Re: Lactobacilli & Bacterial Vaginosis-question

[Guest guest]

Thank you for the informative post. I've been

receiving emails for VPD for a few months. I feel like

I'm learning more and more everyday, which brings up

questions. I was diagnosed with clitoradynia about 5

months ago. All along, I have felt that I have some

kind of infection. I've had two yeast cultures that

came out negative. I was tested for mycoplasma and

chlamydia through a urine test. Both came out

negative. The doctor prescribed disipramine, but it

had terrible side effects and didn't work long. I've

been getting incrementally better and have tried so

many different things (nystatin, diflucan, diet

change, etc). I was told by two doctors that I have

lyme disease (only symptoms are bladder and the

clitoradynia) and by two that I don't. My question

is.....where can I go for more help? Any recommended

tests? My pain and discomfort is internal, not

external. Any recommended specialist?The clitoral skin

is fine and I can have sex without a problem. My

clitoris is hyper stimulated and never does a day go

by that I'm not in pain or just plain uncomfortable.

It has been eight months and like many of you, I'm

sick of going to doctors and no one knows what to do

to help me. Some days I feel that this will never go

away and that I'll never feel normal again. I also

went to PT. That proved useless. Any feedback would be

greatly appreciated. Thank you!

Thank you!

--- Chelle wrote:

>

>

> DeeTroll wrote:

> ======================================

> Premenopausal women have a flora of mostly

> lactobacilli, and is important in conferring

> protection to the woman. As she ages and goes into

> menopause she tends to lose much of this protection

> with the loss of estrogen. (she also loses a lot of

> estrogen with breast feeding)

>

> If not enough lactobacilli in the vagina it

> predisposes a woman to bacterial vaginitis and often

> the fishy odor and usually will have a higher pH

> level which estrogen will normalize.

>

> Patients with BV have 'decreased' levels of normal

> hydrogen peroxide-producing Lactobacillus species in

> the vagina and 'high' concentrations of anaerobic

> bacteria (including Prevotella and Mobiluncus

> species), Gardnerella vaginalis, and Mycoplasma

> hominis.5

>

> Normally, the hydrogen peroxide & shy; producing

> lactobacilli help maintain a healthy acidic pH in

> the vagina of less than 4.5 and inhibit the growth

> of most other vaginal bacteria.7 In healthy

> patients, lactobacilli account for more than 95% of

> the bacteria found in the vagina. In contrast,

> women with BV (Bacterial vaginosis) *note* In

> some cases you'll see the word Bacterial

> ''vaginitis'', I believe some use that to

> differentiate the inflammatory and 'perhaps' an

> infectious stage from a symptomless one? ('itis'

> means inflammatory) but when really looking up the

> two words in depth, vaginosis or vaginitis.. they

> are most often interchanged & both mean an

> infection.(could be yeast or bacterial) but with the

> B. (as in BV) in front it's a bacterial one. Dee~

> have a 1,000-fold higher concentration of other

> bacteria--including those mentioned previously

> bacterias--in the vagina, in association with a

> remarkable 'absence' of lactobacilli.7 The

> cause of this change in vaginal flora is not

> understood. While BV is associated with having

> multiple sexual partners and frequent sexual

> activity, it is considered to be sexually associated

> rather than sexually transmitted. Women who

> never have had intercourse can have BV. However,

> women who have recently acquired a new partner or

> who have intercourse frequently are more prone to

> getting BV. In women who have sex with other women,

> BV occurs very frequently in both members if one

> partner has the infection.10

>

> Under estrogen stimulation, the lower urogenital

> tract is healthy due to its acidic pH and high blood

> flow. The vagina and lower urinary tract arise from

> the same embryologic origin, the endoderm of the

> primitive urogenital sinus.

> Estrogen receptors are heavily concentrated in the

> vagina.

> They are also present in the urethra and to a

> lesser extent in the bladder trigone, pelvic floor

> muscles, and connective tissues [9].

>

> The epithelial and subepithelial tissues of the

> vaginal mucosa are responsible for vaginal

> thickness, distensibility, and a defensive response

> to pathologic organisms.

> The ''estrogen-dominant'' environment enables the

> protective lactobacilli to convert glycogen to

> lactic acid, creating an acidic vaginal pH.

>

> At an acidic pH, the coliform bacteria, such as

> Escherichia coli and yeast, have a hard time

> surviving.

>

> At a lower pH, the normal bacteria in the vagina,

> the lactobacilli, are able to destroy the over

> production of pathogenic bacteria.

>

> As estrogen levels decline, (the pH level becomes

> less acidic) the pathogenic bacteria overgrow, and

> vaginitis results.

>

> As the pelvic blood flow declines with age and the

> cellular glycogen content decreases, the vaginal pH

> becomes more basic (less acidic) and the tissues

> become pale, thin, have less rugations, and are less

> likely to combat the infectious organisms.

>

> The vagina is easily traumatized when physically

> manipulated, and has a greater tendency to bleed.

> Small ulcerations may form in the superficial

> epithelium, which, upon healing, create scar tissue.

> Vaginal adhesions may occur, making the vagina less

> distensible, resulting in painful intercourse,

> otherwise termed dyspareunia.

> In the worst-case scenario, the vaginal sidewalls

> may fuse together, obliterating the vagina and

> making an evaluation and/or intercourse impossible.

> (not likely in a premenopausal woman) DT.

>

> Diagnostic Guidelines The differential

> diagnosis of BV should include evaluation for two

> other common vaginal infections: (other than a lack

> of estrogen, dt) 1. trichomoniasis, which is

> caused by Trichomonas vaginalis, and 2.

> candidiasis, which is caused by Candida albicans

> (Table). 3. Infection with Chlamydia trachomatis

> and Neisseria gonorrhoeae also should be considered.

> 4. Furthermore, contact dermatitis from

> spermicidal creams,(esp. non-oxynol 9) latex in

> condoms, or douching also may 'mimic' the symptoms

> of BV. According to Centers for Disease Control

> and Prevention (CDC) guidelines, diagnosis of BV may

> be made by clinical criteria or Gram's stain.5

> Clinical criteria for bacterial vaginosis require

> that patients have at least three of the following

> four signs: 1. a homogeneous, whitish,

> noninflammatory discharge that smoothly coats the

> vaginal walls; 2. the presence of clue cells on

> microscopic examination; a vaginal pH of greater

> than 4.5;

> and 3. an amine or " fishy " odor before or after

> 10% potassium hydroxide (KOH) is applied to a sample

> of vaginal discharge. When evaluating a woman with

> vaginal complaints, initial laboratory work should

> consist of measuring vaginal pH, as well as saline

> and 10% KOH microscopy. A swab touched to a strip

> of pH paper allows the examiner to determine whether

> BV may be present. A pH of less than 4.5

> effectively rules out the presence of BV. (Because

> BV thrives in a higher pH level. Dee) Saline

> microscopy permits visualization of clue cells

> (Figure) and abnormal flora, that one usually sees

> with BV, and also serves as a test for

> trichomoniasis. By lysing the vaginal epithelial

> cells, 10% KOH allows for easier identification of

> fungal elements such as pseudohypha or blastospores.

> However, the absence of T vaginalis or Candida

> species on these slides does not eliminate the

> possibility of infection with these organisms; if

> either of these organisms is

> suspected as a cause of symptoms, appropriate

> ancillary tests such as culture for yeast or T

> vaginalis, or alternatively, monoclonal antibody

> testing for T vaginalis will serve to clarify the

> diagnosis. Figure. Clue cells

> indicating bacterial vaginosis infection. ©

> SPL/Photo Researchers, Inc.

>

> Gram's stain is another acceptable method for

> diagnosing BV.

>

> This test determines the relative concentration of

> the bacterial morphotypes commonly found in women

> with BV.

> Although they are less commonly used, there are

> other tests that may be useful to diagnose BV:

> a DNA probe-based test for high concentrations of

> G vaginalis; a card test that detects elevated pH

> and trimethylamine; and an office test for vaginal

> sialidase activity.

> In contrast, culture of G vaginalis is not

> specific and should not be used to diagnose BV.

>

> In addition, cervical Papanicolaou tests are of

> limited use in BV diagnosis due to their low

> sensitivity.

>

> Treatment of BV According to CDC guidelines, all

> symptomatic women with BV should be treated.

> Clinical goals should be to relieve the signs and

> symptoms of BV, reduce the risk for infections after

> abortion or hysterectomy, and reduce the risk for

> sexually transmitted diseases. The recommended

> treatment regimens for BV are

> 1. 'oral' metronidazole 500 mg twice a day for

> seven days;

> 2.metronidazole gel .75%, one full applicator (5

> g) intravaginally, once a day for five days; or

> 3.clindamycin cream 2%, one full applicator (5 g)

> intravaginally, at bedtime for seven days.

> The oral and gel formulations of metronidazole are

> similar in efficacy while the clindamycin cream

> seems to be less effective.

>

>

> Differential Diagnosis of Bacterial

> Vaginosis Diagnostic Criteria Normal

> Bacterial vaginosis

> Trichomoniasis Candidiasis Vaginal

> discharge Clear or white, flocculent Thin,

> homogeneous, milky white, adherent to vaginal walls

> Diffuse, yellow-green White, cottage cheese-like

> Amine odor on KOH " whiff " test No

> Present May be present No

> Vaginal pH 3.8 & shy;- 4.2 > 4.5 Often > 4.5

> Usually < 4.5 Main patient

> complaints

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