Anaerobic Vaginosis Research Articles

Disseminated salmonellosis in a patient with the acquired immunodeficency syndrome

bacterial vaginosis. Int. J. STD AIDS 7:61-64. 3. Colli, E., M. Landoni, and F. Parazzini. 1997. Treatment of male partners and recurrence of bacterial vaginosis: a randomized trial. Genitourin. Med. 721267-270. 4. Moi, H. et al. 1989. Should male consorts of women with bacterial vaginosis be treated? Genitourin. Med. 65:263268. 5. Vejtorp, M., A.C. Bollerup, and L. Vejtorp. 1988. Bacterial vaginosis: a double blind randomized trial of the effect of the treatment of the sexual partner. Br. J. Obstet. Gynecol. 95:920926. 6. Centers for Disease Control and Prevention. 1998. Sexually transmitted diseases guidelines. Morbid. Mortal. Weekly Rep. 47 @R-1):70-73. 7. Blackwell, A.L. et al. 1983. Anaerobic vaginosis (non-specific vaginitis): clinical microbiological and therapeutic findings. Lancet ii(8364): 1379-1382.

The effect of stopping smoking on cervical Langerhans' cells and lymphocytes.

To investigate the effects of stopping smoking on cervical Langerhans' cells and lymphocytes. Prospective intervention study. A large family planning clinic in central London. Women volunteers prepared to attempt to give up smoking for six months. Their most recent cervical smear showed no abnormality greater than mild dyskaryosis. The women were seen at three-month intervals for six months. Reduction in smoking was assessed by self-reporting and validated by salivary cotinine concentrations. Colposcopy and a biopsy of a normal area were performed at the first and last visits. Any area of abnormality was also biopsied at the final visit. Langerhans' cells and lymphocytes were counted. Proportional changes in counts of Langerhans' cells and lymphocytes with reduction in smoking. Reduction in smoking by 20 to 40 cigarettes per day was significantly associated with a reduction of between 6% and 16% in counts of Langerhans cells, CD8 and total lymphocytes. Heavy smoking was significantly associated (P = 0.02) with an increased chance of persistent human papillomavirus infection. The presence of candida was associated with significantly higher counts of between 41% and 47% in total lymphocytes and CD8 lymphocytes. In contrast, the presence of anaerobic vaginosis was associated with significantly lower counts of between 16% and 30% in Langerhans cells, CD4 and CD8 lymphocytes. This large intervention study has demonstrated a clear relationship between reduction in smoking and changes in cervical immune cell counts. Future studies need to take into account cytokine interactions, which recent studies suggest may be significant in the immune response to both human papillomavirus and cervical intraepithelial neoplasia and the ever-increasing complexity of the cell-mediated immune system of the cervix.

The effect of stopping smoking on cervical Langerhans'cells and lymphocytes

Objective To investigate the effects of stopping smoking on cervical Langerhans’ cells and lymphocytes. Design Prospective intervention study. Setting A large family planning clinic in central London. Population Women volunteers prepared to attempt to give up smoking for six months. Their most recent cervical smear showed no abnormality greater than mild dyskaryosis. Methods The women were seen at three-month intervals for six months. Reduction in smoking was assessed by self-reporting and validated by salivary cotinine concentrations. Colposcopy and a biopsy of a normal area were performed at the first and last visits. Any area of abnormality was also biopsied at the final visit. Langerhans’ cells and lymphocytes were counted. Main outcome measures Proportional changes in counts of Langerhans’ cells and lymphocytes with reduction in smoking. Results Reduction in smoking by 20 to 40 cigarettes per day was significantly associated with a reduction of between 6% and 16% in counts of Langerhans cells, CD8 and total lymphocytes. Heavy smoking was significantly associated ( P = 0.02) with an increased chance of persistent human papillomavirus infection. The presence of candida was associated with significantly higher counts of between 41% and 47% in total lymphocytes and CD8 lymphocytes. In contrast, the presence of anaerobic vaginosis was associated with significantly lower counts of between 16% and 30% in Langerhans cells, CD4 and CD8 lymphocytes. Conclusions This large intervention study has demonstrated a clear relationship between reduction in smoking and changes in cervical immune cell counts. Future studies need to take into account cytokine interactions, which recent studies suggest may be significant in the immune response to both human papillomavirus and cervical intraepithelial neoplasia and the ever-increasing complexity of the cell-mediated immune system of the cervix.

Vaginal bacterial phaginosis?

Vaginal bacterial phaginosis?

Universal prophylaxis for Chlamydia trachomatis and anaerobic vaginosis in women attending for suction termination of pregnancy: an audit of short-term health gains

A previous study of infection and morbidity in 400 women attending for termination of pregnancy (TOP) had shown that 32 (8%) harboured cervical Chlamydia trachomatis and 112 (28%) had anaerobic (bacterial) vaginosis (AV). Fifty-three per cent of the women with preoperative C. trachomatis had AV. Thirty of the 32 women with chlamydial infection were followed up and 19 (63%) of these developed post-abortion upper genital tract infection, 7 of whom needed re-admission. In view of the high morbidity in women with chlamydial infection attending for TOP, anti-bacterial prophylaxis with metronidazole suppositories and oral oxytetracycline was introduced for women attending for suction termination of pregnancy (STOP). An audit of the clinical and financial benefits and/or losses was carried out. The audit of 1951 consecutive patients attending for STOP revealed that 132 (6.8%) had chlamydial infection with equivocal results reported in a further 2 patients. One hundred and eight of the 134 women responded to recall. Full genital tract infection screening was carried out in 105 of the 108 recalled patients of whom 5 had repeat positive cervical swabs for C. trachomatis, one had Trichomonas vaginalis, 24 had candidiasis and 17 had anaerobic vaginosis, none had gonorrhoea. Thirteen (12%) of the 108 women had pelvic infection as previously defined, none of whom required re-admission. At least pound sterling 20,000 has been saved each year in our Trust following the introduction of pre-abortion chlamydial screening and universal antichlamydial and anti-anaerobe prophylaxis. The introduction of universal prophylaxis against C. trachomatis and AV has profoundly reduced morbidity in patients attending for TOP and has also resulted in substantial financial savings.

Universal prophylaxis for Chlamydia trachomatis and anaerobic vaginosis in women attending for suction termination of pregnancy: an audit of short-term health gains

Universal prophylaxis for Chlamydia trachomatis and anaerobic vaginosis in women attending for suction termination of pregnancy: an audit of short-term health gains

Anaerobic (bacterial) vaginosis and premalignant disease of the cervix

Summary Nitrosamines are carcinogenic substances found in cigarette smoke, and it is known that female smokers have an increased risk of cervical carcinoma and premalignant change. Nitrosamines may also be formed due to the combination of amines and nitrites in an acidic medium. This study has shown a statistically significant association between anaerobic vaginosis which produce amines and cervical intraepithelial neoplasia 2 and 3. In addition nitrate reducing organisms are found in the acidic lower genital tract in a significant number of cases. It is therefore theoretically possible that nitrosamines may be an important agent in the development of premalignant disease of the cervix.

The management of anaerobic (bacterial) vaginosis: past, present & future

The management of anaerobic (bacterial) vaginosis: past, present & future

HIV, sexually transmitted diseases and gynaecologic disorders in women

To determine the incidence of sexually transmitted diseases (STD; gonorrhoea, early syphilis, Chlamydia trachomatis infection, trichomoniasis and primary genital herpes) and gynaecologic disorders (vaginal candidiasis, anaerobic vaginosis, genital ulcerations of unknown cause, pelvic inflammatory disease, recurrent genital herpes, recurrent genital warts) in a cohort of HIV-infected and non-infected drug-using prostitutes in Amsterdam between 1986 and 1992. A subgroup of 212 female drug users with a history of prostitution, who made at least one visit to a special STD clinic for drug-using prostitutes was selected from an ongoing cohort study of drug users in Amsterdam. Using Poisson regression, the relative risk (RR) for each outcome was calculated for HIV-positive women compared with HIV-negative women. To determine potential causal relations with immune suppression, associations between disease incidence and immunologic markers (CD4 cell count and anti-CD3 response) were assessed in HIV-positive women. Adjusted for number of clients and frequency of condom use, HIV-positive women were at strong and significantly increased risk for primary genital herpes (RR, 7.64), recurrent herpes (RR, 8.33) and recurrent genital warts (RR, 15.93); moderately (significantly) increased risks were found for gonorrhoea (RR, 1.43), trichomoniasis (RR, 1.39), vaginal candidiasis (RR, 2.11) and genital ulcers of unknown aetiology (RR, 2.60). Of these HIV-related outcomes, the risk for recurrent genital herpes and genital warts were strongly associated with decreased CD4 cell counts. HIV-infected women experience an excess morbidity of STD and gynaecologic disorders. The strongly increased risk for genital herpes and warts in HIV-seropositive women indicates a causal relation with HIV. This study emphasizes the need for accessible medical care for drug-using prostitutes.

Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy

Infection of the upper genital tract after abortion is well recognised, but routine screening for infection before termination is rare, and few centres are aware of the prevalence of post-abortion complications in their population. We undertook a study to assess the prevalence and sequelae of genital-tract infection in patients undergoing termination of pregnancy and to estimate the costs and potential benefits of introducing screening and prophylaxis for the most commonly found organisms. The study in Swansea, UK, was of 401 consecutive patients attending for termination of pregnancy; only 1 patient refused to take part. Immediately before the termination procedure vaginal and cervical swabs were taken for microscopic examination and culture of Trichomonas vaginalis, Neisseria gonorrhoeae, and candida species. We sought Chlamydia trachomatis by enzyme-linked immunosorbent assay. 112 (28%) women had the typical bacterial flora of anaerobic (bacterial) vaginosis, 95 (24%) had candidal infection, 32 (8%) chlamydial infection, 3 (0 75%) trichomonas infection, and 1 (0·25%) gonorrhoea. Postoperative follow-up of 30 of the women with chlamydial infection showed that pelvic infection developed in 19 (63%), of whom 7 were readmitted to hospital. 9 male partners of women with chlamydial (plus gonococcal in 1 case) infection were examined; 8 were symptom-free, 3 had C trachomatis infection, and 1 N gonorrhoeae. Estimated costs of hospital admissions for complications of chlamydial infection were more than double the costs of providing a routine chlamydia screening programme and prophylactic treatment. Screening for chlamydial infection before termination of pregnancy is essential. Prophylactic treatment for both chlamydial infection and anaerobic vaginosis should also be considered. Male partners of women infected with chlamydia are often symptom-free, but they must be traced to avoid reinfections.

Black-pigmented Gram-negative anaerobes in genito-urinary tract and pelvic infections

Black-pigmented Gram-negative anaerobes are part of the normal vaginal flora and contribute to a range of superficial and deep genital infections. Prevotella melaninogenica is found in moderate numbers (104−6 cfu/g) in healthy women; the numbers and detection rates increase in anaerobic vaginosis (where it may be a significant contributor to changed microbial metabolic activity that gives the signs and symptoms of this condition) and in other vaginal infective conditions. Pr. melaninogenica is also part of the mixed flora in deep pelvic infections: endometritis, post-partum and post-abortal uterine infections; salpingitis and tubo-ovarian abscesses; PID and pelvic abscesses. Porphyromonas asaccharolytica is probably not a vaginal commensal, but may be isolated from patients with vaginal or pelvic disease. It is more specifically associated with superficial abscesses (e.g. Bartholin's abscess) and ulcers of the genitalia and perineum. P. asaccharolytica was the commonest species isolated from men with genital ulcers of various primary causes and ranging in severity from superficial balanitis/balanoposthitis to synergic gangrene.

Black-pigmented Gram-negative anaerobes in genito-urinary tract and pelvic infections

Black-pigmented Gram-negative anaerobes are part of the normal vaginal flora and contribute to a range of superficial and deep genital infections. Prevotella melaninogenica is found in moderate numbers (10(4-6) cfu/g) in healthy women; the numbers and detection rates increase in anaerobic vaginosis (where it may be a significant contributor to changed microbial metabolic activity that gives the signs and symptoms of this condition) and in other vaginal infective conditions. Pr. melaninogenica is also part of the mixed flora in deep pelvic infections: endometritis, post-partum and post-abortal uterine infections; salpingitis and tubo-ovarian abscesses; PID and pelvic abscesses. Porphyromonas asaccharolytica is probably not a vaginal commensal, but may be isolated from patients with vaginal or pelvic disease. It is more specifically associated with superficial abscesses (e.g. Bartholin's abscess) and ulcers of the genitalia and perineum. P. asaccharolytica was the commonest species isolated from men with genital ulcers of various primary causes and ranging in severity from superficial balanitis/balanoposthitis to synergic gangrene.

Anaerobic Vaginosis: Study of Male Sexual Partners

One hundred male sexual partners of women with anaerobic vaginosis (AV) were screened for the presence of sexually transmitted diseases (STD). Thirty male partners had evidence of non-gonococcal urethritis (NGU), compared to 5 in the control group (P less than 0.05). Chlamydia trachomatis was isolated from 14 male partners, compared to 3 in the control group. Forty-five male partners required treatment for STDs, compared to 11 in the control group (P less than 0.02). Nine (40%) male partners with chlamydia-negative NGU were successfully treated with metronidazole alone while 10 required Deteclo in addition. There was no significant association between Bacteroides ureolyticus and chlamydia-negative NGU. Screening of male partners resulted in the treatment of STDs in 62 additional patients who would have otherwise not received treatment. The results suggest that examination of male partners of women with AV results in an increased yield of STD diagnoses.

Tea tree oil treats anaerobic vaginosis

Tea tree oil treats anaerobic vaginosis

Aetiology of Non-Gonococcal Urethritis: A Possible Relation to other Infections

Chlamydia trachomatis can be identified in up to 60% of cases of nongonococcal urethritis (NGU) and the aetiology of most of the remainder is obscure. This paper reports a role for other genitourinary (GU) infections such as candidiasis, warts and herpes simplex, in the causation of NGU. One hundred and ten men fulfilled the entry criteria which included the probability that their contacts would attend the department. Fifty-four of the 110 men had GU infections other than NGU; 56 had no other infections. NGU was detected in 31 (57%) of cases with other GU infections and 8 (26%) were chlamydiae-positive: in contrast NGU was found in only 10 (18%) of those with none of the other infections and 3 (30%) were chlamydiae-positive. Chlamydiae-negative NGU was, therefore, more common in those with other GU infections. Forty-five (86%) of 52 contacts of 41 patients with NGU had various GU infections such as candidosis and anaerobic vaginosis, in contrast with other GU infections in only 7 (23%) of 30 contacts of men with no other GU infections. Other GU infections in patients and their contacts appeared significantly related to the presence of chlamydiae-negative NGU.

The role and prevalence of Gardnerella vaginalis in anaerobic vaginosis

310 cases of anaerobic vaginosis and 80 asymptomatic females were studied for the detection of various organisms from their genital specimens. The main complaint of the symptomatic cases was vaginal discharge. Neisseria gonorrhoeae, Candida albicans, Trichomonas vaginalis. Bacteroides species, anaerobic cocci and Gardnerella vaginalis were detected. The frequency of detection of all except C. albicans was less in pregnant than non-pregnant women. However, the prevalence of anaerobes and G. vaginalis was significantly lower in both the symptomatic and asymptomatic pregnant than the non-pregnant women. G. vaginalis showed mutualism with anaerobic bacteria and was not isolated as a pure culture in any of the cases. It appears that G. vaginalis, like anaerobes, has variable prevalence rates and is under the influence of local physiological and hormonal factors. This organism does not appear to have a primary pathogenic role, but assumes a secondary role in association with non-sporing anaerobes in the pathogenesis of anaerobic vaginosis.

Octadeca-9,11-dienoic acid in cervical intraepithelial neoplasia: A colposcopic study

488 women were studied to evaluate the use of the molar ratio (%MR) of octadeca-9,11-dienoic acid (18:2(9, 11)) to linoleic acid (18:2(9, 12)) as a new screening method for cervical cancer and pre-cancer. A combination of Papanicolaou cytology, colposcopy and %MR 18:2(9, 11)/18:2(9, 12) were employed. 86 women (17.6%) were found to have histologically proven cervical intraepithelial neoplasia (CIN). The %MR was obtained in 452 cases (92%). There was no significant difference in %MR in cervical cell scrapes from women with or without CIN. The %MR of cervical scrapes in some women with anaerobic vaginosis was significantly elevated suggesting bacterial generation of 18:2(9, 11). The %MR of 18:2(9, 11)/18:2(9, 12) is unsuitable for the diagnosis of cervical intraepithelial neoplasia.

Vaginal infections and prematurity.

ABSTRACT: This is a review of four vaginal and cervical infections that may be associated with prematurity, premature rupture of the membranes, or low birthweight. Urea‐plasma urealyticum, group B streptococcus, Chlamydia trachomatis, and anaerobic vaginosis are discussed, along with other data regarding intrauterine infection as a cause of prematurity.

Quality Assurance for Office Laboratories

To the Editor.— I read with interest the review by Belsey et al 1 in the Feb 14 issue ofThe Journal, which mentions under Technical Implications that the new office laboratory will require practitioners to adopt the role of laboratory director, with all its dreary quality control trappings. I am an emergency room (ER) physician and at the time was looking for documentation of the usefulness of clue cells in the diagnosis of Gardnerella vaginitis (or anaerobic vaginosis) to present to the hospital laboratory director, since we have not been allowed a microscope in the ER (because of quality control considerations, among others). I was hoping to have the presence of clue cells included in each vaginal wet preparation report. An hour's worth of telephone calls and a trip to the medical school library revealed the following paradoxical information. Of 11 hospital laboratories telephoned in the area, all with

Bacterial flora of the cervix in women using different methods of contraception

Bacteriologic culture samples were taken from the cervix in three groups of 10 healthy, sexually active women using barrier contraception, oral contraceptives, or a levonorgestrel-releasing intrauterine contraceptive device. Culture samples for Candida albicans and Trichomonas vaginalis were taken, a cytologic vaginal smear was obtained, and an amine sniff test was performed; these were in addition to a routine gynecologic examination. Multiple bacteria were isolated from the cervix in women using oral contraceptives or an intrauterine contraceptive device, whereas lactobacilli alone dominated the flora of women using barrier contraception. Significantly more anaerobic bacteria were isolated from the cervix in oral contraceptive and intrauterine contraceptive device users when compared with the barrier method users. Symptoms and findings evident of anaerobic vaginosis were associated with the occurrence of anaerobic bacteria in the cervix of three patients using the intrauterine contraceptive device. The results showed that the cervical bacterial flora in sexually active healthy women is rich in anaerobes that can be regarded as a normal finding in women using oral contraceptives or intrauterine contraceptive devices. Barrier contraception with a condom prevents this anaerobic shift and maintains a lactobacilli-dominated flora in the cervix.