Multidimensional profile of cytolytic vaginosis

Abstract

The vaginal microbiota plays an important role in women's reproductive health. The predominance of lactobacillus species favors the homeostasis of the vaginal environment through the production of lactic acid, hydrogen peroxide, and bacteriocins, creating an unfavorable environment for the acquisition of agents of Sexually Transmitted Infections (STIs). However, the vaginal microbiota is not static and is constantly influenced by women's health status, and may present conditions such as classic dysbiosis. In contrast to the scenario presented by bacterial vaginosis, there is cytolytic vaginosis (CV), which presents as its main characteristic the overgrowth of Lactobacillus spp., which leads to hyperacidity of the vaginal environment due to the intense production of lactic acid, compromising the integrity of the cells of the vaginal epithelium, causing intense cytolysis. Despite the knowledge of the overgrowth of lactobacilli, there is a lack of literature on the characterization of the microbiome of women suffering from cytolytic vaginosis. Objective: To identify the clinical, biochemical and microbiological characteristics of cytolytic vaginosis in women of reproductive age. Methodology: This is a prospective nested case-control study, with the inclusion of 30 women of reproductive age with a microscopic diagnosis of cytolytic vaginosis and 120 women with Flora I. At the time of inclusion of the patient in the study already with a microscopic diagnosis, stained by the Gram method, cytolytic vaginosis and Flora I, the contents of the Douglas cul-de-sac will be collected to investigate Trichomonas vaginalis infection by culture in Diamond's medium and endocervical secretion for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium to exclude the influence of endocervicitis on the clinical and biochemical characteristics of cytolytic vaginosis. The supernatants obtained from the cervicovaginal lavage will be used to determine IL-6 levels using the ELISA technique. For the quantification of D and L isomers of lactic acid, colorimetric kits will be used and the result will be obtained by comparison with the standard curve. Samples obtained from the middle third of the vaginal wall with a Copan swab will be used for PCR of bacterial DNA by amplification of the sequence of the V3-V4 region of the bacterial 16S rRNA gene. The sequences obtained will be analyzed for taxonomic classification using the RDP Greengenes tool. The classification of samples into bacterial communities based on the relative abundance of the identified species will be carried out using the R Statistical Package software. The statistical analysis will be carried out by the assumptions determined by the results and the significance level adopted will be 5%.