What is normal vaginal flora?

Abstract

OBJECTIVE: To observe the composition of the vaginal flora of healthy women over time, and in relation to hormonal changes, sexual activity, and hygiene habits. DESIGN: A longitudinal surveillance of the vaginal flora over an eight week period. SUBJECTS: 26 female health care workers in local genitourinary medicine clinics. METHODS: The participants were anonymised. They filled in diary cards daily. Blind vaginal swabs were self-taken two-seven times weekly. A smear was air-dried for later Gram staining. The swabs were also cultured for Candida spp, Gardnerella vaginalis, anaerobes, Mycoplasma hominis and Ureaplasma urealyticum. RESULTS: Of 26 subjects, only four had normal vaginal microbiology throughout. One woman, who was not sexually active, had bacterial vaginosis (BV) throughout and nine (35%) had intermittent BV. Candidiasis was found intermittently in eight women (31%), and eight had normal microscopy. U urealyticum was isolated intermittently in 40% of women with BV, 25% with candida, and 50% with normal microscopy. Many women were symptomatic, but symptoms correlated poorly with microbiological findings. All but two women were sexually active; however, more women with BV were exposed to semen. BV seemed to be related to frequent use of scented soap, and there appeared to be an additive effect of clothing and hygiene factors. CONCLUSIONS: Our study raises doubts about what should be regarded as normal vaginal flora. It calls into question the significance of finding BV or U urealyticum on a single occasion in asymptomatic women, or of finding normal flora in symptomatic women. The effect of external factors on the vaginal flora deserve further study.

Premenstrual vaginal colonization of Candida and symptoms of vaginitis

“…It was not powered for statistical analysis and is the first study, to our knowledge, to investigate the daily candidal colonization patterns observed during the luteal phase of the menstrual cycle in three women. Despite finding no previous studies that recorded the daily quantitative counts of Candida spp., one study concluded that colonization levels may fluctuate from day to day and persist for several days before resolving spontaneously (Priestley et al, 1997). This study supports this finding.…”

“…Several studies claim that colonization generally rises in the second half of the menstrual cycle (Larsen and Galask, 1982;Odds et al, 1987;Priestley et al, 1997). The development and rise of colonization levels before menstruation were noted in these case studies.…”

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

“…302 Although colonization of the lower genital tract by fecal flora can occur commonly without adverse consequences, 303,304 infection of the amniotic fluid, the interior of the placenta, and/or the fetus is associated with serious complications. 301 Chorioamnionitis or amniotic fluid infection has been identified as an important cause of fetal death in several studies from developing countries.…”

Vaginose Bacteriana em Mulheres com Infertilidade e em Menopausadas

“…De etiologia não definida 2 , a VB é conceituada hoje como uma alteração da flora vaginal em que os lactobacilos, normalmente predominantes, são substituídos por uma flora complexa abundante, dominada por bactérias anaeróbias estritas e facultativas 6,7 , podendo também ser observados padrões intermediários de flora vaginal em que os microrganismos anaeróbios e lactobacilos coexistem 3 . O estudo de Priestley et al 8 levanta dúvidas sobre o que deveria ser considerado flora vaginal normal, já que torna-se difícil interpretar o achado de VB em mulheres assintomáticas ou o achado de flora normal em mulheres sintomáticas. Também Caillouette et al 9 questionam se estas mulheres sem sintomas deveriam ser sempre tratadas, pois observaram, em seu trabalho, que a presença da Gardnerella na secreção vaginal antecedeu o achado de VB.…”