Clinical variability of bacterial vaginosis and trichomoniasis

Bacterial vaginosis and trichomoniasis are two of the most commonly encountered vaginal diseases. Although risk factors for both vaginal conditions have been identified, there continues to be lack of knowledge in regard to their role in association with other sexually transmitted diseases. Vaginal pH is an essential ingredient in the defense and control of the vaginal environment. The alteration of pH with the sequelae of such pregnancy complications as preterm delivery, preterm labor and premature rupture of the membranes; amniotic fluid infection; postpartum endometritis and surgical infections; and the role of bacterial vaginosis are discussed. Treatment modalities in both the nonpregnant and pregnant woman, as well as treatment of resistant cases of both vaginal conditions, are recommended.     

Is trichomoniasis often associated with bacterial vaginosis in pregnant adolescents?

The same criteria for identifying bacterial vaginosis are often present in women with trichomoniasis. These criteria include elevated vaginal pH, vaginal odor, homogeneous discharge, increased anaerobic bacteriologic vaginal flora, and elevated levels of bacterial enzymes. Clinically mixed vaginal infections occur, and because the treatment for these two conditions can be different, it is important to distinguish between them. Trichomoniasis can interfere with a Gram stain diagnosis or the proline aminopeptidase test for bacterial vaginosis. Clue cells are not generally found in women with Trichomonas vaginalis, but when present, they strongly indicate the concomitant presence of bacterial vaginosis.     

Vulvovaginal symptoms in women with bacterial vaginosis

OBJECTIVE: A substantial, but highly variable, percentage of women with bacterial vaginosis are said to be asymptomatic. The purpose of this study was to estimate the prevalence of symptoms among women with bacterial vaginosis compared with women without bacterial vaginosis by direct, explicit, and detailed questioning of these women. METHODS: Women presenting for a routine health care visit at 12 health department clinics in Birmingham, Alabama, were recruited to participate in a longitudinal study of vaginal flora. At the first visit, they underwent a pelvic examination, lower genital tract microbiological evaluation, and an interview that included detailed questions regarding lower genital tract symptoms. The prevalence of symptoms among women with and without bacterial vaginosis (Gram stain score 7 or higher) was compared. RESULTS: Among 2,888 women without gonorrhea, Chlamydia, or trichomonas, 75% of women with and 82% of women without bacterial vaginosis never noted any vaginal odor in the past 6 months (P <.001). The corresponding values were 63% and 65% for never noting vaginal "wetness" (P =.02); 58% and 57% for vaginal discharge (P =.65); 91% and 86% for irritation (P =.004); 88% and 85% for itching (P =.64); and 96% and 94% for dysuria (P =.002), respectively. Cumulatively, 58% of women with bacterial vaginosis noted odor, discharge, and/or wetness in the past 6 months compared with 57% of women without bacterial vaginosis (P =.70). CONCLUSION: The 2 classic symptoms of bacterial vaginosis discharge and odor are each reported by a minority of women with bacterial vaginosis and are only slightly more prevalent than among women without bacterial vaginosis.     

Urinary tract infections in women with bacterial vaginosis

OBJECTIVE: To evaluate the risk of urinary tract infections in women with bacterial vaginosis. METHODS: One hundred twenty-nine women who presented for routine gynecologic examinations were evaluated for bacterial vaginosis and urinary tract infections between June 1998 and March 1999. RESULTS: Sixty-seven women had bacterial vaginosis and 62 women did not. Fifteen women with bacterial vaginosis (22.4%) had urinary tract infections, compared with six (9.7%) of those without it. Bacterial vaginosis was associated with an increased risk of urinary tract infections (odds ratio 2.79; 95% confidence interval 1.05, 8.33). CONCLUSION: Women with bacterial vaginosis are at increased risk for urinary tract infections.     

女性不孕症患者下生殖道细菌性阴道病感染状况初探

目的了解女性不孕症患者下生殖道细菌性阴道病（BV）感染情况。方法采用横断面调查的方法，把2007年1月～2007年6月在我院妇产科生殖内分泌门诊就诊的93例不孕症患者作为研究对象，把同期的因男性不孕或月经失调的就诊者及健康体检者共54例作为对照，进行下生殖道BV感染的检测。结果实验组有18例BV感染，对照组有9例BV感染，两组间差异存在显著性；原发不孕组BV感染率最高，与继发不孕组和对照组比较差异均存显著性；而继发不孕组与对照组比较不存在统计学差异。结论下生殖道BV感染与女性不孕症间存在明显相关性，可能是引起女性不孕的重要感染因素。女性下生殖道BV感染对生殖健康的影响应引起重视。     

Urinary tract infections in pregnant women with bacterial vaginosis

OBJECTIVE: Our purpose was to investigate the risk of urinary tract infections in pregnant women with bacterial vaginosis. STUDY DESIGN: In a cross-sectional study, 503 pregnant women were examined for bacterial vaginosis and urinary tract infections from July 1999 through April 2000. RESULTS: Nineteen (13.6%) of 140 women who had bacterial vaginosis had urinary tract infections compared with 24 (6.6%) of 363 women without it. Bacterial vaginosis in pregnancy was associated with an increased risk for urinary tract infections (odds ratio 2.21, 95% CI 1.16-4.18). CONCLUSION: Pregnant women with bacterial vaginosis are more likely to have urinary tract infections.     

Endotoxin in vaginal fluid of women with bacterial vaginosis

The concentration of endotoxin in vaginal fluid was measured in 19 women with bacterial vaginosis and in nine controls with normal vaginal flora. The vaginal fluid of the women with bacterial vaginosis contained significantly greater amounts of endotoxin: 0.308 +/- 0.396 versus 0.008 +/- 0.002 endotoxin units/mg vaginal fluid. Endotoxin in vaginal fluid may contribute to the activation of the prostaglandin system, which could provoke premature labor.     

Hydrogen peroxide-producing Lactobacillus species in healthy women and in women with bacterial vaginosis

We compare the prevalence of H2O2--producing Lactobacillus species in women with or without bacterial vaginosis. H2O2--producing facultative Lactobacillus species were found in the vaginas of 37 (92.5%) of 40 normal women and 3 (4.1%) of 72 women with BV. Anaerobic Lactobacillus species (which do not produce H2O2) were isolated from 12 (16.6%) of 72 women with BV and 1 (2.5%) of 40 normal women. The production of H2O2 by Lactobacillus species may represent a nonspecific antimicrobial defence mechanism of the normal vaginal ecosystem.     

Urinary tract infections in pregnant women with bacterial vaginosis.

Urinary tract infections (UTIs) and bacterial vaginosis are common problems in pregnancy and are associated with serious obstetric complications. We evaluated the risk of UTIs in pregnant women with bacterial vaginosis. A total of 322 pregnant women who presented for a prenatal visit were evaluated for bacterial vaginosis and UTIs, between March 2003 and September 2004. Bacterial vaginosis was diagnosed based on Amsel's criteria. Women using antibiotic or other vaginal cream, with specific vaginitis or vaginal bleeding were excluded. Data were analysed using chi(2), Student t-test and multiple logistic regression. A total of 76 women had bacterial vaginosis and 246 women did not; and 18 women (23.6%) with bacterial vaginosis had UTIs, compared with 24 (9.8%) of those without. Bacterial vaginosis was associated with an increased risk of UTIs (odds ratio (OR) 3.05; 95% CI: 1.47-6.33). Pregnant women with bacterial vaginosis are at increased risk for UTIs.     

妊娠期细菌性阴道病的治疗

目的调查妊娠期细菌性阴道病(BV)的发病情况，观察乳酸菌活菌胶囊制剂治疗细菌性阴道病的疗效。方法对不同孕周的612名孕妇进行BV筛查，确定妊娠期细菌性阴道病的发病率。取BV患者100例，乳酸菌活菌胶囊制剂治疗50例，甲硝唑治疗50例，用药10d，停药1周后复查。结果妊娠期。BV的检出率为17．6％(108／612)。乳酸菌活菌胶囊制剂治疗BV有效率86．0％，甲硝唑治疗BV有效率88．0％，二者差异无显著性(P=0．766)。结论妊娠期BV有较高的发病率，乳酸菌活菌胶囊制剂是治疗BV的安全有效药物，疗效肯定。     

Clindamycin versus metronidazole in the treatment of bacterial vaginosis

One hundred forty-three women with complaints of vaginitis were assigned to receive either 500 mg of metronidazole twice daily for 7 days or clindamycin 300 mg twice daily for 7 days. There was no significant difference in the failure rate between patients treated with clindamycin (6.1%) and those treated with metronidazole (4%). Adverse reactions were infrequent and mild in both treatment groups. Three patients who received clindamycin developed non-bloody diarrhea, which was mild and did not necessitate discontinuing therapy. We conclude that clindamycin may be a safe and effective alternative to metronidazole for treating women with bacterial vaginosis.     

细菌性阴道病患者与健康妇女阴道乳杆菌生态学特征的比较

目的:观察健康妇女与细菌性阴道病患者阴道内乳杆菌属内各种乳杆菌在阴道中分布的差异。方法:利用微生态学研究方法,调查45例健康妇女和40例细菌性阴道病患者阴道乳杆菌的分布,鉴定阴道内乳杆菌,比较阴道乳杆菌产生过氧化氢的能力。结果:健康妇女阴道内乳杆菌检出率和平均活菌数量对数值明显高于细菌性阴道病患者(P<0.01),健康妇女阴道内优势乳杆菌是嗜酸乳杆菌(35%,7·68±1.41)、德氏乳杆菌(7·5%,8.06±0.83)和乳酸乳杆菌(7·5%,8.07±1·51),其大多数产生H2O2能力较强;健康妇女阴道内产H2O2乳杆菌的分离率明显高于细菌性阴道病患者(P<0.01)。结论:H2O2阳性的乳杆菌是健康妇女阴道乳杆菌的重要成员,在防治细菌性阴道病发生中起重要作用。