Changes in Vaginal Bacterial Concentrations with Intravaginal Metronidazole Therapy for Bacterial Vaginosis as Assessed by Quantitative PCR
Changes in Vaginal Bacterial Concentrations with Intravaginal Metronidazole Therapy for Bacterial Vaginosis as Assessed by Quantitative PCR
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DOI：
10.1128/jcm.01384-08
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发表时间：
2009-03-01
影响因子：
9.4
通讯作者：
Marrazzo, Jeanne M.
中科院分区：
文献类型：
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作者：
Fredricks, David N.;Fiedler, Tina L.;Marrazzo, Jeanne M.
使用广泛的细菌PCR方法，如共有序列16 S rRNA基因PCR，已将几种苛养菌与细菌性阴道病（BV）相关，但其在BV中的作用仍不清楚。我们描述了甲硝唑治疗BV后阴道细菌浓度的变化。从使用Amsel临床标准诊断为BV的女性收集阴道拭子，并通过革兰氏染色评估阴道液以生成Nugent评分。在阴道0.75%甲硝唑凝胶5天疗程后1个月收集随访拭子，并对24例治愈BV和24例持续BV的受试者进行分析。使用8种细菌特异性16 S rRNA基因定量PCR测定细菌浓度的变化。治疗前，阴道中存在高浓度的几种苛养BV相关细菌（BVAB）的DNA。成功的抗生素治疗导致BVAB 1的中位细菌载量减少3- 4个对数（P = 0.02），BVAB 2（P = 0.0004），BVAB 3（P = 0.03），一种类巨球菌（P < 0.0001）、奇异菌属（P < 0.0001）、多毛菌属（P = 0.0002）和迷走加德纳菌（P < 0.0001）。除了BVAB 3水平下降外，持续性BV受试者的中位治疗后细菌水平未发生显著变化。BV相关细菌（如BVAB 1、BVAB 2、Leptotrichia/Sneathia属、Atopobium属、Gardnerella vagulosa和Megaspaera样细菌）的阴道浓度反映了BV的存在或不存在，表明这些细菌在BV发病机制中起重要作用，可能是疾病和治疗反应的合适标志物。
Several fastidious bacteria have been associated with bacterial vaginosis (BV) using broad-range bacterial PCR methods such as consensus sequence 16S rRNA gene PCR, but their role in BV remains poorly defined. We describe changes in vaginal bacterial concentrations following metronidazole therapy for BV. Vaginal swabs were collected from women with BV diagnosed using Amsel clinical criteria, and vaginal fluid was assessed by Gram stain to generate Nugent scores. Follow-up swabs were collected 1 month after a 5-day course of vaginal 0.75% metronidazole gel and analyzed for 24 subjects with cured BV and 24 subjects with persistent BV. Changes in bacterial concentrations were measured using eight bacterium-specific 16S rRNA gene quantitative PCR assays. DNA from several fastidious BV-associated bacteria (BVAB) were present at high concentrations in the vagina prior to treatment. Successful antibiotic therapy resulted in 3-to 4-log reductions in median bacterial loads of BVAB1 (P = 0.02), BVAB2 (P = 0.0004), BVAB3 (P = 0.03), a Megasphaera-like bacterium (P < 0.0001), Atopobium species (P < 0.0001), Leptotrichia/Sneathia species (P = 0.0002), and Gardnerella vaginalis (P < 0.0001). Median posttreatment bacterial levels did not change significantly in subjects with persistent BV except for a decline in levels of BVAB3. The presence or absence of BV is reflected by vaginal concentrations of BV-associated bacteria such as BVAB1, BVAB2, Leptotrichia/Sneathia species, Atopobium species, Gardnerella vaginalis, and a Megasphaera-like bacterium, suggesting that these bacteria play an important role in BV pathogenesis and may be suitable markers of disease and treatment response.