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At least 19 recordsLinked to original sources
PubMed2004

Value of sonography in the diagnosis of abnormal vaginal bleeding.

Abnormal vaginal bleeding is one of the most common presenting complaints in women of any age seeking gynecologic health care. Two of the most frequently used diagnostic tests to investigate the cause of the bleeding are endometrial biopsy and transvaginal sonography. The most worrisome cause of abnormal bleeding is endometrial carcinoma, yet benign etiologies are far more prevalent, including fibroids, polyps, and endometrial atrophy. Endometrial biopsy and transvaginal sonography have equal sensitivities for carcinoma, but sonography is far more effective in diagnosing benign disease. This article reviews the state-of-the-art in the diagnostic evaluation of abnormal vaginal bleeding and analyzes the data, with emphasis on the prevalence of benign and malignant disease as the basis for determining whether sonography or biopsy is more cost-effective in evaluating women with abnormal vaginal bleeding.

Biopsy↗
PubMed1991

Medical causes of abnormal vaginal bleeding.

Abnormal vaginal bleeding, not easily explained by the presence of a gynecologic lesion, infection, or hormonal abnormality, may be caused by systemic medical disease. Evaluation of the clotting system, both platelets and clotting factors, should be done to rule out hematologic disorders that can cause blood loss. Additionally, a detailed history, directed physical examination, and carefully chosen laboratory studies can establish the presence of endocrine disease, renal insufficiency, hepatic abnormalities, and vasculitis. Specific questions about diet and drug use may uncover nutritional deficiencies or adverse drug reactions that produce or contribute to abnormal vaginal blood loss. Evaluations for medical causes of vaginal bleeding may require subspecialty consultation to facilitate timely diagnosis.

Clinical Protocols↗
PubMed1991

Managing abnormal vaginal bleeding.

Abnormal vaginal bleeding is a diagnostic and therapeutic challenge. A carefully directed patient history and physical examination along with basic laboratory tests can lead to accurate diagnosis. In most cases, symptoms can be controlled with use of oral contraceptives, progesterone supplements, and/or nonsteroidal anti-inflammatory drugs.

Adolescent↗
PubMed1997

HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis.

BACKGROUND: In-vitro research has suggested that bacterial vaginosis may increase the survival of HIV-1 in the genital tract. Therefore, we investigated the association of HIV-1 infection with vaginal flora abnormalities, including bacterial vaginosis and depletion of lactobacilli, after adjustment for sexual activity and the presence of other sexually transmitted diseases (STDs). METHODS: During the initial survey round of our community-based trial of STD control for HIV-1 prevention in rural Rakai District, southwestern Uganda, we selected 4718 women aged 15-59 years. They provided interview information, blood for HIV-1 and syphilis serology, urine for detection of Chlamydia trachomatis and Neisseria gonorrhoeae, and two self-administered vaginal swabs for culture of Trichomonas vaginalis and gram-stain detection of vaginal flora, classified by standardised, quantitative, morphological scoring. Scores 0-3 were normal vaginal flora (predominant lactobacilli). Higher scores suggested replacement of lactobacilli by gram-negative, anaerobic microorganisms (4-6 intermediate; 7-8 and 9-10 moderate and severe bacterial vaginosis). FINDINGS: HIV-1 frequency was 14.2% among women with normal vaginal flora and 26.7% among those with severe bacterial vaginosis (p < 0.0001). We found an association between bacterial vaginosis and increased HIV-1 infection among younger women, but not among women older than 40 years; the association could not be explained by differences in sexual activity or concurrent infection with other STDs. The frequency of bacterial vaginosis was similar among HIV-1-infected women with symptoms (55.0%) and without symptoms (55.7%). The adjusted odds ratio of HIV-1 infection associated with any vaginal flora abnormality (scores 4-10) was 1.52 (95% CI 1.22-1.90), for moderate bacterial vaginosis (scores 7-8) it was 1.50 (1.18-1.89), and for severe bacterial vaginosis (scores 9-10) it was 2.08 (1.48-2.94). INTERPRETATION: This cross-sectional study cannot show whether disturbed vaginal flora increases susceptibility to HIV-1 infection. Nevertheless, the increased frequency of HIV-1 associated with abnormal flora among younger women, for whom HIV-1 acquisition is likely to be recent, but not among older women, in whom HIV-1 is likely to have been acquired earlier, suggests that loss of lactobacilli or presence of bacterial vaginosis may increase susceptibility to HIV-1 acquisition. If this inference is correct, control of bacterial vaginosis could reduce HIV-1 transmission.

Adolescent↗
PubMed2003

Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial.

BACKGROUND: Abnormal vaginal flora and bacterial vaginosis are associated with amplified risks of late miscarriage and spontaneous preterm delivery. We aimed to establish whether antibiotic treatment early in the second trimester might reduce these risks in a general obstetric population. METHODS: We screened 6120 pregnant women attending hospital for their first antenatal visit--who were at 12-22 weeks' gestation (mean 15.6 weeks)--for bacterial vaginosis or abnormal vaginal flora. We used gram-stained slides of vaginal smears to diagnose abnormal vaginal flora or bacterial vaginosis, in accordance with Nugent's criteria. We randomly allocated 494 women with one of these signs to receive either clindamycin 300 mg or placebo orally twice daily for 5 days. Primary endpoints were spontaneous preterm delivery (birth > or =24 but <37 weeks) and late miscarriage (pregnancy loss > or =13 but <24 weeks). Analysis was intention to treat. FINDINGS: Nine women were lost to follow-up or had elective termination. Thus, we analysed 485 women with complete outcome data. Women receiving clindamycin had significantly fewer miscarriages or preterm deliveries (13/244) than did those in the placebo group (38/241; percentage difference 10.4%, 95% CI 5.0-15.8, p=0.0003). Clindamycin also reduced adverse outcomes across the range of abnormal Nugent scores, with maximum effect in women with the highest Nugent score of 10. INTERPRETATION: Treatment of asymptomatic abnormal vaginal flora and bacterial vaginosis with oral clindamycin early in the second trimester significantly reduces the rate of late miscarriage and spontaneous preterm birth in a general obstetric population.

Abortion, Spontaneous↗
PubMed1983

Causes of abnormal vaginal bleeding in a Family Practice Center.

Abnormal vaginal bleeding had an incidence of 20.0 per 1,000 woman-years in patients of the Kanawha Valley Family Practice Center. Contraception-related bleeding was the most common cause, accounting for 28 percent of the cases. Anovulatory and dysfunctional uterine bleeding were the next most common causes, accounting for 15 percent and 13 percent, respectively. All three causes were uncommon in women aged 41 to 55 years, and absent in women older than 55 years. Perimenopausal bleeding, the dominant cause of abnormal vaginal bleeding in the 41-to-55-year group, was also absent in women older than 55 years of age. In women 56 years of age or older, endometrial carcinoma caused 28.6 percent of the bleeding; it did not occur in any other group.

Adult↗
PubMed1989

Abnormal vaginal bleeding in perimenopausal women.

The incidence of abnormal vaginal bleeding increases as women approach the end of their reproductive years. In the perimenopausal age group, the most common cause of abnormal vaginal bleeding is anovulation. In most patients, diagnosis and management can be accomplished in a family physician's office.

Adult↗
PubMed2003

Abnormal vaginal bleeding.

The complaint of abnormal vaginal bleeding in a non-pregnant patient is not a common presentation to a general ED. However, the bleeding may in itself be significant or it may be a harbinger of serious underlying pathology. A systematic approach to diagnosis is required. An initial approach to vaginal bleeding can be to categorize the bleeding by the anatomical site. This article discusses some of the common causes of upper tract or uterine bleeding and outlines the basic approach to diagnosis and management.

Emergency Medical Services↗
PubMed1997

Abnormal vaginal bleeding in young women.

Abnormal vaginal bleeding is common in young women and there are many possible causes. The most serious cause is cancer of the cervix which is curable in its early stages and this diagnosis should not be missed.

Female↗
PubMed2000

Effect of intravaginal clindamycin cream on pregnancy outcome and on abnormal vaginal microbial flora of pregnant women.

OBJECTIVES: To determine whether intravaginal clindamycin cream reduces the incidence of abnormal pregnancy outcome in women with abnormal vaginal microbial flora graded as intermediate or BV and to investigate the effect of the antibiotic on vaginal microbial flora. METHODS: A prospective cohort study of pregnant women in an antenatal clinic of a district general hospital. The subjects were 268 women who had abnormal vaginal microbial flora at first clinic visit by examination of a Gram-stained vaginal smear and 34 women with a normal vaginal flora. Two hundred and thirty-seven women were evaluable. Women with abnormal Gram-stained smears (graded as II or III) on clinic recall were randomised to receive treatment (intravaginal clindamycin cream) or placebo and followed to assess outcome of pregnancy, vaginal flora, and detection of Mycoplasma hominis and Ureaplasma urealyticum after treatment. RESULTS: Abnormal outcomes of pregnancy were not significantly different in treated and placebo groups by Chi square (P = 0.2). However, women with grade III flora responded better to clindamycin than women with grade II flora by numbers of abnormal outcomes (P = 0.03) and return to normal vaginal flora (P = 0.01) (logistic regression analysis model). This may be due to differences in vaginal bacterial species in these grades. Women whose abnormal vaginal flora had spontaneously returned to normal on follow-up and were therefore not treated (revertants) had as many abnormal outcomes as placebos suggesting that damage by abnormal bacterial species occurred early in pregnancy. CONCLUSIONS: Gram-stain screening distinguishing grade II from grade III flora may be helpful in prescribing treatment other than clindamycin for women with grade II flora. Earlier diagnosis and treatment may be more effective in preventing an abnormal outcome, possibly as soon as pregnancy is diagnosed or even offered as a pre-conception screen.

Adult↗
PubMed1989

Abnormal vaginal bleeding secondary to iron deficiency in a thirteen year old.

Abnormal vaginal bleeding in perimenarchal females is usually attributed to immaturity of the hypothalmic/pituitary/gonadal axis (i.e., dysfunctional uterine bleeding). Iron deficiency as a cause for abnormal bleeding has been described, but is poorly understood. This case report describes a 13-year-old Hispanic female with iron deficiency anemia as a presumptive cause for two episodes of abnormal vaginal bleeding. Anemia may be a cause as well as an effect of menorrhagia in young teenagers. Work-up should include evaluation of tissue iron stores if other etiologies for abnormal bleeding are not found.

Adolescent↗
PubMed2005

[Correlation between levels of selected cytokines in cervico-vaginal fluid of women with abnormal vaginal bacterial flora].

The aim of this study was to evaluate the rise of the levels of proinflammatory cytokines - IL-1alpha, IL-1beta, IL-6 and IL-8 in vagina of women with bacterial vaginosis (BV) and if there is any relationship between this levels. One hundred and twenty females between 22nd and 36th week of pregnancy were enrolled in the study. According to the bacterial flora of cervico-vaginal fluid evaluated by Gram stain, all women were divided into three groups. Group I (53 females; 44.2%)--normal bacterial flora, group II (35 females; 29.2%)--intermediate flora, and group with BV (32 females; 26.6%). The level of IL-1b in women with BV was over twelve times higher than in women from I group (131.35 and 10.6 pg/mL respectively). The next was the level of IL-1alpha--about seven times higher (128.45 vs 19.1 pg/mL) and the levels of IL-6 and IL-8, which were 1.7 times higher (16.2 vs 9.7 pg/mL and 656.7 vs 375.3 pg/mL respectively). Except for IL-6 these differences of levels were statistically significant (p<0.05). The levels of IL-1beta in group of women with BV correlated strongly with levels of IL-1alpha (r=0.72; p<0.0001) and weakly with levels of IL-6 (r=0.31; p=0.017). The correlation coefficient between levels of IL-6 and IL-8 rose gradually in II and BV group and reached levels r=0.575; p=0.0014 and r=0.67; p=0.0009 respectively. Our findings show that in vagina of women with BV the levels of proinflammatory cytokines rise, and that the rise of levels is in certain cases correlated.

Adult↗
PubMed2004

Sorting out common causes of abnormal vaginal discharge.

A chief complaint of abnormal vaginal discharge requires a broad differential diagnosis of both infectious and noninfectious causes. The patient's history and the physical exam should guide the choice of laboratory studies, and a complete physical exam that includes a thorough examination of both the external and internal genitalia will yield additional important information. Empirical treatment is unacceptable, considering the low cost of pH testing and saline and KOH preps compared to the cost of inappropriate treatment, repeat office visits, and the likelihood that eventually these tests will need to be performed. Some of the infectious causes of abnormal discharge may lead to serious complications with inappropriate treatment.

Anti-Infective Agents↗
PubMed2002

Colposcopic and cytologic findings among women with abnormal vaginal flora.

OBJECTIVE: The purpose of our study was to evaluate the association of abnormal vaginal flora with pathological colposcopic and cytological findings. MATERIALS AND METHODS: A total of 100 women of reproductive age were examined. Pregnant women were excluded. Each patient completed a self-administered questionnaire regarding sexual history and vaginal symptoms. All participants underwent a gynecological examination and colposcopy. Pap smear of the cervix and samples of vaginal discharge for microbiological analysis were obtained before the colposcopic examination. Statistical analysis was performed using Fisher exact test, chi test, and multifactorial analysis of variance. RESULTS: Results of colposcopic examination were normal in more than 70% of all examined women, except in women with bacterial vaginosis where < 30% had normal results. Of all the women examined only 1 did not have normal (class II) Pap smear results. CONCLUSIONS: Our study indicates that women with abnormal vaginal flora more often have pathological colposcopic findings, such as leukoplakia, vaginal hyperemia, and chronic cervicitis.

Journal Article↗
PubMed2002

Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis.

OBJECTIVE: To define an entity of abnormal vaginal flora: aerobic vaginitis. DESIGN: Observational study. SETTING: University Hospital Gasthuisberg, Leuven, Belgium. SAMPLE: 631 women attending for routine prenatal care or attending vaginitis clinic. METHODS: Samples were taken for fresh wet mount microscopy of vaginal fluid, vaginal cultures and measurement of lactate, succinate and cytokine levels in vaginal fluid. Smears deficient in lactobacilli and positive for clue cells were considered to indicate a diagnosis of bacterial vaginosis. Aerobic vaginitis was diagnosed if smears were deficient in lactobacilli, positive for cocci or coarse bacilli, positive for parabasal epithelial cells, and/or positive for vaginal leucocytes (plus their granular aspect). RESULTS: Genital complaints include red inflammation, yellow discharge, vaginal dyspareunia. Group B streptococci, escherichia coli, staphylococcus aureus and trichomonas vaginalis are frequently cultured. Vaginal lactate concentration is severely depressed in women with aerobic vaginitis, as in bacterial vaginosis, but vaginal succinate is not produced. Also in contrast to bacterial vaginosis, aerobic vaginitis produces a host immune response that leads to high production of interleukin-6, interleukin-1-beta and leukaemia inhibitory factor in the vaginal fluid. CONCLUSION: Aerobic vaginitis is associated with aerobic micro-organisms, mainly group B streptococci and E. coli. Its characteristics are different from those of bacterial vaginosis and elicit an important host response. The most severe form of aerobic vaginitis equals desquamative inflammatory vaginitis. In theory, aerobic vaginitis may be a better candidate than bacterial vaginosis as the cause of pregnancy complications, such as ascending chorioamnionitis, preterm rupture of the membranes and preterm delivery.

Enzyme-Linked Immunosorbent Assay↗
PubMed2001

Relationship of abnormal vaginal flora, proinflammatory cytokines and idiopathic infertility in women undergoing IVF.

OBJECTIVE: To investigate the prevalence of bacterial vaginosis (BV) and abnormal bacterial vaginal flora in an infertile population and correlate with cervical cytokine production and in vitro fertilization (IVF) outcome. STUDY DESIGN: In a blinded study, 331 asymptomatic IVF patients were evaluated for BV, abnormal vaginal flora and cervical cytokine production (interleukin 1 beta [IL-1 beta] and IL-8) on the day of oocyte retrieval. All patients received tetracycline prophylaxis at the time of oocyte retrieval. RESULTS: BV was identified in 4.2% (14/331) of the patients. Patients with idiopathic infertility were more likely to have BV than were women with other causes of infertility (P = .02 vs. male factor, P = .03 vs. tubal factor and P < .01 vs. endometriosis-associated infertility). Patients with abnormal vaginal flora had higher cervical IL-1 beta and IL-8 cytokine levels as compared to patients with normal vaginal flora. IL-1 beta and IL-8 levels in the study subjects correlated highly. No differences were detected in IVF outcome parameters based on the vaginal flora determined at the time of retrieval. CONCLUSION: Abnormal vaginal flora, including that causing BV, is associated with elevated cervical levels of IL-1 beta and IL-8. The induction of proinflammatory cytokines by an altered vaginal ecosystem may be a previously unrecognized cause of idiopathic infertility.

Adult↗
PubMed1986

Abnormal vaginal bleeding in adolescents.

The evaluation and management of abnormal vaginal bleeding should be tailored to the individual case. Pediatricians caring for adolescents need to be skilled in the evaluation and management of this common adolescent problem. Physicians who do not feel comfortable with their skills in the performance of a pelvic exam should obtain consultation from an adolescent specialist or a gynecologist who has experience with adolescents.

Blood Coagulation Disorders↗
PubMed1985

[Prevalence of 7 microorganisms in abnormal vaginal secretions (vaginitis)].

Seven microorganisms (N. gonorrhoeae, C. albicans, T. vaginalis, G. vaginalis, M. hominis, U. urealyticum and Streptococcus of group B) have been assayed in genital samplings of 164 asymptomatic women (control group) and of 374 women suffering from abnormal vaginal secretions (vaginitis group). All these bacteria except group B Streptococci were isolated in the vaginitis group more frequently than in the control group (p less than 0.01). The proportion of negative cultures for all tested bacteria was 39% in the control group and 6.4% in the vaginitis group (p less than 0.01). This shows an association of these bacteria with 70% of the patients of the vaginitis group and with only 26% of the women of the control group (p less than 0.01). It is to be noted that the pH values are higher in the group of women with vaginitis than in the control group (p less than 0.01). Comparison of the microbial flora during "specific" an "non-specific" vaginitis indicates that G. vaginalis is isolated more frequently in patients with non-specific vaginitis than among those with specific vaginitis (p less than 0.01). Likewise, M. hominis is isolated more frequently in groups of women with either non-specific vaginitis or T. vaginalis vaginitis, than in groups of patients with a C. albicans vaginitis (p less than 0,01). The results of this study indicate that there is a causal relationship between vaginitis and the presence of T. vaginalis. C. albicans, G. vaginalis, M. hominis or N. gonorrhoeae, either as a single or a mixed infection, and that there is a relationship between increased pH values and abnormal vaginal secretions.

Adult↗