ACTA FAC. MED. NAISS. 2005; 22(4): 161-165

   Review article

Milena Mišić, Gordana Randjelović, Branislava Kocić, Snežana Antić, Miloš Stojanović, Vesna Mladenović

Public Health Institute, Niš

Bacterial vaginosis (BV) is a change in vaginal ecosystem where lactobacilli dominate, normal flora is absent or greatly reduced, and replaced with a mixed, predominantly anaerobic flora, consisting of Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus spp, Bacteroides spp, Prevotela spp, Peptostreptococcus spp, Fusobacterium spp and Porphyromonas spp. The four studies, conducted and published in the United States, Africa and Thailand, have all shown that women having bacterial vaginosis have a higher prevalence of HIV. Most epidemiological studies have found a "dose-response" relation in which increasingly abnormal flora or severe BV is associated with increasing risk of HIV. Understanding this "dose- response" relation will help clarify why BV enhances HIV transmission. Again, it was found in the multi-variant model that women without lactobacilli were 70% more likely to get gonorrhea and other STD. BV may lead to an increased risk of salpingitis and/or endometritis, postsurgical infections (e.g. postcesarean endometritis, posthysterectomy vaginal cuff cellulitis), and adverse outcomes in pregnancy, including premature rupture of membranes, premature labor, and chorioamnionitis. In addition, there is a possibility that bacterial vaginosis is in some way associated with the development of cervical intraepithelial neoplasia. Furthermore, there are some indications that correlate BV with cytologic inflammatory changes noted on the cervix. The association of BV with numerous obstetric and gynecologic complications requires a compulsory screening and treatment of BV in different clinical conditions. Additional investigations of this disease must include prevention of complications in pregnancy as well as the treatment of BV in non-pregnant women.

Key words: bacterial vaginosis, female genital tract infections, HIV infection, CIN, preterm delivery