Vaginomdiagnostik – eine neue Ära in der gynäkologischen Infektiologie

Genitale Infektionen stellen ein häufiges Problem in der gynäkologischen Sprechstunde dar. Die Diagnose ergibt sich aus der Anamnese und dem Befund der gynäkologischen Untersuchung. Dabei wird ein Nativpräparat zur direkten mikroskopischen Beurteilung angefertigt. Zusätzlich wird typischerweise ein bakteriologischer Abstrich entnommen. Die Therapie folgt entsprechenden Leitlinien – so werden bei einer bakteriellen Vaginose meist Metronidazol oder Clindamycin topisch oder systemisch verordnet.

• Literatur

• 1 Rojo D, Méndez-García C, Raczkowska BA. et al. Exploring the human microbiome from multiple perspectives: factors altering its composition and function. FEMS Microbiol Rev 2017; 41: 453-478
• 2 Ravel J, Gajer P, Abdo Z. et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A 2011; 108 (Suppl. 01) 4680-4687
• 3 Brooks JP, Buck GA, Chen G. et al. Changes in vaginal community state types reflect major shifts in the microbiome. Microb Ecol Health Dis 2017; 28: 1303265
• 4 Hickey RJ, Zhou X, Settles ML. et al. Vaginal microbiota of adolescent girls prior to the onset of menarche resemble those of reproductive-age women. mBio 2015; 6: e00097-15
• 5 Aldunate M, Srbinovski D, Hearps AC. et al. Antimicrobial and immune modulatory effects of lactic acid and short chain fatty acids produced by vaginal microbiota associated with eubiosis and bacterial vaginosis. Front Physiol 2015; 6: 164
• 6 Mirmonsef P, Hotton AL, Gilbert D. et al. Free glycogen in vaginal fluids is associated with Lactobacillus colonization and low vaginal pH. PLoS One 2014; 9: e102467
• 7 OʼHanlon DE, Moench TR, Cone RA. Vaginal pH and microbicidal lactic acid when lactobacilli dominate the microbiota. PLoS One 2013; 8: e80074
• 8 Ocaña VS, Nader-Macías ME. Vaginal lactobacilli: self- and co-aggregating ability. Br J Biomed Sci 2002; 59: 183-190
• 9 Maldonado-Barragán A, Caballero-Guerrero B, Martín V. et al. Purification and genetic characterization of gassericin E, a novel co-culture inducible bacteriocin from Lactobacillus gasseri EV1461 isolated from the vagina of a healthy woman. BMC Microbiol 2016; 16: 37
• 10 Vaneechoutte M. The human vaginal microbial community. Res Microbiol 2017; 168: 811-825
• 11 Witkin SS, Mendes-Soares H, Linhares IM. et al. Influence of vaginal bacteria and D- and L-lactic acid isomers on vaginal extracellular matrix metalloproteinase inducer: implications for protection against upper genital tract infections. mBio 2013; 4: e00460-13
• 12 van der Veer C, Bruisten SM, van der Helm JJ. et al. The Cervicovaginal Microbiota in Women Notified for Chlamydia trachomatis Infection: A Case-Control Study at the Sexually Transmitted Infection Outpatient Clinic in Amsterdam, The Netherlands. Clin Infect Dis 2017; 64: 24-31
• 13 van Houdt R, Ma B, Bruisten SM. et al. Lactobacillus iners-dominated vaginal microbiota is associated with increased susceptibility to Chlamydia trachomatis infection in Dutch women: a case-control study. Sex Transm Infect 2018; 94: 117-123
• 14 Tamarelle J, Ma B, Gajer P. et al. Nonoptimal Vaginal Microbiota After Azithromycin Treatment for Chlamydia trachomatis Infection. J Infect Dis 2020; 221: 627-635
• 15 Peebles K, Velloza J, Balkus JE. et al. High Global Burden and Costs of Bacterial Vaginosis: A Systematic Review and Meta-Analysis. Sex Transm Dis 2019; 46: 304-311
• 16 Mendling W, Palmeira-de-Oliveira A, Biber S. et al. An update on the role of Atopobium vaginae in bacterial vaginosis: what to consider when choosing a treatment? A mini review. Arch Gynecol Obstet 2019; 300: 1-6
• 17 Haahr T, Jensen JS, Thomsen L. et al. Abnormal vaginal microbiota may be associated with poor reproductive outcomes: a prospective study in IVF patients. Hum Reprod 2016; 31: 795-803
• 18 Giakoumelou S, Wheelhouse N, Cuschieri K. et al. The role of infection in miscarriage. Hum Reprod Update 2016; 22: 116-133
• 19 Moreno I, Codoñer FM, Vilella F. et al. Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol 2016; 215: 684-703
• 20 Leopold S. Heretofore undescribed organism isolated from the genitourinary system. U S Armed Forces Med J 1953; 4: 263-266
• 21 Gardner HL, Dukes CD. Haemophilus vaginalis vaginitis: a newly defined specific infection previously classified non-specific vaginitis. Am J Obstet Gynecol 1955; 69: 962-976
• 22 Heizmann WR, Meixner M, Glaubitz R. et al. Bedeutung des Mikrobioms für die Pathogenese der bakteriellen Vaginose. Frauenarzt 2019; 60: 238-241
• 23 Janulaitiene M, Gegzna V, Baranauskiene L. et al. Phenotypic characterization of Gardnerella vaginalis subgroups suggests differences in their virulence potential. PLoS One 2018; 13: e0200625
• 24 Rodriguez Jovita M, Collins MD, Sjödén B. et al. Characterization of a novel Atopobium isolate from the human vagina: description of Atopobium vaginae sp. nov. Int J Syst Bacteriol 1999; 49: 1573-1576
• 25 Austin MN, Rabe LK, Srinivasan S. et al. Mageeibacillus indolicus gen. nov., sp. nov.: A novel bacterium isolated from the female genital tract. Anaerobe 2015; 32: 37-42
• 26 Malaguti N, Bahls LD, Uchimura NS. et al. Sensitive Detection of Thirteen Bacterial Vaginosis-Associated Agents Using Multiplex Polymerase Chain Reaction. Biomed Res Int 2015; 2015: 645853
• 27 Schuyler JA, Mordechai E, Adelson ME. et al. Identification of intrinsically metronidazole-resistant clades of Gardnerella vaginalis. Diagn Microbiol Infect Dis 2016; 84: 1-3
• 28 NN. Diagnostik und Therapie einer assistierten reproduktionsmedizinischen Behandlung (ART). AWMF Registriernummer 015-085, Stand 01.02.2019, gültig bis 31.01.2022.
• 29 Moreno I, Codoñer FM, Vilella F. et al. Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol 2016; 215: 684-703
• 30 Haahr T, Jensen JS, Thomsen L. et al. Abnormal vaginal microbiota may be associated with poor reproductive outcomes: a prospective study in IVF patients. Hum Reprod 2016; 31: 795-803
• 31 Singer M, Borg M, Ouburg S. et al. The relation of the vaginal microbiota to early pregnancy development during in vitro fertilization treatment-A meta-analysis. J Gynecol Obstet Hum Reprod 2019; 48: 223-229
• 32 NN. Diagnostik und Therapie von Frauen mit wiederholten Spontanaborten. AWMF Registriernummer 015-050, Stand 01.02.2018, gültig bis 31.01.2021.
• 33 Al-Memar M, Bobdiwala S, Fourie H. et al. The association between vaginal bacterial composition and miscarriage: a nested case-control study. BJOG 2020; 127: 264-274
• 34 Mitchell CM, Haick A, Nkwopara E. et al. Colonization of the upper genital tract by vaginal bacterial species in nonpregnant women. Am J Obstet Gynecol 2015; 212: 611.e1-611.e9
• 35 Kyono K, Hashimoto T, Nagai Y. et al. Analysis of endometrial microbiota by 16S ribosomal RNA gene sequencing among infertile patients: a single-center pilot study. Reprod Med Biol 2018; 17: 297-306
• 36 Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science 2014; 345: 760-765
• 37 Kindinger LM, Bennett PR, Lee YS. et al. The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk. Microbiome 2017; 5: 6