Interpretation
Mixed vaginitis refers to a vaginitis that combines two or more
pathogens that cause AV, BV, VVC, and TV(2). The interaction
between fungi and bacteria can mutually promote the colonization and
virulence of pathogens (28). C.albicans (VVC pathogen) adhesion
proteins, hyphal wall proteins, and transcriptional regulators play a
crucial role in the interaction between C.albicans andStaphylococcus (AV pathogen)(29, 30). The mouse model of mixed
infection of GBS and C.albicans confirmed that GBS could also
promote the adhesion and colonization of C.albicans , while
reducing the cellular immune response and host immune clearance rate of
helper T cell 17 (Th17), ensuring the persistently chronic infection of
the two(31). C.albicans can
combine with a variety of streptococci and staphylococci(AV pathogen) to help them adhere and form biofilms(30). The
dual-species biofilm formed can provide nutrients for pathogens to
reproduce, and protect microorganisms from being eliminated by
antimicrobial agents, further maintaining the pathogenic ability of
pathogens(30, 32-37).The interaction between aerobic and
anaerobic bacteria can promote biofilm formation and participate in the
pathogenic process. In vitro experiments have confirmed thatEscherichia coli and Enterococcus faecalis (AV pathogens)
coexist and interact with Gardnerella vaginalis (BV pathogen) to
participate in the formation of BV biofilms (38). Therefore, the
interaction between fungi and bacteria and between bacteria and bacteria
is very important for the pathogenic processes of mixed vaginitis.
Immunity is reduced during pregnancy. The host’s ability to suppress
pathogens is reduced. Mixed vaginitis during pregnancy may be more
serious and complicated. The existence of multi-species biofilms in the
vagina of pregnant women is related to the occurrence of adverse
outcomes. This may come from the upward spread of biofilms, but the
mechanism still needs further research.