Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda.
BACKGROUND
The cause of bacterial vaginosis remains poorly understood. Recent evidence strengthens the association between bacterial vaginosis and serious medical complications.


OBJECTIVE
To review the evidence linking bacterial vaginosis with adverse pregnancy outcomes, complications after gynecologic procedures, and HIV infection, and to identify prevention strategies.


METHODS
In March 1999, the Centers for Disease Control and Prevention organized a conference to accomplish this goal.


RESULTS
Better understanding is needed concerning the etiology, epidemiology, and natural history of bacterial vaginosis. More efficacious treatment of bacterial vaginosis and strategies to reduce maternal complications associated with bacterial vaginosis, such as premature rupture of the fetal membranes, chorioamnionitis, premature labor and delivery, postdelivery endometritis, and postpartum infant complications should be developed. Recent evidence shows that screening and treatment of bacterial vaginosis before abortion reduces postabortion pelvic inflammatory disease, and that anaerobic coverage during hysterectomy reduces postoperative complications. Better understanding concerning the relation of bacterial vaginosis to acquisition of sexually transmitted diseases and HIV infection are needed as well as possible prevention strategies.


CONCLUSIONS
A national prevention effort should be guided by the results of research that addresses current knowledge gaps.
Koumans
E H
EH
Division of STD Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. exk0@cdc.gov
Kendrick
J S
JS
D000028:Abortion, Induced / Q000009:adverse effects; D002487:Centers for Disease Control and Prevention, U.S.; D004716:Endometritis / Q000517:prevention & control; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000382:microbiology / Q000517:prevention & control; D015658:HIV Infections / Q000150:complications / Q000517:prevention & control; D006266:Health Education; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008403:Mass Screening; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D000292:Pelvic Inflammatory Disease / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011322:Primary Prevention; D011634:Public Health; D014481:United States; D016585:Vaginosis, Bacterial / Q000150:complications* / Q000209:etiology / Q000517:prevention & control