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Epidemiology
SHORT REPORT
Prevalence of Gardnerella vaginalis among women with lactobacillus-predominant vaginal flora Jane R Schwebke, Moira S Flynn, Charles A Rivers Department of Medicine/ Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA Correspondence to Dr Jane R Schwebke, Department of Medicine/ Infectious Diseases, University of Alabama at Birmingham, 703 19th St. South, ZRB 239, Birmingham, AL 35294-0007, USA; [email protected] Received 12 June 2013 Revised 10 September 2013 Accepted 4 October 2013 Published Online First 20 November 2013
ABSTRACT Objectives To determine the prevalence of Gardnerella vaginalis in women with normal vaginal flora. Methods Women without symptoms or signs of vaginal infection and five or fewer lifetime sexual partners were recruited for a longitudinal study of vaginal flora. Negative Amsel criteria and a Nugent score of 0–3 were required for enrolment. Vaginal specimens were self-collected daily for Gram stain and every 3 days for PCR for G vaginalis for 30 days. Women completed daily diaries recording sexual activity, symptoms and menses. Results Twenty women were recruited for the study with 19 completing all specimens and 1 lost to followup. During the 30-day study period, 13/19 (68.4%) of women had normal Nugent scores (0–3) whereas 6/19 (31.6%) of women had at least 2 days of Nugent scores in the intermediate range ( p=0.09). Among the 19 women, 9 (47%) were negative for G vaginalis by PCR throughout the study period whereas 10 (53%) had at least one specimen that demonstrated the presence of G vaginalis by PCR. Of those women with intermediate flora on Gram stain during the course of the study 5/6 (83.3%) were positive for G vaginalis while 5/13 (38.5%) of those women with only normal Nugent scores were positive for G vaginalis. Thus, 61.5% of women with normal Nugent scores had no evidence of G vaginalis by serial PCR. Conclusions Gardnerella may not be part of the normal flora in women with optimal vaginal health.
INTRODUCTION
To cite: Schwebke JR, Flynn MS, Rivers CA. Sex Transm Infect 2014;90: 61–63.
The composition of the vaginal flora in reproductive-aged women has been well described and in broad terms can be classified as normal, intermediate and consistent with bacterial vaginosis (BV) as defined by the Nugent Gram stain criteria.1 The latter two categories of vaginal flora have been clearly shown to be associated with adverse outcomes such as preterm birth and acquisition of sexually transmitted disease (STD),2 3 perhaps partly due to local production of cytokines associated with these changes. It has been shown that increases in Gardnerella vaginalis alone are associated with acquisition of STD and cytokine production.3 4 Thus, it could be argued that optimal vaginal health should be strictly defined as the presence of lactobacilli without evidence of G vaginalis. We sought to determine the percentage of women without clinical evidence of altered vaginal flora who were colonised with G vaginalis.
Schwebke JR, et al. Sex Transm Infect 2014;90:61–63. doi:10.1136/sextrans-2013-051232
METHODS Women without clinical evidence of vaginitis or STD were invited to participate. Women were recruited with the use of advertisements posted across the University campus. The study was approved by the University of Alabama at Birmingham Institutional Review Board. To be eligible for enrolment, women were required to be heterosexual, premenopausal, have had five or fewer lifetime sex partners, have no symptoms of a genital tract infection, have a vaginal pH of
Epidemiology
SHORT REPORT
Prevalence of Gardnerella vaginalis among women with lactobacillus-predominant vaginal flora Jane R Schwebke, Moira S Flynn, Charles A Rivers Department of Medicine/ Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA Correspondence to Dr Jane R Schwebke, Department of Medicine/ Infectious Diseases, University of Alabama at Birmingham, 703 19th St. South, ZRB 239, Birmingham, AL 35294-0007, USA; [email protected] Received 12 June 2013 Revised 10 September 2013 Accepted 4 October 2013 Published Online First 20 November 2013
ABSTRACT Objectives To determine the prevalence of Gardnerella vaginalis in women with normal vaginal flora. Methods Women without symptoms or signs of vaginal infection and five or fewer lifetime sexual partners were recruited for a longitudinal study of vaginal flora. Negative Amsel criteria and a Nugent score of 0–3 were required for enrolment. Vaginal specimens were self-collected daily for Gram stain and every 3 days for PCR for G vaginalis for 30 days. Women completed daily diaries recording sexual activity, symptoms and menses. Results Twenty women were recruited for the study with 19 completing all specimens and 1 lost to followup. During the 30-day study period, 13/19 (68.4%) of women had normal Nugent scores (0–3) whereas 6/19 (31.6%) of women had at least 2 days of Nugent scores in the intermediate range ( p=0.09). Among the 19 women, 9 (47%) were negative for G vaginalis by PCR throughout the study period whereas 10 (53%) had at least one specimen that demonstrated the presence of G vaginalis by PCR. Of those women with intermediate flora on Gram stain during the course of the study 5/6 (83.3%) were positive for G vaginalis while 5/13 (38.5%) of those women with only normal Nugent scores were positive for G vaginalis. Thus, 61.5% of women with normal Nugent scores had no evidence of G vaginalis by serial PCR. Conclusions Gardnerella may not be part of the normal flora in women with optimal vaginal health.
INTRODUCTION
To cite: Schwebke JR, Flynn MS, Rivers CA. Sex Transm Infect 2014;90: 61–63.
The composition of the vaginal flora in reproductive-aged women has been well described and in broad terms can be classified as normal, intermediate and consistent with bacterial vaginosis (BV) as defined by the Nugent Gram stain criteria.1 The latter two categories of vaginal flora have been clearly shown to be associated with adverse outcomes such as preterm birth and acquisition of sexually transmitted disease (STD),2 3 perhaps partly due to local production of cytokines associated with these changes. It has been shown that increases in Gardnerella vaginalis alone are associated with acquisition of STD and cytokine production.3 4 Thus, it could be argued that optimal vaginal health should be strictly defined as the presence of lactobacilli without evidence of G vaginalis. We sought to determine the percentage of women without clinical evidence of altered vaginal flora who were colonised with G vaginalis.
Schwebke JR, et al. Sex Transm Infect 2014;90:61–63. doi:10.1136/sextrans-2013-051232
METHODS Women without clinical evidence of vaginitis or STD were invited to participate. Women were recruited with the use of advertisements posted across the University campus. The study was approved by the University of Alabama at Birmingham Institutional Review Board. To be eligible for enrolment, women were required to be heterosexual, premenopausal, have had five or fewer lifetime sex partners, have no symptoms of a genital tract infection, have a vaginal pH of
