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Ramesh Bhat, Department of Dermatology, Fr. E-mail: moc. This article has been cited by other articles in PMC. Trichomoniasis, bacterial vaginosis, and yeast infections are the three most frequent causes of vaginal discharge. It is characterized by abundant growth of Lactobacilli resulting in lysis of vaginal epithelial cells; and therefore, it is called as cytolytic vaginosis.
Healthy women of reproductive age groups are usually colonized by lactobacillus and Gardnerella vaginalis. It is also suggested that the presence of oestrogen and lactobacillus are needed to achieve an optimal vagina pH of 4. Lactobacilli produce lactic acid from glucose, keeping the vagina at an acidic pH. After puberty under the influence of oestrogen, glycogen is deposited in the vaginal epithelial cells, which is metabolized by vaginal epithelial cells to glucose.
Lactobacillus converts glucose to lactic acid. This may prevent overgrowth of organisms such as E. It has also been suggested that H2O2 positive strains of Lactobacilli may also protect against human immunodeficiency virus HIV infection. The protective role of various other antimicrobial products such as lactacin B and lactocidin are not clearly established.
According to several studies, Lactobacilli builds up a barrier against candidal overgrowth by blocking the adhesion of yeast to vaginal epithelial cells through competition for nutrients. Further, Lactobacilli in low numbers five bacilli per ten squamous cells in vaginal discharges have been considered as protective factors against vaginal candidiasis. Sometimes, a few individuals within the reproductive age group may have overgrowth of Lactobacilli.
In these patients, Lactobacilli alone or in combination with other bacteria, may cause damage to the vaginal intermediate epithelium that may result in dissolution of the cells. This dissolution causes dysuria in individuals with cytolytic vaginosis. Patients who have diabetes mellitus may also develop cytolytic vaginosis as it has been claimed that the Lactobacilli are more abundant in women with high serum glucose levels.
It has also been observed that symptoms will be more during luteal phase and it has been suggested that in the luteal phase there is remarkable rise in the number of colonizing Lactobacilli. Cyclical increase in symptoms is more pronounced during luteal phase. All of these cases were in the reproductive age groups of 25—40 years.
Five were in the luteal phase, with enhanced complaints of discharge and pruritus. The signs and symptoms were similar to vulvovaginal candidiasis.
Typical candidial yeast cells were also not found. Bacterial vaginosis may be diagnosed by pH measurements and whiff tests. Cytolytic vaginosis patients have an acidic pH of 3. All cases of cytolytic vaginosis will have negative culture results in sabourand dextrose agar SDA.
An increase in number of Lactobacilli. A paucity of white blood cells. Evidence of cytolysis. Treatment involves douching with sodium bicarbonate solution or using a sodium bicarbonate suppository vaginally. Douches are carried out twice weekly for every two weeks. Solution for douches can be prepared by mixing 1—2 table spoons of baking soda with four cups of warm water.
Alternatively, empty gelatin capsules are filled using baking soda and one capsule is inserted intravaginally, twice weekly for every two weeks. These measures help in resolving the symptoms by restoring the normal vaginal environment. If the symptom persists or worsen beyond 2—3 weeks after initiating treatment, re-evaluation is required.
It is not as common as bacterial vaginosis or candidiasis, but is sometimes confused with them especially with the latter. Footnotes Conflict of Interest: None declared. Haefner HK. Current evaluation and management of vulvovaginitis. Clin Obstet Gynecol. The relationship of hydrogen peroxide producing Lactobacilli vaginosis and genital microflora in pregnant women. Obstet Gynecol. Cerikcioglu N, Beksac MS. Cytolytic vaginosis; misdiagnosed as candidal vaginitis.
Infect Dis Obstet Gynecol. Hillier SL. Normal vaginal flora. Sexually transmitted diseases. Newyork: Mc Graw hill; Role of lactobacillus as protector against vaginal candidiasis. Med Clin Barc ;—8. Cytolytic vaginosis. Am J Obstet Gynecol. Vaginal discharge comparision of clinical, laboratory and microbiological findings. Acta Obstet Gynecol Scand. Diagnosing candidiasis.
A new, cost effective technique. J Reprod Med. Paavonen J. Vulvodynia- a complex syndrome of vulval pain. Health update. Available from: www. Health Update. University of Virginia studenthealth.
Cytolytic vaginosis: A review
Lactobacilli[ edit ] This article needs to be updated. Please update this article to reflect recent events or newly available information. December The primary colonizing bacteria of a healthy individual are of the genus Lactobacillus. Lactobacilli have been shown to inhibit in vitro growth of pathogenic microorganisms, e. Bacteroides fragilis, Escherichia coli, Gardnerella vaginalis , Mobiluncus spp. It is generally accepted that this is achieved mainly through the action of lactic acid. This usually reduces pathogens from infecting to the vaginal epithelium.
Qué son los bacilos de Döderlein