Our aim was to evaluate the prevalence of bacterial vaginosis and decrease in lactobacillus colonization in women 40 years old or older in relation to menopausal status by evaluation of Gram-stained smears. A total of 1,486 smears from Italian Caucasian women aged 40 to 79 years were examined. Women were classified as follows: fertile (regular cycles) (n ‫؍‬ 328), perimenopausal (irregular cycles) (n ‫؍‬ 237), and postmenopausal (n ‫؍‬ 921), including 331 women on estroprogestinic hormone replacement therapy (HRT). The prevalences of bacterial vaginosis (assessed as a Nugent score of >7) in fertile (9.8%) and perimenopausal (11.0%) women were not statistically different, whereas the prevalence was significantly lower overall in postmenopausal women (6.0%) (P ‫؍‬ 0.02). Specifically Bacterial vaginosis (BV) is a polymicrobial disorder characterized by an increase in the vaginal pH over 4.5, a reduction in or absence of lactobacillus colonization, and overgrowth of several facultatively and obligately anaerobic bacteria (10). BV is associated with adverse pregnancy outcomes, upper genital tract infections such as pelvic inflammatory disease, endometritis, post-gynecologic-surgery infections, cervicitis, urinary tract infections, cervical intraepithelial neoplasia, and increased risk of sexual acquisition of human immunodeficiency virus infection (7,13,16,17,19,24,25,(29)(30)(31). BV is usually diagnosed by the clinical Amsel's criteria (1) or by the Nugent method (26) of Gram stain interpretation. Both these methods, however, were developed to analyze the vaginal flora of pregnant women, and then their use was extended to evaluation of the vagina flora of fertile women. To our knowledge, no clear indications on how to diagnose vaginal flora alterations in peri-and postmenopausal women have been reported. In fact, in postmenopausal women BV cannot be clinically diagnosed by Amsel's criteria (1) because one of these criteria, the vaginal pH value, is constitutively elevated (3, 23); moreover, the scarcity of vaginal discharge makes it difficult to judge the kind of secretion. The Nugent method is based on the assumption that normal women have full vaginal colonization by lactobacilli (26); this is valid for pregnant and fertile women but not for postmenopausal women (3,15,23).Very few studies have evaluated the prevalence of BV in postmenopausal women (3, 15), and no study has assessed the prevalence of BV in perimenopausal women. Moreover, no data are available on the effect of hormone replacement therapy (HRT) on BV prevalence.The present study is a cohort study to determine the changes in vaginal flora and the prevalence of BV by standardized evaluation of Gram-stained smears for women 40 years old or older as a function of reproductive condition: fertile, perimenopausal, or postmenopausal with or without HRT. MATERIALS AND METHODSStudy population. Nonpregnant women aged 40 to 79 years were consecutively recruited during routine gynecologic examinations (Papanicolaou [Pap] smear tests) in three clinics (located i...

This study shows that AB treatment is associated with a higher occurrence of antibiotic-resistant bacteria, indicating that AB treatment in women with rUTIs is potentially dangerous.

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The integrity of the immunoglobulins in vaginal washings of patients with bacterial vaginosis was examined to answer the question of the lack of immune response against Gardnerella vaginalis cytolysin. Clinically diagnosed patients (n=100) were recruited and their vaginal washings examined by Western blotting. Many showed IgA and IgM partially or extensively degraded. According to the degradation pattern, the patients were subdivided into 4 subsets, from intact (score 0) to completely degraded IgA (score +3). Statistical analysis of the data showed a correlation between IgA degradation and absence of immune response to G. vaginalis cytolysin. The extent of IgA degradation correlated also with the sialidase (but not with the prolidase) activity level. All women showed intact IgG and human serum albumin and no trypsin-like activity. Patients with bacterial vaginosis having high sialidase activity and extensive IgA degradation in their secretions could incur more dangerous infections and adverse pregnancy outcomes.