- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02459665
Rwanda Vaginal Microbiota Restoration Study (VMB)
Preparing for a Clinical Trial of Interventions to Maintain Normal Vaginal Microbiota for Preventing Adverse Reproductive Health Outcomes in Africa
Study Overview
Status
Conditions
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Sexually active, defined as having had sex at least twice in the two weeks prior to screening
- At high risk of HIV/STIs/BV, defined as having had more than one sexual partner in the last 12 months OR having been treated for an STI and/or BV in the last 12 months
- Successfully treated for BV (modified Amsel criteria) or TV (wet mount), and free of STIs, symptomatic vaginal candidiasis and UTI at enrollment
- Currently in good physical and mental health as judged by a study physician
- Willing and able to adhere to study procedures and provide written informed consent.
Exclusion Criteria:
- Pregnant
- HIV positive
- Clinician-observed genital ulcers, condylomata, or other genital abnormalities at screening or enrollment
- Underwent a gynaecological surgery/invasive procedure in the 3 months prior to screening
- History of significant urogenital prolapse, undiagnosed vaginal bleeding, urine or faecal incontinence, or blood clotting disorders
- Allergic to metronidazole or any other components of the study drugs
- Not willing to stop use of other oral or vaginal probiotics from the screening visit until the end of study participation
- Participating in another health intervention study
- For any other reason potentially interfering with participant safety or protocol adherence as judged by the Principal Investigator
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Group 1
Negative control group: After initial treatment for BV/TV, no intervention.
|
|
Other: Group 2
Positive control group: After initial treatment for BV/TV, metronidazole pills (500 mg) twice per week for 2 months.
|
Prophylactic use of metronidazole pills to prevent BV recurrence after metronidazole treatment for BV or TV
Other Names:
|
Active Comparator: Group 3
After initial treatment for BV/TV, Ecologic Femi+ vaginal capsule (a vaginal probiotic) once per day for 5 days immediately after the initial treatment followed by thrice weekly for two months.
|
Vaginal probiotic to restore the vaginal microbiome and prevent BV recurrence after metronidazole treatment for BV or TV
Other Names:
|
Active Comparator: Group 4
After initial treatment for BV/TV, Gynophilus LP vaginal tablet (a vaginal probiotic) once every 4 days for two months.
|
Vaginal probiotic to restore the vaginal microbiome and prevent BV recurrence after metronidazole treatment for BV or TV
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Bacterial Vaginosis (BV) Incidence by Modified Amsel Criteria
Time Frame: 2 months (intervention period)
|
Modified Amsel criteria positive is at least 2 of 3 of the following positive: clue cells, vaginal pH, whiff test. Modified intent-to-treat (ITT) analyses (women with Nugent 7-10 at enrollment excluded), using person-years (PY) at risk as denominator of each incidence rate. |
2 months (intervention period)
|
Bacterial Vaginosis (BV) Incidence by Nugent Scoring (Nugent 7-10)
Time Frame: 2 months (intervention period)
|
The Nugent score is a scale from 0-10 based on visualisation of three different bacterial morphotypes on a Gram stained slide, but in the incidence rates, the variable was used as a binary variable: BV present (Nugent score 7-10) or absent (Nugent score 0-6).
Modified intent-to-treat (ITT) analyses (women with Nugent 7-10 at enrollment excluded), using person-years (PY) at risk as the denominator for each incidence rate.
|
2 months (intervention period)
|
Trichomonas Vaginalis (TV) Incidence by Culture
Time Frame: 2 months (intervention period)
|
A swab was inoculated into an InPouch culture pouch, specifically designed for TV growth. The pouch was checked daily for five days to detect growth. The results was positive when growth detected and negative when no growth detected on the fifth day. Intent-to-treat (ITT) analyses, using person-years (PY) at risk as the denominator for each incidence rate. |
2 months (intervention period)
|
Vaginal Candidiasis Incidence by Wet Mount Microscopy
Time Frame: 6 months: 2 months intervention period plus 4 months after intervention cessation
|
A wet mount is a smear of vaginal fluid on a microscopy slide, which is examined under a microscope.
Yeasts are visible without staining.
The definition of vaginal candidiasis was any yeast visible on the wet mount.
Symptomatic vaginal candidiasis was considered a safety outcome because treatment of bacterial vaginosis often results in vaginal candidiasis.
Intent-to-treat (ITT) analysis with person-years (PY) at risk as the denominator of all incidence rates.
|
6 months: 2 months intervention period plus 4 months after intervention cessation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Vaginal Microbiota Composition by Illumina HiSeq Sequencing: Lactobacillus Genus Concentration
Time Frame: 2 months (intervention period)
|
The vaginal microbiota sequencing results are exploratory and full data can be found in a manuscript on the BioRxiv preprint server.
The most important outcome is the concentration of Lactobacillus genus in vaginal samples taken at the end of the intervention period (M2 visit).
|
2 months (intervention period)
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility/Acceptability of Vaginal Probiotic Use by Structured Face-to-face Interview
Time Frame: 2 months (intervention period)
|
Full results have been submitted for publication.
Adherence was measured at D7, M1, and M2 visits, and a summary measure over the entire period was calculated (available for women using oral metronidazole, Ecologic Femi+, or Gynophilus LP).
After the 2-month intervention period, women using vaginal probiotics (Ecologic Femi+ or Gynophilus LP) were asked structured questions about their experiences with product use.
|
2 months (intervention period)
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Chair: Janneke H van de Wijgert, PhD, University of Liverpool
Publications and helpful links
General Publications
- Verwijs MC, Agaba S, Umulisa MM, van de Wijgert JHHM. Feasibility and acceptability of frequent vaginal self-sampling at home by Rwandan women at high risk of urogenital tract infections. Sex Transm Infect. 2022 Feb;98(1):58-61. doi: 10.1136/sextrans-2020-054816. Epub 2021 Jan 29.
- Verwijs MC, Agaba S, Umulisa MM, Uwineza M, Nivoliez A, Lievens E, van de Wijgert JHHM. Vaginal probiotic adherence and acceptability in Rwandan women with high sexual risk participating in a pilot randomised controlled trial: a mixed-methods approach. BMJ Open. 2020 May 19;10(5):e031819. doi: 10.1136/bmjopen-2019-031819.
- Verwijs MC, Agaba SK, Darby AC, van de Wijgert JHHM. Impact of oral metronidazole treatment on the vaginal microbiota and correlates of treatment failure. Am J Obstet Gynecol. 2020 Feb;222(2):157.e1-157.e13. doi: 10.1016/j.ajog.2019.08.008. Epub 2019 Aug 9.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- RETH000828
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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