Gynecologic conditions and bacterial vaginosis: implications for the non-pregnant patient.

Richard L Sweet

doi:10.1155/s1064744900000260

Richard L Sweet

Open Access

https://doi.org/10.1155/s1064744900000260

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Abstract

Bacterial vaginosis is characterized by a shift from the predominant lactobacillus vaginal flora to an overgrowth of anaerobic bacteria. Bacterial vaginosis is associated with an increased risk of gynecologic complications, including pelvic inflammatory disease, postoperative infection, cervicitis, human immunodeficiency virus (HIV), and possibly cervical intraepithelial neoplasia (CIN). The obstetrical risks associated with bacterial vaginosis include premature rupture of membranes, preterm labor and delivery, chorioamnionitis and postpartum endometritis. Despite the health risks associated with bacterial vaginosis and its high prevalence in women of childbearing age, bacterial vaginosis continues to be largely ignored by clinicians, particularly in asymptomatic women.

Highlights

Bacterial vaginosis is characterized by a shift from the predominant lactobacillus vaginal flora to an overgrowth of anaerobic bacteria
Gynecologic conditions associated with BV include pelvic inflammatory disease, ls,[6] postoperative infection such as postabortion endometritis 7,8 and pelvic cuff cellulitis following hysterectomy, 9,z cervicitis, el human immunodeficiency virus (HIV), zz-z4 and possibly cervical intraepithelial neoplasia (CIN). zs The obstetrical risks associated with BV include premature rupture of membranes, preterm labor and delivery, 7 chorioamnionitis, z6 and postpartum endometritis, z6
Findings by Hillier et al support these results.[4]. They found that high concentrations of pathogenic microorganisms, most frequently those associated with bacterial vaginosis including G. vaginalis, anaerobic Gram-negative rods, Peptostreptococcus spp., and M. hominis, were recovered from the endometria of 94% of women with histologic endometritis (n 117)

Summary

BACTERIAL VAGINOSIS

While BV was once thought to be merely a nuisance condition, more recent investigations have demonstrated that it is associated with an increased risk of gynecologic and obstetric complications. Despite its prevalence and associated health risks, bacterial vaginosis remains underdiagnosed by clinicians and poorly understood by patients. Given the health risks associated with bacterial vaginosis, low patient awareness combined with poor diagnostic practice may have significant implications for the female patient. While much of the recent literature has focused on obstetrical complications, greater emphasis should be placed on the non-pregnant patient for whom gynecologic health risks pose the greatest threat. SWEE T third to one-half of all infectious vaginal conditions,s because non-pregnant women represent the majority of BV cases, many of whom may be asymptomatic, routine screening and prompt treatment in this population is critical. Due to the proximity and permeability of the lower and upper genital tract mucosa, a dominance of pathogens in the vagina places women with BV at higher risk for upper genital tract infection, z6 In addition, enzymes and metabolic byproducts of abnormal vaginal flora impede normal white blood cell response to infection. e BV has been implicated in the gynecologic conditions discussed below

POSTOPERATIVE INFECTION

PELVIC INFLAMMATORY DISEASE

HUMAN IMMUNODEFICIENCY VIRUS

CERVICAL INTRAEPITHELIAL NEOPLASIA

CONCLUSION