Davide De Santo

Prevalence of Bacterial Vaginosis and Vaginal Flora Changes in Peri- and Postmenopausal Women

ABSTRACT 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.

Correlation of Local Interleukin-8 with Immunoglobulin A against Gardnerella vaginalis Hemolysin and with Prolidase and Sialidase Levels in Women with Bacterial Vaginosis

Mucosal immune system activation may represent a critical determinant of adverse consequences associated with bacterial vaginosis (BV), such as sexual human immunodeficiency virus transmission, upper genital tract infections, postsurgical infections, and adverse pregnancy outcomes. Concentrations of sialidase, prolidase, and anti-Gardnerella vaginalis hemolysin (Gvh) immunoglobulin A (IgA) were higher in vaginal fluids of 75 fertile women with BV, compared with concentrations in vaginal fluids of 85 healthy control subjects. Interleukin (IL)-8 levels were positively associated with anti-Gvh IgA response and inversely correlated with high levels of prolidase and sialidase in women with BV. IL-8 concentration was strongly associated with leukocyte count in both healthy and BV-positive women. The absence of leukocytes in most women with BV likely is due to lack of IL-8 induction. Parallel impairment of innate and adaptive mucosal immune factors, likely through microbial hydrolytic effects, may allow for the ascent of microorganisms to the upper genital tract and may facilitate viral infections.

Effects of hormonal contraception on vaginal flora

BACKGROUND The sector of the market that deals with contraception offers a long list of different contraceptive methods. Within the estroprogestinic choice, the routes of administration are oral, transdermic and vaginal one. Even though efficacy is comparable with these methods, secondary and adverse effects are directly involved in the acceptability of the method. STUDY DESIGN This was a prospective comparative study. During 1 year, we enrolled 60 asymptomatic women who voluntarily requested combined oral contraception (COC) or combined contraceptive vaginal ring (CCVR group). After a baseline study of vaginal milieu prior to starting hormonal contraception, we performed a follow-up. For each woman, we examined vaginal pH; quantification of leukocytes, lactobacilli, Candida and cocci on saline microscopy fluid; Gram stain with Nugent score and the presence of vaginal infection [culture for Trichomonas vaginalis, albicans and nonalbicans Candida, Group B Streptococcus (GBS)]. RESULTS At the end of follow-up, there was a little change of vaginal milieu in both groups. We noted an increase of lactobacilli in the CCVR users and an increase of GBS in COC users. CONCLUSION CCVR compared to COC users showed an increase of the number of lactobacilli in vaginal flora. It means that an increase of leukorrhea in that group could be protective in terms of prevention of vaginal imbalance/infection.

Gestational diabetes: universal or selective screening?

OBJECTIVE To evaluate the incidence of gestational diabetes in our population and verify costs of universal screening. To assess neonatal and obstetrical outcomes with respect to maternal epidemiological characteristics. METHODS Eight hundred and fifty-six pregnant women between 24th and 28th weeks of gestation were examined in this observational study. Universal screening with glucose challenge test was used to screen the group for gestational diabetes. History, obstetrical and neonatal outcomes were collected and then analyzed. RESULTS Gestational diabetes was diagnosed in 6.6% of cases. Patients with at least one risk factor had a cesarean section in 50% of cases and a spontaneous vaginal delivery in 23.59% of cases (p < 0.001). The absence of any risk factor was found in 73.7% of positive glucose tolerance test and in 62.5% of affected patients. The cost of universal screening in our study, was 57,60 Euros per case identified. CONCLUSIONS Given the high prevalence of diabetes, the high proportion of patients potentially not identified with a selective screening in this study and the relatively low cost, universal screening for gestational diabetes seems the best way to identify patients and prevent adverse obstetrical and neonatal outcomes.

Condylomata acuminata of the Neovagina in a HIV-Seropositive Male-to-Female Transsexual

We present an unusual case of condylomata acuminata arising in the transplanted skin of a neovagina in a male-to-female transsexual. The neovagina had been constructed using a penile and a scrotal skin flap. Resection of the larger condylomata was performed; then all visible lesions were ablated by electrovaporization. Microsocpic examination and DNA hybridization revealed condylomata acuminata due to human papillomavirus type 16, 31, and 33 infection.

Ovarian pregnancy: a case report

Ectopic pregnancy is an event that concerns from 1/30 to 1/300 pregnancies. About the 0.5–3% of this pathology is represented by the ovarian pregnancy whose incidence seems to be increasing (1) from a rate of 1/40,000 pregnancies in 1950 (2) to a rate of 1/7000 pregnancies in 1983 (3). In the etiology and pathogenesis of OP two seem to be the most responsible causes: – primary OP with intra-follicle fertilization (4, 5). – retrograde flow in the fallopian tube of the fertilized ovum released on to the ovary (6). The increased incidence of OP in women with a history of PID (3) finds its reason in the fact that the PID can induce either a reduction of the tubal motility, or to a thickening of the ovarian albuginea secondary to an inflammatory response, causing an increased risk of intra-follicular pregnancy due to a hampered follicular dehiscence. The symptoms follow those of a tubal pregnancy. The criteria described by Spiegelberg (7) that suggest an ovarian pregnancy are: – the tube of the involved side must appear unruptured; – the gestational sac must be located on the ovary; – the gestational sac must be linked to the uterus by the uterus-ovarian ligament; – some of the ovarian tissue must surround the sac. The therapeutic approach is exclusively surgical, with a major incidence of the laparotomic way (8, 9). Here we will report the case of an OP diagnosed at initial presentation, as follows.

Correlation of Innate Immune Response with IgA against Gardnerella vaginalis Cytolysin in Women with Bacterial Vaginosis

SABINA CAUCI,a SECONDO GUASCHINO,b DOMENICO DE ALOYSIO,c SILVIA DRIUSSI,a,d DAVIDE DE SANTO,b PAOLA PENACCHIONI,c ALINE BELLONI,a PAOLO LANZAFAME,e AND FRANCO QUADRIFOGLIOa aDepartment of Biomedical Sciences and Technologies, School of Medicine, University of Udine, Udine, Italy bObstetric and Gynecologic Unit, Department of Reproductive and Development Sciences, IRCCS Burlo Garofolo Hospital, School of Medicine, University of Trieste, Trieste, Italy cDepartment of Obstetrics and Gynecology, Sant’Orsola Hospital, School of Medicine, University of Bologna, Bologna, Italy dAzienda Servizi Sanitari N. 4 Medio Friuli, Udine, Italy eMicrobiology Unit, Santa Maria della Misericordia Hospital, Udine, Italy