Association of Mobiluncus curtisii With Recurrence of Bacterial Vaginosis

DESPITE THE FACT THAT bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginal discharge in the United States super(1,2) and is a risk factor for preterm birth super(3)and acquisition of HIV, super(4) its cause remains unknown and its treatment suboptimal. Not only are initial cure rates of BV poor, but recurrence rates are high. super(5) Debate exists as to whether recurrences are due to relapse or reinfection. However, 1 hypothesis is that relapse may occur secondary to inadequate treatment of BV-associated organisms, either due to resistance of BV. associated organisms to metronidazole or to inadequate penetration of a biofilm community. super(6,7) Anecdotally it is more difficult to eradicate BV in some women compared with others. Recent data substantiates this by the finding that women with more complicated vaginal flora reflected by higher Nugent scores (predominantly because of morphotypes consistent with Mobiluncus) are more likely to fail therapy than those with lower scores. super(8) The presence of Mobiluncus spp (M. curtisii and M. mulieris) in the vagina is highly specific although not sensitive for the diagnosis of BV. super(9,10) Of the two, M. curtisii appears to predominate and in vitro is resistant to metronidazole, the most commonly used therapy for BV. super(11) Therefore, recurrence of BV could be related to failure to clear this organism. Using specimens obtained from a prospective study of the treatment of BV, we determined if there was an association between persistence of M. curtisii and recurrence of BV at 65 to 70 days after completion of initial therapy.