algburi and colleagues showed that subtilosin and LAE showed synergistic effect with clindamycin and metronidazole, inhibiting G.
Thus, DNase seems to be a promising therapeutic agent for BV either alone or in combination with antibiotics.
This review provides a quick synopsis of the currently approved and available antibiotics for BV treatment while presenting an overview of novel strategies that are being explored for the treatment of this disorder, with special focus on natural compounds that are able to overcome biofilm-associated antibiotic resistance.
This demonstrated that the combination of conventional antibiotics with natural antimicrobials can improve the cure rates of antibiotic therapy, especially in cases where antimicrobial resistant was found.
Another agent that has been long used in the treatment of vaginal infections is boric acid (Van Slyke et al., 1981).
Recently, Reichman and colleagues reported that the use of boric acid in combination with a nitroimidazole reduce the BV recurrence (Reichman et al., 2009), suggesting a potential impact on BV biofilms. However, this need to be further studied and in vitro biofilm experiments will elucidate the role of boric acid in BV prevention. Therefore, vaginal biofilms play a key role not only in BV pathogenesis, but also in its treatment failure and recurrence.
Thus, the purpose of this review is to present currently approved and available therapeutic strategies for BV, as well as to discuss the emerging therapies that are being explored for BV treatment, attributing more emphasis to novel therapeutics targeting vaginal biofilms. These findings provide some evidence of how lactobacilli probiotics might interfere with an abnormal vaginal microflora, reinforcing the hypothesis that probiotics could eradicate vaginal pathogenic biofilms and restore the normal microflora in in vivo situations.




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