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. 1995;3(3):102–109. doi: 10.1155/S106474499500041X

Long, Uniform Lactobacilli (Döderlein's Bacteria): A New Risk Factor for Postoperative Infection After First-Trimester Abortion

Jens-Jörgen Platz-Christensen 1, Carl Påhlson 3, Per-Göran Larsson 2,✉
PMCID: PMC2364428  PMID: 18476030

Abstract

Objective: The production of hydrogen peroxide (H2O2) from different strains of lactobacilli in the vagina has been proposed to play one of the most important protective roles in the vaginal defense system. New data have, however, suggested that Döderlein's bacteria, with the morphological appearance of long lactobacilli, have a low production of H2O2 . The purpose of the present study was to correlate the morphology of lactobacilli with the incidence of infection following legal abortion.

Methods: Seven hundred sixty-nine women with lactobacilli but without Chlamydia trachomatis or bacterial vaginosis in their vaginal wet smears who were to undergo legal abortions were divided into 6 different groups according to the morphological appearance of the lactobacilli. The postoperative infection rates in these different groups were compared. A phenotypic classification of some of the lactobacilli was performed.

Results: The presence of Döderlein's bacteria compared with a mixed flora of lactobacilli increased the risk of postoperative infection 3 times [relative risk (RR) = 3.0; 95% confidence interval (CI), 1.5-6.3]. After a logistic regression analysis, the only independent risk factors were the presence of Döderlein's bacteria and earlier gestational age.

Conclusions: We found that the lactobacilli regarded as commensal organisms and “normal, healthy lactobacilli” in the vagina were present in only 18% of these women and that their presence might be hazardous. Therefore, we must reconsider our concept of the “normal” lactobacilli in the vaginal wet smears of healthy women.

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Selected References

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  1. Amsel R., Totten P. A., Spiegel C. A., Chen K. C., Eschenbach D., Holmes K. K. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983 Jan;74(1):14–22. doi: 10.1016/0002-9343(83)91112-9. [DOI] [PubMed] [Google Scholar]
  2. Bokström H., Wiqvist N. Preoperative dilatation of the cervix at legal abortion with a synthetic, fast-swelling hygroscopic tent. Acta Obstet Gynecol Scand. 1989;68(4):313–318. doi: 10.3109/00016348909028665. [DOI] [PubMed] [Google Scholar]
  3. Eschenbach D. A., Davick P. R., Williams B. L., Klebanoff S. J., Young-Smith K., Critchlow C. M., Holmes K. K. Prevalence of hydrogen peroxide-producing Lactobacillus species in normal women and women with bacterial vaginosis. J Clin Microbiol. 1989 Feb;27(2):251–256. doi: 10.1128/jcm.27.2.251-256.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hamark B., Forssman L. Postabortal endometritis in chlamydia-negative women--association with preoperative clinical signs of infection. Gynecol Obstet Invest. 1991;31(2):102–105. doi: 10.1159/000293111. [DOI] [PubMed] [Google Scholar]
  5. Heisterberg L., Sonne-Holm S., Andersen J. T., Hebjørn S., Dyring-Andersen K., Hejl B. L. Risk factors in first-trimester abortion. Acta Obstet Gynecol Scand. 1982;61(4):357–360. [PubMed] [Google Scholar]
  6. Horowitz B. J., Mårdh P. A., Nagy E., Rank E. L. Vaginal lactobacillosis. Am J Obstet Gynecol. 1994 Mar;170(3):857–861. doi: 10.1016/s0002-9378(94)70298-5. [DOI] [PubMed] [Google Scholar]
  7. Jonasson A., Larsson B., Bygdeman S., Forsum U. The influence of cervical dilatation by laminaria tent and with Hegar dilators on the intrauterine microflora and the rate of postabortal pelvic inflammatory disease. Acta Obstet Gynecol Scand. 1989;68(5):405–410. doi: 10.3109/00016348909021011. [DOI] [PubMed] [Google Scholar]
  8. Larsson P. G., Bergman B., Forsum U., Platz-Christensen J. J., Påhlson C. Mobiluncus and clue cells as predictors of PID after first-trimester abortion. Acta Obstet Gynecol Scand. 1989;68(3):217–220. doi: 10.3109/00016348909020992. [DOI] [PubMed] [Google Scholar]
  9. Larsson P. G., Platz-Christensen J. J. Enumeration of clue cells in rehydrated air-dried vaginal wet smears for the diagnosis of bacterial vaginosis. Obstet Gynecol. 1990 Oct;76(4):727–730. [PubMed] [Google Scholar]
  10. Larsson P. G., Platz-Christensen J. J., Thejls H., Forsum U., Påhlson C. Incidence of pelvic inflammatory disease after first-trimester legal abortion in women with bacterial vaginosis after treatment with metronidazole: a double-blind, randomized study. Am J Obstet Gynecol. 1992 Jan;166(1 Pt 1):100–103. doi: 10.1016/0002-9378(92)91838-2. [DOI] [PubMed] [Google Scholar]
  11. Levallois P., Rioux J. E. Prophylactic antibiotics for suction curettage abortion: results of a clinical controlled trial. Am J Obstet Gynecol. 1988 Jan;158(1):100–105. doi: 10.1016/0002-9378(88)90787-9. [DOI] [PubMed] [Google Scholar]
  12. Moberg P., Sjöberg B., Wiqvist N. The hazards of vacuum aspiration in late first trimester abortions. Acta Obstet Gynecol Scand. 1975;54(2):113–118. doi: 10.3109/00016347509156742. [DOI] [PubMed] [Google Scholar]
  13. Møller B. R., Ahrons S., Laurin J., Mårdh P. A. Pelvic infection after elective abortion associated with Chlamydia trachomatis. Obstet Gynecol. 1982 Feb;59(2):210–213. [PubMed] [Google Scholar]
  14. Osser S., Persson K. Postabortal pelvic infection associated with Chlamydia trachomatis and the influence of humoral immunity. Am J Obstet Gynecol. 1984 Nov 15;150(6):699–703. doi: 10.1016/0002-9378(84)90670-7. [DOI] [PubMed] [Google Scholar]
  15. Påhlson C., Larsson P. G. The ecologically wrong vaginal lactobacilli. Med Hypotheses. 1991 Oct;36(2):126–130. doi: 10.1016/0306-9877(91)90253-u. [DOI] [PubMed] [Google Scholar]
  16. Qvigstad E., Skaug K., Jerve F., Fylling P., Ulstrup J. C. Pelvic inflammatory disease associated with Chlamydia trachomatis infection after therapeutic abortion. A prospective study. Br J Vener Dis. 1983 Jun;59(3):189–192. doi: 10.1136/sti.59.3.189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. ROGOSA M., SHARPE M. E. Species differentiation of human vaginal lactobacilli. J Gen Microbiol. 1960 Aug;23:197–201. doi: 10.1099/00221287-23-1-197. [DOI] [PubMed] [Google Scholar]
  18. Skjeldestad F. E., Tuveng J., Solberg A. G., Molne K., Dalen A., Buhaug H. Induced abortion: Chlamydia trachomatis and postabortal complications. A cost benefit analysis. Acta Obstet Gynecol Scand. 1988;67(6):525–529. doi: 10.3109/00016348809029864. [DOI] [PubMed] [Google Scholar]
  19. Tramer J. Inhibitory effect of Lactobacillus acidophilus. Nature. 1966 Jul 9;211(5045):204–205. doi: 10.1038/211204a0. [DOI] [PubMed] [Google Scholar]
  20. VINCENT J. G., VEOMETT R. C., RILEY R. F. Antibacterial activity associated with Lactobacillus acidophilus. J Bacteriol. 1959 Oct;78:477–484. doi: 10.1128/jb.78.4.477-484.1959. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. WHEATER D. M., HIRSCH A., MATTICK A. T. R. Possible identity of lactobacillin with hydrogen peroxide produced by lactobacilli. Nature. 1952 Oct 11;170(4328):623–624. doi: 10.1038/170623a0. [DOI] [PubMed] [Google Scholar]
  22. Zheng H. Y., Alcorn T. M., Cohen M. S. Effects of H2O2-producing lactobacilli on Neisseria gonorrhoeae growth and catalase activity. J Infect Dis. 1994 Nov;170(5):1209–1215. doi: 10.1093/infdis/170.5.1209. [DOI] [PubMed] [Google Scholar]

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