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Even 70 years ago Gram-negative coccobacilli had been recognized in vaginal discharge and were cultured 30 years ago. The need to have blood in agar medium for cultivation suggested that the organisms might be a Haemophilus species. Later, however, growth characteristics and other features resulted in their being placed in the genus Corynebacterium, before it was realized that this was inappropriate and they were transferred to a new genus and species Gardnerella vaginalis. The organisms are Gram-variable, non-sporing, non-flagellate, non-motile coccobacilli of average size 0.4 X 1-1.5 microns. The cell wall is laminated and some strains possess pili. G. vaginalis is fermentative and dextrose, fructose, galactose, glucose, maltose, mannose, ribose and starch are most likely to be metabolized. However, published patterns of the sugars fermented vary widely and most workers do not rely on such tests as a means of identification. Of many other features exhibited by G. vaginalis, the following are outstanding: it does not produce catalase, cytochrome oxidase, hydrogen sulphide, indole, or urease. Nor does it degrade aesculin, liquefy gelatin, reduce nitrate, or decarboxylate arginine, lysine or ornithine. On the other hand, it is sensitive to hydrogen peroxide, often causes beta-haemolysis and usually hydrolyses hippurate and starch. G. vaginalis is serologically heterogeneous and causes haemagglutination which is mannose resistant. It is resistant to several antibiotics, including amphotericin, colistin, nalidixic acid and gentamicin, which may be incorporated in selective media.(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence of selected microorganisms in the lower genital tract in postmenarchal adolescent girls was assessed, including vaginal Gardnerella vaginalis, group B streptococcus, lactobacillus, Mycoplasma species, Ureaplasma urealyticum, Staphylococcus aureus, and yeast, and endocervical Mycoplasma species, U. urealyticum, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Specific attention was focused on important sexually transmitted disease organisms, and differences in isolations by age, sexual activity, ethnicity, contraception, and the diagnosis of nonspecific vaginitis were measured. Sexually active subjects had a mean of 6.05 organisms (SD = 3.16), compared with 3.12 organisms (SD = 3.92) in non-sexually active subjects (P = 0.001). Sexually active subjects had significantly more vaginal G. vaginalis, lactobacilli, Mycoplasma species, and U. urealyticum, as well as endocervical Mycoplasma species and U. urealyticum, compared with non-sexually active subjects; C. trachomatis, N. gonorrhoea, and T. vaginalis were isolated exclusively from the sexually active group. Significant differences in isolation rates by ethnicity were found in vaginal Mycoplasma species and U. urealyticum, and endocervical Mycoplasma species, U. urealyticum, C. trachomatis, N. gonorrhoeae, and T. vaginalis. In general, organisms were isolated from blacks most frequently; N. gonorrhoea was isolated from blacks exclusively. Differences were found in microbiologic isolations by the presence or absence of nonspecific vaginitis. Vaginal G. vaginalis and Mycoplasma species and endocervical Mycoplasma species and U. urealyticum were found significantly more often in isolates from the group with nonspecific vaginitis. It is important to define the microbial flora of the lower genital tract in adolescent girls in order to understand its role in the pathogenesis of acute salpingitis.

We used Bayes' theorem to evaluate the probability of vaginal foreign bodies in girls with genital complaints. The prevalence of vaginal foreign bodies in outpatient girls under 13 years of age with gynecologic disorders was found to be 4%. Review of the charts of 17 pre-menarcheal girls who had foreign bodies on 19 occasions and of 28 girls with infectious or nonspecific vaginitis demonstrated that patients with foreign bodies reported vaginal bleeding more frequently than discharge (14 and two of 15 symptomatic cases, respectively), while in contrast, patients with infectious or nonspecific vaginitis reported vaginal discharge more often than bleeding (23 and five of 28 symptomatic controls, respectively). Bayes' theorem indicates that, in populations resembling the one we studied, approximately 18% of preteenage girls with vaginal bleeding with or without discharge and 50% of those with bleeding and no discharge will prove to have vaginal foreign bodies.

During a 15-month period, 12,343 consecutive routine urine cultures from female patients were screened for the presence of Gardnerella vaginalis. Of the positive urine cultures, Escherichia coli was found in 1,256 (57%) and presumptive G. vaginalis in 163 (5%). Of the 163 presumptive G. vaginalis isolates, 115 were present in quantitative categories sufficient to suggest the diagnosis of probable urinary tract infection. Of these 115 isolates, 92 were available for specific identification, of which 69 (75%) proved to be G. vaginalis. Comparison of clinical urinary tract diagnoses for the 69 G. vaginalis patients and a matched cohort of E. coli patients showed a significant correlation of E. coli recovery with the diagnosis of urinary tract infection and a significant correlation of G. vaginalis recovery with no urinary tract infection. G. vaginalis was frequently recovered from nonsymptomatic pregnant patients. G. vaginalis appeared at best to be an uncommon urinary tract pathogen.

The lower genital tracts of 137 adolescent women were examined for the presence of Mycoplasma hominis, Ureaplasma urealyticum, and Corynebacterium genitalium in relation to sexual activity, previous pregnancy, presence of vaginal discharge and oral contraceptive use. None of the sexually inactive and 10% of the sexually active adolescent females were colonized with U. urealyticum. None of the sexually inactive and 4% of the sexually active adolescent females were colonized with C. genitalium. Nineteen percent of the sexually inactive and 36% of the sexually active adolescent females were colonized with M. hominis. The presence of M. hominis in the lower genital tract was not associated with any clinically identifiable vaginal discharge or inflammatory changes in exfoliated cervical and vaginal epithelial cells. The presence of M. hominis in the lower genital tract did not appear to be related to the use of oral contraceptives or antecedent pregnancy. There was no significant difference in the recovery rates of these microorganisms when we compared women who had non-specific vaginitis with those who did not. There is no evidence from this study that any of these microorganisms is responsible for non-specific vaginitis.

The role of the nurse practitioner has expanded over the past 15 years in the areas of administration, clinical practice, counseling, and surgical assistance and in postoperative-postpartum rounds. One primary activity of a nurse practitioner in our office is the diagnosis and treatment of vaginitis. Vaginitis is diagnosed fairly easily with a careful physical examination and a wet smear. Because a nurse practitioner can make herself accessible to the patients, compliance with treatment is improved. In a supporting role the nurse practitioner can complement and enhance the physician's practice and improve the quality of women's health care.

A computer simulation is described which generates 'cases' of vaginal discharge. This simulation was used to evaluate the potential effects of dependence between clinical features on the diagnostic performance of Bayes' theorem. The following observations were made: (1) dependence between some but not all pairs of features reduced the overall diagnostic efficiency (judged by the number of true positive diagnoses); (2) the overall reduction in efficiency was never substantial; (3) the largest effects on the diagnosis of individual conditions was observed with rarer diseases, and with combinations of features which were inherently unlikely to be dependent. It is concluded that the diagnostic efficiency of Bayes' theorem will not be greatly influenced by dependence if a reasonable amount of commonsense is applied to the selection of the knowledge base.

The genital herpes infection is mostly caused by HSV-2. The analysis of epidemic data supports the common impression that herpes genitalis markedly increased. The HSV-2 is with few exceptions a sexually transmitted virus, the infectionsity is about 80%. The primary infection with HSV-2 occurs in the youth. HSV-2 survives in a latent stage in the human body for life and causes as a rule to recurrent diseases. The clinical picture is variable. The most severe complication is the sepsis of newborn. The virological diagnosis is made by isolation of virus. The therapy of herpes genitalis is problematic. It is proposed that the HSV-2 plays a key role as an initiating factor in the development of human genital cancer.

Vaginal discharge is a common complaint, the cause of which can be diagnosed on the basis of the distinguishing characteristics of the fluid itself, the course and symptoms of the infection, and the results of a few simple office laboratory tests. Accurate diagnosis is important because treatment can then be selected specifically rather than empirically. Optimal treatment differs with each of the four major causative agents: Candida, Gardnerella, Trichomonas, and Chlamydia. Prompt eradication of the infection promotes patient and public health.

A method for the clinical isolation and recognition of Corynebacterium vaginale (Haemophilus vaginalis) is presented. Wet mount and stained characteristics of genital tract discharges, cellular and colonial morphology of the bacilli, inhibition by H(2)O(2), lack of a catalase, and fermentation of particular carbohydrates are the determinant factors. The method enables differentiation of the species from unclassified diphtheroids common to the genitourinary tract.