Bacterial vaginosis – a laboratory and clinical diagnostics enigma

Abstract

Diagnosing bacterial vaginosis (BV) has long been based on the clinical criteria of Amsel et al., whereby three of four defined criteria must be satisfied. Though there are other criteria and scoring methods which function well in comparison (i.e. Nugent scoring), it is not certain that they will always identify the same category of patients. Point-of-care methods based on various combinations of microbial products, presence of RNA, or more complex laboratory instrumentations such as sensor arrays, have also been introduced for the diagnosis of BV. No method for diagnosing BV can at present be regarded as the best. It could be that--based partly on tacit knowledge on the part of the clinical investigators scoring in the clinic--various scoring systems have been chosen to fit a particular BV-related problem in a particular population. In this review we critically examine these pertinent issues influencing clinical scoring and laboratory diagnostics of BV.

Perfil epidemiológico de mulheres com vaginose bacteriana, atendidas em um ambulatório de doenças sexualmente transmissíveis, em São Paulo, SP

“…4,7,16 Até o momento, entretanto, não há explicação plausível para essa maior ocorrência da doença. Apesar de 100% das mulheres deste estudo serem procedentes de São Paulo, o fato de a VB ser doença de distribuição universal, 3,4,6 e da importante migração ocorrida em São Paulo, acredita-se que seja possível a valorização dos resultados encontrados.…”

“…2 No mundo todo, uma das causas mais comuns de infecção vaginal, em mulheres em idade fértil, é a vaginose bacteriana (VB). 1,[4][5][6][7][8][9] A VB foi mencionada, pela primeira vez, em 1954 por Gardner e Dukes que descreveram o quadro clínico de corrimento fétido em mulheres, inicialmente denominando-o "vaginite não específica". 10,11 Em 1982, Gardner e Spiegel propuseram a mudança do nome para vaginose bacteriana (VB), uma vez que não se observavam sinais inflamatórios importantes e já haviam sido identificadas bactérias anaeróbicas, como os agentes etiológicos causadores da doença (destacando-se a Gardnerella vaginalis e o Mobilluncus sp).…”

Quantitative PCR Assessments of Bacterial Species in Women with and without Bacterial Vaginosis

“…Furthermore, while suspected pathogens such as G. vaginalis have been implicated, no agent or factor has been identified as the cause of BV, despite experimental (10) and epidemiological (28) evidence that suggests that BV is transmissible (10). Because of all the uncertainties surrounding this syndrome, BV has been described as a microbiological and clinical enigma (16,17).Failure to understand the microbiology specific to BV is perhaps not surprising given that the basic ecology of the genitourinary microbiota, namely, the composition, relative abundance, and temporal fluctuations of vaginal species, are poorly understood. This lack of knowledge is highlighted by recent cultivation-independent broad-range PCR surveys, which show that there are scores of species and genera common to the vaginal environment that had not been recognized, and many of these represent new, as-yet-uncultivated species (18,22,33,43,46,47).…”

“…Furthermore, while suspected pathogens such as G. vaginalis have been implicated, no agent or factor has been identified as the cause of BV, despite experimental (10) and epidemiological (28) evidence that suggests that BV is transmissible (10). Because of all the uncertainties surrounding this syndrome, BV has been described as a microbiological and clinical enigma (16,17).…”

Cultivation-Independent Analysis of Changes in Bacterial Vaginosis Flora Following Metronidazole Treatment

“…BV results when the normal, predominantly Lactobacillus vaginal flora shifts to one dominated by Gardnerella vaginalis, Mycoplasma hominis, and a variety of anaerobic organisms. However, no specific pathogen has been identified, and the cause of BV is unknown (6). Metronidazole is the most commonly prescribed antibiotic for treatment of BV, but failure and recurrence rates are high (7).…”