[The bacteriologic diagnosis of bacterial vaginosis in an urban practice].

The term "bacterial vaginosis" carries both bacteriologic and clinical connotations. Indeed, it implies that the vagina is uninflamed (as shown by the absence of polymorphonuclear neutrophils), but that potential pathogens (particularly Gardnerella vaginalis) are present. Many studies conducted over the last 10 years have shown that a tentative diagnosis is simple to make, based on the sniff test, the aspect of the vaginal discharge, the presence of clue cells, and the absence of polymorphonuclear cells and lactobacilli on fresh smears. However, classical treatment with metronidazole can be insufficient given the innumerable microbial associations, and a more thorough bacteriological diagnosis is required. The presence of anaerobes is suggested by a positive sniff test. Direct examination reveals small Gram-negative rods in clue cells, but cannot differentiate between commensal atypical lactobacilli and Gram-positive anaerobes. Culture with CO2 supplementation or in anaerobic conditions yields Bacteroides and Mobiluncus spp, frequently associated with Gardnerella vaginalis and pathogenic Fusobacterium spp. Culture in appropriate conditions will detect metronidazole-resistant Propionibacteria and pathogenic anaerobic cocci. Antibiotic susceptibility testing of these organisms is costly and time-consuming, but can avoid therapeutic failures. Gardnerella vaginalis is also frequently associated in bacterial vaginosis with endogenous (mainly E. coli and group B streptococci) and Ureaplasma. Antibiotic susceptibility testing is useful if the predominant members of the flora are Gram-negative aerobes, group D streptococci or pathogenic anaerobes. Bacterial vaginosis is simple to diagnose but poses a real therapeutic problem since some cases call for a simple readjustment of the commensal flora while others require full chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)