ABSTRACT
Bacterial vaginosis is the most common cause of vaginal discharge and malodor among women of reproductive age. Bacterial vaginosis consists of microecologic alterations in which a characteristic set of bacterial species greatly expand their populations within the vagina. The acidic environment in the healthy vagina is maintained by microbial metabolism of glucose, produced by vaginal epithelial cells from glycogen, to lactic acid. Vaginal fluid protease and phospholipases probably play roles in bacterial vaginosis pathogenesis and ascent of microbes and into the uterus during pregnancy. Mucinases and sialidases lyse protective mucin and promote bacterial attachment, allowing invasion and spread to underlying epithelial cells. Numerous studies have prospectively examined bacterial vaginosis among populations of pregnant women and demonstrated prevalence ranging from 6% to 32%. The “whiff test” is similarly sensitive for the diagnosis of bacterial vaginosis, but may also be positive in trichomoniasis.
