Microbial flora of the lower genital tract during pregnancy: relationship to morbidity.

Abstract

SYNOPSIS Nineteen genera and groups of micro-organisms were isolated from the lower genital tract of 280 women at their first antenatal visit. Chlamydia, viruses, and T-strain mycoplasmas were not sought, and only routine methods of anaerobic culture were used. Growth was recorded as scanty, moderate or heavy. The population studied was grouped according to age, parity, gestational stage at booking, presence and degree of severity of lower genital tract morbidity, past history of vulvovaginitis, and suspicion of lower genital tract morbidity as evidenced by a request for a report on the microbiological findings. The frequency of isolation of the various microbes in health and in disease is given.The grading of Gram-stained smears bore no relation to the isolation rates of lactobacilli, but there was a significant increase (p <0.001) in the isolation rates of each of the following: Mycoplasma hominis, Bacteroides spp., Trichomonas vaginalis, Gram-variable cocco-bacilli, and anaerobic streptococci in those patients with smears in which lactobacilli were adjudged to be absent.The isolation of faecal streptococci was increased (p <0 001) in women aged more than 34 years. Escherichia coli (p <0 05) and anaerobic and microaerophilic streptococci (p <0-02) were isolated more frequently from those booking after the 25th week of pregnancy. The incidence of M. hominis (p <0'02) and of anaerobic streptococci (p <0-05) increased between the first and third trimesters.No significant positive correlations were established between the isolation rates of the various microbes and objective assessment of lower genital tract morbidity or the demonstration of pus cells, but lactobacilli were isolated less frequently (p <0 01) from those with morbidity. The isolation of Candida albicans (p <0 02), T. vaginalis (p <0'05), and M. hominis (p <0 05) was increased in patients in whom vulvovaginitis was suspected, and that of T. vaginalis (p <0 05) was increased in those with a past history of vulvovaginitis.The study indicates that, other than the pathogens T. vaginalis and C. albicans, only M. hominis could be suspected, on statistical grounds, of being associated with disease of the lower genital tract during early pregnancy.Although many papers deal with the isolation of genital tract during pregnancy and to seek relationparticular pathogens, or potential pathogens, from ships that may exist between signs or symptoms of the vagina, there have been few attempts at more morbidity and the isolation of particular microbes, comprehensive studies (Edmunds, 1959; Slotnick et as a basis for further study. Viruses, Chlamydia, andGordon et al 1966). The literature T-strain mycoplasmas were not sought. is briefly reviewed by Hurley et al (1974), who disThe microbiological studies were made on 280 cuss the factors that may influence the microflora pregnant women, of whom 80% were Caucasian, and comment on the difficulty of attempting clinico-89 % were married, and 89% were aged between 18 pathological correlations. The present investigation and 3...

The Normal Microbial Flora of the Baboon Vagina

“…The isolation of lactobacilli from the adult human vagina is generally found to be much higher (4,19) and is thought to be a major factor in maintaining the markedly acidic pH of this site. In contrast, it has been shown that in rats the frequency of vaginal lactobacilli is only 36% and that the vaginal pH is near neutrality (12).…”

Streptococci and the Genital Tract

“…De Louvois et al 38 in a study of vaginal flora in pregnancy involving 280 women were unable to identify a single case of GAS carriage, whereas in a study involving 1083 women admitted to a labour ward the isolation rate of GAS was 0.27%24. Christensen et al 19 failed to identify GAS in urethral or cervical swabs from women suspected of having gonorrhoea but did find an isolation rate of 1.9% in urethral swabs from men suspected of having gonorrhoea.…”

Trichomonas vaginalis: Diagnosis and Clinical Characteristics in Pregnancy

“…9 Similar populations have documented TV infestation rates as low as 3% and as high as 48%. 15,16 Our findings appear to be representative of infection rates in many urban populations. The increased prevalence among AfricanAmerican women is consistent with previous reports.…”