Diagnosis and microecological characteristics of aerobic vaginitis in outpatients based on preformed enzymes.

OBJECTIVE: Aerobic vaginitis (AV) is a recently proposed term for genital tract infection in women. The diagnosis of AV is mainly based on descriptive diagnostic criteria proposed by Donders and co-workers. The objective of this study is to report AV prevalence in southwest China using an objective assay kit based on preformed enzymes and also to determine its characteristics. MATERIALS AND METHODS: A total of 1948 outpatients were enrolled and tested by a commercial diagnostic kit to investigate the AV prevalence and characteristics in southwestern China. The study mainly examined the vaginal ecosystem, age distribution, Lactobacillus amount, and changes in pH. Differences within groups were analyzed by Wilcoxon two-sample test. RESULTS: The AV detection rate is 15.40%. The AV patients were usually seen in the sexually active age group of 20-30 years, followed by those in the age group of 30-40 years. The vaginal ecosystems of all the patients studied were absolutely abnormal, and diagnosed to have a combined infection [aerobic vaginitis (AV) + bacterial vaginitis (BV) 61.33%; 184/300]. Aerobic bacteria, especially Staphylococcus aureus and Escherichia coli, were predominantly found in the vaginal samples of these women. CONCLUSION: AV is a common type of genital infection in southwestern China and is characterized by sexually active age and combined infection predominated by the AV and BV type.

Lactate dehydrogenase and its isoenzymes in vaginal fluid in vaginitis/vaginosis cases and in healthy controls.

The objective of the study was to measure the lactate dehydrogenase (LD) activity in vaginal lavage fluid of women with vaginitis/vaginosis and in healthy pre- and post-menopausal controls. Also to analyse the LD isoenzyme patterns in such samples and compare the influence on the LD activity by different storage and sampling methods. Twenty of the women studied, who had no signs of inflammation as evidenced from vaginal wet smears, were pre-menopausal and 8 post-menopausal. Fifty-eight non-pregnant patients with vaginitis/vaginosis or non-inflammatory gynaecological conditions were analysed for LD isoenzyme patterns. The LD activity was correlated to vaginal pH. Furthermore, the LD activity was determined in another 100 women screened for Chlamydia trachomatis. Finally, the influence on the LD activity when sampling was made by a cytological brush vs vaginal lavage and analysed after different storage periods, as studied. The LD activity was elevated, i.e. >2 micro kat/L, in all but two of the women with leucorrhoea. Only women with bacterial vaginosis (BV) without leucorrhoea, had an increased LD activity. An increased vaginal pH correlated to the LD concentration. The LD activity was elevated in cases with vulvovaginal candidiasis, trichomoniasis, chlamydial cervicitis and senile colpitis. Storage of samples for up to six hours had no influence on the test outcome. Brush and lavage fluid samples did not differ with regard to the rate of positive LD tests. In healthy women, the LD activity is low and predominated by slow-migrating isoenzymes, i.e. LD 4 and 5. The LD activity is generally increased in cases of vaginitis and in women with BV and chlamydial cervicitis. In trichomoniasis, particularly high concentrations of LD 5, are found.

[Intravaginal bacterial flora and clinical significance of granulocyte elastase and pH determination].

In 95 patients with abnormal vaginal and cervical secreta (49 pregnant women and 46 non-pregnant women), the relation between intravaginal flora and intravaginal granulocyte elastase (Elastase) and pH was investigated. The results were as follows. 1) Gram-positive bacteria were detected in the vaginal secreta at a high rate (87/144, 60.4%), and it mainly consisted of Lactobacillus sp. (67/142, 46.5%). It was followed anaerobia (26/144, 18.1%) and fungi (26/144, 18.1%). 2) The patients with cervicitis or vaginitis had higher elastase value (6.65-6.69 micrograms/ml) than the ones with vaginal erosion, and the patients who showed an intravaginal pH value not lower than 5.0 had significantly increased elastase value (6.44 +/- 1.40 micrograms/ml) than the patients who showed the values 4.5 or higher. 3) Regarding the relation between the detected bacteria and elastase values, elastase values were higher in the patients infected by anaerobia (6.58 +/- 1.40 micrograms/ml), Gram-negative bacteria (6.01 +/- 3.61 micrograms/ml), Gram-positive bacteria (5.02 +/- 0.94 micrograms/ml) and fungi (5.14 +/- 1.08 micrograms/ml) than the values in patients with Lactobacillus sp. (pH < 4.5). Further, the intravaginal pH value was higher than 4.5 in all of these groups, which was higher compared with the one in the patients infected with Lactobacillus sp. (4.04 +/- 0.04).

Leukocyte esterase dipstick as a rapid screening test for vaginitis and cervicitis.

STUDY OBJECTIVE: To assess the ability of vaginal and cervical leukocyte esterase (LE) dipstick to detect vaginitis and cervicitis. DESIGN: A prospective, cross-sectional study to assess the ability of the LE dipstick of vaginal secretions to detect trichomonads, candida, and bacterial vaginosis and the LE dipstick of vaginal and cervical secretions to detect gonococcal and chlamydia infection and polymorphonuclear cells (PMNs). SETTING: An inner-city shelter facility clinic. PARTICIPANTS: 183 sexually active, nonmenstruating females aged 13-21 years (Mean = 17.7, SD = 1.98 years): 47% black, 40% white, and 11% Hispanic. OUTCOME MEASURES: Sensitivity (SN), specificity (SP), positive and negative predictive values (PVP, PVN), with 95% confidence intervals, of vaginal and cervical LE dipstick > or = trace in detecting vaginal and cervical infections. RESULTS: A positive vaginal LE had a moderately high SN and PVN but poor SP and PVP in detecting trichomonas and candida vaginitis and bacterial vaginosis. A positive vaginal and cervical LE had a high SN and PVN but poor SP and PVP in detecting gonorrhea and chlamydia infection. A positive cervical LE had a moderate SN and low SP in detecting PMNs on Gram stain. CONCLUSIONS: The LE dipstick of vaginal and cervical secretions was only a moderately good screening test for vaginal infection but a good screening test for cervical infection.

Expression of Candida albicans SAP1 and SAP2 in experimental vaginitis.

Several strains of Candida albicans were compared for their ability to cause vaginal infection in a rat model, and their vaginopathic potentials were correlated with the expression of two aspartyl proteinases genes (SAP1 and SAP2) and adherence in vivo to the vaginal epithelium. Dot blot reactions and Northern blot analysis with RNA extracted from the vaginal fluid of rats infected with the highly vaginopathic strains H12 and 10261 demonstrated the expression of both SAP1 and SAP2 during the first week of infection. In contrast, neither gene was expressed during infection by a nonvaginopathic strain (N), even though the organism could be recovered during the first 24 h postinfection. A moderately vaginopathic strain (P) also expressed both genes, but the level of SAP1 mRNA appeared to decrease prior to that of SAP2. Neither gene was expressed, even by the highly vaginopathic strains, after the first week of infection, concomitant with a decrease in the number of organisms recovered from the vaginas. Analysis of in vivo adherence showed that the nonvaginopathic strain (N) adhered to vaginal epithelial cells less readily than the highly vaginopathic strain (H12) and moderately vaginopathic strain (P). Thus, in addition to its inability to express SAP1 and SAP2 in vivo, the nonvaginopathic strain does not colonize host cells to the same extent as the other strains tested. Our results demonstrate the early in vivo expression of two aspartyl proteinase gene during candidal vaginitis and suggest its association with the establishment of a vaginal infection.

Quality control standards for the proline aminopeptidase assay used to detect bacterial vaginosis.

We describe the preparation and usage of positive and negative quality control standards for the proline aminopeptidase assay of vaginal secretions as an indicator of bacterial vaginosis.

Proline aminopeptidase activity as a rapid diagnostic test to confirm bacterial vaginosis.

Two biochemical indicators of bacterial vaginosis, proline aminopeptidase activity and gas-liquid chromatographic analysis, were compared. Five hundred women had their vaginal secretions tested for pH, presence of a positive amine test, levels of volatile and nonvolatile short-chain organic acids, and proline aminopeptidase activity. In addition, direct microscopic and Gram stain examinations were performed. Of the 500 women, 349 (70%) had some form of vaginitis. One hundred sixteen were diagnosed as having bacterial vaginosis, and 69 of these (59%) had Mobiluncus sp on either direct microscopic or Gram stain examination. Two hundred thirty-three had either mixed or other forms of vaginitis. One hundred fifty-one patients were normal. The sensitivity of the proline aminopeptidase assay was 83 and 79%, respectively, in patients having bacterial vaginosis with and without Mobiluncus morphotypes. In contrast, gas-liquid chromatography of short-chain organic acids had sensitivities of 71 and 30%, respectively. Specificity of both assays was about 95%. The greater sensitivity of the proline aminopeptidase assay, especially in patients without Mobiluncus morphotypes, proves its superiority.