A public health approach to adverse outcomes of pregnancy associated with bacterial vaginosis

Numerous studies have demonstrated that bacŽ . terial vaginosis BV is associated with adverse Ž . outcomes of pregnancy AOP , especially premature delivery and delivery of a low-birthweight w x infant 1 . BV is also associated with pelvic inŽ . flammatory disease PID and complications following gynecologic procedures, and is the most w x common cause of vaginitis in women 2 . No single organism causes BV, rather it is characterized by a change in the microbiologic flora of the vagina. Normally, nearly 90% of the vaginal miw x crobiologic flora 3 are Lactobacillus sp., in particular, lactobacilli that produce H O and lactic 2 2 acid. However, women with BV have fewer lactobacilli, are more likely to have a non-H O -pro2 2 w x ducing lactobacilli 4 , and have much higher