Gardnerella-Associated Vaginitis and Anaerobic Bacteria

Abstract

12 patients with mild or moderate symptoms of Gardnerella-associated vaginitis were examined clinically and microbiologically on 52 different occasions, 27 of which were asymptomatic. The symptomatic state was defined by fulfilling at least three of the following criteria: (1) subjective symptoms; (2) pH above 4.5; (3) positive amine test, and (4) clue cells in wet smear. Variation of the vaginal microflora was considerable. No causative bacterial species could be identified. Microorganisms of the genus Bacteroides were significantly (p < 0.02) more often found in the symptomatic condition. The presence of either peptococci, peptostreptococci or anaerobic streptococci was similarly related to symptoms (p < 0.01). Lactobacilli were significantly more often present when the patient was free of symptoms (p < 0.05). Gardnerella vaginalis was a common isolate whether the patient suffered from symptoms or not. It is concluded that the presence of this microorganism indicates a disturbed ecologic situation within the vagina, resulting in loss of predominance of lactobacilli and hence liability to develop symptoms.

Clinical, Microbiological, and Biochemical Factors in Recurrent Bacterial Vaginosis

“…The explanation for the myriad of findings in patients with BV remains incomplete, although considerable progress has been made in understanding aspects of the pathogenic process (5,7,9,25,27,28). BV is thought to represent a massive overgrowth of vaginal microorganisms, primarily anaerobic gram-positive cocci and gram-negative bacilli, including Prevotella species, Gardnerella vaginalis, and Mobiluncus species (13,19,23,26,30).Published studies indicate that the drug of choice for therapy of BV is oral metronidazole; therapeutic success is achieved in 85 to 90% of patients with this therapy (10). Treatment with metronidazole is followed by eradication of the anaerobes and G. vaginalis together with alleviation of symptoms (4,22).…”

Could Bacterial Vaginosis Be Due to the Competitive Suppression of Lactobacilli by Aerobic Microorganisms?

“…This is to some extent remarkable although not clinically acceptable, par ticularly since metronidazole has given cure rates of about 80% in our hands employing identical criteria [3][4][5][6]. Of course, the present study was not designed to define treat ment efficacy with this drug, but it may be of interest that in a previous study [3] treatment with three different vagi nal preparations other than metronidazole cured only 5 out of 43 patients.…”

“…Colonization with lactobacilli capable of hydrogen per oxide production [16,17] with BV. This prompted us to reexamine our protocols of all the cases reported upon previously [3][4][5][6], Among those lactobacilli recognized to produce HyCb [15,16], 15 iso lates of L. jensenii were found in women without symp toms and only 1 in a woman with BV. L. rogosae was the second most common with 10 isolates in healthy versus 2 in symptomatic women.…”

“…BV is very probably the result of suppression of lacto bacilli in the vagina followed by an overgrowth of a vari ety of anaerobic bacteria [4][5][6][7][8][9]. The reason for the lacto bacilli to loose their predominance could be a disorder of their own or a disorder of the vaginal epithelial cells, which by improper hormonal stimulation or otherwise may loose proper attachment sites.…”

Systemic Concentrations of Metronidazole and Its Main Metabolites after Intravenous Oral and Vaginal Administration

“…Many reports have claimed that BV is an expres sion of a disturbed vaginal ecology with loss of the natural predominance of lactobacilli rather than an infection with pathogenic mi croorganisms [4][5][6][7], With this in mind it would be superfluous to prescribe potent an tibiotics orally for longer or shorter periods even with a relatively innocent drug. Conse quently, treatment with vaginal tablets of metronidazole has been suggested and found to have equal clinical efficacy as oral treat ment [8].…”