1887

Chapter 7 : Bacterial Vaginosis as a Mixed Infection

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Ebook: Choose a downloadable PDF or ePub file. Chapter is a downloadable PDF file. File must be downloaded within 48 hours of purchase

Buy this Chapter
Digital (?) $15.00

Preview this chapter:
Zoom in
Zoomout

Bacterial Vaginosis as a Mixed Infection, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555817947/9781555812447_Chap07-1.gif /docserver/preview/fulltext/10.1128/9781555817947/9781555812447_Chap07-2.gif

Abstract:

Our understanding of bacterial vaginosis (BV) is improving through observational studies and study of the interactions between bacteria in the laboratory. The vaginal ecosystem is subjected to a variety of hormonal changes that affect the balance between lactobacilli and anaerobes. It is likely that the normal lactobacillus flora may be overwhelmed by factors such as a prolonged alteration in the pH of the vagina following vaginal douching or frequent sexual intercourse. Instillation of large numbers of organisms from a male or female sex partner might trigger BV. Alternative hypotheses include the introduction of a lytic bacteriophage infection, reducing the lactobacillus population. Once the BV organisms are allowed to flourish, they utilize each other’s metabolites in a symbiotic manner and continue to maintain a pH of >4.5. Possibly, the lack of HO-producing lactobacilli in the vagina makes it easier for sexually transmitted pathogens, including human immunodeficiency virus (HIV), to gain a foothold, although it may be that the same risk factors for acquiring sexually transmitted diseases (STDs) are in fact precipitating BV. There is an urgent need to determine how to effectively prevent the adverse outcomes of pregnancy associated with BV. If we could control BV, we might additionally be able to reduce the risk of HIV infection, for which BV is an important risk factor. A promising approach is to recolonize the vagina with lactobacilli that are high-level HO producers and may be better able to inhibit the growth of anaerobes than the native lactobacillus flora.

Citation: Hay P. 2002. Bacterial Vaginosis as a Mixed Infection, p 125-136. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch7

Key Concept Ranking

Pelvic Inflammatory Disease
0.62762165
Bacterial Vaginosis
0.47205725
0.62762165
Highlighted Text: Show | Hide
Loading full text...

Full text loading...

Figures

Image of FIGURE 1
FIGURE 1

Changes in the vaginal flora over a period of 3 months in a woman with recurrent BV (17). The day of the menstrual cycle, treatment with metronidazole (Met) or clotrimazole pessaries (Canesten), menstruation (Period), and unprotected sexual intercourse (USI) (indicated by diary and the presence of sperm on the smear) are shown. Days on which no slide was collected are shown as interruptions in the graph. The subject presents with BV, which resolves with metronidazole treatment. During her next period, develops. This resolves with treatment, to be followed by BV. The BV spontaneously resolves in midcycle, but candidiasis and BV recur shortly afterwards, and BV recurs again in the final month.

Citation: Hay P. 2002. Bacterial Vaginosis as a Mixed Infection, p 125-136. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch7
Permissions and Reprints Request Permissions
Download as Powerpoint

References

/content/book/10.1128/9781555817947.chap7
1. Agnew, K. J.,, and S. L. Hillier. 1995. The effect of treatment regimens for vaginitis and cervicitis on vaginal colonization by lactobacilli. Sex. Transm. Dis. 22:269273.
2. Amsel, R.,, P. A. Totten,, C. A. Spiegel,, K. C. Chen,, D. Eschenbach,, and K. K. Holmes. 1983. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am. J. Med. 74:1422.
3. Antonio, M. A.,, S. E. Hawes,, and S. L. Hillier. 1999. The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species. J. Infect. Dis. 180:19501956.
4. Berger, B. J.,, S. Kolton,, J. M. Zenilman,, M. C. Cummings,, J. Feldman,, and W. M. Mc- Cormack. 1995. Bacterial vaginosis in lesbians: a sexually transmitted disease. Clin. Infect. Dis. 21:14021405.
5. Blackwell, A. L.,, P. D. Thomas,, K. Wareham,, and S. J. Emery. 1993. Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy. Lancet 342:206210.
6. Blackwell, A. L. 1999. Vaginal bacterial phaginosis? Sex. Transm. Infect. 75:352353.
7. Boskey, E. R.,, K. M. Telsch,, K. J. Whaley,, T. R. Moench,, and R. A. Cone. 1999. Acid production by vaginal flora in vitro is consistent with the rate and extent of vaginal acidification. Infect. Immun. 67:51705175.
8. Bump, R. C.,, and W. J. Buesching. 1988. Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am. J. Obstet. Gynecol. 158: 935939.
9. Cauci, S.,, R. Monte,, S. Driussi,, P. Lanzafame,, and F. Quadrifoglio. 1998. Impairment of the mucosal immune system: IgA and IgM cleavage detected in vaginal washings of a subgroup of patients with bacterial vaginosis. J. Infect. Dis. 178:16981706.
10. Draper, D. L.,, D. V. Landers,, M. A. Krohn,, S. L. Hillier,, H. C. Wiesenfeld,, and R. P. Heine. 2000. Levels of vaginal secretory leukocyte protease inhibitor are decreased in women with lower reproductive tract infections. Am. J. Obstet. Gynecol. 183:12431248.
11. Gardner, H. L.,, and C. D. Dukes. 1955. Haemophilus vaginalis vaginitis. A newly defined specific infection previously classified “nonspecific” vaginitis. Am. J. Obstet. Gynecol. 69:962976.
12. Goldenberg, R. L.,, J. C. Hauth,, and W. W. Andrews. 2000. Intrauterine infection and preterm delivery. N. Engl. J. Med. 342:15001507.
13. Hawes, S. E.,, S. L. Hillier,, J. Benedetti,, C. E. Stevens,, L. A. Koutsky,, P. Wolner- Hanssen,, and K. K. Holmes. 1996. Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J. Infect. Dis. 174:10581063.
14. Hay, P. E.,, R. F. Lamont,, D. Taylor- Robinson,, D. J. Morgan,, C. Ison,, and J. Pearson. 1994. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. Br. Med. J. 308:295298.
15. Hay, P. E.,, D. J. Morgan,, C. A. Ison,, S. A. Bhide,, M. Romney,, P. McKenzie, et al. 1994. A longitudinal study of bacterial vaginosis during pregnancy. Br. J. Obstet. Gynaecol. 101: 10481053.
16. Hay, P. E.,, D. Taylor-Robinson,, and R. F. Lamont. 1992. Diagnosis of bacterial vaginosis in a gynaecology clinic. Br. J. Obstet. Gynaecol. 99: 6366.
17. Hay, P. E.,, A. Ugwumadu,, and J. Chowns. 1997. Sex, thrush and bacterial vaginosis. Int. J. STD AIDS 8:603608.
18. Hillier, S. L. 1998The vaginal microbial ecosystem and resistance to HIV. AIDS Res. Hum. Retrovir. 14(Suppl. 1):S17S21.
19. Klebanoff, S. J.,, and R. W. Coombs. 1991. Viricidal effect of Lactobacillus acidophilus on human immunodeficiency virus type 1: possible role in heterosexual transmission. J. Exp. Med. 174: 289292.
20. Klebanoff, S. J.,, S. L. Hillier,, D. A. Eschenbach,, and A. M. Waltersdorph. 1991. Control of the microbial flora of the vagina by H2O2-generating lactobacilli. J. Infect. Dis. 164:94100.
21. McGregor, J. A.,, J. I. French,, R. Parker,, D. Draper,, E. Patterson,, W. Jones,, K. Thorsgard,, and J. McFee. 1995. Prevention of premature birth by screening and treatment for common genital tract infections: results of a prospective controlled evaluation. Am. J. Obstet. Gynecol. 173: 157167.
22. Nilsson, U.,, D. Hellberg,, M. Shoubnikova,, S. Nilsson,, and P. A. Mardh. 1997. Sexual behavior risk factors associated with bacterial vaginosis and Chlamydia trachomatis infection. Sex. Transm. Dis. 24:241246.
23. Nugent, R. P.,, M. A. Krohn,, and S. L. Hillier. 1991. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. J. Clin. Microbiol. 29: 297301.
24. Parent, D.,, M. Bossens,, D. Bayot,, C. Kirkpatrick,, F. Graf,, F. E. Wilkinson,, and R. R. Kaiser. 1996. Therapy of bacterial vaginosis using exogenously-applied Lactobacilli acidophili and a low dose of estriol: a placebo-controlled multicentric clinical trial. Arzneimittel-Forschung 46:6873.
25. Pavlova, S. I.,, A. O. Kilic,, S. M. Mou,, and L. Tao. 1997. Phage infection in vaginal lactobacilli: an in vitro study. Infect. Dis. Obstet. Gynecol. 5:3644.
26. Pavlova, S. I.,, and L. Tao. 2000. Induction of vaginal Lactobacillus phages by the cigarette smoke chemical benzo[a]pyrene diol epoxide. Mutat. Res. 466:5762.
27. Paxton, L. A.,, N. Sewankambo,, R. Gray,, D. Serwadda,, D. McNairn,, C. Li,, and M. J. Wawer. 1998. Asymptomatic non-ulcerative genital tract infections in a rural Ugandan population. Sex. Transm. Infect. 74:421425.
28. Pybus, V.,, and A. B. Onderdonk. 1998. A commensal symbiosis between Prevotella bivia and Peptostreptococcus anaerobius involves amino acids: potential significance to the pathogenesis of bacterial vaginosis. FEMS Immunol. Med. Microbiol. 22:317327.
29. Pybus, V.,, and A. B. Onderdonk. 1997. Evidence for a commensal, symbiotic relationship between Gardnerella vaginalis and Prevotella bivia involving ammonia: potential significance for bacterial vaginosis. J. Infect. Dis. 175:406413.
30. Rajamanoharan, S.,, N. Low,, S. B. Jones,, and A. L. Pozniak. 1999. Bacterial vaginosis, ethnicity, and the use of genital cleaning agents: a case control study. Sex. Transm. Dis. 26:404409.
31. Ralph, S. G.,, A. J. Rutherford,, and J. D. Wilson. 1999. Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. Br. Med. J. 319:220223.
32. Redondo-Lopez, V.,, C. Meriwether,, C. Schmitt,, M. Opitz,, R. Cook,, and J. D. Sobel. 1990. Vulvovaginal candidiasis complicating recurrent bacterial vaginosis. Sex. Transm. Dis. 17:5153.
33. Rodrigues, A. G.,, P. A. Mardh,, C. Pina- Vaz,, J. Martinez-de-Oliveira,, and A. F. da Fonseca. 1999. Is the lack of concurrence of bacterial vaginosis and vaginal candidosis explained by the presence of bacterial amines? Am. J. Obstet. Gynecol. 181:367370.
34. Rosenstein, I. J.,, D. J. Morgan,, M. Sheehan,, R. F. Lamont,, and D. Taylor-Robinson. 1996. Bacterial vaginosis in pregnancy: distribution of bacterial species in different Gram-stain categories of the vaginal flora. J. Med. Microbiol. 45:120126.
35. Royce, R. A.,, T. P. Jackson,, J. M. Thorp, Jr.,., S. L. Hillier,, L. K. Rabe,, L. M. Pastore,, and D. A. Savitz. 1999 Race/ethnicity, vaginal flora patterns, and pH during pregnancy. Sex. Transm. Dis. 26:96102.
36. Schroder, R. 1921Zur Pathogenese und Klinik des vaginalen Fluors. Zentbl. Gynakol. 38:13501361.
37. Schwebke, J. R.,, and L. F. Lawing. 2001. Prevalence of Mobiluncus spp. among women with and without bacterial vaginosis as detected by polymerase chain reaction. Sex. Transm. Dis. 28:195199.
38. Schwebke, J. R.,, S. C. Morgan,, and H. L. Weiss. 1997. The use of sequential self-obtained vaginal smears for detecting changes in the vaginal flora. Sex. Transm. Dis. 24:236239.
39. Tao, L.,, S. I. Pavlova,, S. M. Mou,, W. G. Ma,, and A. O. Kilic. 1997. Analysis of Lactobacillus products for phages and bacteriocins that inhibit vaginal lactobacilli. Infect. Dis. Obstet. Gynecol. 5:244251.
40. Taylor-Robinson, D.,, and P. E. Hay. 1997. The pathogenesis of the clinical signs of bacterial vaginosis and possible reasons for its occurrence. Int. J. STD AIDS 8(Suppl. 1):3537.

Tables

Generic image for table
TABLE 1

The composite (Amsel) criteria used for the diagnosis of BV in clinical practice

Citation: Hay P. 2002. Bacterial Vaginosis as a Mixed Infection, p 125-136. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch7
Generic image for table
TABLE 2

Standard treatments for BV

Citation: Hay P. 2002. Bacterial Vaginosis as a Mixed Infection, p 125-136. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch7

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error