Should male consorts of women with bacterial vaginosis be treated?

Nitroimidazoles have been shown to be the drugs of choice to treat women with bacterial vaginosis, but the recurrence rate is high. Some workers have suggested that the recurrence of symptoms may in fact be reinfection by male consorts, but no controlled studies have been undertaken to confirm this. In an international, multicentre, randomised, double blind trial, the recurrence rate was studied in 241 women with a clinical diagnosis of bacterial vaginosis. All women were treated with 2 g metronidazole twice at an interval of two days. The patients were randomly allocated to two groups, one contained 123 women, whose consorts were given the same dose of metronidazole, the other consisted of 118 women whose consorts were given inert but identical placebo tablets. The women were evaluated at weeks 1, 4, and 12 after treatment. At week 1, the cure rate was 97% (115/119) in women whose consorts had been treated and 98% (111/113) in the others. At week 4 bacterial vaginosis had recurred in 17% (19/112) of women whose consorts had been treated and in 13% (14/106) of those whose consorts had received placebo. At week 12 the recurrence rates were 21% (20/95) in women with treated consorts, and 16% (15/95) in the others. The differences in recurrence rates between the two groups of women were not significant. In conclusion, treating the sexual partners of women with bacterial vaginosis does not seem to increase the cure rate.     

When is bacterial vaginosis not bacterial vaginosis?--a case of cervical carcinoma presenting as recurrent vaginal anaerobic infection.

Vaginal anaerobic infection is the most common cause of vaginal discharge in women. We present a case of recurrent vaginal anaerobic infection and cervical carcinoma and discuss the association of the two conditions. More frequent cytology/colposcopy may be indicated in women who give a history of recurrent or persistent vaginal anaerobic infection.     

Predictors of bacterial vaginosis in adolescent women who douche

OBJECTIVE: Risk factors for bacterial vaginosis (BV) include douching and sexual activity, although the exact cause of BV is unknown. GOAL: The goal of this study was to determine the relative significance of douching as a risk factor for BV. STUDY DESIGN: Two hundred fifty adolescent women who regularly douched were enrolled into a randomized douching intervention trial. Behavioral questionnaires and testing for sexually transmitted diseases and BV were performed. Associations between baseline characteristics and behaviors were compared for teens who were BV-positive and BV-negative at baseline. RESULTS: Positive correlates of BV included multiple partners, recent sexual intercourse, douching after menses, recent douching, and gonorrhea. Of these, douching after menses showed the strongest association (odds ratio, 5.11; 95% confidence interval, 1.99-13.15) in a multivariate analysis. CONCLUSIONS: Douching after menses was strongly correlated with BV; however, difficulty remains in trying to evaluate douching and sexual behavior independently.     

Vaginal douching and development of bacterial vaginosis among women with normal and abnormal vaginal microflora

OBJECTIVES: To evaluate the relationship between douching and bacterial vaginosis (BV) among women with and without prior abnormal vaginal flora. STUDY DESIGNS: 1193 women had vaginal swabs obtained for Gram stain for BV, culture for vaginal microflora, and DNA amplification for Neisseria gonorrhoeae and Chlamydia trachomatis at baseline and 6, 12, 24, and 36 months. Self-reported douching was queried every 6 months. RESULTS: In cross-sectional analyses, douching at least once per month was associated with BV among women who had BV at the immediately preceding visit but not among women with normal or intermediate flora. In prospective analyses, douching increased the risk of acquisition for BV among women with intermediate flora (adj. HR 1.5, 95% CI 1.1-2.4) but not among women with normal flora. CONCLUSIONS: Douching appeared to be associated with BV among women with already imbalanced flora but not among women with normal flora.     

Vaginal leucocyte counts in women with bacterial vaginosis: relation to vaginal and cervical infections

OBJECTIVES: To evaluate whether an elevated vaginal leucocyte count in women with bacterial vaginosis (BV) predicts the presence of vaginal or cervical infections, and to assess the relation of vaginal WBC counts to clinical manifestations. METHODS: We retrospectively analysed the relation of vaginal leucocyte counts to vaginal and cervical infections and to clinical manifestations in non-pregnant women diagnosed with BV at an STD clinic visit. RESULTS: Of 296 women with BV studied, the median age was 24 years and 81% were African-American. Elevated vaginal leucocyte counts were associated with objective signs of vaginitis and cervicitis and also predicted candidiasis (OR 7.9, 95% CI 2.2 to 28.9), chlamydia (OR 3.1, 95% CI 1.4 to 6.7), gonorrhoea (OR 2.7, 95% CI 1.3 to 5.4), or trichomoniasis (OR 3.4, 95% CI 1.6 to 7.3). In general, as a screening test for vaginal or cervical infections, vaginal leucocyte count had moderate sensitivities and specificities, low positive predictive values, and high negative predictive values. CONCLUSIONS: An elevated vaginal leucocyte count in women with BV was a strong predictor of vaginal or cervical infections. Vaginal leucocyte quantification may provide an alternative approach to assessing need for empirical therapy for chlamydia and gonorrhoea, particularly in resource-limited high STD risk settings that provide syndromic management.     

Treatment of bacterial vaginosis with lactobacilli.

60 women with bacterial vaginosis were entered into a double blind, placebo-controlled treatment trial with lyophilized Lactobacillus acidophilus. The lactobacilli used were producing H2O2. Immediately after completion of treatment, 16 out of 28 women who were treated with lactobacilli had normal vaginal wet smear results, in comparison to none of the 29 women treated with placebo. All women harboured Bacteroides at inclusion. Bacteroides was eliminated from the vagina of 12 out of 16 healthy women after treatment. Only three of the women who received the Lactobacillus suppository were free of bacterial vaginosis after the subsequent menstruation.     

Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting

OBJECTIVES: High prevalence of bacterial vaginosis (BV) has been reported in lesbians but most studies were based in sexually transmitted infection clinic settings; therefore, we wished to determine the prevalence and risk factors of BV in lesbians and heterosexual women in a community setting in the UK. METHODS: A cross-sectional study recruiting lesbian women volunteers from community groups, events, clubs and bars. Heterosexual women were recruited from a community family planning clinic. They self-swabbed to create a vaginal smear, which was Gram-stained and categorised as BV, intermediate or normal flora. They completed a questionnaire about age, ethnic group, smoking, genital hygiene practices and sexual history. RESULTS: Of 189 heterosexuals and 171 lesbians recruited, 354 had gradeable flora. BV was identified in 43 (25.7%) lesbians and 27 (14.4%) heterosexuals (adjusted OR 2.45, 95% CI 1.25 to 4.82; p = 0.009). Concordance of vaginal flora within lesbian partnerships was significantly greater than expected (27/31 (87%) couples, kappa = 0.63; p<0.001). Smoking significantly increased the risk of BV regardless of sexuality (adjusted OR 2.65; p = 0.001) and showed substantial concordance in lesbian partnerships but less than for concordance of flora. CONCLUSIONS: Women who identified as lesbians have a 2.5-fold increased likelihood of BV compared with heterosexual women. The prevalence is slightly lower than clinic-based studies and as volunteers were recruited in community settings, this figure may be more representative of lesbians who attend gay venues. Higher concordance of vaginal flora within lesbian partnerships may support the hypothesis of a sexually transmissible factor or reflect common risk factors such as smoking.     

Longitudinal association between hormonal contraceptives and bacterial vaginosis in women of reproductive age

OBJECTIVES: This study examined whether hormonal contraceptive use is associated with diagnosis of bacterial vaginosis (BV) over 1 year.STUDY DESIGN: A total of 3,077 women of reproductive age were recruited from gynecologic and family planning clinics for a 1-year prospective longitudinal study. Data collected over 5 visits included demographics, health and hygiene behaviors, and gynecological exams. Gram stains were used to quantify vaginal flora.RESULTS: There was a decreased risk of overall BV prevalence among oral contraceptive users (odds ratio, OR 0.76; confidence interval, CI 0.63-0.90) and among those using hormonal injection/implant (OR 0.64; CI 0.53-0.76). An increased risk for BV prevalence (OR 1.38; CI 1.11-1.71) and incidence (OR 1.43; 1.02-2.07) was observed among those subjects who had tubal ligation. Greater remission of BV was found among those using hormonal injection or implant (OR 1.67; CI 1.23-2.27) whereas less remission occurred among those subjects who had tubal ligation (OR 0.56; CI 0.39-0.80).CONCLUSIONS: Hormonal contraceptive use is associated with a decreased risk of BV.     

Prevalence of Mobiluncus spp among women with and without bacterial vaginosis as detected by polymerase chain reaction

BACKGROUND: Mobiluncus spp are highly associated with bacterial vaginosis, but their role in its pathogenesis is unknown. The authors used polymerase chain reaction (PCR) to compare the prevalence of Mobiluncus in women with and without bacterial vaginosis. GOAL: To compare the prevalence of Mobiluncus spp among women with and without bacterial vaginosis and to compare the sensitivities of PCR and Gram stain for detection. STUDY DESIGN: Vaginal specimens from 74 women were analyzed by PCR and Gram stain for the presence of Mobiluncus spp. Comparisons were made between the prevalence of this organism between the two cohorts and between the Gram stain and PCR detection methods. RESULTS: Mobiluncus was detected by PCR in 84.5% of women with bacterial vaginosis and in 38% of women without infection. M curtisii was rarely detected in the latter group, though it was found in 65.3% of women with bacterial vaginosis. The sensitivity and specificity of Gram stain compared with PCR were 46.9% and 100%, respectively. CONCLUSIONS: Mobiluncus is more common in healthy women than previously suspected, with M mulieris as the predominant species. The significant difference in the prevalence of M curtisii between women with bacterial vaginosis and uninfected women suggests that this species could be involved in the pathogenesis of bacterial vaginosis.     

Vaginal swabs versus lavage for detection of Trichomonas vaginalis and bacterial vaginosis among HIV-positive women

OBJECTIVES: Cervicovaginal lavage (CVL) is often used for research and may be easier and more accurate than vaginal swabs as a specimen collection method. GOAL: The goal of this study was to compare (CVL) with vaginal swabs for the detection of bacterial vaginosis (BV) and Trichomonas vaginalis (TV). STUDY: CVL and vaginal swabs were collected from 216 HIV-infected women. Clinical assessments were made using wet mount for TV and Amsel's criteria for BV through CVL and swab collection methods. Laboratory gold standards used were Nugent's criteria for BV and InPouch (Biomed Diagnostics, San Jose, CA) culture for TV collected by swab. RESULTS: The prevalence by gold standards for BV was 49.3% and for TV was 25.2%. Sensitivities for direct microscopy versus culture for TV were 72.2 for CVL and 52.8 for vaginal swab (P <0.05). Sensitivities for Amsel's versus Nugent's criteria for BV were 36.2 for CVL and 34.0 for vaginal swab (P <0.80). Kappa scores of agreement between CVL and vaginal swabs for BV and TV were excellent for both. CONCLUSION: CVL was comparable to vaginal swabs as a specimen collection method for these 2 lower genital tract infections and may be superior for the diagnosis of TV.     

细菌性阴道病临床表现特征及其与解脲支原体的关系研究

目的:分析细菌性阴道病患者临床表现特征,探讨其与解脲支原体(Uu)的关系。方法:400例疑为细菌性阴道病患者入院时均对外阴、宫颈和阴道粘膜进行检查,采集阴道分泌物。依据阴道状况及分泌物情况对患者进行诊断,将其分为BV组和健康人群组。比较两组阴道临床症状特征和微生态(细菌培养情况及菌群密集度)特征,并进行解脲支原体培养,分析其与BV的关系。结果:250例细菌性阴道病患者主要临床症状:白带异味患者127例,占50.8%;发作时间14天至2年半,平均发作时间(3±6.1)月;白带增多者84例,占33.6%;外阴瘙痒者70例,占28%;64例无明显症状,占25.6%。阴道分泌物检查表明,186例(74.4%)分泌物呈均匀稀薄状,235例(94.0%)阴道pH值高于4.5,所有患者线索细胞呈阳性;139例(55.6%)氨性实验成阳性。与健康人群相比,BV组的pH值、Nugent评分、白带异味、白带增多、无显著症状、均质稀薄分泌物、阴道pH值高于4.5、氨性实验阳性(%)、线索细胞阳性比例患者百分比显著高于健康人群(P<0.05)。BV患者沙眼衣原体和人型支原体检出率分别为6.0%和41.6%,卡方检验表明其显著高于健康人群(P<0.05);BV组乳酸菌密集度较高,集中于0-Ⅰ级,阴道加特纳菌密集度增加,Ⅱ-Ⅳ级占77.6%,组间Ridit分析表明两组的乳酸菌密集度和阴道加特纳菌密集度差异差异具有统计学意义(P<0.05)。250例BV患者中,复发性BV共7例(2.8%)。250例细菌性阴道病患者中,190例(76.0%)解脲支原体呈阳性;150例健康人群中,90例(60.0%)呈解脲支原体阳,二者差异显著(χ2=8.69,P=0.00);215例人群菌量高于104ccu/mL,其中含172例(80%)BV患者,185例菌量低于104ccu/mL,合并BV阳性者78例(42.2%),二者差异显著(χ2=9.92,P=0.00)。经Logistic回归分析表明,BV阳性率与Uu检测菌量之间呈正相关,相关系数R2=0.99,P=0.01。结论:细菌性阴道病患者临床多表现为白带异常、阴道分泌物呈稀薄状、阴道pH值高于4.5和微生态失调,其解脲支原体阳性率较高,其量与BV发生率呈正相关,临床中应注意合并治疗。     

Interrelationships of bacterial vaginosis and cervical inflammation.

BACKGROUND: Women with cervicitis frequently have bacterial vaginosis (BV). Prior studies have suggested that BV is involved in the pathogenesis of cervicitis. GOALS: To delineate the association of BV and cervicitis and to determine whether treatment of BV results in increased resolution of cervicitis. STUDY DESIGN: Women with clinically diagnosed cervicitis and BV received doxycycline and ofloxacin and were randomized to treatment with metronidazole gel or placebo. Resolution of BV and cervicitis was assessed. RESULTS: Metronidazole gel was associated with resolution of BV. Resolution of cervicitis was associated with use of metronidazole gel versus placebo (24/27 [88.9%] versus 15/24 [62.5%]; P = 0.03). When further stratified by resolution of BV, those whose BV resolved were more likely to have resolution of cervicitis than those with persistent BV. Although these trends persisted in multivariate analyses, they did not achieve statistical significance. CONCLUSION: Univariate analyses suggest an association between BV and cervicitis. An association between the use of metronidazole gel and resolution of cervicitis was demonstrated. Hypotheses regarding the latter include nonspecific antiinflammatory effects of metronidazole, its effect on BV flora, and its effect on a specific unrecognized pathogen.     

甲硝唑联合克林霉素在细菌性阴道炎患者中的应用效果探讨

目的:探讨甲硝唑联合克林霉素治疗细菌性阴道炎的临床疗效和安全性.方法:选择2010年1月～2011年12月在我院妇产科治疗的108例细菌性阴道炎患者为研究对象,随机将本研究入选患者分为对照组和实验组,对照组仅给予甲硝唑进行抗感染治疗,而实验组则在对照组治疗的基础上加用克林霉素对患者进行治疗,比较对照组和实验组的临床疗效、药物不良反应的发生情况及复发率.结果:实验组患者治疗总有效率(90.74%)明显高于对照组的(70.37%),而实验组患者治疗复发率(7.41%)明显低对照组的(25.93%),实验组和对照组患者间治疗总有效率和治疗复发率差异有显著性(P>0.05),但是实验组和对照组患者间不良反应发生率差异无显著性(P>0.05).结论:甲硝唑联合克林霉素是治疗细菌性阴道炎一种临床疗效确切的治疗方案,该方案具有不良反应少及复发率低等特点.     

A prospective study of risk factors for bacterial vaginosis in HIV-1-seronegative African women

BACKGROUND: Bacterial vaginosis (BV) is common and has been associated with increased HIV-1 susceptibility. The objective of this study was to identify risk factors for BV in African women at high risk for acquiring HIV-1. METHODS: We conducted a prospective study among 151 HIV-1-seronegative Kenyan female sex workers. Nonpregnant women were eligible if they did not have symptoms of abnormal vaginal itching or discharge at the time of enrollment. At monthly follow-up, a vaginal examination and laboratory testing for genital tract infections were performed. Multivariate Andersen-Gill proportional hazards analysis was used to identify correlates of BV. RESULTS: Participants completed a median of 378 (interquartile range 350-412) days of follow-up. Compared with women reporting no vaginal washing, those who reported vaginal washing 1 to 14 [adjusted hazard ratio (aHR) 1.29, 95% confidence interval (CI) 0.88-1.89], 15 to 28 (aHR 1.60, 95% CI 0.98-2.61), and >28 times/wk (aHR 2.39, 95% CI 1.35-4.23) were at increased risk of BV. Higher BV incidence was also associated with the use of cloth for intravaginal cleansing (aHR 1.48, 95% CI 1.06-2.08) and with recent unprotected intercourse (aHR 1.75, 95% CI 1.47-2.08). Women using depot medroxyprogesterone acetate contraception were at lower risk for BV (aHR 0.59, 95% CI 0.48-0.73). CONCLUSIONS: Vaginal washing and unprotected intercourse were associated with increased risk of BV. These findings could help to inform the development of novel vaginal health approaches for HIV-1 risk reduction in women.