Program Schedule

Utilization of PCR to Characterize Vaginal Flora in a Longitudinal Study of Recurrent Bacterial Vaginosis

Session: Poster Abstract Session: Diagnostic Microbiology: Bacterial Infections
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Bacterial vaginosis (BV) is the most common vaginal infection for women of reproductive age and is associated with pre-term labor and HIV acquisition. It is characterized by a shift in the vaginal flora from commensal lactobacillus to diverse facultative and anaerobic species. Treatment is oral or topical antibiotics, after which up to 80% of patients experience recurrent disease within 6 months.  

Methods: We performed a longitudinal study on symptomatic BV patients, obtaining vaginal specimens at 3 visits: initial diagnosis, 10-14 days and ~1 month later. BV was diagnosed based on signs and symptoms  (Amsel’s criteria) and  Nugent score (Gram-stained vaginal smears).  DNA was extracted from vaginal specimens and analyzed by real-time PCR to quantify the presence of BV-associated microbes and commensal lactobacillus species.

Results: Initial diagnosis of BV by either Amsel’s criteria or Nugent score was strongly correlated with the presence and quantity of Gardnerella vaginalis, Atopobium vaginae, BVAB2 and Megasphaera and reduced presence of commensal lactobacillus species. When evaluated 10-14 days later, treatment was successful in 78/82 patients (95%) and was associated with the eradication of Megasphaera type 1 in 54/55 (98%) and type 2 in 21/21 (100%) patients. In contrast, G. vaginalis, A. vaginae and BVAB2 persisted in 54/75 (72%), 36/69 (52%) and 19/58 (33%) patients, respectively, although their median concentrations decreased by ~3 logs. Frequency of colonization with the commensal lactobacillus species L. crispatus, L. gasseri and L. jensenii all increased after treatment; from 17% to 32%, 7.7% to 12% and 10% to 25%, respectively. Twenty-nine patients (37%) would go on to experience recurrent disease at their 3rd visit, ~ 1 month after diagnosis. However, neither persistence of BV-associated microbes nor colonization with commensal lactobacillus species after treatment was associated with disease recurrence.  

Conclusion: Successful treatment of BV is associated with profound changes in the vaginal flora that can be characterized by PCR. Recurrent disease in this population was not associated with treatment failure and the recovery of commensal lactobacillus species was not protective. Future studies will evaluate additional factors contributing to disease recurrence.

David Hilbert, PhD1, Sergey Balashov, PhD1, Martin Adelson, PhD2, Eli Mordechai, PhD2, Jack D. Sobel, MD, FIDSA3 and Scott Gygax, PhD1, (1)Femeris Women's Health Research Center, Hamilton, NJ, (2)Medical Diagnostic Laboratories, Hamilton, NJ, (3)Detroit Medical Center, Wayne State University, Detroit, MI


D. Hilbert, Medical Diagnostic Laboratories: Employee, Salary

S. Balashov, Medical Diagnostic Laboratories: Employee, Salary

M. Adelson, Medical Diagnostic Laboratories: Employee, Salary

E. Mordechai, Medical Diagnostic Laboratories: Employee, Salary

J. D. Sobel, Medical Diagnostic Laboratories: Board Member, Consulting fee

S. Gygax, Medical Diagnostic Laboratories: Employee, Salary

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