شیوع واژینوز باکتریال و ارتباط آن با فاکتورهای خطر در زنان غیر باردار Prevalence of Bacterial Vaginosis and Its Association with Risk Factors among Nonpregnant Women: A Hospital Based Study

1. Background Vaginitis is an inflammation of the vagina, usually characterized by any of the following: vaginal discharge containing many white blood cells (WBCs), vulvar itching, vulvar irritation, vaginal odor, vaginal erythema, dyspareunia, and dysuria [1, 2]. The three most common causes of vulvovaginitis are bacterial vaginosis (BV), being the most prevalent one, followed by candidiasis and trichomoniasis [3]. BV is a common vaginal infection that occurs mostly in women of child-bearing age [4]. BV is a clinical condition characterized by a thin, gray/offwhite, homogenous, malodorous adherent vaginal discharge which is more noticeable after intercourse and menses, having pH > 4.5. Fishy odor is noticed on addition of 10% potassium hydroxide to the vaginal fluid (whiff test), and the presence of clue cells, a few or no lactobacilli, and small number (<1/hpf) of polymorphonuclear leucocytes (PMNs) are also the characteristic features of BV [5]. Many cases of BV remain asymptomatic or present with only malodorous vaginal discharge with no inflammatory complaints [6]; thus BV is therefore referred to as “vaginosis” and not “vaginitis” [7]. Lactic acid produced by the normal flora, Lactobacillus through hydrogen peroxide (H2O2) production, is attributed to the acidic milieu of the vagina.This provides a local defense mechanism by inhibiting the growth of other organisms. Change in the normal vaginal flora causes change in pH simultaneously, which allows a variety of anaerobes and facultative bacteria to overgrow and cause chronic infection as well as abnormal vaginal discharge [5, 8]. Lactobacilli also produce antimicrobial substances like lactic acid, H2O2, and bacteriocin to promote a healthy ecosystem in the vagina thereby suppressing the growth of pathogens [8, 9].