Haemophilus vaginalis (Corynebacterium vaginale) vaginitis in women attending public health clinics: response to treatment with ampicillin

Isolation and identification of anaerobic organisms from the male and female urogenital tracts

Since Bacteroides spp may play an important role together with Gardnerella vaginalis in the pathogenesis of non-specific vaginitis and balanoposthitis, anaerobic organisms were isolated and identified from 34 female and 20 male patients attending a department of genitourinary medicine, and the results compared with the clinical findings and the presence of other routinely isolated pathogens. Twenty-three different organisms were recovered from 13 of the 20 men; of these organisms, 20 were of the Bacteroides spp. Most isolates were of the B melaninogenicus/oralis group, which forms part of the commensal vaginal flora in women. A definite association between the presence of anaerobes and other pathogens needs to be firmly established, as this obviously causes important complications in treating these conditions.

Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations

Numerous previous studies of nonspecific vaginitis have yielded contradictory results regarding its cause and clinical manifestations, due to a lack of uniform case definition and laboratory methods. We studied 397 consecutive unselected female university students and applied sets of well defined criteria to distinguish nonspecific vaginitis from other forms of vaginitis and from normal findings. Using such criteria, we diagnosed nonspecific vaginitis in up to 25 percent of our study population; asymptomatic disease was recognized in more than 50 percent of those with nonspecific vaginitis. A clinical diagnosis of nonspecific vaginitis, based on simple office procedures, was correlated with both the presence and the concentration of Gardnerella vaginalis (Hemophilus vaginalis) in vaginal discharge, and with characteristic biochemical findings in vaginal discharge. Nonspecific vaginitis was also correlated with a history of sexual activity, a history of previous trichomoniasis, current use of nonbarrier contraceptive methods, and, particularly, use of an intrauterine device. G. vaginalis was isolated from 51.3 percent of the total population using a highly selective medium that detected the organism in lower concentration in vaginal discharge than did previously used media. Practical diagnostic criteria for standard clinical use are proposed. Application of such criteria should assist in clinical management of nonspecific vaginitis and in further study of the microbiologic and biochemical correlates and the pathogenesis of this mild but quite prevalent disease.

Gardnerella vaginalis and its clinical syndrome

The Gardnerella vaginalis syndrome is a well defined but benign condition characterized by a smelly vaginal discharge of pH greater than 5.0. It is not associated with inflammation. It often occurs in association with cervical infections. The microscopic appearance of the discharge is typical and diagnostic. The wet mount shows "clue cells" and "rafts" (floating clumps of small bacilli) and the Gram stain has the "pepper on salt" pattern of masses of small gram-variable bacilli. The amine test is an additional diagnostic aid. Cultures are useful but not necessary for diagnosis. The treatment of choice is oral metronidazole 400 mg twice daily for five days.

Haemophilus vaginalis (Corynebacterium vaginale, Gardnerella vaginalis) in a family planning clinic population

Vaginal specimens were obtained at 902 attendances from 522 women requiring vaginal examination at a family planning clinic. Haemophilus vaginalis was found in 8% of specimens either by culture or by at least two out of three microscopical tests; lactobacilli were seldom found in the presence of the organism. Increased signs and symptoms, especially an offensive odour, were found only when H vaginalis and staphylococcus were isolated together. The organism was found less often in patients using contraceptives methods which protected the vagina, thus suggesting sexual transmission. Treatment is advisable when H vaginalis is in contact with a vascular bed.

Corynebacterium vaginale and vaginitis: a controlled trial of treatment

In a study of the diagnosis and treatment of Corynebacterium vaginale (Haemophilus vaginalis) vaginitis in 30 patients, clinical and microscopical findings were compared with laboratory cultures. The study also included a double-blind randomised trial of treatment regimens including placebo therapy. Laboratory cultures of C. vaginale corresponded well with clinical findings, and we suggest that C. vaginale vaginitis can be reliably diagnosed with clinical and microscopical findings. Tetracycline was effective in half the patients treated, whereas all but 1 of the 17 patients eventually treated with metronidazole were cured. The apparent discrepancy between in-vitro sensitivity and in-vitro efficacy of metronidazole in this condition is discussed.