Skip Navigation LinksHome > August 2004 - Volume 104 - Issue 2 > Vulvovaginal Symptoms in Women With Bacterial Vaginosis
Obstetrics & Gynecology:
doi: 10.1097/01.AOG.0000134783.98382.b0
Original Research

Vulvovaginal Symptoms in Women With Bacterial Vaginosis

Klebanoff, Mark A. MD, MPH*; Schwebke, Jane R. MD†; Zhang, Jun MD, PhD†; Nansel, Tonja R. PhD*; Yu, Kai-Fun PhD*; Andrews, William W. PhD, MD‡

Free Access
Article Outline
Collapse Box

Author Information

From the *Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; and †Department of Medicine and ‡Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.

Supported by contract NO-1-HD-8-3293 from the National Institutes of Health.

Received April 5, 2004. Received in revised form May 14, 2004. Accepted May 21, 2004.

Address reprint requests to: Mark A. Klebanoff, Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Building 6100, Room 7B05; Bethesda, MD 20892; e-mail: mk90h@nih.gov.

Collapse Box

Abstract

OBJECTIVE: A substantial, but highly variable, percentage of women with bacterial vaginosis are said to be asymptomatic. The purpose of this study was to estimate the prevalence of symptoms among women with bacterial vaginosis compared with women without bacterial vaginosis by direct, explicit, and detailed questioning of these women.

METHODS: Women presenting for a routine health care visit at 12 health department clinics in Birmingham, Alabama, were recruited to participate in a longitudinal study of vaginal flora. At the first visit, they underwent a pelvic examination, lower genital tract microbiological evaluation, and an interview that included detailed questions regarding lower genital tract symptoms. The prevalence of symptoms among women with and without bacterial vaginosis (Gram stain score 7 or higher) was compared.

RESULTS: Among 2,888 women without gonorrhea, Chlamydia, or trichomonas, 75% of women with and 82% of women without bacterial vaginosis never noted any vaginal odor in the past 6 months (P < .001). The corresponding values were 63% and 65% for never noting vaginal “wetness” (P = .02); 58% and 57% for vaginal discharge (P = .65); 91% and 86% for irritation (P = .004); 88% and 85% for itching (P = .64); and 96% and 94% for dysuria (P = .002), respectively. Cumulatively, 58% of women with bacterial vaginosis noted odor, discharge, and/or wetness in the past 6 months compared with 57% of women without bacterial vaginosis (P = .70).

CONCLUSION: The 2 classic symptoms of bacterial vaginosis discharge and odor are each reported by a minority of women with bacterial vaginosis and are only slightly more prevalent than among women without bacterial vaginosis.

LEVEL OF EVIDENCE: II-3

Bacterial vaginosis is a condition in which the normal vaginal flora changes from a predominance of hydrogen peroxide–producing Lactobacillus species to high concentrations of a variety of anaerobic organisms, Gardnerella vaginalis and Mycoplasma hominis.1 Typical symptoms are said to include vaginal malodor and a thin discharge.2 However, although bacterial vaginosis is the most prevalent cause of vaginal discharge in reproductive-aged women,3 a substantial but highly variable number of women with bacterial vaginosis are alleged to be asymptomatic.4 The fraction of women with bacterial vaginosis who report symptoms has ranged from 10%5 to 66%.6 In most of these studies, the fraction of women without bacterial vaginosis who also reported symptoms has been highly variable as well.

Whether a woman with bacterial vaginosis reports symptoms may depend on the vigor with which she is questioned. Amsel et al2 noted that 25% of symptomatic women presented to clinics for reasons other than suspicion of infection and only admitted to symptoms upon direct questioning. Possible reasons why women with bacterial vaginosis might fail to report symptoms include the reason for the clinic visit (sexually transmitted disease [STD] versus routine care versus research study), embarrassment about discussing these symptoms, or failure to recognize mild degrees of discharge or malodor as abnormal because they are very common in the population. The purpose of this report is to describe the prevalence of lower genital tract symptoms, as assessed by direct, detailed, and explicit questioning of the study subjects, among women with and without bacterial vaginosis defined by both Gram stain and clinical criteria.

Back to Top | Article Outline

MATERIALS AND METHODS

The women in this study were enrolled in the Longitudinal Study of Vaginal Flora. The purpose of the Flora study was to evaluate the natural history of bacterial vaginosis as well as to describe factors associated with the acquisition and loss of this condition in a cohort of women monitored during quarterly visits for a year. Enrollment occurred from August 1999 to February 2002. Nonpregnant women aged 15–44 years were eligible for the study when they presented for a routine health care visit, not specifically because of suspicion of infection, at 1 of 12 clinics in the Birmingham, Alabama, area. Medical/gynecological conditions that caused a woman to be ineligible included immunocompromised status (congenital, acquired, or secondary to medication), postmenopausal, posthysterectomy, postpelvic radiotherapy, receiving chronic (daily for at least 30 days) antibiotics, or participation in a clinical trial in which antibiotics or topical genital microbicides were administered in a blinded manner. Women expected to develop 1 of these conditions during the next 12 months were also ineligible, although women who developed 1 of the conditions unexpectedly continued to be observed. Additional exclusions were if the subject was planning to move from the area in the next 12 months; was nonfluent in English; or had affective disorder, psychosis, or emotional/intellectual limitations that precluded informed consent. The protocol was approved by the Institutional Review Boards of the Jefferson County Department of Health, the University of Alabama at Birmingham, and the National Institute of Child Health and Human Development. All participating women provided written informed consent.

At the initial study visit, women underwent a standardized pelvic examination and assessment of clinical symptoms. Particular attention was given to the amount and characteristics of the vaginal discharge. Examinations were performed in a single research clinic by research nurses who underwent training sessions to achieve standardized results on the examination and the wet prep. Vaginal samples were taken for pH; wet prep for “clue cells,” yeast, and trichomonads; the potassium hydroxide “whiff test”; cultures for Trichomonas vaginalis (InPouch; BioMed Diagnostics, San Jose, CA) and Lactobacillus species; Gram stain for the evaluation of the flora according to the Nugent criteria;7 and gas-liquid chromatography (sterile deionized water vaginal wash). Cervical samples were obtained for Neisseria gonorrhoeae culture and Chlamydia trachomatis ligase chain reaction, and serum was obtained for a Venereal Disease Research Laboratories test. The women also completed a detailed in-person interview given by specifically trained female interviewers that covered demographic factors, obstetric and gynecologic history, dental symptoms and practices, feminine hygienic and health behaviors, sexual history and practices, history of genital tract infections or STDs, alcohol and drug use, and psychosocial status. In addition, a dental hygienist conducted a standardized examination that was focused on periodontal disease; women with significant disease were given an appropriate referral. These data will be reported in future publications. The interviewer was blinded to the results of the physical examination and vice versa; Gram stains were evaluated blind to clinical data.

The purpose of this analysis was to describe the presence of symptoms reported among women with and without bacterial vaginosis who received specific, detailed questioning from our researchers. To develop the questionnaire, we conducted a series of focus groups among women similar to those intended for enrollment in the study.8 At the initial interview, the women were asked “In the past 6 months, have you had (symptom)?” The symptoms included vaginal wetness, vaginal discharge, vaginal odor, vaginal itch that does not easily go away, vaginal irritation, pain when you urinate, and abdominal or pelvic pain. A distinction was drawn between wetness and discharge because the focus group study revealed that “wetness” is considered normal whereas “discharge” may carry a connotation of disease in this population.8 For each symptom reported, the woman was asked “How often does it occur?” with choices of once a month or less, 2 to 3 times a month, about once a week, or several times a week or more. The woman also was asked, “How bad was it?” with choices of “mild, that is, you hardly notice it,” “moderate, that is, you notice it but it doesn't bother you a lot,” and “severe, that is, it really bothers you.” To investigate the possibility that women had genital odor but didn't recognize it as abnormal, all women were then asked “My usual vaginal odor can best be described as …,” and the interviewer coded the woman's spontaneous response.

If a woman had been sexually active in the past 6 months, she was also asked about the presence and frequency of the 7 symptoms during or immediately after sexual intercourse. Finally, women who had been sexually active in the past 6 months were asked “In the past 6 months, have you noticed a ‘fishy’ smell after sex?” with choices of always, most of the time, about half the time, seldom, or never.

Bacterial vaginosis was alternatively defined as a Nugent Gram stain score of 7 or greater7 or as a clinical diagnosis based on at least 3 of the 4 Amsel criteria (vaginal pH higher than 4.5; thin, homogeneous vaginal discharge; “whiff test”; and more than 20% of all vaginal epithelial cells examined on a standardized wet prep were “clue cells”).2 The Nugent Gram stain score evaluates the number of Lactobacillus (large, gram-positive rods), Gardnerella (gram-negative coccobacillary organisms), and Mobiluncus (thin, curved gram-variable rods) morphotypes per oil-immersion microscope field. By convention, a score of 0–3 represents normal flora, 4–6 represents intermediate flora, and 7–10 represents bacterial vaginosis flora. To eliminate potential confounding by the presence of STDs, women with gonorrhea, Chlamydia, or trichomonas, on the basis of the laboratory tests noted above, were excluded from this analysis. Differences in continuous variables were assessed by the Student t test and in categorical variables by the χ2 test. When the categories were ordered (eg, no, mild, moderate, or severe vaginal odor), the Cochran–Armitage test for trend9 was used to assess statistical significance. In all cases a 2-tailed P value of < .05 was considered statistically significant.

Back to Top | Article Outline

RESULTS

The cohort enrolled 3,620 women, 3,614 of whom completed the baseline interview. Exclusion of women with gonorrhea (n = 86), Chlamydia (n = 356), or trichomonas (n = 265) reduced the number for this analysis to 2,907; Gram stain results were available for 2,888, 1,063 (or 37%; 95% confidence interval [CI] 35–39%) of whom had bacterial vaginosis. Basic demographic characteristics of the women and the prevalence of bacterial vaginosis by Gram stain are presented in Table 1. The women were predominantly African American, young, parous, unmarried, and of low income. Bacterial vaginosis was more common in African-American women and women who smoked. It was less common among women who were currently married and among women with more than 12 years of education, higher income, and younger (aged less than 20 years) age. Worsening general health status was associated with increasing prevalence of bacterial vaginosis.

Table 1
Table 1
Image Tools

The distributions of symptoms are shown for women with and without Gram stain scores of 7 or greater in Figure 1. As a result of women not knowing or refusing to answer individual questions, the numbers for the symptoms in the figure ranged from 2,836 to 2,881. Abdominal or pelvic pain was very rare, did not differ by bacterial vaginosis status, and therefore is not presented. Reported vaginal discharge did not differ between women with and without bacterial vaginosis, although vaginal wetness was significantly more frequent when bacterial vaginosis was present. Odor was highly significantly more frequent among women with bacterial vaginosis. Interestingly, dysuria and vaginal irritation were significantly less frequent among women with bacterial vaginosis. Although associations with wetness, odor, irritation, and dysuria were statistically significant, the actual magnitude of these associations was not great. For example, 75% (95% CI 72–77%) of women with and 82% (95% CI 80–83%) of women without bacterial vaginosis reported never noticing a vaginal odor; differences in other symptoms were even smaller. Cumulatively, 58% of women with and 57% of women without bacterial vaginosis reported wetness, discharge, and/or odor in the past 6 months (P = .70). Among those who reported a particular symptom, itching was significantly less severe (P = .02) and irritation was marginally less severe (P = .09) in women with bacterial vaginosis. Severity of the remaining symptoms was similar between women with and without bacterial vaginosis (data not shown).

Fig. 1
Fig. 1
Image Tools

Among sexually active women, only any odor and fishy odor during or immediately after sexual intercourse were significantly different between women with and without bacterial vaginosis. However, the magnitude of the difference was small—81% of women with and 86% of women without bacterial vaginosis never noticed any odor, and 82% and 87%, respectively, never noticed a fishy odor during or immediately after intercourse. When women with Gram stain scores of 4–6 (“intermediate” flora) were excluded, none of the results were substantially changed.

The corresponding results for bacterial vaginosis defined as at least 3 of the 4 Amsel criteria were generally similar to those for bacterial vaginosis defined by Gram stain (data not shown). Vaginal wetness, discharge, and odor occurred significantly more frequently among women with than among women without bacterial vaginosis by Amsel criteria, although the actual magnitude of the differences was small. There was no significant difference among the women regarding irritation, itching, or dysuria by clinical bacterial vaginosis status. Among those reporting a symptom, the discharge was marginally more severe (P = .09) among women with bacterial vaginosis, but none of the other severity scores even approached significance (data not shown).

The distribution of reported “usual vaginal odor” is shown in Table 2. Virtually all of the various descriptions of odor were more common among women with bacterial vaginosis, although there was no predominance of any particular description. Of note, although “fishy” was reported more frequently among women with bacterial vaginosis, only 6% of women with and 4% of women without bacterial vaginosis reported this as their usual odor. Although the difference in distribution of reported odor between women with and without bacterial vaginosis was statistically significant, it was of small magnitude: 35% of women with bacterial vaginosis and 45% of women without bacterial vaginosis reported no vaginal odor of any kind.

Table 2
Table 2
Image Tools

Table 3 shows the prevalence of bacterial vaginosis according to combinations of symptoms. For any given combination of vaginal discharge and odor, the addition of irritation reduced the prevalence of bacterial vaginosis. Discharge alone was not associated with an increased prevalence of bacterial vaginosis compared with women without symptoms. Vaginal odor was the only symptom associated with even a moderate increase in the prevalence of bacterial vaginosis, and the addition of discharge to odor did not increase the prevalence of bacterial vaginosis further. Nevertheless, bacterial vaginosis was still prevalent among women with no symptoms (37.1%), among women whose only symptom was vaginal irritation (26.3%), or among women who had both irritation and discharge (19.4%). Results were generally similar when reported vaginal “wetness” was substituted for “discharge.”

Table 3
Table 3
Image Tools

Reported symptoms correlated significantly, but not strongly, with the corresponding physical sign. When the woman reported no discharge, the nurse noted a thin, homogeneous discharge 35% of the time compared with 49% when the woman noted severe discharge. The “whiff” test was positive among 36% of woman who reported no odor versus 48% of women reporting severe odor. Frequency of positive signs for women reporting “mild” and “moderate” symptom severity were generally intermediate between those for women reporting “severe” and no symptoms (P for trend = .005 for discharge, and < .001 for odor). Associations between frequency of symptoms and physical signs were of similar magnitude to those for severity of symptoms (data not shown).

Candida was found on wet prep in 5.2% of women. It was less common when bacterial vaginosis was present (3.1%) than when bacterial vaginosis was absent (6.4%). However, the associations between bacterial vaginosis and symptoms did not change substantially by excluding women with Candida.

Back to Top | Article Outline

DISCUSSION

This study found that vaginal wetness/discharge and odor were more common, and irritation less common, in women with bacterial vaginosis than in women without bacterial vaginosis. Although statistically significant, the actual difference in prevalence of symptoms between women with and without bacterial vaginosis was small. In addition, although having any symptom was common among all women, the vast majority of women with bacterial vaginosis denied individual symptoms, even upon direct, detailed, and explicit questioning. There also were no substantial differences in the description of their “usual” vaginal odor between women with and without bacterial vaginosis. Thus, the failure to report symptoms does not appear to be the result of women with bacterial vaginosis considering some degree of vaginal malodor to be “normal.” We inquired about symptoms during the prior 6 months, and it is possible that the correlation between symptoms and bacterial vaginosis would have been stronger had we asked about a shorter time period, such as the prior month.

Our results are similar to those recently reported among unselected female U.S. Marine Corps recruits,10 among whom 24% with a Gram stain diagnosis of bacterial vaginosis reported vaginal discharge versus 18% of women without bacterial vaginosis. The corresponding percentages for vaginal odor were 10% and 5%, respectively. This reinforces our conclusion that although vaginal discharge and odor are reported more frequently by women with than by women without bacterial vaginosis, the differences are not great, and the majority of women with bacterial vaginosis do not report these symptoms even upon direct questioning.

Our findings are in contrast to those of Amsel et al,2 who reported that the prevalence of symptoms among women with bacterial vaginosis increased substantially upon direct, specific questioning. Amsel also reported that 46% of women with bacterial vaginosis diagnosed by clinical criteria reported symptoms. However, Amsel studied a population of women presenting to a student health clinic for a variety of reasons, including symptoms of vaginitis, and in this population 32% of women without bacterial vaginosis also reported symptoms. Nevertheless, it would appear that the nature of the questions (general versus specific) and the manner in which they are asked (blind to clinical findings or not) could have a substantial impact on the reported prevalence of symptoms.

We also found that although “vaginal wetness” was similarly associated with bacterial vaginosis as diagnosed by either Gram stain or clinical (Amsel) criteria, vaginal discharge was only associated with bacterial vaginosis diagnosed by Amsel criteria. Because Gram stain is a more sensitive method to diagnosing bacterial vaginosis than are the Amsel criteria, it is possible that only the more severe cases of bacterial vaginosis fulfill at least 3 Amsel criteria. This may account for the difference we observed in these associations.

“Inflammatory” symptoms—irritation, itching, and dysuria—were less prevalent among women with bacterial vaginosis; differences in irritation and dysuria were statistically significant. When itching was present, it was less severe among women with bacterial vaginosis. Candida vulvovaginitis is generally considered to feature inflammatory symptoms prominently.11 We found, as have others,12 that women with bacterial vaginosis are less likely than women without bacterial vaginosis to be colonized with Candida species. It is therefore possible that differences in Candida colonization account for the reduced occurrence of inflammatory symptoms among women with bacterial vaginosis. However, when women with Candida noted on wet prep were excluded, the reduced prevalence of inflammatory symptoms among women with bacterial vaginosis remained. Microscopic examination of vaginal fluid is a less sensitive method to detect Candida colonization than is fungal culture. It is therefore possible that, had we performed fungal cultures in this study, we might have found that differences in Candida colonization among women with and without bacterial vaginosis account for the difference we observed in inflammatory symptoms.

In summary, we found that although vaginal discharge and odor are more prevalent among women with compared with women without bacterial vaginosis, the difference in prevalence of these symptoms is not of a great magnitude. The vast majority of women do not report any vaginal discharge, wetness, or odor even upon explicit questioning. Future research should determine factors among women with bacterial vaginosis that result in the reporting of symptoms.

Back to Top | Article Outline

REFERENCES

1. Hill GB. The microbiology of bacterial vaginosis [review]. Am J Obstet Gynecol 1993;169:450–4.

2. Amsel R, Totten P, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis: diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983;74:14–22.

3. Eschenbach DA, Hillier S, Critchlow C, Stevens C, DeRouen T, Holmes KK. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol 1988;158:819–28.

4. Eschenbach DA. Bacterial vaginosis and anaerobes in obstetric-gynecologic infection [review]. Clin Inf Dis 1993;16:S282–7.

5. Priestly CJF, Jones BM, Dhar J, Goodwin L. What is normal vaginal flora? Genitourin Med 1997;73:23–8.

6. Begum A, Nilufar S, Akther K, Rahman A, Khatoon F, Rahman M. Prevalence of selected reproductive tract infections among pregnant women attending an urban maternal and childcare unit in Dhaka, Bangladesh [published erratum appears in J Health Popul Nutr 2003;21:298]. J Health Popul Nutr 2003;21:112–6.

7. 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.

8. Lichtenstein B, Nansel TR. Women's douching practices and related attitudes: findings from four focus groups. Women Health 2000;31:117–31.

9. Armitage P. Statistical methods in medical research. Oxford: Blackwell Scientific Publications; 1971. p. 363–5.

10. Yen S, Shafer MA, Moncada J, Campbell CJ, Flinn SD, Boyer CB. Bacterial vaginosis in sexually experienced and non-experienced young women entering the military. Obstet Gynecol 2003;102:927–33.

11. Nyirjesy P. Chronic vulvovaginal Candidiasis [review]. Am Fam Physician 2001;63:697–702.

12. Hellberg D, Nilsson S, Mårdh P-A. The diagnosis of bacterial vaginosis and vaginal flora changes. Arch Gynecol Obstet 2001;265:11–5.

Cited By:

This article has been cited 39 time(s).

New Microbiologica
Bacterial vaginosis: a review on clinical trials with probiotics
Mastromarino, P; Vitali, B; Mosca, L
New Microbiologica, 36(3): 229-238.

Journal of Midwifery & Womens Health
Etiology, diagnosis, and management of vaginitis
Mashburn, J
Journal of Midwifery & Womens Health, 51(6): 423-430.
10.1016/j.jmwh.2006.07.005
CrossRef
Diagnostic Microbiology and Infectious Disease
Comparison of Gram and Kopeloff stains in the diagnosis of bacterial vaginosis in pregnancy
Libman, MD; Kramer, M; Platt, R
Diagnostic Microbiology and Infectious Disease, 54(3): 197-201.
10.1016/j.diagmicrobio.2005.09.017
CrossRef
Canadian Journal of Microbiology
Vaginal microbial diversity among postmenopausal women with and without hormone replacement therapy
Heinemann, C; Reid, G
Canadian Journal of Microbiology, 51(9): 777-781.
10.1139/W05-070
CrossRef
World Journal of Microbiology & Biotechnology
Assessment of Lactobacillus species colonizing the vagina of apparently healthy Nigerian women, using PCR-DGGE and 16S rRNA gene sequencing
Anukam, KC; Osazuwa, EO; Ahonkhai, I; Reid, G
World Journal of Microbiology & Biotechnology, 22(): 1055-1060.
10.1007/s11274-005-4508-6
CrossRef
Epidemiology and Infection
Vaginal symptoms and bacterial vaginosis (BV): how useful is self-report? Development of a screening tool for predicting BV status
Nelson, DB; Bellamy, S; Odibo, A; Nachamkin, I; Ness, RB; Allen-Taylor, L
Epidemiology and Infection, 135(8): 1369-1375.
10.1017/S095026880700787X
CrossRef
New England Journal of Medicine
Molecular identification of bacteria associated with bacterial vaginosis
Fredricks, DN; Fiedler, TL; Marrazzo, JM
New England Journal of Medicine, 353(): 1899-1911.

Journal of Womens Health
Perceived life stress and bacterial vaginosis
Harville, EW; Hatch, MC; Zhang, J
Journal of Womens Health, 14(7): 627-633.

Sexually Transmitted Infections
Bacterial vaginosis
Keane, F; Ison, CA; Noble, H; Estcourt, C
Sexually Transmitted Infections, 82(): 16-18.
10.1136/sti.2006.023119
CrossRef
Current Microbiology
Antimicrobial Activity, Inhibition of Urogenital Pathogens, and Synergistic Interactions Between Lactobacillus Strains
Ruiz, FO; Gerbaldo, G; Asurmendi, P; Pascual, LM; Giordano, W; Barberis, IL
Current Microbiology, 59(5): 497-501.
10.1007/s00284-009-9465-0
CrossRef
American Journal of Obstetrics and Gynecology
The association of psychosocial stress and bacterial vaginosis in a longitudinal cohort
Nansel, TR; Riggs, MA; Yu, KF; Andrews, WBAW; Schwebke, JR; Klebanoff, MA
American Journal of Obstetrics and Gynecology, 194(2): 381-386.
10.1016/j.ajog.2005.07.047
CrossRef
Diagnostic Cytopathology
Microscopic diagnosis of dysbacteriosis in stained vaginal smears in clinical practice
Verbruggen, BSM; Boon, ME; Melkerl, P; van Haaften, M; Heintz, APM
Diagnostic Cytopathology, 34(): 686-691.
10.1002/dc.20530
CrossRef
Sexually Transmitted Diseases
A pilot study of vaginal flora changes with randomization to cessation of douching
Klebanoff, MA; Andrews, WW; Yu, KF; Brotman, RM; Nansel, TR; Zhang, J; Cliver, SP; Schwebke, JR
Sexually Transmitted Diseases, 33(): 610-613.
10.1097/01.olq.000021050.41305.c1
CrossRef
American Journal of Obstetrics and Gynecology
Association of asymptomatic bacterial vaginosis with endometrial microbial colonization and plasma cell endometritis in nonpregnant women
Andrews, WW; Hauth, JC; Cliver, SP; Conner, MG; Goldenberg, RL; Goepfert, AR
American Journal of Obstetrics and Gynecology, 195(6): 1611-1616.
10.1016/j.ajog.2006.04.010
CrossRef
Microbes and Infection
Effect of bacterial vaginosis, Lactobacillus and Premarin estrogen replacement therapy on vaginal gene expression changes
Dahn, A; Saunders, S; Hammond, JA; Carter, D; Kirjavainen, P; Anukam, K; Reid, G
Microbes and Infection, 10(6): 620-627.
10.1016/j.micinf.2008.02.007
CrossRef
American Journal of Medicine
Predictors of urinary tract infection after menopause: A prospective study
Reid, G
American Journal of Medicine, 118(8): 930-931.
10.1016/j.amjmed.2005.01.058
CrossRef
American Journal of Epidemiology
A longitudinal study of vaginal douching and bacterial vaginosis - A marginal structural modeling analysis
Brotman, RM; Klebanoff, MA; Nansel, TR; Andrews, WW; Schwebke, JR; Zhang, J; Yu, KF; Zenilman, JM; Scharfstein, DO
American Journal of Epidemiology, 168(2): 188-196.
10.1093/aje/kwn103
CrossRef
Clinical Microbiology and Infection
Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis
Mastromarino, P; Macchia, S; Meggiorini, L; Trinchieri, V; Mosca, L; Perluigi, M; Midulla, C
Clinical Microbiology and Infection, 15(1): 67-74.
10.1111/j.1469-0691.2008.02112.x
CrossRef
Maternal and Child Health Journal
Characteristics and pregnancy outcomes of pregnant women asymptomatic for bacterial vaginosis
Nelson, DB; Bellamy, S; Nachamkin, I; Ruffin, A; Allen-Taylor, L; Friedenberg, FK
Maternal and Child Health Journal, 12(2): 216-222.
10.1007/s10995-007-0239-7
CrossRef
Fertility and Sterility
Autoimmune response to Chlamydia trachomatis infection and in vitro fertilization outcome
Pacchiarotti, A; Sbracia, M; Mohamed, MA; Frega, A; Pacchiarotti, A; Espinola, SMB; Aragona, C
Fertility and Sterility, 91(3): 946-948.
10.1016/j.fertnstert.2007.12.009
CrossRef
Annals of Epidemiology
Why do women douche? A longitudinal study with two analytic approaches
Brotman, RM; Klebanoff, MA; Nansel, T; Zhang, J; Schwebke, JR; Yu, KF; Zenilman, JM; Andrews, WW
Annals of Epidemiology, 18(1): 65-73.
10.1016/j.annepidem.2007.05.015
CrossRef
Microbes and Infection
Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial
Anukam, K; Osazuwa, E; Ahonkhai, J; Ngwu, M; Osemene, G; Bruce, AW; Reid, G
Microbes and Infection, 8(6): 1450-1454.
10.1016/j.micinf.2006.01.003
CrossRef
Bjog-An International Journal of Obstetrics and Gynaecology
Psychological and biological markers of stress and bacterial vaginosis in pregnant women
Harville, EW; Savitz, DA; Dole, N; Thorp, JM; Herring, AH
Bjog-An International Journal of Obstetrics and Gynaecology, 114(2): 216-223.
10.1111/j.1471-0528.2006.01209.x
CrossRef
Microbes and Infection
Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis
Anukam, KC; Osazuwa, E; Osemene, GI; Ehigiagbe, F; Bruce, AW; Reid, G
Microbes and Infection, 8(): 2772-2776.
10.1016/j.micinf.2006.08.008
CrossRef
Microbiology-Sgm
Phenotypic characterization and genomic DNA polymorphisms of Escherichia coli strains isolated as the sole micro-organism from vaginal infections
Lobos, O; Padilla, C
Microbiology-Sgm, 155(): 825-830.
10.1099/mic.0.021733-0
CrossRef
European Journal of Obstetrics Gynecology and Reproductive Biology
Vaginitis in Turkish women: symptoms, epidemiologic - microbiologic association
Karaer, A; Boylu, M; Avsar, AF
European Journal of Obstetrics Gynecology and Reproductive Biology, 121(2): 211-215.
10.1016/j.ejogrb.2004.11.030
CrossRef
Infection and Immunity
Reversible deficiency of antimicrobial polypeptides in bacterial vaginosis
Valore, EV; Wiley, DJ; Ganz, T
Infection and Immunity, 74(): 5693-5702.
10.1128/IAI.00524-06
CrossRef
European Journal of Obstetrics Gynecology and Reproductive Biology
Chlamydia trachomatis in subfertile couples undergoing an in vitro fertilization program: A prospective study
de Barbeyrac, B; Papaxanthos-Roche, A; Mathieu, C; Germain, C; Brun, JL; Gachet, M; Mayer, G; Bebear, C; Chene, G; Hocke, C
European Journal of Obstetrics Gynecology and Reproductive Biology, 129(1): 46-53.
10.1016/j.ejogrb.2006.02.014
CrossRef
Agro Food Industry Hi-Tech
From gut to urogenital tract - Probiotic-microbes descending and ascending
Anukam, KC
Agro Food Industry Hi-Tech, 18(2): 10-13.

Canadian Journal of Microbiology
Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, double-blind, placebo-controlled trial
Martinez, RCR; Franceschini, SA; Patta, MC; Quintana, SM; Gomes, BC; De Martinis, ECP; Reid, G
Canadian Journal of Microbiology, 55(2): 133-138.
10.1139/W08-102
CrossRef
Chemotherapy
Safety, Tolerability and Pharmacokinetics of Intravaginal Pentamycin
Tirri, BF; Bitzer, J; Geudelin, B; Drewe, J
Chemotherapy, 56(3): 190-196.
10.1159/000316329
CrossRef
Clinical Obstetrics and Gynecology
Difficult-to-Manage Vaginitis
Say, PJ; Jacyntho, C
Clinical Obstetrics and Gynecology, 48(4): 753-768.

PDF (120)
Obstetrics & Gynecology
Prevalence of Bacterial Vaginosis: 2001–2004 National Health and Nutrition Examination Survey Data
Allsworth, JE; Peipert, JF
Obstetrics & Gynecology, 109(1): 114-120.
10.1097/01.AOG.0000247627.84791.91
PDF (410) | CrossRef
Obstetrical & Gynecological Survey
Determining the Cause of Vulvovaginal Symptoms
Farage, MA; Miller, KW; Ledger, WJ
Obstetrical & Gynecological Survey, 63(7): 445-464.
10.1097/OGX.0b013e318172ee25
PDF (792) | CrossRef
Sexually Transmitted Diseases
Lactobacillus Vaginal Microbiota of Women Attending a Reproductive Health Care Service in Benin City, Nigeria
Anukam, KC; Osazuwa, EO; Ahonkhai, I; Reid, G
Sexually Transmitted Diseases, 33(1): 59-62.

PDF (393)
Sexually Transmitted Diseases
Personal Hygienic Behaviors and Bacterial Vaginosis
Klebanoff, MA; Nansel, TR; Brotman, RM; Zhang, J; Yu, K; Schwebke, JR; Andrews, WW
Sexually Transmitted Diseases, 37(2): 94-99.
10.1097/OLQ.0b013e3181bc063c
PDF (201) | CrossRef
Sexually Transmitted Diseases
Race of Male Sex Partners and Occurrence of Bacterial Vaginosis
Klebanoff, MA; Andrews, WW; Zhang, J; Brotman, RM; Nansel, TR; Yu, K; Schwebke, JR
Sexually Transmitted Diseases, 37(3): 184-190.
10.1097/OLQ.0b013e3181c04865
PDF (258) | CrossRef
Sexually Transmitted Diseases
Bacterial Vaginosis: Risk Factors Among Kenyan Women and Their Male Partners
Nguti, R; Njeri, JN; Holmes, KK; Bukusi, EA; Cohen, CR; Meier, AS; Waiyaki, PG
Sexually Transmitted Diseases, 33(6): 361-367.
10.1097/01.olq.0000200551.07573.df
PDF (236) | CrossRef
Sexually Transmitted Diseases
Longitudinal Association Between Hormonal Contraceptives and Bacterial Vaginosis in Women of Reproductive Age
RIGGS, M; KLEBANOFF, M; NANSEL, T; ZHANG, J; SCHWEBKE, J; ANDREWS, W
Sexually Transmitted Diseases, 34(12): 954-959.
10.1097/OLQ.0b013e31811ed0e4
PDF (209) | CrossRef
Back to Top | Article Outline

© 2004 The American College of Obstetricians and Gynecologists

Login

Article Tools

Images

Share