It has been suggested that impaired cell-mediated immunity (CMI) against Candida antigens is responsible for susceptibility to recurrent vulvovaginal candidiasis (RVVC) in adult women. To address this, we conducted a comprehensive longitudinal study examining in vivo and in vitro systemic CMI reactivity in RVVC patients. Results showed that RVVC patients frequently demonstrated a transient loss of Candida-specific delayed cutaneous skin test reactivity during episodes of symptomatic vaginitis. In contrast, in vitro peripheral blood lymphoproliferation and Th1-type lymphokine production by RVVC patients in response to a T cell mitogen and multiple Candida and bacterial antigens were similar to controls both during acute episodes of vaginitis and during periods of infection-free remission. These results suggest that women with RVVC have no detectable impairment of systemic CMI in peripheral blood and that transient reductions in skin test reactivity appear to be a result of vaginal Candida infection and not a predisposing factor to RVVC.
Because so little is known about the pathogenesis of recurrent bacterial vaginosis (BV), a longitudinal microbiological study was conducted on 13 women with recurrent BV treated sequentially with conventional metronidazole therapy. A rapid clinical response characterized by dissappearance of malodor and an improvement in vaginal discharge occurred in 92% of 31 clinical episodes of BV, with patients no longer satisiying the composite clinical criteria for the diagnosis of BV. However, prospective evaluation of these asymptomatic women revealed profound residual biochemical and microbial abnormalities which were best evident on Gram stain and wet mount examination of vaginal secretions. Other common residual abnormalities included mild persistent elevation of vaginal pH and polyamine and fatty acid levels and the presence of clue cells in small numbers. Residual abnormalities could be quantified to create an overall symptom code which predicted recurrence, and it was found that the severity of residual abnormalities was inversely related to the time required until the next recurrence occurred. The severity and prevalence of residual abnormalities following clinically successful therapy support the concept that BV recurrence, especially when it is early, represents a relapse rather than a reinfection. This concept may have important therapeutic implications.Bacterial vaginosis (BV) is considered the most common vaginal infection in women; however, since this infection is not reportable, there are no accurate figures of its prevalence in the community (6). The explanation for the myriad of findings in patients with BV remains incomplete, although considerable progress has been made in understanding aspects of the pathogenic process (5,7,9,25,27,28). BV is thought to represent a massive overgrowth of vaginal microorganisms, primarily anaerobic gram-positive cocci and gram-negative bacilli, including Prevotella species, Gardnerella vaginalis, and Mobiluncus species (13,19,23,26,30).Published studies indicate that the drug of choice for therapy of BV is oral metronidazole; therapeutic success is achieved in 85 to 90% of patients with this therapy (10). Treatment with metronidazole is followed by eradication of the anaerobes and G. vaginalis together with alleviation of symptoms (4,22). In 30 to 40% of women who initially respond to treatment with metronidazole, however, BV recurs within 3 months of the termination of therapy (4). At present, the reasons for the recurrence are unknown. It is unknown whether recurrence is due to sexually transmitted or endogenous (oral cavity or rectum) reinfection or to a relapse of the previous, incompletely resolved vaginal infection. It is conceivable that symptomatic relapse in this context could reflect the persistence of subclinical BV.In the present study, we studied 13 women with recurrent BV longitudinally over a 9-month period in an attempt to identify clinical, laboratory, or vaginal microbiological factors that might clarify the pathogenesis of recurrent episodes of BV. MAT...
Because so little is known about the pathogenesis of recurrent bacterial vaginosis (BV), a longitudinal microbiological study was conducted on 13 women with recurrent BV treated sequentially with conventional metronidazole therapy. A rapid clinical response characterized by disappearance of mal odor and an improvement in vaginal discharge occurred in 92% of 31 clinical episodes of BV, with patients no longer satisfying the composite clinical criteria for the diagnosis of BV. However, prospective evaluation of these asymptomatic women revealed profound residual biochemical and microbial abnormalities which were best evident on Gram stain and wet mount examination of vaginal secretions. Other common residual abnormalities included mild persistent elevation of vaginal pH and polyamine and fatty acid levels and the presence of clue cells in small numbers. Residual abnormalities could be quantified to create an overall symptom code which predicted recurrence, and it was found that the severity of residual abnormalities was inversely related to the time required until the next recurrence occurred. The severity and prevalence of residual abnormalities following clinically successful therapy support the concept that BV recurrence, especially when it is early, represents a relapse rather than a reinfection. This concept may have important therapeutic implications.
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