Vaginitis

Abstract: Background Bacterial vaginosis is believed to be a risk factor for preterm delivery. We undertook a study of the association between bacterial vaginosis and the preterm delivery of infants with low birth weight after accounting for other known risk factors. Methods In this cohort study, we enrolled 10,397 pregnant women from seven medical centers who had no known medical risk factors for preterm delivery. At 23 to 26 weeks' gestation, bacterial vaginosis was determined to be present or absent on the basis of the vaginal pH and the results of Gram's staining. The principal outcome variable was the delivery at less than 37 weeks' gestation of an infant with a birth weight below 2500 g. Results Bacterial vaginosis was detected in 16 percent of the 10,397 women. The women with bacterial vaginosis were more likely to be unmarried, to be black, to have low incomes, and to have previously delivered low-birth-weight infants. In a multivariate analysis, the presence of bacterial vaginosis was related to preterm de...

Abstract: Bacterial vaginosis (BV) is the most frequent type of vaginitis in women of reproductive age [1–3]. BV is an imbalance in the ecology of the normal vaginal flora [4] that is characterized by the depletion of lactobacilli [3], and the proliferation of anaerobic bacteria such as Gardnerella vaginalis, Morbilincus species, Prevotella species, Mycoplasma hominis and the recently identified Atopobium vaginae [2, 5–7]. It most often manifests clinically as a vaginal pH of >4.5, the presence of thin whitish homogenous vaginal discharge, the detection of “clue” cells and the presence of an amine odor after the addition of 10 percent potassium hydroxide [8, 9]. BV has been shown to increase the risk of adverse gynecological and obstetrical outcomes such as preterm delivery[10, 11] pelvic inflammatory disease (PID) and upper genital tract infections [12–14]. However, the effect of BV on the risk of HIV infection in women has not been clearly quantified. The magnitude of the association between BV and HIV has varied in epidemiological studies, ranging from the absence of any association[15] to a near four-fold odds of being HIV infected among BV-positive women compared to BV-negative women [16]. BV is estimated to be the most prevalent vaginal infection particularly in countries with high HIV prevalence [2]. If BV is confirmed to increase the risk of HIV infection, the treatment of BV could be a meaningful intervention to prevent HIV acquisition. In a 2001 review of the role of sexually transmitted diseases in HIV acquisition, Rottingen et al estimated that BV was associated with a 40% increase in the risk of HIV based on an analysis of two studies[17]. Obtaining a precise and updated estimate of the strength of the association between BV and HIV from published studies could be useful in predicting the potential impact of the control of BV on HIV incidence rates in a population. This prediction could also be more accurate if factors that modify the strength of the BV and HIV association were identified. This paper aims to systematically review all published studies of the association between BV and HIV infection. Estimates of the association between BV and HIV are presented for both HIV incidence and prevalence studies, and analyzed for potential modification factors, publication bias, and heterogeneity of study results.

Abstract: Background Bacterial vaginosis has been associated with preterm birth. In clinical trials, the treatment of bacterial vaginosis in pregnant women who previously had a preterm delivery reduced the risk of recurrence. Methods To determine whether treating women in a general obstetrical population who have asymptomatic bacterial vaginosis (as diagnosed on the basis of vaginal Gram's staining and pH) prevents preterm delivery, we randomly assigned 1953 women who were 16 to less than 24 weeks pregnant to receive two 2-g doses of metronidazole or placebo. The diagnostic studies were repeated and a second treatment was administered to all the women at 24 to less than 30 weeks' gestation. The primary outcome was the rate of delivery before 37 weeks' gestation. Results Bacterial vaginosis resolved in 657 of 845 women who had follow-up Gram's staining in the metronidazole group (77.8 percent) and 321 of 859 women in the placebo group (37.4 percent). Data on the time and characteristics of delivery were available fo...

Abstract: This cohort study of 182 women attending a sexually transmitted disease clinic evaluated the hypothesis that women colonized by lactobacilli have decreased acquisition of vaginal infections. During a 2-year follow-up, 50 women acquired bacterial vaginosis (BV), 25 acquired symptomatic vulvovaginal candidiasis (VVC), and 7 acquired vaginal trichomoniasis. By multivariate analysis, utilizing Cox proportional hazards modeling with time-dependent covariates, acquisition of BV was independently associated with lack of vaginal H 2 O 2 -producing lactobacilli (hazard ratio [HR] = 4.0, P <.001) or presence of only non-H 2 O 2 -producing lactobacilli (HR = 2.2, P =.02). Acquisition of BV was associated with having a new sex partner (HR = 2.5, P =.004) and with douching for hygiene (HR = 2.1, P =.05). Absence of lactobacilli did not increase acquisition of VVC. Trichomoniasis was associated only with having a new sex partner (HR = 4.7, P =.05). These results support the hypothesis that H 2 O 2 -producing vaginal lactobacilli protect against acquisition of BV but do not protect against VVC or vaginal trichomoniasis.