{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:59:17Z","timestamp":1792083557192,"version":"4.4.0"},"reference-count":79,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010229","name":"Natural Science Foundation of Tianjin Municipal Science and Technology Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010229","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019065","name":"Tianjin Science and Technology Program","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100019065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>Mixed vaginitis is a complex vaginal dysbiosis that differs from single vaginitis. Vaginitis in the third trimester may lead to adverse maternal and neonatal outcomes. The clinical characteristics, microbiological characteristics, and adverse pregnancy outcomes of mixed vaginitis in late pregnancy are worth studying. Therefore, this study investigated the clinical and microbiological characteristics of vaginitis and adverse pregnancy outcomes of patients with mixed vaginitis. We studied 1,674 women in late pregnancy who attended the Tianjin Medical University General Hospital from November, 2019 to October, 2021. We administered standardized questionnaires, performed vaginal examination and sampling plus microscope examinations, and assessed follow-up pregnancy outcomes. We cultured the vaginal discharge of the patients with mixed vaginitis to isolate pathogens and performed antimicrobial susceptibility tests of the isolated pathogens. For the patients with peripartum infection, we collected a sample to isolate pathogens. Among the 1,674 women, 66 (3.9%) had mixed vaginitis. The independent risk factor for mixed vaginitis in late pregnancy was a history of vaginitis during early and middle pregnancy (OR = 5.637, 95% CI: 3.314\u20139.580). The signs of vaginal erythema (63.6% <jats:italic>vs.<\/jats:italic> 42.0%), yellow discharge (81.8% <jats:italic>vs<\/jats:italic>. 59.6%), and malodor (31.8% <jats:italic>vs<\/jats:italic>. 18.8%) (<jats:italic>P &amp;lt;<\/jats:italic>0.05) were significantly higher in patients with mixed vaginitis than in patients with single vaginitis. Bacterial isolates of the vaginal secretions of patients with mixed bacterial vaginitis were mainly the pathogens of aerobic vaginitis and bacterial vaginosis, such as <jats:italic>Gardnerella vaginalis<\/jats:italic>, <jats:italic>Streptococcus anginosus<\/jats:italic>, and <jats:italic>Staphylococcus epidermidis.<\/jats:italic> Pathogen isolation of the vaginal secretions of patients with mixed fungus and bacteria vaginitis mainly included <jats:italic>Candida albicans<\/jats:italic>, followed by <jats:italic>S. anginosus<\/jats:italic>, <jats:italic>Enterococcus faecalis<\/jats:italic>, <jats:italic>Staphylococcus hemolyticus<\/jats:italic>, <jats:italic>Staphylococcus aureus<\/jats:italic>, <jats:italic>Streptococcus agalactiae<\/jats:italic> and <jats:italic>Staphylococcus simulans<\/jats:italic>. Women with mixed vaginitis had an increased incidence and risk of peripartum infections (6.1% <jats:italic>vs<\/jats:italic>. 1.4%, <jats:italic>P<\/jats:italic> &amp;lt;0.05; OR = 3.985, 95% CI:1.214\u201313.079). <jats:italic>Escherichia coli<\/jats:italic> is the main pathogen that causes peripartum infection. Mixed vaginitis in late pregnancy is characterized by a severe and complex phenotype, complex vaginal dysbiosis, and a long course of vaginal dysbiosis. This can lead to an increased incidence and risk of peripartum infection. Therefore, more attention should be paid to patients with mixed vaginitis in the third trimester of pregnancy.<\/jats:p>","DOI":"10.3389\/fcimb.2022.798738","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T23:15:12Z","timestamp":1648595712000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":20,"title":["Mixed Vaginitis in the Third Trimester of Pregnancy Is Associated With Adverse Pregnancy Outcomes: A Cross-Sectional Study"],"prefix":"10.3389","volume":"12","author":[{"given":"Huanrong","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengting","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjuan","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhui","family":"Qi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Teng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiyang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cha","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengxia","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"490","DOI":"10.3855\/jidc.3197","article-title":"Vaginal Infections Among Pregnant Women at Omdurman Maternity Hospital in Khartoum, Sudan","volume":"8","author":"Abdelaziz","year":"2014","journal-title":"J. Infect. Develop. Cntr."},{"key":"B2","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1186\/s12879-019-4549-3","article-title":"Bacterial Vaginosis, Vulvovaginal Candidiasis and Trichomonal Vaginitis Among Reproductive-Aged Women Seeking Primary Healthcare in Sana\u2019a City, Yemen","volume":"19","author":"Abdul-Aziz","year":"2019","journal-title":"BMC Infect. Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1996","DOI":"10.3390\/microorganisms8121996","article-title":"Maternal Microbiome and Infections in Pregnancy","volume":"8","author":"Amir","year":"2020","journal-title":"Microorganisms"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e499","DOI":"10.1111\/j.1439-0507.2010.01965.x","article-title":"Epidemiological Survey of Vulvovaginal Candidosis in Sfax, Tunisia","volume":"54","author":"Amouri","year":"2011","journal-title":"Mycoses"},{"key":"B5","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1111\/jicd.12048","article-title":"Secretory Products of Escherichia Coli Biofilm Modulate Candida Biofilm Formation and Hyphal Development","volume":"4","author":"Bandara","year":"2013","journal-title":"J. Invest. Clin. Dentist."},{"key":"B6","article-title":"Postpartum Infection","author":"Boushra","year":"2022"},{"key":"B7","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1097\/01.AOG.0000163247.78533.7b","article-title":"Higher-Risk Behavioral Practices Associated With Bacterial Vaginosis Compared With Vaginal Candidiasis","volume":"106","author":"Bradshaw","year":"2005","journal-title":"Obstetr. Gynecol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e61255","DOI":"10.1371\/journal.pone.0061255","article-title":"Enterococcus Faecalis Inhibits Superantigen Toxic Shock Syndrome Toxin-1-Induced Interleukin-8 From Human Vaginal Epithelial Cells Through Tetramic Acids","volume":"8","author":"Brosnahan","year":"2013","journal-title":"PloS One"},{"key":"B9","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1097\/OLQ.0b013e3182631c79","article-title":"Association Between Trichomonas Vaginalis and Vaginal Bacterial Community Composition Among Reproductive-Age Women","volume":"39","author":"Brotman","year":"2012","journal-title":"Sex. Transmit. Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1097\/OLQ.0000000000001066","article-title":"The Vaginal Microbiota and Behavioral Factors Associated With Genital Candida Albicans Detection in Reproductive-Age Women","volume":"46","author":"Brown","year":"2019","journal-title":"Sex. Transmit. Dis."},{"key":"B11","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1155\/S1064744995000391","article-title":"In Vitro Ability of the Group B Streptococci to Inhibit Gram-Positive and Gram-Variable Constituents of the Bacterial Flora of the Female Genital Tract","volume":"3","author":"Chaisilwattana","year":"1995","journal-title":"Infect. Dis. Obstetr. Gynecol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1186\/s12879-015-0813-3","article-title":"Prevalence of Early-Onset Neonatal Infection Among Newborns of Mothers With Bacterial Infection or Colonization: A Systematic Review and Meta-Analysis","volume":"15","author":"Chan","year":"2015","journal-title":"BMC Infect. Dis."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e150","DOI":"10.1097\/AOG.0000000000002046","article-title":"Committee Opinion No 700: Methods for Estimating the Due Date","volume":"129","year":"2017","journal-title":"Obstetr. Gynecol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"BSR20191575","DOI":"10.1042\/BSR20191575","article-title":"The Effect of Group B Streptococcus on Maternal and Infants\u2019 Prognosis in Guizhou, China","volume":"39","author":"Dai","year":"2019","journal-title":"Biosci. Rep."},{"key":"B15","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s12884-019-2230-x","article-title":"Determinants of Puerperal Sepsis Among Post Partum Women at Public Hospitals in West SHOA Zone Oromia Regional STATE, Ethiopia (Institution BASEDCASE Control Study)","volume":"19","author":"Demisse","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1437","DOI":"10.1055\/s-0039-1692718","article-title":"Chorioamnionitis and Infectious Complications After Vaginal Delivery","volume":"36","author":"DeNoble","year":"2019","journal-title":"Am. J. Perinatol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1016\/j.resmic.2017.04.004","article-title":"Aerobic Vaginitis: No Longer a Stranger","volume":"168","author":"Donders","year":"2017","journal-title":"Res. Microbiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e17751","DOI":"10.1097\/MD.0000000000017751","article-title":"Perinatal Outcome in Women With Bacterial Sepsis: A Cross-Sectional Study From West China","volume":"98","author":"Duan","year":"2019","journal-title":"Medicine"},{"key":"B19","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1007\/s00404-012-2571-4","article-title":"Aerobic Vaginitis and Mixed Infections: Comparison of Clinical and Laboratory Findings","volume":"287","author":"Fan","year":"2013","journal-title":"Arch. Gynecol. Obstetr."},{"key":"B20","doi-asserted-by":"publisher","first-page":"103849","DOI":"10.1016\/j.resmic.2021.103849","article-title":"Escherichia Coli Enhances the Virulence Factors of Candida Albicans, the Cause of Vulvovaginal Candidiasis, in a Dual Bacterial\/Fungal Biofilm","volume":"172","author":"Farrokhi","year":"2021","journal-title":"Res. Microbiol."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.649940","article-title":"Protozoan-Viral-Bacterial Co-Infections Alter Galectin Levels and Associated Immunity Mediators in the Female Genital Tract","volume":"11","author":"Fichorova","year":"2021","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1128\/IAI.68.2.651-657.2000","article-title":"Effects of Reproductive Hormones on Experimental Vaginal Candidiasis","volume":"68","author":"Fidel","year":"2000","journal-title":"Infect. Immun."},{"key":"B23","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.bjid.2012.10.026","article-title":"Gardnerella Vaginalis-Associated Bacterial Vaginosis in Bulgarian Women","volume":"17","author":"Gergova","year":"2013","journal-title":"Braz. J. Infect. Dis: an Off. Publ. Braz. Soc. Infect. Dis."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e1006238","DOI":"10.1371\/journal.ppat.1006238","article-title":"Transient Microbiota Exposures Activate Dormant Escherichia Coli Infection in the Bladder and Drive Severe Outcomes of Recurrent Disease","volume":"13","author":"Gilbert","year":"2017","journal-title":"PloS Pathog."},{"key":"B25","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/s0029-7844(99)00577-3","article-title":"Vaginal Colonization by Candida in Asymptomatic Women With and Without a History of Recurrent Vulvovaginal Candidiasis","volume":"95","author":"Giraldo","year":"2000","journal-title":"Obstetr. Gynecol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1159\/000316051","article-title":"Vaginal Flora Alterations and Clinical Symptoms in Low-Risk Pregnant Women","volume":"71","author":"Gondo","year":"2011","journal-title":"Gynecol. Obstetr. Invest."},{"key":"B27","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/0020-7292(96)02744-0","article-title":"Bacterial Vaginosis and Associated Infections in Pregnancy","volume":"55","author":"Govender","year":"1996","journal-title":"Int. J. Gynaecol Obstetr.: Off. Organ Int. Fed. Gynaecol Obstetr."},{"key":"B28","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1016\/j.tem.2021.04.014","article-title":"Gut and Vaginal Microbiomes on Steroids: Implications for Women\u2019s Health","volume":"32","author":"Graham","year":"2021","journal-title":"Trends Endocrinol. Metabol.: TEM"},{"key":"B29","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1007\/s10096-018-3416-2","article-title":"Aerobic Vaginitis in Late Pregnancy and Outcomes of Pregnancy","volume":"38","author":"Han","year":"2019","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis: Off. Publ. Eur. Soc. Clin. Microbiol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1093\/cid\/ciaa260","article-title":"Diagnosis and Treatment of Vaginal Discharge Syndromes in Community Practice Settings","volume":"72","author":"Hillier","year":"2021","journal-title":"Clin. Infect. Dis: Off. Publ. Infect. Dis. Soc. Am."},{"key":"B31","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1139\/m88-042","article-title":"Interaction of Candida Albicans With Genital Mucosa: Effect of Sex Hormones on Adherence of Yeasts In Vitro","volume":"34","author":"Kalo","year":"1988","journal-title":"Can. J. Microbiol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.ejogrb.2004.11.030","article-title":"Vaginitis in Turkish Women: Symptoms, Epidemiologic - Microbiologic Association","volume":"121","author":"Karaer","year":"2005","journal-title":"Eur. J. Obstetrics Gynecol. Reprod. Biol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1111\/jmwh.12119","article-title":"Puerperal Infections of the Genital Tract: A Clinical Review","volume":"58","author":"Karsnitz","year":"2013","journal-title":"J. Midwifery Women\u2019s Health"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1097\/AOG.0000000000003776","article-title":"Trichomonas Vaginalis in Pregnancy: Patterns and Predictors of Testing, Infection, and Treatment","volume":"135","author":"Kim","year":"2020","journal-title":"Obstetr. Gynecol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.ejogrb.2010.06.020","article-title":"Reducing the Rate of Preterm Birth Through a Simple Antenatal Screen-and-Treat Programme: A Retrospective Cohort Study","volume":"153","author":"Kiss","year":"2010","journal-title":"Eur. J. Obstetr. Gynecol. Reprod. Biol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1111\/1471-0528.12892","article-title":"Maternal Sepsis Incidence, Aetiology and Outcome for Mother and Fetus: A Prospective Study","volume":"122","author":"Knowles","year":"2015","journal-title":"BJOG: an Int. J. Obstetr. Gynaecol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1097\/00006199-198611000-00017","article-title":"Determination and Quantification of Content Validity","volume":"35","author":"Lynn","year":"1986","journal-title":"Nurs. Res."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1922","DOI":"10.1093\/infdis\/jit100","article-title":"Unique Vaginal Microbiota That Includes an Unknown Mycoplasma-Like Organism is Associated With Trichomonas Vaginalis Infection","volume":"207","author":"Martin","year":"2013","journal-title":"J. Infect. Dis."},{"key":"B39","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/S0301-2115(98)00141-9","article-title":"Meconium Stained Amniotic Fluid in Preterm Delivery Is an Independent Risk Factor for Perinatal Complications","volume":"81","author":"Mazor","year":"1998","journal-title":"Eur. J. Obstetr. Gynecol Reprod. Biol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1186\/1756-0500-7-822","article-title":"Prevalence of Bacterial Vaginosis Among Pregnant Women Attending Antenatal Care in Tikur Anbessa University Hospital, Addis Ababa, Ethiopia","volume":"7","author":"Mengistie","year":"2014","journal-title":"BMC Res. Notes"},{"key":"B41","doi-asserted-by":"publisher","first-page":"232","DOI":"10.3906\/sag-1208-33","article-title":"Prevalence Study of Genital Tract Infections in Pregnant Women Referred to Health Centers in Iran","volume":"44","author":"Mobasheri","year":"2014","journal-title":"Turkish J. Med. Sci."},{"key":"B42","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1038\/nri.2017.64","article-title":"The Unique Immunological and Microbial Aspects of Pregnancy","volume":"17","author":"Mor","year":"2017","journal-title":"Nat. Rev. Immunol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s12905-015-0197-y","article-title":"Common Causes of Vaginal Infections and Antibiotic Susceptibility of Aerobic Bacterial Isolates in Women of Reproductive Age Attending at Felegehiwot Referral Hospital, Ethiopia: A Cross Sectional Study","volume":"15","author":"Mulu","year":"2015","journal-title":"BMC Women\u2019s Health"},{"key":"B44","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1034\/j.1600-0463.2001.d01-116.x","article-title":"The Effect of Oral Bacteria on Candida Albicans Germ-Tube Formation","volume":"109","author":"Nair","year":"2001","journal-title":"APMIS: Acta Pathol. Microbiol. Immunol. Scand."},{"key":"B45","doi-asserted-by":"publisher","first-page":"817092","DOI":"10.1155\/2015\/817092","article-title":"Clinicoetiological Characterization of Infectious Vaginitis Amongst Women of Reproductive Age Group From Navi Mumbai, India","volume":"2015","author":"Narayankhedkar","year":"2015","journal-title":"J. Sex. Transmit. Dis."},{"key":"B46","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1128\/IAI.01059-15","article-title":"Morphology-Independent Virulence of Candida Species During Polymicrobial Intra-Abdominal Infections With Staphylococcus Aureus","volume":"84","author":"Nash","year":"2016","journal-title":"Infect Immun."},{"key":"B47","doi-asserted-by":"publisher","first-page":"738298","DOI":"10.1155\/2014\/738298","article-title":"Mannose-Binding Lectin Codon 54 Gene Polymorphism and Vulvovaginal Candidiasis: A Systematic Review and Meta-Analysis","volume":"2014","author":"Nedovic","year":"2014","journal-title":"BioMed. Res. Int."},{"key":"B48","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.ijgo.2013.08.023","article-title":"A Clinical Review of Maternal Bacteremia","volume":"124","author":"O\u2019Higgins","year":"2014","journal-title":"Int. J. Gynaecol. Obstetr.: Off. Organ Int. Fed. Gynaecol. Obstetr."},{"key":"B49","doi-asserted-by":"publisher","first-page":"2178","DOI":"10.1128\/IAI.00265-13","article-title":"Candida Albicans-Staphylococcus Aureus Polymicrobial Peritonitis Modulates Host Innate Immunity","volume":"81","author":"Peters","year":"2013","journal-title":"Infect Immun."},{"key":"B50","doi-asserted-by":"publisher","first-page":"2975","DOI":"10.1099\/mic.0.062109-0","article-title":"Staphylococcus Aureus Adherence to Candida Albicans Hyphae Is Mediated by the Hyphal Adhesin Als3p","volume":"158","author":"Peters","year":"2012","journal-title":"Microbiol. (Readi. Engl.)"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.759795","article-title":"Recent Advances in Presentation, Diagnosis and Treatment for Mixed Vaginitis","volume":"11","author":"Qi","year":"2021","journal-title":"Front. Cell. Infect Microbiol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1097\/OLQ.0b013e31820fc3b8","article-title":"Prevalence of Bacterial Vaginosis and Vulvovaginal Candidiasis Mixed Infection in a Southeastern American STD Clinic","volume":"38","author":"Rivers","year":"2011","journal-title":"Sex. Transmit. Dis."},{"key":"B53","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.yhbeh.2012.02.023","article-title":"Pregnancy and Pregnancy-Associated Hormones Alter Immune Responses and Disease Pathogenesis","volume":"62","author":"Robinson","year":"2012","journal-title":"Horm. Behav."},{"key":"B54","doi-asserted-by":"publisher","first-page":"775","DOI":"10.3109\/14767058.2013.844124","article-title":"Bacteria and Endotoxin in Meconium-Stained Amniotic Fluid at Term: Could Intra-Amniotic Infection Cause Meconium Passage","volume":"27","author":"Romero","year":"2014","journal-title":"J. Maternal-Fetal Neonatal Med.: Off. J. Eur. Assoc. Perinatal. Med. Fed. Asia Oceania Perinatal Soc. Int. Soc. Perinatal Obstet."},{"key":"B55","doi-asserted-by":"publisher","first-page":"18358","DOI":"10.1038\/s41598-020-74655-z","article-title":"Vaginal Microbiota Evaluation and Prevalence of Key Pathogens in Ecuadorian Women: An Epidemiologic Analysis","volume":"10","author":"Salinas","year":"2020","journal-title":"Sci. Rep."},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.01033","article-title":"Estrogen Receptor-Alpha (ESR1) Governs the Lower Female Reproductive Tract Vulnerability to Candida Albicans","volume":"9","author":"Salinas-Mu\u00f1oz","year":"2018","journal-title":"Front. Immunol."},{"key":"B57","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/0029-7844(96)00233-5","article-title":"Validity of the Vaginal Gram Stain for the Diagnosis of Bacterial Vaginosis","volume":"88","author":"Schwebke","year":"1996","journal-title":"Obstetr. Gynecol"},{"key":"B58","doi-asserted-by":"publisher","first-page":"1632","DOI":"10.1086\/315065","article-title":"Correlation of Behaviors With Microbiological Changes in Vaginal Flora","volume":"180","author":"Schwebke","year":"1999","journal-title":"J. Infect. Dis."},{"key":"B59","first-page":"293","article-title":"Prevalence of Vaginitis Among Pregnant Women Attending Paropakar Maternity and Women\u2019s Hospital, Thapathali, Kathmandu, Nepal","volume":"13","author":"Shrestha","year":"2011","journal-title":"Nepal Med. Coll. J.: NMCJ"},{"key":"B60","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1007\/s11908-013-0325-5","article-title":"Mixed Vaginitis-More Than Coinfection and With Therapeutic Implications","volume":"15","author":"Sobel","year":"2013","journal-title":"Curr. Infect. Dis. Rep."},{"key":"B61","doi-asserted-by":"publisher","first-page":"e23047","DOI":"10.1002\/jcla.23047","article-title":"Risk Factors, Changes in Serum Inflammatory Factors, and Clinical Prevention and Control Measures for Puerperal Infection","volume":"34","author":"Song","year":"2020","journal-title":"J. Clin. Lab. Anal."},{"key":"B62","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1128\/AAC.47.4.1308-1312.2003","article-title":"Bactericidal Activities of Methoxyfluoroquinolones Gatifloxacin and Moxifloxacin Against Aerobic and Anaerobic Respiratory Pathogens in Serum","volume":"47","author":"Stein","year":"2003","journal-title":"Antimicrob. Agents Chemother."},{"key":"B63","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1055\/s-0036-1585467","article-title":"Midtrimester Cervicovaginal Microbiota: Identification of Microbial Variations Associated With Puerperal Infection at Term","volume":"33","author":"Subramaniam","year":"2016","journal-title":"Am. J. Perinatol."},{"key":"B64","doi-asserted-by":"publisher","first-page":"e20732","DOI":"10.1097\/MD.0000000000020732","article-title":"Characterization of Aerobic Vaginitis in Late Pregnancy in a Chinese Population: A STROBE-Compliant Study","volume":"99","author":"Tang","year":"2020","journal-title":"Medicine"},{"key":"B65","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1111\/j.1600-0643.2007.00735.x","article-title":"Dietary Sugars, Serum and the Biocide Chlorhexidine Digluconate Modify the Population and Structural Dynamics of Mixed Candida Albicans and Escherichia Coli Biofilms","volume":"115","author":"Thein","year":"2007","journal-title":"APMIS: Acta Pathologica Microbiologica Immunologica Scandinavica"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.00910-19","article-title":"Candida Albicans Augments Staphylococcus Aureus Virulence by Engaging the Staphylococcal Agr Quorum Sensing System","volume":"10","author":"Todd","year":"2019","journal-title":"mBio"},{"key":"B67","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.11150\/kansenshogakuzasshi1970.69.1348","article-title":"Effects of the Prevotella Intermedia Culture Filtrate and Short-Chain Fatty Acids on Human Polymorphonuclear Neutrophil Functions","volume":"69","author":"Touyama","year":"1995","journal-title":"Kansenshogaku zasshi J. Jpn. Assoc. Infect. Dis."},{"key":"B68","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1067\/S0002-9378(03)00767-1","article-title":"Meconium-Stained Amniotic Fluid Is Associated With Puerperal Infections","volume":"189","author":"Tran","year":"2003","journal-title":"Am. J. Obstetr. Gynecol"},{"key":"B69","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1007\/s10096-019-03538-7","article-title":"Comparison of Amsel Criteria, Nugent Score, Culture and Two CE-IVD Marked Quantitative Real-Time PCRs With Microbiota Analysis for the Diagnosis of Bacterial Vaginosis","volume":"38","author":"van den Munckhof","year":"2019","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis: Off. Publ. Eur. Soc. Clin. Microbiol."},{"key":"B70","doi-asserted-by":"publisher","first-page":"115431","DOI":"10.1016\/j.diagmicrobio.2021.115431","article-title":"Developing an Algorithm for the Diagnosis of Abnormal Vaginal Discharge in a Dutch Clinical Setting: A Pilot Study","volume":"101","author":"van den Munckhof","year":"2021","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"B71","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1097\/LGT.0000000000000595","article-title":"The International Society for the Study of Vulvovaginal Disease Vaginal Wet Mount Microscopy Guidelines: How to Perform, Applications, and Interpretation","volume":"25","author":"Vieira-Baptista","year":"2021","journal-title":"J. Lower Genital. Tract Dis."},{"key":"B72","first-page":"113","article-title":"An Epidemiological Study on Vaginitis in 6,150 Women of Reproductive Age in Shanghai","volume":"40","author":"Wang","year":"2017","journal-title":"New Microbiologica"},{"key":"B73","volume-title":"WHO Recommendations for Prevention and Treatment of Maternal Peripartum Infections","year":"2015"},{"key":"B74","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","article-title":"Sex. Transmit. Infections Treatment Guidelines, 2021","volume":"70","author":"Workowski","year":"2021","journal-title":"MMWR Recomm. Rep"},{"key":"B75","first-page":"1","article-title":"Sex. Transmit. Diseases Treatment Guidelines, 2015","volume":"64","author":"Workowski","year":"2015","journal-title":"MMWR Recommendations Reports: Morbidity Mortality weekly Rep. Recommendations Rep."},{"key":"B76","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.587235","article-title":"Pathogenic Effect of Prevotella Intermedia on a Mouse Pneumonia Model Due to Methicillin-Resistant Staphylococcus Aureus With Up-Regulated \u03b1-Hemolysin Expression","volume":"11","author":"Yamashita","year":"2020","journal-title":"Front. Microbiol."},{"key":"B77","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2018.00198","article-title":"Streptococcus Agalactiae Inhibits Candida Albicans Hyphal Development and Diminishes Host Vaginal Mucosal TH17 Response","volume":"9","author":"Yu","year":"2018","journal-title":"Front. Microbiol."},{"key":"B78","doi-asserted-by":"publisher","first-page":"9703754","DOI":"10.1155\/2018\/9703754","article-title":"Risk Factors of Vulvovaginal Candidiasis Among Women of Reproductive Age in Xi\u2019an: A Cross-Sectional Study","volume":"2018","author":"Zeng","year":"2018","journal-title":"BioMed. Res. Int."},{"key":"B79","doi-asserted-by":"publisher","first-page":"e11891","DOI":"10.1097\/MD.0000000000011891","article-title":"Association of Gestational Diabetes Mellitus and Abnormal Vaginal Flora With Adverse Pregnancy Outcomes","volume":"97","author":"Zhang","year":"2018","journal-title":"Medicine"}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2022.798738\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T23:15:20Z","timestamp":1648595720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2022.798738\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,28]]},"references-count":79,"alternative-id":["10.3389\/fcimb.2022.798738"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2022.798738","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,28]]},"article-number":"798738"}}