Vaginal flora changes associated with Mycoplasma hominis☆,☆☆,★,★★

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Abstract

OBJECTIVE: The aim of this study was to investigate any association between vaginal carriage of Mycoplasma hominis and genital signs and symptoms, other microbial findings, and some risk behavior factors in women with and without bacterial vaginosis. STUDY DESIGN: Women who had attended two family planning clinics and a youth clinic for contraceptive advice were divided depending on the result of vaginal culture for Mycoplasma hominis and the occurrence of bacterial vaginosis. The study population included 123 (12.3%) women who harbored Mycoplasma hominis. Those 873 (87.7%) with a negative culture for Mycoplasma hominis served as a comparison group. In the former group, 50 (40.7%) had bacterial vaginosis, which was also the case in 81 (9.3%) of the women in the comparison group. The groups were compared with regard to genital signs and symptoms, results of vaginal wet smear microscopy and other office tests, vaginal flora changes as detected by culture, and other means and detection of sexually transmitted diseases. Any history of sexually transmitted diseases and other genital infections, reproductive history, use of oral contraceptives, and smoking habits were registered. RESULTS: Women who harbored Mycoplasma hominis had significantly more often complained of a fishy odor, had a positive amine test, a vaginal pH >4.7, and clue cells than did the comparison group; all these statements were true before and after bacterial vaginosis had been excluded. Vaginal discharge was not significantly more often complained of, and a pathologic discharge was not more often detected in the Mycoplasma hominis carriers. Ureaplasma urealyticum occurred in 75% of the Mycoplasma hominis–positive women and in 59% of the comparison group (p = 0.001). The leukocyte/epithelial cell ratio did not differ significantly from that of the Mycoplasma hominis culture–negative controls. CONCLUSION: The study suggests that Mycoplasma hominis is associated with a number of genital signs and symptoms even after exclusion of bacterial vaginosis. (Am J Obstet Gynecol 1997;176:173-8.)

Section snippets

Material and methods

The study was carried out in Stockholm (the capital of Sweden) and in Eskilstuna, a middle-sized industrial city surrounded by a rural area included in its hospital's catchment area. The women studied had attended for contraception advice at one youth and two family planning clinics. Details about the design of study (i.e., the Swedish Women's Health Study) have been reported elsewhere.11 We compared women who had a positive vaginal culture for M. hominis with those with a negative culture for

Results

Of the 996 women studied, 123 (12.3%) were culture positive for M. hominis. They had a mean age of 26.3 years. The mean age of the 873 (87.7%) women who were culture negative for the organism and who served as a comparison group was 25.8 years (p = 0.39). Because of the age differences, all p values, odds ratios, and 95% confidence intervals given were adjusted for age.

Of the 123 women harboring M. hominis, U. urealyticum was found in 92 (74.8%). This was also the case in 509 (59.4%) in the

Comment

M. hominis is commonly found in the vagina of women with bacterial vaginosis. The organism has been demonstrated in >60% of such women.20 In the current study the recovery rate was 42% in the bacterial vaginosis cases, whereas it was only 7.9% in the 865 women without bacterial vaginosis.

Women with M. hominis in their vaginal flora differed from those who were not carriers in more often having a fishy odor of the vaginal contents, a positive amine test, a vaginal pH ≥4.7, and the presence of

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    ☆

    From the Institute of Clinical Bacteriology, Uppsala University,a the Swedish Institute for Infectious Disease Control,b and the Department of Obstetrics and Gynecology, Falun Hospital.c

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    Supported by Arbetsmarknadens försäkringsaktiebolag (Afa.).

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    Reprint requests: Per-Anders Mårdh, MD, PhD, Institute of Clinical Bacteriology, Box 552, S-751 22 Uppsala, Sweden.

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