Objective: The relationship between pregnancy outcome and expression of the heat shock proteins
(hsps) or hsp-antibody complexes of 60kD (hsp60), 70kD (hsp70), and 90kD (hsp90) in placental tissue and circulating antibodies to hsps was evaluated

E. Brylla

H. Alexander

I. Sziller

M. Ziegert

S. S. Witkin

W. Härtig

English

PubMed

Gilbert G. G. Donders

Crossref

Infectious Diseases in Obstetrics and Gynecology 7:126-127 (1999)
(C) 1999 Wiley-Liss, Inc.
Images in Infectious Diseases in Obstetrics and Gynecology
Section Editor: David E. Soper, M.D.
Microscopy of the Bacterial
Flora on Fresh
Vaginal Smears
Gilbert G.G. Donders
Department of Gynecology and Obstetrics, Katao/ieke
Universteit Leuven, Belgium
aginal bacterial flora can be studied by micros-
copy of fresh vaginal fluid or of a fixed, stained
smear. Classifying the flora by microscopy of fresh
smears of vaginal fluid allows the pathplogy to be
approached in a way other than by application of
Nugent et al.’s criteria for Gram-stained speci-
mens. Therefore, it may enable a more diverse and
accurate assessment of the risk of preterm birth and
other complications,z
The classification is based on the relative quan-
tities of lactobacillary morphotypes present. If lac-
tobacilli of variable size predominate, the fl.ora is
considered normal (lactobacillary grade I Fig. 1).
Sometimes, this grade-I flora leads to production of
excessive amounts of lactate3 and acidity due to
hydrogen peroxidase activity,4 even causing lethal
damage to the epithelial cells (epitheliolysis). The
bare nuclei of these torn cells can be seen, along
with the debris of their cellular cytoplasm and with
numerous lactobacilli (Fig. 2). Care must be taken
to differentiate the cellular debris from coccoid
bacteria and not to misinterpret the bare epithelial
nuclei as leukocytes.
Lactobacillary grade III is an intermediate flora,
with a mixture of lactobacilli and other morpho-
types, usually coccoids. If the lactobacillary mor-
photypes still outnumber the other bacteria, this is
called lactobacillary grade IIa (Fig. 3); if the lacto-
bacillary morphotypes are less abundant than the
other morphotypes, the term used is grade IIb (Fig.
4). Although grade II will partly overlap with the
intermediate group of the bacterial vaginosis score
according to Nugent et al. (score 4-6), it is certainly
not identical to that group.
Lactobacillary grade II indicates complete dis-
ruption of the normal vaginal flora: other bacteria
have completely overgrown the lactobacilli, which
are no longer visible. The most obvious condition
that would cause these lactobacilli to disappear is
bacterial vaginosis, with its pathognomonic granu-
lar background appearance due to large numbers of
anaerobic bacteria (Fig. 5) and the clue cells. It is
not wise, however, to call every condition devoid of
lactobacilli bacterial vaginosis. A search for tricho-
moniasis and other sexually transmitted diseases is
also warranted,s If the grade-III flora consists of
coarse, coccoid bacteria or is accompanied by nu-
merous parabasal epithelial cells and increased
vaginal leukocytosis (Fig. 6), the condition cer-
tainly does not correspond to the anaerobic condi-
tion Gardner and Dukes6 and Amsel et al. 7 had in
mind when discussing the clinical diagnosis of bac-
terial vaginosis. Again, it is unclear in which Nu-
gent score this group belongs; most probably you
would find it dispersed among the intermediate
(score 4-6) or bacterial vaginosis (score 7-10)
groups. Cultures often grow streptococci and gram-
negative bacteria of enteric origin. We propose to
call this condition "aerobic vaginitis," a clinical en-
tity clearly distinct from bacterial vaginosis, rather
to be seen as a lesser form of "desquamative vag-
initis."8,9
REFERENCES
1. Nugent RP, Krohn MA, Hillier SL. Reliability of diag-
nosing bacterial vaginosis is improved by a standardized
method of Gram’s stain interpretation. J Clin Microbiol
1991 ;29:297-301.
2. Donders GGG. Bacterial vaginosis. Screen and treat?
(Editorial). Eur J Obstet Gynecol 1998, in press.
3. Donders GGG, Desmyter J, Vereecken A, Vaginitis.
(Letter) N Engl J Med 1998;338:1547-1548.
Images in Infectious Diseases in Obstetrics and Gynecology presents clinically important visual images that a practitioner in women’s health
might encounter. If you have a high-quality color or black-and-white photograph or slide representing such an image that you would
like considered for publication, send it with a descriptive legend to David E. Soper, MD, Department of Obstetrics and Gynecology,
Rush-Presbyterian-St. Luke’s Medical Center, 1653 West Congress Parkway, Chicago, IL 60612-3833.
Images is made possible through an educational grant from Pfizer, Inc.
MICROSCOPY OF THE BACTERIAL FLORA ON FRESH VAGINAL SMEARS DONDERS
4. Donders GGG, De Wet GH, Hooft P, Desmyter J. Lac-
tobacilli in Pap smears, genital infections and preg-
nancy. Am J Perinatol 1993;10:358-361.
5. Eschenbach DA, Davick, PR, Williams BL, et al. Preva-
lence of hydrogen peroxide-producing Lactobacillus spe-
cies in normal women with bacterial vaginosis. J Clin
Microbiol 1989;27:251-256.
6. Gardner HL, Dukes CD. Haemophilus vaginalis vagini-
tis. A newly defined specific infection previously clas-
sified ’Nonspecific’ vaginitis. Am J Obstet Gynecol
1955;69:962-976.
7. Amsel R, Totten PA, Spiegel CA, Chen K, Eshenbach
DA, Holmes KK. Nonspecific vaginitis. Diagnostic cri-
teria and microbial and epidemiological associations.
Am J Med 1983;74:14-22.
8, Gardner HL. Desquamative inflammatory vaginitis: a
newly defined entity. Am J Obstet GynecoI 1968;102:
1102-1105.
9. Sobel JD. Desquamative inflammatory vaginitis: a new
subgroup of purulent vaginitis responsive to topical 2%
clindamycin therapy. Am J Obstet Gynecol 1994;171:
1215-1220.
INFECTIOUS DISEASES IN OBSTETRICS AND GYNECOLOGY 127
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Microscopy of the Bacterial Flora on Fresh Vaginal Smears

Sebastian Faro

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Microscopy of the bacterial flora on fresh vaginal smears.

Microscopy of the bacterial flora on fresh vaginal smears.

Abstract

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