1887

Abstract

Background. Recurrent vulvovaginal infections are a frequent complaint in young women in need of contraception. However, the influence of the contraceptive method on the course of the disease is not well known.

Aim. To investigate the influence of the levonorgestrel-releasing intrauterine-system (LNG-IUS) on the vaginal microflora.

Methods. Short-term (3 months) and long-term (1 to 5 years) changes of vaginal microbiota were compared with pre-insertion values in 252 women presenting for LNG-IUS insertion. Detailed microscopy on vaginal fluid was used to define lactobacillary grades (LBGs), bacterial vaginosis (BV), aerobic vaginitis (AV) and the presence of Candida. Cultures for enteric aerobic bacteria and Candida were used to back up the microscopy findings. Fisher's test was used to compare vaginal microbiome changes pre- and post-insertion.

Results. Compared to the pre-insertion period, we found a temporary worsening in LBGs and increased rates of BV and AV after 3 months of LNG-IUS. After 1 and 5 years, however, these changes were reversed, with a complete restoration to pre-insertion levels. Candida increased significantly after long-term carriage of LNG-IUS compared to the period before insertion [OR 2.0 (CL951.1–3.5), P=0.017].

Conclusions. Short-term use of LNG-IUS temporarily decreases lactobacillary dominance, and increases LBG, AV and BV, but after 1 to 5 years these characteristics return to pre-insertion levels, reducing the risk of complications to baseline levels. Candida colonization, on the other hand, is twice as high after 1 to 5 years of LNG-IUS use, making it less indicated for long-term use in patients with or at risk for recurrent vulvovaginal candidosis.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000657
2018-01-29
2019-12-09
Loading full text...

Full text loading...

/deliver/fulltext/jmm/67/3/308.html?itemId=/content/journal/jmm/10.1099/jmm.0.000657&mimeType=html&fmt=ahah

References

  1. van de Wijgert JH, Morrison CS, Cornelisse PG, Munjoma M, Moncada J et al. Bacterial vaginosis and vaginal yeast, but not vaginal cleansing, increase HIV-1 acquisition in African women. J Acquir Immune Defic Syndr 2008;48:203–210 [CrossRef][PubMed]
    [Google Scholar]
  2. Marconi C, Donders GG, Martin LF, Ramos BR, Duarte MT et al. Chlamydial infection in a high risk population: association with vaginal flora patterns. Arch Gynecol Obstet 2012;285:1013–1018 [CrossRef][PubMed]
    [Google Scholar]
  3. Bretelle F, Rozenberg P, Pascal A, Favre R, Bohec C et al. High Atopobium vaginae and Gardnerella vaginalis vaginal loads are associated with preterm birth. Clin Infect Dis 2015;60:860–867 [CrossRef][PubMed]
    [Google Scholar]
  4. Donders GG, van Calsteren K, Bellen G, Reybrouck R, van den Bosch T et al. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG 2009;116:1315–1324 [CrossRef][PubMed]
    [Google Scholar]
  5. Donders GG, Vieira-Baptista P. Bacterial vaginosis and inflammatory response showed association with severity of cervical neoplasia in HPV-positive women. Diagn Cytopathol 2017;45:472–473 [CrossRef][PubMed]
    [Google Scholar]
  6. Caixeta RC, Ribeiro AA, Segatti KD, Saddi VA, Figueiredo Alves RR et al. Association between the human papillomavirus, bacterial vaginosis and cervicitis and the detection of abnormalities in cervical smears from teenage girls and young women. Diagn Cytopathol 2015;43:780–785 [CrossRef][PubMed]
    [Google Scholar]
  7. Ojala T, Kankainen M, Castro J, Cerca N, Edelman S et al. Comparative genomics of Lactobacillus crispatus suggests novel mechanisms for the competitive exclusion of Gardnerella vaginalis. BMC Genomics 2014;15:1070 [CrossRef][PubMed]
    [Google Scholar]
  8. Kenyon CR, Osbak K. Recent progress in understanding the epidemiology of bacterial vaginosis. Curr Opin Obstet Gynecol 2014;26:448–454 [CrossRef][PubMed]
    [Google Scholar]
  9. Brotman RM, He X, Gajer P, Fadrosh D, Sharma E et al. Association between cigarette smoking and the vaginal microbiota: a pilot study. BMC Infect Dis 2014;14:471 [CrossRef][PubMed]
    [Google Scholar]
  10. van de Wijgert JH, Borgdorff H, Verhelst R, Crucitti T, Francis S et al. The vaginal microbiota: what have we learned after a decade of molecular characterization?. PLoS One 2014;9:e105998 [CrossRef][PubMed]
    [Google Scholar]
  11. Bezirtzoglou E, Voidarou C, Papadaki A, Tsiotsias A, Kotsovolou O et al. Hormone therapy alters the composition of the vaginal microflora in ovariectomized rats. Microb Ecol 2008;55:751–759 [CrossRef][PubMed]
    [Google Scholar]
  12. Srinivasan S, Liu C, Mitchell CM, Fiedler TL, Thomas KK et al. Temporal variability of human vaginal bacteria and relationship with bacterial vaginosis. PLoS One 2010;5:e10197 [CrossRef][PubMed]
    [Google Scholar]
  13. Donders GG, Caeyers T, Tydhof P, Riphagen I, van den Bosch T et al. Comparison of two types of dipsticks to measure vaginal pH in clinical practice. Eur J Obstet Gynecol Reprod Biol 2007;134:220–224 [CrossRef][PubMed]
    [Google Scholar]
  14. Donders GG. Definition and classification of abnormal vaginal flora. Best Pract Res Clin Obstet Gynaecol 2007;21:355–373 [CrossRef][PubMed]
    [Google Scholar]
  15. Donders GG. Microscopy of the bacterial flora on fresh vaginal smears. Infect Dis Obstet Gynecol 1999;7:177–179 [CrossRef][PubMed]
    [Google Scholar]
  16. Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G et al. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG 2002;109:34–43 [CrossRef][PubMed]
    [Google Scholar]
  17. Donders GG, Berger J, Heuninckx H, Bellen G, Cornelis A. Vaginal flora changes on Pap smears after insertion of levonorgestrel-releasing intrauterine device. Contraception 2011;83:352–356 [CrossRef][PubMed]
    [Google Scholar]
  18. Ravel J, Brotman RM, Gajer P, Ma B, Nandy M et al. Daily temporal dynamics of vaginal microbiota before, during and after episodes of bacterial vaginosis. Microbiome 2013;1:29 [CrossRef][PubMed]
    [Google Scholar]
  19. Jacobson JC, Turok DK, Dermish AI, Nygaard IE, Settles ML. Vaginal microbiome changes with levonorgestrel intrauterine system placement. Contraception 2014;90:130–135 [CrossRef][PubMed]
    [Google Scholar]
  20. Heffron R, Were E, Celum C, Mugo N, Ngure K et al. A prospective study of contraceptive use among African women in HIV-1 serodiscordant partnerships. Sex Transm Dis 2010;37:621–628 [CrossRef][PubMed]
    [Google Scholar]
  21. Pettifor A, Delany S, Kleinschmidt I, Miller WC, Atashili J et al. Use of injectable progestin contraception and risk of STI among South African women. Contraception 2009;80:555–560 [CrossRef][PubMed]
    [Google Scholar]
  22. Cheng G, Yeater KM, Hoyer LL. Cellular and molecular biology of Candida albicans estrogen response. Eukaryot Cell 2006;5:180–191 [CrossRef][PubMed]
    [Google Scholar]
  23. Dennerstein GJ, Ellis DH. Oestrogen, glycogen and vaginal candidiasis. Aust N Z J Obstet Gynaecol 2001;41:326–328 [CrossRef][PubMed]
    [Google Scholar]
  24. Hillier SL, Lau RJ. Vaginal microflora in postmenopausal women who have not received estrogen replacement therapy. Clin Infect Dis 1997;25:S123–S126 [CrossRef][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000657
Loading
/content/journal/jmm/10.1099/jmm.0.000657
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error