Zusammenfassung
Hintergrund und Methoden
Das Verständnis der normalen und gestörten vaginalen Mikrobiota hat sich in den letzten Jahren stark gewandelt. Kulturelle Methoden sind nicht geeignet, um zwischen normal und abnormal zu unterscheiden. Nichtkulturelle moderne Bestimmungsmethoden lassen ein komplexes dynamisches System mit individuellen und genetisch beeinflussten Varianten unter Dominanz von Laktobazillen erkennen. Der aktuelle Wissensstand soll anhand der Literatur zusammenfassend dargestellt werden.
Ergebnisse
Das normale und das abnormale vaginale Mikrobiom sind komplexe Ökosysteme aus mehr als 200 Bakterienarten, die von Genen, ethnischen und äußeren Faktoren sowie vom Verhalten beeinflusst werden. Meist dominieren Laktobazillen, i.d.R. mehrere Arten pro Individuum, die gesunde Vagina. Zusammen mit antibakteriellen Substanzen, Zytokinen, Defensinen u. a., unterstützen sie ein Abwehrsystem gegen Dysbiose und Infektionen, ferner eine normale Schwangerschaft ohne Frühgeburt. Im Fall einer Dysbiose nimmt die Zahl von Lactobacillus (L.) iners zu. Bakterielle-Vaginose-assoziierte Bakterien (BVAB), ein oder 2 von 4 Gardnerella-vaginalis-Stämmen, Atopobium vaginae und Clostridiales führen in bestimmter Zusammensetzung und Menge zur bakteriellen Vaginose (BV) mit Bildung von polymikrobiellen Biofilmen an der Vaginalwand. Diese lösen sich unter der leitliniengerechten Antibiotikatherapie nicht auf und provozieren so die häufigen Rezidive. Die aerobe Vaginitis (AV) scheint eine immunologische Störung in der Vaginalwand mit Einfluss auf die Mikrobiota zu sein, die von Aerobiern wie Streptococcus agalactiae, Escherichia coli u. a. dominiert wird. Ihre Rolle bei der AV ist unklar. Die vaginale bzw. orale Zufuhr von Laktobazillen verbessert die Heilungsquoten bei BV/Dysbiose.
Fazit
Die normale vaginale Mikrobiota besteht aus einer grossen Zahl verschiedener Bakterien, die von verschiedenen Laktobazillusarten in einem ausbalancierten Gleichgewicht gehalten werden.
Abstract
Background
In recent years the understanding of the normal and abnormal vaginal microbiome has substantially changed. Culturing methods are not suitable for distinguishing between normal and abnormal microbiomes. Modern non-culture-based technologies reveal a complex dynamic system mostly dominated by lactobacilli and influenced by genetic, ethnic, environmental and behavioral factors. The current state of knowledge is summarized based on the available literature.
Results
The normal and abnormal vaginal microbiomes are complex ecosystems of more than 200 bacterial species influenced by ethnic background, genetic, environmental and behavioral factors. The healthy vagina is mostly dominated by several species of lactobacilli per individual. Together with antibacterial substances, cytokines and defensins they support the defence system against dysbiosis and infections as well as providing conditions for a normal pregnancy without preterm birth. The numbers of Lactobacillus (L.) iners increase in the case of dysbiosis. Bacterial vaginosis (BV)-associated bacteria (BVAB), Atopobium vaginae, Clostridiales and one or two of four Gardnerella vaginalis strains in certain combinations and amounts lead to BV with the formation of polymicrobial biofilms on the vaginal wall epithelium. These films are not dissolved by guideline-conform antibiotic therapy thus provoking the frequent recurrences. Aerobic vaginitis (AV) seems to be an immunological disorder of the vaginal wall which influences the microbiota, which is here dominated by aerobic bacteria, e.g. Streptococcus agalactiae and Escherichia coli but their role in AV is unknown. Vaginal or oral administration of lactobacilli improves the therapeutic success of BV and dysbiosis.
Conclusion
The normal vaginal microbiota is a mixture of many bacteria in a balance dominated by different lactobacilli.
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Der Autor erhielt in den letzten 3 Jahren Vortragshonorare oder Reisekostenerstattungen von den Firmen Abbott/Mylan Healthcare GmbH Hannover, Aristo Pharma GmbH Berlin, Bayer Vital GmbH Leverkusen, Dr. Kade Pharmazeutische Fabrik GmbH Berlin, Medinova Zürich, Pierre Fabre Pharma GmbH Freiburg, Polichem S.A. Lugano, Velvian germany GmbH Ismaning und Dr. August Wolff GmbH & Co. KG Bielefeld.
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K. Friese, Oberaudorf
W. Mendling, Wuppertal
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Mendling, W. Vaginale Mikrobiota – ein Update. Gynäkologe 48, 780–786 (2015). https://doi.org/10.1007/s00129-015-3743-7
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DOI: https://doi.org/10.1007/s00129-015-3743-7