Streptococcal vaginosis

This study was initiated to discover the etiology and pathogenesis of persistent vulvovaginal symptoms after adequate and appropriate therapy for bacterial vaginosis.

Included in this study, which spanned the period from January 1988 to June 1996, were all patients who were referred by their gynecologists for continuing vulvovaginal symptoms after treatment for bacterial vaginosis. History, pelvic examination, saline wet-mount and 10% potassium hydroxide preparations, and aerobic and anaerobic cultures were performed. Several antibiotic regimens were prescribed, and results were tabulated. Patients were considered to be cured when asymptomatic, when the saline wet-mount preparation showed lactobacillus-dominant flora, and when cultures were reported as normal or mixed vaginal flora.

Twenty-four patients were recruited for this study. These patients had been treated for a total of 554 months prior to their referral for vulvovaginal consultation. After saline wet-mount examination, 90% had no lactobacilli and showed an abundance of coccal bacterial forms. Twenty-six cultures were performed, of which 92% were positive for streptococci. Group B streptococci were reported in 71%, group D in 29%, and group A in none. The most successful therapy was amoxicillin, 500 mg three times daily for 10 days. Treatment for 7 days was inadequate.

Overgrowth of streptococci after appropriate therapy for bacterial vaginosis produces continuing vulvovaginal symptoms. Amoxicillin, 500 mg three times daily for 10 days, returns lactobacillus-dominated flora and an asymptomatic patient in a majority of cases.