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CC BY-NC-ND 4.0 · Libyan International Medical University Journal 2021; 06(01): 33-40
DOI: 10.4103/liuj.liuj_49_20
Original Article

Impact of treatment and the contribution of persistent posttreatment bacterial vaginosis infection on pregnancy outcome among asymptomatic women: A cohort study

Babatunde Ogunniran
Bridge Clinic, Lagos
,
Abiodun Adeniran
1   Department of Obstetrics & Gynaecology, University of Cape Town, Observatory, Cape Town, South Africa
,
Rakiya Saidu
1   Department of Obstetrics & Gynaecology, University of Cape Town, Observatory, Cape Town, South Africa
,
Ajibola Akanbi II
2   Department of Medical Microbiology and Parasitology, University of Ilorin, Ilorin, Nigeria
,
Kikelomo Adesina
1   Department of Obstetrics & Gynaecology, University of Cape Town, Observatory, Cape Town, South Africa
,
Munirdeen Ijaiya
1   Department of Obstetrics & Gynaecology, University of Cape Town, Observatory, Cape Town, South Africa
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Abstract

Objective: The objective of this study was to evaluate the effect of antibiotic treatment and posttreatment persistent bacterial vaginosis (BV) infection on pregnancy outcome among asymptomatic women. Materials and Methods: A prospective cohort study was conducted among consenting, asymptomatic pregnant women without background medical disorders. All participants were recruited in the second trimester and had BV testing using Nugent score. BV-positive women were treated with a 7-day course of metronidazole with a repeat posttreatment laboratory testing after 4 weeks. The primary outcome was pregnancy outcome of BV-positive versus negative women; the secondary outcomes were posttreatment laboratory BV test result and pregnancy outcome among women with resolution versus persistent infection. Data analysis was performed using SPSS version 21.0 and P < 0.05 was significant. Results: The prevalence of BV in pregnancy was 24.1%; vulva itching and vaginal douching were more common among BV-positive women (P = 0.011 and P = 0.001), respectively. Adverse pregnancy outcomes such as premature rupture of membranes (PROM) (odds ratio [OR]: 8.185, 95% confidence interval [CI]: 3.196–20.962; P = 0.005), preterm delivery (OR: 24.517, 95% CI: 6.985–86.049; P = 0.001), and birth weight <2500 g (OR: 6.460, 95% CI: 2.893–14.429; P = 0.005) were more common among BV-positive women. Posttreatment persistent BV infection was 25.0% with significantly higher PROM (OR: 18.21, 95% CI: 4.654–71.317; P = 0.001), preterm delivery (OR: 14.571, 95% CI: 4.138–51.308; P = 0.001), birth weight <2500 g (OR: 14.57, 95% CI: 4.138–51.308; P = 0.001), and low 1st min Apgar scores (OR: 7.333, 95% CI: 1.223–43.960; P = 0.049). Conclusion: Symptom-based approach to BV in pregnancy excludes many asymptomatic women; we hereby recommend routine screening. Also, women with BV in pregnancy should undergo repeat testing posttreatment while those with persistent infection will benefit from repeat treatment pending further evidence to formulate a widely acceptable treatment guideline.

Key-words:

Adverse pregnancy outcome - bacterial vaginosis - persistent infection

Financial support and sponsorship

This study was financially supported by the researchers.




Publication History

Received: 10 December 2020

Accepted: 22 April 2021

Article published online:
14 June 2022

© 2021. Libyan International Medical University. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Nelson DB, Macones G. Bacterial vaginosis in pregnancy: Current findings and future directions. Epidemiol Rev 2002;24:102-8.
  • 2 Lennox JA, Abbey SD, Udiba D, Mbato CI, Ikpoh IS, Akubuenyi FC. Prevalence of vaginitis and vaginosis among University of Calabar female students. J Public Health Epidemiol 2013;5:167-72.
  • 3 Abdullateef RM, Ijaiya MA, Abayomi F, Adeniran AS, Idris H. Bacterial vaginosis: Prevalence and associated risk factors among non-pregnant women of reproductive age attending a Nigerian tertiary hospital. Malawi Med J 2017;29:290-3.
  • 4 Torrone EA, Morrison CS, Chen P, Kwok C, Francis SC, Hayes RJ, et al. Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18HIV prevention studies. PLoS Med 2018;15:e1002511.doi: 10.1371/journal.pmed.1002511.
  • 5 Ibrahim SM, Bukar M, Galadima GB, Audu BM, Ibrahim HA. Prevalence of bacterial vaginosis in pregnant women in Maiduguri, North-Eastern Nigeria. Niger J Clin Pract 2014;17:154-8.
  • 6 Abhilasha G, Priyanka G, Shipra N. Bacterial vaginosis in pregnancy <28 weeks and its effect on pregnancy outcome: A study from a western UP city. Indian J Clin Pract 2013;23:740-4.
  • 7 Lata I, Pradeep Y, Sujata N, Jain A. Estimation of the incidence of bacterial vaginosis and other vaginal infections and its consequences on Maternal/Foetal outcome in pregnant women attending an antenatal clinic in North India. Indian J Community Med 2010;35:285-9.
  • 8 Adesiji YO, Taiwo SS, Adekanle DA, Oboro VO, Fayemiwo SA, Opaleye OO. Bacterial Vaginosis and pregnancy outcome in Osogbo, Nigeria. Res J Med Sci 2007;1:195-8.
  • 9 Mengistie Z, Woldeamanuel Y, Asrat D, Adera A. Prevalence of bacterial vaginosis among pregnant women attending ANC in Tukur Anbessa Hospital, Addis Ababa, Ethopia. BMC Res Notes 2014;7:822.
  • 10 Svare JA, Schmidt H, Hansen BB, Lose G. Bacterial vaginosis in a cohort of Danish pregnant women: Prevalence and relationship with preterm delivery, low birth weight and perinatal infections. BJOG 2006;113:1419-25.
  • 11 Krauss-Silva L, Almada-Horta A, Alves MB, Camacho KG, Moreira ME, Braga A. Basic vaginal pH, bacterial vaginosis and aerobic vaginitis: Prevalence in early pregnancy and risk of spontaneous preterm delivery, a prospective study in a low socioeconomic and multiethnic South American population. BMC Pregnancy Childbirth 2014;14:107.
  • 12 Klatt TE, Cole DC, Eastwood DC, Barnabei VM. Factors associated with recurrent bacterial vaginosis. J Reprod Med 2010;55:55-61.
  • 13 U.S. Preventive Services Task Force. Screening for bacterial vaginosis in pregnancy to prevent preterm delivery: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008;148:214-9.
  • 14 Araoye MO. Sample size determination. In: Araoye MO, editor. Research Methodology with Statistics for Health and Social Sciences. Ilorin: Nathadex Publishers; 2004. p. 115-8.
  • 15 Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991;29:297-301.
  • 16 Afolabi BB, Moses OE, Oduyebo OO. Bacterial vaginosis and pregnancy outcome in Lagos, Nigeria. Open Forum Infect Dis 2016;3:ofw030.
  • 17 Joyisa N, Moodley D, Nkosi T, Talakgale R, Sebitloane M, Naidoo M, et al. Asymptomatic bacteria vaginosis in pregnancy and missed opportunities for treatment: A cross-sectional study. Infect Dis Obstet Gynaecol 2019. Article ID 7808179 |DOI: https://doi.org/10.1155/2019/7808179.
  • 18 Moodley D, Moodley P, Sebitloane M, Soowamber D, McNaughtton-Reyes HL, Groves AK, et al. High prevalence and incidence of asymptomatic sexually transmitted infections during pregnancy and post delivery in KwaZulu Natal, South Africa. Sex Transm Dis 2015;42:43-7.
  • 19 Hutchinson KB, Kip KE, Ness RB; Gynecologic Infection Follow-Through (GIFT) Investigators. Vaginal douching and development of bacterial vaginosis among women with normal and abnormal vaginal microflora. Sex Transm Dis 2007;34:671-5.
  • 20 Luong ML, Libman M, Dahhou M, Chen MF, Kahn SR, Goulet L, et al. Vaginal douching, bacterial vaginosis, and spontaneous preterm birth. J Obstet Gynaecol Can 2010;32:313-20.
  • 21 Shaaban OM, Youssef AE, Khodry MM, Mostafa SA. Vaginal douching by women with vulvovaginitis and relation to reproductive health hazards. BMC Womens Health 2013;13. DOI: 10.1186/1472-6874-13-23.
  • 22 Ugwumadu A, Manyonda I, Reid F, Hay P. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: A randomised controlled trial. Lancet 2003;361:983-8.
  • 23 Centers for Disease Control and Prevention, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006;55:1-94.
  • 24 Centres for Disease Control and Prevention. Sexually Transmitted Infections. U.S. Department of Health and Human Services, Atlanta, GA 30329-4027, USA: CDC; 2015. Available from: http://Cdc.gov/std/tg2015/bv.htm. [Last accessed on 2018 Mar 18].
  • 25 Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB, Moss LM, et al. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis 2006;193:1478-86.
  • 26 Otsuki K, Imai N. Effects of lactoferrin in 6 patients with refractory bacterial vaginosis. Biochem Cell Biol 2017;95:31-3.
  • 27 Das TR, Jahan S, Begum SR, Akhtar MF. Association between bacterial vaginosis and preterm delivery. Mymensingh Med J 2011;20:115-20.