Studies of Vaginal Flora and Bacterial Vaginosis

细菌性阴道病是一种以乳杆菌为主的正常阴道菌群被以厌氧菌为主的混合微生物取代的综合征。在普通人群中，有10%到25%的女性患有此病，是最常见的阴道感染。它与生殖健康中的一些不良后遗症有关，包括感染艾滋病毒、盆腔炎、宫颈发育不良和妇科手术的并发症。在怀孕期间，它与早产和产后产妇感染的风险增加有关。然而，阴道微生物区系仍然知之甚少。关于微生物区系的变化及其与BV的关系的纵向研究的信息是不可用的。这项前瞻性的观察性研究旨在提高我们对阴道微生物区系的自然历史和异常变化的认识，并确定与这些变化相关的危险因素。在阿拉巴马州伯明翰，总共登记了3600名健康的非怀孕育龄妇女，并对她们进行了为期一年的跟踪(基线访问加上此后每三个月一次，总共五次访问)。通过面对面访谈，收集有关社会人口状况、病史、卫生习惯、性行为和心理社会压力的详细信息。在研究访问期间进行了常规的妇科和牙科检查。采集阴道分泌物和血样。进行了实验室测试，以量化阴道微生物菌群，并确定细菌性阴道病和常见性传播疾病的感染情况。子研究评估每天阴道菌群的变化，以及停止冲洗的效果。 最后的考察访问已于2003年6月完成，目前正在进行各种分析。2004年，一项关于停止冲洗和细菌性阴道病的发病率和持久性的试点随机试验的摘要被提交给妇科调查学会。2005财年发表了描述BV妇女无症状程度的手稿，以及心理应激和BV发病率之间的联系，一篇关于避孕用法和BV的论文正在审查中。摘要描述了BV和牙周病之间的联系。正在进行的分析集中于停止冲洗和BV发病率的影响，以及BV的饮食风险因素。

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 are being 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 were 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. An abstract on the a pilot randomized trial of douching cessation and the incidence and persistence of bacterial vaginosis was presented at the Society for Gynecologic Investigation in 2004. Manuscripts describing the degree to which women with BV are asymptomatic, and the association between psychosicial stress and BV incidence were published in FY05, and a paper on contraceptive use and BV is under review. Abstracts describing the association between BV and periodontal disease was presented. Ongoing analysis are focusing on the effect of douching cessation and BV incidence, and dietary risk factors for BV.