HPV Virus Research

Brown D Jr. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.

Bacterial vaginosis and trichomoniasis are two of the most commonly encountered vaginal diseases. Although risk factors for both vaginal conditions have been identified, there continues to be lack of knowledge in regard to their role in association with other sexually transmitted diseases. Vaginal pH is an essential ingredient in the defense and control of the vaginal environment. The alteration of pH with the sequelae of such pregnancy complications as preterm delivery, preterm labor and premature rupture of the membranes; amniotic fluid infection; postpartum endometritis and surgical infections; and the role of bacterial vaginosis are discussed. Treatment modalities in both the nonpregnant and pregnant woman, as well as treatment of resistant cases of both vaginal conditions, are recommended.

Publication Types:
• Review
• Review, Tutorial

Int J STD AIDS. 2005 Apr;16(4):290-3.

Higher vaginal pH is associated with Chlamydia trachomatis infection in women: a prospective case-controlled study.

Das S, Sabin C, Allan S. Department of Genito-Urinary Medicine and HIV Medicine, Coventry Teaching Primary Care Trust, Coventry, UK.

This is a prospective case-controlled study of female attendees in Coventry. This study found an association of higher vaginal pH with chlamydial infection, independent of any other factors. Studies in vitro have shown that an acidic vaginal secretion inhibits chlamydial infection. Our objective was to analyse the association of vaginal pH and chlamydial infection in women attending a genitourinary medicine clinic. Chlamydial infections were diagnosed with ELISA and confirmed within direct immunofluorescence. Vaginal pH was measured by a pH indicator tape ranging from 3 to 8. Consecutive female attendees with no sexually transmitted infections (STIs) were included as controls. In all, 144 female cases, diagnosed with chlamydial infection, had a median age of 20 years. Seventeen women had associated bacterial vaginosis. Eighty-two women had no other STIs. Ninety-eight women were using the oral contraceptive pill (OCP). The 145 control women had a median age of 26 years and 52 were receiving the OCP. A significantly higher vaginal pH was seen in the cases (P = 0.0001, Wilcoxon test), even after adjusting for other risk factors associated with vaginal pH, including OCP use (odds ratio: 6.49, 95% confidence interval, 3.59-11.73, P = 0.0001). Chlamydial infection in women was associated with a higher vaginal pH level, independent of any other factors. This study has implications for the treatment of other conditions known to lead to an increase in vaginal pH, even in asymptomatic individuals.

APMIS. 2005 Apr;113(4):233-45.

Bacterial vaginosis. Transmission, role in genital tract infection and pregnancy outcome: an enigma.

Larsson PG, Bergstrom M, Forsum U, Jacobsson B, Strand A, Wolner-Hanssen P. Department of Molecular and Clinical Medicine, Linkoping University, Linkoping, Sweden. p-g.larsson@vgregion.se

Whether bacterial vaginosis (BV) is acquired from an endogenous or an exogenous source is subject to controversy. Despite findings of an association between sexual behaviour and BV, some data indicate that BV is not a sexually transmitted infection in the traditional sense, while other data indicate that BV is an exogenous infection. A third aspect of BV is its tendency to go unnoticed by affected women. All of this will have a strong impact on how physicians view the risks of asymptomatic BV. This review focuses on whether or not BV should be regarded as a sexually transmitted infection (STI), its role in postoperative infections and pelvic inflammatory disease (PID), and on whether or not treatment of BV during pregnancy to reduce preterm delivery should be recommended. The reviewed studies do not lend unequivocal support to an endogenous or exogenous transmission of the bacteria present in BV. For women undergoing gynaecological surgery such as therapeutic abortion, the relative risk of postoperative infection is clearly elevated (approx. 2.3-2.8). A weaker association exists between BV and pelvic inflammatory disease. Data on treatment of BV as a way of reducing preterm delivery are inconclusive and do not support recommendations for general treatment of BV during pregnancy. The discrepant associations between BV and preterm birth found in recent studies may be explained by variations in immunological response to BV. Genetic polymorphism in the cytokine response--both regarding the TNF alleles and in interleukin production--could make women more or less susceptible to BV, causing different risks of preterm birth. Thus, studies on the vaginal inflammatory response to microbial colonization should be given priority.

Rev Cubana Med Trop. 2002 May-Aug;54(2):85-90.

Frequency of Trichomonas vaginalis infection in couples with fertility problems

HPV Virus Research - Article in Spanish

One-hundred and seventy two couples which went for the first time to the Infertility Service of the National Institute of Endocrinology from June 1999 to June 2000, were studied to find out the frequency of Trichomonas vaginalis infection in this group, and determine its interaction with a number of clinical and risk variables. The results yielded that 10.5% were positive to the parasite, the prevailing symptom was leukorrea in women and 96.6% of men showed no symptoms. It was highly significant the fact of having a previous pathological history that might be related to infertility and current T. vaginalis infection. This protozoon was frequently associated with Candida sp. and causative agents of bacterial vaginosis in women and Haemophilus influenzae in men. This parasite seems to play an important role as a likely causative agent to be considered in fertility problems.

Acta Derm Venereol. 2005;85(1):42-6.

A double-blind treatment study of bacterial vaginosis with normal vaginal lactobacilli after an open treatment with vaginal clindamycin ovules.

Eriksson K, Carlsson B, Forsum U, Larsson PG. Department of Obstetrics and Gynecology, Alands Centralsjukhus, Finland.

The expected 4-week cure rate after conventional treatment of bacterial vaginosis are only 65-70%. In an attempt to improve the cure rate by adding probiotic lactobacilli we performed a double-blind placebo-controlled study of adjuvant lactobacilli treatment after an open treatment with vaginal clindamycin ovules. Women with bacterial vaginosis as defined by Amsel's criteria were treated with clindamycin ovules. Vaginal smears were collected and analysed according to Nugent's criteria. During the following menstruation period the women used, as an adjuvant treatment, either lactobacilli-prepared tampons or placebo tampons. The lactobacilli tampons were loaded with a mixture of freeze-dried L. fermentum, L. casei var. rhamnosus and L. gasseri. The cure rate was recorded after the second menstruation period. There was no improvement in the cure rate after treatment with lactobacilli-containing tampons compared to placebo tampons; the cure rates as defined by Amsel's criteria were 56% and 62%, respectively, and 55% and 63%, as defined by Nugent's criteria. This is the first study to report cure rates for women with 'intermediate' wet smear ratings according to Nugent's classification and this group had an overall cure rate of 44%. The cure rate of treatment of bacterial vaginosis was not improved by using lactobacilli-prepared tampons for one menstruation.

HPV Virus Research - HPV and Vaginosis Facts Links

Bacterial Vaginosis and Other Genital Infections - Learn about risk factors for vaginosis and other cervical and genital infections.

Sexually Transmitted Diseases - Here you can read about new technologies for bacterial vaginosis and trichomoniasis treatment and detection.