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Volume 38, Number 2, April 2005

Gram stain as a relapse predictor of bacterial vaginosis after metronidazole treatment


Mei Huang, Jen-Hsien Wang
Section of Infectious Diseases, Department of Internal Medicine, Show-Chwan Memorial Hospital, Changhua; and Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

Received: May 21, 2004    Revised: August 30, 2004    Accepted: September 23, 2004   

 

Corresponding author:

Jen-Hsien Wang, Head of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, 2 Yuh-Der Rd., Taichung, Taiwan. E-mail: jenhsien@www.cmuh.org.tw This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Methods:

Bacterial vaginosis is the most prevalent disease of the female genital tract. In spite of various effective antibiotics in the treatment of bacterial vaginosis, its high relapse rate is a common problem. Bacterial species causing bacterial vaginosis are generally unable to be cultured by conventional methods. It is impractical and inadequate to use culture methods to guide initial treatment. Gram stain of vaginal secretion is a practical tool to establish the diagnosis of bacterial vaginosis. We enrolled 78 cases of Gram stain-proven bacterial vaginosis and tried to use Gram stain as a predictor of relapse after 1 week of treatment with metronidazole. Possible predictive factors for relapse in Gram stain were analyzed, including absence of large Gram-positive rods, presence of small Gram-negative rods, small Gram-variable rods, curved Gram-variable rods, or Gram-positive cocci. Gram stain was repeated immediately after treatment, and at 1 month and 3 months after treatment. All cases showed beneficial clinical effect after metronidazole treatment. Eighteen cases (23.1%) relapsed during the follow-up period. All 16 cases with significant Gram-positive cocci in pretreatment smears relapsed after metronidazole treatment. Presence of small Gram-negative rods, small Gram-variable rods, and curved Gram-variable rods, or absence of large Gram-positive rods did not predict relapse. Gram-positive cocci in pretreatment smear was a good predictor of relapse after metronidazole treatment.

 



 

Key words:

Bacterial vaginosis, Gram's stain, metronidazole, recurrence



 



 

J Microbiol Immunol Infect2005;38:137-140