title: Utilization of molecular methods to identify prognostic markers for recurrent bacterial vaginosis.
abstract: BACKGROUND
  Recurrent bacterial vaginosis (BV) after antimicrobial therapy is a major problem, affecting >50% of patients within 1 year. The objective of this study was to determine if prospective identification of patients at risk for recurrence using molecular methods is feasible.
  
  
  METHODS
  Women were evaluated for BV by Amsel criteria and Nugent score. Vaginal specimens were analyzed using a panel of quantitative real-time polymerase chain reactions (qPCRs) at three times: pre-treatment, 7-10days post-treatment and 40-45days post-treatment. The PCRs quantified DNA of the following organisms: Gardnerella vaginalis; Atopobium vaginae; Bacterial Vaginosis-Associated Bacteria-1 (BVAB1), -2 (BVAB2) and -3 (BVAB3); Leptotrichia/Sneathia; Megasphaera Phylotypes 1 and 2; and Lactobacillus spp. (L. crispatus, L. gasseri, L. iners and L. jensenii).
  
  
  RESULTS
  Out of 84 women diagnosed with BV (Amsel ≥3 and Nugent ≥4), 77 (91.7%) were successfully treated after 7-10days (asymptomatic and Amsel of either 0 or 1 with elevated vaginal pH and Nugent ≤6). Of these 77 women, 46 (59.7%) remained cured after 40-45days and 31 (40.3%) developed recurrent BV. In univariate analysis, we found that women who would have recurrent BV during the study had greater concentrations of Megasphaera Phylotype 2 (P=0.001) and BVAB2 (P=0.015) at initial diagnosis and greater vaginal pH (P=0.030), higher Nugent score (P=0.043) and a greater concentration of G. vaginalis (P=0.012) post-treatment, when compared to women who were cured during the study. These differences largely remained when cure was defined as Nugent ≤3 or when only women treated with intravaginal metronidazole were evaluated.
  
  
  CONCLUSIONS
  Molecular analysis of BV is a useful adjunct to clinical and microscopic analysis to prospectively identify patients at high risk for recurrent BV.
authors.affiliation: Femeris Women's Health Research Center, Medical Diagnostic Laboratories, A Member of Genesis Biotechnology Group, 2439 Kuser Rd., Hamilton, NJ, USA. Electronic address: dhilbert@mdlab.com.
authors.forename: David W
authors.initials: DW
authors.lastname: Hilbert
authors.affiliation: Femeris Women's Health Research Center, Medical Diagnostic Laboratories, A Member of Genesis Biotechnology Group, 2439 Kuser Rd., Hamilton, NJ, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Smith
authors.affiliation: Femeris Women's Health Research Center, Medical Diagnostic Laboratories, A Member of Genesis Biotechnology Group, 2439 Kuser Rd., Hamilton, NJ, USA.
authors.forename: Teresa E
authors.initials: TE
authors.lastname: Paulish-Miller
authors.affiliation: Femeris Women's Health Research Center, Medical Diagnostic Laboratories, A Member of Genesis Biotechnology Group, 2439 Kuser Rd., Hamilton, NJ, USA.
authors.forename: Sean G
authors.initials: SG
authors.lastname: Chadwick
authors.affiliation: Femeris Women's Health Research Center, Medical Diagnostic Laboratories, A Member of Genesis Biotechnology Group, 2439 Kuser Rd., Hamilton, NJ, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Toner
authors.affiliation: Femeris Women's Health Research Center, Medical Diagnostic Laboratories, A Member of Genesis Biotechnology Group, 2439 Kuser Rd., Hamilton, NJ, USA.
authors.forename: Eli
authors.initials: E
authors.lastname: Mordechai
authors.affiliation: Femeris Women's Health Research Center, Medical Diagnostic Laboratories, A Member of Genesis Biotechnology Group, 2439 Kuser Rd., Hamilton, NJ, USA.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Adelson
authors.affiliation: Division of Infectious Diseases, Wayne State University School of Medicine, 540 E. Canfield St., Detroit, MI, USA.
authors.forename: Jack D
authors.initials: JD
authors.lastname: Sobel
authors.affiliation: Femeris Women's Health Research Center, Medical Diagnostic Laboratories, A Member of Genesis Biotechnology Group, 2439 Kuser Rd., Hamilton, NJ, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Gygax
mesh_terms: D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001419:Bacteria / Q000145:classification* / Q000235:genetics*; D058491:Bacterial Load; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011379:Prognosis; D060888:Real-Time Polymerase Chain Reaction; D012008:Recurrence; D012307:Risk Factors; D016585:Vaginosis, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: Bacterial vaginosis; Gardnerella vaginalis; qPCR