Bacterial vaginosis Transmission, role in genital tract infection and pregnancy outcome: an enigma

Abstract

Whether bacterial vaginosis (BV) is acquired from an endogenous or an exogenous source is subject to controversy. Despite findings of an association between sexual behaviour and BV, some data indicate that BV is not a sexually transmitted infection in the traditional sense, while other data indicate that BV is an exogenous infection. A third aspect of BV is its tendency to go unnoticed by affected women. All of this will have a strong impact on how physicians view the risks of asymptomatic BV. This review focuses on whether or not BV should be regarded as a sexually transmitted infection (STI), its role in postoperative infections and pelvic inflammatory disease (PID), and on whether or not treatment of BV during pregnancy to reduce preterm delivery should be recommended. The reviewed studies do not lend unequivocal support to an endogenous or exogenous transmission of the bacteria present in BV. For women undergoing gynaecological surgery such as therapeutic abortion, the relative risk of postoperative infection is clearly elevated (approx. 2.3-2.8). A weaker association exists between BV and pelvic inflammatory disease. Data on treatment of BV as a way of reducing preterm delivery are inconclusive and do not support recommendations for general treatment of BV during pregnancy. The discrepant associations between BV and preterm birth found in recent studies may be explained by variations in immunological response to BV. Genetic polymorphism in the cytokine response--both regarding the TNF alleles and in interleukin production--could make women more or less susceptible to BV, causing different risks of preterm birth. Thus, studies on the vaginal inflammatory response to microbial colonization should be given priority.

Analysis of adherence, biofilm formation and cytotoxicity suggests a greater virulence potential of Gardnerella vaginalis relative to other bacterial-vaginosis-associated anaerobes

“…Symptoms of BV can include a thin greyish-white vaginal discharge with a foul odour, and mild irritation. Of more concern is that BV is associated with serious disorders, such as pelvic inflammatory disease (Sobel, 2000;Larsson et al, 2005) and adverse pregnancy outcomes, such as preterm delivery, low birth weight and post-partum endometritis. BV also increases the risk of male-to-female, and female-to-male, HIV transmission (Schmid et al, 2000).…”

Prevalence Of Bacterial Vaginosis Among Female Students Of Michael Okpara University Of Agriculture,Umudike, Abia State, Nigeria

“…It may also be attributed to the difference in socio-economic and hygienic level of people. Some studies have found a relationship between BV and high-risk behaviours associated with sexually transmitted infections (STIs) such as early sexual debut and multiple sex partners (Larsson, et al, 2005). According to Olartan (2006), asymptomatic BV occurred relatively more frequently in females as compared with males and it is a major criterion of urinary tract infection (UTI).…”

Dairy Probiotic Foods and Bacterial Vaginosis: A Review on Mechanism of Action

“…It has also been suggested that the presence of BV increases the risk for human immunodeficiency virus infection [12]. It is noteworthy that many women with BV do not show any symptoms [13], pelvic inflammatory disease [14], infections following gynecological surgery [15] and pre-term birth. BV is not transmitted through toilet seats, bedding, swimming pools, or touching of objects.…”

“…The second systemic treatment for BV is oral clindamycin. The one known clinical trial conducted describing the efficacy of oral clindamycin reported that a 300-mg, twice-daily course of clindamycin for 7 days resulted in a 94 percent cure rate [15]. The two topical treatments for BV include metronidazole 0.75 percent vaginal gel and clindamycin 2 percent vaginal cream [5].…”