Bacterial vaginosis pathophysiology: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
Bacterial vaginosis is resulting from replacement of the normal hydrogen peroxide producing [[Lactobacillus|Lactobacillus sp.]] in the vagina with high concentrations of [[anaerobic|anaerobic bacteria]] (e.g., [[Prevotella|Prevotella sp.]] and [[Mobiluncus|Mobiluncus sp.]]), [[Garderella vaginalis,]] [[Ureaplasma]], [[Mycoplasma]], and numerous fastidious or uncultivated anaerobes.<ref name=BV-US>Koumans EH, Sternberg M, Bruce C, 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.</ref> | Bacterial vaginosis is resulting from replacement of the normal hydrogen peroxide producing [[Lactobacillus|Lactobacillus sp.]] in the vagina with high concentrations of [[anaerobic|anaerobic bacteria]] (e.g., [[Prevotella|Prevotella sp.]] and [[Mobiluncus|Mobiluncus sp.]]), [[Garderella vaginalis,]] [[Ureaplasma]], [[Mycoplasma]], and numerous fastidious or uncultivated anaerobes.<ref name=BV-US>Koumans EH, Sternberg M, Bruce C, 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.</ref> | ||
=== | ===Pathogenesis=== | ||
Bacterial vaginosis is actually a syndrome resulting from an imbalance in the different types of [[bacteria]] in the [[vagina]] (also called vaginal "flora"). | Bacterial vaginosis is actually a syndrome resulting from an imbalance in the different types of [[bacteria]] in the [[vagina]] (also called vaginal "flora"). | ||
The healthy vaginal microflora has been described as being constituted mainly by Gram-positive bacilli of the genus [[Lactobacillus]] including L. crispatus, L. iners, L. gasseri, and L. jensenii the most common species. However, other non-beneficial microbial species, including [[Gardnerella vaginalis]], [[Enterococcus|Enterococcus spp]]., and [[Prevotella| Prevotella spp.]], can be present in small numbers, not sufficient to cause disease. Lactobacilli play an important role in maintaining the female genital tract health by keeping the vagina's [[pH]] at normal levels.<ref name="pmid26834706">{{cite journal| author=Machado D, Castro J, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, Cerca N| title=Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions. | journal=Front Microbiol | year= 2015 | volume= 6 | issue= | pages= 1528 | pmid=26834706 | doi=10.3389/fmicb.2015.01528 | pmc=4718981 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26834706 }} </ref> | The healthy vaginal microflora has been described as being constituted mainly by Gram-positive bacilli of the genus [[Lactobacillus]] including L. crispatus, L. iners, L. gasseri, and L. jensenii the most common species. However, other non-beneficial microbial species, including [[Gardnerella vaginalis]], [[Enterococcus|Enterococcus spp]]., and [[Prevotella| Prevotella spp.]], can be present in small numbers, not sufficient to cause disease. Lactobacilli play an important role in maintaining the female genital tract health by keeping the vagina's [[pH]] at normal levels.<ref name="pmid26834706">{{cite journal| author=Machado D, Castro J, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, Cerca N| title=Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions. | journal=Front Microbiol | year= 2015 | volume= 6 | issue= | pages= 1528 | pmid=26834706 | doi=10.3389/fmicb.2015.01528 | pmc=4718981 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26834706 }} </ref> | ||
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[[image:PHIL_3719_thumb.jpg||center|thumb|This photomicrograph reveals bacteria adhering to vaginal epithelial cells known as “clue cells”]] | [[image:PHIL_3719_thumb.jpg||center|thumb|This photomicrograph reveals bacteria adhering to vaginal epithelial cells known as “clue cells”]] | ||
*Decrease in [[hydrogen-peroxide]] production result in overgrowth of the anaerobes | |||
*Loss of [[lactobacilli]] result in PH rises and massive overgrowth of vaginal anaerobes, also facilitates adherence of [[Gardnerella vaginalis]] to the exfoliating epithelial cells | |||
*[[Anaerobes]] produce large amounts of proteolytic carboxylase enzymes | |||
*Proteolytic carboxylase enzymes break down vaginal peptides into a variety of amines that are volatile, malodorous, and associated with increased vaginal transudation | |||
===Associated Conditions=== | ===Associated Conditions=== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Bacterial vaginosis is actually a syndrome resulting from an imbalance in the different types of bacteria in the vagina (also called vaginal "flora"). The healthy vaginal microflora has been described as being constituted mainly by Gram-positive bacilli of the genus Lactobacillus. Lactobacilli play an important role in maintaining the female genital tract health by keeping the vagina's pH at normal levels. When vagina's pH levels become unbalanced, certain microorganisms may overtake the normal flora leading to a low-grade infection that often produces an abnormal vaginal discharge.[1][2]
Pathophysiology
Bacterial vaginosis is resulting from replacement of the normal hydrogen peroxide producing Lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria (e.g., Prevotella sp. and Mobiluncus sp.), Garderella vaginalis, Ureaplasma, Mycoplasma, and numerous fastidious or uncultivated anaerobes.[3]
Pathogenesis
Bacterial vaginosis is actually a syndrome resulting from an imbalance in the different types of bacteria in the vagina (also called vaginal "flora"). The healthy vaginal microflora has been described as being constituted mainly by Gram-positive bacilli of the genus Lactobacillus including L. crispatus, L. iners, L. gasseri, and L. jensenii the most common species. However, other non-beneficial microbial species, including Gardnerella vaginalis, Enterococcus spp., and Prevotella spp., can be present in small numbers, not sufficient to cause disease. Lactobacilli play an important role in maintaining the female genital tract health by keeping the vagina's pH at normal levels.[1] When vagina's pH levels become unbalanced, certain microorganisms may overtake the normal flora leading to a low-grade infection that often produces an abnormal vaginal discharge.[2]
- Decrease in hydrogen-peroxide production result in overgrowth of the anaerobes
- Loss of lactobacilli result in PH rises and massive overgrowth of vaginal anaerobes, also facilitates adherence of Gardnerella vaginalis to the exfoliating epithelial cells
- Anaerobes produce large amounts of proteolytic carboxylase enzymes
- Proteolytic carboxylase enzymes break down vaginal peptides into a variety of amines that are volatile, malodorous, and associated with increased vaginal transudation
Associated Conditions
Bacterial vaginosis has been associated with serious health problems including:[4][5][6][1]
- Pre-term birth
- Spontaneous abortion
- Pelvic inflammatory disease
- Endometritis
- Acquisition and transmission of several sexually transmitted agents
References
- ↑ 1.0 1.1 1.2 Machado D, Castro J, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, Cerca N (2015). "Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions". Front Microbiol. 6: 1528. doi:10.3389/fmicb.2015.01528. PMC 4718981. PMID 26834706.
- ↑ 2.0 2.1 Borges S, Silva J, Teixeira P (2014). "The role of lactobacilli and probiotics in maintaining vaginal health". Arch Gynecol Obstet. 289 (3): 479–89. doi:10.1007/s00404-013-3064-9. PMID 24170161.
- ↑ Koumans EH, Sternberg M, Bruce C, 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.
- ↑ Guerra B, Ghi T, Quarta S, Morselli-Labate AM, Lazzarotto T, Pilu G; et al. (2006). "Pregnancy outcome after early detection of bacterial vaginosis". Eur J Obstet Gynecol Reprod Biol. 128 (1–2): 40–5. doi:10.1016/j.ejogrb.2005.12.024. PMID 16460868.
- ↑ Rothman KJ, Funch DP, Alfredson T, Brady J, Dreyer NA (2003). "Randomized field trial of vaginal douching, pelvic inflammatory disease and pregnancy". Epidemiology. 14 (3): 340–8. PMID 12859036.
- ↑ Jacobsson B, Pernevi P, Chidekel L, Jörgen Platz-Christensen J (2002). "Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis". Acta Obstet Gynecol Scand. 81 (11): 1006–10. PMID 12421167.