Skip to main content

Advertisement

Log in

Gardnerella vaginalis: Still a Prime Suspect in the Pathogenesis of Bacterial Vaginosis

  • GENITOURINARY INFECTIONS (J SOBEL, SECTION EDITOR)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Bacterial vaginosis (BV) is the most common cause of vaginal infection, yet its pathogenesis remains controversial. Although it has never been proven to be a sexually transmitted diseases the epidemiological evidence favoring this is quite robust. Although BV is characterized by its polymicrobial nature, it is highly likely that the inciting organism is Gardnerella vaginalis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sobel JD. Bacterial vaginosis. Annu Rev Med. 2000;51:349–56.

    Article  PubMed  CAS  Google Scholar 

  2. Schwebke J. Gynecologic consequences of bacterial vaginosis. Obstet Gynecol Clin North Am. 2003;30:685–94.

    Article  PubMed  Google Scholar 

  3. Hillier SL. Diagnostic microbiology of bacterial vaginosis. Am J Obstet Gynecol. 1993;169:455–9.

    PubMed  CAS  Google Scholar 

  4. Amsel R, Totten PA, Spiegel CA, Chen KCS, Eschenbach D, Holmes KK. Non-specific vaginitis: diagnostic and microbial and epidemiological associations. Am J Med. 1983;74:14–22.

    Article  PubMed  CAS  Google Scholar 

  5. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. J Clin Microbiol. 1991;29:297–301.

    PubMed  CAS  Google Scholar 

  6. • Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110. This is the current CDC treatment guidelines for STD treatment.

    PubMed  Google Scholar 

  7. Hillier SL, Krohn MA, Rabe LK, Klebanoff SJ, Eschenbach DA. The normal vaginal flora, H2O2-producing lactobacilli and bacterial vaginosis in pregnant women. Clin Infect Dis. 1993;16(S4):S273–81.

    Article  PubMed  Google Scholar 

  8. Sobel J, Ferris D, Schwebke J, Nyirjesy P, Wiesenfeld HC, Peipert J, et al. Suppressive maintenance antibacterial therapy with 0.75 % metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol. 2006;194:1283–9.

    Article  PubMed  CAS  Google Scholar 

  9. •• Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB, Moss LM, et al. High recurrence rates of bacterial vaginosis over 12 months following oral metronidazole and factors associated with recurrence. J Infect Dis. 2006;193:1478–86. An excellent study of the factors associated with recurrent BV.

    Article  PubMed  Google Scholar 

  10. Hawes SE, Hillier SL, Benedetti J, Stevens CE, Koutsky LA, Wolner-Hanssen P, et al. Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J Infect Dis. 1996;174:1058–63.

    Article  PubMed  CAS  Google Scholar 

  11. Schwebke J, Desmond RA. Risk factors for bacterial vaginosis in women at high risk for STDs. Sex Transm Dis. 2005;32:654–8.

    Article  PubMed  Google Scholar 

  12. Gardner HL, Dukes CD. Haemophilus vaginalis vaginitis. A newly defined specific infection previously classified “nonspecific vaginitis”. Am J Obstet Gynecol. 1955;69:962–76.

    PubMed  CAS  Google Scholar 

  13. Holst E. Reservoir of four organisms associated with bacterial vaginosis suggests lack of sexual transmission. J Clin Microbiol. 1990;28:2035–9.

    PubMed  CAS  Google Scholar 

  14. Hillier SL, Rabe LK, Muller CH, Zarutskie P, Kuzan FB, Stenchever MA. Relationship of bacteriologic characteristics to semen indices in men attending an infertility clinic. Obstet Gynecol. 1990;75:800–4.

    PubMed  CAS  Google Scholar 

  15. Bump RC, Buesching WJ. Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am J Obstet Gynecol. 1988;158:935–9.

    PubMed  CAS  Google Scholar 

  16. • Fethers K, Fairley CK, Morton A, Hocking JS, Hopkins C, Kennedy LJ, et al. Early sexual experiences and risk factors for bacterial vaginosis. J Infect Dis. 2009;200:1662–70. A study of BV and sexual behavior in college-aged women.

    Article  PubMed  Google Scholar 

  17. Sanchez S, Garcia PJ, Thomas KK, Catlin M, Holmes KK. Intravaginal metronidazole gel versus metronidazole plus nystatin ovules for bacterial vaginosis: a randomized controlled trial. Am J Obstet Gynecol. 2004;191:1898–906.

    Article  PubMed  CAS  Google Scholar 

  18. Schwebke JR, Desmond RA. A randomized trial of metronidazole duration plus or minus azithromycin for treatment of symptomatic bacterial vaginosis. Clin Infect Dis. 2007;44:213–9.

    Article  PubMed  CAS  Google Scholar 

  19. Hutchinson K, Kip KE, Ness RB. Condom use and its association with bacterial vaginosis and bacterial vaginosis-associated vaginal microflora. Epidemiology. 2007;18:702–8.

    Article  PubMed  Google Scholar 

  20. Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, et al. The prevalence of bacterial vaginosis in the United States, 2001-2004; Associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007;34:864–9.

    Article  PubMed  Google Scholar 

  21. Marrazzo J, Koutsky L, Eschenbach D, Agnew K, Stine K, Hillier S. Characterization of vaginal flora and bacterial vaginosis in women who have sex with women. J Infect Dis. 2002;185:1307–13.

    Article  PubMed  Google Scholar 

  22. • Marrazzo J, Thomas KK, Fiedler T, Ringwood K, Fredricks D. Risks for acquisition of bacterial vaginosis among women who report sex with women: a cohort study. PLoS One. 2010;5:e11139. Important study of risk factors for BV in women who have sex with women.

    Article  PubMed  Google Scholar 

  23. Marrazzo J, Thomas KK, Agnew K, Stine K, Hillier SL. Prevalence and risks for bacterial vaginosis in women who have sex with women. Sex Transm Dis. 2010;37:335–9.

    PubMed  Google Scholar 

  24. Marrazzo J, Fiedler T, Srinivasin S, Thomas KK, Liu C, Ko D, Xie, et al. Extravaginal reservoirs of vaginal bacterial risk factors for incident bacterial vaginosis. J Infect Dis. 2012;205:1580–8.

    Article  PubMed  Google Scholar 

  25. •• Swidsinski A, Mendling W, Loening-Baucke V, Ladhoff A, Swidsinski S, Hale LP, et al. Adherent biofilms in bacterial vaginosis. Obstet Gynecol. 2005;106:1013–23. Sentinel paper on biofilm in BV.

    Article  PubMed  Google Scholar 

  26. Srinavasin S, Fredricks D. The human vaginal bacterial biota and bacterial vaginosis. Interdiscip Perspect Infect Dis. 2008;2008:750479.

    Google Scholar 

  27. • Fredricks D, Fiedler BS, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med. 2005;353:1899–911. Comprehensive study of noncultivatable bacteria associated with BV.

    Article  PubMed  CAS  Google Scholar 

  28. Ruby J, Goldner M. Nature of symbiosis in oral disease. J Dent Res. 2007;86:8–11.

    Article  PubMed  CAS  Google Scholar 

  29. • Swidsinski A, Doerffel Y, Loening-Baucke V, Swidsinski S, Verstraelen H, Vaneechoutte M, et al. Gardnerella biofilm involves females and males and is sexually transmitted. Gynecol Obstet Invest. 2010;70:256–63. Interesting study of the sexual transmission of BV.

    Article  PubMed  Google Scholar 

  30. Hill GB. The microbiology of bacterial vaginosis. Am J Obstet Gynecol. 1993;169:450–4.

    PubMed  CAS  Google Scholar 

  31. Criswell BS, Ladwig CL, Gardner HL, Dukes CD. Haemophilus vaginalis: vaginitis by inoculation from culture. Obstet Gynecol. 1969;33:195–9.

    PubMed  CAS  Google Scholar 

  32. •• Patterson JL, Stull-Lane A, Girerd PH, Jefferson KK. Analysis of adherence, biofilm formation and cytotoxicity suggests a greater virulence potential of Gardnerella vaginalis relative to other bacterial-vaginosis-associated anaerobes. Microbiology. 2010;156:392–9. Study of the virulence factors of Gardnerella.

    Article  PubMed  CAS  Google Scholar 

  33. Piot P, Van Dyck E, Peeters M, Hale J, Totten PA, Holmes KK. Biotypes of Gardnerella vaginalis. J Clin Microbiol. 1984;20:677–9.

    PubMed  CAS  Google Scholar 

  34. Briselden AM, Hillier SL. Longitudinal study of the biotypes of Gardnerella vaginalis. J Clin Microbiol. 1990;28:2761–4.

    PubMed  CAS  Google Scholar 

  35. Hedges S, Barrientes F, Desmond RA, Schwebke JR. Local and systemic cytokine levels in relation to changes in vaginal flora. J Infect Dis. 2006;193:556–62.

    Article  PubMed  CAS  Google Scholar 

  36. •• Brotman RM, Klebanoff MA, Nansel TR, Yu KF, Andrews WW, Zhang J, et al. Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection. J Infect Dis. 2010;202:1907–15. Important data on the association between BV and acquisition of STD.

    Article  PubMed  Google Scholar 

  37. Vejtorp M, Bollerup AC, Vejtorp L, Fanøe E, Nathan E, Reiter A, et al. Bacterial vaginosis: a double-blind randomized trial of the effect of treatment of the sexual partner. Br J Obstet Gynaecol. 1988;95:920–6.

    Article  PubMed  CAS  Google Scholar 

  38. Mengel MB, Berg AO, Weaver CH, Herman DJ, Herman SJ, Hughes VL, et al. The effectiveness of single-dose metronidazole therapy for patients and their partners with bacterial vaginosis. J Fam Pract. 1989;28:163–71.

    PubMed  CAS  Google Scholar 

  39. Swedberg J, Steiner JF, Deiss F, Steiner S, Driggers DA. Comparison of single-dose vs. one-week course of metronidazole for symptomatic bacterial vaginosis. JAMA. 1985;254:1046–9.

    Article  PubMed  CAS  Google Scholar 

  40. •• Mehta S. Systematic review of randomized trials of treatment of male sexual partners for improved bacterial vaginosis outcomes in women. Sex Transm Dis. 2012;39:822–30. Nice review of the published studies of treatment of the male partner to prevent recurrent BV.

    Article  PubMed  Google Scholar 

  41. Fethers K, Twin J, Fairley CK, Fowkes FJ, Garland SM, Fehler G, et al. Bacterial vaginosis (BV) candidate bacteria: associations with BV and behavioural practices in sexually-experienced and inexperienced women. PLoS One. 2012;7:e30633.

    Article  PubMed  CAS  Google Scholar 

  42. Totten PA, Amsel R, Hale J, Piot P, Holmes KK. Selective differential human blood bilayer media for isolation of Gardnerella (Haemophilus) vaginalis. J Clin Microbiol. 1982;15:141–7.

    PubMed  CAS  Google Scholar 

  43. Fredricks DN, Fiedler TL, Thomas KK, Oakley BB, Marrazzo JM. Targeted PCR for detection of vaginal bacteria associated with bacterial vaginosis. J Clin Microbiol. 2007;45:3270–6.

    Article  PubMed  CAS  Google Scholar 

  44. Thies F, Konig W, Konig B. Rapid characterization of the normal and disturbed vaginal microbiota by application of 16S rRNA gene terminal RFLP fingerprinting. J Med Microbiol. 2007;56:755–61.

    Article  PubMed  CAS  Google Scholar 

  45. Schwebke J, Richey C, Weiss H. Correlation of behaviors with microbiological changes in vaginal flora. J Infect Dis. 1999;180:1632–6.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. R. Schwebke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muzny, C.A., Schwebke, J.R. Gardnerella vaginalis: Still a Prime Suspect in the Pathogenesis of Bacterial Vaginosis. Curr Infect Dis Rep 15, 130–135 (2013). https://doi.org/10.1007/s11908-013-0318-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-013-0318-4

Keywords

Navigation