por Coccoid flora is a term used to describe the microbial community or set of bacteria in the vaginal area that have a “coccoid” morphological appearance (one of the characteristic shapes of bacteria). These microorganisms can be found in a greater or lesser proportion depending on the person or the physiological conditions of the genital organ.
Generally, sexually active women are those who present significant increases in the coccoid flora of the genital area and different researchers attribute this to unhygienic sexual intercourse or exposure to sexually transmitted diseases.
The presence of abundant coccoid flora has been correlated with the socioeconomic level of women, believing that this is due to a lack of information about the benefits and implications of having hygienic and protected sexual relations.
Based on the analysis of clinical data obtained from different hospitals in Latin American countries, a relationship has been found between patients who present a high proportion of coccoid flora with pathologies such as leucorrhoea (49%), dyspareunia (16%) , bleeding during intercourse (4%) and vulvar pruritus (29%).
Orally administered contraceptives tend to increase the coccoid flora in the vagina. In fact, studies have been carried out to characterize the microorganisms present in the atypical coccoid flora sampled in patients undergoing birth control pills.
When the coccoid flora presents high values, there is a certain predisposition to infections by microbial species of the genera Trichomona, Gardnerella or Kingella and fungi of the genus Candida, which can have serious implications for the genital health of women.
[toc]
Characteristics
It is estimated that about 20% of women of reproductive age suffer an increase in coccoid flora and that in four out of ten women in whom this increase is observed, it is due to benign changes in the vaginal flora or temporary hormonal changes. .
Gynecologists consider that a normal vaginal flora should have less than 10% representatives of genera with coccoid morphologies. It is normal to find more than 80% of bacterial species of the Lactobacillus genus, specifically Lactobacillus crispatus and Lactobacillus acidophilus.
Usually, the species found in the vaginal coccoid flora come from the anus, so they are almost always anaerobic Gram-positive enterobacteria. However, pathogenic agents of external origin can also be found, which implies a high probability of contracting diseases.
representative genera
The species of bacteria most commonly found in the coccoid flora of Pap smears (linking the endocervix and ectocervix) belong to the genera Staphylococcus, Peptococcus, Enterococcus, and Streptococcus, with the most common species being Staphylococcus epidermidis, Staphylococcus aureus, and Enterococcus faecalis. .
staphylococcus
They are species of bacteria with the appearance of spheres grouped in piles or in a granular form that are distributed throughout the mucous membranes and body fluids and in the epidermis of the skin.
Up to 17 different species of these microbes can be found on human skin, in contrast to the three species that have been reported in the vaginal coccoid flora: Staphylococcus epidermidis, Staphylococcus aureus, and, in some cases, Staphylococcus faecalis.
enterococcus
These bacteria are shaped like pairs of spheres (cocci) joined by a central point or chains of cocci. They are generally difficult to distinguish from Streptococcus.
They are distributed in saliva, the gastrointestinal tract and the genitourinary cavity. These bacteria are the main causes of urinary tract infections, bacteremia and endocarditis.
streptococcus
Bacteria of this genus are grouped in chains or pairs of cocci. They are distributed in the mouth, on the skin, and in the gastrointestinal and respiratory tracts of humans.
Many of the species in this genus cause serious infectious diseases in humans such as tonsillitis or pneumonia.
Peptococcus
Bacteria of the genus Peptococcus are also found as chains of cocci and have been found primarily throughout the gastrointestinal cavity. However, it is not yet known for sure if they live permanently in the oral and vaginal flora.
These bacteria have been related to the appearance of abscesses in the brain, ear and jaw.
Pathologies related
An increase in the coccoid flora can cause bacterial vaginosis in most women since, by increasing the presence of these bacteria, the relative abundance of the species of the genus Lactobacillus can be altered, producing changes in the regular vaginal ecosystem.
Doctors affirm with certainty that if the coccoid flora exceeds in relative abundance the lactobacillary flora of the vulvo-vaginal region, one can speak of bacterial vaginosis. This disease is mainly caused by an alteration of the acidic pH of the genital organ.
Bacterial vaginosis causes inflammation in the cervicovaginal area, excessive secretion of fluids, burning in the genitals, burning when urinating and even, in more serious conditions, it can present feverish symptoms and general malaise.
The problem when making the diagnosis of bacterial infections based on the increase in coccoid flora is that, in some people, «abnormal» vaginal microflora are asymptomatic or «non-pathological», so they cannot be classified as infections.
In fact, these so-called «abnormal» microfloras may, rather, be «intermediate» floras that become transiently evident during some stages of sexual development in women.
Diagnosis
Despite the above, the presence of coccoid flora in most women is usually very low, so an increase in the amount of coccoid bacteria in the vaginal cavity is attributed to infections, pathologies, injuries, or other types of disturbances. pathological.
Specialist gynecologists have considered that women with an increased proportion of the vaginal coccoid flora are more susceptible to sexually transmitted diseases, the human immunodeficiency virus (HIV), postoperative infections, premature abortions and other diseases.
The diagnoses of these alterations in the vaginal flora are usually made through direct cytology of vaginal secretions, which are subjected to a Gram stain.
However, more in-depth studies imply a combination between the analysis of the secretions and a cervical cytology processed with a Papanicolaou stain, in order to be able to analyze and identify all the native species of the vaginal tract.
Polymerase chain reaction (PCR) is often used only for investigative purposes to detect abnormal increases in coccoid flora. However, this tool could be used as a current alternative for the rapid and accurate detection of coccoid bacteria in the vaginal flora.
References
Bartlett, JG, Onderdonk, AB, Drude, E., Goldstein, C., Anderka, M., Alpert, S., & McCormack, WM (1977). Quantitative bacteriology of the vaginal flora. Journal of Infectious Diseases, 136(2), 271-277.
Donders, GG, Vereecken, A., Bosmans, E., Dekeersmaecker, A., Salembier, G., & Spitz, B. (2002). Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG: An International Journal of Obstetrics & Gynaecology, 109(1), 34-43
Donders, GG, Bellen, G., & Ruban, KS (2018). Abnormal vaginal microbiome is associated with severity of localized provoked vulvodynia. Role of aerobic vaginitis and Candida in the pathogenesis of vulvodynia. European Journal of Clinical Microbiology & Infectious Diseases, 37(9), 1679-1685.
Gutman, RE, Peipert, JF, Weitzen, S., & Blume, J. (2005). Evaluation of clinical methods for diagnosing bacterial vaginosis. Obstetrics & Gynecology, 105(3), 551-556.
Priestley, CJ, Jones, BM, Dhar, J., & Goodwin, L. (1997). What is normal vaginal flora?. Sexually Transmitted Infections, 73(1), 23-28.
Yoshimura, K., Morotomi, N., Fukuda, K., Nakano, M., Kashimura, M., Hachisuga, T., & Taniguchi, H. (2011). Intravaginal microbial flora by the 16S rRNA gene sequencing. American Journal of obstetrics and Gynecology, 205(3), 235-e1.
Yoshimura, K., Morotomi, N., Fukuda, K., Hachisuga, T., & Taniguchi, H. (2016). Effects of pelvic organ prolapse ring pessary therapy on intravaginal microbial flora. International urogynecology journal, 27(2), 219-227.