Gardnerella vaginalis and anaerobic bacteria in the etiology of bacterial (nonspecific) vaginosis.

G. vaginalis was originally described as the etiologic agent of bacterial vaginosis (nonspecific vaginitis) because it was recovered only from women with signs and symptoms of "bacterial vaginitis" and not from normal controls. Recent data have shown that G. vaginalis is present in normal women but at concentrations lower than the limit of sensitivity of the media formerly used. Detection of low concentrations of G. vaginalis in normal controls has been made possible by development of a selective and differential medium (HBT). Anaerobically performed studies of the vaginal flora have indicated that while lactobacilli predominate in the normal vagina with or without G. vaginalis, anaerobic bacteria including Bacteroides spp., Peptococcus spp., Eubacterium spp. and curved rods as well as G. vaginalis predominate in bacterial vaginosis. Anaerobic bacteria and G. vaginalis are decreased after appropriate therapy. After treatment with metronidazole, lactobacilli again predominate. Lactobacilli are less prevalent after treatment with ampicillin or amoxicillin. These data suggest that as in infections at other mucous membrane sites, bacterial vaginosis is a mixed infection involving a finite number of facultative and anaerobic species. The data also suggest an important role for facultative lactobacilli.