Vaginal microflora in healthy women with Gardnerella vaginalis

doi:10.1007/s101560070018

Journal of Infection and Chemotherapy

Volume 6, Issue 3, 2000, Pages 173-177

https://doi.org/10.1007/s101560070018 Get rights and content

Abstract

In order to find the vaginal prevalence of Gardnerella vaginalis in a normal female population, we determined the incidence of G. vaginalis in relation to that of other bacterial genera and species in the vagina. Two-hundred and thirty-nine healthy women were the subjects of this study. Vaginal discharge was collected and bacteriological studies were performed. The mean total aerobe count in the G. vaginalis-positive group was 9.02 log₁₀ colony-forming units (CFU)/g, which was significantly higher (P < 0.0001) than that (6.80 log₁₀ CFU/g) in the G. vaginalis-negative group. In contrast, there was no difference in the mean total anaerobe count between the two groups of subjects (8.82 and 8.24 log₁₀ CFU/g, respectively in the case of including Lactobacillus species count). Also, the mean pH level of vaginal secretion in the G. vaginalis-positive group was 4.58, which was significantly higher (P < 0.005) than that (4.10) in the G. vaginalis-negative group. Aerobes were isolated at equal incidence in the two groups. Anaerobes were isolated at a significantly higher rate in the G. vaginalis-positive group (P < 0.005) than in the G. vaginalis-negative group. The mean count of Lactobacillus species was significantly higher (P < 0.0001) in the G. vaginalis-negative group than in the positive counterpart (7.02 vs 8.66). Elevation of vaginal pH, an increase in the anaerobe count, and decreases in the Lactobacillus species count could be good predictors of the prevalence of bacterial vaginosis in healthy women.

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The pathogenic impact of G. vaginalis has been the subject of debate for nearly 40 years, with observations that both implicate and absolve it in multiple roles of pathogeenesis (Catlin, 1992; Swidsinski et al., 2008). The involvement of G. vaginalis has been questioned partly because its presence, in some studies, seems independent of disease state (Mikamo et al., 2000; Buhimschi et al., 2005). Here, we have shown that G. vaginalis can induce highly inflammatory conditions over a 24-h period, including pyroptotic cell death and the secretion of the proinflammatory cytokines, TNF-α and IL-1β, at levels comparable to those observed in BV (Zaga-Clavellina et al., 2012).
Gardnerella vaginalis is a Gram-positive bacterium associated with bacterial vaginosis (BV), pelvic inflammatory disease, and preterm birth. BV is the most prevalent vaginal dysbiosis in women of childbearing age characterized by the absence of normal lactobacilli and an overgrowth of G. vaginalis and other bacteria. Although mucosal fluids from BV patients exhibit increases in proinflammatory cytokines and Toll-like receptor 2 and 4 mRNA, G. vaginalis has not been demonstrated to directly induce an inflammatory response. This study tested the hypothesis that G. vaginalis induces an inflammatory response in the human monocyte cell line, THP-1. The objectives of the study were to measure proinflammatory cytokine production, molecular mechanisms by which cytokines are produced, and whether G. vaginalis results in death of the monocytic cells. We found that G. vaginalis induced significant increases in the inflammasome-dependent cytokines IL-1β, IL-18, as well as TNF-α in treated cells. G. vaginalis caused significant cell death by 24 h post-treatment compared with untreated controls, but cells remained 66% viable. Caspase-1 cleavage in treated cells confirmed the inflammatory cell death, and NLRP3 knockdown confirmed its involvement through reduction of IL-1β secretion. Using a stably expressing YFP-ASC THP-1 cell model with immunofluorescent staining, YFP-ASC colocalized with NLRP3 in G. vaginalis-treated cells and the addition of a caspase-1 inhibitor wholly ameliorated IL-1β secretion. Our study provides new insight into the role of G. vaginalis in inflammatory conditions in the genital tract.
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Thus, Zariffard et al. [18] analysed the cervicovaginal lavage samples of 21 human immunodeficiency virus-positive women by real-time PCR, and found that the median number of lactobacilli was significantly lower and the median number of G. vaginalis organisms was significantly higher in five women with BV, compared with 16 women without BV (8.5 × 106 vs. 1.1 × 109, p 0.013, and 1.3 × 1010 vs. 5.4 × 107, p 0.004, respectively). Mikamo et al. [19] also found that the mean count of Lactobacillus spp. was significantly lower in 129 G. vaginalis-positive women than in 110 G. vaginalis-negative women (7.02 vs. 8.66 log10 CFU/g, p <0.0001). It has been suggested that H2O2-producing vaginal lactobacilli may prevent infection of the vaginal epithelium by bacteria that cause BV.
This review considers whether probiotics are effective agents for the treatment and/or prevention of bacterial vaginosis (BV). There seems to be an association between the absence of, or low concentrations of, vaginal lactobacilli and the development of BV. Many studies have suggested that the presence of H₂O₂-producing vaginal lactobacilli may protect against BV, although some studies do not support this hypothesis. In-vitro studies have suggested that certain specific strains of lactobacilli are able to inhibit the adherence of Gardnerella vaginalis to the vaginal epithelium and/or produce H₂O₂, lactic acid and/or bacteriocins, which inhibit the growth of bacteria causing BV. Clinical trials showed that intra-vaginal administration of Lactobacillus acidophilus for 6–12 days, or oral administration of L. acidophilus or Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14 for 2 months, resulted in the cure of BV (defined as a 0–1 positive score according to Amsel's criteria), and/or reduced the recurrences of BV, and/or caused an increase in vaginal lactobacilli and restoration of a normal vaginal microbiota, significantly more frequently than did a placebo, acetic acid or no treatment. However, several trials have found no significant difference in the cure rate of BV and in the number of vaginal lactobacilli after intra-vaginal instillation of lactobacilli when compared with the effect of a placebo or oestrogen. Thus, although the available results concerning the effectiveness of the administration of lactobacilli for the treatment of BV are mostly positive, it cannot yet be concluded definitively that probiotics are useful for this purpose.
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Vaginal microflora in healthy women with Gardnerella vaginalis

Abstract

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Med

Lancet

J Infect Chemother

Am J Obstet Gynecol

Am J Obstet Gynecol

Lancet

Am J Med

Selective differential human blood bilayer media for isolation of Gardnerella (Haemophilus) vaginalis

J Clin Microbiol

Bacteriology of the vagina

Scand J Urol Nephrol

Bacterial vaginosis is not a simple ecological disorder

Gynecol Obstet Invest

Quantitative studies of vaginal bacteria

Genitourin Med

Bacterial vaginosis: prevalence in outpatients, association with some microorganisms and laboratory indices

Genitourin Med

Importance of Gardnerella vaginalis as an aetiological agent in bacterial vaginosis

Genitourin Med