Gynecologic sequelae of bacterial vaginosis

[Bacterial vaginosis]

Bacterial vaginosis is a widely spread health problem with multiple connotations. It has been the subject of many studies and work during decades and it still remains a polemic entity, with contradictory finding. The polymicrobian etiology, unsolved epidemiology, obstetrico-gynecological complications and high recurrence rate following treatment, make this infection a target for researchers. It is not an inflammatory process -yet an immune response exists. In this disorder, vaginal discharge increases, and it is associated with a high risk of developing sexually transmitted diseases.

Bacterial vaginosis in sexually experienced and non-sexually experienced young women entering the military

OBJECTIVE

To estimate the prevalence of bacterial vaginosis by Nugent Gram stain criteria in a nonclinic national sample of young women entering recruit training; to examine clinical associations with bacterial vaginosis; and to evaluate the performance of a pH test card and Papanicolaou smear against Gram stain as screening tools for bacterial vaginosis.

METHODS

A cross-sectional study of 1938 women was conducted. Self-collected vaginal swabs were applied to a colorimetric pH test card and a glass slide for Gram stain evaluation according to the Nugent criteria. Papanicolaou smears and samples for sexually transmitted diseases screening were collected during routine entry pelvic examinations.

RESULTS

Bacterial vaginosis prevalence was 27%, with 28% in sexually experienced and 18% in non-sexually experienced women (P = .001). Bacterial vaginosis prevalence was 11% in Asian/Pacific Islanders, which was lower than in other nonwhite ethnic groups (P = .004). Clinically, bacterial vaginosis was directly related to multiple sexual partners (P = .026), self-report of vaginal discharge (P = .001), self-report of vaginal odor (P < .001), and concurrent Chlamydia trachomatis infection (P = .002), and inversely related to hormonal contraceptive use (P = .013). Vaginal discharge did not achieve statistical significance in multivariate analysis. Compared with the Nugent criteria, the sensitivities and specificities for bacterial vaginosis diagnosis were as follows: colorimetric pH test: 72% and 67%; Papanicolaou smear: 72% and 79%, respectively.

CONCLUSION

Among these diverse young women, bacterial vaginosis occurs commonly in both sexually experienced and inexperienced young women and differs by race and ethnicity. The pH colorimetric test and Papanicolaou smear performed moderately well as screening tools for bacterial vaginosis. The inverse relationship of bacterial vaginosis with hormonal contraceptive use and its direct relationship with C. trachomatis need further study.

Colposcopic and Cytologic Findings Among Women with Abnormal Vaginal Flora

OBJECTIVE

The purpose of our study was to evaluate the association of abnormal vaginal flora with pathological colposcopic and cytological findings.

MATERIALS AND METHODS

A total of 100 women of reproductive age were examined. Pregnant women were excluded. Each patient completed a self-administered questionnaire regarding sexual history and vaginal symptoms. All participants underwent a gynecological examination and colposcopy. Pap smear of the cervix and samples of vaginal discharge for microbiological analysis were obtained before the colposcopic examination. Statistical analysis was performed using Fisher exact test, chi test, and multifactorial analysis of variance.

RESULTS

Results of colposcopic examination were normal in more than 70% of all examined women, except in women with bacterial vaginosis where < 30% had normal results. Of all the women examined only 1 did not have normal (class II) Pap smear results.

CONCLUSIONS

Our study indicates that women with abnormal vaginal flora more often have pathological colposcopic findings, such as leukoplakia, vaginal hyperemia, and chronic cervicitis.

[Microbiologic profile in symptomatic pregnant women's genital secretions in Gran Buenos Aires, Argentina]

BACKGROUND

Establish the prevalence of microorganisms associated with genital colonization in symptomatic pregnant women. In order to review the evolution of frequent pathogens ecology and adjust the laboratory design, in a population attended at the public health Hospital, in the Great Buenos Aires.

METHODS

Vaginal and endocervical samples, were explored for specific detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Streptococcus agalactie, Trichomonas vaginalis, Candida spp., Mycoplasma hominis, Ureaplasma urealyticum and bacterial vaginosis (VB).Direct methods, culture, inmunodetection and PCR, were employed. In 1999; 198 women, with genital discharge, were studied. Age in the group range from 16 to 42 years old (Median 27 years old).

RESULTS

In 51 cases (25.7%) none of the above microorganisms or bacterial vaginosis were detected. In 30 cases (15.1%) bacterial vaginosis was diagnosed. Frequency of detection was: Ureaplasma urealyticum, 49,5%; Candida spp., 34,3%; Mycoplasma hominis, 14.1%; Streptococcus agalactie, 4.5%; Trichomonas vaginalis, 3.5%; Chlamydia trachomatis, 2.5%. No detection of Neisseria gonorrhoeae was demonstrated.

CONCLUSIONS

There is a relevant frequency of bacterial vaginosis. On the other hand, lower prevalence of the Trichomonas vaginalis and Chlamydia trachomatis and also the absence of Neisseria gonorrhoeae was demonstrated. Culture for Streptococcus agalactie (at birth) and detection of Chlamydia trachomatis. must be extended to all pregnant women. Study of species and drug sensitivity of Candida spp., and detection of Ureaplasma urealyticum, Mycoplasma hominis and Neisseria gonorrhoeae, have to be explored under specific clinical requirement.