Clinical and Morphological Diagnosis and Treatment of Sexually Transmitted Infections - Yakimova, T. P. 2007

Bacterial Vaginosis: Modern Diagnostic Methods, Morphological Characteristics, and Treatment

Urogenital bacterial infections represent one of the most pressing challenges in contemporary venereology, gynecology, obstetrics, urology, and other medical fields.

According to modern concepts, primary bacterial non-inflammatory urogenital diseases in men and women should be suspected upon the onset of relevant symptoms, provided that gonococcal, chlamydial, mycoplasmal, trichomonal, viral, or mycotic etiologies have been ruled out during examination.

The vaginal microflora, which Functions as a dynamic microecosystem, plays an exceptionally vital role in maintaining optimal women's health. The impact of various exogenous or endogenous factors on the host Organism can lead to disruptions in the normal microflora and The Development of vaginal dysbiosis. In turn, alterations in the COMPOSITION OF THE resident genital microflora contribute to a decrease in colonization resistance and, consequently, a reduction in the functional activity of the host's protective barriers against opportunistic microorganisms. The decline in vaginal colonization resistance is primarily associated with a significant decrease in the number of lactic acid Bacteria—Döderlein bacilli—and an increase in the content of opportunistic, typically multi-antibiotic-resistant microorganisms. These changes underlie subsequent pathological shifts within the female body.

In clinical practice, identifying the etiological factor in urogenital disorders is most often restricted primarily to screening for Gonorrhea, Trichomoniasis, and Syphilis. This is also evidenced by the grading systems for vaginal discharge cleanliness adopted both domestically and internationally.

Depending on The Nature of the microflora, the number of inflammatory elements, and the cellular composition of the discharge, four degrees of vaginal cleanliness are distinguished (M. A. Bazarnova et al., 1991).

First degree of cleanliness: the vaginal discharge reveals a pure culture of the vaginal bacillus, isolated epithelial Cells, and occasional leukocytes and mucus. The vaginal pH is 4.0–4.7 (normal is 4.0–4.5). Döderlein bacilli appear as coarse, thick, Gram-positive rods distributed diffusely and in clusters, frequently in pairs. This microscopic picture is characteristic of the vaginal discharge of healthy women, but is rarely observed (color insert, Fig. 7).

Second degree of cleanliness: the vaginal discharge contains numerous Döderlein bacilli, along with occasional cocci, leukocytes, epitheliocytes, and abundant mucus; pH ranges from 4.5 to 5.0. The discharge is semi-fluid and whitish. This MACROSCOPIC AND MICROSCOPIC profile is the most frequent and typical for healthy women (color insert, Fig. 8).

Third degree of cleanliness: the vaginal discharge contains a negligible number of Döderlein bacilli, numerous cocci (including streptococci and staphylococci), leukocytes, and a moderate number of epitheliocytes. pH ranges from 5.0 to 6.5. Microscopically, the vaginal discharge is yellowish and fluid. This picture is characteristic of an inflammatory process in the vaginal mucosa (color insert, Fig. 9).

Fourth degree of cleanliness: Döderlein bacilli are absent. A large number of leukocytes and pyogenic microorganisms are detected, along with a few epitheliocytes; pH ranges from 6.5 to 8.5. Macroscopically, the vaginal discharge is purulent. In trichomonal colpitis, the discharge is foamy. This characteristic is typical of a pronounced inflammatory process in the vaginal mucosa. Trichomonads thrive in an alkaline environment (color insert, Fig. 10).

A zero degree of vaginal cleanliness is also distinguished, characterized by a complete absence of Microorganisms in the Vagina alongside numerous leukocytes. Such Cell/15.html">Microscopy is typical of discharge following antibacterial therapy (Antibiotics, sulfonamides) and douches (color insert, Figs. 11, 12).

Abroad, the Classification by O'Jirovec et al. (1996) is used to determine the degree of vaginal cleanliness.

As seen from the data presented in Table 1, the detection of bacterial vaginosis pathogens is not accounted for when determining the degree of vaginal cleanliness. At the same time, a group of opportunistic pathogens—non-clostridial anaerobes—has recently gained significant prominence. Consequently, recent literature has increasingly discussed the rising incidence of urogenital tract Infections caused by opportunistic anaerobes such as Gardnerella vaginalis and Mobiluncus, which cause urogenital diseases more frequently than gonococci, trichomonads, and Fungi. Nevertheless, many clinical laboratory physicians still fail to report this bacterial vaginosis during routine screenings because inflammatory elements are typically absent or present in very small quantities in this condition. Gardnerella vaginalis apparently suppresses the viability of other microflora, as in the majority of cases (80%) it is detected alone and is found in association with other bacterial flora, leptotrichia, Candida fungi, chlamydia, and very rarely with trichomonads in only 20% of cases.

Class="center">Table 1 Degrees of vaginal cleanliness according to O'Jirovec et al. (1996)

Bacterial vaginosis (BV) is a term applied to conditions formerly known as "corynebacterial vaginitis," "Gardnerellosis," and "anaerobic vaginosis."

The high prevalence of bacterial vaginosis—detected in 20–30% of women of reproductive age—and the development of severe complications associated with this condition, such as Pregnancy loss, amniotic infection, postpartum and post-abortion endometritis, salpingitis, salpingooophoritis, and wound infections, underscore the high clinical relevance of this pathology.

Bacterial vaginosis is an infectious, non-inflammatory process associated with vaginal dysbiosis, characterized by a high concentration of obligately anaerobic microorganisms and a sharp decrease or complete absence of lactobacilli in the vaginal contents. It is now established that bacterial vaginosis arises as dysbiosis resulting from the disruption of normal vaginal microflora during various pathological states, both within the FEMALE Reproductive System and systemically, such as impaired immune and hormonal status, among others. Particular importance in the development of bacterial vaginosis is attributed to The Use of medications such as sulfonamides and antibiotics. The vaginal microflora is altered by the use of contraceptives, douching, and intrauterine devices, which compromise the barrier function of the cervical mucus glands. Normally, the vaginal pH is maintained by a high concentration of lactic acid under normal hormonal status, whereby Gram-positive Döderlein bacilli—Lactobacillus acidophilus—break down Glycogen released by degenerating superficial epithelial Cells of the vaginal mucosa into lactic acid, sustaining a normal acidic environment with a pH of 4.0–4.7. In this process, lactic acid serves a barrier function, preventing the invasion of other microorganisms. Concurrently, the normal vaginal microflora in women fluctuates with the Phases of the Menstrual cycle. The highest counts of anaerobic and aerobic microorganisms are detected during menstruation, with the greatest diversity of species observed on the 2nd, 10th, and 14th days of the menstrual cycle. Among anaerobic microorganisms in the vagina, three genera dominate: Bacteroides (57–58%), Peptococci and Peptostreptococci (33–69%), and Clostridia (5%).

During menopause, the number of lactobacilli decreases and eventually disappears altogether, whereas in healthy women of reproductive age, the vaginal contents are represented by the Gram-positive, non-spore-forming rod Lactobacillus acidophilus or in combination with other bacteria of the Lactobacillus family, notably Lactobacillus fermentum. The pathogenicity of obligate anaerobes is linked to their ability to produce Enzymes, toxins, and BIOLOGICALLY ACTIVE SUBSTANCES.

The development of bacterial vaginosis can be promoted by endogenous factors (Alterations in hormonal status, decreased immunological reactivity, disruption of intestinal microbiocenosis) and exogenous factors (prior antibacterial therapy, past and concurrent Inflammatory Diseases of the urogenital tract, use of hormonal medications, and immunosuppressants).

Risk factors for the development of bacterial vaginosis include frequent changes of sexual partners, the use of intrauterine contraceptives, urogenital inflammatory diseases, and the use of antibacterial drugs and immunosuppressants.

Although bacterial vaginosis is more common in women with multiple sexual partners and is rarely diagnosed in sexually inactive women, it is not a true sexually transmitted infection.

The MAIN CLINICAL MANIFESTATIONS of bacterial vaginosis are abundant, creamy, grayish-white discharge adhering to the vaginal mucosa and emitting an unpleasant foul fish or herring odor. An inflammatory reaction of the vaginal mucosa is not typical for bacterial vaginosis, but its presence does not rule out the Diagnosis, as it is found in one-third of patients presenting with genital Complaints. Subjective sensations such as itching and burning may occur.

A diagnosis of bacterial vaginosis is considered well-founded when 3 of the 4 following criteria are met: homogeneous creamy discharge adhering to the vaginal mucosa and having an unpleasant odor; the presence of "clue cells" in smears stained by any method, which represent desquamated superficial squamous epithelial cells coated with Gram-variable microorganisms; a positive amine test (release of a fishy odor upon mixing equal parts of vaginal discharge and a 10% KOH solution); and an elevation of vaginal pH above 4.5–4.7.

Studies addressing the Etiology of BV primarily reveal diverse and sometimes diametrically opposed viewpoints. For instance, some researchers view vaginosis as a monoinfectious process, assigning the leading etiological role to a single pathogen, most commonly G. vaginalis or Mobiluncus sp. Conversely, an opposing view holds that strict anaerobic bacteria such as Bacteroides, Peptococci, and Peptostreptococci are among the most clinically significant etiological agents of BV. T. A. Pfeifer et al. (1978) were the first to put forward this hypothesis. The anaerobic microorganisms isolated in BV provided the rationale for introducing the term "anaerobic vaginosis," as mentioned earlier.

It is known that H₂O₂-producing lactobacilli (LB-H₂O₂), present in high concentrations in the vagina of healthy women, inhibit the growth of pathogenic microorganisms, including Bacteroides bivius and Gardnerelia vaginalis. The efficacy of LB-H₂O₂ can be inhibited by catalase from numerous bacteria that produce this enzyme. In other words, a decline in their numbers is accompanied by a suppression of antagonistic activity, while catalase from other bacteria exacerbates this process. On the other hand, these authors found that the toxicity of LB-H₂O₂ against foreign microbes is restored in the presence of leukocytic peroxidase and chlorides. In short, LB-H₂O₂ contribute to maintaining an optimal biocenosis, particularly in the presence of peroxidase and halide salts. Thus, according to preliminary data, it can be considered that the peroxidase activity of LB-H₂O₂ also plays a specific role in The Mechanism of the vaginal barrier function.

In addition to various Bacteroides species, anaerobic gram-positive cocci, Mobiluncus species, and other anaerobes—whose counts can increase a thousandfold or more—several authors identify G. vaginalis and M. hominis among the causative agents of bacterial vaginosis (BV). However, Gardnerella strains are detected not only in BV but also in other conditions. G. vaginalis is isolated in approximately 1/3 of healthy women, which is considered colonization.

Statistically significant shifts in the vaginal biocenosis are also observed in the quantitative ratios of various microorganism groups. In BV, the total bacterial count in the vagina rises to 10⁹–10¹¹/g of discharge, whereas in a normal vaginal ecosystem, it does not exceed 10⁵–10⁶/g of discharge (p < 0.01).

From an etiological standpoint, BV is a polymicrobial condition caused by an altered normal vaginal ecology characterized by a pronounced proliferation of anaerobes, both in terms of species diversity and quantity. The vaginal microflora in patients with BV consists of a combination of aerobic, facultatively anaerobic, oxygen-tolerant anaerobic, and obligate anaerobic microorganisms coexisting in Symbiosis. It is hard to overlook the fact that aerobic species constitute only a minor fraction of the microbial landscape in vaginosis. This balance is disrupted in BV: some microorganism species disappear while others emerge. In this scenario, the etiological factor is not a single isolated microbe, but rather an association with specific biological properties acquired through the symbiosis of various microorganisms. Each individual associate may lack the specific traits exhibited by the association as a whole. Consequently, it is difficult to single out one or two specific microorganisms. From an etiological perspective, all isolated bacteria are significant, as they acquire properties in symbiosis with other species that they do not possess independently. Alterations in the microflora during BV may result from an alternative mechanism in which lactobacilli and the vaginal epithelium compete with other microorganisms.

Gardnerellosis holds a specific place among Sexually Transmitted Diseases. The condition results from vaginal infection by Gardnerella vaginalis. Previously known as Haemophilus vaginalis, Gardnerella vaginalis is a non-motile gram-negative rod, though gram-variable variants also occur.

Gardnerella infection is contagious and sexually transmitted. Transmission of the infection to a newborn during passage through the mother's birth canal is possible. Intrauterine fetal infection has also been noted, which can lead to fatal outcomes in the perinatal period.

The primary sites of infection are the vagina, cervix, and Urethra.

Gardnerella causes vaginitis, Endocervicitis, and urethritis in women, and prostatitis in men. Gardnerella-induced vaginitis is the most prevalent bacterial vaginitis. Typical cases present with profuse, grayish-white, watery discharge with an unpleasant "fishy" or herring-like odor, which arises from The breakdown of amines produced by anaerobic bacteria that actively proliferate during Gardnerella vaginitis.

Asymptomatic forms of gardnerellosis also exist and are regarded as colonization.

In addition to the objective and subjective clinical signs of gardnerellosis mentioned above, severe complications have been described, such as pelvic inflammatory disease (adnexitis), endometritis (E. B. Lazareva et al., 1997), pregnancy loss, amniotic infection, post-abortion endometritis, uterine bleeding (E. K. Nazarova, 1997), prostatitis, cystitis, urethritis, neonatal meningitis, and neonatal Pneumonia.

It should be noted that gardnerellosis is quite common in gynecological practice. According to various authors, the frequency of gardnerellosis among gynecological patients ranges from 58% to 91.3%. In practically healthy individuals without clinical manifestations of the disease, Gardnerella vaginalis can be isolated in 23–32% of cases, which is attributed to carrier status (E. F. Kira, 1990; E. K. Nazarova, 1997). E. B. Lazareva et al. (1997) believe that light microscopy Diagnostics of gardnerellosis allows this pathology to be detected twice as often compared to detection via indirect immunofluorescence. The authors used Vagitest test kits (JSO "Soyuzagromed"). However, indirect immunofluorescence is not always readily available for routine clinical practice, and the pathogen often has to be diagnosed using light microscopy in smears stained with Pappenheim's stain, Nocht's stain, a 1% methylene blue solution, or Gram stain.

Microscopically, Döderlein's bacilli are absent in smears of vaginal contents in cases of gardnerellosis. Leukocytes may be present in single instances, but more frequently they are absent, and a large number of superficial squamous epithelial cells are discovered, densely covered with small, short, gram-variable, predominantly gram-negative rods characterized as "bacterial sand." Gardnerella vaginalis densely and uniformly coats both the squamous epithelial cells and the spaces between them, clustering more densely around the Plasmalemma of certain cells to form a thick, narrow, dense rim around The Cell (color insert, Fig. 14). The primary morphological and diagnostic hallmark of gardnerellosis is clue cells, which are superficial squamous epithelial cells with densely adhered Gardnerella bacteria (color insert, Fig. 13). It should be emphasized once again that clue cells originate exclusively from the superficial layers of the mucous membrane (color insert, Figs. 13, 14).

R. Amsel et al. (1983) proposed the "gold standard" for the diagnosis of gardnerellosis, consisting of 4 criteria: profuse, thick, creamy discharge; the presence of clue cells; a positive amine test; and a vaginal pH greater than 4.5.

The amine test is performed as follows: 1 drop of discharge, collected from the lesion site using a Volkmann spoon, is placed on a Glass slide, mixed with 1 drop of a 10% KOH solution, and evaluated for odor. The amine test is considered positive if a herring or fishy odor is detected.

Determination of the pH of vaginal discharge.

In gardnerellosis, the vaginal pH typically ranges from 5.5 to 7.0. The normal pH is 4.0–4.5. To measure vaginal pH, indicator paper is inserted using a speculum, and the pH is determined by the color change. The acidity of the vaginal contents can be measured more precisely via pHmetry. 2 mL of sterile H₂O is introduced into the posterior vaginal fornix, mixed with the discharge, and the mixture is collected in a capped vial and sent to the laboratory. The biomaterial can be stored in a freezer at -20°C for up to one month.

The amine test using a 10% KOH solution and the determination of vaginal pH are non-specific. Furthermore, alkaline discharge from the cervical canal, when mixed with vaginal contents, shifts the reaction of the vaginal environment toward alkalinity.

A. S. Ankirskaya et al. (1997) conducted a comparative evaluation of the efficacy of various diagnostic Methods for bacterial vaginosis, including Gas-Liquid Chromatography of vaginal discharge, Determination of bacterial enzyme levels (Proline aminopeptidase and sialase) in vaginal discharge, the amine test, pH measurement, and microscopy. The authors concluded that the highest sensitivity and Specificity are characteristic of microscopic examination of smears stained by any method, with Gram staining being optimal. Gas-liquid chromatography was recognized as the least effective method. The authors classified vaginal pH determination as a low-efficiency criterion due to contamination by mucus and Blood from the cervical canal. According to the authors, the amine test also exhibits insufficient sensitivity.

EXAMINATION OF SMEARS STAINED WITH METHYLENE BLUE

Cellular elements of various biomaterials appear blue in preparations stained with this dye. Cell nuclei stain intensely blue, while the Cytoplasm stains light blue (in varying shades from pale blue to colorless). Mucus is also blue. Gardnerella bacteria stain variably: some appear pale blue, while others stain deep blue. Mobiluncus appears pale blue.

The quantitative characteristics of microflora can be graded on a four-point scale or indicated by four crosses: 1 point — small amount — low colonization — 10–50 bacteria per microscopic field; 2 points — moderate colonization — 60 to 300 bacteria per microscopic field; 3 points — significant colonization — 300 to 600; 4 points — 600 or more — heavy colonization.

Thus, bacterial vaginosis is a frequent infection of the female genitalia, manifests with clinical symptoms in the majority of cases, and requires medical Treatment.

Upon Bacteriological examination in culture, Gardnerella grows on blood Agar in an anaerobic environment. In bacterioscopic examination of smears prepared from cultures, The Challenge of detecting anaerobic microflora in laboratory settings is resolved by utilizing light microscopy combined with

Gram staining. This examination readily reveals microorganisms with characteristic Morphology and localization.

TREATMENT

Gardnerella species are resistant to Tetracyclines, Aminoglycosides, Cephalosporins, and sulfonamides, exhibit low susceptibility to penicillin and lincomycin, and are sensitive to clindamycin and ampicillin.

FIRST-LINE TREATMENT

Metronidazole 500 mg orally twice daily for 7 days.

ALTERNATIVE REGIMENS

Metronidazole 2 g as a single oral dose.

Metrogyl gel (0.75%) administered intravaginally using a standard applicator, 5.0 g once daily for 7 days (contraindicated in the first trimester of pregnancy) or 5.0 g twice daily for 5 days.

Dalacin C capsules (clindamycin hydrochloride): 300 mg taken orally twice daily for 7 days.

Dalacin vaginal cream (2% clindamycin phosphate): applied topically (intravaginally) at 5.0 g once daily at bedtime for 7 days using disposable applicators (also suitable during pregnancy).

Clotrimazole cream applied topically twice daily for 7 days.

For pregnant women starting from the second trimester, first-line treatments include oral metronidazole and clindamycin (clindamycin 300 mg twice daily for 5 days, or metronidazole 500 mg twice daily for 3–5 days), as well as ornidazole 0.5 g orally twice daily for 5 days. Oral administration of these drugs is contraindicated in the first trimester of pregnancy. For topical treatment in pregnant women, Metrogyl gel is recommended in addition to 2% Dalacin vaginal cream. In the first trimester, if local therapy is insufficiently effective, amoxicillin 500 mg orally three times daily for 7 days is recommended as a systemic treatment option.

IMMUNOTHERAPY

Solco Trichovac®—a vaccine derived from specific Lactobacillus strains—is used for the immunotherapy and immunoprophylaxis of bacterial vaginosis. Antibodies produced As a result of Solco Trichovac treatment act against a range of pathogenic bacteria, including the CAUSATIVE AGENT OF bacterial vaginosis. Solco Trichovac eliminates pathogenic microorganisms causing the infection; normalizes the vaginal flora and reduces vaginal pH to normal physiological levels; and provides long-term protection against reinfection and disease recurrence. Vaccination is carried out as follows: 3 injections of 0.5 mL at 2-week intervals, which provides 1-year protection. A single booster injection of 0.5 mL is administered a year later.

The management of bacterial vaginosis should include therapeutic measures aimed at eliminating factors that contribute to the development and recurrence of the condition. Where indicated, it is advisable to use eubiotics, biogenic stimulants, Vitamins, and other agents that help normalize the microbiosenosis of the vagina and intestine.

For chronic bacterial vaginosis, local treatment consisting of two consecutive stages is prescribed:

1) establishment of optimal physiological conditions in the vaginal environment; correction of local and systemic Immunity, as well as endocrine status;

2) restoration of the normal vaginal microbial biocenosis.

The First stage of treatment begins with daily vaginal installations of 100 mL of a 2–3% lactic or boric acid solution with a 10-minute exposure time, once daily. These instillations lower the pH of the vaginal contents (restoring an acidic environment), thereby creating unfavorable conditions for the proliferation of anaerobes and Gardnerella. In addition, weak lactic acid solutions exhibit pronounced antiseptic properties and provide optimal conditions for the restoration of lactoflora.

All patients are prescribed vaginal suppositories or ointment tampons containing metronidazole, ornidazole, or tinidazole (0.5); synestrol (0.005), ovestin (1.5 mg), or folliculin (10,000 IU); and ascorbic acid (0.3) and lactic acid (0.05). If indicated (itching, burning, pain), menthol, anesthesin, novocaine, or dicaine are added to the formulation, prepared on an oil base (cocoa butter, sea buckthorn, olive, or rosehip oil). Suppositories or tampons are prescribed twice daily: morning and evening for 2–3 hours. The duration of a single treatment course is 7–10 days. An oral antihistamine (such as Tavegil, Suprastin, or Pipolfen) may be prescribed additionally.

The Second Stage of treatment involves the restoration of vaginal biocenosis through the topical application of biological products (eubiotics): Lactobacterin, Acilact, Bifidumbacterin, and Bifidin. All of these microbial preparations represent a lyophilized biomass of live cultures derived from various strains of lactobacilli and bifidobacteria, which possess antagonistic activity against pathogenic and opportunistic microorganisms.

All preparations are administered intravaginally at 1–2.5 doses twice a day. Before use, the dry biomass is diluted with boiled Water (5 mL) supplemented with 5% lactose solution. A gauze tampon is moistened with the resulting homogeneous suspension and inserted into the vagina for 2–3 hours. The interval between tampon insertions is 10–12 hours. The course of treatment is 7–10 days.

The efficacy of bacterial vaginosis treatment is evaluated based on the resolution of subjective sensations, the dynamics of clinical symptoms, and the normalization of laboratory parameters. The first clinical and laboratory follow-up examination should be performed one week after therapy completion, and a repeat examination after 4–6 weeks.

Barrier methods of Contraception are recommended during treatment and follow-up monitoring. Sexual partners of women with bacterial vaginosis should undergo evaluation and, if necessary, treatment. However, the outcomes of treating male partners remain controversial, as studies have not confirmed a reduction in recurrence rates resulting from partner treatment. Nevertheless, some clinicians prefer to administer such treatment in cases of persistent or recurrent disease in women.

The exact nature of bacterial vaginosis remains unclear, as it is uncertain whether the signs constituting the clinical picture of the disease are its cause or consequence. According to the authors, the condition can only conditionally be classified as a sexually transmitted infection, as it represents one of the specific manifestations of impaired systemic Homeostasis.

MOBILUNCUS (Mobiluncus spp.)

In addition to Gardnerella, R. Durieux and A. Dublanchet (1980) isolated a new type of curved, anaerobic rod-shaped bacteria from female patients with bacterial vaginosis. Subsequently, due to their motility, these microorganisms were assigned to a new genus, Mobiluncus. These bacteria had never been detected in healthy women before, which led to their designation as a distinctive clinical marker of the disease.

In 1984, C. Spiegel and M. Roberts isolated two species of Mobiluncus: Mobiluncus curtisii and Mobiluncus mulieris. These curved, crescent-shaped bacteria with tapered ends derived their name from two words: mobile (motile) and uncus (hook). The genus Mobiluncus comprises strict anaerobes that are frequently isolated from clinical vaginal samples of women with bacterial vaginosis. These microorganisms are extremely fastidious and very difficult to cultivate. Their isolation rate in bacterial vaginosis ranges between 50% and 75%.

In smears, Mobiluncus is typically present in small numbers and is frequently found in association with Gardnerella. In native preparations, the rod attaches by one end to superficial epithelial cells—much like Gardnerella—while its free end, raised above the cell surface, remains motile. Occasionally, their numbers in smears are so low that they may go undetected. Mobiluncus rarely forms clue cells and adheres to superficial cells much less densely.

The staining patterns of Mobiluncus vary considerably, presenting in three main variants. Larger rods may take up stain only in the center, appearing colorless at the periphery. Completely and uniformly stained rods are also observed. In the third variant, small, Curved Rods with tapered ends stain pale blue exclusively at the periphery, while the center remains unstained because The Cell wall fails to take up the dye, creating the impression that the rod consists of two halves.

Its characteristic crescent shape, combined with these staining properties, allows for the identification of Mobiluncus via smear microscopy. This is of significant clinical value, as Mobiluncus acts as a distinct causative agent of bacterial vaginosis, present in 72% of bacterial vaginosis cases.

Smears may reveal Mobiluncus representatives exhibiting any of the three characteristic morphologies and staining profiles. They are Gram-variable or Gram-negative upon Gram staining, despite possessing a cell wall ultrastructure typical of Gram-positive bacteria. This discrepancy is attributed to an exceptionally thin peptidoglycan layer, which diminishes staining efficiency.

TREATMENT OF MOBILUNCUS INFECTION

Since mobiluncosis is a condition closely related to gardnerellosis, its treatment is fundamentally identical to that of gardnerellosis.

Patients do not always require therapy; however, due to the risk of severe infectious complications during pregnancy, gynecological disorders, or pelvic surgery in infected individuals, adequate treatment is essential. Treating asymptomatic mobiluncosis in pregnant women can help prevent adverse pregnancy outcomes.

Mobiluncosis poses a serious challenge during pregnancy, given its high prevalence in expectant mothers (up to 20%) and its association with preterm birth and ascending infections involving the amniochorionic space.

Management of mobiluncosis typically involves 2% clindamycin phosphate vaginal cream, 0.75% metronidazole gel, metronidazole vaginal tablets (400 mg) for 10 days, oral metronidazole (500 mg twice daily for 7 days), clindamycin hydrochloride (300 mg twice daily for 7 days), or ornidazole (0.5 g twice daily for 10 days).

It is also advisable to prescribe biogenic stimulants, eubiotics, vitamins, and agents that promote the normalization of vaginal and intestinal microbiocenosis.

Patients with mobiluncosis can transmit the infection to their partners, thus sustaining the epidemiological chain. However, treating sexual partners has been shown to affect neither therapeutic success in women nor recurrence rates. In recent years, Applications of physiological natural therapeutic products—such as lactate gel and yogurt containing Lactobacillus strains—have been utilized. Barrier contraception should be recommended throughout treatment and the follow-up observation period. General hygienic and restorative Procedures are also indicated for patients.