#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Bacterial vaginosis and the role of vaginal acidification


Authors: J. Minárik
Published in: Prakt Gyn 2008; 12(4): 217-224

Overview

Bacterial vaginosis (BV) is one of the most frequent vaginal infections in women of reproductive age. It accounts for more than 50 % of BV cases. Bacterial vaginosis impairs vaginal microenvironment equilibri um by virtue of incre asing vaginal pH over 4.5, suppressing lactobacilli flora and, primarily, by proliferating anaerobe bacteria. In most women, the BV has an asymptomatic course. In case of symptomatic BV mainly vaginal discharge is present, of white to grey colour and with a characteristic “fish‑like” odour. BV patients are more often affected by post‑op infections in the pelvic region and by urinary infections, and have a higher risk of preterm delivery, low birth weight and infertility. In spite of high efficiency of standard therapy, a significant trend towards recurrence has been observed. Administration of exogenous lactobacilli has not brought the expected results. It is the persistence of a higher vaginal pH which appe ars to hinder the renewal of the prevailing lactobacillus flora. The latest trend consists in the effort to reduce the higher pH in order to facilitate the colonisation of vaginal epitheli um by natural lactobacilli. A vaginal cre am with acid pH and vitamin C (e. g. VITAgyn C) can be newly used for acidification and stimulation of colonisation to intensify basic BV therapy.

Key words:
bacterial vaginosis –  lactobacilli –  pH acidity –  vitamin C –  recurrence –  vaginal microflora


Sources

1. Chan RCY, Bruce AW, Reid G. Adherence of cervical, vaginal and distal urethral normal microbial flora to human uroepithelial cells and the inhibition of adherence of uropathogens by competitive exclusion. J Urol 1984; 131: 596– 601.

2. Schwebke JR, Richey CM, Weiss HL. Correlation of behavior with microbiological changes in vaginal flora. J Infect Dis 1999; 180: 1632– 1636.

3. Eden CS, Hanson LA, Jodal U et al. Variable adherence to normal human urinary- tract epithelial cells of Escherichia coli strains associated with various forms of urinary- tract infection. Lancet 1976; 1: 490– 492.

4. Ho olon TM, Hillier S, Johnson C et al. Escherichia coli bacteri uria and contraceptive method. JAMA 1991; 265: 64– 69.

5. Reid G, Bruce AW, Co ok RL, Llano M. Effect on the urogenital flora of antibiotic therapy for urinary tract infection. Scand J Infect Dis 1990; 22: 43– 47.

6. Pirotta M, Gunn J, Chondros P et al. The PAV trial: Does lactobacillus prevent post‑antibiotic vulvovaginal candidiasis? Protocol of a randomised controled trial. BMC Family Practice 2004; 5: 5.

7. Pirotta M, Gunn J, Chondros P, Grover S, Hurley S, Garland S. Effect of lactobacillus in preventing post‑antibiotic vulvovaginal candidiasis: a randomized controlled trial. BMJ, online first bmj.com published 27. 8. 2004.

8. Schwebke JR, Weiss H. Influence of the normal menstru al cycle on vaginal microflora. Clin Infect Dis. 2001; 32: 325.

9. Nansel T, Riggs M, Yu KF et al. The association of psychosocial stress and bacterial vaginosis in a longitudinal cohort. Am J Ob Gyn Febru ary 2006; 194(2): 381– 386.

10. Verstraelen H, Delanghe J, Roelens K et al. Subclinical iron deficiency is a strong predictor of bacterial vaginosis in e arly pregnancy. BMC Infectious Dise ases 2005; 5: 55.

11. González PAA, Ortíz ZMC, Irigoyen CA. Bacterial vaginosis a “bro ad overview”. Rev Latino am Microbiol. 1999 Jan- Mar; 41(1): 25– 34.

12. Wiesenfeld H.C, Hillier SL, Krohn MA et al. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoe ae and Chlamydia trachomatis infection. Clin Infect Dis 2003; 36: 663– 668.

13. Taha TE, Gray RH, Kumwenda NI et al. HIV infection and disturbances of vaginal flora during pregnancy. JAcquir Immune Defic Syndr Hum Retrovirol 1999; 20: 52– 59.

14. Royce RA, Thorp J, Granados JL et al. Bacterial vaginosis associated with HIV infection in pregnant women from North Carolina. J Acquir Immune Defic Syndr Hum Retrovirol 1999; 20: 382– 386.

15. Sewankambo N, Gray RH, Wawer MJ et al. HIV- 1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet 1997; 350: 546– 550.

16. Taha TE, Ho over DR, Dallabetta GA et al. Bacterial vaginosis and disturbances of vaginal flora: association with incre ased acquisition of HIV. AIDS 1998; 12: 1699– 1706.

17. Martin H, Nyange PM, Richardson BA et al. Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexu ally transmitted dise ase acquisition. J Infect Dis 1999; 180: 1863– 1868.

18. Hashemi FB, Ghassemi M, Roebuck KA et al. Activation of human immunodeficiency type I expression by Garnerella vaginalis. J Infect Dis 1999; 179: 924.

19. Morris M, Nicoll A, Simms I, Wilson J, Catchpole M. Bacterial vaginosis: a public he alth review. BJOG 2001; 108: 439– 450.

20. Genc MR, Vardhana S, Delaney ML et al. MAP Study Group: Relationship between a toll‑like receptor- 4 gene polymorphism, bacterial vaginosis related flora and vaginal cytokine responses in pregnant women. Eur J Obstet Gynecol Reprod Biol 2004; 116: 152– 156.

21. Simhan H, Caritis S, Hillier S et al. Cervical anti‑inflammatory cytokine concentrations are decre ased among pregnant women with bacterial vaginosis. Am J Obstet Gynecol 2004, 191:11(suppl).

22. Bendich A. Micronutrients in women’s he alth and immune function. Nutrition 2001; 17: 858– 867.

23. Bhaskaram P. Immunobiology of mild micronutrient deficiencies. Br J Nutr 2001: 75– 80.

24. Rosenstein IJ, Fontaine EA, Morgan DJ et al. Relationship between hydrogen peroxide- producing strains of lactobacilli and vaginosis‑associated bacterial species in pregnant women. Eur J Clin Microbiol Infect Dis 1997; 16(7): 517– 522.

25. Hillier SL, Krohn MA, Klebanoff SJ et al. The relationship of hydrogen peroxide- producing lactobacilli to bacterial vaginosis and genital microflora in pregnant women. Obstet Gynecol 1992; 79(3): 369– 373.

26. Pu apermpo onsiri S, Kato N, Watanabe K et al. Vaginal microflora associated with bacterial vaginosis in Japanese and Thai pregnant women. Clin Infect Dis 1996; 23(4): 748– 752.

27. Beigi RH, Wiesenfeld HC, Hillier SL et al. Factors Associated with Absence of H2O2 Producing Lactobacillus among Women with Bacterial Vaginosis. J Infect Dis 2005; 191: 924– 929.

28. Agnew KJ, Hillier SL. The effect of tre atment regimens for vaginitis and cervicitis on vaginal colonization by lactobacilli. Sex Transm Dis 1995; 22: 269– 273.

29. Hillier SL, Nugent RP, Eschenbach DA et al. Association between bacterial vaginosis and preterm delivery of a low birth weight infant. N Engl J Med 1995; 333: 1737– 1742.

30. Hillier SL, Marti us J.; Krohn MA et al. A case- control study of chorio amnionic infection and histologic chorio amnionitis in prematurity. N Engl J Med 1988; 319: 972– 978.

31. Paavonen J, Teisala K, Heinonen PK et al. Microbiological and histopathological findings in acute pelvic inflammatory dise ase. Br J Obstet Gynaecol 1987; 94: 454– 460.

32. Hillier SL, Kiviat NB, Hawes SE et al. Role of bacterial vaginosis associated micro organisms in endometritis. Am J Obstet Gynecol 1996; 175: 435– 441.

33. Watts DH, Krohn MA, Hillier SJ, Eschenbach DA. Bacterial vaginosis as a risk factor for post cesare an endometritis. Obstet Gynecol 1990; 75: 52– 58.

34. Larsson P, Platz- Christensen JJ, Thejls H et al. Incidence of pelvic inflammatory dise ase after first trimester legal abortion in women with bacterial vaginosis after tre atment with metronidazole: a double- blind, randomized study. Am J Obstet Gynecol 1992; 166: 100– 103.

35. Soper DE, Bump RC, Hurt WG. Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy. Am J Obstet Gynecol 1990; 163: 1016– 1021.

36. Ness RB, Hillier SL, Richter HE et al. Douching in Relation to Bacterial Vaginosis, Lactobacilli, and Facultative Bacteria in the Vagina. Obstet Gynecol 2002; 100: 765– 772.

37. Amsel R, Totten PA, Spiegel CA et al. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74: 14– 22.

38. Ison CA, Hay PE. Validation of a simplified grading of Gram stained vaginal sme ars for use in genitourinary medicine clinics. Sex Transm Infect 2002; 78: 413– 415.

39. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. J Clin Microbiol 1991; 29: 297– 301.

40. Fredricsson B, Englund K, Weintra ub L et al. Ecological tre atment of bacterial vaginosis. Lancet 1987; 7: 276.

41. Sarra PC, Dellaglio F. Colonization of a human intestine by four different genotypes of Lactobacillus acidophilus. Microbiologia 1984; 7: 331– 339.

42. Larsson PG, Stray- Pedersen B, Ryttig KR et al. Human lactobacilli as supplementation of clindamycin to patients with bacterial vaginosis reduce the recurrence rate; a 6- month, double- blind, randomized, placebo- controlled study. BMC Women’s He alth 2008; 8: 3.

43. ACOG Practice Bulletin. Clinical management guidelines for obstetrician- gynecologists, Number 72, May 2006. Vaginitis. Obstet Gynecol 2006; 107(5): 1195– 1206.

44. Kane KY, Pierce R. What are the most effective tre atments for bacterial vaginosis in nonpregnant women? J Fam Pract 2001; 50(5): 399– 400.

45. Joesoef MR, Schmid G. Bacterial vaginosis. Clin Evid 2004; 2054– 2063.

46. Larsson PG, Forsum U. Bacterial vaginosis –  a disturbed bacterial flora and tre atment enigma. Apmis 2005; 113(5): 305– 316.

47. Bradshaw CS, Morton AN, Hocking J et al. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis 2006; 193(11): 1478– 1486.

48. Vasquez A, Jakobsson T, Ahrne S et al. Vaginal lactobacillus flora of he althy Swedish women. J Clin Microbiol 2002; 40(8): 2746– 2749.

49. Hallen A, Jarstrand C, Pahlson C. Tre atment of bacterial vaginosis with lactobacilli. Sex Transm Dis 1992; 19(3): 146– 148.

50. Swedberg J, Steiner JF, Deiss F et al. Comparison of single vs. one- week course of metronidazole for symptomatic bacterial vaginosis. JAMA 1985; 254: 1046.

51. Gardner HL, Dukes CD. Haemophilus vaginalis vaginitis. A newly defined specific infection previously classified “non‑specific” vaginitis. Am J Obstet Gynecol 1955; 69: 962– 976.

52. Screening Guideline Steering Group. Sexu ally Transmitted Infections: UK National Screening and Testing Guidelines. August 2006.

53. Holzman C, Leventhal JM, Qi u H. et al. Factors Linked to Bacterial Vaginosis in Nonpregnant Women. Am J Pub He alth 2001; 91(10): 1664– 1470.

54. Priestley CJ, Jones BM, Dhar J, Go odwin L. What is normal vaginal flora? Genitourin Med 1997; 73: 23– 28.

55. Ke ane FE, Ison CA, Taylor Robinson D. A longitudinal study of the vaginal flora over a menstru al cycle. Int J STD AIDS 1997; 8: 489– 494.

56. Hay PE, Ugwumadu A, Chowns J. Sex, thrush and bacterial vaginosis. Int J STD AIDS 1997; 8: 603– 608.

57. Ness RB, Kip KE, Hillier SL et al. A Cluster Analysis of Bacterial Vaginosis‑associated Microflora and Pelvic Inflammatory Dise ase. Am J Epidemiol 2005; 162: 585– 590.

58. Soledad B, Su árez JE, Vázquez F et al. Adherence of Human Vaginal Lactobacilli to Vaginal Epithelial Cells and Interaction with Uropathogens. Infection and Immunity May 1998: 1985– 1989.

59. Osset J, Bartolomé RM, García E et al. Assessment of the Capacity of Lactobacillus to Inhibit the Growth of Uropathogens and Block Their Adhesion to Vaginal Epithelial Cells. J Infect Dis 2001; 183: 485– 491.

60. Witkins SS, Giraldo PC, Linhares I. New insights into the immune pathogenesis of recurrent vulvovaginal candidiasis. It J Gynecol Obstet 2000; 3: 114

61. Andre u A, Stapleton AE, Fennell CL et al. Hemagglutination, adherence, and surface properties of vaginal Lactobacillus species. J Infect Dis 1995; 171(5): 1237– 1243.

62. Barrons R, Tassone D. Use of Lactobacillus probiotics for bacterial genitourinary infections in women: A review. Clin Ther 2008; 30(3): 453– 468.

63. Eschenbach DA, Critchlow CM, Watkins H et al. A dose‑duration study of metronidazole for the tre atment of nonspecific vaginosis. Scand J Infect Dis 1983; 40(suppl): 73.

64. Ugwumadu AHN, Hay PE. Bacterial vaginosis: sequelae and management. Curr Opin Infect Dis 1999 12(1): 53.

65. Hillier SL, Holmes KK. Bacterial vaginosis, p. 547. In: Holmes KK, Mardh PA, Sparling PF, Wiesner PJ (eds.). Sexu ally transmitted dise ases, 2nd ed. McGraw- Hill Bo ok Co., New York, 1990.

66. Miniello G. Una associazione Vitamina C e Argento nella profilassi della Vaginosi Batterica ricorrente. La Colposcopia in Italia Anno XXI –  N. 2. 17– 21.

67. Larsson PG, Forsum U. Bacterial vaginosis- a disturbed bacterial flora and tre atment enigma. Apmis 2005; 113(5): 305– 316.

68. Austria R, Semenzato A, Bettero A et al. Stability of vitamin C derivatives in solution and topical formulations. J Pharm Biomed Anal 1997; 15(6): 795– 801.

69. Spiclin P, Homar M, Zupancic- Valant A et al. Sodi um ascorbyl phosphate in topical microemulsions. Int J Pharm 2003; 256(1– 2): 65– 73.

70. Hughes VL, Hillier SL. Microbiologic characteristics of Lactobacillus products used for colonization of the vagina.Obstet Gynecol 1990; 75(2): 244– 248.

71. Souhrn údajů o přípravcích Entizol, Dalacin C, Dalacin vaginální krém, Betadine vaginální čípky, Fermalac vaginal a Gynoflor. Staženo z www.sukl.cz dne 9. 5. 2008.

72. Příbalový leták přípravků VITAgyn C –  vaginální krém s kyselým pH a Feminella Vagi C.

73. Miniello G. Vaginal Environment. Prezentace na celostátní konferenci České gynekologické a porodnické společnosti ČLS JEP a Sdružení soukromých gynekologů ČR. Hradec Králové, 6.– 8. 6. 2008.

74. Mašata J, Jedličková A et al. Infekce v gynekologii a porodnictví. Praha: Maxdorf 2004.

75. Reid G, Bruce AW. Urogenital infections in women: can probiotics help? Postgrad. Med. J. 2003; 79: 428– 432.

76. Sobel JD, Chaim W. Vaginal Microbiology of Women with Acute Recurrent Vulvovaginal Candidiasis. J. Clin. Microbiol 1996; 34(10): 2497– 2499.

77. Vallor AC, Antonio MAD, Hawes SE et al. Factors Associated with Acquisition of, or Persistent Colonization by, Vaginal Lactobacilli: Role of Hydrogen Peroxide Production. J Infect Dise ases 2001; 184: 1431– 1436.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#