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Chapter 7 : Bacterial Vaginosis

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Abstract:

Bacterial vaginosis (BV) is the name of a syndrome formerly called nonspecific vaginitis, vaginitis, and vaginitis, among others. In the healthy vagina, the normal vaginal flora consists predominantly of species, which make up about 95% or more of the total bacterial count. The cytokine concentration in the amniotic fluid of infected patients is equal to or higher than the concentration of cytokines in the cerebrospinal fluid of children with meningitis or in the abdominal fluid of adults with peritonitis. The most important aspect of BV in causing vaginitis is the tremendous increase in the concentration of the bacteria in the vagina. The increased concentration of bacteria explains, in part, the relationship between BV and preterm delivery/low birth weight and infection of the amniotic fluid and chorioamnion. The time when BV-related bacteria move from the lower to the upper genital tract is not known. This phenomenon could occur at a constant rate throughout pregnancy, but indirect information suggests otherwise. A current working hypothesis for acute or chronic chlamydia infection is that a component(s) of the immune response to chlamydia heat shock protein cross-reacts with the analogous human heat shock protein and somehow results in infertility or first-trimester spontaneous abortion and even preterm delivery. The natural history of BV in the nonpregnant patient must be elucidated. Natural history studies of women with and without BV who will attempt pregnancy are needed.

Citation: Eschenbach D. 1999. Bacterial Vaginosis, p 103-124. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch7
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References

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Tables

Generic image for table
Table 1

Cytokine and prostaglandin concentrations in various infections

Citation: Eschenbach D. 1999. Bacterial Vaginosis, p 103-124. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch7
Generic image for table
Table 2

Estimated frequency of BV in pregnancy

Citation: Eschenbach D. 1999. Bacterial Vaginosis, p 103-124. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch7
Generic image for table
Table 3

Association between BV and preterm delivery

Citation: Eschenbach D. 1999. Bacterial Vaginosis, p 103-124. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch7
Generic image for table
Table 4

Data linking anaerobic infection with prematurity

Citation: Eschenbach D. 1999. Bacterial Vaginosis, p 103-124. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch7
Generic image for table
Table 5

Bacteria isolated from amniotic fluid of women in preterm labor with intact membranes

Citation: Eschenbach D. 1999. Bacterial Vaginosis, p 103-124. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch7
Generic image for table
Table 6

Association between amniotic fluid infection and cytokines in the amniotic fluid

Citation: Eschenbach D. 1999. Bacterial Vaginosis, p 103-124. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch7
Generic image for table
Table 7

Cytokine and prostaglandin concentrations in cerebrospinal fluid before and after treatment of meningitis with dexamethasone plus antibiotics or antibiotics alone

Citation: Eschenbach D. 1999. Bacterial Vaginosis, p 103-124. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch7

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