New Developments in the Etiology and Pathogenesis of Bacterial Vaginosis

Abstract

Vaginitis by definition means inflammation of the vagina and is to be distinguished from cervicitis which has its own set of pathogens. We are aware of relatively few agents that cause vaginitis. Trichomonas vaginalis, a protozoan parasite, is usually associated with a voluminous, often frothy, green vaginal discharge. Yeast vaginitis is usually caused by the yeast-like fungus Candida albicans and is characterized by a curd-like vaginal discharge often associated with itching. Vaginitis caused by these two agents has been termed specific vaginitis and represents approximately 50% of all cases. Patients presenting to a physician with complaints of vaginitis but having evidence of neither T. vaginalis nor C. albicans were defined as having nonspecific vaginitis (NSV). NSV is not a new syndrome. As early as 1895, Kronig (1) published drawings of vaginal fluid from patients with NSV which showed a mixed flora devoid of large rods and including vibrio-like organisms. Later Doderlein (cited in reference 2) described three grades of vaginal flora. Grade I, defined as a clean vagina, contained large rod-shaped organisms which became known as Doderlein’s bacilli and represent various species of the genus Lactobacillus. Grade II was a mixed flora, and Grade III, the pathological flora, was notable by its absence of the large rod-shaped organisms. Kronig’s drawings and Doderlein’s description of the Grade III flora are characteristic of the syndrome we now call NSV.