Studies of Vaginal Flora and Bacterial Vaginosis

细菌性阴道病是一种综合征，其中正常的乳酸杆菌为主的阴道植物群被混合的厌氧菌为主的微生物所取代。它存在于一般人群中10%至25%的女性中，是最常见的阴道感染。它与生殖健康方面的一些不良后遗症有关，包括艾滋病毒感染、盆腔炎、宫颈发育不良和妇科手术并发症。在怀孕期间，它与早产和产后母体感染的风险增加有关。然而，阴道微生物植物群仍然知之甚少。关于微生物植物群变化及其与BV相关性的纵向研究信息不可用。这项前瞻性观察性研究旨在提高我们对阴道微生物植物群的自然史和异常改变的认识，并确定与这些变化相关的风险因素。在亚拉巴马的伯明翰，共招募了3600名健康的非妊娠育龄妇女，并随访1年（基线访视加上此后每3个月一次，共5次访视）。通过面对面访谈收集有关社会人口学状况、病史、卫生习惯、性行为和心理社会压力的详细信息。在研究访视期间进行常规妇科和牙科检查。采集阴道分泌物和血液样本。进行了实验室检测，以量化阴道微生物植物群，并确定细菌性阴道病以及常见性传播疾病的感染。子研究评价了阴道植物群的每日变化以及停止冲洗的影响。 最后一次研究访问于2003年6月完成，目前正在进行各种分析。在本报告期间公布的结果中，一项关于冲洗停止和细菌性阴道病的发生率和持续性的初步随机试验证明了这种大型试验的可行性。对指定治疗的依从性非常好，并且没有发现持续冲洗与停止冲洗的不良影响。此外，已证明感知的心理压力会增加女性获得BV的风险。本研究采用了新颖的“病例交叉”设计，是第一篇利用这种方法的论文。摘要描述了BV和牙周病之间的关系，BV和肥胖之间的关系，以及BV的营养风险因素。此外，关于促使冲洗行为改变的因素的病例交叉设计导致了今年流行病学大会的摘要。正在进行的分析侧重于冲洗停止和BV发生率的影响。 此外，NICHD MFMU网络细菌性阴道病和阴道毛滴虫临床试验的工作仍在继续，并发表了几篇来自这项工作的次要论文。

Bacterial vaginosis is a syndrome in which the normal Lactobacillus-predominant vaginal flora is replaced with mixed anaerobic-predominant organisms. It is present in 10 to 25% of women in the general population, and is the most common vaginal infection. It has been associated with a number of adverse sequelae in reproductive health including acquisition of HIV, pelvic inflammatory disease, cervical dysplasia, and complications of gynecological procedures. During pregnancy it has been associated with an increased risk of preterm birth and postpartum maternal infection. However, the vaginal microbial flora remains poorly understood. Information on variation in microbial flora and its association with BV from a longitudinal study is unavailable. This prospective observational study aims to advance our knowledge of the natural history and abnormal alteration in vaginal microbial flora, and to identify risk factors that are associated with these changes. A total of 3600 healthy, non-pregnant women of reproductive age have been enrolled and were followed in Birmingham, Alabama for one year (baseline visit plus once every three months afterwards, totaling five visits). Detailed information on sociodemographic status, medical history, hygiene practice, sexual behavior and psychosocial stress was collected through in-person interviews. Routine gynecological and dental examinations were carried out during the study visits. Samples of vaginal secretion and blood were collected. Laboratory tests to quantify vaginal microbial flora and to identify infection of bacterial vaginosis as well as common sexually transmitted diseases were conducted. Sub-studies evaluate the day-to-day change in vaginal flora, and the effect of cessation of douching. The final study visits were completed in June 2003, and various analyses are underway. In results poublished during this reporting period, a pilot randomized trial of douching cessation and the incidence and persistence of bacterial vaginosis demonstrated the feasibility of such a large trial. Compliance with assigned treatment was very good, and no adverse effects of douching continuation versus cessation were found. Also, perceived psychological stress was demonstrated to increase a woman's risk of acquiring BV. This study used the novel "case-crossover" design, and is the first paper on this topic to utilize this approach. Abstracts describing the association between BV and periodontal disease, between BV and obesity, and on nutritional risk factors for BV were presented. In addition, the case-crossover design on factors that prompt a change in douching behavior resulted in an abstract at this year's Congress of epidemiology. Ongoing analysis are focusing on the effect of douching cessation and BV incidence. In addition, work continued with the NICHD MFMU Network Bacterial Vaginosis and Trichomonas vaginalis clinical trials, publishing several secondary papers from this effort.