Genitourinary Medicine, Vol 73, Issue 1 23-28, Copyright © 1997 by Sexually Transmitted Infections
What is normal vaginal flora?
CJ Priestley, BM Jones, J Dhar and L Goodwin
Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield.
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.
