Clinical, Microbiological, and Biochemical Factors in Recurrent Bacterial Vaginosis

Abstract

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...

Bacterial vaginosis: Culture- and PCR-based characterizations of a complex polymicrobial disease’s pathobiology

“…The only BV-associated anaerobes that decrease after treatment are G. vaginalis, A. vaginae, Prevotella, BVAB2, BVAB3, and Leptotrichia, but only by about 10-fold. The trends found here agree well with some culture-based studies [71].…”

Impairment of the Mucosal Immune System: IgA and IgM Cleavage Detected in Vaginal Washings of a Subgroup of Patients with Bacterial Vaginosis

“…In fact, some patients spontaneously recover, some have this syndrome for years if not properly treated, some recover after a single treatment, and some need repeated treatments [43]. Our results allow BV patients to be divided into 2 main subgroups: those who maintain the integrity of the local mucosal immune response (IgA cleavage score 0 and ϩ1, low sialidase activity, positive anti-Gvh IgA response) and those who exhibit impaired defenses (IgA cleavage score ϩ2 and ϩ3, high sialidase activity, no anti-Gvh IgA response).…”

In vitro Antibacterial Activity of FK037, a New Parenteral Broad-Spectrum Cephalosporin, against Recent Clinical Isolates in the Fields of Obstetrics and Gynecology

“…vaginalis and Mobiluncus spp. arc the major bacteria detected in bacterial vaginosis [12,13]. FK037 exerted excellent activity against both of these bacteria, although flo moxef was a little more active than FK037.…”