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Medline ® Abstracts for References 40-43

of 'Bacterial vaginosis'

40
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Bacterial vaginosis: diagnostic and pathogenetic findings during topical clindamycin therapy.
AU
Livengood CH 3rd, Thomason JL, Hill GB
SO
Am J Obstet Gynecol. 1990 Aug;163(2):515-20.
 
We examined subjective and objective correlates among 67 women with symptomatic bacterial vaginosis before and after treatment with intravaginal clindamycin or placebo. We found no preponderance of any sexual practices among these patients. Nine patients (13.4%) had had hysterectomy. Whereas odor and discharge were the most common symptoms, 30 patients (44.8%) also complained of vulvovaginal irritation. Symptoms correlated poorly with objective therapeutic outcome. On examination the diagnosis would have been missed in seven patients (10.4%) if the clinician relied on presence of an abnormal vaginal discharge to suggest bacterial vaginosis. Vaginal pH greater than 4.5 was found immediately after curative therapy in 59.6% of patients. Mobiluncus spp. morphotypes were 99.0% specific and 52.1% sensitive and proline aminopeptidase activity in vaginal fluid was 84.4% sensitive and 70.2% specific for diagnosis. Our Gram stain criteria yielded no false-negative results, 6.1% false-positive, and frequent indeterminate results after therapy. We found little evidence for sexual transmission of bacterial vaginosis. Recurrence after effective therapy was not predicted by vaginal pH elevation, positive or indeterminate Gram stain result, or positive proline aminopeptidase test.
AD
Department of Obstetrics and Gynecology of Duke University Medical Center, Durham, NC 27710.
PMID
41
TI
Mixed vaginitis-more than coinfection and with therapeutic implications.
AU
Sobel JD, Subramanian C, Foxman B, Fairfax M, Gygax SE
SO
Curr Infect Dis Rep. 2013;15(2):104.
 
Mixed vaginitis is due to the simultaneous presence of at least two vaginal pathogens, both contributing to an abnormal vaginal milieu and, hence, symptoms and signs of vaginitis. In mixed vaginitis, both pathogens require specific therapy for complete eradication of concurrent manifestations. In coinfection, although two pathogens are identified, a potential pathogen may be present but may not be a cause of existing vaginal symptoms. Although data remain sparse, mixed vaginitis occurs rarely (<5 %). By contrast, pathogen coinfection occurs frequently in women with vaginitis. Approximately 20 %-30 % of women with bacterial vaginosis (BV) are coinfected with Candida species. Coexistence of BV pathogens and T. vaginalis is even more common, with coinfection rates of 60 %-80 %. Both coinfection and mixed vaginitis have significant clinical and therapeutic implications and are worthy of further investigation.
AD
Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI, USA, Jsobel@med.wayne.edu.
PMID
42
TI
Risk factors for cervicitis among women with bacterial vaginosis.
AU
Marrazzo JM, Wiesenfeld HC, Murray PJ, Busse B, Meyn L, Krohn M, Hillier SL
SO
J Infect Dis. 2006;193(5):617.
 
BACKGROUND: Cervicitis commonly occurs in women with bacterial vaginosis (BV), often without concomitant chlamydial or gonococcal infection. The risk factors for cervicitis have not been described.
METHODS: We characterized the risk factors for cervicitis, which is defined as endocervical mucopurulent discharge or easily induced bleeding, among women with BV who were 14-45 years of age. Associations between cervicitis and the characteristics of the subjects, including the presence of specific vaginal bacteria and chlamydial or gonococcal infection detected by strand displacement assay, were analyzed.
RESULTS: Of 424 women with BV, 63 (15%) had cervicitis. Of these 63 women, only 8 (13%) had chlamydia or gonorrhea. The risk factors for cervicitis, adjusted for variables, included older age (P<.001, for trend),<or=12 years of education (odds ratio [OR], 2.4 [95% confidence interval {CI}, 1.3-4.6]; P=.006), new male sex partner (OR, 2.7 [95% CI, 1.4-5.4]; P=.004), female sex partner (OR, 6.2 [95% CI, 1.3-28.3]; P=.02), recent oral sex (OR, 2.3 [95% CI, 1.2-4.2]; P=.008), and absence of vaginal H2O2-producing Lactobacillus species (OR, 2.7; 95% CI, 3.3-5.9; P=.01). No association with cervicitis was seen for current douching or smoking, race, time since or frequency of intercourse, or presence or quantity of vaginal bacteria other than H2O2-producing Lactobacillus species.
CONCLUSIONS: Cervicitis is common among women with BV and is associated with some risk factors that are distinct from those associated with endocervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis. Absence of H2O2-producing lactobacilli may contribute to the development of cervicitis.
AD
Department of Medicine, University of Washington, Seattle 98104, and Department of Pediatrics, Children's Hospital of Pittsburgh, PA, USA. jmm2@u.washington.edu
PMID
43
TI
European (IUSTI/WHO) guideline on the management of vaginal discharge, 2011.
AU
Sherrard J, Donders G, White D, Jensen JS, European IUSTI
SO
Int J STD AIDS. 2011 Aug;22(8):421-9.
 
Three common infections are associated with vaginal discharge: bacterial vaginosis, trichomoniasis and candidiasis, of which trichomoniasis is a sexually transmitted infection (STI). This guideline covers the presentation and clinical findings of these infections and outlines the differential diagnoses. Recommendations for investigation and management based on currently available evidence are made, including the management of persistent and recurrent infections.
AD
Department of Genitourinary Medicine, Churchill Hospital, Oxford, UK. jackiesherrard@doctors.org.uk
PMID