title: Recalcitrance of bacterial vaginosis among herpes-simplex-virus-type-2-seropositive women.
abstract: OBJECTIVE
  The multifactorial etiology of bacterial vaginosis (BV) impedes development of effective treatment and prevention strategies. Herein, we evaluated the effects of herpes simplex virus type 2 (HSV-2), a suspected BV risk factor, on vaginal flora composition.
  
  
  METHODS
  Correlations between HSV-2 infection and BV were prospectively explored among 12 HSV-2-seropositive women with asymptomatic BV who were asked to collect daily vaginal swab specimens for Gram stain analysis of vaginal flora and determination of HSV-2 shedding frequencies during the 1month before and after metronidazole therapy.
  
  
  RESULTS
  Unlike prior longitudinal studies that reported rapid fluctuations in vaginal flora composition and frequent episodes of spontaneously resolving BV, we found that 99.4% (310/312) of vaginal smears collected before initiation of metronidazole were consistent with a diagnosis of BV. Effectiveness of metronidazole therapy was also much lower than previously reported in studies not restricting enrollment to HSV-2-seropositive women; we observed a BV recurrence rate of 89% in the first month after completion of therapy while the median time to this recurrence occurred only 14days after treatment.
  
  
  CONCLUSIONS
  Our study demonstrates BV recalcitrance among HSV-2-infected women and provides additional evidence for a linkage between this chronic viral infection and abnormal vaginal flora. Additional work will be needed to define mechanisms responsible for this correlation and to determine if vaginal flora health of HSV-2-infected women is improved by medications that suppress HSV-2 shedding.
authors.affiliation: Departments of Obstetrics and Gynecology and Reproductive Sciences             Pediatrics             Medicine             Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Stoner
authors.forename: Seth D
authors.initials: SD
authors.lastname: Reighard
authors.forename: Rodolfo D
authors.initials: RD
authors.lastname: Vicetti Miguel
authors.forename: Douglas
authors.initials: D
authors.lastname: Landsittel
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cosentino
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kant
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Cherpes
mesh_terms: D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D005260:Female; D006558:Herpes Genitalis / Q000382:microbiology / Q000821:virology*; D018258:Herpesvirus 2, Human / Q000276:immunology*; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D012307:Risk Factors; D014621:Vagina / Q000382:microbiology / Q000821:virology*; D016585:Vaginosis, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000821:virology*; D017201:Virus Shedding
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole