Bacterial vaginosis in virginal and sexually active adolescent females: Evidence against exclusive sexual transmission

doi:10.1016/0002-9378(88)90097-X

American Journal of Obstetrics and Gynecology

Volume 158, Issue 4, April 1988, Pages 935-939

https://doi.org/10.1016/0002-9378(88)90097-X Get rights and content

Abstract

Sixty-eight sexually active and 52 virginal asymptomatic adolescent girls were evaluated for bacterial vaginosis and various laboratory indicators of bacterial vaginosis in a 3-month observational noninterventive study. Sixteen of 120 (13%) subjects had bacterial vaginosis during the study. There was no significant difference in the prevalence of bacterial vaginosis or in the prevalence of isolation of Gardnerella vaginalis between the sexually active and virginal groups. Only a few cases of bacterial vaginosis (one of eight), wet mount clue cells (four of 11), sniff tests (two of eight), and abnormal vaginal fluid succinate/lactate ratios (none of 6) persisted for 3 months in the absence of therapy. These results are discussed in light of several recent reports that suggest using the isolation of G. vaginalis or the diagnosis of bacterial vaginosis as evidence of sexual abuse in children. It is concluded that bacterial vaginosis should not be considered an exclusively sexually transmitted disease. The presence of the condition is neither proof of sexual activity nor warrants male sexual partner therapy. In addition, therapy seems unwarranted for the incidental finding of bacterial vaginosis in the patient without symptoms.

References (15)

R Amsel et al.
Nonspecific vaginitis: diagnostic criteria and microbial and epidemiologic associations
Am J Med
(1983)
RC Bump et al.
The prevalence, six-month persistence, and predictive values of laboratory indicators of bacterial vaginosis (nonspecific vaginitis) in asymptomatic women
Am J Obstet Gynecol
(1984)
MA Shafer et al.
Microbiology of the lower genital tract in postmenarchal adolescent girls: Differences by sexual activity, contraception, and presence of nonspecific vaginitis
J Pediatr
(1985)
CA Spiegel et al.
Anaerobic bacteria in nonspecific vaginitis
N Engl J Med
(1980)
D Brown et al.
Gardnerella vaginalis vaginitis: the current opinion
J Reprod Med
(1984)
JB Glaser et al.
Sexually transmitted diseases in victims of sexual assault
N Engl J Med
(1986)
DA Eschenbach
Vaginal infection
Clin Obstet Gynecol
(1983)

There are more references available in the full text version of this article.

Cited by (151)

Noncandidal vaginitis: a comprehensive approach to diagnosis and management
2020, American Journal of Obstetrics and Gynecology
Vaginitis is one of the most common causes of patient visits to gynecologists, primary care providers, and urgent care centers. However, many women leave without a clear diagnosis or experience recurrent symptoms despite treatment. The 3 most common etiologies of vaginitis are trichomonas, bacterial vaginosis, and vulvovaginal candidiasis, which account for an estimated 70% of cases. The remaining 30% may be related to other causes of vaginitis, including atrophic vaginitis, desquamative inflammatory vaginitis, and vaginal erosive disease. The purpose of this review is to describe the noncandidal causes of acute and recurrent vaginitis, with the goal of improving the likelihood of accurate diagnosis as well as efficient and effective therapy. We excluded candidal vaginitis from our review because there was a recently published review on this topic in the Journal. The clinical presentation and evaluation of patients with symptoms of vaginitis can be triaged into 1 of 2 diagnostic pathways: noninflammatory and inflammatory vaginitis. The most common noninflammatory cause is bacterial vaginosis. Features such as irritation, purulent discharge, and the presence of polymorphonuclear neutrophils are more suggestive of an inflammatory process. Trichomoniasis is the most common cause of inflammatory vaginitis. Other well-described forms of inflammatory vaginitis include atrophic vaginitis, desquamative inflammatory vaginitis, and erosive disease. We present a review of the pathogenesis, symptoms, examination findings, diagnostic testing, and treatment for each of these causes of noncandidal vaginitis.
No. 211-Screening and Management of Bacterial Vaginosis in Pregnancy
2017, Journal of Obstetrics and Gynaecology Canada
Citation Excerpt :
It has been associated with racial origin, smoking, sexual activity, and vaginal douching. Bacterial vaginosis is more common in black women,27 women who smoke,28 women who are sexually active compared with virginal women,29 and those who use vaginal douches.30 Bacterial vaginosis is a syndrome that can be diagnosed both clinically and microbiologically.
To review the evidence and provide recommendations on screening for and management of bacterial vaginosis in pregnancy.
The clinical practice options considered in formulating the guideline.
Outcomes evaluated include antibiotic treatment efficacy and cure rates, and the influence of the treatment of bacterial vaginosis on the rates of adverse pregnancy outcomes such as preterm labour and delivery and preterm premature rupture of membranes.
Medline, EMBASE, CINAHL, and Cochrane databases were searched for articles, published in English before the end of June 2007 on the topic of bacterial vaginosis in pregnancy.
The evidence obtained was rated using the criteria developed by the Canadian Task Force on Preventive Health Care.
Guideline implementation will assist the practitioner in developing an approach to the diagnosis and treatment of bacterial vaginosis in pregnant women. Patients will benefit from appropriate management of this condition.
These guidelines have been prepared by the Infectious Diseases Committee of the SOGC, and approved by the Executive and Council of the SOGC.
The Society of Obstetricians and Gynaecologists of Canada.
There is currently no consensus as to whether to screen for or treat bacterial vaginosis in the general pregnant population in order to prevent adverse outcomes, such as preterm birth.
- 1.
  In symptomatic pregnant women, testing for and treatment of bacterial vaginosis is recommended for symptom resolution. Diagnostic criteria are the same for pregnant and non-pregnant women (I-A).
- 2.
  Treatment with either oral or vaginal antibiotics is acceptable for achieving a cure in pregnant women with symptomatic bacterial vaginosis who are at low risk of adverse obstetric outcomes (I-A).
- 3.
  Asymptomatic women and women without identified risk factors for preterm birth should not undergo routine screening for or treatment of bacterial vaginosis (I-B).
- 4.
  Women at increased risk for preterm birth may benefit from routine screening for and treatment of bacterial vaginosis (I-B).
- 5.
  If treatment for the prevention of adverse pregnancy outcomes is undertaken, it should be with metronidazole 500 mg orally twice daily for seven days or clindamycin 300 mg orally twice daily for seven days. Topical (vaginal) therapy is not recommended for this indication (I-B).
- 6.
  Testing should be repeated one month after treatment to ensure that cure was achieved (III-L).
Sexually transmitted infections: challenges ahead
2017, The Lancet Infectious Diseases
Citation Excerpt :
Women with bacterial vaginosis have an earlier median age of sexual debut than women without bacterial vaginosis.251 Although several studies252–254 reported bacterial vaginosis in women who have not engaged in sexual intercourse, the definition was limited to women with no history of penile-vaginal sex and self-report from potentially vulnerable populations. By contrast, a study255 of 500 female students collected detailed data on sexual behaviours via self-completed questionnaires and employed self-sampling.
WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.
No. 211 - Screening and management of bacterial vaginosis in pregnancy
2017, Journal of Obstetrics and Gynaecology Canada
Analyser les résultats et fournir des recommandations au sujet du dépistage et de la prise en charge de la vaginose bactérienne pendant la grossesse.
Les options de pratique clinique prises en considération au moment de formuler la présente directive clinique.
Parmi les issues évaluées, on trouve les taux d’efficacité et de guérison de l’antibiothérapie, et l’influence de la prise en charge de la vaginose bactérienne sur les taux d’issues de grossesse indésirables (tels que le travail et l’accouchement prétermes, et la rupture prématurée des membranes préterme).
Des recherches ont été menées dans les bases de données Medline, EMBASE, CINAHL et Cochrane afin d’en tirer les articles, publiés en anglais avant le fin de juin 2007, traitant de la vaginose bactérienne pendant la grossesse.
Les données obtenues ont été évaluées au moyen des critères élaborés par le Groupe d’étude canadien sur les soins de santé préventifs.
Avantages, désavantages et coûts : La mise en œuvre de la présente directive clinique aidera le praticien à élaborer une approche quant au diagnostic et à la prise en charge de la vaginose bactérienne chez les femmes enceintes. Les patientes bénéficieront d’une prise en charge appropriée de cette pathologie.
La présente directive clinique a été rédigée par le comité sur les maladies infectieuses et approuvée par le comité exécutif et le Conseil de la Société des obstétriciens et gynécologues du Canada.
La Société des obstétriciens et gynécologues du Canada.
Il n’existe présentement aucun consensus quant à la question de savoir s’il faut procéder au dépistage ou à la prise en charge de la vaginose bactérienne, au sein de la population générale de femmes enceintes, afin de prévenir la survenue d’issues indésirables (telles que l’accouchement préterme).
- 1.
  Chez les femmes enceintes symptomatiques, le dépistage et la prise en charge de la vaginose bactérienne sont recommandés pour la résolution des symptômes. Les critères diagnostiques sont les mêmes tant pour les femmes enceintes que pour celles qui ne le sont pas (I-A).
- 2.
  La prise en charge au moyen d’antibiotiques, administrés par voie orale ou vaginale, est acceptable pour l’obtention d’une guérison chez les femmes enceintes qui présentent une vaginose bactérienne symptomatique et qui ne courent que de faibles risques de connaître des issues obstétricales indésirables (I-A).
- 3.
  Les femmes asymptomatiques et les femmes chez lesquelles aucun facteur de risque d’accouchement préterme n’a été identifié ne devraient pas être systématiquement soumises au dépistage ou à la prise en charge de la vaginose bactérienne (I-B).
- 4.
  Les femmes qui courent des risques accrus d’accouchement préterme pourraient tirer profit de la mise en œuvre systématique du dépistage et de la prise en charge de la vaginose bactérienne (I-B).
- 5.
  Lorsqu’un traitement visant la prévention des issues de grossesse indésirables est mis en œuvre, il devrait faire appel à du métronidazole, à raison de 500 mg par voie orale deux fois par jour pendant sept jours, ou à de la clindamycine, à raison de 300 mg par voie orale deux fois par jour pendant sept jours. Le traitement topique (par voie vaginale) n’est pas recommandé à cette fin (I-B).
- 6.
  Un nouveau dépistage devrait être effectué un mois à la suite du traitement afin de s’assurer de la guérison (III-L).
Relationship between Bacterial Vaginosis and Sexually Transmitted Infections: Coincidence, Consequence or Co-Transmission?
2023, Microorganisms
State of the Art for Diagnosis of Bacterial Vaginosis
2023, Journal of Clinical Microbiology

View all citing articles on Scopus

^☆: Supported by a grant from the Procter & Gamble Company, Cincinati, Ohio.

View full text

Article preview

American Journal of Obstetrics and Gynecology

Abstract

References (15)

Nonspecific vaginitis: diagnostic criteria and microbial and epidemiologic associations

Am J Med

The prevalence, six-month persistence, and predictive values of laboratory indicators of bacterial vaginosis (nonspecific vaginitis) in asymptomatic women

Am J Obstet Gynecol

Microbiology of the lower genital tract in postmenarchal adolescent girls: Differences by sexual activity, contraception, and presence of nonspecific vaginitis

J Pediatr

Anaerobic bacteria in nonspecific vaginitis

N Engl J Med

Gardnerella vaginalis vaginitis: the current opinion

J Reprod Med

Sexually transmitted diseases in victims of sexual assault

N Engl J Med

Vaginal infection

Clin Obstet Gynecol

Cited by (151)

Noncandidal vaginitis: a comprehensive approach to diagnosis and management

No. 211-Screening and Management of Bacterial Vaginosis in Pregnancy

Sexually transmitted infections: challenges ahead

No. 211 - Screening and management of bacterial vaginosis in pregnancy

Relationship between Bacterial Vaginosis and Sexually Transmitted Infections: Coincidence, Consequence or Co-Transmission?

State of the Art for Diagnosis of Bacterial Vaginosis

Bacterial vaginosis in virginal and sexually active adolescent females: Evidence against exclusive sexual transmission☆

Abstract

Am J Med

Am J Obstet Gynecol

J Pediatr

Anaerobic bacteria in nonspecific vaginitis

N Engl J Med

Gardnerella vaginalis vaginitis: the current opinion

J Reprod Med

Sexually transmitted diseases in victims of sexual assault

N Engl J Med

Vaginal infection

Clin Obstet Gynecol