Relationship between hydrogen peroxide-producing strains of lactobacilli and vaginosis-associated bacterial species in pregnant women.

This study was conducted to determine the relationship between lactobacilli and bacterial species associated with bacterial vaginosis in pregnancy and the prevalence of H2O2-producing and non-producing strains of lactobacilli in pregnant women whose vaginal flora had already been analysed. Information was available for 174 pregnant women whose vaginal flora had been evaluated previously by examining gram-stained vaginal smears: 50 had grade III flora (bacterial vaginosis). 50 grade II flora, 41 flora graded as abnormal which then reverted to grade I (revertants) and 33 normal flora (controls). Lactobacilli were isolated from 19 of 50 women whose vaginal flora was grossly abnormal culturally and categorised as grade III by Gram staining. In 6 of these 50 women lactobacilli were isolated in large numbers, i.e. 10(5)-10(6) cfu/ml. H2O2-producing strains of lactobacilli were isolated from 11 of 12 women with grade III flora who were randomly selected from this group. Thus, in those 11 women it appears that H2O2-producing lactobacilli had not protected them from developing bacterial vaginosis. Bacterial species associated with vaginosis were isolated in high numbers from a large proportion of women in the revertant and grade II groups in association with high counts of lactobacilli. Thus, in some women it is possible that a change to an abnormal flora could occur before the complete disappearance of lactobacilli. It is concluded that bacterial vaginosis may develop in some women despite the presence of H2O2-producing strains of lactobacilli and that other factors, as yet unidentified, might be conducive to the appearance of abnormal bacterial flora with progression to vaginosis.