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The association of asymptomatic bacterial vaginosis with upper genital tract infection
INFECTION 19 positive and 81 negative based on the independent swab results, for comparison to the slide and amplified DNA probe methods. Results: The slide-based method gave a sensitivity of 84% (16/19) and a specificity of 100% (81/81). Of 3 discrepant specimens, 2 tested positive by the amplified probe method, while all 3 remained negative by repeat DFA. The amplified probe method gave a sensitivity of 95% (18/19) and a specificity of 99% (80/81) after analysis of discrepant samples by repeat testing. Conclusions: Feasibility has been demonstrated for accurate and effective routine testing for chlamydia with either DFA or DNA probe methods, from a single, fluid-based sample already approved for primary Pap screening.
The association of asymptomatic bacterial vaginosis with upper genital tract infection Barbara B. Bennett, MD, Penny Clark, PhD, Poorti Riley, MD, Nancy S. Hardt, MD,* Patrick Duff, MD University of Florida College of Medicine, Departments of Obstetrics and Gynecology and *Pathology and Laboratory Medicine Objective: To determine whether asymptomatic bacterial vaginosis (BV) is associated with upper genital tract inflammation or bacterial colonization. Methods: Fifty nonpregnant women with intact uteri who planned to undergo gynecologic surgery and had no recent symptoms of vaginal infection were enrolled. We obtained a vaginal swab for Gram stain, endocervical swab for chlamydia and gonorrhea DNA probe testing, and Pipelle endometrial biopsy for aerobic and anaerobic cultures and histology. We correlated surgical findings and histology of available surgical specimens with the microbiologic results. The diagnosis of BV was made according to Speigel’s criteria. Bacteria isolated from the uterus were classified as high virulence versus low virulence. Contingency tables were analyzed using the chisquare or Fisher Exact tests. Results: Twenty-one of 50 patients had BV on Gram stain, 3 had intermediate BV, and 3 had unreadable slides. Eleven patients had histologic endometritis, including 7 of the 21 with BV. The association between BV and endometritis was not statistically significant. Thirty-eight patients had a positive endometrial culture; 18 of these also had BV and 3 had intermediate BV. Of patients with a positive endometrial culture, isolates from those who also had BV or intermediate BV were more likely to be highly virulent pathogens compared to those who tested negative for BV (P , .05). No patients had positive gonorrhea or chlamydia tests. Of the 37 patients who underwent abdominal surgery, 20 had visible adhesions. The association between adhesions and endometritis, BV, or positive endometrial cultures was not significant. 150
Conclusion: Patients with asymptomatic BV are more likely than patients without BV to have highly virulent bacteria isolated from the endometrium. BV may predispose to upper genital tract infection.
Safety and efficacy comparison of two dosing regimens of MetroGelVaginalt in the treatment of bacterial vaginosis: a multicenter, randomized, single-blind, parallel comparison David E. Soper, MD, Charles Livengood III, MD, Katharine L. Sheehan, MD, Dee E. Fenner, MD, Mark G. Martens, MD, Anita L. Nelson, MD, Mahmoud Ismail, MD, John M. Thorp, MD, Myra Lappin, MD, Frederick J. Fleury, MD, Barbara J. Long, MD, Theodore Blackwelder, MD, Richard L. Sweet, MD, Stanley Sagov, MD Medical University of South Carolina, Charleston, South Carolina Objective: To compare the safety and efficacy of 0.75% metronidazole vaginal gel (MGV) administered QD for 5 days to MGV administered BID for 5 days for the treatment of bacterial vaginosis (BV). Methods: Nonpregnant women 18 years or older with a diagnosis of BV were enrolled into this trial. Patients were determined to have BV if their vaginal discharge had $20% clue cells and if they had at least 2 of the following criteria: homogeneous discharge, positive KOH amine odor test, or vaginal pH $4.7. In addition, microbiologic confirmation of BV at baseline was required to be evaluable. Patients were evaluated at baseline and at 7–12 days after completion of therapy. If patients remained free of BV after therapy, they were evaluated at a follow-up visit 28 –35 days after therapy. Results: A total of 514 patients were enrolled in the trial; 252 in the QD treatment group and 262 in the BID treatment group. Clinical cure rates based on patients considered evaluable at first return visits were 77% and 80% for QD and BID dosing regimens, respectively. Clinical cure rates based on patients considered evaluable at the final visit were 58% and 61% for QD and BID dosing regimens, respectively. Clinical cure rates at the final return visit based on intent-to-treat analysis were 53% and 57% for the QD and BID regimens, respectively. Two adverse events in two patients were reported as serious. Both adverse events resolved and neither event was judged to be related to therapy. Conclusion: MetroGel-Vaginal administered QD for 5 days was found to be as effective as MetroGel-Vaginal administered BID for 5 days in the treatment of bacterial vaginosis 28 –35 days after therapy. The number of patients reporting adverse events judged to be related to therapy was also statistically comparable in both treatment groups. Prim Care Update Ob/Gyns
The association of asymptomatic bacterial vaginosis with upper genital tract infection Barbara B. Bennett, MD, Penny Clark, PhD, Poorti Riley, MD, Nancy S. Hardt, MD,* Patrick Duff, MD University of Florida College of Medicine, Departments of Obstetrics and Gynecology and *Pathology and Laboratory Medicine Objective: To determine whether asymptomatic bacterial vaginosis (BV) is associated with upper genital tract inflammation or bacterial colonization. Methods: Fifty nonpregnant women with intact uteri who planned to undergo gynecologic surgery and had no recent symptoms of vaginal infection were enrolled. We obtained a vaginal swab for Gram stain, endocervical swab for chlamydia and gonorrhea DNA probe testing, and Pipelle endometrial biopsy for aerobic and anaerobic cultures and histology. We correlated surgical findings and histology of available surgical specimens with the microbiologic results. The diagnosis of BV was made according to Speigel’s criteria. Bacteria isolated from the uterus were classified as high virulence versus low virulence. Contingency tables were analyzed using the chisquare or Fisher Exact tests. Results: Twenty-one of 50 patients had BV on Gram stain, 3 had intermediate BV, and 3 had unreadable slides. Eleven patients had histologic endometritis, including 7 of the 21 with BV. The association between BV and endometritis was not statistically significant. Thirty-eight patients had a positive endometrial culture; 18 of these also had BV and 3 had intermediate BV. Of patients with a positive endometrial culture, isolates from those who also had BV or intermediate BV were more likely to be highly virulent pathogens compared to those who tested negative for BV (P , .05). No patients had positive gonorrhea or chlamydia tests. Of the 37 patients who underwent abdominal surgery, 20 had visible adhesions. The association between adhesions and endometritis, BV, or positive endometrial cultures was not significant. 150
Conclusion: Patients with asymptomatic BV are more likely than patients without BV to have highly virulent bacteria isolated from the endometrium. BV may predispose to upper genital tract infection.
Safety and efficacy comparison of two dosing regimens of MetroGelVaginalt in the treatment of bacterial vaginosis: a multicenter, randomized, single-blind, parallel comparison David E. Soper, MD, Charles Livengood III, MD, Katharine L. Sheehan, MD, Dee E. Fenner, MD, Mark G. Martens, MD, Anita L. Nelson, MD, Mahmoud Ismail, MD, John M. Thorp, MD, Myra Lappin, MD, Frederick J. Fleury, MD, Barbara J. Long, MD, Theodore Blackwelder, MD, Richard L. Sweet, MD, Stanley Sagov, MD Medical University of South Carolina, Charleston, South Carolina Objective: To compare the safety and efficacy of 0.75% metronidazole vaginal gel (MGV) administered QD for 5 days to MGV administered BID for 5 days for the treatment of bacterial vaginosis (BV). Methods: Nonpregnant women 18 years or older with a diagnosis of BV were enrolled into this trial. Patients were determined to have BV if their vaginal discharge had $20% clue cells and if they had at least 2 of the following criteria: homogeneous discharge, positive KOH amine odor test, or vaginal pH $4.7. In addition, microbiologic confirmation of BV at baseline was required to be evaluable. Patients were evaluated at baseline and at 7–12 days after completion of therapy. If patients remained free of BV after therapy, they were evaluated at a follow-up visit 28 –35 days after therapy. Results: A total of 514 patients were enrolled in the trial; 252 in the QD treatment group and 262 in the BID treatment group. Clinical cure rates based on patients considered evaluable at first return visits were 77% and 80% for QD and BID dosing regimens, respectively. Clinical cure rates based on patients considered evaluable at the final visit were 58% and 61% for QD and BID dosing regimens, respectively. Clinical cure rates at the final return visit based on intent-to-treat analysis were 53% and 57% for the QD and BID regimens, respectively. Two adverse events in two patients were reported as serious. Both adverse events resolved and neither event was judged to be related to therapy. Conclusion: MetroGel-Vaginal administered QD for 5 days was found to be as effective as MetroGel-Vaginal administered BID for 5 days in the treatment of bacterial vaginosis 28 –35 days after therapy. The number of patients reporting adverse events judged to be related to therapy was also statistically comparable in both treatment groups. Prim Care Update Ob/Gyns