gasseri and L iners on tRFLP, we were unable to differentiate be

gasseri and L. iners on tRFLP, we were unable to differentiate between L. gasseri and L. iners, also because we failed to culture these species consistently. Previous studies have applied tRFLP more successfully in this respect [33, 34]. Fifthly, it must be acknowledged that we did not record any behavioural factors that might have impinged on vaginal microflora status VS-4718 during the study. Though not necessarily confounding our results, this might have been most informative. Finally, as the study was conducted among pregnant women our results may not be representative for the natural history of the

vaginal microflora among non-pregnant women. Conclusion In conclusion, we believe to have documented that the presence of different Lactobacillus species with the normal vaginal microflora (VMF) is a major RepSox order determinant to the stability of the VMF in pregnancy. The presence of L. crispatus seems to ensure ongoing presence of L. crispatus and normal VMF; the Selleckchem KU57788 presence of L. jensenii is associated with normal VMF, but L. jensenii is more likely to disappear over time which may lead to overgrowth by other bacteria; the presence of L. gasseri/L. iners is likely to vary over time and strongly predisposes to bacterial overgrowth of the vagina in pregnancy. These observations are paramount in view of the vast disease burden associated

with depleted lactobacilli and bacterial vaginosis in particular, a condition that affects at any time some 10 to 50% of women worldwide [35]. As a matter of fact, the whole point of it is that these selleck screening library observations appear to challenge the century-old paradigm of “”normal”" or “”healthy”" vaginal microflora, a State that is still defined by the enumeration of bacterial cell morphotypes on microscopy.

In particular, as we found that some half of women actually have a microflora characterized by the poorer colonizers and defenders L. gasseri and L. iners, it may be inferred that in a substantial proportion of women lactobacilli-driven antimicrobial defence of the lower female genital tract is actually less optimal than can be assumed by the mere presence of lactobacilli. Methods Study Population In a prospective cohort study, unselected pregnant women were consecutively enrolled through informed consent on the occasion of their first antenatal visit, from January 2003 through May 2004, at the outpatient obstetric clinic of the Ghent University Hospital [8]. Patients were scheduled to provide three vaginal swabs at three points in time corresponding to subsequent pregnancy trimesters. The first 100 women with complete series of swabs were considered for longitudinal analysis of the normal vaginal microflora. Clinical procedures A cotton-tipped wooden vaginal swab (Euron, Ontex, Belgium) was rolled against the lateral vaginal walls, carefully withdrawn, and rolled out on a plain glass slide; the air-dried vaginal smear was then Gram-stained.

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