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Quantitative and Qualitative Assessment of Vaginal Microbiology in Women With and Without Vulvodynia

Posted on: Tuesday, 8 February 2005, 03:00 CST

Scientific poster session. Poster #27

Objectives: Vulvodynia is a syndrome characterized by unexplained burning, knife-like pain or excruciating pain on contact with the vulvar region that results in severe physical and psychological distress. A diagnosis of vulvodynia is made after excluding other explainable vulvar pain disorders including candidiasis, inflammatory vaginitis, sexually transmitted diseases, dermatoses, menopausal dyspareunia or other pelvic pain syndromes. We present preliminary findings from an ongoing NIH-funded study to determine etiological predictors of this disorder.

Study design: We identified 100 symptomatic cases and 100 age- matched controls from among 4000 women, aged 18-64 years, from the general population. Of these, 31 cases and 13 controls (thus far) have provided vaginal swab samples to quantitatively and qualitatively assess the presence of microorganisms. Vaginal smears from each subject were Gram stained and evaluated using the Nugent criteria to detect bacterial vaginosis (BV). Results: A comparison of vaginal pH, total aerobic and anaerobic bacterial counts, and individual genera comprising the total counts showed no significant differences between the two groups of subjects. Analysis of the frequency of isolation for the various bacterial genera present showed a significantly higher prevalence of group D streptococcus (GDS) in the subjects with vulvodynia when compared with the control subjects (64% versus 3 1%, p = 0.04). Furthermore, when we compared the frequency of GDS in vulvodynia subjects with previously published data from overtly healthy subjects (expected prevalence = 15-20%) the association remained highly significant. In contrast, Prevotella sp. and Actinomyce sp. were isolated with greater frequency from control subjects than those with vulvodynia (p<0.01).

Conclusions: Preliminary data suggest that the vaginal microflora of women with vulvodynia may be unique. Furthermore, the association of GDS with vulvodynia appears to far exceed that observed for candidiasis, BV or an elevated pH, all of which have been suggested as risk factors for vulvodynia.

Copyright CRC Press Sep-Dec 2004

Source: Infectious Diseases in Obstetrics and Gynecology

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