Control of the Microbial Flora of the Vagina by H202-Generating Lactobacilli

Klebanoff, Seymour J.; Hillier, Sharon L.; Eschenbach, David A.; Waltersdorph, A M

doi:10.1093/infdis/164.1.94

Cited by 383 publications

(287 citation statements)

References 32 publications

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“…Multiple bacteria species are present in BV flora [9,[39][40][41], while normal flora species consist predominantly of lactobacilli [42,43]. Therefore, the results suggest that DC recognize products released by bacteria responsible for BV but not those released by lactobacilli.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the results suggest that DC recognize products released by bacteria responsible for BV but not those released by lactobacilli. However, many of the bacteria present in BV are also present at low levels in healthy vaginal flora, such as Lactobacillus inners, G. vaginalis, and Mycoplasma hominis [39,[42][43][44]. Therefore, both the type and number of DC-stimulating bacteria may be limiting factors for activation of DC by normal flora.…”

Section: Discussionmentioning

confidence: 99%

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Dendritic cell activation and maturation induced by mucosal fluid from women with bacterial vaginosis

John

Martinson

Simões

et al. 2007

Clinical Immunology

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Dendritic cells (DC) at mucosal surfaces mature when exposed to "danger" signals such as LPS. Bacterial vaginosis (BV) is a prevalent alteration of the vaginal bacterial flora associated with preterm childbirth and increased risk for HIV acquisition. We examined the effect of mucosal fluid from women with BV or healthy flora on DC function. IL-12, IL-23 and p40 production by monocytederived dendritic cells (MDDC) were all induced by BV samples. Activation/maturation markers HLA-DR, CD40, and CD83 on MDDC incubated with BV CVL were also induced. BV CVL also decreased the endocytic ability of MDDC and increased proliferation of T-cells in allogeneic MLR. Plasmacytoid dendritic cell (pDC) CD86 expression was induced by BV CVL. Healthy flora CVL had little effect in any of the tests. This study suggests that BV, but not healthy flora, affects local dendritic cell function in vivo suggesting a mechanism through which BV affects mucosal immunity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Dendritic cell activation and maturation induced by mucosal fluid from women with bacterial vaginosis

John

Martinson

Simões

et al. 2007

Clinical Immunology

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“…BV was categorized as positive (≥ 7), intermediate (4)(5)(6), and negative (<4). Time to first episode of STD was defined as the number of days from baseline to development of first episode of STD.…”

Section: Time To First Std and Std Ratesmentioning

confidence: 99%

A randomized trial of metronidazole in asymptomatic bacterial vaginosis to prevent the acquisition of sexually transmitted diseases

Schwebke

Desmond

2007

American Journal of Obstetrics and Gynecology

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Objective-To determine if treatment of BV decrease the incidence of sexually transmitted diseases.Study Design-Women with asymptomatic BV were studied prospectively to determine the effect of treatment of BV for the prevention of STD. Women were randomized to observation or treatment and prophylaxis with intravaginal metronidazole gel. Women were screened monthly for STDs.Results-Women randomized to metronidazole gel had a significantly longer time to development of STD compared to women in the observation group (p=0.02). The 6-month STD rate was 1.58/ person-year (95% CI 1.29, 1.87) for women in the metronidazole gel group versus 2.29/person-year (95% CI 1.95, 2.63) for women in the observational group. The difference in STD rates was driven by a significant difference in the number of chlamydial infections (0.013).Conclusion-Treatment and twice-weekly prophylactic use of intravaginal metronidazole gel resulted in significantly fewer cases of chlamydia.

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“…55 Ninety-six percent of normal women have hydrogen peroxide-producing Lactobacillus species compared with only 6% of women with bacterial vaginosis. 56 The production of hydrogen peroxide by lactobacilli combines with chlorine, a halide present in cervical mucus, to produce a nonspecific antimicrobial host defense. The combination of these substances is toxic to some of the organisms associated with bacterial vaginosis, including Gardnerella vaginalis and prevotella.…”

Section: Bacterial Vaginosis Pathologymentioning

confidence: 99%

Evaluation and management of vaginitis

1998

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V aginitis is a common medical problem in women that is associated with substantial discomfort and frequent medical visits. Roughly 5 to 10 million office visits per year are attributed to vaginitis. 1 Research in recent years has increased our understanding of the disease process and its potential sequelae and resulted in improved diagnostic and treatment modalities. 2-6 Nevertheless, adequate diagnosis and treatment of vaginitis in the office setting often is problematic for practitioners. 2,5,7-9 Moreover, the availability of over-the-counter medications for fungal vaginitis has increased the likelihood that women will come to medical attention with partially or inadequately treated infections. 10 We will focus on the common infectious causes of vaginal discharge-yeast infection, bacterial vaginosis, and trichomonas infection, emphasizing new developments in diagnosis, associated complications, and treatment of these infections.The initial evaluation of vaginal discharge requires an understanding of physiologic vaginal discharge and what differentiates it from abnormal, pathologic discharge. Substances from the vulvar, sebaceous, sweat, Bartholin's and Skene's glands, as well as exfoliated cells, cervical mucus, and secretions of the endometrial cavity and fallopian tubes constitute the normal physiologic secretions of the vagina. These secretions pool in the posterior fornix and do not adhere to the vaginal walls. 11 The pH of normal vaginal secretions in women of childbearing age is between 3.8 and 4.5. The presence of sperm, blood, amniotic fluid, or cervical mucus raises the vaginal pH. 11 The amount and fluidity of the discharge can vary over the menstrual cycle. Cervical mucus becomes more fluid around ovulation, and women frequently mistake this change in consistency for an abnormal discharge. Stress increases the rate of vaginal desquamation and thus the amount of discharge, which patients can also mistake for a pathologic discharge. 12 Women generally do not have other symptoms if their discharge is physiologic.In contrast, a pathologic discharge adheres to the vaginal walls and is often accompanied by irritation, pruritus, odor, or urinary symptoms such as dysuria or frequency. 6 The discharge can be thick to watery and frothy, and white to yellow, gray, or green. 11 Causes of an abnormal discharge include infectious causes of vaginitis such as yeast infection, bacterial vaginosis, and trichomonas infection, as well as cervicitis and sexually transmitted diseases such as gonorrhea and chlamydia infection. Noninfectious etiologies include chemical irritants such

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Control of the Microbial Flora of the Vagina by H202-Generating Lactobacilli

Cited by 383 publications

References 32 publications

Dendritic cell activation and maturation induced by mucosal fluid from women with bacterial vaginosis

Dendritic cell activation and maturation induced by mucosal fluid from women with bacterial vaginosis

A randomized trial of metronidazole in asymptomatic bacterial vaginosis to prevent the acquisition of sexually transmitted diseases

Evaluation and management of vaginitis

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