Nonspecific vaginitis: role of Haemophilus vaginalis and treatment with metronidazole

The New England Journal of Medicine
T A PheiferK K Holmes


To assess the cause of nonspecific vaginitis, we performed a prospective case-control study of vaginal flora and a randomized unblinded trial of different therapies. Haemophilus vaginalis was isolated from 17 to 18 women with signs of vaginitis but only one of 18 normal matched controls (P less than 0.002). The concentration of anaerobic bacteria in vaginal washings also was increased in patients. Clinical improvement and eradication of H. vaginalis occurred in one of seven patients given sulfonamide vaginal cream, two of 15 given oral doxycycline, nine of 27 given oral ampicillin, and 80 of 81 given oral metronidazole. On the seventh day of therapy signs of nonspecific vaginitis persisted in 31 of 31 with, and in two of 92 without, persistent H. vaginalis infection (P less than 0.001). These data suggest the causal role of H. vaginalis in nonspecific vaginitis, possibly in concert with vaginal anaerobes. The widespread use of sulfonamide creams is inappropriate. Metronidazole is effective, but its efficacy must be weighed against its possible toxicity.


Dec 17, 1977·Lancet·H R InghamA A Codd
May 1, 1977·The Journal of Clinical Investigation·W R BowieK K Holmes
Dec 1, 1977·The Journal of Infectious Diseases·W M McCormackS H Zinner
Apr 1, 1977·Sexually Transmitted Diseases·W E Dunkelberg
Jul 24, 1975·The New England Journal of Medicine·D A EschenbachK K Holmes
Jan 1, 1977·Sexually Transmitted Diseases·R F Smith, W E Dunkelberg
Sep 1, 1975·Journal of Clinical Pathology·J de LouvoisV C Stanley
Dec 1, 1974·Antimicrobial Agents and Chemotherapy·E D RalphW M Kirby
Jan 11, 1973·The New England Journal of Medicine·W M McCormackE H Kass
Mar 15, 1973·American Journal of Obstetrics and Gynecology·L Lee, J D Schmale
Nov 1, 1971·American Journal of Clinical Pathology·J F LewisT Burke
Jan 1, 1961·Acta Pathologica Et Microbiologica Scandinavica·S P LAPAGE
Jun 1, 1964·The Journal of Obstetrics and Gynaecology of the British Commonwealth·J FRAMPTON, Y LEE
Aug 15, 1964·American Journal of Obstetrics and Gynecology·E C DELAHAH J OSBORNE
Jan 1, 1965·Acta Obstetricia Et Gynecologica Scandinavica·S BERGMANP LUNDSTROEM
Mar 1, 1948·Proceedings of the Society for Experimental Biology and Medicine·A B KUPFERBERGH SPRINCE


Jul 1, 1991·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·K W BennettP D Woolley
Oct 1, 1987·European Journal of Clinical Microbiology·E HolstP A Mårdh
Aug 1, 1982·European Journal of Clinical Microbiology·A Dyas, R Wise
Oct 1, 1982·European Journal of Clinical Microbiology·M J Balsdon
Oct 1, 1982·European Journal of Clinical Microbiology·D MilatovicI Braveny
Oct 1, 1982·European Journal of Clinical Microbiology·S ShankerR Munro
Oct 1, 1982·European Journal of Clinical Microbiology·P PiotJ Vanderheyden
Oct 1, 1982·European Journal of Clinical Microbiology·J C Clay
Oct 1, 1982·European Journal of Clinical Microbiology·B M JonesB Duerden
Dec 1, 1986·Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception·W E Brenner, J R Dingfelder
Feb 26, 2009·Current Infectious Disease Reports·J R Schwebke
May 1, 1989·European Journal of Obstetrics, Gynecology, and Reproductive Biology·O P BlekerS I Dirks-Go
Jul 1, 1987·Diagnostic Microbiology and Infectious Disease·L E PhillipsR M Turner
May 15, 1998·Journal of Nurse-midwifery·D M PaigeJ Chang
Jul 1, 1988·Zentralblatt Für Bakteriologie, Mikrobiologie, Und Hygiene. Series A, Medical Microbiology, Infectious Diseases, Virology, Parasitology·P ElsnerI Wecker
Nov 4, 2000·Clinical Cornerstone·M Quan
Jun 12, 2003·Infection, Genetics and Evolution : Journal of Molecular Epidemiology and Evolutionary Genetics in Infectious Diseases·I Z SøgaardM H Schierup
Feb 18, 2003·APMIS : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica·Helen WolrathUrban Forsum
Jun 5, 1998·Journal of General Internal Medicine·P L CarrR H Friedman
May 1, 1980·The New England Journal of Medicine·D Taylor-Robinson, W M McCormack
Sep 11, 1980·The New England Journal of Medicine·C A SpiegelK K Holmes
Sep 11, 1980·The New England Journal of Medicine·R H Kaufman
Nov 20, 1980·The New England Journal of Medicine·J Koch-Weser, P Goldman
Oct 18, 1990·The New England Journal of Medicine
Jan 1, 1987·Health Care for Women International·E C Bennett
Feb 1, 1982·Journal of Toxicology and Environmental Health·H S Buttar
Oct 13, 2006·Current Opinion in Infectious Diseases·A H Ugwumadu, P Hay
Apr 1, 1992·Journal of Clinical Microbiology·R L CookJack D Sobel
Dec 1, 1995·The Journal of Family Practice·C Spaulding
May 11, 2000·Obstetrical & Gynecological Survey·J McGregor, J I French
Jan 23, 1998·Sexually Transmitted Diseases·G GiacominiR Cristofani
Sep 18, 2008·Sexually Transmitted Diseases·J R SchwebkeJeannette Lee
Aug 1, 1979·Antimicrobial Agents and Chemotherapy·L R McCarthyE G Smith
Jul 1, 1980·Antimicrobial Agents and Chemotherapy·E D Ralph, Y E Amatnieks
Apr 1, 1981·Antimicrobial Agents and Chemotherapy·B M Jones, M N Bhattacharyya
Sep 1, 1983·Antimicrobial Agents and Chemotherapy·E J GoldsteinV L Sutter
Dec 1, 1993·Antimicrobial Agents and Chemotherapy·A B KharsanyJ Van den Ende
Oct 15, 2005·Clinical Microbiology Reviews·Ken B WaitesRobert L Schelonka
Jun 2, 1979·British Medical Journal·M J GoldacreM P Vessey
Apr 23, 1988·British Medical Journal·R R WestJ E Smail
May 1, 1982·Journal of Clinical Pathology·Catherine A IsonC S Easmon
Apr 1, 1982·The British Journal of Venereal Diseases·G R KinghornI Geary
Aug 1, 1982·The British Journal of Venereal Diseases·S G DawsonC S Easmon
Aug 1, 1982·The British Journal of Venereal Diseases·C S EasmonS G Dawson
Dec 1, 1982·The British Journal of Venereal Diseases·A L Blackwell, D Barlow
Apr 1, 1983·The British Journal of Venereal Diseases·S TabaqchaliR N Thin
Oct 1, 1983·The British Journal of Venereal Diseases·B E SandersonM J Baldson
Jun 1, 1984·The British Journal of Venereal Diseases·F JerveE Hoftvedt
Dec 1, 1984·The British Journal of Venereal Diseases·A P Johnson, H A Davies
Apr 1, 1985·Genitourinary Medicine·L V Hill
Apr 1, 1985·Genitourinary Medicine·Catherine A Ison, C S Easmon
Oct 1, 1985·Genitourinary Medicine·G Buttigieg
Aug 1, 1986·Genitourinary Medicine·A N MasfariG R Kinghorn
Jun 1, 1987·Genitourinary Medicine·Catherine A IsonC S Easmon
Aug 1, 1989·Genitourinary Medicine·H MoiE Tornqvist
Apr 1, 1992·Genitourinary Medicine·C S EasmonC A Ison
Jan 5, 2000·Sexually Transmitted Infections·A L Blackwell
Feb 7, 2001·Sexually Transmitted Infections·O P AryaA D Goddard
Dec 11, 2002·Sexually Transmitted Infections·Catherine A Ison, P E Hay
Jan 13, 2005·Gynäkologisch-geburtshilfliche Rundschau·Christian Ruef
May 1, 1979·The Journal of Clinical Investigation·K C ChenK K Holmes
Apr 1, 2010·BMC Infectious Diseases·Hans VerstraelenMarleen Temmerman
Jun 10, 2011·Indian Journal of Medical Microbiology·J UdayalaxmiS Kotigadde
Oct 1, 1984·Journal of Clinical Microbiology·P PiotK K Holmes
Sep 19, 1981·British Medical Journal
Feb 1, 1982·The British Journal of Venereal Diseases·I M DattaniB A Evans
Jun 1, 1996·Genitourinary Medicine·S Edwards
Jan 1, 1997·Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology·A B KharsanyJ Moodley
Dec 1, 1985·American Journal of Obstetrics and Gynecology·J R WoodM Robbie
Aug 1, 1993·American Journal of Obstetrics and Gynecology·P B Mead
Oct 1, 1991·American Journal of Obstetrics and Gynecology·J L ThomasonN J Scaglione
Oct 1, 2008·Phytomedicine : International Journal of Phytotherapy and Phytopharmacology·M SimbarH Alavi Majd
Jun 1, 1983·Journal of Adolescent Health Care : Official Publication of the Society for Adolescent Medicine·W L MinkowskiB Schultz
Mar 1, 1981·Journal of Adolescent Health Care : Official Publication of the Society for Adolescent Medicine·J F RussoG Furness
Apr 16, 1998·American Journal of Obstetrics and Gynecology·S CauciF Quadrifoglio
Apr 25, 2000·Postgraduate Medicine·A S Coco, M Vandenbosche
Jan 1, 1989·Scandinavian Journal of Infectious Diseases·B WathneE Holst
Dec 1, 1994·Scandinavian Journal of Primary Health Care·A BaerheimA Digranes
Jan 1, 1997·Archives of Gynecology and Obstetrics·W ChaimJ R Leiberman
Jul 1, 1990·Journal of Veterinary Diagnostic Investigation : Official Publication of the American Association of Veterinary Laboratory Diagnosticians, Inc·S A SalmonB E Robinson
Dec 1, 1981·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·J F RussoG Furness
Apr 10, 2008·International Journal of STD & AIDS·W E Josey, J R Schwebke
Jan 1, 1996·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·S KüknerO Gökmen
Apr 16, 2015·MBio·Sujatha SrinivasanDavid N Fredricks
Oct 12, 2018·Expert Review of Molecular Diagnostics·Barbara Van Der Pol
Sep 1, 1993·Molecular Microbiology·S CauciG Menestrina
Nov 16, 2007·The Journal of Obstetrics and Gynaecology Research·Atef DarwishMohammad H Makarem
Feb 29, 2008·Orvosi hetilap·Zoltán KazyEndre Czeizel
Jan 25, 2005·BJOG : an International Journal of Obstetrics and Gynaecology·Erdinc OzkinayGungor Tuncay
Oct 1, 1986·Pediatric Annals·M Y FarmerF P Heald
Sep 1, 1988·British Journal of Obstetrics and Gynaecology·M VejtorpS S Schrøder
Apr 6, 2006·The Journal of Obstetrics and Gynaecology Research·Ditas Cristina D DecenaMarievi A Lelis
Nov 4, 2009·Expert Review of Anti-infective Therapy·Hans Verstraelen, Rita Verhelst
Jul 24, 2007·Indian Journal of Medical Microbiology·A AggarwalR Jain
Mar 4, 2014·Expert Opinion on Pharmacotherapy·Gilbert G G DondersDace Rezeberga
Nov 19, 2002·Journal of Medical Microbiology·H BirleyG B Wyatt
Jun 1, 1995·Obstetrical & Gynecological Survey·M C McCoyC H Livengood
May 1, 1986·Scandinavian Journal of Primary Health Care·H SchmidtB Korsager
Jun 17, 2009·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Ferenc BánhidyAndrew E Czeizel
Nov 19, 2010·Postgraduate Medicine·Martin Quan
Feb 22, 2011·Journal of Applied Microbiology·Y TurovskiyM L Chikindas
Sep 1, 1978·Postgraduate Medicine·K K Holmes, D Martin
Mar 1, 1992·International Journal of STD & AIDS·P D WoolleyA Eley
Nov 1, 1990·International Journal of STD & AIDS·K R Haye, D Mandal
Apr 1, 1991·Nihon Hinyōkika Gakkai zasshi. The japanese journal of urology·N Kawamura
Oct 1, 1990·Postgraduate Medicine·A Foreman, C B Smith
Jan 1, 1985·Archives of Gynecology·D A Eschenbach
Sep 1, 1985·Scandinavian Journal of Primary Health Care·H Schmidt, J G Hansen
May 1, 1983·Postgraduate Medicine·T Novotny
Nov 1, 1981·Drug Intelligence & Clinical Pharmacy·M H Stranz, W E Bradley
Jan 1, 1982·Clinical and Experimental Dialysis and Apheresis·M De PaepeG Verschraegen
Apr 1, 1982·Acta Pathologica, Microbiologica, Et Immunologica Scandinavica. Section B, Microbiology·P A CsángóG Jagars
Apr 1, 1994·The Annals of Pharmacotherapy·J R Schlicht
Jun 1, 1991·Asia-Oceania Journal of Obstetrics and Gynaecology·V ChandeyingS Tungphaisal
Sep 1, 1985·Scandinavian Journal of Primary Health Care·J G Hansen, H Schmidt
Jul 1, 1992·International Journal of STD & AIDS·P G Larsson
Sep 1, 1987·Diagnostic Cytopathology·G GiacominiA D'Acunto
Aug 1, 1982·Postgraduate Medicine·R S Edson, J E Rosenblatt
Sep 5, 1981·The Medical Journal of Australia·A Barton, M Kerr

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