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Bacterial vaginosis Transmission, role in genital tract infection and pregnancy outcome: an enigma: Review article III

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Larsson PG, Bergström M, Forsum U, Jacobsson B, Strand A, Wölner-Hanssen P. Bacterial vaginosis. Transmission, role in genital tract infection and pregnancy outcome: an enigma. APMIS 2005;113:233–45.

Whether bacterial vaginosis (BV) is acquired from an endogenous or an exogenous source is subject to controversy. Despite findings of an association between sexual behaviour and BV, some data indicate that BV is not a sexually transmitted infection in the traditional sense, while other data indicate that BV is an exogenous infection. A third aspect of BV is its tendency to go unnoticed by affected women. All of this will have a strong impact on how physicians view the risks of asymptomatic BV. This review focuses on whether or not BV should be regarded as a sexually transmitted infection (STI), its role in postoperative infections and pelvic inflammatory disease (PID), and on whether or not treatment of BV during pregnancy to reduce preterm delivery should be recommended. The reviewed studies do not lend unequivocal support to an endogenous or exogenous transmission of the bacteria present in BV. For women undergoing gynaecological surgery such as therapeutic abortion, the relative risk of postoperative infection is clearly elevated (approx. 2.3–2.8). A weaker association exists between BV and pelvic inflammatory disease. Data on treatment of BV as a way of reducing preterm delivery are inconclusive and do not support recommendations for general treatment of BV during pregnancy. The discrepant associations between BV and preterm birth found in recent studies may be explained by variations in immunological response to BV. Genetic polymorphism in the cytokine response – both regarding the TNF alleles and in interleukin production – could make women more or less susceptible to BV, causing different risks of preterm birth. Thus, studies on the vaginal inflammatory response to microbial colonization should be given priority.
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Keywords: Bacterial vaginosis; postoperative complications; preterm delivery; review; risk

Document Type: Review Article

Affiliations: 1: Department of Gynecology, Södersjukhuset, Stockholm, 2: Department of Molecular and Clinical Medicine, Linköping University, Linköping, 3: Department of Dermatology and Venereology, University Hospital, Uppsala, 4: Department of Obstetrics and Gynecology, University Hospital of Lund, Lund, Sweden

Publication date: 2005-04-01

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