Abstract

Objectives: As the etiology of bacterial vaginosis (BV) is not well understood, we sought to determine the relationships between several fastidious microbes, BV, and selected clinical characteristics of BV.

Methods: Endometrial and cervical specimens from 50 women with non-gonococcal, non-chlamydial endometritis were tested for Leptotrichia sanguinegens/amnionii, Atopobium vaginae, bacterial vaginosis-associated bacteria 1 (BVAB1), Ureaplasma urealyticum biovar 2 (UU-2), and Ureaplasma parvum using PCR. BV was categorized using Nugent's and Amsel's criteria. Odds ratios adjusted for age and race were estimated using multivariable logistic regression.

Results: Although elevated pH was a universal feature, other BV characteristics differed by pathogen, suggesting variable clinical presentation. Only UU-2 was strongly associated with vaginal discharge, but a positive whiff test and a 20% or greater classification of epithelial cells as clue cells were more common among women with L. sanguinegens/amnionii, A. vaginae, and BVAB1. For each of these bacteria, there were trends toward associations with BV defined by Amsel's criteria (L. sanguinegens/amnionii OR 2.9, 95% CI 0.5 - 15.7; A. vaginae OR 2.6, 95% CI 0.6 - 11.4; and BVAB1 OR 5.7, 95% CI 1.0 - 31.1) and significant associations with BV defined by Gram stain (L. sanguinegens/amnionii OR 17.7, 95% CI 2.8 - 113.0; A. vaginae OR 19.2, 95% CI 3.7 - 98.7; and BVAB1 OR 21.1, 95% CI 2.2 - 198.5).

Conclusions: L. sanguinegens/amnionii, A. vaginae, and BVAB1 are associated with clinical characteristics consistent with BV and BV defined by Nugent's and Amsel's criteria. These fastidious bacteria may cause unrecognized infection, as none were associated with abnormal vaginal discharge.