Current Infectious Disease Reports

, Volume 11, Issue 2, pp 143–147

New concepts in the etiology of bacterial vaginosis



Bacterial vaginosis (BV) is the most common vaginal infection worldwide. It has been linked to serious public health consequences including preterm birth, postoperative infections, and the acquisition and transmission of sexually transmitted diseases including HIV. The etiology of BV remains unknown. In this article, controversies about sexual transmission, microbial pathogens, and heterogeneity of BV as a disease entity are discussed.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Sobel JD: Bacterial vaginosis. Annu Rev Med 2000, 51:349–356.PubMedCrossRefGoogle Scholar
  2. 2.
    Amsel R, Totten PA, Spiegel CA, et al.: Nonspecific vaginitis: diagnostic and microbial and epidemiological associations. Am J Med 1983, 74:14–22.PubMedCrossRefGoogle Scholar
  3. 3.
    Moi H: Prevalence of bacterial vaginosis and its association with genital infections, inflammation and contraceptive methods in women attending sexually transmitted disease and primary health clinics. Int J STD AIDS 1990, 1:86–94.PubMedGoogle Scholar
  4. 4.
    Barbone F, Austin H, Louv WC, Alexander WJ: A follow-up study of methods of contraception, sexual activity and rates of trichomoniasis, candidiasis and bacterial vaginosis. Am J Obstet Gynecol 1990, 163:510–514.PubMedGoogle Scholar
  5. 5.
    Hawes SE, Hillier SL, Benedetti J, et al.: Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J Infect Dis 1996, 174:1058–1063.PubMedGoogle Scholar
  6. 6.
    Schwebke JR, Desmond RA: Risk factors for bacterial vaginosis in women at high risk for STDs. Sex Transm Dis 2005, 32:654–658.PubMedCrossRefGoogle Scholar
  7. 7.
    Gardner HL, Dukes CD: Haemophilus vaginalis vaginitis. A newly defined specific infection previously classified “nonspecific vaginitis.” Am J Obstet Gynecol 1955, 69:962–976.PubMedGoogle Scholar
  8. 8.
    Masfari AN, Kinghorn GR, Duerden BI: Anaerobes in genitourinary infections in men. Br J Vener Dis 1983, 59:255–259.PubMedGoogle Scholar
  9. 9.
    Kinghorn GR, Jones BM, Chowdhury FH, Geary I: Balanoposthitis associated with Gardnerella vaginalis infection in men. Br J Vener Dis 1982, 58:127–129.PubMedGoogle Scholar
  10. 10.
    Hillier SL, Rabe LK, Muller CH, et al.: Relationship of bacteriologic characteristics to semen indices in men attending an infertility clinic. Obstet Gynecol 1990, 75:800–804.PubMedGoogle Scholar
  11. 11.
    Vejtorp M, Bollerup AC, Vejtorp L, et al.: Bacterial vaginosis: a double-blind randomized trial of the effect of treatment of the sexual partner. Br J Obstet Gynaecol 1988, 95:920–926.PubMedGoogle Scholar
  12. 12.
    Mengel MB, Berg AO, Weaver CH, et al.: The effectiveness of single-dose metronidazole therapy for patients and their partners with bacterial vaginosis. J Fam Pract 1989, 28:163–171.PubMedGoogle Scholar
  13. 13.
    Bump RC, Buesching WJ: Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am J Obstet Gynecol 1988, 158:935–939.PubMedGoogle Scholar
  14. 14.
    Berger BJ, Kolton S, Zenilman JM, et al.: Bacterial vaginosis in lesbians: a sexually transmitted disease. Clin Infect Dis 1995, 21:1402–1405.PubMedGoogle Scholar
  15. 15.
    Smart S, Singal A, Mindel A: Social and sexual risk factors for bacterial vaginosis. Sex Transm Infect 2004, 80:58–62.PubMedCrossRefGoogle Scholar
  16. 16.
    Bradshaw CS, Morton AN, Hocking J, et al.: High recurrence rates of bacterial vaginosis over 12 months following oral metronidazole and factors associated with recurrence. J Infect Dis 2006, 193:1475–1477.CrossRefGoogle Scholar
  17. 17.
    Sanchez S, Garcia PJ, Thomas KK, et al.: Intravaginal metronidazole gel versus metronidazole plus nystatin ovules for bacterial vaginosis: a randomized controlled trial. Am J Obstet Gynecol 2004, 191:1898–1906.PubMedCrossRefGoogle Scholar
  18. 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, 44:213–219.PubMedCrossRefGoogle Scholar
  19. 19.
    Hutchinson K, Kip KE, Ness RB, et al.: Condom use and its association with bacterial vaginosis and bacterial vaginosis-associated vaginal microflora. Epidemiology 2007, 18:702–708.PubMedCrossRefGoogle Scholar
  20. 20.
    Ness R, Hillier S, Richter H, et al.: Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina. Obstet Gynecol 2002, 100:765–772.PubMedCrossRefGoogle Scholar
  21. 21.
    Schwebke J, Desmond R, Oh M: Predictors of bacterial vaginosis in adolescent women who douche. Sex Transm Dis 2004, 31:433–436.PubMedCrossRefGoogle Scholar
  22. 22.
    Hutchinson K, Kip KE, Ness RB, et al.: Vaginal douching and development of bacterial vaginosis among women with normal and abnormal vaginal microflora. Sex Transm Dis 2007, 34:671–675.PubMedCrossRefGoogle Scholar
  23. 23.
    Ness R, Kip KE, Soper DA, et al.: Variability of bacterial vaginosis over 6- to 12-month intervals. Sex Transm Dis 2006, 33:381–385.PubMedCrossRefGoogle Scholar
  24. 24.
    Clark R, Theall KP, Amedee AM, Kissinger PJ: Frequent douching and clinical outcomes among HIV-infected women. Sex Transm Dis 2007, 34:985–990.PubMedGoogle Scholar
  25. 25.
    Brotman R, Klebanoff M, Nansel T, et al.: A longitudinal study of vaginal douching and bacterial vaginosis—a marginal structural modeling analysis. Am J Epidemiol 2008, 168:188–196.PubMedCrossRefGoogle Scholar
  26. 26.
    Amaral R, Giraldo PC, Goncalves AK, et al.: Evaluation of hygienic douching on the vaginal microflora of female sex workers. Int J STD AIDS 2007, 18:770–773.PubMedCrossRefGoogle Scholar
  27. 27.
    Hill GB: The microbiology of bacterial vaginosis. Am J Obstet Gynecol 1993, 169:450–454.PubMedGoogle Scholar
  28. 28.
    Eschenbach DA, Hillier S, Critchlow C, et al.: Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol 1988, 158:819–828.PubMedGoogle Scholar
  29. 29.
    Ness R, Hillier SL, Kip KE, et al.: Bacterial vaginosis and risk of pelvic inflammatory disease. Obstet Gynecol 2004, 104:761–769.PubMedGoogle Scholar
  30. 30.
    Totten P, Amsel R, Hale J, et al.: Selective differential human blood bilayer media for isolation of Gardnerella (Haemophilus) vaginalis. J Clin Microbiol 1982, 15:141–147.PubMedGoogle Scholar
  31. 31.
    Schwebke J, Richey C, Weiss H: Correlation of behaviors with microbiological changes in vaginal flora. J Infect Dis 1999, 180:1632–1636.PubMedCrossRefGoogle Scholar
  32. 32.
    Funke G, Bernard, KA: Coryneform Gram-positive rods. In Manual of Clinical Microbiology. Edited by Murray P. Washington, DC: ASM Press; 1999:319–345.Google Scholar
  33. 33.
    Lam M, Birch DF: Survival of Gardnerella vaginalis in human urine. Am J Clin Pathol 1991, 95:234–239.PubMedGoogle Scholar
  34. 34.
    Keane FE, Thomas BJ, Whitaker L, et al.: An association between non-gonococcal urethritis and bacterial vaginosis and the implications for patients and their sexual partners. Genitourin Med 1997, 73:373–377.PubMedGoogle Scholar
  35. 35.
    Schwebke J, Rivers C, Lee J: Prevalence of Gardnerella vaginalis in male sexual partners of women with and without bacterial vaginosis. Sex Transm Dis 2008 (Epub ahead of print).Google Scholar
  36. 36.
    Pheiffer TA, Forsyth PS, Durfee MA, et al.: Nonspecific vaginitis: role of Haemophilus vaginalis and treatment with metronidazole. N Engl J Med 1978, 298:1429–1434.CrossRefGoogle Scholar
  37. 37.
    Piot P, VanDyck E, Peeters M, et al.: Biotypes of Gardnerella vaginalis. J Clin Microbiol 1984, 20:677–679.PubMedGoogle Scholar
  38. 38.
    Briselden AM, Hillier SL: Longitudinal study of the biotypes of Gardnerella vaginalis. J Clin Microbiol 1990, 28:2761–2764.PubMedGoogle Scholar
  39. 39.
    Hedges S, Barrientes F, Desmond RA, Schwebke JR: Local and systemic cytokine levels in relation to changes in vaginal flora. J Infect Dis 2005, 193:556–562.CrossRefGoogle Scholar
  40. 40.
    Ferris M, Masztal A, Aldridge KE, et al.: Association of Atopobium vaginae, a recently described metronidazole resistant anaerobe, with bacterial vaginosis. BMC Infect Dis 2004, 4:5.PubMedCrossRefGoogle Scholar
  41. 41.
    Fredricks D, Fiedler BS, Marrazzo JM: Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med 2005, 353:1899–1911.PubMedCrossRefGoogle Scholar
  42. 42.
    Donder GG, Veerekan A, Bosmans E, et al.: Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG 2002, 109:34–43.PubMedCrossRefGoogle Scholar
  43. 43.
    Tohill BC, Heilig CM, Klein RS, et al.: Vaginal flora morphotypic profiles and assessment of bacterial vaginosis in women at risk for HIV infection. Infect Dis Obstet Gynecol 2004, 12:121–126.PubMedCrossRefGoogle Scholar
  44. 44.
    Verhelst R, Verstraelen H, Claeys G, et al.: Comparison between Gram stain and culture for the characterization of vaginal microflora: definition of a distinct grade that resembles grade I microflora and revised categorization of grade I microflora. BMC Microbiol 2005, 5:61.PubMedCrossRefGoogle Scholar
  45. 45.
    Hillier S: The complexity of microbial diversity in bacterial vaginosis. N Engl J Med 2005, 353:1886–1887.PubMedCrossRefGoogle Scholar
  46. 46.
    Sha BE, Zariffard MR, Wang QJ, et al.: Female genitaltract HIV load correlates inversely with Lactobacillus species but positively with bacterial vaginosis and Mycoplasma hominis. J Infect Dis 2005, 191:25–32.PubMedCrossRefGoogle Scholar
  47. 47.
    Swidsinski A, Mendling W, Loening-Baucke V, et al.: Adherent biofilms in bacterial vaginosis. Obste Gynecol 2005, 106:1013–1023.Google Scholar
  48. 48.
    Swidsinski A, Mendling W, Loening-Baucke V, et al.: An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole. Am J Obstet Gynecol 2008, 198:97.e1–e6.CrossRefGoogle Scholar
  49. 49.
    Saunders S, Bocking A, Challis J, Reid G: Effect of Lactobacillus challenge on Gardnerella vaginalis biofilms. Colloids Surf B Biointerfaces 2007, 55:138–142.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.University of Alabama at BirminghamBirminghamUSA

Personalised recommendations