Abstract
Bacterial vaginosis (BV) is a common cause of vaginal discharge in women of childbearing age. In some individuals, it recurs frequently after treatment, frustrating both the patient and the physician. Standard BV treatment—metronidazole or clindamycin, administered either intravaginally or orally—is followed by relapse in approximately 30% of cases, within one month. Our inability to prevent relapse reflects our lack of understanding of how BV originates. BV has been associated with infectious morbidity in obstetrics and gynecology. Recent studies have found it to be a risk factor for HIV spread. These findings increase the need for us to be able to control recurrent BV and reduce its prevalence in the general population.
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References and Recommended Reading
Larsson PG: Treatment of bacterial vaginosis. Int J STD AIDS 1992, 3:239–247.
Hay PE: Therapy of bacterial vaginosis. J Antimicrob Chemother 1998, 41:6–9.
Carey JC, Klebanoff MA, Hauth JC, et al.: Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med 2000, 342:534–540. This large, multi-center study found no reduction in preterm birth when pregnant women with bacterial vaginosis (BV) are treated with short courses of metronidazole.
Mayaud P: Tackling bacterial vaginosis and HIV in developing countries. Lancet 1997, 350:530–531.
Klebanoff SJ, Hillier SL, Eschenbach DA, Waltersdorph AM: Control of the microbial flora of the vagina by H2O2-generating lactobacilli. J Infect Dis 1991, 164:94–100.
Agnew KJ, Hillier SL: The effect of treatment regimens for vaginitis and cervicitis on vaginal colonization by lactobacilli. Sex Transm Dis 1995, 22:269–273.
Nugent RP, Krohn MA, Hillier SL: Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991, 29:297–301.
Hay PE, Lamont RF, Taylor-Robinson D, et al.: Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. Br Med J 1994, 308:295–298.
Bump RC, Buesching WJ: Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am J Obstet Gynecol 1988, 158:935–939.
Hay PE, Taylor-Robinson D, Lamont RF: Diagnosis of bacterial vaginosis in a gynaecology clinic. Br J Obstet Gynaecol 1992, 99:63–66.
Blackwell AL, Thomas PD, Wareham K, Emery SJ: Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy. Lancet 1993, 342:206–210.
Ralph SG, Rutherford AJ, Wilson JD: Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. Br Med J 1999, 319:220–223. This prospective study associates BV with early pregnancy loss in women undergoing in vitro fertilization.
McGregor JA, French JI, Parker R, et al.: Prevention of premature birth by screening and treatment for common genital tract infections: results of a prospective controlled evaluation. Am J Obstet Gynecol 1995, 173:157–167.
Paxton LA, Sewankambo N, Gray R, et al.: Asymptomatic non-ulcerative genital tract infections in a rural Ugandan population. Sex Transm Infect 1998, 74:421–425.
Priestley CJ, Jones BM, Dhar J, Goodwin L: What is normal vaginal flora? Genitourin Med 1997, 73:23–28.
Schwebke JR, Richey CM, Weiss HL: Correlation of behaviors with microbiological changes in vaginal flora. J Infect Dis 1999, 180:1632–1636. At the writing of this article, this was the most recent study investigating changes in vaginal flora on a daily basis; it used vaginal smears prepared by volunteers.
Keane FE, Ison CA, Taylor-Robinson D: A longitudinal study of the vaginal flora over a menstrual cycle. Int J STD AIDS 1997, 8:489–494.
Hay PE, Ugwumadu A, Chowns J: Sex, thrush and bacterial vaginosis. Int J STD AIDS 1997, 8:603–608.
Rodrigues AG, Mardh PA, Pina-Vaz C, et al.: Is the lack of concurrence of bacterial vaginosis and vaginal candidosis explained by the presence of bacterial amines? Am J Obstet Gynecol 1999, 181:367–370.
Redondo-Lopez V, Meriwether C, Schmitt C, et al.: Vulvovaginal candidiasis complicating recurrent bacterial vaginosis. Sex Transm Dis 1990, 17:51–53.
Nilsson U, Hellberg D, Shoubnikova M, et al.: Sexual behavior risk factors associated with bacterial vaginosis and Chlamydia trachomatis infection. Sex Transm Dis 1997, 24:241–246.
Hawes SE, Hillier SL, Benedetti J, et al.: Hydrogen peroxideproducing lactobacilli and acquisition of vaginal infections. J Infect Dis 1996, 174:1058–1063.
Rajamanoharan S, Low N, Jones SB, Pozniak AL: Bacterial vaginosis, ethnicity, and the use of genital cleaning agents: a case control study. Sex Transm Dis 1999, 26:404–409. This case-control study carefully examines associations between different vaginal washing practices and bacterial vaginosis.
Aral SO, Mosher WD, Cates W: Vaginal douching among women of reproductive age in the United States:1988. Am J Pub Health 1992, 82:210–214.
Antonio MA, Hawes SE, Hillier SL: The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species. J Infect Dis 1999, 180:1950–1956. These researchers reexamine the normal Lactobacillus species using whole-chromosomal DNA probes.
Boskey ER, Telsch KM, Whaley KJ, et al.: Acid production by vaginal flora in vitro is consistent with the rate and extent of vaginal acidification. Infect Immun 1999, 67:5170–5175.
Rosenstein IJ, Morgan DJ, Sheehan M, et al.: Bacterial vaginosis in pregnancy: distribution of bacterial species in different gram-stain categories of the vaginal flora. J Med Microbiol 1996, 45:120–126.
Rosenstein IJ, Fontaine EA, Morgan DJ, et al.: Relationship between hydrogen peroxide-producing strains of lactobacilli and vaginosis-associated bacterial species in pregnant women. Eur J Clin Microbiol Infect Dis 1997, 16:517–522. This detailed study examines the microbiology of bacterial vaginosis, intermediate flora and spontaneous changes in flora in pregnant women.
Pybus V, Onderdonk AB: Evidence for a commensal, symbiotic relationship between Gardnerella vaginalis and Prevotella bivia involving ammonia: potential significance for bacterial vaginosis. J Infect Dis 1997, 175:406–413.
Pybus V, Onderdonk AB: A commensal symbiosis between Prevotella bivia and Peptostreptococcus anaerobius involves amino acids: potential significance to the pathogenesis of bacterial vaginosis. FEMS Immunol Med Microbiol 1998, 22:317–327.
Blackwell AL: Vaginal bacterial phaginosis? Sex Transm Infect 1999, 75:352–353. This is a good summary of the hypothesis that Lactobacillus phages might cause bacterial vaginosis by inhibiting growth of Lactobacillus populations.
Pavlova SI, Kilic AO, Mou SM, et al.: Phage infection in vaginal lactobacilli: an in vitro study. Infect Dis Obstet Gynecol 1997, 5:36–44. This is one of the studies supporting the concept that Lactobacillus phages might cause bacterial vaginosis.
Tao L, Pavlova SI, Mou SM, et al.: Analysis of Lactobacillus products for phages and bacteriocins that inhibit vaginal lactobacilli. Infect Dis Obstet Gynecol 1997, 5:244–251.
Pavlova SI, Tao L: Induction of vaginal Lactobacillus phages by the cigarette smoke chemical benzo[a]pyrene diol epoxide. Mutat Res 2000, 466:57–62.
Korn AP, Bolan G, Padian N, et al.: Plasma cell endometritis in women with symptomatic bacterial vaginosis. Obstet Gynecol 1995, 85:387–390.
Hillier SL, Kiviat NB, Hawes SE, et al.: Role of bacterial vaginosis-associated microorganisms in endometritis. Am J Obstet Gynecol 1996, 175:435–441.
Liversedge NH, Turner A, Horner PJ, et al.: The influence of bacterial vaginosis on in-vitro fertilization and embryo implantation during assisted reproduction treatment. Hum Reprod 1999, 14:2411–2415.
Livengood CH, Soper DE, Sheehan KL, et al.: Comparison of once-daily and twice-daily dosing of 0.75% metronidazole gel in the treatment of bacterial vaginosis. Sex Transm Dis 1999, 26:137–142.
Ahmed-Jushuf IH, Shahmanesh M, Arya OP: The treatment of bacterial vaginosis with a 3 day course of 2% clindamycin cream: results of a multicentre, double blind, placebo controlled trial. BV Investigators Group. Genitourin Med 1995, 71:254–256.
Anonymous: Management of bacterial vaginosis. Drug Ther Bull 1998, 36:33–35.
Bannatyne RM, Smith AM: Recurrent bacterial vaginosis and metronidazole resistance in Gardnerella vaginalis. Sex Transm Infect 1998, 74:455–456.
Keane FE, Thomas BJ, Whitaker L, et al.: An association between non-gonococcal urethritis and bacterial vaginosis and the implications for patients and their sexual partners. Genitourin Med 1997, 73:373–377.
Parent D, Bossens M, Bayot D, et al.: Therapy of bacterial vaginosis using exogenously-applied Lactobacilli acidophili and a low dose of estriol: a placebo-controlled multicentric clinical trial. Arzneimittelforschung 1996, 46:68–73.
Pulkkinen P, Saranen M, Kaaja R: Metronidazole combined with nystatin (vagitories) in the prevention of bacterial vaginosis after initial treatment with oral metronidazole. Gynecol Obstet Invest 1993, 36:181–184.
Boris J, Pahlson C, Larsson PG: Six year follow-up after successful treatment for bacterial vaginosis. Int J STD AIDS 1997, 8S1:41–41.
Wawer MJ, Sewankambo NK, Serwadda D, et al.: Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. Rakai Project Study Group. Lancet 1999, 353:525–535. This is one of a series of reports arising from the Rakai study in rural Uganda. Despite a reduction in the prevalence of some STDs following intermittent mass treatment, there was no demonstrated reduction in the incidence of HIV.
Cohen CR, Duerr A, Pruithithada N, et al.: Bacterial vaginosis and HIV seroprevalence among female commercial sex workers in Chiang Mai, Thailand. AIDS 1995, 9:1093–1097.
Martin HL, Richardson BA, Nyange PM, et al.: Vaginal Lactobacilli, Microbial Flora, and Risk of Human Immunodeficiency Virus Type 1 and Sexually Transmitted Disease Acquisition. J Infect Dis 1999, 180:1863–1868.
Sewankambo N, Gray RH, Wawer MJ, et al.: HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet 1997, 350:546–550.
Taha TE, Gray RH, Kumwenda NI, et al.: HIV infection and disturbances of vaginal flora during pregnancy. J Acquir Immune Defic Syndr Hum Retrovirol 1999, 20:52–59.
Hillier SL: The vaginal microbial ecosystem and resistance to HIV. AIDS Res Hum Retroviruses 1998, 14 S1:S17-S21. This article thoroughly reviews the mechanisms by which BV may enhance HIV transmission.
Cauci S, Monte R, Driussi S, et al.: Impairment of the mucosal immune system: IgA and IgM cleavage detected in vaginal washings of a subgroup of patients with bacterial vaginosis. J Infect Dis 1998, 178:1698–1706.
Olinger GG, Hashemi FB, Sha BE, Spear GT: Association of indicators of bacterial vaginosis with a female genital tract factor that induces expression of HIV-1. AIDS 1999, 13:1905–1912.
Olaitan A, Johnson MA, Reid WM, Poulter LW: Changes to the cytokine microenvironment in the genital tract mucosa of HIV+ women. Clin Exp Immunol 1998, 112:100–104.
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Hay, P. Recurrent bacterial vaginosis. Curr Infect Dis Rep 2, 506–512 (2000). https://doi.org/10.1007/s11908-000-0053-5
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DOI: https://doi.org/10.1007/s11908-000-0053-5