Prevalence and characterization of lactobacilos vaginais species in healthy women at reproductive age

Orientador: Luis Guillermo BahamondesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: A microflora vaginal de mulheres saudáveis em idade reprodutiva é composta por uma variedade de bactérias aeróbias e anaeróbias, mas as espécies dominantes são os lactobacilos (bacilos de Döderlein), que exercem significante influência sobre a microbiota local. Além de restringir o crescimento de patógenos competindo pelo espaço e nutrientes, os lactobacilos produzem substâncias antimicrobianas como ácidos orgânicos, peróxido de hidrogênio (H2O2) e bacteriocinas. Esta atividade antagonista é importante na proteção contra várias infecções, principalmente a vaginose bacteriana (VB). Objetivos: Identificar as espécies de lactobacilos isolados do conteúdo vaginal de mulheres saudáveis e assintomáticas e determinar as espécies mais prevalentes e caracterizá-las quanto à produção de ácido láctico, peróxido de hidrogênio (H2O2) e sua capacidade de adesão às células do epitélio vaginal. Métodos: Foram isoladas 83 linhagens de lactobacilos de amostras de conteúdo vaginal de 135 mulheres, sem queixa de corrimento e com diagnóstico laboratorial negativo para infecções vaginais, acompanhadas no ambulatório de Planejamento Familiar da Faculdade de Ciências Médicas - UNICAMP. As linhagens isoladas foram identificadas por PCR multiplex e, quando necessário, submetidas ao sequenciamento do gene RNAr 16S. Foram então avaliadas quanto à produção de ácido láctico, de H2O2, bacteriocinas e a capacidade de adesão às células epiteliais. Resultados: A espécie predominante foi L. crispatus presente em 30,1% das mulheres, seguida de L. jensenii (26,5%), L. gasseri (22,9%) e L. vaginalis (8,4%). As outras espécies isoladas foram L. delbrueckii, L fermentum, L reuteri e L rhamnosus, com duas linhagens cada uma, e L. mucosae e L. salivarius com uma cepa cada. Das 83 linhagens de lactobacilos analisadas, apenas 20 não apresentaram produção de H2O2 detectável pela técnica de cultivo em agar MRS com TMB. Foram selecionadas 37 linhagens para teste de adesão às células epiteliais. Destas, 12 tiveram adesão entre 50% e 69% e 10 igual ou maior a 70%. As linhagens restantes apresentaram pouca capacidade de aderir às células epiteliais. Nenhuma das linhagens testadas produziu bacteriocinas. Conclusões: As espécies de lactobacilos mais prevalentes em mulheres sem vulvovaginites, isoladas em meio de cultura seletivo e identificadas por métodos moleculares, foram L. crispatus, L. jensenii e L. gasseri. Dentre as linhagens analisadas, além de mais frequentes, estas também foram as que atingiram menores valores de pH em meio de cultura e apresentaram melhor produção de H2O2Abstract: The vaginal microflora of healthy women is composed of a large variety of aerobic and anaerobic bacteria. The dominant species is a group of lactobacilli (Doderlein's bacillus), which has a significant effect on vaginal microbiota, curtailing the growth of pathogens competing for space and nutrients. The lactobacilli specie produces various antimicrobial substances that include organic acids, hydrogen peroxide (H202) and bacteriocins. Objectives: Identify the prevalence of the different species of lactobacilli isolated from the vagina of healthy asymptomatic women, determine the most prevalent species and characterize them regarding the production of lactic acid, hydrogen peroxide (H2O2) and their capacity to adhere to vaginal epithelial cells. Methods: Eightythree strains of lactobacilli were isolated from the vagina of 135 women, with no complaints of vaginal discharge and negative laboratory diagnosis for vaginal infection, who were being followed up at the Family Planning clinic of the Medical school, Unicamp. The isolates were identified using multiplex polymerase chain reaction (PCR) and, when necessary, 16S rRNA gene sequencing. They were then evaluated with regards to the production of lactic acid, H2O2, bacteriocins, and their capacity to adhere to epithelial cells. Results: The predominant species found were L. crispatus (in 30.1% of the women), followed by L. jensenii (26.5%), L. gasseri (22.9%) and L. vaginalis (8.4%). The other species isolated were L. delbrueckii, L fermentum, L reuteri and L rhamnosus (two strains) and L. mucosae and L. salivarius (one strain). Only 20 out of 83 lactobacilli analyzed using the plate technique (in MRS agar with TMB) were found to be non-producers of H2O2. Thirty-seven lineages were selected and tested for their capacity to adhere to epithelial cells. Of these, 12 had an adhesion between 50% and 69% and 10 equal or superior to 70%. The remainder had little capacity to adhere to epithelial cells. None of the strains tested produced bacteriocins. Conclusions: L. crispatus, L. jensenii and L. gasseri were the most prevalent species isolated in selective culture media and identified through molecular techniques. Besides their frequencies, they also presented best H2O2 production and lowest pH in culture mediaDoutoradoCiencias BiomedicasDoutor em Tocoginecologi

Uso do ácido láctico com lactoserum em sabonete líquido íntimo para higiene externa na prevenção da recorrência de vaginose bacteriana após tratamento oral com metronidazol

OBJECTIVE: To determine the recurrence of bacterial vaginosis (BV) after the use of a lactic acid plus lactoserum liquid soap starting immediately after the treatment with oral metronidazole and the quality of life of the participants. METHODS: A total of 123 women with diagnosis of BV with at least three of the following criteria: 1) homogeneous vaginal discharge without inflammation of the vagina or vulva; 2) vaginal pH ≥ 4.5; 3) positive Whiff test; and 4) clue cells in more than 20% of the epithelial cells in the vagina. A Nugent score ≥ 4 in the vaginal bacterioscopy was also used. After BV diagnosis, metronidazole 500 mg was administered orally bid during 7 days. Patients cured of BV were then instructed to use 7.5 to 10 mL of a lactic acid plus lactoserum liquid soap once-a-day for hygiene of the external genital region. Three subsequent control visits after starting the hygiene treatment (30, 60, and 90 days; ± 5 days) were scheduled. A questionnaire was applied in the form of visual analogue scale (VAS) in all the visits regarding: 1) level of comfort at the genital region; 2) malodorous external genitalia; 3) comfort in sexual intercourse; 4) satisfaction with intimate hygiene; and 5) self-esteem. RESULTS: Ninety two (74.8%) women initiated the use of a lactic acid plus lactoserum liquid soap at visit 1. At visit 2, 3, and 4 there were 84, 62 and 42 women available for evaluation, respectively. The rate of recurrence of BV was 19.0%, 24.2% and 7.1%, respectively in the three visits and vaginal candidiasis was observed in five treated women. Quality of life was evaluated in the 42 women who completed the four visits schedule and there were significant improvement in the five domains assessed. CONCLUSION: A lactic acid plus lactoserum liquid soap for external intimate hygiene may be an option for the prevention of BV recurrence after treatment and cure with oral metronidazoleOBJETIVO: Determinar a ocorrência de vaginose bacteriana (VB) após o uso de acido láctico com lactoserum em sabonete líquido iniciado imediatamente após o tratamento com metronidazol oral e qualidade de vida das participantes. MÉTODOS: Um total de 123 mulheres com dianóstico de VB com ao menos três dos seguintes critérios: 1) leucorreia vaginal homogênea sem inflamação de vagina ou vulva; 2) pH vaginal ≥ 4,5; 3) teste positivo de Whiff; e 4) clue cells em mais de 20% das células epiteliais na vagina. O escore de Nugent ≥ 4 na bacterioscopia vaginal também foi usado. Após o diagnóstico de VB, metronidazol 500 mg oral foi ministrado durante 7 dias. Pacientes curados da VB foram instruídos a usar 7,5 a 10 mL de acido láctico com lactoserum em sabonete líquido uma vez ao dia para higiene da genitália externa. Três visitas de controle foram agendadas (30, 60 e 90 dias; ± 5 dias). Um questionário foi aplicado na forma de escala visual análoga (EVA) em todas as visitas sobre: 1) nível de conforto na região genital; 2) mau odor na genitália; 3) conforto na relação sexual; 4) satisfação com higiene íntima; e 5) autoestima. RESULTADOS: Noventa e duas (74,8%) mulheres iniciaram o uso de ácido láctico com lactoserum líquido na visita 1. Na visita 2, 3 e 4 foram 84, 62 e 42 mulheres para avaliação, respectivamente. A taxa de recorrência da VB foi 19,0%, 24,2% e 7,1%, respectivamente nas três visitas e candidíase vaginal foi observada em cinco mulheres. Qualidade de vida foi avaliada em 42 mulheres que completaram as quatro visitas agendadas e houve uma melhora significativa nos cinco domínios avaliados. CONCLUSÃO: O uso de acido láctico com lactoserum em sabonete líquido para higiene externa intima pode ser uma opção para a prevenção da recorrência de VB após tratamento e cura com metronidazol oral41542

Prevalence and characterization of vaginal lactobacillus species in women at reproductive age without vulvovaginitis

PURPOSE: to identify species of lactobacillus isolated from the vaginal contents of healthy and asymptomatic women, determining the most prevalent species and characterizing them phenotypically. METHODS: lactobacillus have been isolated in selective milieu from samples of the vaginal contents of 135 women without complaints of vaginal secretion, and with negative laboratorial diagnosis of vaginal infection, followed up at an outpatient clinic. After being identified by multiplex PCR, the isolates have been submitted to RNAr 16S gene sequencing, when necessary. They have also been evaluated concerning the production of lactic acid, H2O2, bacteriocins and the ability to adhere to epithelial cells. RESULTS: eight-three lactobacillus strains were isolated and identified, L. crispatus (30.1%), L. jensenii (26.5%), L. gasseri (22.9%) e L. vaginalis (8.4%), being the prevalent species. Only 20 of those isolates did not present H2O2 production, in detectable amounts. From the 37 strains selected for the test of adhesion to the epithelial cells, 12 presented 50 to 69% of adhesion, 10 presented 70% or more, and the remaining, little or no adhesion at all. None of the tested strains produced bacteriocins. CONCLUSIONS: the lactobacillus species more prevalent in women without vulvovaginitis, isolated in selective culture milieu and identified by molecular methods were L. crispatus, L. jensenii and L. gasseri. Besides the fact of being more prevalent, these strains also presented better production of H2O2, and reached lower pH values in the culture milieu.OBJETIVO: identificar espécies de lactobacilos isolados do conteúdo vaginal de mulheres saudáveis e assintomáticas; determinar as espécies mais prevalentes e caracterizá-las fenotipicamente. MÉTODOS: lactobacilos foram isolados em meio seletivo a partir de amostras de conteúdo vaginal de 135 mulheres, sem queixa de corrimento e com diagnóstico laboratorial negativo para infecções vaginais, acompanhadas em um ambulatório de Planejamento Familiar. Os isolados foram identificados por PCR multiplex e, quando necessário, submetidos ao sequenciamento do gene RNAr 16S. Foram também avaliados quanto à acidificação do meio de cultura, à produção de ácido láctico, de H2O2, bacteriocinas e a capacidade de adesão às células epiteliais. RESULTADOS: oitenta e três cepas de lactobacilos foram isoladas e identificadas, sendo as espécies predominantes L. crispatus (30,1%), L. jensenii (26,5%), L. gasseri (22,9%) e L. vaginalis (8,4%). Apenas 20 destes isolados não produziram H2O2 em quantidades detectáveis. Das 37 linhagens selecionadas para teste de adesão a células epiteliais, 12 apresentaram adesão entre 50 a 69%, 10 apresentaram 70% ou mais, e as restantes pouca ou nenhuma adesão. Nenhum dos isolados produziu bacteriocinas. CONCLUSÕES: as espécies de lactobacilos mais prevalentes em mulheres sem vulvovaginites, isoladas em meio de cultura seletivo e identificadas por métodos moleculares, foram L. crispatus, L. jensenii e L. gasseri. Além de mais frequentes, tais linhagens também apresentaram melhor produção de H2O2 e atingiram menores valores de pH em meio de cultura.18919

Seleção e utilização de bacterias lacticas produtoras de diacetil em leites fermentados

Orientador : Alda Luiza Santos LerayerDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de BiologiaMestrad

The effect of "breathable" panty liners on the female lower genital tract

Objective: To evaluate whether the use of "breathable" panty liners (BPLs) alters the normal vaginal flora, increases the incidence of bacterial vaginosis and/or vaginal candidiasis, or causes vulvar irritation. Methods: A randomized controlled trial assessed the vaginal ecosystem of women without complaints of vaginal discharge. The study group (n = 53) wore BPLs for 10-12 hours each day for 75 consecutive days, whereas the control group (n = 54) wore only their usual underwear. At each of 6 visits during 3 menstrual cycles, participants underwent gynecologic examination with colposcopic evaluation and pH measurement, in addition to assessment of vaginal microbial flora, intensity of inflammatory processes, and presence of vaginal candidiasis/bacterial vaginosis in Gram-stained smears. Results: After 75 consecutive days of BPL use, 40/44 (90.9%) and 42/44 (95.5%) women reported no complaints of vaginal discharge or vulvar itching/burning, respectively. There was no significant difference between the study group and the control group with regard to positive vaginal fungus cultures (5/44 [11.4%] vs 8/50 [16.0%]; P=0.7848) or bacterial vaginosis (3/44 [6.8%] vs 2/50 [4.0%]; P=0.7974) at the end of the study period. Conclusion: After 75 days of BPL use, there was no significant increase in vulvovaginal candidiasis, bacterial vaginosis, vulvovaginal irritation, or vulvovaginal inflammation. (C) 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.1151616

Use Of A Lactic Acid Plus Lactoserum Intimate Liquid Soap For External Hygiene In The Prevention Of Bacterial Vaginosis Recurrence After Metronidazole Oral Treatment [uso Do ácido Láctico Com Lactoserum Em Sabonete Líquido íntimo Para Higiene Externa Na Prevenção Da Recorrência De Vaginose Bacteriana Após Tratamento Oral Com Metronidazol]

Objective: To determine the recurrence of bacterial vaginosis (BV) after the use of a lactic acid plus lactoserum liquid soap starting immediately after the treatment with oral metronidazole and the quality of life of the participants. Methods: A total of 123 women with diagnosis of BV with at least three of the following criteria: 1) homogeneous vaginal discharge without inflammation of the vagina or vulva; 2) vaginal pH > 4.5; 3) positive Whiff test; and 4) clue cells in more than 20% of the epithelial cells in the vagina. A Nugent score > 4 in the vaginal bacterioscopy was also used. After BV diagnosis, metronidazole 500 mg was administered orally bid during 7 days. Patients cured of BV were then instructed to use 7.5 to 10 mL of a lactic acid plus lactoserum liquid soap once-a-day for hygiene of the external genital region. Three subsequent control visits after starting the hygiene treatment (30, 60, and 90 days; ± 5 days) were scheduled. A questionnaire was applied in the form of visual analogue scale (VAS) in all the visits regarding: 1) level of comfort at the genital region; 2) malodorous external genitalia; 3) comfort in sexual intercourse; 4) satisfaction with intimate hygiene; and 5) self-esteem. Results: Ninety two (74.8%) women initiated the use of a lactic acid plus lactoserum liquid soap at visit 1. At visit 2, 3, and 4 there were 84, 62 and 42 women available for evaluation, respectively. The rate of recurrence of BV was 19.0%, 24.2% and 7.1%, respectively in the three visits and vaginal candidiasis was observed in five treated women. Quality of life was evaluated in the 42 women who completed the four visits schedule and there were significant improvement in the five domains assessed. Conclusion: A lactic acid plus lactoserum liquid soap for external intimate hygiene may be an option for the prevention of BV recurrence after treatment and cure with oral metronidazole. © 2011 Elsevier Editora Ltda.574415420Hillier, S., Holmes, K.K., Bacterial vaginosis (1999) Sexually Transmitted Diseases, pp. 563-586. , In: Holmes KK, Mardh PA, Sparling PF, Lemon SM, Stamm WE, Piot P et al., editors, 3 rd ed. New York: McGraw-HillSpiegel, C.A., Gardnerella vaginalis and Mobiluncus Species (2000) Principles and Practice of Infectious Diseases, 2, pp. 2383-2386. , In: Mandell GL, Bennett JE, Dolin R, editors, 5 th Philadelphia: Churchill LivingstoneMartin, H.L., Richardson, B.A., Nyange, P.M., Lavreys, L., Hiller, S.L., Chohan, B., Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition (1999) J Infect Dis, 180, pp. 1863-1868Guidelines for treatment of sexually transmitted diseases (1998) MMWR Morb Mortal Wkly Rep, 47 (RR-1), pp. 70-79. , Centers for Disease Control and Prevention, 1998Livengood, C.H., Soper, D.E., Sheehan, K.L., Fenner, D.E., Martens, M.G., Nelson, A.L., Comparison of once-daily and twice-daily dosing of 0.75% metronidazole gel in the treatment of bacterial vaginosis (1999) Sex Transm Dis, 26, pp. 137-142Sobel, J.D., Schmitt, C., Meriwether, C., Long-term follow-up of patients with bacterial vaginosis treated with oral metronidazole and topical clindamycin (1993) J Infect Dis, 167, pp. 783-784Boris, J., Pahlson, C., Larsson, P.G., Six years observation after successful treatment of bacterial vaginosis (1997) Infect Dis Obstet Gynecol, 5, pp. 297-302Ferris, D.G., Francis, S.L., Dickman, E.D., Miler-Miles, K., Waller, J.L., McClendon, N., Variability of vaginal pH determination by patients and clinicians (2006) J Am Board Fam Med, 19, pp. 368-373Soper, D.E., Gynecologic complications of bacterial vaginosis: Fact or fiction? (1999) Curr Infect Dis Rep, 1, pp. 393-397Andersch, B., Forssman, L., Lincoln, K., Torstensson, P., Treatment of bacterial vaginosis with an acid cream: A comparison between the effect of lactate-gel and metronidazole (1986) Gynecol Obstet Invest, 21, pp. 19-25Simoes, J.A., Discacciati, M.G., Brolazo, E.M., Portugal, P.M., Dini, D.V., Dantas, M.C., Clinical diagnosis of bacterial vaginosis (2006) Int J Gynaecol Obstet, 94, pp. 28-32Amsel, R., Totten, P.A., Spiegel, C.A., Chen, K.C.S., Eschenbach, D., Holmes, K.K., Non-specific vaginitis. Diagnostic criteria and microbial and epidemiological associations (1983) Am J Med, 74, pp. 14-22Nugent, R.P., Krohn, M.A., Hillier, S.L., Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation (1991) J Clin Microbiol, 29, pp. 297-301Bradshaw, C.S., Morton, A.N., Hocking, J., Garland, S.M., Morris, M.B., Moss, L.M., High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence (2006) J Infect Dis, 193, pp. 1478-1486Bradshaw, C.S., Tabrizi, S.N., Fairley, C.K., Morton, A.N., Rudland, E., Garland, S.M., The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy (2006) J Infect Dis, 194, pp. 828-836Gray, R.H., Wabwire-Mangen, F., Kigozi, G., Serwadda, D., Moulton, L.H., Quinn, T.C., Randomized trial of presumptive sexually transmitted disease therapy during pregnancy in Rakai, Uganda (2001) Am J Obstet Gynecol, 185, pp. 1209-1217Camargo, R.P., Simões, J.A., Cecatti, J.G., Alves, V.M., Faro, S., Impact of treatment for bacterial vaginosis on prematurity among Brazilian pregnant women: A retrospective cohort study (2005) São Paulo Med J, 123, pp. 108-112Hay, P., Recurrent bacterial vaginosis (2009) Curr Opin Infect Dis, 22, pp. 82-86Alfonsi, G.A., Shlay, J.C., Parker, S., Neher, J.O., What is the best approach for managing recurrent bacterial vaginosis? (2004) J Fam Pract, 53, pp. 650-652CDC Sexually Transmitted Disease Treatment Guidelines 2006 (2006) MMWR Morb Mortal Wkly Rep, 55, pp. 50-52. , 2006(2006) National Guideline For the Management of Bacterial Vaginosis, , http://www.guide-line.gov, Clinical Effectiveness Group British Association for Sexual Health and HIV, cited 2009 oct. 22. Available fromSobel, J.D., Ferris, D., Schwebke, J., Nyirjesy, P., Wiesenfeld, H.C., Peipert, J., Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis (2006) Am J Obstet Gynecol, 194, pp. 1283-1289Holley, R.L., Richter, H.E., Varner, R.E., Pair, L., Schwebke, J.R., A randomized, double-blind clinical trial of vaginal acidification versus placebo for the treatment of symptomatic bacterial vaginosis (2004) Sex Transm Dis, 31, pp. 236-238Boeke, A.J., Dekker, J.H., van Eijk, J.T., Kostense, P.J., Bezemer, P.D., Effect of lactic acid suppositories compared with oral metronidazole and placebo in bacterial vaginosis: A randomized clinical trial (1993) Genitourin Med, 69, pp. 388-392Decena, D.C.D., Co, J.T., Manalastas, R.M., Palaypayon, E.P., Padolina, C.S., Sison, J.M., Metronidazole with Lactacyd vaginal gel in bacterial vaginosis (2006) J Obstet Gynaecol Res, 32, pp. 243-251Ness, R.B., Kip, K.E., Soper, D.E., Stamm, C.A., Rice, P., Richter, H.E., Variability of bacterial vaginosis over 6 to 12-month intervals (2006) Sex Transm Dis, 33, pp. 381-385Ferraz do Lago, R., Simões, J.A., Bahamondes, L., Camargo, R.P., Perrotti, M., Monteiro, I., Follow-up of users of intrauterine device with and without bacterial vaginosis and other cervicovaginal infections (2003) Contraception, 68, pp. 105-109Guaschino, S., Benvenuti, C., SOPHY project: An observational study of vaginal pH, lifestyle and correct intimate hygiene in women of different ages and in different physiopathological conditions (2008) Minerva Ginecol, 60, pp. 353-362. , SOPHY Study Grou

Clinical diagnosis of bacterial vaginosis

Objective: To evaluate the accuracy of Amsel's criteria individually or in combinations of two for the clinical diagnosis of bacterial vaginosis. Methods: This cross-sectional study enrolled. 135 women at UNICAMP, and evaluated Amsel's four clinical criteria. Sensitivity, specificity, positive and negative predictive values were calculated for each criterion individually, in combinations of two, and for the classic test with at least three criteria present. The Nugent method was used as gold standard. Results: The most sensitive individual criteria were pH and vaginal discharge (97%), the latter having lowest specificity (26%). The criterion with highest specificity was the presence of clue cells (86%). The combination of two criteria showed sensitivity of 83% to 93%, and specificity of 82% to 94%. Conclusion: The accuracy of Amset's clinical criteria individually or in combinations of two was as accurate as the presence of at least three criteria for the diagnosis of bacterial vaginosis. (c) 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.941283

Tinidazole Versus Cefazolin In Antibiotic Prophylaxis Of Vaginal And Abdominal Hysterectomy [tinidazol Versus Cefazolina Na Antibioticoprofilaxia De Histerectomia Vaginal E Abdominal]

PURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction); Group T (2 g of tinidazole orally, 12 hours before the surgery); or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction). Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV) was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The χ2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-β) was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12). There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02). BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%), though without statistical significance (p=0.19). CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post hysterectomy. 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