General Obstetrics and Gynecology GynecologyPathogenesis of abnormal vaginal bacterial flora☆
Section snippets
Patient population
After oral consent was given, vaginal samples were obtained from 631 unselected women who sought treatment at the obstetrics and gynecology clinic at Gasthuisberg University Hospital, Leuven, Belgium. Among these women, 263 were undergoing examination for a pregnancy follow-up visit and 368 were examined for a contraceptive checkup or because of genital infection.
Menopausal women who were not receiving hormonal replacement therapy, women with genital prolapse, and women with overt genital
Results
Lactobacillary grades were normal (lactobacillary grade I) in 256 of 631 cases (40%), slightly disturbed (lactobacillary grade IIa) in 201 (32%), moderately disturbed (lactobacillary grade IIb) in 58 (9%), and severely disturbed (lactobacillary grade III) in 116 (18%). Vaginal leukocytosis was <5 leukocytes per high-power field in 21 of 593 (3.5%), >10 leukocytes per high-power field but <5 leukocytes per epithelial cell in 381 (64%), 5 to 10 leukocytes per epithelial cell in 141 (25%), and
Comment
This study demonstrated a good correlation between lactobacillary grades and pH, lactate content, and increased cytokine production in the vagina. Lactobacillary grade III corresponds to a complete disruption of the normal lactobacillary resistance of the vagina, with no lactobacillary morphotyes present on microscopic examination of the vaginal fluid. Although it is tempting to equate lactobacillary grade III with bacterial vaginosis, the two conditions should be seen as overlapping but
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Reprint requests: Gilbert G.G. Donders, MD, PhD, University Hospital Gasthuisberg, Herestraat 49, Leuven 3000, Belgium.