Bacterial Vaginosis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

BACTERIAL VAGINOSIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES ...

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BACTERIAL VAGINOSIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2003 by ICON Group International, Inc. Copyright ©2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Bacterial Vaginosis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83759-7 1. Bacterial Vaginosis-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on bacterial vaginosis. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON BACTERIAL VAGINOSIS ............................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Bacterial Vaginosis ....................................................................... 4 E-Journals: PubMed Central ....................................................................................................... 36 The National Library of Medicine: PubMed ................................................................................ 37 CHAPTER 2. NUTRITION AND BACTERIAL VAGINOSIS ................................................................... 81 Overview...................................................................................................................................... 81 Finding Nutrition Studies on Bacterial Vaginosis ...................................................................... 81 Federal Resources on Nutrition ................................................................................................... 83 Additional Web Resources ........................................................................................................... 83 CHAPTER 3. ALTERNATIVE MEDICINE AND BACTERIAL VAGINOSIS ............................................. 85 Overview...................................................................................................................................... 85 National Center for Complementary and Alternative Medicine.................................................. 85 Additional Web Resources ........................................................................................................... 89 General References ....................................................................................................................... 90 CHAPTER 4. CLINICAL TRIALS AND BACTERIAL VAGINOSIS ......................................................... 91 Overview...................................................................................................................................... 91 Recent Trials on Bacterial Vaginosis ........................................................................................... 91 Keeping Current on Clinical Trials ............................................................................................. 92 CHAPTER 5. PATENTS ON BACTERIAL VAGINOSIS.......................................................................... 95 Overview...................................................................................................................................... 95 Patents on Bacterial Vaginosis .................................................................................................... 95 Patent Applications on Bacterial Vaginosis............................................................................... 104 Keeping Current ........................................................................................................................ 107 CHAPTER 6. BOOKS ON BACTERIAL VAGINOSIS ........................................................................... 109 Overview.................................................................................................................................... 109 Book Summaries: Federal Agencies............................................................................................ 109 Book Summaries: Online Booksellers......................................................................................... 110 The National Library of Medicine Book Index ........................................................................... 110 Chapters on Bacterial Vaginosis ................................................................................................ 111 CHAPTER 7. MULTIMEDIA ON BACTERIAL VAGINOSIS ................................................................ 113 Overview.................................................................................................................................... 113 Video Recordings ....................................................................................................................... 113 Bibliography: Multimedia on Bacterial Vaginosis ..................................................................... 113 CHAPTER 8. PERIODICALS AND NEWS ON BACTERIAL VAGINOSIS ............................................. 115 Overview.................................................................................................................................... 115 News Services and Press Releases.............................................................................................. 115 Academic Periodicals covering Bacterial Vaginosis................................................................... 119 CHAPTER 9. RESEARCHING MEDICATIONS ................................................................................... 121 Overview.................................................................................................................................... 121 U.S. Pharmacopeia..................................................................................................................... 121 Commercial Databases ............................................................................................................... 122 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 125 Overview.................................................................................................................................... 125 NIH Guidelines.......................................................................................................................... 125 NIH Databases........................................................................................................................... 127 Other Commercial Databases..................................................................................................... 131 APPENDIX B. PATIENT RESOURCES ............................................................................................... 133 Overview.................................................................................................................................... 133

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Patient Guideline Sources.......................................................................................................... 133 Finding Associations.................................................................................................................. 138 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 141 Overview.................................................................................................................................... 141 Preparation................................................................................................................................. 141 Finding a Local Medical Library................................................................................................ 141 Medical Libraries in the U.S. and Canada ................................................................................. 141 ONLINE GLOSSARIES................................................................................................................ 147 Online Dictionary Directories ................................................................................................... 147 BACTERIAL VAGINOSIS DICTIONARY............................................................................... 149 INDEX .............................................................................................................................................. 197

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with bacterial vaginosis is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about bacterial vaginosis, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to bacterial vaginosis, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on bacterial vaginosis. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to bacterial vaginosis, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on bacterial vaginosis. The Editors

1 From

the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

3

CHAPTER 1. STUDIES ON BACTERIAL VAGINOSIS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on bacterial vaginosis.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and bacterial vaginosis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “bacterial vaginosis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Bacterial Vaginosis Increases in Pessary Users Source: International Urogynecology Journal. 11(4): 219-223. August 2000. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This article reports on a study undertaken to examine the association between pessary use, smoking, and changes in the vaginal flora (bacteria). Patients using pessaries (n = 44) were age matched with non pessary using controls (n = 176). All candidates examined were women attending the Mount Sinai Hospital, Toronto, for genitourinary problems. Vaginal cultures were routinely performed on all women attending the unit, irrespective of symptoms. The mean age was 60.1 years (plus or

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Bacterial Vaginosis

minus 12.6 years), and 15 percent of these women were premenopausal. The duration of pessary use ranged from 0.5 to 8 years (mean 3.3 years, plus or minus 1.7 years). Weight, parity (number of pregnancies), smoking status, diabetes mellitus, thyroid disease, urinary tract infection (UTI), and postvoid residual urine volume were not significantly different between pessary users and controls. Bacterial vaginosis (BV) was noted in 32 percent of pessary users, versus 10 percent of controls. The relative risk of developing BV in pessary users was 3.3. Smoking independently affected the vaginal flora, increasing the relative risk of developing BV to 2.9. The authors conclude that pessary use is a very effective and conservative method for the treatment of genital prolapse. However, the authors found that the presence of a foreign body (the pessary) was associated with changes in the vaginal flora, thereby increasing the odds of developing bacterial vaginosis to 4.37; this was further compounded by smoking. 4 tables. 28 references.

Federally Funded Research on Bacterial Vaginosis The U.S. Government supports a variety of research studies relating to bacterial vaginosis. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to bacterial vaginosis. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore bacterial vaginosis. The following is typical of the type of information found when searching the CRISP database for bacterial vaginosis: •

Project Title: A RAPID DIAGNOSTIC TEST FOR BACTERIAL VAGINOSIS Principal Investigator & Institution: Johnson, Stephen C.; Ibbex, Inc. 2800 Milan Ct, Ste 373 Birmingham, Al 35211 Timing: Fiscal Year 2001; Project Start 01-JUN-2000; Project End 31-MAY-2002 Summary: The long-term goal of this project is to develop an effective and rapid diagnostic test for bacterial vaginosis which infects about 35% of women. This test is based on the fact that consistently elevated levels of sialidase enzyme was observed in the vaginal samples of women who had bacterial vaginosis. The specific aims for this period include: (1) analytical studies on synthetic chromogenic substrates using pure stock-culture aerobic and anaerobic isolates, (2) pre-clinical trials on synthetic chromogenic substrate compounds using patient vaginal fluid samples, (3) scale-up synthesis of the most promising compound, (4) develop a packaging format for the product, (5) conduct a planned human clinical trial, and (6) file 510(k) application with the US FDA. Based on the results of previous studies, effective treatment of bacterial

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

Studies

5

vaginosis in pregnant women reduces preterm labor and preterm delivery by 50%. The new test developed from this technology will significantly aid physicians in correctly and rapidly diagnosing bacterial vaginosis, which is believed to be under diagnosed due to limitations of available methods. PROPOSED COMMERCIAL APPLICATION: This new diagnostic test will aid physicians to correctly and rapidly diagnose the common disease, bacterial vaginosis. Published data has shown that effective treatment of diagnosed cases of bacterial vaginosis reduces the incidence of preterm birth by 50%. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: A SIMPLE SELF-TEST FOR VAGINAL FLORA STATUS Principal Investigator & Institution: Lawrence, Paul J.; Litmus Concepts, Inc. 2981 Copper Rd Santa Clara, Ca 95051 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 30-MAY-2002 Summary: Bacterial vaginosis (BV) is now recognized as a risk factor for adverse reproductive health sequelae in women. It results from a complex disturbance of the vaginal ecology. Normal vaginal flora (FLORA) is usually characterized by a predominance of aerobic lactobacilli. BV results from the replacement of the normal FLORA with a mixed FLORA consisting primarily of facultative and anaerobic organisms. Vaginal lactobacilli act as endogenous vaginal microbicides by producing H2O2 and other factors that can inhibit growth or survival of genital pathogens. The use of a vaginal suppository containing viable lactobacilli is now being evaluated as a prophylaxis against genital tract infection. Unfortunately, the recommended methods for detecting FLORA changes associated with BV [the Amsel criteria (AMSEL) and Gram stain (GRAM)] are unsuitable for direct use by patients and consumers. Litmus Concepts, Inc. (LCI) has shown that its resident technology can be modified to distinguish women with a predominance of normal FLORA from women with a disturbed FLORA. This technology advance will be incorporated into a consumer device to permit women to determine their own vaginal flora status. After completing product development, LCI will manufacture three commercial lots of the product; test the ability of untrained women to self-sample VF, use the product, and interpret test results. Clinical data will be compiled into a regulatory submission to the FDA to obtain clearance to market the device. PROPOSED COMMERCIAL APPLICATION: The LCI product will be suitable for direct use by women as a surrogate for the presence of normal FLORA. By providing an objective, reproducible, visual determination quickly and easily, the LCI product can assist women to monitor their gynecological health. A consumer use product can reduce health care costs, improve quality of life and assist physicians in monitoring patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: ANTI-HIV MICROBICIDE: CELLULOSE ACETATE PHTHALATE (CAP) Principal Investigator & Institution: Neurath, Alexander R.; Member; New York Blood Center 310 E 67Th St New York, Ny 10021 Timing: Fiscal Year 2001; Project Start 26-SEP-2001; Project End 31-JUL-2005 Summary: (provided by applicant): Cellulose acetate phthalate (CAP) has been used as an enteric film coating material or as a matrix binder for tablets and capsules. It is widely used in oral pharmaceutical products and is generally regarded as a nontoxic material free of adverse effects. It is included in the FDA Inactive Ingredients Guide and is listed in pharmacopoeias internationally. CAP is available in large quantities and is

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inexpensive. It was demonstrated that CAP: 1) has antiviral activity against HIV-1 and several herpesviruses (HSV); and 2) when formulated in a micronized form a) inactivated in vitro HIV-1, HSV-1. HSV-2, cytomegalovirus, Neisseria gonorrhoeae, Trichomonas vaginalis, Haemophilus ducreyi and Chlamydia trachomatis; b) inactivated bacteria associated with bacterial vaginosis; c) protected mice against vaginal infection by HSV-2; and d) protected 4/6 rhesus monkeys from vaginal infection with simian immunodeficiency virus (SIVmac251). These results have established the promise of CAP as a microbicide for prevention of sexual transmission of HIV-1. Additional preclinical studies are needed to further support this promise. This includes: (Project I): Prevention of infection by primary HIV-1 isolates and distinct HIV-1 clades in cell cultures in vitro and in human cervical and rectal tissue models; (Project II): a) Assess the safety of CAP in a monkey model by colposcopic examinations and measurement of pro-inflammatory chemokines and cytokines; b) Assessment of CAP distribution after vaginal application in monkeys using chemically tagged CAP and colposcopy, and magnetic resonance imaging (MRI); and c) Evaluate the efficacy of CAP against infection with pathogenic X4- and R5-specific simian/human chimeric HIV viruses (SHIV), respectively; (Project III): Measurement of pro-inflammatory chemokines and cytokines after exposure of cervical and vaginal epithelial cells in culture to CAP; (Project IV): Studies on CAP-human sperm interactions to assess the spermicidal/contraceptive potential of CAP and its formulations. Information gained from the proposed studies, coordinated and supplied by uniform and quality controlled formulations by Cores A, B, respectively, is expected to facilitate the design of Phase I, II and III human clinical trials. CAP meets criteria proposed for an ideal microbicide: activity in presence of semen and blood; activity against sexually transmitted infections other than HIV-1; condom compatibility, negligible systemic absorption (due to its large, molecular mass and micronized state); lack of color and unpleasant taste; and low cost. The proposed research is expected to help transform this ideal into a reality. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BACTERIAL VAGINITIS AS A COFACTOR FOR HIV1 SHEDDING Principal Investigator & Institution: Hitti, Jane E.; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002 Summary: We propose a 5 year study of the interactions between reproductive tract infection, inflammation and genital HIV shedding in women. We plan to examine the hypothesis that increased genital tract HIV-1 shedding occurs in association with altered vaginal flora, cervicitis, and endometricitis, all of which are usually sub-clinical conditions that describes a continuum of ascending genital tract infection. An increase in vaginal and cervical proteolytic enzymes may promote the traffic microbes through the cervix to the endometrium to produce cervicitis and endometritis. The mechanisms by which abnormal vaginal flora, cervicitis increase genital HIV shedding include depletion of protective H2O2 lactobacilli, increased vaginal pH, decreased reduction-oxidation potential and altered vaginal and cervical inflammatory cytokines, which together selectively up-regulate LTR transcription through NF-kappaB. As such, oral antibiotic treatment of BV and cervicitis should decrease HIV shedding. We will examine the following specific aims: 1. To examine the associations between vaginal flora and HIV RNA concentrations in endocervical and vaginal fluid. We hypothesize that increased anaerobes, G. vaginalis and M. hominis in vaginal flora caused increased cervical and vaginal HIV RNA replication and that H2O2- producing Lactobacillus are productive. 2. To study the relationship between reproductive tract inflammation and genital HIV

Studies

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shedding. We hypothesize that an inflammatory response in the vagina, cervix and uterus results in increased genital HIV shedding. 3. To determine whether antibiotic treatment for bacterial vaginosis and cervicitis decreased genital HIV shedding. We hypothesize that oral antibiotic treatment will re-establish normal vaginal flora and decrease local inflammation, resulting in decreased endocervical HIV shedding. Women will be enrolled from 2 sites in the United States. In addition, a BV treatment study will be carried our in parallel in a cohort of HIV- infected Kenyan women not on antiretroviral therapy. These studies should help to define the inter-relationships between altered vaginal flora, upper genital tract inflammation, the host inflammatory response and genital HIV shedding. By including an African cohort, we will learn about the relative contributions of genital tract infection and inflammation and anti-retroviral therapy to genital HIV load. Finally, we will learn whether antibiotic therapy with the goal to establish normal vaginal flora and decreases cervicitis and endometritis has the potential to decrease HIV shedding in the female genital tract in both anti-retroviralexperienced women and women without access to HIV treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BACTERIAL VAGINOSIS AND HIV IN THE GENITAL TRACT Principal Investigator & Institution: Spear, Gregory T.; Professor; Rush-Presbyterian-St Lukes Medical Ctr Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 23-APR-2001; Project End 31-MAR-2006 Summary: Bacterial vaginosis (BV) is a common condition in women characterized by an overgrowth of a mixture of anaerobic and other bacteria, typically including Gardnerella vaginalis and Mycoplasmas. However, the flora that constitutes BV can be highly variable. Women with BV have a higher incidence of HIV infection suggesting that BV increases susceptibility to HIV infection. One expansion for increased susceptibility is that BV organisms replace lactobacilli that produce virucidal substances. However, it is also possible that BV affects HIV replication in the genital tract by either increasing the susceptibility of cells to HIV infection or by stimulating cells to produce virus. A recent study showed that HIV RNA was detected more frequently in cervicovaginal lavage (CVL) fluid from women with BV showed that HIV RNA was detected more frequently in cervico vaginal lavage (CVL) fluid from women with BV than those without. Previous work by our group showed that some BV-associated organisms (e.g. G vaginalis and M. hominis) stimulated HIV expression by infected cells while others (U. Urealyticum and lactobacilli) did not). We hypothesize that colonization by certain BV-associated bacteria increases genital tract virus load (VL). To test this in aim 1 we will obtain CVL samples from a cross-section of HIV+ women with and without BV. The numbers of four specific bacteria, G. vaginalis, M. hominis, Mobiluncus and Lactobacillus will be determined by PCR and compared with the genital tract VL. In aim 2, women with BV will be treated and the effect on genital tract VL and bacterial will be determined. A significant association between HIV and a specific organism, or reduction due to treatment, would indicate that colonization with that organism influences genital tract VL, provide an explanation for how BV increases susceptibility to HIV infection and point strategies for reducing transmission. Earlier we found that expression of a genital tract factor that induces HIV replication (HIF) was significantly associated with BV. We also hypothesize that treatment of BV will decrease HIF expression and will test this aim in aim 3 to determine a cause and effect relationship between BV and HIF. Finally, in aim 4 the effect of BV, HIF and BV-bacteria on induction of specific genital tract immune responses in vaccinated seronegative women will be determined.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BACTERIAL VAGINOSIS AND SPONTANEOUS ABORTION Principal Investigator & Institution: Nelson, Deborah B.; Biostatistics and Epidemiology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAR-2005 Summary: Bacterial vaginosis (BV) is extremely prevalent among low-income, urban pregnant women. The current standard of medical care does not involve screening pregnant women for BV unless clinical symptoms are reported; however, the majority of pregnant women with BV are asymptomatic. A number of studies have found associations between BV and late pregnancy outcomes; such as, preterm labor, premature rupture of membrane, chorioamnionitis, and low birth weight. The impact of BV on the risk for spontaneous abortion (SAB) is unclear. In the proposed prospective cohort study, all women will be screened for BV early in pregnancy regardless of symptoms. The specific aims of this study are to: 1) characterize the prevalence and predictors of BV in women early in pregnancy and 2) evaluate whether BV during pregnancy is an important, independent predictor of SAB. Women attending their first clinical prenatal care visit at the Hospital of the University of Pennsylvania Obstetric Clinic with a pregnancy of 12 weeks gestation or less as determined by last menstrual period will be recruited. We will screen all women for bacterial vaginosis and followup through 22 weeks gestation to identify women experiencing a spontaneous abortion. We will enroll 2200 women over a three year period arid compare SAB rates for the estimated 400 women found to test positive for BY (20 percent of patients) and the 1600 women found to test negative for By. Baseline data collection will be standardized and include a structured in-person interview, a vaginal smear used to detect By, and urine analysis to determine alcohol, cocaine and cotinine. Follow-up telephone interviews will be conducted at 22 weeks gestation to determine the status of pregnancy (SAB vs. nonSAB) and BV diagnosis and treatment. Pregnancy outcome status will also be ascertained through ongoing review of medical records, pathology logs and birth certificates. Initial analyses will be exploratory and descriptive, characterizing the prevalence and predictors of BV and the risk factors for SAB. The primary analysis will be logistic regression, with relative risks and 95 percent confidence intervals, to explore whether BV is an independent predictor of SAB. This study will provide a unique opportunity to evaluate the prevalence of BV among pregnant women and to determine the relationship between BV and incident SAB. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: BIOMEDICAL APPLICATION OF AN ELECTRONIC NOSE Principal Investigator & Institution: Lewis, Nathan S.; Professor; None; California Institute of Technology Mail Code 201-15 Pasadena, Ca 91125 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2005 Summary: The focus of this proposal will be to exploit the vapor detection technology developed recently at Caltech that forms the basis for a low power, simple, manufacturable, "electronic nose". In this technology, an array of sensors responds to essentially all vapors, but produces a distinguishable response pattern for each separate type of analyte or mixture, much like the mammalian olfactory sense produces such diagnostic patterns and then transmits them to the brain for processing and analysis. Pattern recognition algorithms and/or neural network hardware are used on the output signals arising from the electronic nose to classify, identify, and where necessary

Studies

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quantify the vapor or odors of concern and to associate them with certain disease states associated with volatile biomarkers in the breath or other headspace samples. Due to the present high sensitivity of our electronic nose to biogenic amines (detection levels of 110 ppt in a few seconds in room air), which far exceeds that of humans for this class of compounds, we plan to initially explore the use of the sensor arrays to screen for bacterial vaginosis, which has been positively associated with the presence of "fishy" odors that arise from volatile biogenic amines in the headspace above vaginal swabs. In addition, we will advance the science and technology of the electronic nose sensors to obtain still improved sensitivity and time response for other biomarkers, so as to open up further medical application areas and to respond to potential confounding interferences identified by the initial small-scale clinical studies on the targeted, initial demonstration application of the technology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BV TRANSMISSION

ETIOLOGY,

NATURAL

HISTORY,

AND

SEXUAL

Principal Investigator & Institution: Wawer, Maria J.; Professor; Population and Family Health; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-MAR-2005 Summary: The proposed study will test hypotheses regarding microbiological, virological and behavioral risk factors for the development of bacterial vaginosis (BV), a common vaginal condition which is increasingly recognized as having serious health sequelae, including adverse pregnancy outcomes, pelvic inflammatory disease, and increased risk of HIV infection. The etiology and natural history of BV are poorly understood. The study will be conducted in Rakai District, Uganda, where approximately 50 percent in the general population of women of reproductive age have BV. We propose to conduct two complementary research activities: I, a BV natural history study in a cohort of 250 women (with and without BV, HIV and prior sexual experience), and II, a study in 50 polygamous family units which will enrol the husband, his wives and other women residing in the household. Repeated interview and sample collection in the two studies will be used to assess transition probabilities of BV onset, persistence, regression and recurrence in relation to: a) detailed sociodemographic, behavioral and health data; b) vaginal microflora, particularly Lactobacillus species (which will be characterized using DNA homology and assessed for H2O2 production) and c) the potential presence of lactobacillus bacteriophages, whose possible role in Lactobacillus depletion will be explored. In the polygamous household study, we will determine whether factors associated with normal vaginal flora or with BV (including lactobacilli, anaerobes and phages) may be transmitted sexually or via close household contact such as through the sharing of bathing utensils or water, by comparing women with a polygamous sexual network to other women within the household. The Rakai population offers a unique opportunity to assess BV. We previously enrolled and followed approximately 7,000 women in a population-based trial of STD control for AIDS prevention, have documented increased risk of HIV and adverse birth outcomes in women with BV, and have evidence of improved pregnancy outcomes with STD/BV treatment. The proposed study will provide unique epidemiological, microbiological and virological data regarding normal vaginal flora in this rural African population, the natural history of BV, and on potential causes of this prevalent condition. Such information will be critical for the design of future BV prevention, treatment and control trials, including selection of interventions to be tested, sample size requirements and definition of study end points.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHLAMYDIA TRACHOMATIS AND BACTERIAL VAGINOSIS Principal Investigator & Institution: Wagar, Elizabeth; Professor; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001 Summary: The worldwide epidemic of sexually transmitted disease is threatening, especially to young adults. New female-controlled strategies for preventing STDs are needed urgently. Also needed are more effective means of managing bacterial vaginitis/vaginosis (BV) - a common condition of unknown cause, that increases the likelihood of upper genitourinary tract infections. This proposal is based on the discovery that protegrins, a recently described class of antibiotic peptides inactivate the elementary bodies (Ebs) of Chlamydia trachomatis, kill N. gonorrhoeae and H. ducreyii, and also protect cells from infection by HIV-1. Our previous studies defined the essential structural features of protegrins needed for activity against chlamydia EBS, gonococci and C. albicans. We now propose to "fine tune" the protegrin design. By this process, we expect to generate protegrins that will kill the major bacterial STD pathogens and protect cells from HIV-1 uptake, without affecting normal vaginal Lactobacilli. Preliminary data show that this can be accomplished by replacing selected key amino acid residues. Our two specific aims are essential components of the overall plan to design a protegrin molecule with optimal properties. Specific Aim 1. We will test the susceptibility of bacteria (Gardnerella vaginalis, Mobiluncus, Prevotella, Bacteroides, etc.) typically associated with bacterial vaginosis (BV) to synthetic protegrins and to selected peptides. The BV microorganisms to be tested will include: These studies will focus on protegrins with little or no effect against Lactobacillus sp. Specific Aim 2. We will examine the sensitivity of C. trachomatis Ebs to protegrins and to selected peptides. In addition to testing pure cultures of archival vaginal isolates, we will test protegrins and other antimicrobial peptides on fresh clinical isolates that will be obtained from normal women and subjects with BV. Since these studies will be closely coordinated with an examination of vaginal antimicrobial polypeptides, they can also provide important insights into the pathogenesis of bacterial vaginosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CHLORHEXIDINE IRRIGATION TO PREVENT INFECTION Principal Investigator & Institution: Rouse, Dwight J.; Obstetrics and Gynecology; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 01-JAN-1999; Project End 31-DEC-2001 Summary: Clinically overt infection of the placenta, fetal membranes, or uterus during labor (chorioamnionitis) complicates from 1% to 11% of pregnancies. The incidence of uterine infection after delivery (endometritis) varies from 1%-3% after vaginal delivery to 15-20% after cesarean delivery. Chorioamnionitis is a recognized risk factor for bacteremia and septic shock and is associated with a several-fold increase in the risk for cesarean delivery. Women who undergo cesarean delivery in the setting of chorioamnionitis are at increased risk of serious pelvic and wound infection. The most severe complications of endometritis (including, rarely, death from whelming sepsis) usually occur after cesarean delivery. The economic costs of chorioamnionitis and endometritis (collectively referred to as peripartal infection) are substantial and can be conservatively estimated at $120,000,000 a year in the U.S. for post- cesarean infections alone. The offspring of women with chorioamnionitis are exposed to invasive diagnostic

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testing (e.g. lumbar puncture for cerebrospinal fluid assessment), intravenous antibiotic therapy, prolonged hospitalization, sepsis, and death, Survivors face an increased risk of cerebral palsy. Furthermore, the costs of caring for infants born to mothers with chorioamnionitis may easily exceed the maternal costs of peripartal infection. Because the etiology of chorioaminonitis and endometritis is ascending infection of endogenous cervico-vaginal bacteria, intrapartum irrigation of the vagina and cervix with an antibacterial as a logical approach to prevention of peripartal infection. To be clinically useful, such an agent would need to possess broad antimicrobial activity, and be nontoxic and non-irritating for mother and fetus. Ideally the agent would be commercially available and inexpensive. The widely used medical disinfectant chlorhexidine satisfies these requirements. There we aim: 1) To conduct a placebo-controlled, double- masked, randomized clinical trial to determine whether intrapartum vaginal irrigation with a dilute chlorhexidine solution will prevent or lessen the trial to determine whether intrapartum vaginal irrigation with a dilute chlorhexidine solution will prevent or lessen the severity of the maternal peripartal infections--chorioamnionitis and endometritis; 2) To determine whether intrapartum vaginal irrigation with a dilute chlorhexidine solution will reduce the rate of microbial invasion of the chorioamnion; 3) To determine whether intrapartum vaginal irrigation with a dilute chlorhexidine solution will reduce the rate of acute histologic chorioamnionitis; 4) To determine whether the presence of bacterial vaginosis is associated with a differential effect of chlorhexidine vaginal irrigation on the maternal peripartal infection rate; and 5) To determine whether intrapartum vaginal irrigation with a dilute chlorhexidine solution reduces the rates of neonatal sepsis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL ASPECTS OF VIRUS-HARBORING TRICHOMONAS VAGINALIS Principal Investigator & Institution: Piper, Jeanna M.; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2001 Summary: Human suffering and health care costs due to sequellae of STDs are escalating worldwide, including pelvic inflammatory disease, chronic pelvic pain, involuntarily infertility, and ectopic pregnancies. Project 5 will correlate clinical characteristics of T. vaginalis infections (including behavioral and demographic features as well as co-infections with other STD agents) with the presence or absence of dsRNA virus in T. vaginalis isolates. These two clinical T. vaginalis isolate types (i.e., with and without dsRNA virus) exist naturally and contribute to different outcomes in clinical demographic, and behavior parameters to be evaluated. Thus, as documented in Project 1, the virus provides a marker from which to carry out comparative clinical and adverse outcome studies. Specific Aim 1 perform a comprehensive evaluation of T. vaginalis isolates with an without dsRNA virus and relate these data to various clinical parameters by a) examining characteristics (genitourinary symptoms and physical findings) between vaginitis caused by virus-harboring and virus-minus isolates in pregnant and non-pregnant women, b) evaluating behaviors, demographic features and partner history associated with the two isolate types of T. vaginalis, and c) establishing linkages between infection with the two isolate types and other STD agents. Specific Aim 2 will evaluate the risk of adverse outcomes in women with STDs during pregnancy by a) examining infections by T. vaginalis with and without dsRNA virus and b) simultaneously examining and identifying other current infections (gonorrhea, chlamydia, bacterial vaginosis, group B, streptococcus, syphilis, HHV8, and M.

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genitalium). Specific Aim 3 will facilitate collaborations with the other four Projects by a) providing fresh clinical T. vaginalis isolates from patients with trichomonosis for Project #1, b) coordinating identification and follow-up of pregnant women with the HHV8 Project #2 by collecting maternal samples and pregnancy outcome data, c) providing clinical data dn specimens for the Mycoplasma genitalium Project 3, and d) providing clinical expertise and additional infection information to Behavioral Project 4. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DOUCHING AND REPRODUCTIVE TRACT INFECTIONS Principal Investigator & Institution: Funkhouser, Ellen M.; Epidemiology & Interntl Health; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: Douching is a common practice among American women, especially in the South, among Black women, and among women who are less educated. Douching has been associated with many adverse health events including pelvic inflammatory disease and ectopic pregnancy, and to a much less well established degree, sexually transmitted diseases (STDs). The proposed project is a cross-sectional study of reproductive tract infections and douching practices in Jefferson County, AL. Women attending the County STD clinic and 2 County Family Planning Clinics will be interviewed prior to examination regarding douching practices and history of sexual activities, pregnancies, contraceptive practices, and STDs. Presence of infections and pH of vaginal secretions will be ascertained from appropriate tests. Cases will be women presenting with syphilis, gonorrhea, trichomonas, chlamydia , or bacterial vaginosis. Over a 29 month period 4,370 women, 1,400 from the STD clinic and 2,970 from the Family Planning Clinics, will be interviewed. This should provide about 935 STD cases, 577 cases of bacterial vaginosis without an STD, and 2,858 women with no infections. Douching practices among women with and without a reproductive tract infections will be compared. Logistic regression analysis will be used to assess the following: 1) whether douching is associated with increased risks of STDs or bacterial vaginosis; 2) whether douching is associated with vaginal pH; 3) whether there is a dose-response relationship regarding frequency of douching; and 4) whether the risk differs according to preparation used. We believe the similarities in socioeconomic status of women attending the clinics will be substantial making douching practices potentially one of the most distinguishing characteristics of women with and without an infection. Furthermore, the findings will be readily generalizable to a population that historically and currently has some of the highest STD rates in the nation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DOUCHING, VAGINAL MICROBIOLOGY, AND PID Principal Investigator & Institution: Ness, Roberta B.; Professor and Chair; Epidemiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 01-DEC-1998; Project End 30-NOV-2003 Summary: Pelvic inflammatory disease is a major or cause of reproductive morbidity worldwide. Its sequelae include tubal infertility, chronic pelvic pain, recurrent PID and ectopic pregnancy. Douching is a common and possibly modifiable potential risk factor for PID, but a handful of previous studies examining this association are retrospective and conflicting. At the same time, compelling data suggest that douching may alter the vaginal microenvironment, thereby predisposing to bacterial vaginosis and perhaps,

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resultant PID, but this has not been fully tested. We propose to conduct a large, multicenter, prospective cohort study to examine the independent association between douching and PID and to study the effect of douching on vaginal microbiology. We will enroll 1800 women at high risk for acquiring sexually transmitted infections. Half will be women who report douching consistently at least once per month over the past six months; half will be women who report never douching in the past six months. Enrolled women will be evaluated at baseline by interview for behavioral characteristics related to douching and STD risk and by lower genital tract microbiology for N. gonorrhoea, C. trachomatis, bacterial vaginosis, and concentrations of lactobacillus, anaerobes and facultative bacteria. During 3-4.5 years of follow-up, serial interviews will be completed and self-obtained vaginal swabs assessed for lactobacilli and other vaginal bacteria. The primary outcome of PID (symptomatic endometritis), will be compared between the douching and non-douching groups. We will also compare the following: 1) gonococcal or chlamydial cervicitis at baseline, 2) bacterial vaginosis and semi-quantitative lactobacilli concentration at baseline, 3) change during follow-up in the concentration of lactobacilli (hydrogen-peroxide producing and non-producing), as well as anaerobic and facultative bacteria. Given the paucity of information regarding the relationship between douching and reproductive outcomes, the proposed study is imperative in order to direct future public health recommendations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FEMALE GENITAL TRACT IN HIV PATHOGENESIS Principal Investigator & Institution: Landay, Alan L.; Professor and Associate Chairman; Rush-Presbyterian-St Lukes Medical Ctr Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 23-APR-2001; Project End 31-MAR-2006 Summary: The program project " Genital Tract in HIV pathogenesis" will investigate immunologic, and host factors in the female genital microenvironment that influence HIV infectivity and susceptibility. This program project integrates three research projects and three Core facilities. Subproject 0001, "Bacterial Vaginosis ( BV) and HIV in the Female Genital Tract" proposes that BV in the genital tract increases HIV susceptibility and will assess the effects or organisms associated with BV on HIV expression. Subproject 0002, "Female Genital Tract Immunity and HIV vaccine responses" focuses on HIV specific vaccination, and the role of pre-existing genital tract HIV immunity in the response to immunization. Subproject 0002, "HIV-1 Susceptibility Factors in Cervical Secretions" will focus on the microbiology/immunology of the cervical microenvironment and how secreted and microbial factors inhibit or enhance susceptibility to HIV infection in the female genital tract. The projects will utilize the well established HIV cohorts (REACH, WIHS, WITS) spanning ages from adolescence to adulthood and the spectrum of HIV infection from asymptomatic to AIDS as well as two nigh risk seronegative cohorts. The research projects are supported by three Cores: Statistics and Data Management Core coordinating research, scientific meetings and data management support; the Clinical Core managing subject recruitment, existing cohort utilization and clinical data collection; and the Laboratory Core establishing a specimen repository and providing virologic and immunologic assays. By characterizing factors affecting HIV infectivity and susceptibility to infection, the studies will increase our understanding of sexual and perinatal HIV transmission and contribute to future therapy and vaccine strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENITAL TRACT MUCOSAL IMMUNE FACTORS IN PREGNANCY Principal Investigator & Institution: Goepfert, Alice R.; Obstetrics and Gynecology; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 28-AUG-2000; Project End 30-JUN-2002 Summary: (Adapted from applicant's description): Pregnancy is associated with substantial hormonal and anatomical changes primarily for the support and protection of the developing fetus. In fact, the leading cause of infant morbidity and mortality in the U.S. today, preterm birth, has been associated with upper genital tract infection which presumably ascends from the lower genital tract. However, no studies in the current literature have evaluated the mucosal immune system during pregnancy. In order to characterize mucosal immune factors of the lower genital tract in pregnancy, have propose the following specific aims: 1) To determine if there are longitudinal changes in the mucosal immune system of the lower genital tract (cervix and vagina) in pregnant women when followed in each trimester during pregnancy, 2) To determine if differences exist in mucosal immune factors of the lower genital tract in pregnant women at each trimester of pregnancy with and without selected risk factors (such as bacterial vaginosis, other pelvic infections, black race) for certain pregnancy complications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GLOBAL NETWORK FOR WOMEN'S & CHILDREN'S HEALTH RESEARCH Principal Investigator & Institution: Goldenberg, Robert L.; Professor; Obstetrics and Gynecology; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 03-SEP-2001; Project End 30-APR-2006 Summary: We will develop a University of Alabama at Birmingham-Aga Khan University multidisciplinary research team with its major goal the reduction of infection-related perinatal mortality in Pakistan. To accomplish this goal, we will continue to build the UAB-AKU research relationship around a series of studies on perinatal infection and pregnancy outcome. The first study will characterize two populations of Pakistani pregnant women. A cohort study consisting of 1500 urban and later 1500 rural women will be performed in which data will be collected near midpregnancy on infections such as bacterial vaginosis, gonorrhea and chlamydia, and on various pregnancy-associated cervicovaginal and serum markers of infections. These data will be correlated with pregnancy outcome. We will also collect psychosocial, nutritional, medical and dental data and correlate these results with bacterial infection of the vagina, the infection markers and with pregnancy outcome. The goal of this study is 1) to determine the current pregnancy outcomes in two Pakistani populations, 2) to determine the prevalence of vaginal infections and markers of infection in these two populations, and 3) to determine the prevalence of various psychosocial, nutritional, medical and dental factors associated with vaginal infection, markers of infection and adverse pregnancy outcomes. Upon completion of the urban cohort study, women identified as high risk for perinatal death because of a previous perinatal death will be invited to participate in a randomized trial of prenatal and perinatal antibiotics to reduce infection-related perinatal mortality. In this study, women who have had a previous stillbirth or a neonatal death will be randomized to one week of treatment with metronidazole and erythromycin or placebos in the late second trimester, with a repeat course of antibiotics or placebo in labor. The primary endpoint will be perinatal mortality. Our second attempt to decrease infection-related mortality will be in a

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randomized trial of an intrapartum and infant chlorhexidine wash versus placebo washes with saline. With the completion of these projects, not only will we have answered some very important questions related to infections and pregnancy outcome, but AKU, in partnership with UAB, will have developed superb rural and urban pregnancy-related research infrastructures tightly linked to their developing maternity health care systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GU INFECTION SELF-DIAGNOSIS FOR DEPLOYED MILITARY WOMEN Principal Investigator & Institution: Ryan-Wenger, Nancy A.; Professor; None; Ohio State University 1800 Cannon Dr, Rm 1210 Columbus, Oh 43210 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-JAN-2005 Summary: Approximately 347,000 women serve in the U.S. military, and regularly deploy to austere military environments where harsh climate and terrain, primitive hygiene facilities, and unavailable or unacceptable health care resources for women increase women's risk for development of vaginitis and urinary tract infections (UTI). Untreated or inadequately treated symptoms of bacterial vaginosis, trichomonas vaginitis, candida vaginitis, and UTI are miserable, embarrassing, distracting and significantly interfere with women's quality of life, comfort, and concentration. In deployment situations, a viable solution to the problem is a field-expedient kit for selfdiagnosis and self-treatment of these symptoms. Preliminary work supports the need for such a kit and the feasibility of developing a kit that is user-friendly, sensitive and specific. In this study, 1560 Army and Navy women who seek care from a military clinic for vaginal or urinary symptoms, will conduct a self-diagnosis using a Decision-Making Guide and selected materials to measure vaginal and urinary symptoms, and vaginal pH and amines. We will test the sensitivity and specificity of military women's selfdiagnoses in comparison with laboratory reference standards (urine culture and DNA probe testing for gardnerella vaginalis, trichomonas vaginalis, and candida species). A research advanced practice nurse (APN) will enroll women in the study, conduct a protocol-driven clinical diagnostic examination, and treat the women with selected single-dose oral medications that will ultimately be included in the field-expedient selfcare kit. The women's observations on the Decision-Making Guide will be compared with the APN's clinical observations to evaluate the extent to which each item in the Guide contributes to the true diagnosis. We will also estimate the frequency with which women would have made an error in self-treatment based on their self- diagnoses if they had used this kit during deployment. The women will return to the clinic for follow-up visits with the APN in order to evaluate their satisfaction with the selfdiagnosis process and the single-dose oral treatment of their symptoms, and for their recommendations for improvement of the kit. While this proposed research focuses on a self-care intervention for military women, it has a much broader potential for use by civilian women who find themselves in austere environments for other reasons, i.e. missionary work, Peace Corps, humanitarian missions, expeditions, or foreign travel. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HERPES & STIGMA Principal Investigator & Institution: Fischhoff, Baruch; Social and Decision Sciences; Carnegie-Mellon University 5000 Forbes Ave Pittsburgh, Pa 15213 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2003

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Summary: This Sexually Transmitted Diseases Cooperative Research Center will emphasize prevention of selected STDs and the consequences of STDs. In particular we are stressing STDs which have significant adverse impact on the health of women. With this approach we will identify ways in which the burden of complications associated with STDs that disproportionately result in adverse affects on the reproductive health of women can be reduced. To achieve this goal we will be taking several approaches. Two intervention studies, an indirect and direct approach, will be undertaken to prevent acquisition of bacterial vaginosis (BV), chlamydia and herpes and thereby the complications associated with these STDs. In a biologic intervention approach use of a Lactobacillus capsule will be assessed in a double blinded placebo-controlled trial to prevent infection with BV, C. trachomatis, and other genital infections. By studying the stigma associated with herpes and developing an intervention designed to produce more rational herpes-related decision making we are attempting to prevent acquisition of HSV. Determining the antimicrobial protective function of secretory leukocyte protease inhibitor (SLPI) will add to our understanding of the biologic interaction between T. vaginalis and HIV and other STDs; it also may lead to innovative vaginal microbicidal strategies. Determining the molecular mechanisms of gonococcal iron acquisition and the expression and Immunogenicity of iron acquisition will provide information relevant to developing gonococcal vaccines based on the human transferrinbinding protein complex and pathogen-targeted antimicrobial interventions targeting the iron-acquisition mechanism of N. gonorrhoeae. Studies to measure expression of the HPV genes E1, E2, E7 and E7 will expand our knowledge of HPV progression, thus allowing development of strategies to prevent cervical cancer. Determining the role of BV in spontaneous abortion will allow establishment of interventions to decrease the fetal loss associated with second trimester spontaneous abortion. This STD CRC proposal integrates clinical, epidemiological, behavioral and fundamental research into a collaborative effort by investigators from Ob/Gyn, Medicine, Infectious Diseases, Microbiology, Molecular Biology, Immunology, Behavioral Sciences and Epidemiology that addresses the disproportionate burden of the STD epidemic that affects women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HIV-1 SHEDDING FROM FEMALE GENITAL TRACT Principal Investigator & Institution: Coombs, Robert W.; Associate Professor; Laboratory Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 23-APR-2001; Project End 31-MAR-2006 Summary: This is a new Program Project application in response to RFA-HD-00- 006 to establish a Women's HIV Pathogenesis program at the University of Washington in collaboration the University of Rochester and the University of Nairobi, Kenya. The central Program these is to explore the hypothesis that the female genital tract is a separate virological compartment from blood. As such, viral application in the genital compartment may be influenced by several factors including the host's hormonal status (i.e., menses), and both viral and microbiological cofactors that could have an important influence on the evolution of HIV- 1 (i.e., generation of viral diversity), re-seeding of the blood compartment with potentially drug-resistant, and disease pathogenesis both within the genital tract (changes from favorable to unfavorable microbiological flora) and systemically (HIV-1 disease progression). Understanding these gender-specific HIV-1 factors may provide additional insight into the control of both vertical and horizontal transmission of HIV-1. To accomplish the central Program theme, we will use three different cohorts of HIV-1-infected women recruited at the three collaborating institutions. The research activities of the Program Project will be accomplished through

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three Cores and three Research Projects. The infrastructure will reside within an Administrative Core (Core A) located at the University of Washington, a Clinical Core (Core B) and a Laboratory Core (Core C). Both internal and external advisory committees will review the Program's research progress and report to the Principal Investigator, Dr. Coombs. Since our hypothesis is that genital tract inflammation represents a continuum as defined by local vaginitis (bacterial vaginosis), to cervicitis (cytomegalovirus), to endometritis (microbial) and ultimately to pelvic inflammatory disease, each of the three research Projects are designed to capture this continuum. In Project I (HIV-1 shedding and evolution), we will characterize subjects for shedding of HIV-1, CMV and HSV-2, and definitively establish, through viral phylogenetic typing that HIV-1- re-emerges from the genital tract to re-infect the blood compartment in subjects that receive stable anti- retroviral therapy. In Project II (CMV co-shedding) we will show that CMV is an independent viral co-factor for HIV-1 shedding, whether CMV shedding from the cervix represents reactivation or re-infection, and that the suppression of CMV using valganciclovir can decrease HIV- 1 genital shedding. In Project III( Bacterial Vaginosis), we will show the effect of bacterial vaginosis as a local co-factor for HIV-1 shedding, how this local abnormal microbiological flora contributes to HIV-1 shedding through local cytokine-mediated mechanisms, and that antimicrobial treatment of bacterial vaginosis in both anti-retroviral treated and untreated women results in decreased HIV-1 genital shedding. Taken together, these studies will provide important comparative data to the male genital tract shedding of HIV-1 and may have implications for both the vertical and horizontal transmission of HIV-1. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HIV-1 SUSCEPTIBILITY FACTORS IN CERVICAL SECRETIONS Principal Investigator & Institution: Patterson, Bruce K.; Rush-Presbyterian-St Lukes Medical Ctr Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 23-APR-2001; Project End 31-MAR-2006 Summary: Our broad long-term objective is to prevent sexual transmission of HIV by changing the genital tract milieu to one that decreases the risk of HIV infection. Since a major route of HIV transmission is between heterosexual partners, a promising HIVprevention approach is to topically modify the microbiology and immunology of the female genital tract. Using our recently published cervical explant model, we intent to investigate the role of cervical secretion (CVL)s in determining the susceptibility to HIV1 infection. Our laboratory is particularly well- qualified to investigate key HIV-1 related modifications in the immunology and virology of the female genital tract including susceptibility to HIV infection and expression on HIV-receptors such as chemokine receptors (CheRec) and CDR. Our hypothesis is: HIV-1 susceptibility is altered by the microbiology/immunology of the female genital tract through the production of factors in cervical secretion (CVL)s that either inhibit or stimulate HIV-1 production. In the following AIMS, we propose 4 questions corresponding to 2 different intentionally in explant culture. [1a] Does the addition of lysates from cultures of organisms known to cause bacterial vaginosis (see subproject 0001, a condition associated with increased risk of HIV-1 transmission, to cut our cervical explant model increase or decrease susceptibility to different isolates of HIV-1? [1b] Does the addition of cervical [CVL)s from women in our cohorts with cultured confirmed bacterial vaginosis to our cervical explant model increase or decrease susceptibility to different isolates of HIV-1? [2a] Does the addition of IgA or IgG from cervical secretions (CVL)s of HIV-1 exposeduninfected women (see subproject 0002) to our cervical explant model increase or decrease susceptibility to different isolates of HIV-1? (2b) Does the addition of cervical

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secretion (CVLs)s (i.e. IgA), known to inhibit HIV-1 in vitro, from HIV-1, exposeduninfected women (see subproject 0001) to our cervical explant model increase or decrease susceptibility to different isolates of HIV-1? Confirmation of our hypotheses of our hypotheses through these specific aims may result in successful HIV-1 prevention strategies applicable to women in developing nations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IRON, ZINC AND FOLATE AND PRETERM DELIVERY Principal Investigator & Institution: Savitz, David A.; Professor and Chair; Epidemiology; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 01-JAN-1995; Project End 31-DEC-2002 Summary: The proposed study is designed to identify etiologic factors for preterm premature rupture of the membranes (preterm PROM) in which preterm delivery is precipitated by rupture of the chorioamnionic membranes. Exposures which decrease the strength of the membranes are postulated to predispose to rupture, focusing on genital tract infections, vitamin C, and tobacco smoke. This nested case-control study will be conducted within the cohort of 8,000 women who obtain prenatal care at three high- volume clinics affiliated with the University of North Carolina Hospitals and two clinics affiliated with Wake Medical Center Obstetrical Teaching Services (approximately half black and half white) over the period of January 1, 1995 to December 31, 1997. All 8,000 patients will have specimens collected at 22-28 weeks of gestation and stored for future assessment of genital tract infection, plasma and leukocyte levels of vitamin C, urinary cotinine, and urinary drug metabolites. The 250 women who develop preterm PROM, a sample of 250 women who deliver early due to preterm labor, and 500 controls will be recruited, with an expected 80% response to yield 200 preterm PROM cases, 200 preterm labor cases, and 400 controls. Preterm PROM and preterm labor cases will be identified in the hospital and controls will selected from prenatal clinics, with the same gestational age distribution as preterm PROM cases. For selected cases and controls, we will assay the stored genital tract specimens to identify bacterial vaginosis, chlamydia, and trichomonas infections, assay the blood sample for vitamin C, and assay the urine specimen for cotinine and illicit drugs. All cohort members will be interviewed to obtain information on diet, tobacco, drug, and alcohol use, sexual activity late in pregnancy, reproductive history, and other potential risk factors. The analyses will focus on the impact of specific genital tract infections, vitamin C, and smoking on the risk of preterm PROM by contrasting preterm PROM cases to controls. Comparison of the preterm labor cases to controls will suggest whether preterm PROM and preterm labor are etiologically distinct entities based on shared or distinct risk factors. This study will be the first large- scale evaluation of preterm PROM that simultaneously addresses genital tract infection, nutrition, and tobacco with biological assessments as well as detailed self-report in a large bi-racial population. Although all are strongly suspected of influencing risk of preterm delivery, this study should provide evidence relevant to screening practice for infection and vitamin use during pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANISMS FOR PRETERM BIRTH IN AFRICAN-AMERICAN WOMEN Principal Investigator & Institution: Gennaro, Susan; Professor, Director of Doctoral and Post; None; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104

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Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): Nationally, 11% of pregnant women experience a spontaneous preterm delivery every year but only 40-50% of preterm labors end in preterm delivery. The mechanism for preterm delivery remains poorly understood especially among African-American women and especially in early preterm labor (prior to 34 weeks gestation). In our earlier federally funded work, mothers of preterm infants compared to mothers of term infants had significantly poorer immune function (diminished lymphocyteproliferation in response to concanavalin A, pokeweed mitogen, and phytohemagglutinin) at delivery, and 1, 2 and 4 months postpartum. However, it is not known if this altered immune response was present prior to preterm delivery. Infection is also purported to be a causative factor in preterm birth and recent work by one of our research team linking increases in cervicovaginal cytokines with vaginal infections in non pregnant women underscores the need to examine the relationship between local and systemic cellular immune response to birth outcomes. This study will compare stress (perception of stress, CRH), infection (chlamydia, gonorrhea, bacterial vaginosis), health behaviors (smoking, nutrition) and immune response (cervicovaginal and serum IL-1, IL-6 and TNF-alpha) between three groups of African-American women: 20 experiencing a normal pregnancy and term delivery, 20 women presenting between 24-34 weeks of gestation in preterm labor delivering at term and 20 women presenting between 24-34 weeks of gestation in preterm labor who deliver before 34 weeks gestation. The study will provide us with necessary preliminary data to support a major grant submission, allow us to standardize laboratory procedures and inform the methodology of the larger study by providing data on the correlation between serum, cervical, and vaginal cytokine levels. It will also provide preliminary data to identify those factors that best differentiate African American women who experience preterm labor but deliver at term from those who deliver experience preterm labor and deliver prematurely from those who never labor prematurely and who deliver at term. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MICROBICIDAL LACTOBACILLI FOR GENITAL INFECTION PREVENTION Principal Investigator & Institution: Hillier, Sharon L.; Professor; Magee-Women's Hospital of Upmc 300 Halket St Pittsburgh, Pa 15213 Timing: Fiscal Year 2002 Summary: Lactobacilli function as microbicides in the human vagina through production of H2O2, acids and other products which inhibit the survival and/or growth of genital pathogens. The goal of the proposed project is to evaluate the efficacy of a Lactobacillus capsule in colonizing the vagina and decreasing acquisition of bacterial vaginosis. A vaginal capsule containing Lactobacillus crispatus has been developed and shown to colonize women during a phase II study. The proposed study is a doubleblind, placebo-controlled trial of a Lactobacillus crispatus capsule in women attending an Adolescent Medicine Clinic (n=200), the Allegheny Country Health Department (n=250) or the University of Pittsburgh Student Health Clinic (n=250). Women will be followed at 3 month intervals for 1 year. The presence of genital tract injection and vaginal lactobacilli will be determined at baseline and each follow-up visit. The hypothesis is that monthly use of exogenous lactobacilli intravaginally will decrease acquisition of bacterial vaginosis. The use of exogenous lactobacilli intravaginally will decrease acquisition of bacterial vaginosis. The use of exogenous lactobacilli intravaginally will decrease acquisition of bacterial vaginosis. The use of exogenous

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Bacterial Vaginosis

lactobacilli intravaginally will decrease acquisition of bacterial vaginosis. The specific aims are 1) to assess the relationship between genital infection and lack of lactobacilli in a population of women of reproductive age; 2) to assess the effect of the Lactobacillus capsule on the vaginal ecosystem (vaginal pH, lactobacilli, other microorganisms); 3) to determine whether women randomized to receive the Lactobacillus capsule have decreased acquisition of bacterial vaginosis compared to placebo-treated women after accounting for potentially confounding behaviors; 4) to evaluate thje effect of the Lactobacillus capsule on acquisition of other injections including chlamydia, trichomoniasis, vulvovaginal candidiasis, urinary tract infections and pelvic inflammatory disease; 5) assess the immunologic response to Lactobacillus crispatus among women assigned to the microbiologic factors associated with loss or acquisition of H2O2-producing and H2O2-negative lactobacilli. This project will yield new information on lactobacilli as endogenous microbicides and suggest new strategies for prevention of STD's and their sequelae. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NATURAL HISTORY OF HPV--INFECTION TO NEOPLASIA Principal Investigator & Institution: Moscicki, Anna-Barbara B.; Professor; Pediatrics; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-JUL-1990; Project End 31-AUG-2005 Summary: (Adapted from investigator's abstract): The long term goal of this renewal is to better understand local and systemic immune responses to human papillomavirus (HPV) infection in its natural setting of the cervix early in its course as well as in states of persistence or clearance. The first aim of the study is to examine the local immune response in the natural history of cervical HPV infection in young women by comparing changes in the local cervical cytokine milieu, specifically interferon (IFN)-gamma, interleukin (IL)-12, IL-2, IL-10 and IL-4, in association: a) persistence, b) clearance of initial and/or c) secondary infections, and d) development of SIL. The second aim is to examine systemic response to HPV specifically cytotoxic T cell response to HPV 16 infections in association with the four HPV states described above. Four groups of women will be recruited for the study: 1) women with a long history of persistent HPV infection, 2) women with secondary HPV type infections, 3) adolescent and young women with evidence of initial HPV infection, 4) women with a long history of persistent HPV negativity (control group). Examinations for women from the first three groups seen every 4 months will include samples for: HPV DNA, cytology, cervical cell cytokine analysis using RT-PCR, C. trachomatis, N. gonorrhea, herpes simplex virus, bacterial vaginosis, and peripheral blood CTL assays on women with HPV 16 infection. The control group (HPV negative) will have similar examinations every 6 months and have HPV serology to virus-like particles (VLP) to characterize HPV exposure not defined by repeated HPV testing. The understanding of both local and systemic immune responses to initial and subsequent HPV infections may be key in vaccine or therapeutic developments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PERIODONTITIS AND PRETERM LOW BIRTH WEIGHT Principal Investigator & Institution: Offenbacher, Steven; Professor of Periodontology; Dental Research Center; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 01-APR-1997; Project End 28-FEB-2003

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Summary: Research conducted on this grant has established periodontal disease as a significant risk factor (P=0.0033) for preterm delivery and low birth weight (PLBW) in humans. Data from a case-control study of 124 mothers demonstrate that pregnant women with generalized periodontitis (i.e. greater than or equal to 60% of sites with 3 or more mm of attachment loss) have an adjusted odds ratio of 7.5 for having a PLBW. the risk of having PLBW as a result of periodontal infection is of greater magnitude than the risk attributable to smoking or alcohol usage. This continuation proposal seeks to reveal new data regarding the attributable risk and molecular basis for this newly observed association. In t his continuation proposal we plan to conduct a perspective study of pregnant women to quantify the added burden of periodontal infection using odds ratios and attributable risk for PLBW, analyzing for possible confounders. We will incorporate periodontal disease variables such as measures of disease extent, severity, microbial specificity and local inflammatory mediator secretion, in addition to traditional risk variables to form new multifactorial risk assessment models for PLBW. We will determine whether periodontal crevicular fluid levels of PGE2 or IL-1beta area associated with preterm delivery, premature rupture of membranes (PROM) or impaired fetal growth. This five year prospective study on over 2500 pregnant women will enable us to confirm the association between periodontal disease and PLBW, controlling for potential obstetric confounders such as age, race, nutrition, bacterial vaginosis, prenatal care and behavioral variables. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHARMACOKINETICS OF FLAGYL ER IN BACTERIAL VAGINOSIS IN Principal Investigator & Institution: Frederiksen, Marilynn C.; Associate Professor; Northwestern University Office of Sponsored Programs Chicago, Il 60611 Timing: Fiscal Year 2001 Summary: This is an open-label, three center, randomized, multiple-dose, two-group, parallel treatment study. An attempt will be made to match the patients in the two groups by age. One treatment group will consist of 24 non-pregnant female patients diagnosed with bacterial vainosis and the other treatment group will consist of 24 patients in their second to third trimester of pregnancy requiring treatment for bacterial vaginosis. The primary objective of this study is to compare the steady-state pharmacokinetics of metronidazole, after a daily oral dose of Flagyl ER (metronidazole extended release tablets, 750 mg), administered for 7 days between non-pregnant female patients and patients in their second to third trimester of pregnancy requiring treatment for bacterial vaginosis. The secondary objective of this study is to compare the safety and effectiveness of Flagyl ER in non-pregnant and pregnant patients requiring treatment for bacterial vaginsosi. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DELIVERY

PLACENTAL

VASCULAR

COMPROMISE

AND

PRETERM

Principal Investigator & Institution: Thorp, John M.; Professor; Obstetrics and Gynecology; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): There is substantial interest in determining the etiology of preterm delivery (PTD). Despite much effort, the cause remains elusive and

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Bacterial Vaginosis

effective prevention measures do not exist. Uteroplacental vascular compromise (UPVC) via inflammation, thrombosis, or atherosis is a biologically plausible cause of preterm delivery, albeit not adequately explored. We propose to test his hypothesis by conducting a prospective, epidemiologic study of UPVC and by integrating information about known risk factors for PTD. Placental histopathologic examination and morphometric analysis of the basal plate will be done to assess compromise of placental vessels. We will explore novel, possible antecedents of such compromise, dyslipidemia and insulin resistance, using nuclear magnetic resonance analysis of lipid subclasses and fasting insulin-glucose ratios. Given the inaccessibility of the uteroplacental vasculature in ongoing gestations at midpregnancy, we will utilize non-invasive measures of UPVC, Doppler velocimetry of the uterine artery, and maternal serum alpha fetoprotein to indirectly evaluate vascular function. In addition, we will carefully evaluate tobacco and cocaine use, nutrition, and changes in vaginal microflora within our cohort. The data will enable us to thoroughly assess whether UPVC constitutes a distinct etiologic pathway for PTD and help to identify modifiable risk factors. We will utilize cohort and case-cohort techniques, refined in our present research, to answer these questions. Blood, urine and vaginal fluid are collected twice between 15 and 20 weeks and between 24 and 29 weeks gestation. Hair will be collected after delivery. All subjects will complete two telephone interviews and two self administered questionnaires regarding various behaviors, dietary intake, physical activity, and psychosocial stressors. Placentas will be collected at the time of delivery and histopathologic analysis will be completed by an experienced perinatal pathologist for cases and a non-case subgroup. Nuclear magnetic resonance measurement of lipoprotein subclasses will be done to assess dyslipidemia. Insulin glucose ratios will be measured from fasting blood samples. We expect to enroll a cohort of 1800 women with 250 preterm deliveries and a randomly selected non-case subgroup (n=500). We will analyze the relationship between UPVC and PTD using logistic regression. Given 1) the size of the study, 2) thorough histopathologic assessment of the placenta, 3) extensive questionnaire data, 4) biologic markers of exposure to bacterial vaginosis, insulin resistance, dyslipidemia, and cocaine use, and 5) the careful assessment of potential confounding factors, this study promises to markedly advance our knowledge of the potential role of UPVC in the etiology of PTD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREMATURE BIRTH, FATTY ACIDS, BACTERIAL VAGINOSIS Principal Investigator & Institution: Meis, Paul J.; Professor; Wake Forest University 2240 Reynolda Rd Winston-Salem, Nc 27106 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PRENATAL ENDOTOXIN AS A MODEL OF PARKINSON'S DISEASE Principal Investigator & Institution: Ling, Zaodung; Assistant Professor; RushPresbyterian-St Lukes Medical Ctr Chicago, Il 60612 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2006 Summary: (provided by applicant): Current animal models of Parkinson's disease (PD) use high-dosages of dopamine (DA) neurotoxins to produce rapidly evolving lesions. We have recently shown that injection of the Gram (-) bacteriotoxin, lipopolysaccharide (LPS), into gravid female rats at embryonic (E) day 10.5 produces offspring born with

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fewer dopamine (DA) neurons. The 30-40% DA neuron loss routinely seen is still present after 4 months and presumed permanent. This DA neuron loss is similar to that seen in the PD patient since it is more pronounced in the lateral nigra and its ventral tier, spares the ventral tegmental area and calbindin immunoreactive DA neurons in the nigra, and is associated with reduced striatal DA and increased DA activity as well as tumor necrosis factor (TNFalpha). Exposure of these animals to the DA neurotoxin 6hydroxydopamine (6OHDA) after 4 months, produces a greater inflammatory response and further DA cell loss. We hypothesize that the elevated DA activity and TNF seen in adult animals as a result of prenatal LPS treatment will lead to increased production of reactive oxygen species (ROS) that will eventually overwhelm ROS detoxification systems leading to further, progressive DA neuron loss as a result of aging or low dose exposure to 6OHDA. Based on this hypothesis we will study rats exposed to prenatal LPS and determine if further DA cell loss occurs with aging (through 21 months; Aim 1). Aim 2 will examine the combined effects of prenatal LPS and postnatal 6OHDA at various ages and determine if the combined effects of these two treatments is additive or synergistic and if the magnitude of the DA neuron loss as a result of these two neurotoxins increases with age. Whether or not animals exposed to prenatal LPS and 6OHDA at a young age exhibit a greater rate of DA neuron loss as they age compared with animals treated later in life, will be evaluated in Specific Aim 3. The successful implementation of these Specific Aims will address the notion that prenatal exposure to bacterial endotoxin is a risk factor for PD. Moreover, they would further demonstrate that prenatal infections such as bacterial vaginosis can interact with postnatal neurotoxin exposure to produce a gradual, protracted DA neuron loss that could be useful as a new animal model of PD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRETERM BIRTH: PSYCHONEUROIMMUNOLOGY IN HISPANICS Principal Investigator & Institution: Ruiz, Roberta J.; Family Nursing Care; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 31-MAR-2006 Summary: (provided by applicant) Low birth weight (LBW) related to preterm birth of newborns is the leading cause of infant mortality in the United States. Its incidence, which has not decreased in the last twenty years, varies by ethnicity. Stress, anxiety, and depression are potential major factors in ethnic differences in preterm birth. Hispanics are one of the fastest growing ethnic groups in the US, having a pronounced increase in the preterm birth rate associated with length of stay in the US. At the same time there is a paucity of studies with biological components that examine the problem of prematurity and LBW in Hispanics. The overall purpose of this proposal is to test a biobehavioral model of causal pathways initiated by stress, cervical changes, and depression that may alter endocrine and immune factors leading to an inflammatory response, cervical changes, and ultimately LBW and preterm birth in Hispanics. The specific aims are to 1) determine the effects of stress, anxiety, and depression on endocrine and immune factors in Hispanic pregnant women that may lead to an inflammatory response and cervical changes resulting in alterations in gestational age at birth and birth weight, 2) assess the effects of stress, anxiety, and depression on health behaviors in pregnant Hispanic women that may impact endocrine and immune factors resulting in alterations in gestational age at birth and birth weight, and 3) ascertain the effects of demographic factors, social/cultural factors, and previous preterm birth on stress, anxiety, and depression in pregnant Hispanic women. In this prospective study pregnant women (n=508 minimum) will be recruited from two sites. Blood samples for

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Bacterial Vaginosis

assessment of levels of hormones, cytokines, and neopterin will be taken. Vaginal samples for assessment of levels of cytokines, neopterin, fetal fibronectin and bacterial vaginosis will also be obtained. Psychological questionnaires assessing stress, anxiety, and depression will be completed. Cervical length will be assessed by vaginal ultrasound. Medical record review for neonatal outcome data and an assessment of gestational age and birth weight will be completed after delivery on infants greater than 35 weeks. Data analysis will include structural equation modeling, multiple linear and logistic regression analysis, and correlation coefficient analysis. There is an urgent need to better understand the determinants of ethnic disparities as well as pathways involved in preterm birth. This study adopts a dynamic, biobehavioral approach that holds great promise in understanding the problem of preterm birth in Hispanic women. A clearer understanding of the interrelationships of the pathways leading to preterm birth and associated LBW is essential to determine and develop appropriate preventive strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREVENTION OF INFERTILITY IN WOMEN WITH SUBCLINICAL PID Principal Investigator & Institution: Wiesenfeld, Harold C.; Magee-Women's Health Corporation 204 Craft Ave Pittsburgh, Pa 15213 Timing: Fiscal Year 2003; Project Start 01-MAY-1998; Project End 31-JAN-2008 Summary: (provided by applicant): The broad, long-term goals of this study are to evaluate whether longer course antibiotic therapy for women at-risk for subclinical PID prevents subsequent infertility better than currently used short course antibiotic regimens for lower genital tract infections. Subclinical pelvic inflammatory disease (PID) is an important yet overlooked cause of infertility, responsible for more cases of postinfectious tubal infertility than acute PID. Subclinical PID is present in 25% of women with gonorrhea or chlamydia, and one in seven women with bacterial vaginosis, despite the absence of symptoms of acute PID. Most importantly, there is a doubling in infertility among women with subclinical PID compared to women without PID. Current treatment strategies for cervicitis and vaginitis do not address ongoing upper genital tract inflammation. Our hypothesis is that the preservation of fertility is greater among women with subclinical PID treated with a long-course antibiotic regimen compared to women receiving standard single-dose regimens for uncomplicated lower genital tract infections. The proposed application describes a randomized, double-blind, comparative phase III clinical trial studying a novel treatment regimen that incorporates azithromycin, an antimicrobial with potent immunomodulatory properties, on fertility outcomes in women at-risk for post-infectious fallopian tube damage. The specific aims are to 1) compare fertility rate of women with subclinical PID receiving two weeks of broad-spectrum antibiotic therapy with the fertility rate of women with subclinical PID receiving single-dose antibiotic regimen, 2) determine whether the resolution of endometritis is more common in women treated with the enhanced antimicrobial regimens utilized for acute PID compared to currently recommended single-dose regimens for lower genital tract infections, 3) characterize the inflammatory response in the lower genital tract in women with and without subclinical PID, and 4) evaluate whether women with subclinical PID have evidence of fallopian tube inflammation. During this study, very real public health questions will be asked and answered which will affect the way that lower genital tract infections are routinely managed, potentially enhancing fertility among American women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PROTEGRIN DESIGN Principal Investigator & Institution: Lehrer, Robert I.; Professor; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001 Summary: Our long term goal is to design protegrin peptides that will be used both as topical microbicides to prevent sexually transmitted diseases (STDs) and as topical therapeutics to remediate bacterial vaginosis (BV). The Specific Aims of this project are: 1. To design protegrin-like molecules that inactivate multiple STD agents and the bacteria associated with bacterial vaginosis, without affecting normal vaginal flora. 2. To determine how the beta-sheet and turn regions of protegrins contribute to these activities. 3. To learn how protegrins interact with factors relevant to their use as topical microbicides, including a) host proteins, peptides, peptides and cells; b) host and microbial proteases; c) nonoxynol-9 other surfactants. 4. To study the effects of protegrins on C. albicans a frequent vaginal opportunist. 5. To examine how protegrins assemble into dimers and oligomers, and ascertain if and how such assemble relates to their antimicrobial, cytotoxic and hemolytic properties. Protegrins are small, exceptionally potent, beta-sheet peptides that rapidly inactivate many microbes, including those responsible for most sexually transmitted bacterial infections. We will use solid-phase peptide synthesis and precise methods of antimicrobial testing to "fine tune" protegrins for future intravaginal application. Our intent is to develop protegrinlike peptides that do not affect vaginal lactobacilli (e.g., L. acidophilus and L. crispatus), but are highly active against C. albicans, STD bacteria, and the flora associated with bacterial vaginitis/vaginosis. We can obtain this constellation of properties by introducing one or two amino acid substitutions into protegrins with 15-18 residues and two intramolecular disulfide bonds. We plan to generate a relatively small number of additional protegrin variants and to test their activity against a panel of STD target organisms. Overall, these studies will facilitate the development of novel, peptidecontaining topical microbicides that are designed specifically for intravaginal use. Given the prevalence and serious consequences of STDs, topical microbicides that can protect and empower women are urgently needed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: QUANTITIVE MICRBIOLOGIC MODEL FOR PRETERM DELIVERY Principal Investigator & Institution: Onderdonk, Andrew B.; Associate Professor of Pathology; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2001; Project Start 01-JAN-1999; Project End 31-DEC-2001 Summary: Preterm delivery (PTD) is the leading cause of infant morbidity and mortality in the United States, and prevention of PTD is a primary goal in perinatal health care. Recent data indicates a strong association a strong association between maternal genital tract infection, including bacterial vaginosis, and PTD, with compelling evidence that micro- organisms are a cause of PTD. However, the relationship between concentrations of vaginal microorganisms and PTD, the identification of key microbial populations that are significant risk factors for PTD, and the pathophysiologic mechanisms by which bacteria contribute to PTD remain to be determined. In addition, the interactions between microbial populations of significance to PTD are unknown. Preterm labor may be initiated by bacterial phospholipases A2 and which release arachidonic acid-the primary substance for prostaglandins which are considered fundamental to the initiation of labor. It has been hypothesized that the combined activities of lipase and phospholipases also account for a variety of effects associated with membrane damage.

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Bacterial Vaginosis

However, the relationship between these combined enzyme activities in the vagina and pregnancy outcome has not been determined. The objective of the proposed project is to prospectively collect quantitative data on microbiologic populations and enzyme activities and to receptor the presence or absence of bacterial vaginosis in two cohorts at high risk for PTD and one to record the presence or absence of bacterial vaginosis in two cohorts at high risk for PTD and one cohort at low risk. Generalized estimating equation regression will be used to analyze repeat measurement data and to formulate quantitative models to predict PTD. The following Specific Aims will be addressed: (1) quantitatively identify key microbial population as risk factors for PTD, (2) identify interactions between microbial populations that contribute to PTD, (3) determine whether there is an association between vaginal enzyme (lipase, phospholipase) activities and PTD, and (4) document any relationship between the presence or absence of bacterial vaginosis and PTD, and (4) document any relationship between the presence of absence of bacterial vaginosis and PTD. Recognition of predictive pathway(s) for PTD may permit the identification of individuals at risk for PTD may permit the identification of individuals at risk for PTD and, ultimately, the implementation of noel strategies for its prevention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VAGINOSIS

RANDOMIZED

TRIAL/REDUCE

RECURRENCE/BACTERIAL

Principal Investigator & Institution: Holmes, King K.; Director; Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 14-JAN-2002; Project End 31-DEC-2004 Summary: (provided by applicant) Bacterial vaginosis (BV), the most common bacterial vaginal infection in women of reproductive ages, has been linked to female HIV-1 acquisition and infection in both cross sectional and prospective studies. Women in subSaharan Africa have the highest prevalence of BV, approximately 40-50 percent in Uganda and Kenya. Thus with such a high prevalence and approximately a 2-fold increased risk of HIV acquisition in women with BV, the attributable risk percent for HIV infection associated with BV is high, and treatment and prevention of prevalent and recurrent BV in African women could potentially have a substantial impact on reducing female HIV-1 acquisition. Although treatment of women with BV using metronidazole successfully eliminates symptoms and signs of vaginal discharge, recurrence rates are high. Clinical trials of treating male partners of women with BV targeting anaerobic bacteria have not reduced the risk of BV recurrence. However, our preliminary work has demonstrated BV- associated morphotypes in the urethra of male partners of women with BV significantly more often than in the urethra of male partners of women without BV. Poor male genital hygiene was also associated with BV in the female partners. We hypothesize that poor genital hygiene in men represents an important risk factor for BV, and that improved male genital hygiene or antisepsis, especially among uncircumcised men, and/or antibiotic treatment of the male partners with broad-spectrum antibiotics (active not only against anaerobes but also against facultative microorganisms) will reduce the frequency of recurrence of BV in women ffter initial treatment, as compared to antibiotic treatment of the women only. We propose a pilot (phase 2) study to determine the impact of topical antimicrobial/antiseptic use of women undergoing treatment for BV and of their male partners on the risk of recurrence of BV after treatment. We will screen 1000 couples attending two STD clinics in Nairobi, Kenya for BV and other reproductive tract infections, and (to confirm our preliminary studies) to collect smears from the male

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urethra and subprepuce (from uncircumcised men) to detect BV-associated bacterial morphotypes. Of the 40 percent (N= 400) of women expected to be diagnosed with BV and enrolled in our treatment trial, 380 will have male partners who will agree to be randomized to use of antisepsis or control; and within those 2 arms, the male partners will be evenly randomized to either metronidazole plus azithromycin or placebo. Female participants will be followed at monthly intervals for 3 months, repeating vaginal Gram stains to ascertain cure versus recurrence or persistence of BV. We will also monitor the acceptability and adverse effects with the use of genital topical antisepsis, and occurrence of symptoms or signs of any adverse effects of antiseptic use among the men. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REDUCTION OF DOUCHING BEHAVIOR IN ADOLESCENT WOMEN Principal Investigator & Institution: Oh, Myung-Hi K.; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001 Summary: The overall goals are to reduce the use of douching, a behavior linked with a number of adverse gynecologic and reproductive health outcomes, and to determine the effects of douching practices on the vaginal microecology of adolescents. Specific aims are to ascertain psychosocial determinants and behavioral correlates of douching in adolescents; to correlate changes in douching practices with incidence of STDs and behavior among adolescents; and to evaluate the effectiveness of the intervention by comparing adolescents in infections and vaginal ecology as the outcome indicators. The study design is a randomized clinical trial. The behavioral intervention is based on the Transtheoretical Model of Change. A total sample of 400 sexually active females, 14 to 18 years of age, who report any douching practices n past 35 days (5 weeks) will be recruited and randomized into: (1) the client-centered intervention tailored to their stage of change, and delivered by the research nurse at baseline (15-minute session), 1-months after baseline (15-minute session) and at the 3-month visit (15-minutes); or, (2) the placebo-attention control group who will receive an additional counseling at the same length in time, focusing on healthy eating habits and nutrition education. Participants will be assessed for the determination of each genital infection. The primary outcome indicator is cessation of douching measured at 12-month post- randomizing measured by self-report and confirmed by the use of the gynecologic event calendars Secondary outcomes are: 1) the proportion of adolescents who have progressed through the stages of change towards taking action (cessation of douching); and 2) the incidence of STDs and bacterial vaginosis in the 12-month measurements will be made at 3- month intervals and sophisticated data analysis methodology will be used to correlate biological and behavioral data collected. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ROLE OF BACTERIAL VAGINOSIS IN PRETERM DELIVERY Principal Investigator & Institution: Ross, Robin A.; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2004 Summary: (provided by applicant): Bacterial vaginosis (BV) results from a disruption of the vaginal ecosystem characterized by a complex shift in the microflora. Concentrations of the normally dominant Lactobacillus decrease while other microflora increase

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Bacterial Vaginosis

(Prevotella, Peptostreptococcus, Gardnerella, Mobiluncus). Studies have linked BV with upper genital tract infections and adverse pregnancy outcomes, particularly preterm delivery (PTD). Bacteria can weaken fetal membranes through production of soluble factors that lead to PTD either by induction of a proinflammatory response or stimulation of prostaglandin E2 production. An inflammatory response leading to PTD can also be stimulated in host cells directly through attachment and internalization of bacteria. Our laboratory has developed in vitro models of the vaginal ecosystem that combine mixed cultures of normal (NMVF) and BV-associated (BVAF) bacteria with immortalized cervical and vaginal epithelial cells in coculture. Preliminary studies demonstrate these are viable models for studying bacterial-epithelial interactions of the vaginal ecosystem. Data from studies using NMVF and both cell lines indicate that all microflora components adhere to the epithelial cells, but only Lactobacillus (La), Prevotella (Pb), and Enterococcus are internalized. In addition, Pb stimulated interleukin-8 production while La induced significant apoptosis in cocultures. This application is divided into 2 aims designed to analyze the role of BV-associated microflora (BVAF) in the pathogenesis of PTD using these unique models. The inflammatory response to coculture will be characterized, comparing findings using NMVF and BVAF. Adherence, internalization, and apoptosis rates will be determined for BVAF and NMVF and compared. Bacterial factors produced during coculture will be determined and correlated with stimulation of an inflammatory response. Due to the novelty of the models, we have the unique opportunity to determine the role of BVAF in PTD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SOCIAL FACTORS INFLUENCE THE RISK OF PRETERM DELIVERY Principal Investigator & Institution: Misra, Dawn P.; Assistant Professor; Population & Family Hlth Scis; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-AUG-2001 Summary: Our model for preterm delivery builds on the biologic model proposed by Lockwood and the social model proposed by James by linking social and biomedical risk factors to the three proximate biologic "triggers" (infection, bleeding, stress) of the preterm delivery process. There has been little success in modifying these proximate triggers. Infection could be considered an exception as rates of preterm delivery are lower among women who are diagnosed and treated. But infection screening is not routine and women with late or no prenatal care cannot be screened and treated. Successful prevention of preterm delivery requires knowledge of the more distal determinants, social and biomedical, which influence the triggers of this final biologic pathway. Our model, therefore, focuses on social (socioeconomic status, stress, stress modifiers, racism) factors and how they are mediated by biomedical factors (health behaviors with a focus on douching, physical activity; medical and pregnancy history; acute complications of pregnancy) and the proximate biologic triggers to influence preterm delivery risk. In the proposed study, we will build on recent research, both biological and epidemiological, to identify the factors which affect the risk as well as describe the processes that underlie these relationships. We also go further and consider the context of individual risk factors. Several investigators have demonstrated the influence of neighborhood and work environments on health behaviors and health outcomes of individuals and even on low birth weight. Therefore, to examine contextual physical and economic factors at the neighborhood-level, we will link geocoded addresses of the sample women with existing databases of environmental characteristics for residential neighborhoods in Baltimore City. The design for the study is a cohort

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with subjects identified prospectively during gestation. Prenatal and postpartum interviews will be conducted to collect data on many of the social and biomedical factors. Medical records will also be reviewed. Biologic specimens will be collected to: (a) assess stress as a biologic construct by measuring cortisol and catecholamine levels, and (b) detect bacterial vaginosis, an infection not routinely screened for and therefore not available in medical records. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STDS AND THE PATHOGENESIS OF SUBCLINICAL PID Principal Investigator & Institution: Sweet, Richard L.; Professor and Chair; MageeWomen's Hospital of Upmc 300 Halket St Pittsburgh, Pa 15213 Timing: Fiscal Year 2001; Project Start 01-MAY-1998; Project End 30-APR-2003 Summary: Unrecognized pelvic inflammatory disease (PID) may be a major factor in the pathogenesis of tubal factor infertility. This is supported by the presence of serologic evidence of prior sexually transmitted diseases (STD's) in a large proportion of women with tubal factor infertility, yet most of these women do not recall a history of STD's or PID. In addition, many women with lower genital tract infection associated with STD's (gonorrhea, chlamydia, bacterial vaginosis) have histologic evidence of endometritis even though they do not have symptoms of PID. Our hypothesis is that unrecognized PID due to STD's is associated with tubal obstruction. We propose to test this hypothesis in a cohort of 1500 women aged 15-30 with lower genital tract STD associated infection. A group of 200 women with acute symptomatic PID will be evaluated for comparison. Specimens will be obtained from the vagina and cervix for microbiologic analysis and measurement of defensins (neutrophil granule products). An endometrial biopsy will be obtained for histologic and microbiologic analysis. The primary outcome of this study is tubal impatency, therefore all women will undergo a hysterosalpingogram 12 weeks from enrollment. Other outcomes include infertility and ectopic pregnancy formation, which will be determined using regular telephone contact for at least one year to determine the rate of adverse reproductive sequelae. The frequency of tubal impatency will be compared between women with acute symptomatic PID, women with unrecognized PID, and uninfected women. The risk of unrecognized PID will be compared between women testing positive for an STD and uninfected women. As the diagnostic accuracy for the diagnosis of PID is currently suboptimal, risk factors for unrecognized PID will be established, a clinical prediction model will be devised, and defensins from the lower genital tract will be evaluated as less-invasive markers of PID. The microbiology and histology of unrecognized PID will be compared to these findings in acute PID, in an effort to understand the pathogenesis of PID. Information obtained from this study will: i) determine the role of unrecognized PID in subsequent tubal damage ii) establish risk factors and predictors of PID iii)improve the understanding of the pathogenesis of PID. Earlier detection of unrecognized PID will enable more timely treatment, with the intent on reducing the rate of tubal impatency and resultant adverse reproductive sequelae. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: PREGNANCY

STRESS

BIOLOGY,

RACE/ETHNICITY

&

INFECTION

IN

Principal Investigator & Institution: Wadhwa, Pathik D.; Assistant Professor; Psychiatry and Human Behavior; University of California Irvine Campus Dr Irvine, Ca 92697 Timing: Fiscal Year 2002; Project Start 05-AUG-2002; Project End 31-JUL-2007

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Bacterial Vaginosis

Summary: (provided by applicant): Bacterial vaginosis (BV), the most common reproductive tract infection in pregnancy, is associated with an increased risk for preterm birth. The determinants of susceptibility for developing BV and infectionrelated preterm birth are not well understood. Moreover, the causes of racial/ethnic differences in the prevalence and sequella of BV are largely unexplained. We propose a biobehavioral framework to study these issues, with the central hypothesis that prenatal stress, operationalized as a biological construct, heightens susceptibility for acquiring BV and potentiates its pathophysiological consequences. We focus on the maternalplacental-fetal endocrine and immune-inflammatory processes as the primary mechanisms of interest because both systems play a critical role in regulating susceptibility to infection, participate in the physiology and pathophysiology of term and preterm parturition, and are highly responsive to stress. We propose a longitudinal, cohort study of 900 African-American, Hispanic and nonHispanic White pregnant women to assess the prevalence of BV at two time points during early and mid gestation, quantify the endocrine and immune-inflammatory milieu at each of these times, measure behaviors known to be associated with the acquisition of BV, and follow subjects through delivery. BV status will be assessed by Gram stained vaginal smears. Endocrine stress parameters will be assessed by measures of cortisol, corticotropinreleasing hormone (CRH), and estriol (E3). Immune-inflammatory process will be quantified from responses of the cytokines interleukin (IL)-1, IL-6, TNFalpha, IL-10 and IL-12 to bacterial endotoxin (LPS) challenge using ex-vivo whole blood tissue culture system. Our specific aims are to examine: (1) the role of endocrine stress physiology in increasing susceptibility to developing bacterial vaginosis (BV) in pregnancy, and the role of immunosuppression as a mediator of this effect; (2) the role of endocrine stress physiology in increasing the susceptibility of BV+ women for spontaneous preterm birth, and the role of pro-inflammatory immune responses as a mediator of this effect; and (3) the extent to which stress-related endocrine and immune processes account for racial/ethnic disparities in prevalence of infection and infection-related preterm birth The scientific significance of this proposal pertains to elucidating biological mechanisms that determine susceptibility or vulnerability for developing reproductive tract infection in pregnancy and its adverse consequences (preterm birth), and clarifying the physiological basis for the observed effects of race/ethnicity on these outcomes. The practical significance of this proposal is the development and assessment of new ways (e.g., the ex-vivo immune challenge methodology) to identify women who are at heightened risk for infection and infection-related preterm birth, thereby improving obstetric risk assessment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE ACQUISITION OF BACTERIAL VAGINOSIS IN LESBIANS Principal Investigator & Institution: Marrazzo, Jeanne M.; Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Bacterial vaginosis (BV) results from a shift in the microbial ecosystem of the vagina from Lactobacillus predominance to overgrowth by anaerobic and facultative species, and has been associated with postpartum/postabortal endometritis, preterm birth, pelvic inflammatory disease, and human immunodeficiency virus acquisition. The etiology of BV is unclear, as is the role of sexual transmission of an undefined precipitant. BV frequently recurs in women who initially respond to standard antibiotic therapy. More effective interventions to prevent and treat BV require an understanding of the role of sexual transmission. Relative to most heterosexual women,

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lesbians have a two to three-fold higher BV prevalence (25 percent-52 percent). Preliminary evidence strongly implicates sexual transmission of vaginal secretions between women as a risk for BV. The proposed work will define the temporal association between sexual practices that transfer vaginal secretions and BV acquisition, and design an intervention to prevent this transfer and test its efficacy in reducing BV recurrence. Specific aims are: (1) prospectively define risk factors associated with acquisition of BV in a cohort of lesbians, including sexual practices that transfer vaginal secretions, sex with men, lubricant use, douching, menses, and changes in vaginal lactobacilli. The hypothesis is that BV in lesbians occurs after sexual transmission of vaginal fluid from a woman with BV to a woman without BV; that women not colonized with vaginal hydrogen peroxide-producing lactobacilli will be at highest risk for BV acquisition by this mechanism; and that comparative analyses of vaginal flora in sex partners will show similar microbial profiles. (2) Test the efficacy of an intervention to reduce transfer of vaginal fluid between female sex partners in reducing recurrence of BV following treatment with metronidazole in a prospective, randomized trial. The hypothesis is that the intervention will improve knowledge, attitudes, beliefs, and intention about BV prevention, reduce sexual exposures that increase risk of transfer of vaginal fluid, and reduce rates of BV recurrence. Lesbian couples provide a unique opportunity to conduct comparative studies of vaginal microbial ecology in sex partners, and to directly analyze determinants of transmission. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE MOLECULAR MICROBIOLOGY OF BACTERIAL VAGINOSIS Principal Investigator & Institution: Fredricks, David N.; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2002; Project Start 20-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Bacterial vaginosis (BV) is a condition that affects millions of women and is linked to several serious health conditions, including preterm labor, cervical intraepithelial neoplasia, and HIV infection. About half of women with BV complain of a malodorous vaginal discharge, and half are asymptomatic. The cause of BV is not known, though current evidence suggests that women with BV undergo a change in the bacterial flora of the vagina. No single cultivated bacterium has been definitively determined to cause BV. Advanced methods in molecular biology have recently been used to study environmental and human ecosystems, allowing investigators to detect and identify microbes without cultivation. These studies reveal many novel, cultivation-resistant bacteria, and expand our understanding of the microbial diversity in these niches. We propose to apply the same molecular methods to the microbial ecosystem of the human vagina. The Specific Aims are to: 1. Create a census of the bacteria that inhabit the normal vagina. Vaginal fluid samples from 4 women without BV will be obtained and subjected to broad range PCR to directly amplify bacterial 16S rDNA without cultivation. The PCR products will be cloned into E. coli, and the clones screened by performing PCR on the inserts. Inserts of the correct size will be analyzed with PCR RFLP analysis, and unique inserts will be sequenced. Phylogenetic analysis of these 16S rDNA sequences will allow us to identify bacteria, or to infer evolutionary relationships for novel bacteria; 2. Create a census of the bacteria that inhabit the vagina of women with BV. Vaginal fluid samples from 4 women with BV will be subjected to the analysis outlined in aim 1; 3. Identify bacteria or bacterial communities that may be the cause of BV. Bacteria that are only associated with BV in our initial cohort will be selected for further study. Specific PCR assays will be developed and validated for each candidate pathogen. In future studies, vaginal fluid

32

Bacterial Vaginosis

samples from a larger cohort of women will be assayed to determine if a candidate pathogen is specifically associated with BV. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE UAB STD COOPERATIVE RESEARCH CENTER Principal Investigator & Institution: Hook, Edward W.; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 01-SEP-1995; Project End 31-AUG-2004 Summary: The University of Alabama at Birmingham (UAB) STD CTU is the product of over a decade of institutional prioritization of sexually transmitted diseases (STD), as both a research and public health priority. After three productive years made possible by partial funding of the UAB STD CRC by NIAID, this application builds on productive years made possible by partial funding of the UAB STD CRC by NIAID, this application builds on the increasing momentum of a still expanding interdisciplinary, public health-oriented STD research effort. Partners in the current proposal include basic scientists, clinicians, behavioral scientists, epidemiologists, and biostatisticians from two Schools (Medicine and Public Health) at UAB, the Jefferson Country Department of Health, and two UAB-affiliated hospitals , The Children's Hospital of Alabama and The Cooper Green Hospital. The current application emphasizes efforts to translate cutting edge research methods into more effective interventions to reduce STD morbidity and sequelae with a strong focus (two of four projects) on adolescents, the population subgroup with the highest rates of STD acquisition. Utilizing two Cores Biostatistical and Laboratory), the four main projects in this application include: a project to further characterize the origins and pathogenesis of bacterial vaginosis (BV), the most common cause of vaginal discharge in women, and the contribution of BV to modification of susceptibility for STD acquisition in women; an epidemiologic study of douching behavior in women and a behavioral intervention to reduce this behavior in high risk women; a behavioral intervention to reduce bacterial STD transmission and complications by encouraging the large proportion (over 20%) of infected persons detected through STD screening who currently fail to do so to obtain their test results and to seek timely treatment using a newly developed interactive multimedia, computerized system which simultaneously provides an individualized intervention and collects data on the client; and a project which capitalizes on the potential screening opportunities providing by nucleic acid amplification tests for detection of gonococcal and chlamydial infections to reach high risk adolescents through the first randomized controlled trial of traditional partner notification via social- and sexual-network based urine screening for these infections. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: THERAPEUTIC CANDIDIASIS

AGENT

IN

MITIGATION

OF

VAGINAL

Principal Investigator & Institution: Charland, Diane; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001 Summary: Millions of women every year suffer Vaginal Candidaiasis (VC) caused by Candida albican and Bacterial Vaginosis (BV) caused by Garderella vaginalis. The majority of women with VC resort to using over the counter medications as a treatment regimen and prescription antibiotic to treat BV. However, these medications do in many cases have side effects that are unpleasant or painful. In addition, antibiotic and

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33

antifungal medications that are used for the mitigation of vaginal diseases have been shown to be associated with the reduction in indigenous lactic acid bacteria that contribute to healthy vaginal ecology. In this study, we will determine whether Bacillus coagulans Hamer, a facultative and gram positive rod, can be used as a biorational therapeutic agent for the treatment and prevention of Candida related vaginal infections and whether Bacterial Vaginosis can be mitigated or controlled using the same treatment methodology. The study population will include non-pregnant women ages 18-60 years with the recent diagnosis of VC or BV. Fifty women will be randomized in equal numbers to an outpatient regimen consisting of the use of a biorational bath containing 10 billion spores of bacillus coagulans. This treatment will be repeated on the third day. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THERAPY AND PREVENTION FOR BACTERIAL VAGINOSIS Principal Investigator & Institution: Schwebke, Jane R.; Professor; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 01-JAN-2002; Project End 31-DEC-2007 Summary: Bacterial vaginosis (BV) is a sexually associated disease caused by a complex mixture or anaerobic bacteria. BV is the most prevalent cause of symptomatic vaginal discharge in the U.S. and is associated with numerous complications including pre term delivery of infants, pelvic inflammatory disease, urinary tract infections and acquisition/transmission of sexually transmitted diseases including human immunodeficiency virus. Widespread control of BV has been suggested as a possible means for decreasing the incidence of HIV in the developing world, however, current achievable cure rates combined with high recurrence rates makes this solution impractical. Further, half of all women who meet the clinical diagnostic criteria for BV are asymptomatic and the appropriate management of these women is unknown. Although the microbiological changes which occur in women with symptomatic and asymptomatic BV appear by culture techniques to be identical, the clinical significance of asymptomatic BV is unclear. The current therapy for BV consists of seven days of oral or topical metronidazole or clindamycin. However, there is a growing concern that eradication of organisms from the lower genital tract may be inadequate to prevent recurrences or complications and that more intensive therapy may be required for eradication of upper tract infection/colonization. Further, some of the key organisms associated with BV such as Mobiluncus and mycoplasmas are resistant to the standard therapies. Lastly, although BV has epidemiological characteristics of an STD, the role of the male partner in its pathogenesis remains unknown. We propose to conduct clinical trials which will assess enhanced therapy for BV, including longer duration of therapy and combination therapy as well as increased use of condoms to improve initial cure rates and decrease recurrences. We will also utilize specimens from these prospective studies to further study the association of Mobiluncus, an organism strongly associated with BV using sensitive PCR technology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: VAGINAL DOUCHING AS A RISK FACTOR FOR VAGINITIS Principal Investigator & Institution: Hatch, Maureen C.; Director; Community and Preventive Med; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2001; Project Start 01-DEC-1998; Project End 30-NOV-2001

34

Bacterial Vaginosis

Summary: (Adapted from investigator's abstract) Incident and recurrent vaginitis are highly prevalent health problems in women of reproductive age resulting in significant medical care costs and limitation of work activity. The symptoms of excessive vaginal discharge, malodor and intensive vulvovaginal pruritus can seriously impair women=s productivity and social life. Vaginitis also facilitates HIV transmission. Bacterial vaginosis and candidiasis are the most common causes of vaginitis. However, despite their high prevalence, risk factors for developing these infections remain unclear. The investigators hypothesize that frequent vaginal douching increases the risk of bacterial vaginosis and candidiasis by disturbing the normal vaginal microflora and immunologic defense system. To test this hypothesis, it is proposed to recruit a cohort of 1260 black women seeking treatment at Mount Sinai Hospital's outpatient gynecologic/family planning clinic between January, 1999 and June, 2000. A standardized questionnaire will be used to collect detailed information on douching practices and other risk factors for vaginitis, with particular attention to the three months prior to the clinic visit. In addition to recording clinical symptoms and signs, samples of vaginal discharge will be collected for diagnostic verification using Gram stain with scoring (for bacterial vaginosis) and culture (or Candida albicans). Subjects will also be tested for trichomoniasis (culture), gonorrhea and chlamydia (DNA probe tests); those with symptomatic infections will be excluded. The association between vaginal douching in the previous three months and risk of bacterial vaginosis and between douching and candidacies will be examined using multiple logistic regression models to control for confounding variables. In addition, frequency of douching and duration of douching practice will be examined to test a dose-response pattern. The investigators state that the elucidation of the role of douching practices in the etiology of vaginitis will have important public health implications and could make a major contribution to promoting women's health. Further, both douching and vaginitis are very common in minority heterosexual women, among whom the prevalence of AIDS is growing fastest. In the era of the AIDS epidemic, this study will have public health significance beyond vaginitis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VARIATION IN CYTOKINE AND MMP GENES AND RISK OF PPROM Principal Investigator & Institution: Ferrand, Pedro E.; University of Chile Av. Bernardo O'higgins 1058 Santiago, Timing: Fiscal Year 2002; Project Start 19-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant) Preterm Premature rupture of the membranes (PPROM) is a major cause of preterm birth and perinatal morbidity/mortality. It has been hypothesized that pro-inflammatory cytokines are important mediators of PPROM. Cytokines induce expression of matrix metalloproteinases (MMPs) that degrade the extracellular matrix, which gives the membranes their tensile strength. We hypothesize that variation in pro-inflammatory cytokine and MMP genes contributes to the risk of PROM and that gene-environment interactions amplify the risk. The longterm goal of this research is to identify genes that make significant contributions to risk of preterm premature rupture of membranes (PPROM) and how infection interacts with these genes to increase the risk of the unfavorable obstetrical outcome. Our specific aim are: 1) To determine if variation in the MMP-7 gene influences risk of PPROM. The hypothesis to be tested is that MMP-7 promoter alleles with stronger activity will be associated/linked with increased risk of PPROM. 2) To determine if variation in the IL-6 gene influences risk of PPROM. The hypothesis to be tested is that alleles that confer

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35

greater IL-6 expression will be associated/linked with increased risk of PPROM. 3) To determine if variation in the MMP-8 gene influences risk of PPROM. We will determine if there are polymorphisms in the MMP-8 promoter and if these variants affect MMP-8 promoter activity and influences risk of PPROM. 4) To determine if bacterial vaginosis and maternal or fetal genotype for the IL-6, MMP-7 or MMP-8 genes interact to affect the risk of PPROM. The hypothesis to be tested is that bacterial vaginosis will increase the risk of PPROM when the maternal or fetal genotypes include alleles with the strongest promoter activity. "To address these aims we will conduct allelic association studies using a case-control design. The study population will be recruited from the obstetrical services of the Hospital San Borja Arriaran, Santiago, Chile (over 9,000 deliveries/year). The study will be restricted to Hispanic women, their partners and offspring. If positive results emerge from the association studies, we will examine linkage using the transmission disequilibrium test. Collectively, these studies could provide evidence for the contribution of genetic factors to the risk of preterm birth. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VIRAL INFECTION IN LACTOBACILLI: AN ANIMAL BV MODEL Principal Investigator & Institution: Tao, Lin; Associate Professor; Oral Biology; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2003; Project Start 15-MAR-2003; Project End 28-FEB-2005 Summary: This application is in response to the NIH RFA (AI-02-008) entitled "Impact of Microbial Interactions on Infectious Diseases." Specifically we will study the interaction between viruses (phages) and vaginal lactobacilli during the development of experimental bacterial vaginosis (BV) in animals. BV is the most common vaginal disorder affecting women worldwide. Because the cause is unknown, no methods are available to prevent BV. Although BV itself only has mild discomfort, such as discharge and fishy smell, BV is associated with two major health risks in women: preterm delivery and increased susceptibility to contract HIV. Both incidences kill millions of newborns and adults annually. Therefore, it is urgent to study the cause of BV, because discovering its cause will be a key step in developing more effective ways to prevent and cure the disease. In healthy women, lactobacilli dominate the vaginal microbial ecology. During BV, a shift in microbial dominance occurs-lactobacilli decrease while Gardnerrella vaginalis and anaerobic bacteria increase It is unknown, however, what triggers the shift in vaginal ecology to cause BV. We have isolated phages that infect vaginal lactobacilli. Because these phages can potentially shift vaginal microbial dominance, they are implicated as an underlying cause for BV. We hypothesize that BV may occur after phages infect vaginal lactobacilli. We will test this hypothesis according to Koch's postulates. Namely, a virus isolated from lactobacilli will be inoculated into an animal to cause BV in the animal. We will achieve two specific aims: 1) Study in vitro interactions between phages and monkey vaginal lactobacilli. 2) Establish a monkey BV model by shifting vaginal ecology with a Lactobacillus phage. Upon completion of the study, we expect to have developed a BV animal model based on Koch's postulates, documented that BV can be an infectious disease and that the infectious pathogen is the Lactobacillus phage. We will have an improved understanding of the BV etiology. This will be the first step in attaining our long-term goal: developing better methods to treat and prevent BV. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Bacterial Vaginosis

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “bacterial vaginosis” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for bacterial vaginosis in the PubMed Central database: •

Analysis of Bacterial Vaginosis-Related Amines in Vaginal Fluid by Gas Chromatography and Mass Spectrometry. by Wolrath H, Forsum U, Larsson PG, Boren H.; 2001 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=88482

•

Association between bacterial vaginosis or chlamydial infection and miscarriage before 16 weeks' gestation: prospective community based cohort study. by Oakeshott P, Hay P, Hay S, Steinke F, Rink E, Kerry S.; 2002 Dec 7; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137811

•

BVBlue Test for Diagnosis of Bacterial Vaginosis. by Myziuk L, Romanowski B, Johnson SC.; 2003 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=154737

•

DNA Hybridization Test: Rapid Diagnostic Tool for Excluding Bacterial Vaginosis in Pregnant Women with Symptoms Suggestive of Infection. by Witt A, Petricevic L, Kaufmann U, Gregor H, Kiss H.; 2002 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=120636

•

Genomic DNA fingerprint analysis of biotype 1 Gardnerella vaginalis from patients with and without bacterial vaginosis. by Wu SR, Hillier SL, Nath K.; 1996 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=228759

•

Humoral antibody to Mobiluncus curtisii, a potential serological marker for bacterial vaginosis. by Schwebke JR, Morgan SC, Hillier SL.; 1996 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=170407

•

In vitro activities of 10 antimicrobial agents against bacterial vaginosis-associated anaerobic isolates from pregnant Japanese and Thai women. by Puapermpoonsiri S, Watanabe K, Kato N, Ueno K.; 1997 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=164113

3 Adapted 4

from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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•

In Vitro Susceptibilities of Lactobacilli and Organisms Associated with Bacterial Vaginosis to Melaleuca alternifolia (Tea Tree) Oil. by Hammer KA.; 1999 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=89050

•

Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. by Ralph SG, Rutherford AJ, Wilson JD.; 1999 Jul 24; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28171

•

Prevalence of Bacterial Vaginosis and Vaginal Flora Changes in Peri- and Postmenopausal Women. by Cauci S, Driussi S, De Santo D, Penacchioni P, Iannicelli T, Lanzafame P, De Seta F, Quadrifoglio F, de Aloysio D, Guaschino S.; 2002 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=130764

•

Tampon sampling for diagnosis of bacterial vaginosis: a potentially useful way to detect genital infections? by Wilkinson D, Ndovela N, Kharsany A, Connolly C, Sturm AW.; 1997 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229978

•

Two Novel Vaginal Microbicides (Polystyrene Sulfonate and Cellulose Sulfate) Inhibit Gardnerella vaginalis and Anaerobes Commonly Associated with Bacterial Vaginosis. by Simoes JA, Citron DM, Aroutcheva A, Anderson RA Jr, Chany II CJ, Waller DP, Faro S, Zaneveld LJ.; 2002 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=127353

•

Use of 5-Bromo-4-Chloro-3-Indolyl-[alpha]-d-N-Acetylneuraminic Acid in a Novel Spot Test To Identify Sialidase Activity in Vaginal Swabs from Women with Bacterial Vaginosis. by Wiggins R, Crowley T, Horner PJ, Soothill PW, Millar MR, Corfield AP.; 2000 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=87196

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with bacterial vaginosis, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “bacterial vaginosis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for bacterial vaginosis (hyperlinks lead to article summaries): 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A commensal symbiosis between Prevotella bivia and Peptostreptococcus anaerobius involves amino acids: potential significance to the pathogenesis of bacterial vaginosis. Author(s): Pybus V, Onderdonk AB. Source: Fems Immunology and Medical Microbiology. 1998 December; 22(4): 317-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9879923&dopt=Abstract

•

A comparison of acridine orange, wet microscopy and Gram staining in the diagnosis of bacterial vaginosis. Author(s): Nunns D, Mandal D, Farrand RJ, O'Neill H, Henshaw G. Source: The Journal of Infection. 1997 May; 34(3): 211-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9200027&dopt=Abstract

•

A comparison of the use of Papanicolaou-stained cervical cytological smears with Gram-stained vaginal smears for the diagnosis of bacterial vaginosis in early pregnancy. Author(s): Lamont RF, Hudson EA, Hay PE, Morgan DJ, Modi V, Ison CA, TaylorRobinson D. Source: International Journal of Std & Aids. 1999 February; 10(2): 93-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10215113&dopt=Abstract

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A multicenter study of bacterial vaginosis in women with or at risk for human immunodeficiency virus infection. Author(s): Warren D, Klein RS, Sobel J, Kieke B Jr, Brown W, Schuman P, Anderson J, Cu-Uvin S, Mayer K, Jamieson DJ, Holmberg S, Duerr A; HIV Epidemiology Research Study Group. Source: Infectious Diseases in Obstetrics and Gynecology. 2001; 9(3): 133-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11516061&dopt=Abstract

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A multiplex polymerase chain reaction-based diagnostic method for bacterial vaginosis. Author(s): Obata-Yasuoka M, Ba-Thein W, Hamada H, Hayashi H. Source: Obstetrics and Gynecology. 2002 October; 100(4): 759-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12383546&dopt=Abstract

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A pilot study of treatment of bacterial vaginosis with a buffering vaginal microbicide. Author(s): Harwell JI, Moench T, Mayer KH, Chapman S, Rodriguez I, Cu-Uvin S. Source: Journal of Women's Health (2002). 2003 April; 12(3): 255-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804356&dopt=Abstract

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A public health approach to adverse outcomes of pregnancy associated with bacterial vaginosis. Author(s): Koumans EH, Markowitz LE, Berman SM, St Louis ME. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1999 November; 67 Suppl 1: S29-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10661734&dopt=Abstract

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A randomised controlled trial of vaginal clindamycin for early pregnancy bacterial vaginosis. Author(s): Kurkinen-Raty M, Vuopala S, Koskela M, Kekki M, Kurki T, Paavonen J, Jouppila P. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 November; 107(11): 1427-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11117774&dopt=Abstract

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A randomized controlled trial of a new ovule formulation of ornidazole for the treatment of bacterial vaginosis. Author(s): Baloglu E, Ozyazici M, Baloglu A, Ova L. Source: Journal of Clinical Pharmacy and Therapeutics. 2003 April; 28(2): 131-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713610&dopt=Abstract

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A study on the possible association of dysfunctional uterine bleeding with bacterial vaginosis, mycoplasma, ureaplasma, and Gardnerella vaginalis. Author(s): Bhattacharjee B, Ghosh AK, Murray A, Murray AE. Source: Sexually Transmitted Infections. 2000 October; 76(5): 407. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11141864&dopt=Abstract

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A wet smear criterion for bacterial vaginosis. Author(s): Schmidt H, Hansen JG. Source: Scandinavian Journal of Primary Health Care. 1994 December; 12(4): 233-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7863139&dopt=Abstract

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Accuracy of cervical/vaginal cytology in the diagnosis of bacterial vaginosis. Author(s): Giacomini G, Calcinai A, Moretti D, Cristofani R. Source: Sexually Transmitted Diseases. 1998 January; 25(1): 24-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9437781&dopt=Abstract

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Adverse obstetric sequelae of bacterial vaginosis. Author(s): Adinkra P, Lamont RF. Source: Hosp Med. 2000 July; 61(7): 475-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11091802&dopt=Abstract

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An association between non-gonococcal urethritis and bacterial vaginosis and the implications for patients and their sexual partners. Author(s): Keane FE, Thomas BJ, Whitaker L, Renton A, Taylor-Robinson D. Source: Genitourinary Medicine. 1997 October; 73(5): 373-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9534747&dopt=Abstract

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An international study of the interobserver variation between interpretations of vaginal smear criteria of bacterial vaginosis. Author(s): Forsum U, Jakobsson T, Larsson PG, Schmidt H, Beverly A, Bjornerem A, Carlsson B, Csango P, Donders G, Hay P, Ison C, Keane F, McDonald H, Moi H, PlatzChristensen JJ, Schwebke J. Source: Apmis : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica. 2002 November; 110(11): 811-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12596717&dopt=Abstract

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Analysis of bacterial vaginosis-related amines in vaginal fluid by gas chromatography and mass spectrometry. Author(s): Wolrath H, Forsum U, Larsson PG, Boren H. Source: Journal of Clinical Microbiology. 2001 November; 39(11): 4026-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11682525&dopt=Abstract

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Antibiotic prophylaxis to prevent post-abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial. Author(s): Crowley T, Low N, Turner A, Harvey I, Bidgood K, Horner P. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 April; 108(4): 396-402. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11305547&dopt=Abstract

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Antibiotic treatment of bacterial vaginosis in pregnancy: a meta-analysis. Author(s): Leitich H, Brunbauer M, Bodner-Adler B, Kaider A, Egarter C, Husslein P. Source: American Journal of Obstetrics and Gynecology. 2003 March; 188(3): 752-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12634652&dopt=Abstract

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Antibiotics for treating bacterial vaginosis in pregnancy. Author(s): McDonald H, Brocklehurst P, Parsons J, Vigneswaran R. Source: Cochrane Database Syst Rev. 2003; (2): Cd000262. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804393&dopt=Abstract

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Application of a novel human cervical mucin-based assay demonstrates the absence of increased mucinase activity in bacterial vaginosis. Author(s): Wiggins R, Millar MR, Soothill PW, Hicks SJ, Corfield AP. Source: International Journal of Std & Aids. 2002 November; 13(11): 755-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437895&dopt=Abstract

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Are neonatal scalp abscesses another complication of bacterial vaginosis? Author(s): McGregor JA, French JI. Source: The Pediatric Infectious Disease Journal. 1988 June; 7(6): 437. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3393405&dopt=Abstract

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Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis. Author(s): Cherpes TL, Meyn LA, Krohn MA, Lurie JG, Hillier SL. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2003 August 1; 37(3): 319-25. Epub 2003 July 15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12884154&dopt=Abstract

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Association between bacterial vaginosis and expression of human immunodeficiency virus type 1 RNA in the female genital tract. Author(s): Cu-Uvin S, Hogan JW, Caliendo AM, Harwell J, Mayer KH, Carpenter CC; HIV Epidemiology Research Study. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 September 15; 33(6): 894-6. Epub 2001 August 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11512096&dopt=Abstract

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Association between bacterial vaginosis and fetal fibronectin at 24-29 weeks' gestation. Author(s): Pastore LM, Royce RA, Jackson TP, Thorp JM Jr, Savitz DA, Kreaden US. Source: Obstetrics and Gynecology. 1999 January; 93(1): 117-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9916968&dopt=Abstract

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Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. Author(s): Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, Martin DH, Cotch MF, Edelman R, Pastorek JG 2nd, Rao AV, et al. Source: The New England Journal of Medicine. 1995 December 28; 333(26): 1737-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7491137&dopt=Abstract

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Association between bacterial vaginosis or chlamydial infection and miscarriage before 16 weeks' gestation: prospective community based cohort study. Author(s): Oakeshott P, Hay P, Hay S, Steinke F, Rink E, Kerry S. Source: Bmj (Clinical Research Ed.). 2002 December 7; 325(7376): 1334. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12468483&dopt=Abstract

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Association of bacterial vaginosis with a history of second trimester miscarriage. Author(s): Llahi-Camp JM, Rai R, Ison C, Regan L, Taylor-Robinson D. Source: Human Reproduction (Oxford, England). 1996 July; 11(7): 1575-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8671507&dopt=Abstract

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Association of indicators of bacterial vaginosis with a female genital tract factor that induces expression of HIV-1. Author(s): Olinger GG, Hashemi FB, Sha BE, Spear GT. Source: Aids (London, England). 1999 October 1; 13(14): 1905-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10513649&dopt=Abstract

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Association of viridans group streptococci from pregnant women with bacterial vaginosis and upper genital tract infection. Author(s): Rabe LK, Winterscheid KK, Hillier SL. Source: Journal of Clinical Microbiology. 1988 June; 26(6): 1156-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2454943&dopt=Abstract

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Asymptomatic bacterial vaginosis: response to therapy. Author(s): Schwebke JR. Source: American Journal of Obstetrics and Gynecology. 2000 December; 183(6): 1434-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11120507&dopt=Abstract

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Bacterial vaginosis a “broad overview”. Author(s): Gonzalez Pedraza Aviles A, Ortiz Zaragoza MC, Irigoyen Coria A. Source: Rev Latinoam Microbiol. 1999 January-March; 41(1): 25-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10932748&dopt=Abstract

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Bacterial vaginosis among a group of married Jordanian women: occurrence and laboratory diagnosis. Author(s): Abu Shaqra QM. Source: Cytobios. 2001; 105(408): 35-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11368266&dopt=Abstract

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Bacterial vaginosis and cervical dilation and effacement at 24-29 weeks' gestation. Author(s): Pastore LM, Hartmann KE, Thorp JM Jr, Royce RA, Jackson TP, Savitz DA. Source: American Journal of Perinatology. 2000; 17(2): 83-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11023166&dopt=Abstract

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Bacterial vaginosis and Chlamydia trachomatis among pregnant abused and nonabused Hispanic women. Author(s): King EA, Britt R, McFarlane JM, Hawkins C. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2000 November-December; 29(6): 606-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11110331&dopt=Abstract

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Bacterial vaginosis and contraceptive methods. Author(s): Calzolari E, Masciangelo R, Milite V, Verteramo R. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2000 September; 70(3): 341-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10967168&dopt=Abstract

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Bacterial vaginosis and HIV infection. Author(s): Schmid G, Markowitz L, Joesoef R, Koumans E. Source: Sexually Transmitted Infections. 2000 February; 76(1): 3-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10817059&dopt=Abstract

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Bacterial vaginosis and other asymptomatic vaginal infections in pregnancy. Author(s): Carey JC, Klebanoff MA. Source: Curr Womens Health Rep. 2001 August; 1(1): 14-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12112946&dopt=Abstract

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Bacterial vaginosis and smoking. Author(s): Hellberg D, Nilsson S, Mardh PA. Source: International Journal of Std & Aids. 2000 September; 11(9): 603-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10997505&dopt=Abstract

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Bacterial vaginosis and treatment of sexual partners. Author(s): Hamrick M, Chambliss ML. Source: Archives of Family Medicine. 2000 July; 9(7): 647-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10910313&dopt=Abstract

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Bacterial vaginosis and vaginal fluid defensins during pregnancy. Author(s): Balu RB, Savitz DA, Ananth CV, Hartmann KE, Miller WC, Thorp JM, Heine RP. Source: American Journal of Obstetrics and Gynecology. 2002 November; 187(5): 126771. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439518&dopt=Abstract

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Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Author(s): Leitich H, Bodner-Adler B, Brunbauer M, Kaider A, Egarter C, Husslein P. Source: American Journal of Obstetrics and Gynecology. 2003 July; 189(1): 139-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861153&dopt=Abstract

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Bacterial vaginosis during pregnancy. Should we screen for and treat it? Author(s): Einarson A, Koren G. Source: Can Fam Physician. 2002 May; 48: 877-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12053630&dopt=Abstract

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Bacterial vaginosis in a family practice population. Author(s): Schmidt H, Hansen JG. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2000 November; 79(11): 9991005. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11081687&dopt=Abstract

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Bacterial vaginosis in climacteric and menopausal women. Author(s): Taylor-Robinson D, McCaffrey M, Pitkin J, Lamont RF. Source: International Journal of Std & Aids. 2002 July; 13(7): 449-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12171662&dopt=Abstract

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Bacterial vaginosis in early pregnancy and adverse pregnancy outcome. Author(s): Purwar M, Ughade S, Bhagat B, Agarwal V, Kulkarni H. Source: The Journal of Obstetrics and Gynaecology Research. 2001 August; 27(4): 175-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11721727&dopt=Abstract

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Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis. Author(s): Jacobsson B, Pernevi P, Chidekel L, Jorgen Platz-Christensen J. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 November; 81(11): 1006-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12421167&dopt=Abstract

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Bacterial vaginosis in pregnancy and the risk of prematurity: a meta-analysis. Author(s): Flynn CA, Helwig AL, Meurer LN. Source: The Journal of Family Practice. 1999 November; 48(11): 885-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10907626&dopt=Abstract

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Bacterial vaginosis in pregnancy. Author(s): Ugwumadu AH. Source: Current Opinion in Obstetrics & Gynecology. 2002 April; 14(2): 115-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11914687&dopt=Abstract

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Bacterial vaginosis in pregnancy. Author(s): McGregor JA, French JI. Source: Obstetrical & Gynecological Survey. 2000 May; 55(5 Suppl 1): S1-19. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10804540&dopt=Abstract

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Bacterial vaginosis in pregnancy: current findings and future directions. Author(s): Nelson DB, Macones G. Source: Epidemiologic Reviews. 2002; 24(2): 102-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762086&dopt=Abstract

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Bacterial vaginosis increases in pessary users. Author(s): Alnaif B, Drutz HP. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2000; 11(4): 219-22; Discussion 222-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11005473&dopt=Abstract

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Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Author(s): Wiesenfeld HC, Hillier SL, Krohn MA, Landers DV, Sweet RL. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2003 March 1; 36(5): 663-8. Epub 2003 February 07. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12594649&dopt=Abstract

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Bacterial vaginosis, vaginal fluid neutrophil defensins, and preterm birth. Author(s): Balu RB, Savitz DA, Ananth CV, Hartmann KE, Miller WC, Thorp JM, Heine RP. Source: Obstetrics and Gynecology. 2003 May; 101(5 Pt 1): 862-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738141&dopt=Abstract

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Bacterial vaginosis. Author(s): Joesoef M, Schmid G. Source: Clin Evid. 2002 June; (7): 1400-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230755&dopt=Abstract

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Bacterial vaginosis: a public health problem for women. Author(s): Rauh VA, Culhane JF, Hogan VK. Source: J Am Med Womens Assoc. 2000 Summer; 55(4): 220-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10935356&dopt=Abstract

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Bacterial vaginosis: a public health review. Author(s): Morris M, Nicoll A, Simms I, Wilson J, Catchpole M. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 May; 108(5): 439-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11368127&dopt=Abstract

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Bacterial vaginosis: a threat to reproductive health? Historical perspectives, current knowledge, controversies and research demands. Author(s): Mardh PA. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 2000 September; 5(3): 208-19. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11131786&dopt=Abstract

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Bacterial vaginosis: the quest continues. Author(s): Faro S. Source: Infectious Diseases in Obstetrics and Gynecology. 2000; 8(2): 75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10805359&dopt=Abstract

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BVBlue test for diagnosis of bacterial vaginosis. Author(s): Myziuk L, Romanowski B, Johnson SC. Source: Journal of Clinical Microbiology. 2003 May; 41(5): 1925-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12734228&dopt=Abstract

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Can a laboratory diagnosis of bacterial vaginosis be made from a transported high vaginal swab using anaerobic culture and microscopy of a wet preparation? Author(s): Crowley T, Berry J, Horner PJ, Gough KR, Turner A. Source: Sexually Transmitted Infections. 1998 June; 74(3): 228. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9849564&dopt=Abstract

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Can known risk factors explain racial differences in the occurrence of bacterial vaginosis? Author(s): Ness RB, Hillier S, Richter HE, Soper DE, Stamm C, Bass DC, Sweet RL, Rice P. Source: Journal of the National Medical Association. 2003 March; 95(3): 201-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12749680&dopt=Abstract

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Cefadroxil as an alternative to metronidazole in the treatment of bacterial vaginosis. Author(s): Wathne B, Hovelius B, Holst E. Source: Scandinavian Journal of Infectious Diseases. 1989; 21(5): 585-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2685988&dopt=Abstract

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Cervical cytology in women with bacterial vaginosis. Author(s): Bhalla P, Kaushika A. Source: Indian J Pathol Microbiol. 1998 July; 41(3): 271-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9805847&dopt=Abstract

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Cervical intraepithelial neoplasia and bacterial vaginosis: correlation or risk factor? Author(s): Frega A, Stentella P, Spera G, Pace S, Cipriano L, Di Ruzza D, Villani C, Pachi A. Source: Eur J Gynaecol Oncol. 1997; 18(1): 76-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9061331&dopt=Abstract

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Cervical morphology in pregnancy, bacterial vaginosis and the risk of preterm delivery. Author(s): Ugwumadu AH. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2000 March; 15(3): 174-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10846769&dopt=Abstract

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Characterization of the inflammatory cytokines in the vagina during pregnancy and labor and with bacterial vaginosis. Author(s): Imseis HM, Greig PC, Livengood CH 3rd, Shunior E, Durda P, Erikson M. Source: Journal of the Society for Gynecologic Investigation. 1997 March-April; 4(2): 904. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9101468&dopt=Abstract

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Characterization of vaginal flora and bacterial vaginosis in women who have sex with women. Author(s): Marrazzo JM, Koutsky LA, Eschenbach DA, Agnew K, Stine K, Hillier SL. Source: The Journal of Infectious Diseases. 2002 May 1; 185(9): 1307-13. Epub 2002 April 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12001048&dopt=Abstract

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Clindamycin versus metronidazole in the treatment of bacterial vaginosis. Author(s): Greaves WL, Chungafung J, Morris B, Haile A, Townsend JL. Source: Obstetrics and Gynecology. 1988 November; 72(5): 799-802. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3050654&dopt=Abstract

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Clinical and cervical cytokine response to treatment with oral or vaginal metronidazole for bacterial vaginosis during pregnancy: a randomized trial. Author(s): Yudin MH, Landers DV, Meyn L, Hillier SL. Source: Obstetrics and Gynecology. 2003 September; 102(3): 527-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962937&dopt=Abstract

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Clinical and laboratory findings in women with bacterial vaginosis and trichomoniasis versus controls. Author(s): van der Meijden WI, Duivenvoorden HJ, Both-Patoir HC, Hazen-Engelsman ME, Drogendijk AC. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1988 May; 28(1): 39-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3260566&dopt=Abstract

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Clinical diagnosis of bacterial vaginosis. Author(s): Nelson MS. Source: The American Journal of Emergency Medicine. 1987 November; 5(6): 488-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3663289&dopt=Abstract

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Clinical manifestations and diagnosis of bacterial vaginosis in a clinic of sexually transmitted diseases. Author(s): Tchoudomirova K, Stanilova M, Garov V. Source: Folia Med (Plovdiv). 1998; 40(1): 34-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9630766&dopt=Abstract

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Cochrane for clinicians: putting evidence into practice. Screening for and treating asymptomatic bacterial vaginosis in pregnancy. Author(s): Chandran R. Source: American Family Physician. 2002 September 1; 66(5): 780-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12322768&dopt=Abstract

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Combination of bacterial vaginosis and leukorrhea as a predictor of cervical chlamydial or gonococcal infection. Author(s): Steinhandler L, Peipert JF, Heber W, Montagno A, Cruickshank C. Source: Obstetrics and Gynecology. 2002 April; 99(4): 603-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12039120&dopt=Abstract

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Comparison of clindamycin phosphate vaginal cream with triple sulfonamide vaginal cream in the treatment of bacterial vaginosis. Author(s): McCormack WM, Covino JM, Thomason JL, Eschenbach DA, Mou S, Kapernick P, McGregor J, Rein MF, Hillier SL. Source: Sexually Transmitted Diseases. 2001 October; 28(10): 569-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11689755&dopt=Abstract

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Comparison of Gram stain and Pap smear procedures in the diagnosis of bacterial vaginosis. Author(s): Vardar E, Maral I, Inal M, Ozguder O, Tasli F, Postaci H. Source: Infectious Diseases in Obstetrics and Gynecology. 2002; 10(4): 203-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12648314&dopt=Abstract

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Comparison of once-daily and twice-daily dosing of 0.75% metronidazole gel in the treatment of bacterial vaginosis. Author(s): Livengood CH 3rd, Soper DE, Sheehan KL, Fenner DE, Martens MG, Nelson AL, Ismail M, Thorp JM, Lappin M, Long BJ, Blackwelder T, Sweet RL, Sagov S. Source: Sexually Transmitted Diseases. 1999 March; 26(3): 137-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10100770&dopt=Abstract

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Comparison of tinidazole given as a single dose and on 2 consecutive days for the treatment of nonspecific bacterial vaginosis. Author(s): Ekgren J, Norling BK, Degre M, Midtvedt T. Source: Gynecologic and Obstetric Investigation. 1988; 26(4): 313-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3068098&dopt=Abstract

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Contraceptive use in women with bacterial vaginosis. Author(s): Shoubnikova M, Hellberg D, Nilsson S, Mardh PA. Source: Contraception. 1997 June; 55(6): 355-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9262931&dopt=Abstract

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Correlation between cervical cytologic results and Gram stain as diagnostic tests for bacterial vaginosis. Author(s): Davis JD, Connor EE, Clark P, Wilkinson EJ, Duff P. Source: American Journal of Obstetrics and Gynecology. 1997 September; 177(3): 532-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9322619&dopt=Abstract

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Correlation of local interleukin-1beta levels with specific IgA response against Gardnerella vaginalis cytolysin in women with bacterial vaginosis. Author(s): Cauci S, Driussi S, Guaschino S, Isola M, Quadrifoglio F. Source: American Journal of Reproductive Immunology (New York, N.Y. : 1989). 2002 May; 47(5): 257-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12148539&dopt=Abstract

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Correlation of local interleukin-8 with immunoglobulin A against Gardnerella vaginalis hemolysin and with prolidase and sialidase levels in women with bacterial vaginosis. Author(s): Cauci S, Guaschino S, Driussi S, De Santo D, Lanzafame P, Quadrifoglio F. Source: The Journal of Infectious Diseases. 2002 June 1; 185(11): 1614-20. Epub 2002 May 06. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12023767&dopt=Abstract

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Corynebacterium lipophiloflavum sp. nov. isolated from a patient with bacterial vaginosis. Author(s): Funke G, Hutson RA, Hilleringmann M, Heizmann WR, Collins MD. Source: Fems Microbiology Letters. 1997 May 15; 150(2): 219-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9170265&dopt=Abstract

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Cost of bacterial vaginosis in pregnancy. Decision analysis and cost evaluation of a clinical study in Germany. Author(s): Muller E, Berger K, Dennemark N, Oleen-Burkey M. Source: J Reprod Med. 1999 September; 44(9): 807-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10509306&dopt=Abstract

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Defining bacterial vaginosis: to BV or not to BV, that is the question. Author(s): Hay PE, Taylor-Robinson D. Source: International Journal of Std & Aids. 1996 July; 7(4): 233-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8876352&dopt=Abstract

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Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. Author(s): Donder GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 January; 109(1): 34-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11845812&dopt=Abstract

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Detection and identification of amines in bacterial vaginosis. Author(s): Kubota T, Sakae U, Takeuchi H, Usui M. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 1995 February; 21(1): 51-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8591111&dopt=Abstract

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Detection of bacterial vaginosis in Papanicolaou smears. Author(s): Platz-Christensen JJ, Larsson PG, Sundstrom E, Bondeson L. Source: American Journal of Obstetrics and Gynecology. 1989 January; 160(1): 132-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2912076&dopt=Abstract

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Detection of bacterial vaginosis in wet mount, Papanicolaou stained vaginal smears and in gram stained smears. Author(s): Platz-Christensen JJ, Larsson PG, Sundstrom E, Wiqvist N. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1995 January; 74(1): 67-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7856436&dopt=Abstract

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Detection of bacterial vaginosis-related organisms by real-time PCR for Lactobacilli, Gardnerella vaginalis and Mycoplasma hominis. Author(s): Zariffard MR, Saifuddin M, Sha BE, Spear GT. Source: Fems Immunology and Medical Microbiology. 2002 December 13; 34(4): 277-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12443827&dopt=Abstract

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Diagnosis and clinical manifestations of bacterial vaginosis. Author(s): Eschenbach DA, Hillier S, Critchlow C, Stevens C, DeRouen T, Holmes KK. Source: American Journal of Obstetrics and Gynecology. 1988 April; 158(4): 819-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3259075&dopt=Abstract

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Diagnosis and prevalence of bacterial vaginosis. Author(s): Saharan SP, Surve C, Raut V, Bhattacharya M. Source: Journal of Postgraduate Medicine. 1993 April-June; 39(2): 72-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8169866&dopt=Abstract

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Diagnosis of bacterial vaginosis by Amsel's criteria. Author(s): Iftikhar R. Source: J Coll Physicians Surg Pak. 2003 February; 13(2): 76-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12685947&dopt=Abstract

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Diagnosis of bacterial vaginosis by wet mount identification of bacterial morphotypes in vaginal fluid. Author(s): Schmidt H, Hansen JG. Source: International Journal of Std & Aids. 2000 March; 11(3): 150-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10726936&dopt=Abstract

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Diagnosis of bacterial vaginosis on self-collected vaginal tampon specimens. Author(s): Sturm PD, Moodley P, Nzimande G, Balkistan R, Connolly C, Sturm AW. Source: International Journal of Std & Aids. 2002 August; 13(8): 559-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12194740&dopt=Abstract

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Diagnostic methods for bacterial vaginosis. Author(s): Schwebke JR. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1999 November; 67 Suppl 1: S21-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10661732&dopt=Abstract

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Diagnostic microbiology of bacterial vaginosis. Author(s): Hillier SL. Source: American Journal of Obstetrics and Gynecology. 1993 August; 169(2 Pt 2): 455-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8357044&dopt=Abstract

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Direct or referral microscopy of vaginal wet smear for bacterial vaginosis: experience from an STD clinic. Author(s): Petersen CS, Danielsen AG, Renneberg J. Source: Acta Dermato-Venereologica. 1999 November; 79(6): 473-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10598765&dopt=Abstract

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DNA hybridization test: rapid diagnostic tool for excluding bacterial vaginosis in pregnant women with symptoms suggestive of infection. Author(s): Witt A, Petricevic L, Kaufmann U, Gregor H, Kiss H. Source: Journal of Clinical Microbiology. 2002 August; 40(8): 3057-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12149379&dopt=Abstract

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Does bacterial vaginosis alter the sensitivity of screening tests for Chlamydia trachomatis? An analysis of patient characteristics. Author(s): Hussey J, Edirisinghe DN, Pattman RS, Sankar KN, Wipat W, Kearns A, Turner AJ. Source: International Journal of Std & Aids. 2003 July; 14(7): 448-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12869223&dopt=Abstract

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Does oral metronidazole prevent preterm delivery in normal-risk pregnant women with asymptomatic bacterial vaginosis (BV)? Author(s): Lazar PA. Source: The Journal of Family Practice. 2000 June; 49(6): 495-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10923545&dopt=Abstract

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Does pre- and postoperative metronidazole treatment lower vaginal cuff infection rate after abdominal hysterectomy among women with bacterial vaginosis? Author(s): Larsson PG, Carlsson B. Source: Infectious Diseases in Obstetrics and Gynecology. 2002; 10(3): 133-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12625969&dopt=Abstract

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Does prepregnancy bacterial vaginosis increase a mother's risk of having a preterm infant with cerebral palsy? Author(s): Dammann O, Leviton A. Source: Developmental Medicine and Child Neurology. 1997 December; 39(12): 836-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9433862&dopt=Abstract

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Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina. Author(s): Ness RB, Hillier SL, Richter HE, Soper DE, Stamm C, McGregor J, Bass DC, Sweet RL, Rice P. Source: Obstetrics and Gynecology. 2002 October; 100(4): 765. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12383547&dopt=Abstract

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Ecological treatment of bacterial vaginosis. Author(s): Fredricsson B, Englund K, Weintraub L, Olund A, Nord CE. Source: Lancet. 1987 January 31; 1(8527): 276. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2880095&dopt=Abstract

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Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial. Author(s): Ugwumadu A, Manyonda I, Reid F, Hay P. Source: Lancet. 2003 March 22; 361(9362): 983-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12660054&dopt=Abstract

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Effect of lactic acid suppositories compared with oral metronidazole and placebo in bacterial vaginosis: a randomised clinical trial. Author(s): Boeke AJ, Dekker JH, van Eijk JT, Kostense PJ, Bezemer PD. Source: Genitourinary Medicine. 1993 October; 69(5): 388-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8244360&dopt=Abstract

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Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo-controlled, double-blind study. Author(s): Morales WJ, Schorr S, Albritton J. Source: American Journal of Obstetrics and Gynecology. 1994 August; 171(2): 345-7; Discussion 348-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8059811&dopt=Abstract

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Effectiveness of current therapy of bacterial vaginosis. Author(s): Andreeva PM, Omar HA. Source: Int J Adolesc Med Health. 2002 April-June; 14(2): 145-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12467186&dopt=Abstract

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Efficacy of clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis. Author(s): Fischbach F, Petersen EE, Weissenbacher ER, Martius J, Hosmann J, Mayer H. Source: Obstetrics and Gynecology. 1993 September; 82(3): 405-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8355942&dopt=Abstract

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Efficacy of clindamycin vaginal ovule (3-day treatment) vs. clindamycin vaginal cream (7-day treatment) in bacterial vaginosis. Author(s): Sobel J, Peipert JF, McGregor JA, Livengood C, Martin M, Robbins J, Wajszczuk CP. Source: Infectious Diseases in Obstetrics and Gynecology. 2001; 9(1): 9-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11368263&dopt=Abstract

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Efficacy of intravaginal 0.75% metronidazole gel for the treatment of bacterial vaginosis. Author(s): Hillier SL, Lipinski C, Briselden AM, Eschenbach DA. Source: Obstetrics and Gynecology. 1993 June; 81(6): 963-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8497364&dopt=Abstract

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Efficacy of the combination of 2 g oral tinidazole and acidic buffering vaginal gel in comparison with vaginal clindamycin alone in bacterial vaginosis: a randomized, investigator-blinded, controlled trial. Author(s): Milani M, Barcellona E, Agnello A. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2003 July 1; 109(1): 67-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818447&dopt=Abstract

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Endotoxin and interleukin-1 alpha in the cervical mucus and vaginal fluid of pregnant women with bacterial vaginosis. Author(s): Platz-Christensen JJ, Mattsby-Baltzer I, Thomsen P, Wiqvist N. Source: American Journal of Obstetrics and Gynecology. 1993 November; 169(5): 1161-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8238178&dopt=Abstract

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Epidemiology of bacterial vaginosis. Author(s): Mead PB. Source: American Journal of Obstetrics and Gynecology. 1993 August; 169(2 Pt 2): 446-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8357042&dopt=Abstract

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Erythromycin versus metronidazole in the treatment of bacterial vaginosis. Author(s): Wathne B, Holst E, Hovelius B, Mardh PA. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1993 August; 72(6): 470-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8394627&dopt=Abstract

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Evaluation of a new rapid diagnostic kit (FemExam) for bacterial vaginosis in patients with vaginal discharge syndrome in The Gambia. Author(s): West B, Morison L, van der Loeff MS, Gooding E, Awasana AA, Demba E, Mayaud P. Source: Sexually Transmitted Diseases. 2003 June; 30(6): 483-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782948&dopt=Abstract

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Evaluation of a novel diagnostic test for bacterial vaginosis: 'the electronic nose'. Author(s): Hay P, Tummon A, Ogunfile M, Adebiyi A, Adefowora A. Source: International Journal of Std & Aids. 2003 February; 14(2): 114-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12662390&dopt=Abstract

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Evaluation of a rapid diagnostic test for bacterial vaginosis. Author(s): O'Dowd TC, West RR, Winterburn PJ, Hewlins MJ. Source: British Journal of Obstetrics and Gynaecology. 1996 April; 103(4): 366-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8605135&dopt=Abstract

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Evaluation of the Etest for antimicrobial spectrum and potency determinations of anaerobes associated with bacterial vaginosis and peritonitis. Author(s): Croco JL, Erwin ME, Jennings JM, Putnam LR, Jones RN. Source: Diagnostic Microbiology and Infectious Disease. 1994 December; 20(4): 213-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7705035&dopt=Abstract

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Evaluation of the Etest for determinations of antimicrobial spectrum and potency against anaerobes associated with bacterial vaginosis and peritonitis. Author(s): Croco JL, Erwin ME, Jennings JM, Putnam LR, Jones RN. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1995 June; 20 Suppl 2: S339-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7548592&dopt=Abstract

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Evidence for a commensal, symbiotic relationship between Gardnerella vaginalis and Prevotella bivia involving ammonia: potential significance for bacterial vaginosis. Author(s): Pybus V, Onderdonk AB. Source: The Journal of Infectious Diseases. 1997 February; 175(2): 406-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9203662&dopt=Abstract

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Exposure to chronic stress and ethnic differences in rates of bacterial vaginosis among pregnant women. Author(s): Culhane JF, Rauh V, McCollum KF, Elo IT, Hogan V. Source: American Journal of Obstetrics and Gynecology. 2002 November; 187(5): 1272-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439519&dopt=Abstract

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Factors associated with trichomoniasis, candidiasis and bacterial vaginosis. Author(s): Hart G. Source: International Journal of Std & Aids. 1993 January-February; 4(1): 21-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8427898&dopt=Abstract

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Factors linked to bacterial vaginosis in nonpregnant women. Author(s): Holzman C, Leventhal JM, Qiu H, Jones NM, Wang J; BV Study Group. Source: American Journal of Public Health. 2001 October; 91(10): 1664-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11574333&dopt=Abstract

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Fetal fibronectin and bacterial vaginosis in smokers and nonsmokers. The National Institute of Child Health and Human Development Maternal- Fetal Medicine Units Network. Author(s): Goldenberg RL, Das A. Source: American Journal of Obstetrics and Gynecology. 2000 January; 182(1 Pt 1): 164-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10649173&dopt=Abstract

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Fetal fibronectin, endotoxin, bacterial vaginosis and cervical length as predictors of preterm birth and neonatal morbidity in twin pregnancies. Author(s): Wennerholm UB, Holm B, Mattsby-Baltzer I, Nielsen T, Platz-Christensen J, Sundell G, Hosseini N, Hagberg H. Source: British Journal of Obstetrics and Gynaecology. 1997 December; 104(12): 1398404. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9422019&dopt=Abstract

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Few microorganisms associated with bacterial vaginosis may constitute the pathologic core: a population-based microbiologic study among 3596 pregnant women. Author(s): Thorsen P, Jensen IP, Jeune B, Ebbesen N, Arpi M, Bremmelgaard A, Moller BR. Source: American Journal of Obstetrics and Gynecology. 1998 March; 178(3): 580-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9539529&dopt=Abstract

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Fibronectin binding of Lactobacillus species isolated from women with and without bacterial vaginosis. Author(s): Nagy E, Froman G, Mardh PA. Source: Journal of Medical Microbiology. 1992 July; 37(1): 38-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1625314&dopt=Abstract

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Frequency of Mobiluncus spp. in bacterial vaginosis in Italy. Author(s): Fenocchi M, Gatti M. Source: Microbiologica. 1992 October; 15(4): 409-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1435353&dopt=Abstract

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Gardnerella vaginalis isolated from patients with bacterial vaginosis and from patients with healthy vaginal ecosystems. Author(s): Aroutcheva AA, Simoes JA, Behbakht K, Faro S. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 October 1; 33(7): 1022-7. Epub 2001 September 05. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11528575&dopt=Abstract

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Genomic DNA fingerprint analysis of biotype 1 Gardnerella vaginalis from patients with and without bacterial vaginosis. Author(s): Wu SR, Hillier SL, Nath K. Source: Journal of Clinical Microbiology. 1996 January; 34(1): 192-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8748302&dopt=Abstract

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Gestational bleeding, bacterial vaginosis, and common reproductive tract infections: risk for preterm birth and benefit of treatment. Author(s): French JI, McGregor JA, Draper D, Parker R, McFee J. Source: Obstetrics and Gynecology. 1999 May; 93(5 Pt 1): 715-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10912974&dopt=Abstract

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Glycosidase and proteinase activity of anaerobic gram-negative bacteria isolated from women with bacterial vaginosis. Author(s): Olmsted SS, Meyn LA, Rohan LC, Hillier SL. Source: Sexually Transmitted Diseases. 2003 March; 30(3): 257-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616147&dopt=Abstract

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Gram stain method shows better sensitivity than clinical criteria for detection of bacterial vaginosis in surveillance of pregnant, low-income women in a clinical setting. Author(s): Donders GG. Source: Infectious Diseases in Obstetrics and Gynecology. 1999; 7(6): 273-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10598915&dopt=Abstract

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Gram stain method shows better sensitivity than clinical criteria for detection of bacterial vaginosis in surveillance of pregnant, low-income women in a clinical setting. Author(s): Tam MT, Yungbluth M, Myles T. Source: Infectious Diseases in Obstetrics and Gynecology. 1998; 6(5): 204-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9894174&dopt=Abstract

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Gram-stain diagnosis of bacterial vaginosis after rupture of membranes. Author(s): Core La BQ, Mastrobattista JM, Bishop K, Newton ER. Source: American Journal of Perinatology. 2000; 17(6): 315-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11144314&dopt=Abstract

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Gynecologic conditions and bacterial vaginosis: implications for the non-pregnant patient. Author(s): Sweet RL. Source: Infectious Diseases in Obstetrics and Gynecology. 2000; 8(3-4): 184-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10968604&dopt=Abstract

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Gynecologic sequelae of bacterial vaginosis. Author(s): Soper DE. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1999 November; 67 Suppl 1: S25-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10661733&dopt=Abstract

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Heterogeneity in restriction patterns of Gardnerella vaginalis isolates from individuals with bacterial vaginosis. Author(s): Nath K, Devlin D, Beddoe AM. Source: Research in Microbiology. 1992 February; 143(2): 199-209. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1410795&dopt=Abstract

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High levels of Gardnerella vaginalis detected with an oligonucleotide probe combined with elevated pH as a diagnostic indicator of bacterial vaginosis. Author(s): Sheiness D, Dix K, Watanabe S, Hillier SL. Source: Journal of Clinical Microbiology. 1992 March; 30(3): 642-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1372621&dopt=Abstract

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High levels of tumor necrosis factor-alpha and interleukin-1beta in bacterial vaginosis may increase susceptibility to human immunodeficiency virus. Author(s): Sturm-Ramirez K, Gaye-Diallo A, Eisen G, Mboup S, Kanki PJ. Source: The Journal of Infectious Diseases. 2000 August; 182(2): 467-73. Epub 2000 July 18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10915077&dopt=Abstract

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High performance ion exclusion chromatographic characterization of the vaginal organic acids in women with bacterial vaginosis. Author(s): Stanek R, Gain RE, Glover DD, Larsen B. Source: Biomedical Chromatography : Bmc. 1992 September-October; 6(5): 231-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1463935&dopt=Abstract

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High rate of bacterial vaginosis among women with intrauterine devices in Manado, Indonesia. Author(s): Joesoef MR, Karundeng A, Runtupalit C, Moran JS, Lewis JS, Ryan CA. Source: Contraception. 2001 September; 64(3): 169-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11704096&dopt=Abstract

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Historical review of the treatment of bacterial vaginosis. Author(s): Ledger WJ. Source: American Journal of Obstetrics and Gynecology. 1993 August; 169(2 Pt 2): 474-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8357049&dopt=Abstract

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History and review of bacterial vaginosis. Author(s): Eschenbach DA. Source: American Journal of Obstetrics and Gynecology. 1993 August; 169(2 Pt 2): 441-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8357040&dopt=Abstract

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HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Author(s): Ledru S, Meda N, Ledru E, Bazie AJ, Chiron JP. Source: Lancet. 1997 October 25; 350(9086): 1251-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9652590&dopt=Abstract

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HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Author(s): Ugwumadu A, Hay P, Taylor-Robinson D. Source: Lancet. 1997 October 25; 350(9086): 1251. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9652589&dopt=Abstract

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HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Author(s): Gray RH, Wawer MJ, Sewankambo N, Serwadda D. Source: Lancet. 1997 December 13; 350(9093): 1780. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9413492&dopt=Abstract

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HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Author(s): Sewankambo N, Gray RH, Wawer MJ, Paxton L, McNaim D, WabwireMangen F, Serwadda D, Li C, Kiwanuka N, Hillier SL, Rabe L, Gaydos CA, Quinn TC, Konde-Lule J. Source: Lancet. 1997 August 23; 350(9077): 546-50. Erratum In: Lancet 1997 October 4; 350(9083): 1036. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9284776&dopt=Abstract

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Humoral antibody to Mobiluncus curtisii, a potential serological marker for bacterial vaginosis. Author(s): Schwebke JR, Morgan SC, Hillier SL. Source: Clinical and Diagnostic Laboratory Immunology. 1996 September; 3(5): 567-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8877136&dopt=Abstract

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Identifying and managing bacterial vaginosis. Author(s): Young F. Source: J Fam Health Care. 2002; 12(4): 102-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416017&dopt=Abstract

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Improving Gram-stained reproducible result by further adding clue cells in diagnosing bacterial vaginosis. Author(s): Lin DP, Pan BJ, Fuh JC, Huang TH. Source: Kaohsiung J Med Sci. 2002 April; 18(4): 164-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12164009&dopt=Abstract

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In vitro activity of a cellulose acetate phthalate topical cream against organisms associated with bacterial vaginosis. Author(s): Neurath AR, Li YY, Mandeville R, Richard L. Source: The Journal of Antimicrobial Chemotherapy. 2000 May; 45(5): 713-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10797102&dopt=Abstract

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In vitro activity of azithromycin and erythromycin against organisms associated with bacterial vaginosis and chancroid. Author(s): Jones BM, Kinghorn GR, Duerden BI. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 1988 August; 7(4): 551-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3141171&dopt=Abstract

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In vitro antagonistic effect of Lactobacillus on organisms associated with bacterial vaginosis. Author(s): Strus M, Malinowska M, Heczko PB. Source: J Reprod Med. 2002 January; 47(1): 41-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11838310&dopt=Abstract

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Indications for therapy and treatment recommendations for bacterial vaginosis in nonpregnant and pregnant women: a synthesis of data. Author(s): Koumans EH, Markowitz LE, Hogan V; CDC BV Working Group. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2002 October 15; 35(Suppl 2): S152-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12353202&dopt=Abstract

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Induction of human immunodeficiency virus type 1 expression by anaerobes associated with bacterial vaginosis. Author(s): Hashemi FB, Ghassemi M, Faro S, Aroutcheva A, Spear GT. Source: The Journal of Infectious Diseases. 2000 May; 181(5): 1574-80. Epub 2000 May 15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10823756&dopt=Abstract

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Infertility, preterm birth, and bacterial vaginosis. Author(s): Wilson JD, Ralph SG, Jackson F, Rutherford AJ. Source: Lancet. 1999 August 7; 354(9177): 511. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10465196&dopt=Abstract

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Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. Author(s): Ralph SG, Rutherford AJ, Wilson JD. Source: Bmj (Clinical Research Ed.). 1999 July 24; 319(7204): 220-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10417083&dopt=Abstract

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Inhibition of chemotaxis by organic acids from anaerobes may prevent a purulent response in bacterial vaginosis. Author(s): Al-Mushrif S, Eley A, Jones BM. Source: Journal of Medical Microbiology. 2000 November; 49(11): 1023-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11073156&dopt=Abstract

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Interrelationships among human immunodeficiency virus type 1 infection, bacterial vaginosis, trichomoniasis, and the presence of yeasts. Author(s): Moodley P, Connolly C, Sturm AW. Source: The Journal of Infectious Diseases. 2002 January 1; 185(1): 69-73. Epub 2001 December 04. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11756983&dopt=Abstract

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Interrelationships of bacterial vaginosis and cervical inflammation. Author(s): Schwebke JR, Weiss HL. Source: Sexually Transmitted Diseases. 2002 January; 29(1): 59-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11773880&dopt=Abstract

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Interrelationships of interleukin-8 with interleukin-1beta and neutrophils in vaginal fluid of healthy and bacterial vaginosis positive women. Author(s): Cauci S, Guaschino S, De Aloysio D, Driussi S, De Santo D, Penacchioni P, Quadrifoglio F. Source: Molecular Human Reproduction. 2003 January; 9(1): 53-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12529421&dopt=Abstract

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Interventions for treating bacterial vaginosis in pregnancy. Author(s): Brocklehurst P, Hannah M, McDonald H. Source: Cochrane Database Syst Rev. 2000; (2): Cd000262. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796189&dopt=Abstract

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Is analysis of vaginal secretions for volatile organic acids to detect bacterial vaginosis of any diagnostic value? Author(s): Thomason JL, Gelbart SM, James JA, Edwards JM, Hamilton PR. Source: American Journal of Obstetrics and Gynecology. 1988 December; 159(6): 1509-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3061299&dopt=Abstract

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Is bacterial vaginosis a sexually transmitted infection. Author(s): Fethers K. Source: Sexually Transmitted Infections. 2001 October; 77(5): 390. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11588295&dopt=Abstract

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Is bacterial vaginosis a sexually transmitted infection? Author(s): Morris MC, Rogers PA, Kinghorn GR. Source: Sexually Transmitted Infections. 2001 February; 77(1): 63-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11158694&dopt=Abstract

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Is bacterial vaginosis associated with cervical intraepithelial neoplasia? Author(s): Boyle DC, Barton SE, Uthayakumar S, Hay PE, Pollock JW, Steer PJ, Smith JR. Source: International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society. 2003 March-April; 13(2): 159-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12657117&dopt=Abstract

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Is the lack of concurrence of bacterial vaginosis and vaginal candidosis explained by the presence of bacterial amines? Author(s): Rodrigues AG, Mardh PA, Pina-Vaz C, Martinez-de-Oliveira J, da Fonseca AF. Source: American Journal of Obstetrics and Gynecology. 1999 August; 181(2): 367-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10454684&dopt=Abstract

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Leukorrhea and bacterial vaginosis as in-office predictors of cervical infection in high-risk women. Author(s): Hakakha MM, Davis J, Korst LM, Silverman NS. Source: Obstetrics and Gynecology. 2002 October; 100(4): 808-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12383553&dopt=Abstract

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Local treatment for bacterial vaginosis. Author(s): Ison CA, Taylor RF, Link C, Buckett P, Harris JR, Easmon CS. Source: British Medical Journal (Clinical Research Ed.). 1987 October 10; 295(6603): 886. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3119087&dopt=Abstract

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Local treatment of bacterial vaginosis with a bioadhesive metronidazole tablet. Author(s): Voorspoels J, Casteels M, Remon JP, Temmerman M. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 October 10; 105(1): 64-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12270567&dopt=Abstract

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Longitudinal analysis of bacterial vaginosis: findings from the HIV epidemiology research study. Author(s): Jamieson DJ, Duerr A, Klein RS, Paramsothy P, Brown W, Cu-Uvin S, Rompalo A, Sobel J. Source: Obstetrics and Gynecology. 2001 October; 98(4): 656-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11576584&dopt=Abstract

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Long-term follow-up of patients with bacterial vaginosis treated with oral metronidazole and topical clindamycin. Author(s): Sobel JD, Schmitt C, Meriwether C. Source: The Journal of Infectious Diseases. 1993 March; 167(3): 783-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8440952&dopt=Abstract

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Management of bacterial vaginosis during pregnancy. Author(s): Ferris DG. Source: American Family Physician. 1998 March 15; 57(6): 1215-8, 1228. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9531904&dopt=Abstract

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Maternal stress is associated with bacterial vaginosis in human pregnancy. Author(s): Culhane JF, Rauh V, McCollum KF, Hogan VK, Agnew K, Wadhwa PD. Source: Maternal and Child Health Journal. 2001 June; 5(2): 127-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11573838&dopt=Abstract

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Metronidazole combined with nystatin (vagitories) in the prevention of bacterial vaginosis after initial treatment with oral metronidazole. Author(s): Pulkkinen P, Saranen M, Kaaja R. Source: Gynecologic and Obstetric Investigation. 1993; 36(3): 181-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8244194&dopt=Abstract

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Metronidazole for bacterial vaginosis. A comparison of vaginal gel vs. oral therapy. Author(s): Hanson JM, McGregor JA, Hillier SL, Eschenbach DA, Kreutner AK, Galask RP, Martens M. Source: J Reprod Med. 2000 November; 45(11): 889-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11127100&dopt=Abstract

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Metronidazole hypersensitivity in a patient with bacterial vaginosis. Author(s): Bhaduri S, Riley VC. Source: International Journal of Std & Aids. 1997 January; 8(1): 57-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9043984&dopt=Abstract

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Metronidazole pessaries compared with placebo in the treatment of bacterial vaginosis. Author(s): Bro F. Source: Scandinavian Journal of Primary Health Care. 1990 December; 8(4): 219-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2284521&dopt=Abstract

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Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Author(s): Carey JC, Klebanoff MA, Hauth JC, Hillier SL, Thom EA, Ernest JM, Heine RP, Nugent RP, Fischer ML, Leveno KJ, Wapner R, Varner M. Source: The New England Journal of Medicine. 2000 February 24; 342(8): 534-40. Summary for Patients In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10684911&dopt=Abstract

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Metronidazole-containing vaginal sponges for the treatment of bacterial vaginosis. Author(s): Brenner WE, Dingfelder JR. Source: Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception. 1986 December; 2(4): 363-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3551523&dopt=Abstract

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Microbial interactions in the vaginal ecosystem, with emphasis on the pathogenesis of bacterial vaginosis. Author(s): Pybus V, Onderdonk AB. Source: Microbes and Infection / Institut Pasteur. 1999 April; 1(4): 285-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10602662&dopt=Abstract

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Microbiologic efficacy of intravaginal clindamycin cream for the treatment of bacterial vaginosis. Author(s): Hillier S, Krohn MA, Watts DH, Wolner-Hanssen P, Eschenbach D. Source: Obstetrics and Gynecology. 1990 September; 76(3 Pt 1): 407-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2381617&dopt=Abstract

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Microbiological diagnosis of bacterial vaginosis. Author(s): Flournoy DJ. Source: J Okla State Med Assoc. 1992 June; 85(6): 281-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1282150&dopt=Abstract

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Mobiluncus species in bacterial vaginosis: aspects of pathogenesis. Author(s): Moi H, Fredlund H, Tornqvist E, Danielsson D. Source: Apmis : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica. 1991 November; 99(11): 1049-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1958349&dopt=Abstract

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Morphology assessed by transvaginal ultrasonography differs in patients in preterm labor with vs. without bacterial vaginosis. Author(s): Surbek DV, Hoesli IM, Holzgreve W. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2000 March; 15(3): 242-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10846781&dopt=Abstract

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Mycoplasma hominis in women with bacterial vaginosis. Author(s): Deodhar LP, Pandit DV. Source: The Indian Journal of Medical Research. 1992 May; 95: 144-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1506065&dopt=Abstract

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New approaches for the treatment of bacterial vaginosis. Author(s): Sweet RL. Source: American Journal of Obstetrics and Gynecology. 1993 August; 169(2 Pt 2): 47982. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8357050&dopt=Abstract

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New concepts in bacterial vaginosis. Author(s): Majeroni BA. Source: American Family Physician. 1991 October; 44(4): 1215-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1927836&dopt=Abstract

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New developments in the etiology and pathogenesis of bacterial vaginosis. Author(s): Spiegel CA. Source: Advances in Experimental Medicine and Biology. 1987; 224: 127-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3329809&dopt=Abstract

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Oral metronidazole vs. Metrogel Vaginal for treating bacterial vaginosis. Costeffectiveness evaluation. Author(s): Ransom SB, McComish JF, Greenberg R, Tolford DA. Source: J Reprod Med. 1999 April; 44(4): 359-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10319306&dopt=Abstract

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Patient education. Diagnosis and treatment of bacterial vaginosis. Author(s): Temple CA. Source: Nurs Times. 1994 September 14-20; 90(37): 43-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7971311&dopt=Abstract

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Pediatric management problems. Bacterial vaginosis (BV). Author(s): Belkengren R, Sapala S. Source: Pediatric Nursing. 1999 March-April; 25(2): 200-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10532017&dopt=Abstract

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Permanent diagnosis of bacterial vaginosis: gram stain or Papanicolaou stain? Author(s): Giacomini G. Source: Diagnostic Cytopathology. 2000 October; 23(4): 292-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11002374&dopt=Abstract

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Plasma cell endometritis in women with symptomatic bacterial vaginosis. Author(s): Korn AP, Bolan G, Padian N, Ohm-Smith M, Schachter J, Landers DV. Source: Obstetrics and Gynecology. 1995 March; 85(3): 387-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7862377&dopt=Abstract

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Polyphasic approach to the classification and identification of Gardnerella vaginalis and unidentified Gardnerella vaginalis-like coryneforms present in bacterial vaginosis. Author(s): van Esbroeck M, Vandamme P, Falsen E, Vancanneyt M, Moore E, Pot B, Gavini F, Kersters K, Goossens H. Source: International Journal of Systematic Bacteriology. 1996 July; 46(3): 675-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8782675&dopt=Abstract

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Potential patient preference for 3-day treatment of bacterial vaginosis: responses to new suppository form of clindamycin. Author(s): Broumas AG, Basara LA. Source: Adv Ther. 2000 May-June; 17(3): 159-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11183453&dopt=Abstract

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Preliminary efficacy study of a bioadhesive vaginal metronidazole tablet in the treatment of bacterial vaginosis. Author(s): Bouckaert S, Temmerman M, Voorspoels J, Van Kets H, Remon JP, Dhont M. Source: The Journal of Pharmacy and Pharmacology. 1995 November; 47(11): 970-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8708994&dopt=Abstract

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Preterm delivery and bacterial vaginosis--logistic regression analysis. Author(s): Wood S. Source: American Journal of Obstetrics and Gynecology. 1996 September; 175(3 Pt 1): 753-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8828452&dopt=Abstract

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Preterm labour--is bacterial vaginosis involved? Author(s): Odendaal HJ, Popov I, Schoeman J, Smith M, Grove D. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 2002 March; 92(3): 231-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12040953&dopt=Abstract

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Preterm prediction study: is socioeconomic status a risk factor for bacterial vaginosis in Black or in White women? Author(s): Meis PJ, Goldenberg RL, Mercer BM, Iams JD, Moawad AH, Miodovnik M, Menard MK, Caritis SN, Thurnau GR, Dombrowski MP, Das A, Roberts JM, McNellis D. Source: American Journal of Perinatology. 2000; 17(1): 41-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10928603&dopt=Abstract

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Prevalence of bacterial vaginosis and correlation of clinical to Gram stain diagnostic criteria in low risk pregnant women. Author(s): Can Fam Physician. 2002 May;48:891-3 Source: European Journal of Epidemiology. 1999 November; 15(10): 913-6. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12138871

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Prevalence of bacterial vaginosis and vaginal flora changes in peri- and postmenopausal women. Author(s): Cauci S, Driussi S, De Santo D, Penacchioni P, Iannicelli T, Lanzafame P, De Seta F, Quadrifoglio F, de Aloysio D, Guaschino S. Source: Journal of Clinical Microbiology. 2002 June; 40(6): 2147-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12037079&dopt=Abstract

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Prevalence of bacterial vaginosis in adolescent girls. Author(s): Pawlaczyk M, Grys E. Source: Acta Dermatovenerol Croat. 2001 December; 9(4): 279-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11879583&dopt=Abstract

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Prevalence of bacterial vaginosis in antenatal women. Author(s): Mathew R, Kalyani J, Bibi R, Mallika M. Source: Indian J Pathol Microbiol. 2001 April; 44(2): 113-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11883123&dopt=Abstract

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Prevalence of bacterial vaginosis in women attending one of three general practices for routine cervical cytology. Author(s): Lamont RF, Morgan DJ, Wilden SD, Taylor-Robinson D. Source: International Journal of Std & Aids. 2000 August; 11(8): 495-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10990331&dopt=Abstract

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Prevalence of hydrogen peroxide-producing Lactobacillus species in normal women and women with bacterial vaginosis. Author(s): Eschenbach DA, Davick PR, Williams BL, Klebanoff SJ, Young-Smith K, Critchlow CM, Holmes KK. Source: Journal of Clinical Microbiology. 1989 February; 27(2): 251-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2915019&dopt=Abstract

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Prevalence of Mobiluncus spp among women with and without bacterial vaginosis as detected by polymerase chain reaction. Author(s): Schwebke JR, Lawing LF. Source: Sexually Transmitted Diseases. 2001 April; 28(4): 195-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11318249&dopt=Abstract

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Prevalence of vaginal infections with bacterial vaginosis, Trichomonas vaginalis and Candida albicans among pregnant women at the Port Moresby General Hospital Antenatal Clinic. Author(s): Klufio CA, Amoa AB, Delamare O, Hombhanje M, Kariwiga G, Igo J. Source: P N G Med J. 1995 September; 38(3): 163-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9522855&dopt=Abstract

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Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda. Author(s): Koumans EH, Kendrick JS; CDC Bacterial Vaginosis Working Group. Source: Sexually Transmitted Diseases. 2001 May; 28(5): 292-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11354269&dopt=Abstract

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Proline aminopeptidase activity as a rapid diagnostic test to confirm bacterial vaginosis. Author(s): Thomason JL, Gelbart SM, Wilcoski LM, Peterson AK, Jilly BJ, Hamilton PR. Source: Obstetrics and Gynecology. 1988 April; 71(4): 607-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3353052&dopt=Abstract

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Quality control standards for the proline aminopeptidase assay used to detect bacterial vaginosis. Author(s): Thomason JL, Gelbart SM, Osypowski PJ, Walt AK, Hamilton PR. Source: American Journal of Obstetrics and Gynecology. 1989 March; 160(3): 757-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2784630&dopt=Abstract

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Rates of bacterial vaginosis in women undergoing in vitro fertilisation for different types of infertility. Author(s): Wilson JD, Ralph SG, Rutherford AJ. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 June; 109(6): 714-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12118653&dopt=Abstract

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Recurrent bacterial vaginosis and metronidazole resistance in Gardnerella vaginalis. Author(s): Bannatyne RM, Smith AM. Source: Sexually Transmitted Infections. 1998 December; 74(6): 455-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10195061&dopt=Abstract

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Recurrent bacterial vaginosis and Netherton's syndrome. Author(s): Nicholls S, Patel HC, Jones M. Source: International Journal of Std & Aids. 1999 March; 10(3): 202-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10340203&dopt=Abstract

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Recurrent bacterial vaginosis in a virgin adolescent: a new method of treatment. Author(s): Papanikolaou EG, Tsanadis G, Dalkalitsis N, Lolis D. Source: Infection. 2002 December; 30(6): 403-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12478334&dopt=Abstract

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Recurrent bacterial vaginosis unresponsive to metronidazole: successful treatment with oral clindamycin. Author(s): Tepper RS, Ives TJ, Kebede M. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1994 September-October; 7(5): 431-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7810359&dopt=Abstract

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Recurrent bacterial vaginosis. Author(s): Hay PE. Source: Dermatologic Clinics. 1998 October; 16(4): 769-73, Xii-Xiii. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9891678&dopt=Abstract

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Recurrent bacterial vaginosis--an old approach to a new problem. Author(s): Winceslaus SJ, Calver G. Source: International Journal of Std & Aids. 1996 July; 7(4): 284-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8876361&dopt=Abstract

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Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. Author(s): Steele RW. Source: Clinical Pediatrics. 1996 July; 35(7): 378-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8829012&dopt=Abstract

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Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. Author(s): Hauth JC, Goldenberg RL, Andrews WW, DuBard MB, Copper RL. Source: The New England Journal of Medicine. 1995 December 28; 333(26): 1732-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7491136&dopt=Abstract

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Relation between Gram-stain and clinical criteria for diagnosing bacterial vaginosis with special reference to Gram grade II evaluation. Author(s): Taylor-Robinson D, Morgan DJ, Sheehan M, Rosenstein IJ, Lamont RF. Source: International Journal of Std & Aids. 2003 January; 14(1): 6-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590785&dopt=Abstract

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Relationship of bacterial vaginosis and mycoplasmas to the risk of spontaneous abortion. Author(s): Donders GG, Van Bulck B, Caudron J, Londers L, Vereecken A, Spitz B. Source: American Journal of Obstetrics and Gynecology. 2000 August; 183(2): 431-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10942482&dopt=Abstract

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Relationship of Ureaplasma urealyticum biovars to the presence or absence of bacterial vaginosis in pregnant women and to the time of delivery. Author(s): Povlsen K, Thorsen P, Lind I. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2001 January; 20(1): 65-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11245329&dopt=Abstract

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Relationships of vaginal Lactobacillus species, cervical Chlamydia trachomatis, and bacterial vaginosis to preterm birth. Author(s): Martius J, Krohn MA, Hillier SL, Stamm WE, Holmes KK, Eschenbach DA. Source: Obstetrics and Gynecology. 1988 January; 71(1): 89-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3336545&dopt=Abstract

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Risk factors for and relationship between bacterial vaginosis and cervicitis in a high risk population for cervicitis in Southern Iran. Author(s): Keshavarz H, Duffy SW, Sadeghi-Hassanabadi A, Zolghadr Z, Oboodi B. Source: European Journal of Epidemiology. 2001; 17(1): 89-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11523583&dopt=Abstract

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Risk factors for plasma cell endometritis among women with cervical Neisseria gonorrhoeae, cervical Chlamydia trachomatis, or bacterial vaginosis. Author(s): Korn AP, Hessol NA, Padian NS, Bolan GA, Donegan E, Landers DV, Schachter J. Source: American Journal of Obstetrics and Gynecology. 1998 May; 178(5): 987-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9609572&dopt=Abstract

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Risk score for antenatal bacterial vaginosis: BV PIN points. Author(s): Pastore LM, Thorp JM Jr, Royce RA, Savitz DA, Jackson TP. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2002 March; 22(2): 125-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896517&dopt=Abstract

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Risk scoring, fetal fibronectin, and bacterial vaginosis to predict preterm delivery. Author(s): Crane JM, Armson BA, Dodds L, Feinberg RF, Kennedy W, Kirkland SA. Source: Obstetrics and Gynecology. 1999 April; 93(4): 517-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10214825&dopt=Abstract

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Role of bacterial vaginosis in pelvic inflammatory disease. Author(s): Sweet RL. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1995 June; 20 Suppl 2: S271-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7548573&dopt=Abstract

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Role of bacterial vaginosis-associated microorganisms in endometritis. Author(s): Hillier SL, Kiviat NB, Hawes SE, Hasselquist MB, Hanssen PW, Eschenbach DA, Holmes KK. Source: American Journal of Obstetrics and Gynecology. 1996 August; 175(2): 435-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8765265&dopt=Abstract

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Routine Pap smears for the diagnosis of bacterial vaginosis. Author(s): Prey M. Source: Diagnostic Cytopathology. 1999 July; 21(1): 10-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10405800&dopt=Abstract

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Scanning electron microscopy of endometrial biopsies of patients with bacterial vaginosis shows morphology resembling mycoplasma/ureaplasma organisms. Author(s): Bhattacharjee B, Herrington CS, Sunderland D, Birley HD. Source: Sexually Transmitted Infections. 1999 June; 75(3): 202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10448406&dopt=Abstract

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Screening and treatment of bacterial vaginosis during pregnancy: a model for determining benefit. Author(s): Glantz JC. Source: American Journal of Perinatology. 1997 September; 14(8): 487-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9376012&dopt=Abstract

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Screening and treatment of sexually transmitted diseases. Part 1: Chlamydia, gonorrhea, and bacterial vaginosis. Author(s): Lahoti S, McClain N, Girardet R, McNeese M, Cheung K. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 2000 January-February; 14(1): 34-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11141826&dopt=Abstract

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Screening for bacterial vaginosis and cervicitis aimed at preventing premature delivery. Author(s): Begum S, Sagawa T, Fujimoto S. Source: The Journal of Obstetrics and Gynaecology Research. 1997 February; 23(1): 10310. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9094827&dopt=Abstract

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Screening for bacterial vaginosis in pregnancy. Author(s): Guise JM, Mahon SM, Aickin M, Helfand M, Peipert JF, Westhoff C. Source: American Journal of Preventive Medicine. 2001 April; 20(3 Suppl): 62-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11306234&dopt=Abstract

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Screening for bacterial vaginosis in pregnancy: recommendations and rationale. Author(s): U.S. Preventive Services Task Force. Source: The American Journal of Nursing. 2002 August; 102(8): 91-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12394045&dopt=Abstract

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Screening for bacterial vaginosis in pregnancy: recommendations and rationale. Author(s): U.S. Preventive Services Task Force. Source: American Family Physician. 2002 March 15; 65(6): 1147-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11925093&dopt=Abstract

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Screening for bacterial vaginosis in pregnancy: recommendations and rationale. Author(s): US Preventive Services Task Force. Source: American Journal of Preventive Medicine. 2001 April; 20(3 Suppl): 59-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11306233&dopt=Abstract

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Screening for bacterial vaginosis. Author(s): Faro S. Source: Infectious Diseases in Obstetrics and Gynecology. 1998; 6(6): 235. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9972482&dopt=Abstract

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Screening for bacterial vaginosis: a novel application of artificial nose technology. Author(s): Chandiok S, Crawley BA, Oppenheim BA, Chadwick PR, Higgins S, Persaud KC. Source: Journal of Clinical Pathology. 1997 September; 50(9): 790-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9389983&dopt=Abstract

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Secnidazole. A review of its antimicrobial activity, pharmacokinetic properties and therapeutic use in the management of protozoal infections and bacterial vaginosis. Author(s): Gillis JC, Wiseman LR. Source: Drugs. 1996 April; 51(4): 621-38. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8706597&dopt=Abstract

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Sex, thrush and bacterial vaginosis. Author(s): Hay PE, Ugwumadu A, Chowns J. Source: International Journal of Std & Aids. 1997 October; 8(10): 603-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9310218&dopt=Abstract

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Sexual behavior risk factors associated with bacterial vaginosis and Chlamydia trachomatis infection. Author(s): Nilsson U, Hellberg D, Shoubnikova M, Nilsson S, Mardh PA. Source: Sexually Transmitted Diseases. 1997 May; 24(5): 241-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9153730&dopt=Abstract

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Sexual intercourse association with asymptomatic bacterial vaginosis and Trichomonas vaginalis treatment in relationship to preterm birth. Author(s): Berghella V, Klebanoff M, McPherson C, Carey JC, Hauth JC, Ernest JM, Heine RP, Wapner RJ, Trout W, Moawad A, Leveno KJ, Miodovnik M, Sibai BM, Van Dorsten JP, Dombrowski MP, O'Sullivan MJ, Varner M, Langer O; National Institute for Child Health and Development Maternal Fetal Medicine Units Network. Source: American Journal of Obstetrics and Gynecology. 2002 November; 187(5): 127782. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439520&dopt=Abstract

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Should sexual partners of women with bacterial vaginosis receive treatment? Author(s): Potter J. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1999 November; 49(448): 913-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10818662&dopt=Abstract

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Single dose of ornidazole in the treatment of bacterial vaginosis. Author(s): Erkkola R, Jarvinen H. Source: Ann Chir Gynaecol Suppl. 1987; 202: 94-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3499111&dopt=Abstract

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Single hydrogen peroxide vaginal douching versus single-dose oral metronidazole for the treatment of bacterial vaginosis: a randomized controlled trial. Author(s): Chaithongwongwatthana S, Limpongsanurak S, Sitthi-Amorn C. Source: J Med Assoc Thai. 2003 June; 86 Suppl 2: S379-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930014&dopt=Abstract

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Socioeconomic and environmental risk factors of bacterial vaginosis in early pregnancy. Author(s): Kalinka J, Hanke W, Wasiela M, Laudanski T. Source: Journal of Perinatal Medicine. 2002; 30(6): 467-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12530102&dopt=Abstract

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Specific immune response against Gardnerella vaginalis hemolysin in patients with bacterial vaginosis. Author(s): Cauci S, Scrimin F, Driussi S, Ceccone S, Monte R, Fant L, Quadrifoglio F. Source: American Journal of Obstetrics and Gynecology. 1996 December; 175(6): 1601-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8987947&dopt=Abstract

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Spontaneous recovery of bacterial vaginosis during pregnancy is not associated with an improved perinatal outcome. Author(s): Gratacos E, Figueras F, Barranco M, Vila J, Cararach V, Alonso PL, Fortuny A. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1998 January; 77(1): 37-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9492715&dopt=Abstract

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The association between receptive cunnilingus and bacterial vaginosis. Author(s): Tchamouroff SE, Panja SK. Source: Sexually Transmitted Infections. 2000 April; 76(2): 144-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10858723&dopt=Abstract

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The association of Mycoplasma hominis, Ureaplasma urealyticum and Mycoplasma genitalium with bacterial vaginosis: observations on heterosexual women and their male partners. Author(s): Keane FE, Thomas BJ, Gilroy CB, Renton A, Taylor-Robinson D. Source: International Journal of Std & Aids. 2000 June; 11(6): 356-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10872907&dopt=Abstract

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The diagnosis of bacterial vaginosis and vaginal flora changes. Author(s): Hellberg D, Nilsson S, Mardh PA. Source: Archives of Gynecology and Obstetrics. 2001 March; 265(1): 11-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11327086&dopt=Abstract

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The diagnosis of bacterial vaginosis: established criteria versus reality in a community-based family practice residency program. Author(s): Hunt RR, Trachier JA. Source: J Okla State Med Assoc. 2002 November; 95(11): 707-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12471734&dopt=Abstract

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The effect of introduction of a guideline on the management of vaginal discharge and in particular bacterial vaginosis in primary care. Author(s): Langsford MJ, Dobbs FF, Morrison GM, Dance DA. Source: Family Practice. 2001 June; 18(3): 253-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11356730&dopt=Abstract

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The effectiveness of single-dose metronidazole therapy for patients and their partners with bacterial vaginosis. Author(s): Mengel MB, Berg AO, Weaver CH, Herman DJ, Herman SJ, Hughes VL, Koepsell TD. Source: The Journal of Family Practice. 1989 February; 28(2): 163-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2644391&dopt=Abstract

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The epidemiology of bacterial vaginosis. Author(s): Schmid GP. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1999 November; 67 Suppl 1: S17-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10661731&dopt=Abstract

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The future of bacterial vaginosis-related research. Author(s): Taylor-Robinson D. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1999 November; 67 Suppl 1: S35-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10661735&dopt=Abstract

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The impact of regular vaginal pH screening on the diagnosis of bacterial vaginosis in pregnancy. Author(s): Gjerdingen D, Fontaine P, Bixby M, Santilli J, Welsh J. Source: The Journal of Family Practice. 2000 January; 49(1): 39-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10678339&dopt=Abstract

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The influence of bacterial vaginosis on in-vitro fertilization and embryo implantation during assisted reproduction treatment. Author(s): Liversedge NH, Turner A, Horner PJ, Keay SD, Jenkins JM, Hull MG. Source: Human Reproduction (Oxford, England). 1999 September; 14(9): 2411-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10469722&dopt=Abstract

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The papanicolaou smear: inadequate screening test for bacterial vaginosis during pregnancy. Author(s): Greene JF 3rd, Kuehl TJ, Allen SR. Source: American Journal of Obstetrics and Gynecology. 2000 May; 182(5): 1048-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10819823&dopt=Abstract

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The role of bacterial vaginosis in infection after major gynecologic surgery. Author(s): Lin L, Song J, Kimber N, Shott S, Tangora J, Aroutcheva A, Mazees MB, Wells A, Cohen A, Faro S. Source: Infectious Diseases in Obstetrics and Gynecology. 1999; 7(3): 169-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10371477&dopt=Abstract

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The role of bacterial vaginosis in preterm labor and preterm birth: a case-control study. Author(s): Subtil D, Denoit V, Le Goueff F, Husson MO, Trivier D, Puech F. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 February 10; 101(1): 41-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11803099&dopt=Abstract

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The role of the midwife when the pathology report states your pregnant client has bacterial vaginosis. Author(s): Annells MF. Source: Aust J Midwifery. 2001 June; 14(2): 18-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760012&dopt=Abstract

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The treatment of vaginitis: Trichomonas, yeast, and bacterial vaginosis. Author(s): Landers DV. Source: Clinical Obstetrics and Gynecology. 1988 June; 31(2): 473-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3042226&dopt=Abstract

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To screen or not to screen? Bacterial vaginosis in pregnancy. Author(s): Weissman AM. Source: The Journal of Family Practice. 1999 November; 48(11): 897-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10907627&dopt=Abstract

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Treatment recommendations for bacterial vaginosis in pregnant women. Author(s): Klebanoff MA, Guise JM, Carey JC. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2003 June 15; 36(12): 1630-1; Author Reply 1631-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12802775&dopt=Abstract

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Trichomonas vaginalis and bacterial vaginosis. Coexistence in vaginal wet mount preparations from pregnant women. Author(s): Franklin TL, Monif GR. Source: J Reprod Med. 2000 February; 45(2): 131-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10710744&dopt=Abstract

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Trimethylamine content in vaginal secretion and its relation to bacterial vaginosis. Author(s): Wolrath H, Boren H, Hallen A, Forsum U. Source: Apmis : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica. 2002 November; 110(11): 819-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12588422&dopt=Abstract

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Two novel vaginal microbicides (polystyrene sulfonate and cellulose sulfate) inhibit Gardnerella vaginalis and anaerobes commonly associated with bacterial vaginosis. Author(s): Simoes JA, Citron DM, Aroutcheva A, Anderson RA Jr, Chany CJ 2nd, Waller DP, Faro S, Zaneveld LJ. Source: Antimicrobial Agents and Chemotherapy. 2002 August; 46(8): 2692-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12121959&dopt=Abstract

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Unusual causes of vaginitis (excluding trichomonas, bacterial vaginosis, and Candida albicans). Author(s): Hammill HA. Source: Obstetrics and Gynecology Clinics of North America. 1989 June; 16(2): 337-45. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2674801&dopt=Abstract

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Urinary tract infections in pregnant women with bacterial vaginosis. Author(s): Hillebrand L, Harmanli OH, Whiteman V, Khandelwal M. Source: American Journal of Obstetrics and Gynecology. 2002 May; 186(5): 916-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12015512&dopt=Abstract

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Use of 5-bromo-4-chloro-3-indolyl-alpha-D-N-acetylneuraminic acid in a novel spot test To identify sialidase activity in vaginal swabs from women with bacterial vaginosis. Author(s): Wiggins R, Crowley T, Horner PJ, Soothill PW, Millar MR, Corfield AP. Source: Journal of Clinical Microbiology. 2000 August; 38(8): 3096-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10921986&dopt=Abstract

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Use of a lactoferrin assay in the differential diagnosis of female genital tract infections and implications for the pathophysiology of bacterial vaginosis. Author(s): Rein MF, Shih LM, Miller JR, Guerrant RL. Source: Sexually Transmitted Diseases. 1996 November-December; 23(6): 517-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8946639&dopt=Abstract

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Vaginal and cervical pH in bacterial vaginosis and cervicitis during pregnancy. Author(s): Sagawa T, Negishi H, Kishida T, Yamada H, Fujimoto S. Source: Hokkaido Igaku Zasshi. 1995 November; 70(6): 839-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8582707&dopt=Abstract

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Vaginal clindamycin and oral metronidazole for bacterial vaginosis: a randomized trial. Author(s): Paavonen J, Mangioni C, Martin MA, Wajszczuk CP. Source: Obstetrics and Gynecology. 2000 August; 96(2): 256-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10908773&dopt=Abstract

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Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. Author(s): Kekki M, Kurki T, Pelkonen J, Kurkinen-Raty M, Cacciatore B, Paavonen J. Source: Obstetrics and Gynecology. 2001 May; 97(5 Pt 1): 643-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11339909&dopt=Abstract

•

Vaginal hydrolytic enzymes, immunoglobulin A against Gardnerella vaginalis toxin, and risk of early preterm birth among women in preterm labor with bacterial vaginosis or intermediate flora. Author(s): Cauci S, Hitti J, Noonan C, Agnew K, Quadrifoglio F, Hillier SL, Eschenbach DA. Source: American Journal of Obstetrics and Gynecology. 2002 October; 187(4): 877-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12388968&dopt=Abstract

•

Vaginal lactobacilli inhibiting growth of Gardnerella vaginalis, Mobiluncus and other bacterial species cultured from vaginal content of women with bacterial vaginosis. Author(s): Skarin A, Sylwan J. Source: Acta Pathol Microbiol Immunol Scand [b]. 1986 December; 94(6): 399-403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3494379&dopt=Abstract

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Vaginal microflora associated with bacterial vaginosis in Japanese and Thai pregnant women. Author(s): Puapermpoonsiri S, Kato N, Watanabe K, Ueno K, Chongsomchai C, Lumbiganon P. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1996 October; 23(4): 748-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8909838&dopt=Abstract

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Vaginal microflora associated with bacterial vaginosis in nonpregnant women: reliability of sialidase detection. Author(s): Smayevsky J, Canigia LF, Lanza A, Bianchini H. Source: Infectious Diseases in Obstetrics and Gynecology. 2001; 9(1): 17-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11368254&dopt=Abstract

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Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease. Author(s): Yudin MH, Hillier SL, Wiesenfeld HC, Krohn MA, Amortegui AA, Sweet RL. Source: American Journal of Obstetrics and Gynecology. 2003 February; 188(2): 318-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12592233&dopt=Abstract

•

Vaginal redox potential in bacterial vaginosis (nonspecific vaginitis). Author(s): Holmes KK, Chen KC, Lipinski CM, Eschenbach DA. Source: The Journal of Infectious Diseases. 1985 August; 152(2): 379-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4031548&dopt=Abstract

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Vaginitis including bacterial vaginosis. Author(s): Eschenbach DA. Source: Current Opinion in Obstetrics & Gynecology. 1994 August; 6(4): 389-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7742505&dopt=Abstract

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Validity of the vaginal gram stain for the diagnosis of bacterial vaginosis. Author(s): Schwebke JR, Hillier SL, Sobel JD, McGregor JA, Sweet RL. Source: Obstetrics and Gynecology. 1996 October; 88(4 Pt 1): 573-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8841221&dopt=Abstract

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Validity of wet-mount bacterial morphotype identification of vaginal fluid by phasecontrast microscopy for diagnosis of bacterial vaginosis in family practice. Author(s): Schmidt H, Hansen JG. Source: Apmis : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica. 2001 September; 109(9): 589-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11878711&dopt=Abstract

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Vulvovaginal candidiasis complicating recurrent bacterial vaginosis. Author(s): Redondo-Lopez V, Meriwether C, Schmitt C, Opitz M, Cook R, Sobel JD. Source: Sexually Transmitted Diseases. 1990 January-March; 17(1): 51-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2305336&dopt=Abstract

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Wet smear compared with gram stain diagnosis of bacterial vaginosis in asymptomatic pregnant women. Author(s): Mastrobattista JM, Bishop KD, Newton ER. Source: Obstetrics and Gynecology. 2000 October; 96(4): 504-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11004348&dopt=Abstract

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What are the most effective treatments for bacterial vaginosis in nonpregnant women? Author(s): Kane KY, Pierce R. Source: The Journal of Family Practice. 2001 May; 50(5): 399-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11350701&dopt=Abstract

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When is bacterial vaginosis not bacterial vaginosis?--a case of cervical carcinoma presenting as recurrent vaginal anaerobic infection. Author(s): Hudson MM, Tidy JA, McCulloch TA, Rogstad KE. Source: Genitourinary Medicine. 1997 August; 73(4): 306-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9389957&dopt=Abstract

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CHAPTER 2. NUTRITION AND BACTERIAL VAGINOSIS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and bacterial vaginosis.

Finding Nutrition Studies on Bacterial Vaginosis The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “bacterial vaginosis” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “bacterial vaginosis” (or a synonym): •

Bacterial vaginosis is not a simple ecological disorder. Author(s): Department of Obstetrics and Gynecology, Huddinge University Hospital, Sweden. Source: Fredricsson, B Englund, K Weintraub, L Olund, A Nord, C E Gynecol-ObstetInvest. 1989; 28(3): 156-60 0378-7346

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Bacterial vaginosis: drugs versus alternative treatment. Author(s): Department of Obstetrics and Gynecology, Beilinson Medical Center, Petah Tiqva, Israel. Source: Neri, A Rabinerson, D Kaplan, B Obstet-Gynecol-Survolume 1994 December; 49(12): 809-13 0029-7828

•

Characterisation and selection of a Lactobacillus species to re-colonise the vagina of women with recurrent bacterial vaginosis. Author(s): Imperial College of Science, Technology and Medicine, Department of GenitoUrinary Medicine, London. Source: McLean, N W Rosenstein, I J J-Med-Microbiol. 2000 June; 49(6): 543-52 0022-2615

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Efficacy of povidone-iodine vaginal suppositories in the treatment of bacterial vaginosis. Author(s): Federal Public Health Laboratory, Vienna, Austria. [email protected] Source: Wewalka, Gunther Stary, Angelika Bosse, Bjoern Duerr, Heike E Reimer, Karen Dermatology. 2002; 204 Suppl 1: 79-85 1018-8665

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Ingestion of probiotics: optional treatment of bacterial vaginosis in pregnancy. Author(s): Department of Obstetrics and Gynecology, HaEmek Medical Center, Afula, Israel. [email protected] Source: Shalev, Eliezer Isr-Med-Assoc-J. 2002 May; 4(5): 357-60 1565-1088

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Inhibition of chemotaxis by organic acids from anaerobes may prevent a purulent response in bacterial vaginosis. Author(s): Division of Molecular and Genetic Medicine, University of Sheffield Medical School. Source: Al Mushrif, S Eley, A Jones, B M J-Med-Microbiol. 2000 November; 49(11): 102330 0022-2615

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Lactobacillus acidophilus and yogurt in the prevention and therapy of bacterial vaginosis. Source: Sieber, R. Dietz, U.T. Int-dairy-j. Oxford, U.K. : Elsevier Science Limited. July 1998. volume 8 (7) page 599-607. 0958-6946

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Microecology, bacterial vaginosis and probiotics: perspectives for bacteriotherapy. Author(s): Department of Medical Sciences, San Camillo Hospital, Rome, Italy. [email protected] Source: Famularo, G Pieluigi, M Coccia, R Mastroiacovo, P De Simone, C MedHypotheses. 2001 April; 56(4): 421-30 0306-9877

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Preterm labour--is bacterial vaginosis involved? Author(s): Department of Obstetrics and Gynaecology, University of Stellenbosch, Tygerberg Hospital, Medical Research Council Perinatal Mortality Research Unit, Tygerberg, W Cape. Source: Odendaal, H J Popov, I Schoeman, J Smith, M Grove, D S-Afr-Med-J. 2002 March; 92(3): 231-4 0038-2469

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Therapy of bacterial vaginosis using exogenously-applied Lactobacilli acidophili and a low dose of estriol: a placebo-controlled multicentric clinical trial. Author(s): Hopital Universitaire Erasme, Brussels, Belgium. Source: Parent, D Bossens, M Bayot, D Kirkpatrick, C Graf, F Wilkinson, F E Kaiser, R R Arzneimittelforschung. 1996 January; 46(1): 68-73 0004-4172

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Use of a lactoferrin assay in the differential diagnosis of female genital tract infections and implications for the pathophysiology of bacterial vaginosis. Author(s): Department of Medicine, University of Virginia, School of Medicine, Charlottesville, USA. Source: Rein, M F Shih, L M Miller, J R Guerrant, R L Sex-Transm-Dis. 1996 NovDecember; 23(6): 517-21 0148-5717

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

•

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMD®Health: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to bacterial vaginosis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Food and Diet Crème Fraîche Source: Healthnotes, Inc.; www.healthnotes.com Kefir Source: Healthnotes, Inc.; www.healthnotes.com Lhassi Source: Healthnotes, Inc.; www.healthnotes.com Milk Source: Healthnotes, Inc.; www.healthnotes.com Yogurt Source: Healthnotes, Inc.; www.healthnotes.com Yogurt Cheese Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND BACTERIAL VAGINOSIS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to bacterial vaginosis. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to bacterial vaginosis and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “bacterial vaginosis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to bacterial vaginosis: •

A randomised, double-blind placebo-controlled trial of ascorbic acid supplementation for the prevention of preterm labour. Author(s): Steyn PS, Odendaal HJ, Schoeman J, Stander C, Fanie N, Grove D. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 March; 23(2): 150-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745558&dopt=Abstract

•

Bacterial vaginosis: drugs versus alternative treatment. Author(s): Neri A, Rabinerson D, Kaplan B. Source: Obstetrical & Gynecological Survey. 1994 December; 49(12): 809-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7885656&dopt=Abstract

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Bacteriotherapy may be useful in treating bacterial vaginosis. Author(s): Taylor-Robinson D, Rosenstein I. Source: Bmj (Clinical Research Ed.). 2001 November 10; 323(7321): 1128. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11701585&dopt=Abstract

•

Characterisation and selection of a Lactobacillus species to re-colonise the vagina of women with recurrent bacterial vaginosis. Author(s): McLean NW, Rosenstein IJ. Source: Journal of Medical Microbiology. 2000 June; 49(6): 543-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10847208&dopt=Abstract

•

Clinical trial with praneem polyherbal cream in patients with abnormal vaginal discharge due to microbial infections. Author(s): Mittal A, Kapur S, Garg S, Upadhyay SN, Suri S, Das SK, Gupta S, Talwar GP. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1995 May; 35(2): 190-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7677686&dopt=Abstract

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Common complementary and alternative therapies for yeast vaginitis and bacterial vaginosis: a systematic review. Author(s): Van Kessel K, Assefi N, Marrazzo J, Eckert L. Source: Obstetrical & Gynecological Survey. 2003 May; 58(5): 351-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719677&dopt=Abstract

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Common gynecologic infections. Author(s): Denenberg R. Source: World. 1998 March; (No 83): 3-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11365173&dopt=Abstract

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Could probiotics be an option for treating and preventing urogenital infections? Author(s): Reid G, Bruce AW. Source: Medscape Women's Health [electronic Resource]. 2001 October; 6(5): 9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11698931&dopt=Abstract

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Efficacy of povidone-iodine vaginal suppositories in the treatment of bacterial vaginosis. Author(s): Wewalka G, Stary A, Bosse B, Duerr HE, Reimer K. Source: Dermatology (Basel, Switzerland). 2002; 204 Suppl 1: 79-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12011527&dopt=Abstract

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Evaluation of two self-care treatments for prevention of vaginal candidiasis in women with HIV. Author(s): Williams AB, Yu C, Tashima K, Burgess J, Danvers K. Source: The Journal of the Association of Nurses in Aids Care : Janac. 2001 July-August; 12(4): 51-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11486720&dopt=Abstract

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Haemagglutination by vaginal anaerobic curved rods and its inhibition by oligosaccharides. Author(s): Mardh PA, Svensson S. Source: Scand J Urol Nephrol Suppl. 1984; 86: 179-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6598919&dopt=Abstract

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HIV / STD interactions immunosuppression and future research development. Author(s): Hafez ES, Merino G, Bailon R, Moran C. Source: Arch Aids Res. 1992; 6(4): 221-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12286086&dopt=Abstract

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In vitro susceptibilities of lactobacilli and organisms associated with bacterial vaginosis to Melaleuca alternifolia (tea tree) oil. Author(s): Hammer KA, Carson CF, Riley TV. Source: Antimicrobial Agents and Chemotherapy. 1999 January; 43(1): 196. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10094671&dopt=Abstract

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Ingestion of probiotics: optional treatment of bacterial vaginosis in pregnancy. Author(s): Shalev E. Source: Isr Med Assoc J. 2002 May; 4(5): 357-60. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12040825&dopt=Abstract

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Microecology, bacterial vaginosis and probiotics: perspectives for bacteriotherapy. Author(s): Famularo G, Pieluigi M, Coccia R, Mastroiacovo P, De Simone C. Source: Medical Hypotheses. 2001 April; 56(4): 421-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11339841&dopt=Abstract

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Nutritional and antimicrobial interventions to prevent preterm birth: an overview of randomized controlled trials. Author(s): Villar J, Gulmezoglu AM, de Onis M. Source: Obstetrical & Gynecological Survey. 1998 September; 53(9): 575-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9751940&dopt=Abstract

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Oral probiotics can resolve urogenital infections. Author(s): Reid G, Bruce AW, Fraser N, Heinemann C, Owen J, Henning B.

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Source: Fems Immunology and Medical Microbiology. 2001 February; 30(1): 49-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11172991&dopt=Abstract •

Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms. Author(s): Nyirjesy P, Weitz MV, Grody MH, Lorber B. Source: Obstetrics and Gynecology. 1997 July; 90(1): 50-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9207812&dopt=Abstract

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Potential role of lactobacilli as prophylactic agents against genital pathogens. Author(s): Barbes C, Boris S. Source: Aids Patient Care and Stds. 1999 December; 13(12): 747-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10743538&dopt=Abstract

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Probiotic agents to protect the urogenital tract against infection. Author(s): Reid G. Source: The American Journal of Clinical Nutrition. 2001 February; 73(2 Suppl): 437S443S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11157354&dopt=Abstract

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Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. Author(s): Reid G, Beuerman D, Heinemann C, Bruce AW. Source: Fems Immunology and Medical Microbiology. 2001 December; 32(1): 37-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11750220&dopt=Abstract

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Probiotics for urogenital health. Author(s): Reid G. Source: Nutrition in Clinical Care : an Official Publication of Tufts University. 2002 January-February; 5(1): 3-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12134717&dopt=Abstract

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Probiotics--a therapy in search of a disease. Author(s): Dan M. Source: Isr Med Assoc J. 2002 October; 4(10): 846. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12389361&dopt=Abstract

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Probiotics--an important therapeutic concept awaiting validation. Author(s): Lebenthal E, Lebenthal Y. Source: Isr Med Assoc J. 2002 May; 4(5): 374-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12040830&dopt=Abstract

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Tea tree oil and anaerobic (bacterial) vaginosis. Author(s): Blackwell AL. Source: Lancet. 1991 February 2; 337(8736): 300. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1671134&dopt=Abstract

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Urogenital infections in women: can probiotics help? Author(s): Reid G, Bruce AW. Source: Postgraduate Medical Journal. 2003 August; 79(934): 428-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954951&dopt=Abstract

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Use of Lactobacillus to prevent infection by pathogenic bacteria. Author(s): Reid G, Burton J. Source: Microbes and Infection / Institut Pasteur. 2002 March; 4(3): 319-24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11909742&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMD®Health: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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The following is a specific Web list relating to bacterial vaginosis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Vaginitis Source: Healthnotes, Inc.; www.healthnotes.com Yeast Infection Source: Healthnotes, Inc.; www.healthnotes.com

•

Herbs and Supplements L. Acidophilus Source: Integrative Medicine Communications; www.drkoop.com Lactobacillus Acidophilus Source: Integrative Medicine Communications; www.drkoop.com Melaleuca Alternative names: Tea Tree Oil; Melaleuca alternifolia Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. CLINICAL TRIALS AND BACTERIAL VAGINOSIS Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning bacterial vaginosis.

Recent Trials on Bacterial Vaginosis The following is a list of recent trials dedicated to bacterial vaginosis.8 Further information on a trial is available at the Web site indicated. •

Perinatal Infections in Pakistan Condition(s): Bacterial Chorioamnionitis

Vaginosis;

Fetal

Membranes,

Premature

Rupture;

Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Child Health and Human Development (NICHD); Bill and Melinda Gates Foundation; National Institute of Dental and Craniofacial Research (NIDCR); National Center for Complementary and Alternative Medicine (NCCAM); National Cancer Institute (NCI) Purpose - Excerpt: The study's goal is to determine how infections, medical history, health care behavior and psychosocial issues are associated with pregnancy outcomes in Pakistan. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00070746

8 These

are listed at www.ClinicalTrials.gov.

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Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “bacterial vaginosis” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 5. PATENTS ON BACTERIAL VAGINOSIS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “bacterial vaginosis” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on bacterial vaginosis, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Bacterial Vaginosis By performing a patent search focusing on bacterial vaginosis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 9Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on bacterial vaginosis: •

Bacterial vaginosis screening technique and a diagnostic kit for use therein Inventor(s): Louderback; Allan L. (P.O. Box 761, Temple City, CA 91780) Assignee(s): none reported Patent Number: 6,255,066 Date filed: February 8, 2000 Abstract: A screening test for bacterial vaginosis is performed by (a) combining a sample of vaginal fluid with a developer reagent selected from the group consisting of phenol, derivatives thereof, and mixtures thereof to form a first reaction medium; (b) combining the first reaction medium with a water soluble base and a halogen-containing oxidizing agent to form a second reaction medium having a pH of at least about 9.5; and (c) observing the color of the second reaction medium. The concentration of the halogencontaining oxidizing agent in the second reaction medium is about 0.12 or greater (on a molar basis) than the concentration of the developer reagent in the second reaction medium. The foregoing procedure can be used to test for the presence of amines in any aqueous fluid as well as for synthesizing various dyes. Excerpt(s): The invention pertains to a method for screening for bacterial vaginosis and a diagnostic kit for use therein. More generically, the invention pertains to a method for detecting the presence of an amine in a sample of fluid, a diagnostic kit for use therein, as well as a method for making a dye, especially 2,6-dichloroindophenol. Vaginitis is the most common gynecological problem in adult women. Infectious vaginitis presents itself in three primary forms: (a) bacterial vaginosis, (b) candidal vaginitis or "yeast", and (c) trichomonas vaginitis or "trich." Bacterial vaginosis, which affects up to 25% of American women in the normal clinical populations, is nearly twice as common as Candida and is, in fact, the most common form of vaginal infection. Bacterial vaginosis is caused by a replacement of the normal vaginal flora with facultative anaerobic bacteria, primarily Gardnerella vaginalis. Unfortunately, the symptoms of bacterial vaginosis are non-specific or non-existent and differential diagnosis is problematic. Complications associated with bacterial vaginosis represent a major health care cost burden. For example, obstetric complications of bacterial vaginosis include (1) preterm labor/birth, (2) low birth weight babies; (3) premature rupture of the amniotic membranes or PROM; (4) amniotic fluid infections; (5) postpartum endometritis, and (6) chorioamnionitis. Preterm/low birth weight babies is the second leading cause of infant mortality, next to birth defects. Also, bacterial vaginosis is suspected of being one of the many causes of cerebral palsy. In addition, gynecologic complications of bacterial vaginosis include (1) postoperative infections; (2) pelvic inflammatory disease (PID); (3) abnormal cervical cytology, (4) increased susceptibility to sexually transmitted diseases (STDs), and (5) posthysterectomy infections. STDs such as chlamydia, herpes, syphillis, gonorrhea, and trichomoniasis also cause potential harm to the fetus. Furthermore, a Swedish study reported in Acta Obstetricia et Gynecologica Scandinavica, 73:586-588 (1994) suggests that bacterial vaginosis may potentially be a cofactor with human papilloma virus in the development of cervical intraepithelial neoplasia (CIN), a precursor of cervical cancer. Web site: http://www.delphion.com/details?pn=US06255066__

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Detection of diamines in biological fluids Inventor(s): Davis; Robert H. (Corntown, GB), Hewlins; Michael J. E. (Penylan, GB), O'Dowd; Thomas C. (Woodborough, GB), Winterburn; Peter J. (Cyncoed, GB) Assignee(s): University College Cardiff Consultants Limited (Cardiff, GB2), Welsh Medical School Enterprises Limited (Cardiff, GB2) Patent Number: 5,124,254 Date filed: October 2, 1990 Abstract: A fast-acting and portable diagnostic kit for detecting diamines in biological fluids is in the form of a diamine oxidase and a chromogenic system to detect the presence of hydrogen peroxide resulting from oxidation of such diamines. The kit may especially be used to detect cadaverine or putrescine or a mixture thereof, for example in a vaginal secretion, in order to detect Gardnerella-related bacterial vaginosis. Excerpt(s): This invention relates to a method for the identification of diamines, particularly putrescine and cadaverine in vaginal secretions, and the use of this in diagnosis of a certain clinical condition, and to a diagnostic kit to enable the method to be applied routinely. Vaginitis is a widespread problem in general practice. One common form of vaginitis was characterised by Gardner and Dukes (H. L. Gardner and C. D. Dukes, Am. J. Obstet. Gynecol., 1955, 69, 962-976) who described a condition associated with a grey homogeneous discharge having a pH of 5.0-5.5 and accompanied by minimal inflammation. The condition appears to be associated with the organism Gardnerella vaginalis in the presence of other organisms, notably anaerobic bacteria. This form of vaginitis is now often called bacterial vaginosis to acknowledge the complexity of its microbiological origin. Clinical diagnosis of this condition is aided by identification of "clue cells" (vaginal epithelial cells with adherent surface bacteria), a raised pH, and a "fishy" odour generated on adding alkali to the secretion (the "amine" test) (H. L. Gardner and C. D. Dukes, loc. cit.; T. Pheifer et al., New Eng. J. Med., 1978, 298, 1429-1434; R. Amsel et al., Am. J. Med., 1983, 74, 14-22; Report of The Working Group on "The Diagnosis of Bacterial Vaginosis", Scand. J. Urol. Nephrol. (Suppl.), 1984, 86, 260-261). Web site: http://www.delphion.com/details?pn=US05124254__

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Diagnostic test for vaginal infections Inventor(s): Parkinson; Chris (166 Emerald Street South, Suite 2, Hamilton, CA) Assignee(s): none reported Patent Number: 6,019,734 Date filed: December 4, 1997 Abstract: An apparatus, method and diagnostic kit for assessing the presence or absence of a vaginal infection including bacterial vaginosis which includes a pH indicator means and a KOH patch for detecting bacterially derived amines. A method, apparatus and test kit for diagnosing vaginosis in a simple test series which can be readily performed in a doctor's office at the time a vaginal fluid sample is taken. Excerpt(s): The present invention relates generally to a diagnostic test for vaginal infections including bacterial vaginosis. It includes a rapid, easy, self-contained, noninvasive method of diagnosing bacterial vaginosis which conforms to accepted diagnostic guidelines and can be performed in a physician's office. Bacterial vaginosis

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("BV") is a common, underdiagnosed condition afflicting millions of women in North America alone. Left untreated, BV can cause pelvic inflammatory disease, premature rupture of membrane, pre-term labour, and post-abortal and post-hysterectomy infections. Currently, diagnosis of BV occurs in two ways. Firstly, the physician may diagnose BV by ordering a complete microbiological workup which involves the physician obtaining a sample of vaginal fluid, labeling the sample, packaging the sample and sending the specimen to a laboratory for analysis. This results in a two to four day turn around to receive the results from the laboratory. In addition, laboratory analysis of a vaginal smear is expensive. Web site: http://www.delphion.com/details?pn=US06019734__ •

Intravaginal clindamycin ovule composition Inventor(s): Bowman; Phil Bryan (Kalamazoo, MI), Chao; Robert Shih-Liang (Portage, MI), Pena; Lorraine Elisabeth (Kalamazoo, MI), Pesheck; Carolyn V. (Kalamazoo, MI) Assignee(s): Pharmacia & Upjohn Company (Kalamazoo, MI) Patent Number: 6,495,157 Date filed: July 20, 2000 Abstract: A highly storage-stable composition for vaginal administration of clindamycin is disclosed which is useful for the treatment of bacterial vaginosis. The composition is a vaginal suppository containing an antimicrobially effective amount of clindamycin dispersed in a Hard Fat NF suppository base. Hard Fat NF suppository bases provide a clindamycin product having long term storage stability while providing efficacy against bacterial vaginosis which is equivalent to clindamycin vaginal creams. Excerpt(s): The present invention is directed to a treatment for bacterial vaginosis (BV). The exact etiology of BV is unclear although it appears to result from an overgrowth of organisms in the vaginal flora. Although generally a mild condition, BV is distressing to the patient because of the unpleasant vaginal odor and discharge. In addition, it is epidemiologically linked to several urogenital diseases. Clindamycin vaginal cream (CVC) 100 mg per day for 7 days is a standard treatment for BV. It has recently been demonstrated that a 3-day treatment course of CVC is as effective as a 7-day course. However, even with a 3-day treatment, the use of creams is considered to be inconvenient. A vaginal ovule (suppository) formulation containing clindamycin would offer patients an alternative, more convenient dosage form. Therefore, the development of a vaginal suppository having at least the same efficacy as CVC was undertaken. As a result of this development effort, it was discovered that Hard Fat NF suppository bases significantly increased the storage stability of clindamycin. We have developed a highly storage-stable composition for vaginal administration of clindamycin which comprises a vaginal suppository containing an antimicrobially effective amount of clindamycin dispersed in a Hard Fat suppository base, preferably Hard Hat NF grade. Hard Fat bases are a mixture of glyceride esters of higher saturated fatty acids. The Hard Fat NF suppository bases provide a clindamycin product having increased stability over the CVC formulation while providing equivalent efficacy against BV. The present invention comprises a composition for intravaginal administration of clindamycin which composition contains an antimicrobially effective amount of clindamycin dispersed in a Hard Fat NF base. Hard Fat is defined in the National Formulary as "a mixture of glycerides of saturated fatty acids." It was surprisingly found that clindamycin is extremely storage stable in a Hard Fat NF base.

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Web site: http://www.delphion.com/details?pn=US06495157__ •

Intravaginal treatment compositions

of

vaginal

infections

with

buffered

metronidazole

Inventor(s): Borgman; Robert J. (Mundelein, IL) Assignee(s): Curatek Pharmaceuticals Limited Partnership (Elk Grove Village, IL) Patent Number: 5,536,743 Date filed: August 24, 1994 Abstract: A non-flowing composition and method for treatment of bacterial vaginosis are disclosed. An afflicted vagina is treated with a therapeutically effective but relatively low dose of metronidazole in a composition that includes a buffer system maintaining the composition at a pH value in the range of about 3.75 to about 4.25. The composition can also be used for prophylactic purposes. Excerpt(s): This invention contemplates a low dosage form and a method for intravaginal treatment of bacterial vaginosis with metronidazole formulations buffered to physiological vaginal pH. Bacterial vaginosis (BV) is associated with an increased volume of vaginal discharge which has a foul, fishy odor. Vaginal pH is elevated from the normal range (pH 3-4) to values.gtoreq.pH 4.7. The odor and elevated pH are caused by a high level of amines, most notably trimethylamine, in the vagina. These amines are volatilized when the pH is raised, for example, as with addition of KOH or interaction with semen. The vaginal discharge is homogenous in appearance as opposed to the flocculent discharge seen in Candida vaginalis. In contrast to candidiasis and trichomoniasis, itching generally is not associated with BV. A microscopic examination of a wet mount of the vaginal discharge in BV reveals an absence of polymorphonuclear leukocytes (PMNs). In contrast, the presence of many PMNs in a vaginal discharge is indicative of trichomoniasis, gonorrhea, or chlamydial cervicitis. The causative organism for BV is a matter of some controversy. Gardnerella vaginalis is usually implicated as the causative agent because it is isolated from 98% of women with BV. However, G. vaginalis is also recovered in smaller numbers as normal flora in the vagina of asymptomatic women in incidences as high as 68% (Totten et al, 1982). Web site: http://www.delphion.com/details?pn=US05536743__ •

Method for inactivating bacteria associated with bacterial vaginosis using cellulose acetate phthalate and/or hydroxypropyl methycellulose phthalate Inventor(s): Neurath; Alexander R. (New York, NY) Assignee(s): New York Blood Center, Inc. (New York, NY) Patent Number: 6,462,030 Date filed: June 19, 2000 Abstract: A method for treating or preventing bacterial vaginosis comprising administering to a human female an effective anti-bacterial vaginosis amount of a composition comprising at least one active compound selected from the group consisting of cellulose acetate phthalate and hydroxypropyl methylcellulose phthalate, either alone or in combination with a pharmaceutically acceptable carrier.

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Excerpt(s): The present invention concerns a method for treating or preventing bacterial vaginosis using cellulose acetate phthalate and/or hydroxypropyl methylcellulose phthalate. Recent findings suggest that bacterial vaginosis ("BV") may increase susceptibility to HIV-1 infection (Sewankambo, EN., Gray R. H., Wawer et al., M. J., "HIV-1 Infection Associated with Abnormal Vaginal Flora Morphology and Bacterial Vaginosis", Lancet, 350, 546-550, (1997); Taha, T. E., Hoover, D. R., Dallabeta et al., G. A., "Bacterial Vaginosis and Disturbances of Vaginal Flora: Association with Increased Acquisition of HIV", AIDS, 12, 1699-1706, (1998); Cohen, C. R., Duerr, A., Pruithithada et al., N., "Bacterial Vaginosis and HIV Seroprevalence Among Female Commercial Sex Workers in Chiang Mai, Thailand", AIDS, 9, 1093-1097, (1995)). Depending on the population studied, up to nearly 40% of selected groups may have BV (Sobel, J. D., "Vaginitis", New England J. Med., 337, 1896-1903, (1997)). Although unequivocal evidence that BV is a sexually transmitted disease is lacking (Carr, P. L., Felsenstein, D., Friedman, R. H., "Evaluation and Management of Vaginitis", J. Gen. Intern. Med., 13, 335-346, (1998)), BV behaves in many ways as if it were a sexually transmitted disease ("STD") (Schwebke, J. R., "Bacterial Vaginosis--More Questions Than Answers" [editorial], Genitourin Med., 73, 333-334, (1997)). Therefore, treatment of BV is expected to contribute to controlling the spread of STDs, including HIV-1 (Schwebke, J. R., "Bacterial Vaginosis--More Questions Than Answers" [editorial], Genitourin Med., 73, 333-334, (1997)). It has recently been reported that cellulose acetate phthalate ("CAP") (Eastman Kingston, Tenn., USA) which has heretofore been used as an excipient for the enteric coating of tablets and capsules (Lee, J. C., (1994), Cellulose acetate phthalate, Handbook of Pharmaceutical Excipients, 2nd Ed., Wade, A. and Weller, P. J., pp. 91-93, American Pharmaceutical Association Publishers, Washington, D.C.), has antiviral activity in vitro against HIV-1 and herpesviruses ("HSV") and, when appropriately formulated, inactivated HIV-1, herpesviruses and several bacterial STD pathogens without affecting Lactobacilli (Neurath, A. R., Strick, N., Li, Y-Y, Jiang, S., "Design of a `Microbicide` for Prevention of Sexually Transmitted Diseases Using `Inactive` Pharmaceutical Excipients", Biologicals, 27, 11-21, (1999)), essential for maintaining a normal vaginal flora (Martin, Jr., H. L., Richardson, B. A., Nyange, P., Lavreys, L., Hiller, S. L., Chohan, B. et al. (1999), "Vaginal Lactobacilli, Microbial Flora, and Risk of Human Immunodeficiency Virus Type 1 and Sexually Transmitted Disease Acquisition", Journal of Infectious Diseases, 180, 1863-1868), (Handbook of Pharmaceutical Excipients), Wade, A. and Weller, P. J., eds., 2nd Ed., American Pharmaceutical Association, (1994); Klebanoff, S. J., Coombs, R. W., "Viricidal Effect of Lactobacillus Acidophilus on Human Immunodeficiency Virus Type 1: Possible Role in Heterosexual Transmission", J. Exp. Med., 174, 289-292, (1991)). These findings have been further strengthened by the favorable outcome of experiments in the HSV-2/mouse (Gyotoku, T., Aurelian, L. and Neurath, A. R., "Cellulose Acetate Phthalate (CAP): An `Inactive` Pharmaceutical Excipient with Antiviral Activity in the Mouse Model of Genital Herpesvirus Infection", Antiviral Chemistry & Chemotherapy, 10, 327-332, (1999)) and simian immunodeficiency virus/monkey models for vaginal infection. Web site: http://www.delphion.com/details?pn=US06462030__

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PH and amine test elements Inventor(s): Lawrence; Paul J. (Campbell, CA), Ly; Peter U. (San Jose, CA), Shockey; David R. (Cupertino, CA) Assignee(s): Litmus Concepts, Inc. (Santa Clara, CA) Patent Number: 5,660,790 Date filed: August 13, 1996 Abstract: Tests for elevated pH and volatile amines in aqueous fluids are disclosed, including tests useful in the diagnosis of bacterial vaginosis and in other biological conditions. By using formulated indicators and indicators held in matrices that are permeable to gas but not to liquid, the tests provide clear and sharp transitions detectable by visual or machine-readable means rather than by subjective judgments such as small gradations in color or olfactory determinations. The tests lend themselves readily to iconic readouts of the test indications and to the inclusion of positive and negative controls. Excerpt(s): This invention relates to test devices for clinical use, and in particular to test devices for conditions characterized by an abnormal pH in an aqueous fluid, and for conditions characterized by the presence of volatile amines. A particular area of interest for the use of these tests is the diagnosis of vaginal diseases. An early study of bacterial vaginosis (BV) involved comparisons of the pH of vaginal fluids of women known to be suffering from BV with those known to be free of the disease. Gardner, H. L., et al., Am. J. Obstet. Gynecol. 69:962 (1955). All of the BV positive women in the study were determined to have a vaginal fluid pH greater than 4.5, and 91% of these women had a vaginal fluid pH greater than 5.0. Of the normal (disease-free) women in the test, 92% were found to have vaginal pH between 4.0 and 4.7. The conclusion drawn from the study was that a vaginal pH equal to or greater than 5.0 in conjunction with other clinical criteria was indicative of the presence of BV. Subsequent studies culminating in a report by Amsel, R., et al., Am. J. Med. 74:14-22 (1983), resulted in a reduction of the pH threshold for BV to 4.5, and established the remaining criteria as vaginal fluid homogeneity, the whiff test (treatment with alkali followed by an olfactory test to detect for an amine odor), and the presence of clue cells. These are commonly referred to as the Amsel clinical criteria for BV. The conclusion was based on a study group of 397 women in which 81% of BV positive women were found to have a pH greater than 4.5 while only 23% of the normal women were found to have a vaginal fluid pH greater than 4.5. Studies subsequent to the report by Amsel et al. have now adjusted the pH threshold to 4.7. One of these is the study of Holst, E., J. Clin. Microbiol. 28:2035-2039 (1990), in which 100% of the women diagnosed as BV positive by the Amsel criteria were reported to have vaginal fluid pH greater than 4.7. Another is the study by Eschenbach, D. A., Am. J. Obstet. Gynecol. 158(4):819-828 (1988), in which all 257 women in the study group who had at least 20% clue cells were shown to have a vaginal fluid pH greater than or equal to 4.7, leading to the conclusion that a threshold value of 4.7 correlated best with the other clinical evidence of BV. Krohn, M. A., et al., J. Clin. Microbiol. 27(6):1266-1271 (1989), also verified the correlation between the vaginal fluid pH threshold of 4.7 and the presence of clue cells, and Holmes, K. K., and coworkers further confirmed the pH 4.7 threshold as an indicator of BV--Holmes, K. K., et al., eds., Sexually Transmitted Diseases, McGraw-Hill, New York (1990), Chapter 46:527-545 (Holmes, K. K., et al.), and Chapter 47:547-559 (Hillier, S. L., et al.). Web site: http://www.delphion.com/details?pn=US05660790__

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Pharmaceutical compositions containing rifaximin for treatment of vaginal infections Inventor(s): Egidio; Marchi (Casalecchio di Reno, IT), Gabriele; Rotini L. (Bologna, IT), Massimo; Grillli (Highland Park, IL), Subhash; Desai (Grayslake, IL) Assignee(s): Alfa Wassermann S.p.A. (Alanno, IT) Patent Number: 5,314,904 Date filed: June 16, 1992 Abstract: Vaginal pharmaceutical compositions administrable through the topical route, particularly in the form of vaginal foams and creams containing a therapeutically effective amount of rifaximin (Common International Denomination) are useful in the treatment of vaginal infections, particularly bacterial vaginosis. Excerpt(s): The present invention relates to rifaximin (Common International Denomination) which is the compound 4-desoxy-4'-methyl-pyrido [1'2':1.2] imidazo [5.4-c] rifamycin SV, which is described in Italian Patent 1,154,655 and in U.S. Pat. No. 4,341,785. The substance has been described to be endowed with an antibacterial activity similar to the activity of rifampin [Venturini A. P. and Marchi E., Chemiotherapia, 5 (4), 257-256, (1986)]. However, its mechanism of action differs from rifampin in that it is not absorbed through the systemic route after oral administration [Venturini A. P., Chemotherapy, 29, 1-3, (1983) and Cellai L. et al., Chemiotherapia, 3, (6), 373-377, (1984)] due to the zwitterionic nature of the compound, which cannot be absorbed by the gastrointestinal tract [Marchi E. et al., J. Med. Chem., 28, 960-963, (1985)]. Due to this particular pharamcokinetic behavior, rifaximin has no toxicity at a dose of 2000 mg/kg/os, when administered orally in rats, and therefore, on the basis of the microbiological pharmacodynamic and toxicological data, this substance has been used as a drug for the therapy of bacterial gastroenteritis, neurological symptoms and clinical symptoms of hepatic encefalopathy and for the pre- and post-surgical treatment of the gastrointestinal tract [Alvisi V. et al., J. Int. Med. Res., 15, 49-56, (1987), Testa R. et al., Drugs Exptl. Clin. Res., 11, 387-392, (1985), Gruttadauria G. et al., Eur. Rev. Med. Pharm. Sci., 9, 100-105, (1987)]. The present invention relates to a novel therapeutic use of rifaximin in the treatment of vaginal infections, in particular bacterial vaginosis, because this antibiotic has now been shown to exhibit excellent activity in vitro (MIC) with respect to microorganisms such as Bacteroides bivius-disiens, Gardnerella vaginalis, Mobiluncus spp., Neisseria gonorrhoeae, Lactobacillus spp. and Haemophilus ducreyi, in addition, Chlamydia trachomatis, another organism, infecting the vaginal tract, has shown susceptibility to rifaximin. Web site: http://www.delphion.com/details?pn=US05314904__

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Use of polycarboxylic acid polymers to treat vaginal infections Inventor(s): Bologna; William J. (NY, NY), Robinson; Joseph R. (Madison, WI) Assignee(s): Columbia Laboratories, Inc. (Aventura, FL) Patent Number: 6,017,521 Date filed: October 16, 1997 Abstract: The present invention relates to the use of a bioadhesive aqueous composition to control the pH of the vagina to alleviate microorganism growth and feminine odor such as presented by bacterial vaginosis. The composition contemplated herein comprises water and an acidic polymer, specifically one wherein 80% of the monomers

Patents 103

contain at least one carboxyl group [--COOH] and wherein the polymer is cross-linked so as to be water-swellable, but water-insoluble. The composition of the present invention is additionally a bioadhesive providing for a long-lasting benefit and control of vaginal pH. Excerpt(s): Bacterial vaginosis is the most common form of infectious vaginitis, accounting for 45% of symptomatic cases and estimated to be present in 15% of asymptomatic sexually active women. See Breen, J., ed., The Gynecologist and the Older Patient, pp. 304-305 (1988). Bacterial vaginosis (also called nonspecific vaginitis) is a polymicrobial vaginal infection believed to be caused by an increase in the number of anaerobic organisms with a concomitant decrease in lactobacilli in the vagina. The decrease in the number of lactobacilli in the vagina has a dual effect, i.e., (i) a decreased competition for nutrients and (ii) a decrease in the amount of lactic acid present, thus allowing for the multiplication of opportunistic pathogens in the vagina, whose growth is normally suppressed by the lactobacilli. The principal pathogens associated with bacterial vaginosis are believed to be Gardnerella vaginalis and anaerobes of the Mobiluncus species. However, numerous other pathogenic anaerobes are also believed to be involved in the etiology of vaginosis. See Kaufman et al., Benign Diseases of the Vulva and Vagina, 3rd ed., pp. 401-418 (1989). Thus, bacterial vaginosis is considered a broad spectrum infection requiring a broad spectrum treatment. Clinically, bacterial vaginosis presents itself as a superficial vaginal infection with few irrative symptoms and no inflammatory response. Some noticeable symptoms include an unpleasant smell, an elevated vaginal pH greater than about 5.0, a thin homogeneous discharge, the presence of Gardnerella clue cells and a high succinate/lactate ratio (.gtoreq.0.4). See, e.g., Livengood et al., "Bacterial Vaginosis: Diagnostic and Pathogenic findings during Topical Clindamycin Therapy," Am. J. Obstet. Gynecol., vol. 163, No. 2, p. 515 (August 1990). It is believed that the composition of organic acids in the vagina shifts from primarily lactic acid (pK.sub.a =3.86) to succinic acid (pK.sub.a1 =4.21, pK.sub.a2 =5.64) as a result of the decrease in the lactobacilli, which produce lactic acid, and a rise in Mobiluncus, which produce succinic acid. This shift in acid composition tends to raise the pH of the vagina. It is unclear whether the change in acidity is a cause or effect of the infection. However, it is known that certain anaerobes will grow better at a higher pH than is normally present in the vagina. It is thus believed that lowering the vaginal pH is an effective measure against the infection. Web site: http://www.delphion.com/details?pn=US06017521__ •

Vaginal pH buffering for preventing miscarriage and premature labor, by treating or preventing bacterial vaginosis Inventor(s): Bologna; William J. (Paris, FR), Levine; Howard L. (Oceanside, NY) Assignee(s): Columbia Laboratories, Inc. (Rockville Centre, NY) Patent Number: 6,479,045 Date filed: December 21, 2000 Abstract: The present invention concerns compositions and methods for preventing miscarriage and premature labor, and for treating and preventing Bacterial Vaginosis using a pH-buffering polymer. The present invention further concerns formulating such a composition or method in such a way as to provide therapeutically sufficient levels of the composition to a patient in need thereof.

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Excerpt(s): This invention relates to compositions and methods for preventing miscarriage and premature labor, and for treating and preventing Bacterial Vaginosis. Bacterial Vaginosis (BV) is broadly defined as a shift in vaginal ecology from a normal lactobacillus dominated flora to a profuse mixed microbial flora consisting of facultative and anaerobic organisms. An ancient condition first described by Hippocrates, BV is now the most common vaginal disorder in women of reproductive age, Kent, H. L., Epidemiology of vaginitis, A. J Obstet. Gynecol. 1991 165:1168, afflicting 15 to 20 percent of all women at any given time. In the United States, BV is the leading variety of vaginal infection, affecting a broader spectrum of women than gonorrhea. Id. A primary medical significance of BV is its impact upon the quality of fetal implantation and its potential to induce premature labor, resulting in low birth-weight infants. BV during pregnancy also has been associated with an increased risk of late miscarriage. Kurki, T, et al., Bacterial vaginosis in early pregnancy and pregnancy outcome, Obstet. Gynecol. 1992, 80:173-77; Riduan, J. M. et al., Bacterial vaginosis and prematurity in Indonesia: Association in early and late pregnancy, Am. J. Obstet. Gynecol. 1993, 169:175-78; Hay, P. E., et al., Abnormal bacterial colonization of the genital tract and subsequent preterm delivery and late miscarriage, BMJ 1994, 308:295-98; McGregor, J. A., et al., Prevention of premature birth by screening and treatment for common genital tract infections results of a prospective controlled evaluation, Am J. Obstet. Gynecol. 1995, 173:157-67, Hillier, S. L., et al., Association between bacterial vaginosis and preterm delivery of a low birthweight infant, N. Engl. J. Med. 1995, 333,1737-42; Watts, D. H., et al., Bacterial vaginosis as a risk factorforpost-cesarean endometriosis, Obstet. Gynecol. 1990, 75,52-58. Web site: http://www.delphion.com/details?pn=US06479045__

Patent Applications on Bacterial Vaginosis As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to bacterial vaginosis: •

Detection of bacterial vaginosis Inventor(s): Chaudry, Amjad Nissar; (Manchester, GB), Henery, Martin James; (Alderley Edge, GB), Travers, Paul James; (Manchester, GB), Tummon, Andrew John; (Middlewich, GB) Correspondence: MARGER JOHNSON & MCCOLLOM PC; 1030 SW MORRISON STREET; PORTLAND; OR; 97205; US Patent Application Number: 20030044996 Date filed: August 14, 2002 Abstract: There is disclosed a method for detecting the presence of bacterial vaginosis in a female subject comprising the steps of:obtaining a sample from the vaginal region of the subject;detecting acetic acid present in the sample; andcorrelating the presence of detected acetic acid with the presence of bacterial vaginosis. Excerpt(s): This invention relates to the detection of bacterial vaginosis using a gas detector. Bacterial vaginosis (EV) is a well known, but not well understood or well

10

This has been a common practice outside the United States prior to December 2000.

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defined, condition which exhibits uncertain symptoms. Numerous reports cite as much as 50% of the affected population being asymptomatic. The remaining 50% of the population either go undetected or present during routine examination for an associated or uncorrelated problem. Originally thought to be a benign infection recent studies have linked the problem to increased risk of intra-amniotic infection, choroamionitis, postcaesarean and post-partum endornetritis, adverse pregnancy outcome, pre-term labour and birth, premature rupture of membranes at term and post-hysterectomy cuff cellulitis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method for the prevention, inhibition, or treatment of vaginitis and/or bacterial vaginosis using polystyrene sulfonate Inventor(s): Anderson, Robert Anthony JR.; (Chicago, IL), Zaneveld, Lourens Jan Dirk; (Chicago, IL) Correspondence: FITCH EVEN TABIN AND FLANNERY; 120 SOUTH LA SALLE STREET; SUITE 1600; CHICAGO; IL; 60603-3406; US Patent Application Number: 20020114776 Date filed: December 18, 2000 Abstract: A method for preventing, inhibiting, or treating vaginitis or bacterial vaginosis using polystyrene sulfonate is provided. The polystyrene sulfonate used in the present invention inhibits Trichomonas (a flagellate protozoon), Gardnerella, and other vaginitis/vaginosis-causing bacteria. The method of this invention generally comprises the application of an effective amount of an inhibitory agent into the vagina of a female in need of prevention, inhibition, and/or treatment of vaginitis and/or bacterial vaginosis. Preferably the polystyrene sulfonate in contained in an aqueous based composition, more preferably in an aqueous based composition buffered to a pH of about 3.5 to about 7.5, and even more preferably in an aqueous based composition buffered to a pH of about 3.5 to about 5. Excerpt(s): This invention generally provides a method for preventing, inhibiting, or treating vaginitis or bacterial vaginosis. More specifically, the present invention provides a method for preventing, inhibiting, or treating vaginitis and/or bacterial vaginosis using polystyrene sulfonate. The polystyrene sulfonate used in the present invention inhibits Trichomonas (a flagellate protozoon), Gardnerella, and other vaginitis/vaginosis-causing bacteria. The female vagina is colonized by a variety of bacteria. Under normal conditions, the vagina flora provides a protective mechanism, including the maintenance of a low pH, to guard against the invasion of pathogenic microbes. A normal vagina generally contains more than about 10.sup.4 lactobacilli per milliliter of vaginal material. Infectious vaginitis is a common clinical syndrome and is diagnosed in more that 25 percent of women visiting sexually transmitted disease clinics. Common symptoms of infectious vaginitis include, for example, disruption of the normal vagina flora, irritation, odor, and/or vaginal discharge. Infectious vaginitis or vulvovaginities includes Candidiasis, trichomoniasis, bacterial vaginosis, and other vaginal infections. Bacterial vaginosis is the most common form of infectious vaginitis, accounting for 45 percent of symptomatic cases and estimated to be present in 15 percent of asymptomatic sexually active women. See, e.g., The Gynecologist and the Older Patient, Breen, J. (ed.), pp. 304-305 (1988); Principles and Practice of Infectious Diseases, Mandell, G. L., J. E, Bennett, & R. Dolin (eds.), vol. 1, ch. 95, pp. 1218-1235 (5.sup.th Edition, 2000); The Merck Manual of Medical Information: Home Edition,

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Berkow, R. (Editor-in-Chief, 1081-1083 (1997). Bacterial vaginosis is a polymicrobial vaginal infection believed to be caused by an increase in the number of anaerobic organisms with a concomitant decrease in lactobacilli in the vagina. The decrease in the number of lactobacilli in the vagina has a dual effect, i.e., (1) a decreased competition for nutrients and (2) a decrease in the amount of lactic acid present (i.e., increasing the pH), thus allowing for the multiplication of opportunistic pathogens in the vagina, whose growth is normally suppressed by the lactobacilli and the acidic pH of the vagina. The principal pathogens associated with bacterial vaginosis are believed to be Gardnerella vaginitis and other pathogenic anaerobes. Thus, bacterial vaginosis is considered a broad spectrum infection requiring a broad spectrum treatment. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Oral administration of lactobacillus for the treatment and prevention of urogenital infection Inventor(s): Bruce, Andrew W.; (Toronto, CA), Reid, Gregor; (London, CA) Correspondence: SCULLY, SCOTT, MURPHY & PRESSER; 400 Garden City Plaza; Garden City; NY; 11530; US Patent Application Number: 20020044926 Date filed: June 11, 2001 Abstract: The present invention provides methods and compositions for the oral administration of at least one Lactobacillus and/or other probiotic organisms, such as Bifidobacterium, for improving vaginal health. The invention also provides methods and compositions to treat vaginitis, bacterial vaginosis and reduce candida colonization. Excerpt(s): This application is a continuation-in-part of U.S. Ser. No. 09/459,292, filed Dec. 10, 1999. The present invention provides methods and compositions for the oral administration of lactobacilli or other probiotic organisms such as Bifidobacterium, for reduction of the risk of urogenital infection and concomitant restoration and/or maintenance of the desired urogenital flora. Urogenital infections, including urinary tract infections (UTI), bacterial vaginosis (BV) and yeast vaginitis, afflict an estimated one billion women in the world annually. While antimicrobial agents are effective at providing clinical remediation, the incidence of infections by multi-drug resistant Gram positive cocci appears to be rising and there is great concern that methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE) may thwart even the most potent antimicrobial agents. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Vaginal pH Buffering for preventing miscarriage and premature labor, and for treating or preventing bacterial vaginosis Inventor(s): Bologna, William J.; (Paris, NY), Levine, Howard L.; (Oceanside, NY) Correspondence: LYON & LYON LLP; SUITE 4700; 633 WEST FIFTH STREET; LOS ANGELES; CA; 90071-2066; US Patent Application Number: 20010031251 Date filed: December 27, 2000

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Abstract: The present invention concerns compositions and methods for preventing miscarriage and premature labor, and for treating and preventing Bacterial Vaginosis using a pH-buffering polymer. The present invention further concerns formulating such a composition or method in such a way as to provide therapeutically sufficient levels of the composition to a patient in need thereof. Excerpt(s): This application claims the benefit of United States Provisional Patent Application No. 60/171,454, filed Dec. 22, 1999. This invention relates to compositions and methods for preventing miscarriage and premature labor, and for treating and preventing Bacterial Vaginosis. Bacterial Vaginosis (BV) is broadly defined as a shift in vaginal ecology from a normal lactobacillus dominated flora to a profuse mixed microbial flora consisting of facultative and anaerobic organisms. An ancient condition first described by Hippocrates, BV is now the most common vaginal disorder in women of reproductive age, Kent, H. L., Epidemiology of vaginitis, A. J. Obstet. Gynecol. 1991,165:1168, afflicting 15 to 20 percent of all women at any given time. In the United States, BV is the leading variety of vaginal infection, affecting a broader spectrum of women than gonorrhea. Id. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with bacterial vaginosis, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “bacterial vaginosis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on bacterial vaginosis. You can also use this procedure to view pending patent applications concerning bacterial vaginosis. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON BACTERIAL VAGINOSIS Overview This chapter provides bibliographic book references relating to bacterial vaginosis. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on bacterial vaginosis include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “bacterial vaginosis” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on bacterial vaginosis: •

Sexually Transmissible Diseases Source: Guidelines for Women's Health Care; 1996. Contact: American College of Obstetricians and Gynecologists, PO Box 96920, Washington, DC, 20090-6920, (202) 638-5577, http://www.acog.com. Summary: This book chapter reviews the assessment, evaluation, diagnosis, and treatment of sexually transmitted diseases (STDs). The chapter provides an overview and history of the more common STDs followed by guidelines for the treatment of gonorrhea, pelvic inflammatory disease, chlamydia, syphilis, trichomoniasis, herpes simplex virus, human papillomavirus, bacterial vaginosis, candidal vaginitis, hepatitis B, and HIV.

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•

General Practitioner's Guide to Genitourinary Medicine and Sexual Health Source: Cambridge, England: Cambridge University Press. 1996. 107 p. Contact: Available from Cambridge University Press. 40 West 20th Street, New York, NY 10011-4211. (800) 872-7423. Fax (212) 691-3239. PRICE: $29.95. ISBN: 0521556562. Summary: This illustrated text provides general practitioners with guidelines for diagnosing and managing the many common genitourinary and sexual health problems seen in general practice. The author provides a symptom-oriented approach. Early chapters provide advice on how to take a patient's sexual history and on indications for referral. Seventeen topical chapters cover bacterial vaginosis; candidiasis; other causes of vaginal discharge; a general approach to the management of vaginal discharge; vulval problems; frequency dysuria syndrome; pelvic pain; cytology and colposcopy; contraception and genital tract infection; dysuria in young men; prostatitis, prostatodynia, and hematospermia; scrotal pain; penile rashes; genital ulceration; genital 'lumps'; genital irritation; human immunodeficiency virus (HIV) infection; and genital problems in children. The text is illustrated throughout with black and white photographs; in addition, a section of full-color plates is included. A subject index concludes the volume. 9 references. (AA-M).

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “bacterial vaginosis” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “bacterial vaginosis” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “bacterial vaginosis” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Bacterial Vaginosis: Clue Cell-Positive Discharge: Diagnostic, Ultra-Structural, and Therapeutic Aspects by W.I. Van Der Meijden; ISBN: 9023223098; http://www.amazon.com/exec/obidos/ASIN/9023223098/icongroupinterna

•

The Diagnosis and Management of Bacterial Vaginosis (Round Table Series (RTS)) by C.S.F. Easmon (Editor); ISBN: 1853152374; http://www.amazon.com/exec/obidos/ASIN/1853152374/icongroupinterna

•

The Official Patient's Sourcebook on Bacterial Vaginosis: A Revised and Updated Directory for the Internet Age by Icon Health Publications; ISBN: 0597832854; http://www.amazon.com/exec/obidos/ASIN/0597832854/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “bacterial vaginosis” (or synonyms) into the search box, and select “books

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only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

Bacterial vaginosis Author: Mårdh, Per-Anders.; Year: 1993; Stockholm, Sweden: Almqvist; Wiksell International, c1984; ISBN: 9122006427

•

The diagnosis and management of bacterial vaginosis: proceedings of a round table meeting held at Robinson College, Cambridge, on 4 July 1993 Author: Easmon, C. S. F.; Year: 2001; London: Royal Society of Medicine Services with an educational grant from Upjohn Limited, c1993

•

Treatment of trichomoniasis, candidiasis, bacterial vaginosis, pediculosis and scabies Author: Guerrero, E.; Year: 1995; 1993

Chapters on Bacterial Vaginosis In order to find chapters that specifically relate to bacterial vaginosis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and bacterial vaginosis using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “bacterial vaginosis” (or synonyms) into the “For these words:” box.

11

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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CHAPTER 7. MULTIMEDIA ON BACTERIAL VAGINOSIS Overview In this chapter, we show you how to keep current on multimedia sources of information on bacterial vaginosis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on bacterial vaginosis is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “bacterial vaginosis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “bacterial vaginosis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on bacterial vaginosis: •

Bacterial Vagniosis: The Balance of Bacteria Contact: NIMCO, PO Box 9, Calhoun, KY, 42327-0009, (502) 273-5050. Summary: This video provides information about the sexually transmitted disease (STD), bacterial vaginosis. The video discusses bacterial vaginosis and its transmission, possible long-term effects if left untreated, prevention, and treatment.

Bibliography: Multimedia on Bacterial Vaginosis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in bacterial vaginosis (or synonyms).

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Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on bacterial vaginosis: •

Bacterial vaginosis [videorecording] Source: [presented by] the University of Texas Health Science Center at Houston; Year: 1990; Format: Videorecording; [Houston, Tex.: UT/TV], c1990

•

Bacterial vaginosis [videorecording] Source: Marshfield Video Network, in cooperation with Marshfield Clinic, St. Joseph's Hospital, and Marshfield Medical Research Foundation; Year: 1988; Format: Videorecording; Marshfield, WI: The Network, [1988]

•

Non-specific vaginitis [videorecording]: today's bacterial vaginosis Source: by George P. Schmid; Year: 1986; Format: Videorecording; Atlanta, Ga.: Emory University, c1986

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CHAPTER 8. PERIODICALS AND NEWS ON BACTERIAL VAGINOSIS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover bacterial vaginosis.

News Services and Press Releases One of the simplest ways of tracking press releases on bacterial vaginosis is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “bacterial vaginosis” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to bacterial vaginosis. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “bacterial vaginosis” (or synonyms). The following was recently listed in this archive for bacterial vaginosis: •

Bacterial vaginosis early in pregnancy a strong risk factor for preterm delivery Source: Reuters Medical News Date: August 04, 2003

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Antibiotic treatment of bacterial vaginosis in high-risk pregnancy reduces preterm delivery Source: Reuters Industry Breifing Date: April 18, 2003

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Antibiotic treatment of bacterial vaginosis reduces late miscarriage, preterm risk Source: Reuters Industry Breifing Date: March 20, 2003

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CORRECTION: Bacterial vaginosis associated with increased risk of miscarriage Source: Reuters Medical News Date: December 07, 2002

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Bacterial vaginosis associated with increased risk of miscarriage Source: Reuters Medical News Date: December 05, 2002

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Screening for bacterial vaginosis may reduce rate of low birthweight infants Source: Reuters Medical News Date: September 09, 2002

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Persistent bacterial vaginosis explains higher prevalence among HIV-infected women Source: Reuters Medical News Date: October 23, 2001

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Douching increases the risk of bacterial vaginosis Source: Reuters Medical News Date: October 08, 2001

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Routine treatment not advisable for women with asymptomatic bacterial vaginosis Source: Reuters Medical News Date: January 03, 2001

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Metronidazole gel comparable to oral preparation for bacterial vaginosis Source: Reuters Medical News Date: December 13, 2000

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Bacterial vaginosis in early pregnancy increases risk of miscarriage Source: Reuters Medical News Date: August 25, 2000

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Vaginal drug better tolerated, as effective as oral agent for bacterial vaginosis Source: Reuters Industry Breifing Date: August 01, 2000

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Specific bacteria in bacterial vaginosis linked to HIV transmission Source: Reuters Medical News Date: July 05, 2000

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Metronidazole does not prevent preterm delivery associated with bacterial vaginosis Source: Reuters Medical News Date: February 24, 2000

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FDA approves antibiotic for bacterial vaginosis Source: Reuters Medical News Date: August 17, 1999

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FDA approves suppository for bacterial vaginosis Source: Reuters Health eLine Date: August 16, 1999

Periodicals and News

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Bacterial vaginosis may raise miscarriage risk Source: Reuters Health eLine Date: July 23, 1999

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Bacterial vaginosis linked to increased risk of first-trimester miscarriage in IVF patients Source: Reuters Medical News Date: July 23, 1999

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Bacterial vaginosis may be caused by a sexually transmissible bacteriophage Source: Reuters Medical News Date: June 03, 1999

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High rate of bacterial vaginosis seen among HIV-positive pregnant women Source: Reuters Medical News Date: March 29, 1999

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Once-daily topical metronidazole a new option in treatment of bacterial vaginosis Source: Reuters Medical News Date: March 12, 1999

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Most women do not know symptoms of bacterial vaginosis Source: Reuters Medical News Date: June 24, 1998

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Viral infection of lactobacilli may contribute to bacterial vaginosis Source: Reuters Medical News Date: May 29, 1998

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FDA Approves Three-Day Bacterial Vaginosis Treatment Source: Reuters Medical News Date: March 04, 1998

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Pap Test Valid For Diagnosis Of Bacterial Vaginosis Source: Reuters Medical News Date: January 08, 1998

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Metronidazole For Bacterial Vaginosis: Greater Efficacy In An Acidic Formulation Source: Reuters Medical News Date: November 03, 1997

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Artificial Nose Technology Recognizes Bacterial Vaginosis Source: Reuters Medical News Date: October 21, 1997

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Bacterial Vaginosis May Increase Susceptibility To HIV Infection Source: Reuters Medical News Date: August 22, 1997

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Bacterial Vaginosis-Associated Microorganisms Increase Risk Of Endometritis Source: Reuters Medical News Date: September 18, 1996

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Bacterial Vaginosis: Metronidazole And Clindamycin Equally Effective Source: Reuters Medical News Date: November 30, 1995

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Bacterial Vaginosis Not Associated With Cervical Neoplasia Source: Reuters Medical News Date: October 20, 1995

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Screening And Treatment Of Bacterial Vaginosis Reduces Risk For Preterm Birth Source: Reuters Medical News Date: August 15, 1995 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “bacterial vaginosis” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “bacterial vaginosis” (or synonyms). If you know the name of a company that is relevant to bacterial vaginosis, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “bacterial vaginosis” (or synonyms).

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Academic Periodicals covering Bacterial Vaginosis Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to bacterial vaginosis. In addition to these sources, you can search for articles covering bacterial vaginosis that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for bacterial vaginosis. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with bacterial vaginosis. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

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The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to bacterial vaginosis: Clindamycin •

Vaginal - U.S. Brands: Cleocin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202700.html

Metronidazole •

Vaginal - U.S. Brands: MetroGel-Vaginal http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202704.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

12

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

13

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “bacterial vaginosis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “bacterial vaginosis” (or synonyms) into the “For these words:” box. The following is a sample result: •

Tracking the Hidden Epidemics: Trends in the STD Epidemics in the United States 1998 Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Prevention Services, Division of Sexually Transmitted Disease, 1600 Clifton Rd NE, Atlanta, GA, 30333, (404) 639-8002. CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 208496003, (800) 458-5231, http://cdcnpin.org. Summary: This report discusses the epidemiology of sexually transmitted diseases (STDs) among various demographic groups in the United States (US). Specifically, information on the most common STDs other than the human immunodeficiency virus (HIV) are discussed. These include chlamydia, gonorrhea, syphilis, genital herpes (HSV2), hepatitis B, trichomoniasis, bacterial vaginosis, human papillomavirus (HPV), and chancroid. The report discusses trends by disease, gender, age, race, and region. Other topics briefly discussed include sexual transmission, perinatal transmission, symptoms, treatment, consequences of not being treated, association with HIV transmission, and outcomes for individuals with HIV. Status of STDs by city and state are also provided. The fifteen cities that lead the nation in reported rates of both gonorrhea and syphilis are listed. Many of these communities also face a significant threat from chlamydia, which remains widespread across much of the United States (US). Twenty-one states now have rates of gonorrhea that exceed the national goal, while nine states and Puerto Rico now have rates of syphilis that exceed the national goal. There is very little regional variation in the prevalence of other STDs. The report also contains answers to eight frequently asked questions about STDs: (1) Are STDs increasing or decreasing in the US? (2) What are the most serious STDs in women? (3) What are the most common STDs among teens? (4) Are STDs in teens increasing or decreasing? (5) What areas of the country have the greatest problems with STDs? (6) Which STDs threaten infants? (7) Are STDs more common among racial and ethnic minorities, and if so, why? (8) Why don't we have more exact data on the number of STDs?.

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Sexually Transmitted Diseases in America : How Many Cases and at What Cost Contact: Henry J Kaiser Family Foundation, 2400 Sand Hill Rd, Menlo Park, CA, 94025, (650) 854-9400, http://www.kff.org. Summary: This report examines the epidemiology and financial impact on health care systems and individuals of sexually transmitted diseases (STDs) in the United States (US). The report categorizes STDs as either bacterial and viral infections/diseases and explains who is affected by STDs. It examines the efforts in the US to prevent the transmission of STDs and the need for parents, children, sex partners, teachers, students, patients, and health care providers to communicate and discuss STD prevention and transmission risks. The report discusses the epidemiology of STDs in the US and data collection methods. It analyzes the accuracy of this surveillance evidence and breaks down the data by infection/disease such as chlamydia, gonorrhea, syphilis, herpes, human papillomavirus (HPV), hepatitis B, trichomonasis, bacterial vaginosis, and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The report includes information concerning the direct medical costs incurred in the US as a result of health care for STDs and supplies the readers with the estimated costs of STD care per year by state.

The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “bacterial vaginosis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 1525 37 836 125 2 2525

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quick15

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

16

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18

The HSTAT URL is http://hstat.nlm.nih.gov/.

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reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “bacterial vaginosis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

19

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 20 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 21

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on bacterial vaginosis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to bacterial vaginosis. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to bacterial vaginosis. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “bacterial vaginosis”:

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•

Other guides Chlamydia Infections http://www.nlm.nih.gov/medlineplus/chlamydiainfections.html Pelvic Inflammatory Disease http://www.nlm.nih.gov/medlineplus/pelvicinflammatorydisease.html Sexually Transmitted Diseases http://www.nlm.nih.gov/medlineplus/sexuallytransmitteddiseases.html Vaginal Cancer http://www.nlm.nih.gov/medlineplus/vaginalcancer.html Vaginal Diseases http://www.nlm.nih.gov/medlineplus/vaginaldiseases.html

Within the health topic page dedicated to bacterial vaginosis, the following was listed: •

Diagnosis/Symptoms Colposcopy http://www.nlm.nih.gov/medlineplus/tutorials/colposcopyloader.html Colposcopy Source: American Academy of Family Physicians http://familydoctor.org/handouts/082.html Genital Problems in Women: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/537.html

•

Specific Conditions/Aspects Bacterial Vaginosis Source: American Academy of Family Physicians http://familydoctor.org/handouts/234.html Bacterial Vaginosis (BV) Source: Centers for Disease Control and Prevention http://www.cdc.gov/nchstp/dstd/Fact_Sheets/FactsBV.htm Bartholin Gland Cyst Source: American Academy of Family Physicians http://familydoctor.org/handouts/235.html Douching Source: National Women's Health Information Center http://www.4woman.gov/faq/douching.htm Dyspareunia: Painful Sex for Women Source: American Academy of Family Physicians http://familydoctor.org/handouts/669.html Genital Candidiasis (Vulvovaginal Candidiasis (VVC), Vaginal Yeast Infections) Source: National Center for Infectious Diseases http://www.cdc.gov/ncidod/dbmd/diseaseinfo/candidiasis_gen_g.htm

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Information to Live By: Vaginitis Source: American Social Health Association http://www.ashastd.org/stdfaqs/vaginitis.html Questions and Answers about Lichen Sclerosus Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/hi/topics/lichen/lichen.htm Vaginal Bleeding: An Interview with a Mayo Clinic Specialist Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HO00159 Vaginal Yeast Infections Source: National Women's Health Information Center http://www.4woman.gov/faq/yeastinfect.htm Vulvar Problems Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZQX9DQA7C &sub_cat=9 Vulvodynia Source: American Academy of Family Physicians http://familydoctor.org/handouts/367.html Vulvodynia Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00159 Yeast Infection? Are You Sure? Source: Interstitial Cystitis Association http://www.ichelp.org/FeatureArticles/YeastInfectionAreYouSure.html •

From the National Institutes of Health Vaginitis Due to Vaginal Infections Source: National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/factsheets/stdvag.htm Vaginitis: Important Information for Your Good Health Source: National Institute of Child Health and Human Development http://www.nichd.nih.gov/publications/pubs/vagtoc.htm

•

Organizations National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/ National Vulvodynia Association http://www.nva.org

•

Pictures/Diagrams Vulvar Anatomy Source: National Vulvodynia Association http://www.nva.org/about_vulvodynia/vulvar_anatomy.html

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Teenagers Are Changes in My Vaginal Discharge OK? Source: Nemours Foundation http://kidshealth.org/teen/sexual_health/girls/vdischarge2.html Yeast Infections Source: Nemours Foundation http://kidshealth.org/teen/sexual_health/stds/yeast_infections.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on bacterial vaginosis. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

What Is Bacterial Vaginosis? Contact: California Department of Health Services, Office of AIDS, California AIDS Clearinghouse, 1443 N Martel Ave, Los Angeles, CA, 90046-4207, (323) 845-4180, http://www.hivinfo.org/cac/cachouse.shtml. Summary: This fact sheet provides a general overview of bacterial vaginosis (BV), an infection caused by the overgrowth of vaginal bacteria. It is not known whether or not BV can be transmitted sexually. The symptoms of BV include a gray, yellow, or white smelly discharge or itching around the vagina though it can be asymptomatic. If BV is left untreated it can lead to difficulty during childbirth or can develop into pelvic inflammatory disease (PID). Women can help to prevent BV by practicing safer sex with condoms during every sexual encounter and avoiding douching. BV is generally treated with a drug called metronidazole (flagyl). Women with BV should tell their health care providers if they are pregnant because they may require a different medicine. The fact sheet provides contact information for services from which individuals can learn more about STDs and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS).

•

Bacterial Vaginosis (Gardnerella, Haemophilus, Vaginitis or BV) Contact: Washington Department of Social and Health Services, Office of Disease Prevention and Control, Office on AIDS, Airdustrial Pk, Olympia, WA, 98504-0095, (360) 586-3887.

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Summary: This fact sheet, for women, discusses the sexually transmitted disease (STD), bacterial vaginosis. Bacterial vaginosis, also known as gardnerella, haemophilus, vaginitis, or BV, is a very common cause of vaginal infections. BV can be transmitted by sex and/or caused by a disturbance in the bacterial balance in the vagina due to natural or medicinally induced side effects. The symptoms, diagnosis, treatment, and prevention of BV are outlined. The fact sheet explains that BV causes no permanent damage to the vagina, but that the bacteria has been found in the lining of the uterus and in the tubes of women with pelvic inflammatory disease (PID), suggesting a possible correlation between the two. Contact information for the National STD Hotline is provided. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “bacterial vaginosis” (or synonyms). The following was recently posted: •

2002 national guideline for the management of bacterial vaginosis Source: Association for Genitourinary Medicine - Medical Specialty Society; 1999 August (revised 2002); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3032&nbr=2258&a mp;string=bacterial+AND+vaginosis

•

Screening for bacterial vaginosis in pregnancy: recommendations and rationale Source: United States Preventive Services Task Force - Independent Expert Panel; 1996 (revised 2001 Apr); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2659&nbr=1885&a mp;string=bacterial+AND+vaginosis The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to bacterial vaginosis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

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Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to bacterial vaginosis. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with bacterial vaginosis. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about bacterial vaginosis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “bacterial vaginosis” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received

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your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “bacterial vaginosis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “bacterial vaginosis” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “bacterial vaginosis” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

23

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

24

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

143

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

144 Bacterial Vaginosis

•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

146 Bacterial Vaginosis

•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

147

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

149

BACTERIAL VAGINOSIS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 2,6-Dichloroindophenol: A dye used as a reagent in the determination of vitamin C. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acridine Orange: Cationic cytochemical stain specific for cell nuclei, especially DNA. It is used as a supravital stain and in fluorescence cytochemistry. It may cause mutations in microorganisms. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU]

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Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allantois: An embryonic diverticulum of the hindgut of reptiles, birds, and mammals; in man its blood vessels give rise to those of the umbilical cord. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alpha-Defensins: Defensins found in azurophilic granules of neutrophils and in the secretory granules of intestinal paneth cells. [NIH] Alpha-fetoprotein: AFP. A protein normally produced by a developing fetus. AFP levels are usually undetectable in the blood of healthy nonpregnant adults. An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acid Substitution: The naturally occurring or experimentally induced replacement of one or more amino acids in a protein with another. If a functionally equivalent amino acid is substituted, the protein may retain wild-type activity. Substitution may also diminish or eliminate protein function. Experimentally induced substitution is often used to study enzyme activities and binding site properties. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amnion: The extraembryonic membrane which contains the embryo and amniotic fluid. [NIH]

Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH]

Dictionary 151

Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a

152 Bacterial Vaginosis

specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-infective: An agent that so acts. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antisepsis: The destruction of germs causing disease. [NIH] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Aqueous: Having to do with water. [NIH] Aqueous fluid: Clear, watery fluid that flows between and nourishes the lens and the cornea; secreted by the ciliary processes. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aspiration: The act of inhaling. [NIH]

Dictionary 153

Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrial: Pertaining to an atrium. [EU] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Bacillus: A genus of Bacillaceae that are spore-forming, rod-shaped cells. Most species are saprophytic soil forms with only a few species being pathogenic. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Beta-Defensins: Defensins found mainly in epithelial cells. [NIH] Beta-sheet: Two or more parallel or anti-parallel strands are arranged in rows. [NIH] Beta-Thromboglobulin: A platelet-specific protein which is released when platelets aggregate. Elevated plasma levels have been reported after deep venous thrombosis, pre-

154 Bacterial Vaginosis

eclampsia, myocardial infarction with mural thrombosis, and myeloproliferative disorders. Measurement of beta-thromboglobulin in biological fluids by radioimmunoassay is used for the diagnosis and assessment of progress of thromboembolic disorders. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biogenic Amines: A group of naturally occurring amines derived by enzymatic decarboxylation of the natural amino acids. Many have powerful physiological effects (e.g., histamine, serotonin, epinephrine, tyramine). Those derived from aromatic amino acids, and also their synthetic analogs (e.g., amphetamine), are of use in pharmacology. [NIH] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biopterin: A natural product that has been considered as a growth factor for some insects. [NIH]

Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotype: A group of individuals having the same genotype. [NIH] Birth Certificates: Official certifications by a physician recording the individual's birth date, place of birth, parentage and other required identifying data which are filed with the local registrar of vital statistics. [NIH] Birth Rate: The number of births in a given population per year or other unit of time. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blennorrhoea: A general term including any inflammatory process of the external eye which gives a mucoid discharge, more exactly, a discharge of mucus. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH]

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Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Cadaverine: A foul-smelling diamine formed by bacterial decarboxylation of lysine. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]

Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH]

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Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulitis: An acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervical intraepithelial neoplasia: CIN. A general term for the growth of abnormal cells on the surface of the cervix. Numbers from 1 to 3 may be used to describe how much of the cervix contains abnormal cells. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chancroid: Acute, localized autoinoculable infectious disease usually acquired through sexual contact. Caused by Haemophilus ducreyi, it occurs endemically almost worldwide, especially in tropical and subtropical countries and more commonly in seaports and urban areas than in rural areas. [NIH] Chemokines: Class of pro-inflammatory cytokines that have the ability to attract and activate leukocytes. They can be divided into at least three structural branches: C (chemokines, C), CC (chemokines, CC), and CXC (chemokines, CXC), according to variations in a shared cysteine motif. [NIH] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH]

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Chlamydia: A genus of the family Chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is Chlamydia trachomatis. [NIH] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chorioamnionitis: An inflammatory process involving the chorion, its fetal blood vessels, the umbilical cord, and the amnion by extension of the inflammation, as the amnion itself has no blood supply. This inflammatory process is potentially fatal to mother and fetus. [NIH]

Chorion: The outermost extraembryonic membrane. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary processes: The extensions or projections of the ciliary body that secrete aqueous humor. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Climacteric: Physiologic period, characterized by endocrine, somatic, and psychic changes with the termination of ovarian function in the female. It may also accompany the normal diminution of sexual activity in the male. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local

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anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Coculture: The culturing of normal cells or tissues with infected or latently infected cells or tissues of the same kind (From Dorland, 28th ed, entry for cocultivation). It also includes culturing of normal cells or tissues with other normal cells or tissues. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Coliphages: Viruses whose host is Escherichia coli. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colposcopy: The examination, therapy or surgery of the cervix and vagina by means of a specially designed endoscope introduced vaginally. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Commensal: 1. Living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. An organism living on or within another, but not causing injury to the host. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in

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the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confidence Intervals: A range of values for a variable of interest, e.g., a rate, constructed so that this range has a specified probability of including the true value of the variable. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]

Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH]

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Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corticotropin-Releasing Hormone: A neuropeptide released by the hypothalamus that stimulates the release of corticotropin by the anterior pituitary gland. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cotinine: 1-Methyl-5-(3-pyridyl)-2-pyrrolidinone antidepressant. Synonym: Scotine. [NIH]

fumarate.

Stimulant

proposed

as

Criterion: A standard by which something may be judged. [EU] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH]

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Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Defensins: Family of antimicrobial peptides that have been identified in humans, animals, and plants. They are thought to play a role in host defenses against infections, inflammation, wound repair, and acquired immunity. Based on the disulfide pairing of their characteristic six cysteine residues, they are divided into alpha-defensins and beta-defensins. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diamines: Organic chemicals which have two amino groups in an aliphatic chain. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU]

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Dietary Fats: Fats present in food, especially in animal products such as meat, meat products, butter, ghee. They are present in lower amounts in nuts, seeds, and avocados. [NIH]

Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dominance: In genetics, the full phenotypic expression of a gene in both heterozygotes and homozygotes. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Douching: A jet or current of water, sometimes a dissolved medicating or cleansing agent, applied to a body part, organ or cavity for medicinal or hygienic purposes. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dysuria: Painful or difficult urination. [EU] Ecosystem: A dynamic complex of plant, animal and micro-organism communities and their non-living environment interacting as a functional unit. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Ectopic Pregnancy: The pregnancy occurring elsewhere than in the cavity of the uterus.

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[NIH]

Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU]

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Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estriol: (16 alpha,17 beta)-Estra-1,3,5(10)-triene-3,16,17-triol. A metabolite of estradiol and usually the predominant estrogenic metabolite in urine. During pregnancy, large amounts of estriol are produced by the placenta. It has also been obtained from plant sources. The 16 beta-isomer has also been isolated from the urine of pregnant women. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expander: Any of several colloidal substances of high molecular weight. used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. called also extender. [NIH] Expeditions: Usually refers to planned scientific data-gathering excursions. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extrapyramidal: Outside of the pyramidal tracts. [EU] Family Planning: Programs or services designed to assist the family in controlling

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reproduction by either improving or diminishing fertility. [NIH] Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetal Blood: Blood of the fetus. Exchange of nutrients and waste between the fetal and maternal blood occurs via the placenta. The cord blood is blood contained in the umbilical vessels at the time of delivery. [NIH] Fetal Membranes: Thin layers of tissue which surround the embryo or fetus and provide for its nutrition, respiration, excretion and protection; they are the yolk sac, allantois, amnion, and chorion. [NIH] Fetoprotein: Transabdominal aspiration of fluid from the amniotic sac with a view to detecting increases of alpha-fetoprotein in maternal blood during pregnancy, as this is an important indicator of open neural tube defects in the fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibronectin: An adhesive glycoprotein. One form circulates in plasma, acting as an opsonin; another is a cell-surface protein which mediates cellular adhesive interactions. [NIH] Flagellum: A whiplike appendage of a cell. It can function either as an organ of locomotion or as a device for moving the fluid surrounding the cell. [NIH] Flatus: Gas passed through the rectum. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Formularies: Lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from pharmacopoeias in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy. [NIH] Fornix: A bundle of nerves connected to the hippocampus. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some

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reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganciclovir: Acyclovir analog that is a potent inhibitor of the Herpesvirus family including cytomegalovirus. Ganciclovir is used to treat complications from AIDS-associated cytomegalovirus infections. [NIH] Gardnerella: A genus of bacteria found in the human genital and urinary tract. It is considered to be a major cause of bacterial vaginosis. [NIH] Gardnerella vaginalis: The only species in the genus Gardnerella, and previously classed as Haemophilus vaginalis. This bacterium, also isolated from the female genital tract of healthy women, is implicated in the cause of bacterial vaginosis. It occasionally causes postpartum bacteremia and bacteremia following a transurethral resection of the prostate. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU]

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Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Gonorrhoea: Infection due to Neisseria gonorrhoeae transmitted sexually in most cases, but also by contact with infected exudates in neonatal children at birth, or by infants in households with infected inhabitants. It is marked in males by urethritis with pain and purulent discharge, but is commonly asymptomatic in females, although it may extend to produce suppurative salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. Bacteraemia occurs in both sexes, resulting in cutaneous lesions, arthritis, and rarely meningitis or endocarditis. Formerly called blennorrhagia and blennorrhoea. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a

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primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-Negative Bacteria: Bacteria which lose crystal violet stain but are stained pink when treated by Gram's method. [NIH] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granule: A small pill made from sucrose. [EU] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Haemophilus: A genus of Pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gram-negative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterozygotes: Having unlike alleles at one or more corresponding loci on homologous chromosomes. [NIH]

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Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Homozygotes: An individual having a homozygous gene pair. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral

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walls of the third ventricle. [NIH] Hysterectomy: Excision of the uterus. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infant Mortality: Perinatal, neonatal, and infant deaths in a given population. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local

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infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infestation: Parasitic attack or subsistence on the skin and/or its appendages, as by insects, mites, or ticks; sometimes used to denote parasitic invasion of the organs and tissues, as by helminths. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Interleukin-8: A cytokine that activates neutrophils and attracts neutrophils and Tlymphocytes. It is released by several cell types including monocytes, macrophages, T-

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lymphocytes, fibroblasts, endothelial cells, and keratinocytes by an inflammatory stimulus. IL-8 is a member of the beta-thromboglobulin superfamily and structurally related to platelet factor 4. [NIH] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Labor, Premature: Onset of labor before term but after the fetus has become viable, usually sometime during the 29th through 38th week of gestation. [NIH] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH]

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Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lice: A general name for small, wingless, parasitic insects, previously of the order Phthiraptera. Though exact taxonomy is still controversial, they can be grouped in the orders Anoplura (sucking lice), Mallophaga (biting lice), and Rhynchophthirina (elephant lice). [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Lincomycin: (2S-trans)-Methyl 6,8-dideoxy-6-(((1-methyl-4-propyl-2pyrrolidinyl)carbonyl)amino)-1-thio-D-erythro-alpha-D-galacto-octopyranoside. An antibiotic produced by Streptomyces lincolnensis var. lincolnensis. It has been used in the treatment of staphylococcal, streptococcal, and Bacteroides fragilis infections. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. It is produced by glands on the tongue and by the pancreas and initiates the digestion of dietary fats. (From Dorland, 27th ed) EC 3.1.1.3. [NIH] Lipid: Fat. [NIH] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Loc: A brain region associated with object recognition. [NIH]

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Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumbar puncture: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a spinal tap. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve

Dictionary 175

or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mesolimbic: Inner brain region governing emotion and drives. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Methylcellulose: Methylester of cellulose. Methylcellulose is used as an emulsifying and suspending agent in cosmetics, pharmaceutics and the chemical industry. It is used therapeutically as a bulk laxative. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbicide: Any substance (gels, creams, suppositories, etc.) that can reduce transmission of sexually transmitted infections. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living

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organisms, they are sometimes classified as microorganisms. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Miscarriage: Spontaneous expulsion of the products of pregnancy before the middle of the second trimester. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular mass: The sum of the atomic masses of all atoms in a molecule, based on a scale in which the atomic masses of hydrogen, carbon, nitrogen, and oxygen are 1, 12, 14, and 16, respectively. For example, the molecular mass of water, which has two atoms of hydrogen and one atom of oxygen, is 18 (i.e., 2 + 16). [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle

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known as cardiac muscle. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neopterin: A pteridine derivative present in body fluids; elevated levels result from immune system activation, malignant disease, allograft rejection, and viral infections. (From Stedman, 26th ed) Neopterin also serves as a precursor in the biosynthesis of biopterin. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Neutrophil: A type of white blood cell. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Noel: The highest dose level of a chemical that, in a given toxicity test, causes no observable adverse effect in the test animals. [NIH] Nonoxynol: Nonionic surfactant mixtures varying in the number of repeating ethoxy (oxy1,2-ethanediyl) groups. They are used as detergents, emulsifiers, wetting agents, defoaming

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agents, etc. Nonoxynol-9, the compound with 9 repeating ethoxy groups, is a spermatocide, formulated primarily as a component of vaginal foams and creams. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus Accumbens: Collection of pleomorphic cells in the caudal part of the anterior horn of the lateral ventricle, in the region of the olfactory tubercle, lying between the head of the caudate nucleus and the anterior perforated substance. It is part of the so-called ventral striatum, a composite structure considered part of the basal ganglia. [NIH] Nystatin: Macrolide antifungal antibiotic complex produced by Streptomyces noursei, S. aureus, and other Streptomyces species. The biologically active components of the complex are nystatin A1, A2, and A3. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Odour: A volatile emanation that is perceived by the sense of smell. [EU] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Oophoritis: Inflammation of an ovary. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Ornidazole: A nitroimidazole antiprotozoal agent used in ameba and trichomonas infections. It is partially plasma-bound and also has radiation-sensitizing action. [NIH] Ornithine: An amino acid produced in the urea cycle by the splitting off of urea from arginine. [NIH]

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Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papilloma: A benign epithelial neoplasm which may arise from the skin, mucous membranes or glandular ducts. [NIH] Papillomavirus: A genus of Papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Parturition: The act or process of given birth to a child. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pediculosis: Infestation with lice of the family Pediculidae, especially infestation with Pediculus humanus. [EU] Pelvic: Pertaining to the pelvis. [EU] Pelvic inflammatory disease: A bacteriological disease sometimes associated with intrauterine device (IUD) usage. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue

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enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]

Peripheral blood: Blood circulating throughout the body. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied to each other. [NIH] Pessary: 1. An instrument placed in the vagina to support the uterus or rectum or as a contraceptive device. 2. A medicated vaginal suppository. [EU] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacopoeias: Authoritative treatises on drugs and preparations, their description, formulation, analytic composition, physical constants, main chemical properties used in identification, standards for strength, purity, and dosage, chemical tests for determining identity and purity, etc. They are usually published under governmental jurisdiction (e.g., USP, the United States Pharmacopoeia; BP, British Pharmacopoeia; P. Helv., the Swiss Pharmacopoeia). They differ from formularies in that they are far more complete: formularies tend to be mere listings of formulas and prescriptions. [NIH]

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Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipases A: Phosphatide acylhydrolases. Catalyze the hydrolysis of one of the acyl groups of phosphoglycerides or glycerophosphatidates. Phospholipase A1 hydrolyzes the acyl group attached to the 1-position (EC 3.1.1.32) and phospholipase A2 hydrolyzes the acyl group attached to the 2-position (EC 3.1.1.4). [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placebos: Any dummy medication or treatment. Although placebos originally were medicinal preparations having no specific pharmacological activity against a targeted condition, the concept has been extended to include treatments or procedures, especially those administered to control groups in clinical trials in order to provide baseline measurements for the experimental protocol. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platelet Factor 4: A high-molecular-weight proteoglycan-platelet factor complex which is released from blood platelets by thrombin. It acts as a mediator in the heparin-neutralizing capacity of the blood and plays a role in platelet aggregation. At high ionic strength (I=0.75), the complex dissociates into the active component (molecular weight 29,000) and the proteoglycan carrier (chondroitin 4-sulfate, molecular weight 350,000). The molecule exists in the form of a dimer consisting of 8 moles of platelet factor 4 and 2 moles of proteoglycan. [NIH]

Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH]

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Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Povidone: A polyvinyl polymer of variable molecular weight; used as suspending and dispersing agent and vehicle for pharmaceuticals; also used as blood volume expander. [NIH] Povidone-Iodine: An iodinated polyvinyl polymer used as topical antiseptic in surgery and for skin and mucous membrane infections, also as aerosol. The iodine may be radiolabeled for research purposes. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Pregnancy Complications: The co-occurrence of pregnancy and a disease. The disease may precede or follow conception and it may or may not have a deleterious effect on the pregnant woman or fetus. [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or

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artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Care: Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond

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(5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatitis: Inflammation of the prostate. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoal: Having to do with the simplest organisms in the animal kingdom. Protozoa are single-cell organisms, such as ameba, and are different from bacteria, which are not members of the animal kingdom. Some protozoa can be seen without a microscope. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to

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obtain relief. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Putrefaction: The process of decomposition of animal and vegetable matter by living organisms. [NIH] Putrescine: A toxic diamine formed by putrefaction from the decarboxylation of arginine and ornithine. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process,

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such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Reactivation: The restoration of activity to something that has been inactivated. [EU] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reference Standards: A basis of value established for the measure of quantity, weight, extent or quality, e.g. weight standards, standard solutions, methods, techniques, and procedures used in diagnosis and therapy. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a

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relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Ristocetin: An antibiotic mixture of two components, A and B, obtained from Nocardia lurida (or the same substance produced by any other means). It is no longer used clinically because of its toxicity. It causes platelet agglutination and blood coagulation and is used to assay those functions in vitro. [NIH] Rod: A reception for vision, located in the retina. [NIH] Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salpingitis: 1. Inflammation of the uterine tube. 2. Inflammation of the auditory tube. [EU] Saturated fat: A type of fat found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, lard, and in some vegetable oils, including coconut, palm kernel, and palm oils. Saturated fat raises blood cholesterol more than anything else eaten. On a Step I Diet, no more than 8 to 10 percent of total calories should come from saturated fat, and in the Step II Diet, less than 7 percent of the day's total calories should come from saturated fat. [NIH] Scabies: A contagious cutaneous inflammation caused by the bite of the mite Sarcoptes scabiei. It is characterized by pruritic papular eruptions and burrows and affects primarily the axillae, elbows, wrists, and genitalia, although it can spread to cover the entire body. [NIH]

Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Screening: Checking for disease when there are no symptoms. [NIH]

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Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sexual Partners: Married or single individuals who share sexual relations. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shedding: Release of infectious particles (e. g., bacteria, viruses) into the environment, for example by sneezing, by fecal excretion, or from an open lesion. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the

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brain. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal tap: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a lumbar puncture. [NIH] Spirochete: Lyme disease. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Standardize: To compare with or conform to a standard; to establish standards. [EU] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH]

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Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Supplementation: Adding nutrients to the diet. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppurative: Consisting of, containing, associated with, or identified by the formation of pus. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Symbiosis: The living together of organisms of different species. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic

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nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

Systemic: Affecting the entire body. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tinidazole: A nitroimidazole antitrichomonal agent effective against Trichomonas vaginalis, Entamoeba histolytica, and Giardia lamblia infections. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU]

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Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]

Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral resection of the prostate: Surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra. Also called TURP. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trichomonas: A genus of parasitic flagellate protozoans distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. [NIH] Trichomonas Infections: Infections in birds and mammals produced by various species of Trichomonas. [NIH] Trichomonas vaginalis: A species of trichomonas that produces a refractory vaginal discharge in females, as well as bladder and urethral infections in males. [NIH] Trichomonas Vaginitis: Inflammation of the vagina, marked by a purulent discharge. This disease is caused by the protozoan Trichomonas vaginalis. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Tricuspid Atresia: Absence of the orifice between the right atrium and ventricle, with the presence of an atrial defect through which all the systemic venous return reaches the left heart. As a result, there is left ventricular hypertrophy because the right ventricle is absent or not functional. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH]

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Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tyramine: An indirect sympathomimetic. Tyramine does not directly activate adrenergic receptors, but it can serve as a substrate for adrenergic uptake systems and monoamine oxidase so it prolongs the actions of adrenergic transmitters. It also provokes transmitter release from adrenergic terminals. Tyramine may be a neurotransmitter in some invertebrate nervous systems. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Umbilical Cord: The flexible structure, giving passage to the umbilical arteries and vein, which connects the embryo or fetus to the placenta. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Ureaplasma: A genus of gram-negative, nonmotile bacteria which are common parasitic inhabitants of the urogenital tracts of man, cattle, dogs, and monkeys. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urethritis: Inflammation of the urethra. [EU] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urogenital Diseases: Diseases of the urogenital tract. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH]

194 Bacterial Vaginosis

Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginal Discharge: A common gynecologic disorder characterized by an abnormal, nonbloody discharge from the genital tract. [NIH] Vaginal Smears: Collection of pooled secretions of the posterior vaginal fornix for cytologic examination. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vaginosis: A condition caused by the overgrowth of anaerobic bacteria (e. g., Gardnerella vaginalis), resulting in vaginal irritation and discharge. [NIH] Valganciclovir: An antiviral agent that is being studied as a treatment for AIDS-related cytomegalovirus. It is converted in the body to ganciclovir. [NIH] Vancomycin: Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventral Tegmental Area: A region in the mesencephalon which is dorsomedial to the substantia nigra and ventral to the red nucleus. The mesocortical and mesolimbic dopaminergic systems originate here, including an important projection to the nucleus accumbens. Overactivity of the cells in this area has been suspected to contribute to the positive symptoms of schizophrenia. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vital Statistics: Used for general articles concerning statistics of births, deaths, marriages, etc. [NIH] Vitamin U: A vitamin found in green vegetables. It is used in the treatment of peptic ulcers, colitis, and gastritis and has an effect on secretory, acid-forming, and enzymatic functions of the intestinal tract. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation

Dictionary 195

occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] Wetting Agents: A surfactant that renders a surface wettable by water or enhances the spreading of water over the surface; used in foods and cosmetics; important in contrast media; also with contact lenses, dentures, and some prostheses. Synonyms: humectants; hydrating agents. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Wound Infection: Invasion of the site of trauma by pathogenic microorganisms. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Yolk Sac: An embryonic membrane formed from endoderm and mesoderm. In reptiles and birds it incorporates the yolk into the digestive tract for nourishing the embryo. In placental mammals its nutritional function is vestigial; however, it is the source of most of the intestinal mucosa and the site of formation of the germ cells. It is sometimes called the vitelline sac, which should not be confused with the vitelline membrane of the egg. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

197

INDEX 2 2,6-Dichloroindophenol, 96, 149 A Abdomen, 149, 155, 172, 173, 189, 190, 191 Abdominal, 52, 149, 166, 179, 180 Abdominal Pain, 149, 166, 180 Abscess, 149, 167 Acceptor, 149, 179 Acridine Orange, 38, 149 Acute renal, 149, 168 Acyl, 149, 181 Adolescence, 13, 149 Adrenal Cortex, 149, 160, 164 Adrenal Medulla, 149, 156, 164, 178 Adrenergic, 149, 162, 164, 190, 193 Adverse Effect, 5, 27, 149, 177, 188 Aerobic, 4, 5, 50, 149 Aerosol, 149, 182 Agonist, 149, 162 Algorithms, 8, 149, 154 Alkaline, 149, 150, 155 Alkaloid, 150, 157 Allantois, 150, 165 Alleles, 34, 150, 168 Allograft, 150, 177 Allylamine, 150 Alpha-Defensins, 150, 161 Alpha-fetoprotein, 150, 165 Alternative medicine, 88, 118, 150 Amebiasis, 150, 175 Amine, 96, 97, 101, 150, 169 Amino Acid Substitution, 25, 150 Amino Acids, 38, 150, 154, 164, 166, 177, 180, 182, 184, 192 Ammonia, 55, 150 Amnion, 150, 157, 165 Amniotic Fluid, 96, 150, 167 Amphetamine, 151, 154 Amplification, 32, 151 Anaesthesia, 151, 170 Anal, 151, 165, 180 Analog, 151, 157, 166 Anatomical, 14, 151, 153, 170 Angiogenesis, 151, 174 Animal model, 22, 35, 151 Annealing, 151, 182 Anorexia, 151, 166 Antibacterial, 102, 151, 157, 189, 194

Antibiotic, 6, 10, 11, 24, 26, 30, 32, 40, 102, 116, 151, 153, 155, 164, 173, 178, 187, 189 Antibodies, 151, 170, 174 Antibody, 36, 59, 151, 152, 158, 169, 170, 175, 188, 189 Anticoagulant, 151, 184 Antidepressant, 151, 160 Antifungal, 33, 151, 178 Antigen, 151, 158, 169, 170, 175, 188 Anti-infective, 152, 157, 169, 172 Antimicrobial, 10, 11, 16, 24, 25, 26, 36, 55, 60, 73, 77, 87, 106, 152, 161 Antioxidant, 152 Antisepsis, 26, 152 Antiseptic, 26, 152, 182 Antiviral, 6, 100, 152, 171, 194 Anus, 151, 152, 155, 186 Anxiety, 23, 152 Apolipoproteins, 152, 173 Apoptosis, 28, 152 Aqueous, 96, 101, 102, 105, 152, 153, 157, 160, 169, 173 Aqueous fluid, 96, 101, 152 Arachidonic Acid, 25, 152, 173, 183 Arginine, 152, 178, 185 Aromatic, 152, 154 Arterial, 150, 152, 157, 160, 184 Arteries, 152, 154, 160, 174, 175, 185, 191, 193 Ascorbic Acid, 85, 152 Aspiration, 152, 165 Assay, 18, 40, 68, 78, 83, 153, 187 Atrial, 153, 160, 192 Atrioventricular, 153, 160 Atrium, 153, 160, 192, 194 Azithromycin, 24, 27, 60, 153 B Bacillus, 33, 153 Bacteremia, 10, 153, 166 Bacteria, 3, 6, 7, 10, 11, 13, 25, 26, 28, 31, 33, 35, 52, 89, 96, 97, 99, 105, 113, 116, 136, 137, 149, 151, 152, 153, 163, 166, 168, 172, 175, 176, 184, 186, 188, 189, 190, 193, 194 Bacterial Infections, 25, 153 Bacteriophage, 117, 153, 181 Bacteriostatic, 153, 164 Bacterium, 31, 153, 166, 168

198 Bacterial Vaginosis

Base, 38, 96, 98, 153, 161, 166, 172, 191 Basement Membrane, 153, 164 Basophils, 153, 173 Benign, 103, 105, 153, 177, 179, 195 Beta-Defensins, 153, 161 Beta-sheet, 25, 153 Beta-Thromboglobulin, 153, 172 Biochemical, 150, 154, 188 Biogenic Amines, 9, 154 Biological response modifier, 154, 171 Biomarkers, 9, 154 Biopsy, 29, 154 Biopterin, 154, 177 Biosynthesis, 152, 154, 177 Biotechnology, 36, 37, 111, 118, 127, 154 Biotype, 36, 56, 154 Birth Certificates, 8, 154 Birth Rate, 23, 154 Bladder, 154, 177, 184, 192, 193 Blastocyst, 154, 159, 163, 181 Blennorrhoea, 154, 167 Blood pressure, 154, 176, 185 Blood vessel, 150, 151, 154, 160, 163, 168, 190, 191, 194 Blood Volume, 154, 182 Body Fluids, 154, 155, 177, 192 Bone Marrow, 155, 170, 174, 176, 190 Bowel, 151, 155, 162, 172, 177, 180 Bowel Movement, 155, 162 Branch, 145, 155, 166, 179, 185, 189, 191 Breakdown, 155, 162, 166 Broad-spectrum, 24, 26, 155 C Cadaverine, 97, 155 Calcium, 155, 158, 174 Candidiasis, 20, 34, 55, 80, 87, 99, 105, 110, 111, 134, 155 Candidosis, 62, 155 Capsules, 5, 100, 155, 166 Carbon Dioxide, 155, 161, 181, 187 Carcinogen, 155, 175 Carcinogenic, 155, 171, 183, 189 Carcinoma, 80, 155 Cardiac, 150, 155, 160, 163, 164, 177, 189 Case report, 155, 157 Case series, 155, 157 Catecholamine, 29, 156, 162 Causal, 23, 156, 172 Cell Death, 152, 156, 177 Cell Division, 153, 156, 176, 181 Cellobiose, 156 Cellulitis, 105, 156

Cellulose, 5, 37, 60, 77, 99, 100, 156, 165, 175, 181 Central Nervous System, 151, 156, 158, 167, 173, 188 Cerebral, 11, 52, 96, 156, 164 Cerebral Palsy, 11, 52, 96, 156 Cerebrospinal, 11, 156, 174, 189 Cerebrospinal fluid, 11, 156, 174, 189 Cerebrum, 156 Cervical intraepithelial neoplasia, 31, 46, 62, 96, 156 Cervix, 6, 11, 14, 17, 20, 29, 156, 158 Chancroid, 60, 128, 156 Chemokines, 6, 156 Chemotaxis, 61, 82, 156 Chlorhexidine, 11, 15, 157 Cholesterol, 157, 162, 169, 173, 174, 187, 189 Cholesterol Esters, 157, 173 Chorioamnionitis, 8, 10, 91, 96, 157 Chorion, 157, 165 Chromatin, 152, 157, 163, 189 Chromosomal, 151, 157 Chromosome, 157, 173 Chronic, 11, 12, 55, 88, 150, 157, 162, 171, 190 Chylomicrons, 157, 173 Ciliary, 152, 157 Ciliary processes, 152, 157 Citrus, 152, 157 Climacteric, 44, 157 Clindamycin, 33, 39, 47, 48, 53, 54, 63, 64, 66, 69, 78, 98, 103, 117, 122, 157 Clinical Medicine, 157, 182 Clinical study, 49, 157 Clinical trial, 4, 6, 24, 26, 33, 53, 83, 86, 91, 92, 127, 157, 159, 176, 181, 184, 185 Cloning, 154, 157 Coca, 157 Cocaine, 8, 22, 157 Coculture, 28, 158 Coenzyme, 152, 158 Cofactor, 96, 158, 184, 191 Coliphages, 153, 158 Colitis, 158, 194 Collagen, 153, 158, 164, 165, 166, 174, 183 Colposcopy, 6, 110, 134, 158 Combination Therapy, 33, 158 Commensal, 38, 55, 158 Complement, 158, 159 Complementary and alternative medicine, 85, 90, 159

Index 199

Complementary medicine, 85, 159 Computational Biology, 127, 159 Conception, 37, 60, 159, 165, 182, 189 Concomitant, 103, 106, 159 Condoms, 33, 136, 159 Cone, 159, 190 Confidence Intervals, 8, 159 Confounding, 9, 20, 22, 34, 159 Connective Tissue, 152, 155, 156, 158, 159, 166, 174 Constipation, 159, 180 Consumption, 159, 166, 187 Continuum, 6, 17, 159 Contraception, 45, 49, 58, 64, 110, 159 Contraceptive, 6, 12, 43, 49, 159, 180 Contraindications, ii, 159 Control group, 20, 27, 159, 181, 183 Cor, 30, 160 Cornea, 152, 160 Coronary, 160, 175 Coronary Thrombosis, 160, 175 Corticotropin-Releasing Hormone, 30, 160 Cortisol, 29, 30, 160 Cotinine, 8, 18, 160 Criterion, 39, 160 Cryptosporidiosis, 153, 160 Curative, 160, 191 Cutaneous, 155, 160, 167, 187 Cyclic, 160, 184 Cysteine, 156, 160, 161 Cytokine, 17, 19, 20, 34, 47, 160, 171 Cytomegalovirus, 6, 17, 160, 166, 194 Cytoplasm, 152, 153, 160, 163, 176 Cytotoxic, 20, 25, 160 D Dairy Products, 161, 187 Data Collection, 8, 13, 129, 161 Databases, Bibliographic, 127, 161 Decarboxylation, 154, 155, 161, 169, 185 Decidua, 161, 181 Decision Making, 16, 161 Defensins, 29, 43, 45, 150, 153, 161 Degenerative, 161, 168 Deletion, 152, 161 Delivery of Health Care, 161, 168 Denaturation, 161, 182 Dendrites, 161, 177 Density, 161, 162, 173 Detergents, 161, 177 Detoxification, 23, 161 Deuterium, 161, 169 Diabetes Mellitus, 4, 161, 167

Diagnostic procedure, 95, 118, 161 Diamines, 97, 161 Diarrhoea, 161, 166 Dietary Fats, 162, 173 Digestion, 155, 162, 172, 173, 180, 190 Digestive system, 92, 162 Dilatation, 162, 183 Dilation, 42, 162 Direct, iii, 5, 13, 16, 51, 121, 129, 157, 162, 167, 186 Disease Progression, 16, 162 Disinfectant, 11, 157, 162 Distal, 28, 162, 184 Dominance, 35, 162 Dopamine, 22, 151, 158, 162 Douching, 12, 27, 28, 31, 32, 34, 52, 74, 116, 134, 136, 162 Drug Interactions, 122, 162 Dyes, 96, 153, 162 Dyslipidemia, 22, 162 Dysuria, 110, 162 E Ecosystem, 20, 27, 30, 31, 64, 162 Ectopic, 11, 12, 29, 162 Ectopic Pregnancy, 12, 29, 162 Efficacy, 6, 19, 31, 53, 54, 64, 66, 82, 86, 98, 117, 163 Ejaculation, 163, 188 Electrons, 152, 153, 163, 172, 179, 185 Embryo, 76, 150, 154, 163, 165, 170, 183, 189, 193, 195 Embryo Transfer, 163, 183 Endocarditis, 155, 163, 167 Endocrine Glands, 163 Endometrial, 29, 71, 163 Endometriosis, 104, 163 Endometrium, 6, 161, 163 Endoscope, 158, 163 Endothelial cell, 163, 172, 191 Endotoxin, 23, 30, 54, 56, 163, 193 Environmental Health, 126, 128, 163 Enzymatic, 154, 155, 158, 163, 169, 182, 194 Enzyme, 4, 26, 150, 158, 163, 173, 182, 184, 190, 191, 194, 195 Eosinophils, 163, 173 Epidemic, 10, 16, 34, 163 Epidemiological, 9, 16, 28, 33, 163 Epinephrine, 149, 154, 162, 164, 178, 193 Epithelial, 6, 28, 97, 153, 161, 164, 168, 179 Epithelial Cells, 6, 28, 97, 153, 164, 168 Erythromycin, 14, 54, 60, 70, 153, 164 Esophagus, 162, 164, 190

200 Bacterial Vaginosis

Estradiol, 164 Estriol, 30, 83, 164 Ethnic Groups, 23, 164 Excipient, 100, 164 Exogenous, 19, 164 Expander, 164, 182 Expeditions, 15, 164 Extracellular, 34, 159, 164, 165, 174 Extracellular Matrix, 34, 159, 164, 165, 174 Extracellular Matrix Proteins, 164, 174 Extracellular Space, 164 Extrapyramidal, 162, 164 F Family Planning, 12, 34, 127, 164 Family Practice, 44, 52, 69, 75, 76, 79, 80, 165 Fat, 98, 152, 155, 160, 165, 173, 187, 190 Fatty acids, 98, 165, 183, 191 Fertilization in Vitro, 165, 183 Fetal Blood, 157, 165 Fetal Membranes, 10, 28, 91, 165 Fetoprotein, 22, 165 Fetus, 11, 14, 96, 150, 157, 165, 172, 181, 182, 183, 189, 193 Fibrin, 165, 180, 191 Fibroblasts, 165, 172 Fibronectin, 24, 41, 55, 56, 71, 165 Flagellum, 165, 192 Flatus, 165, 166 Fluorescence, 149, 165 Fold, 10, 26, 31, 165 Formularies, 165, 180 Fornix, 165, 194 Fungi, 151, 165, 166, 175, 176, 189, 195 Fungus, 155, 165 G Gallbladder, 149, 162, 166 Ganciclovir, 166, 194 Gas, 36, 40, 101, 104, 150, 155, 165, 166, 169, 177 Gastritis, 166, 194 Gastroenteritis, 102, 166 Gastrointestinal, 102, 164, 166, 173, 188, 190, 192 Gastrointestinal tract, 102, 166, 173, 188, 192 Gelatin, 166, 190 Gels, 166, 175 Gene, 34, 111, 150, 154, 162, 166, 169 General practitioner, 110, 166 Genetic Code, 166, 178 Genetic testing, 166, 182

Genetics, 162, 166 Genitourinary, 3, 10, 11, 40, 53, 80, 110, 137, 166, 193 Genotype, 35, 154, 167 Gestation, 8, 18, 19, 22, 29, 30, 36, 41, 42, 167, 172, 180, 181, 189 Gestational, 18, 23, 57, 167 Gestational Age, 18, 23, 167 Giardiasis, 167, 175 Gland, 134, 149, 167, 174, 179, 181, 184, 188, 190, 191 Glucose, 22, 152, 156, 161, 167, 171 Glucose Intolerance, 161, 167 Glutamic Acid, 167, 183 Glycogen, 157, 167 Glycoprotein, 165, 167, 191, 193 Glycosidic, 156, 167, 178 Gonorrhea, 11, 12, 14, 19, 20, 24, 29, 34, 72, 96, 99, 104, 107, 109, 128, 129, 167 Gonorrhoea, 13, 167 Governing Board, 167, 182 Grade, 70, 98, 167 Graft, 167, 169 Grafting, 167, 170 Gram-negative, 57, 157, 167, 168, 176, 193 Gram-Negative Bacteria, 57, 168 Gram-positive, 168, 172, 190 Granule, 29, 168 Gravidity, 168, 179 H Haemophilus, 6, 102, 136, 137, 156, 166, 168 Health Behavior, 19, 23, 28, 168 Health Care Costs, 5, 11, 168 Health Expenditures, 168 Health Status, 168 Hemolytic, 25, 168 Hemorrhage, 168, 190 Hepatic, 102, 168 Hepatitis, 109, 128, 129, 168 Hepatocytes, 168 Heredity, 166, 168 Herpes, 16, 20, 41, 96, 109, 128, 129, 168 Herpes Zoster, 168 Heterozygotes, 162, 168 Histamine, 154, 169 Histology, 29, 169 Homogeneous, 97, 103, 159, 169 Homologous, 150, 168, 169 Homozygotes, 162, 169 Hormonal, 14, 16, 169 Hormone, 160, 164, 169, 171, 172, 191

Index 201

Host, 7, 13, 16, 25, 28, 153, 155, 158, 161, 169, 170, 173, 193, 194 Human papillomavirus, 20, 109, 128, 129, 169 Hybrid, 169 Hybridization, 36, 52, 169 Hydrogen, 13, 31, 68, 74, 97, 149, 150, 153, 161, 164, 169, 176, 178, 179, 184 Hydrogen Peroxide, 31, 68, 74, 97, 169 Hydrolysis, 156, 169, 181, 182, 184 Hydrophobic, 161, 169, 173 Hygienic, 162, 169 Hypercholesterolemia, 162, 169 Hyperlipidemia, 162, 169 Hypersensitivity, 63, 169, 173 Hypertriglyceridemia, 162, 169 Hypertrophy, 160, 169, 192 Hypothalamus, 160, 169, 181 Hysterectomy, 52, 98, 105, 170 I Id, 83, 89, 104, 107, 135, 137, 138, 144, 146, 170 Immune function, 19, 170 Immune response, 7, 19, 20, 30, 74, 152, 170, 190, 193, 194 Immune Sera, 170 Immune system, 14, 170, 173, 174, 177, 193, 195 Immunity, 13, 161, 170, 192 Immunization, 13, 170 Immunodeficiency, 6, 30, 33, 38, 41, 58, 60, 61, 100, 110, 128, 129, 136, 170 Immunoglobulin, 49, 78, 151, 170 Immunologic, 13, 20, 34, 167, 170 Immunology, 13, 16, 17, 38, 49, 50, 59, 88, 170 Impairment, 170, 175 Implantation, 76, 104, 159, 170 In vitro, 6, 18, 28, 35, 36, 60, 69, 87, 100, 102, 163, 170, 182, 187, 188, 191 In vivo, 170, 191 Incision, 170, 172 Indicative, 99, 101, 110, 170, 179, 194 Induction, 7, 28, 60, 170 Infant Mortality, 23, 96, 170 Infarction, 154, 160, 170, 175 Infertility, 11, 12, 24, 29, 60, 69, 171 Infestation, 171, 179 Initiation, 25, 171 Inlay, 171, 187 Inner ear, 171, 194 Inorganic, 171, 176

Inotropic, 162, 171 Insight, 16, 171 Insulin, 22, 171 Insulin-dependent diabetes mellitus, 171 Interferon, 20, 171 Interferon-alpha, 171 Interleukin-1, 49, 54, 58, 61, 171 Interleukin-2, 171 Interleukin-8, 28, 49, 61, 171 Intervention Studies, 16, 172 Intestinal, 150, 160, 172, 194, 195 Intestine, 155, 167, 169, 172, 190 Intracellular, 170, 172, 184 Intraepithelial, 172 Intravenous, 11, 172 Invasive, 10, 22, 29, 170, 172, 174 Iodine, 172, 182 Ions, 153, 169, 172 Irrigation, 11, 172 K Kb, 126, 172 Keratinocytes, 172 L Labor, Premature, 8, 172 Large Intestine, 162, 172, 186 Lavage, 7, 172 Laxative, 172, 175 Least-Squares Analysis, 172, 186 Length of Stay, 23, 173 Lens, 152, 173 Lesion, 173, 188, 193 Leukocytes, 79, 99, 153, 155, 156, 163, 171, 173, 176, 193 Leukotrienes, 152, 173 Library Services, 144, 173 Lice, 173, 179 Likelihood Functions, 173, 186 Lincomycin, 157, 173 Linear Models, 173, 186 Linkage, 35, 156, 173 Lipase, 25, 173 Lipid, 22, 152, 171, 173 Lipopolysaccharide, 22, 168, 173 Lipoprotein, 22, 162, 168, 173, 174 Liver, 149, 150, 152, 160, 162, 166, 167, 168, 173 Loc, 97, 173 Localized, 156, 170, 174, 181, 193 Logistic Models, 174, 186 Low-density lipoprotein, 162, 173, 174 Lumbar, 11, 174, 189 Lumbar puncture, 11, 174, 189

202 Bacterial Vaginosis

Lymph, 156, 163, 174 Lymph node, 156, 174 Lymphatic, 171, 174, 189, 191 Lymphocyte, 152, 174, 175 Lysine, 155, 174 Lytic, 174, 188 M Macrophage, 171, 174 Magnetic Resonance Imaging, 6, 174 Malignant, 174, 177 Matrix metalloproteinase, 34, 174 Meat, 162, 174, 187 Mediate, 162, 174 Mediator, 21, 30, 171, 174, 181, 188 Medical Records, 8, 29, 175 Medicament, 175, 190 MEDLINE, 127, 175 Membrane, 8, 25, 98, 150, 157, 159, 163, 168, 175, 176, 180, 181, 182, 187, 192, 195 Meningitis, 167, 175 Menopause, 175, 182, 183 Mental Disorders, 93, 175 Mental Health, iv, 4, 93, 126, 130, 175, 185 Mesolimbic, 175, 194 Meta-Analysis, 40, 43, 44, 175 Metabolite, 164, 175 Metastasis, 174, 175 Methylcellulose, 99, 100, 175 MI, 98, 147, 175 Microbe, 175, 191 Microbicide, 6, 38, 100, 175 Microbiological, 9, 16, 33, 64, 97, 98, 102, 175 Microorganism, 102, 158, 175, 179, 195 Micro-organism, 162, 176 Microscopy, 38, 46, 51, 71, 79, 153, 176 Milliliter, 105, 176 Miscarriage, 36, 37, 41, 53, 60, 103, 104, 106, 107, 116, 117, 176 Mitosis, 152, 176 Modeling, 24, 176 Modification, 32, 176, 185 Molecular, 6, 16, 21, 31, 61, 82, 127, 130, 151, 154, 159, 164, 176, 181, 182, 193 Molecular mass, 6, 176 Molecule, 10, 152, 153, 158, 167, 169, 176, 178, 179, 181, 186 Monitor, 5, 27, 176, 178 Monocytes, 171, 173, 176 Mononuclear, 176, 193 Morphological, 163, 165, 176 Morphology, 47, 59, 65, 71, 100, 176

Mucus, 54, 154, 176 Multicenter study, 38, 176 Mycoplasma, 7, 12, 33, 39, 50, 65, 70, 71, 74, 176 Mydriatic, 162, 176 Myocardium, 175, 176 N Nausea, 166, 177 NCI, 1, 91, 92, 125, 177 Necrosis, 152, 170, 175, 177 Need, 3, 11, 15, 19, 24, 103, 105, 107, 109, 111, 113, 128, 129, 139, 149, 167, 174, 177 Neonatal, 11, 14, 24, 41, 42, 56, 167, 170, 177 Neoplasia, 117, 177 Neoplasm, 177, 179 Neopterin, 24, 177 Nerve, 149, 161, 174, 177, 187, 190, 192 Nervous System, 151, 156, 174, 177, 190, 193 Neural, 8, 165, 177 Neural tube defects, 165, 177 Neurons, 23, 158, 161, 177 Neuropeptide, 160, 177 Neurotoxin, 23, 177 Neutrophil, 29, 45, 177 Nitrogen, 150, 164, 176, 177 Noel, 26, 177 Nonoxynol, 25, 177 Norepinephrine, 149, 162, 178 Nuclear, 22, 163, 177, 178 Nuclei, 149, 163, 174, 176, 178, 184 Nucleic acid, 32, 166, 169, 177, 178 Nucleic Acid Hybridization, 169, 178 Nucleus, 152, 153, 157, 160, 161, 163, 176, 178, 184, 190, 194 Nucleus Accumbens, 178, 194 Nystatin, 63, 178 O Odds Ratio, 21, 178, 186 Odour, 97, 152, 178 Oligosaccharides, 87, 178 Oophoritis, 167, 178 Organ Culture, 178, 191 Ornidazole, 39, 74, 178 Ornithine, 178, 185 Outpatient, 33, 34, 179 Ovum, 161, 167, 179, 195 Oxidation, 6, 97, 149, 152, 179 P Palliative, 179, 191 Pancreas, 149, 154, 162, 171, 173, 179, 192

Index 203

Papilloma, 96, 179 Papillomavirus, 179 Parasite, 179, 192 Parasitic, 160, 171, 173, 179, 192, 193 Parity, 4, 179 Parturition, 30, 179 Patch, 97, 179 Pathogen, 16, 31, 35, 179 Pathogenesis, 10, 13, 16, 28, 29, 32, 33, 38, 64, 65, 179 Pathologic, 56, 152, 154, 155, 160, 169, 179 Pathologic Processes, 152, 179 Pathophysiology, 30, 78, 83, 179 Patient Education, 136, 142, 144, 147, 179 Pediculosis, 111, 179 Pelvic inflammatory disease, 9, 11, 12, 17, 20, 24, 29, 30, 33, 71, 79, 96, 98, 109, 136, 137, 179 Penis, 159, 163, 179 Peptic, 180, 194 Peptic Ulcer, 180, 194 Peptide, 25, 180, 182, 184 Perception, 19, 159, 180 Perinatal, 13, 14, 22, 25, 34, 71, 74, 82, 91, 128, 170, 180 Periodontal disease, 21, 180 Periodontitis, 21, 180 Peripheral blood, 20, 171, 180 Peritoneum, 180 Peritonitis, 55, 167, 180 Peroxide, 13, 180 Pessary, 3, 45, 180 Pharmaceutical Preparations, 156, 166, 180 Pharmacodynamic, 102, 180 Pharmacokinetic, 73, 180 Pharmacologic, 180, 192 Pharmacopoeias, 5, 165, 180 Phospholipases, 25, 181 Phospholipases A, 25, 181 Phospholipids, 165, 173, 181 Physical Examination, 167, 181 Physiologic, 149, 154, 157, 181, 183, 186 Physiology, 30, 181 Pilot study, 38, 181 Pituitary Gland, 160, 181 Placebos, 14, 181 Placenta, 10, 22, 164, 165, 181, 193 Plants, 150, 155, 157, 161, 167, 176, 178, 181, 189, 192 Plaque, 157, 181

Plasma, 18, 66, 71, 151, 153, 154, 157, 164, 165, 166, 167, 176, 178, 181, 188 Platelet Factor 4, 172, 181 Poisoning, 166, 177, 181 Polymerase, 38, 68, 182 Polymerase Chain Reaction, 38, 68, 182 Polymers, 102, 182, 184 Polypeptide, 158, 169, 182, 195 Polysaccharide, 152, 156, 182 Posterior, 151, 179, 182, 194 Postmenopausal, 37, 67, 182 Postnatal, 23, 182 Postoperative, 52, 96, 182 Potentiates, 30, 171, 182 Povidone, 82, 86, 182 Povidone-Iodine, 82, 86, 182 Practice Guidelines, 129, 137, 182 Preclinical, 6, 182 Precursor, 96, 152, 162, 163, 177, 178, 182, 193 Pregnancy Complications, 14, 182 Pregnancy Outcome, 8, 9, 12, 14, 26, 28, 44, 91, 104, 105, 182 Pregnancy Tests, 167, 183 Premenopausal, 4, 183 Prenatal, 8, 14, 18, 21, 23, 28, 30, 163, 183 Prenatal Care, 8, 18, 21, 28, 183 Prevalence, 8, 14, 25, 26, 30, 31, 34, 37, 51, 67, 68, 116, 128, 178, 183 Primary endpoint, 14, 183 Probe, 15, 34, 58, 183 Progression, 16, 151, 183 Progressive, 23, 168, 177, 183 Projection, 178, 183, 186, 194 Prolapse, 4, 183 Proline, 68, 158, 183 Promoter, 34, 183 Prophylaxis, 5, 40, 183, 193 Prospective Studies, 26, 33, 183 Prospective study, 21, 23, 183 Prostaglandin, 28, 183, 191 Prostaglandins A, 183, 184 Prostate, 154, 184, 192 Prostatitis, 110, 184 Protease, 16, 158, 184 Protein C, 16, 152, 153, 173, 184 Protein S, 111, 154, 164, 166, 184 Proteins, 25, 150, 152, 157, 158, 164, 169, 171, 174, 176, 177, 180, 181, 182, 184, 186, 188, 192 Proteolytic, 6, 158, 184 Protocol, 15, 181, 184

204 Bacterial Vaginosis

Protons, 169, 184, 185 Protozoa, 175, 184, 189 Protozoal, 73, 184 Proximal, 162, 184 Pruritic, 184, 187 Pruritus, 34, 184 Psychic, 157, 185 Public Health, 13, 24, 32, 34, 39, 45, 55, 68, 82, 128, 130, 185 Public Policy, 127, 185 Publishing, 36, 185 Pulmonary, 154, 159, 160, 173, 185, 190, 194 Pulmonary hypertension, 160, 185 Pulse, 176, 185 Pupil, 160, 162, 176, 185 Purulent, 61, 82, 149, 167, 185, 192, 194 Putrefaction, 185 Putrescine, 97, 185 Q Quality of Life, 5, 15, 185 R Race, 14, 21, 30, 128, 185 Radiation, 165, 175, 178, 185, 195 Radioactive, 169, 170, 178, 185 Radiography, 167, 185 Radiolabeled, 182, 185 Randomized, 11, 14, 20, 21, 24, 27, 31, 32, 33, 39, 47, 54, 74, 78, 87, 163, 185 Randomized clinical trial, 11, 27, 185 Randomized Controlled Trials, 87, 185 Reactivation, 17, 186 Reactive Oxygen Species, 23, 186 Reagent, 96, 149, 186 Receptor, 26, 152, 159, 162, 186, 188 Rectal, 6, 186 Rectum, 152, 155, 162, 165, 166, 172, 180, 184, 186, 190 Recurrence, 9, 26, 31, 33, 186 Red blood cells, 168, 186 Red Nucleus, 186, 194 Refer, 1, 158, 165, 168, 186 Reference Standards, 15, 186 Refraction, 186, 189 Refractory, 186, 192 Regimen, 24, 32, 163, 186 Regression Analysis, 12, 24, 66, 186 Relative risk, 4, 8, 186 Reliability, 79, 187 Remission, 186, 187 Reproduction Techniques, 183, 187 Respiration, 155, 165, 176, 187

Restoration, 106, 186, 187, 195 Retina, 173, 187 Retrospective, 12, 187 Ristocetin, 187, 194 Rod, 33, 153, 168, 172, 187 S Saline, 15, 187 Salivary, 160, 162, 187 Salivary glands, 160, 162, 187 Salpingitis, 167, 187 Saturated fat, 98, 187 Scabies, 111, 187 Schizophrenia, 187, 194 Screening, 8, 18, 28, 32, 48, 52, 72, 73, 75, 76, 96, 104, 116, 118, 137, 157, 187 Secretion, 17, 21, 77, 97, 169, 171, 176, 188 Secretory, 16, 150, 188, 194 Semen, 6, 99, 163, 184, 188 Semisynthetic, 157, 188 Sensor, 9, 188 Sepsis, 10, 188 Septic, 10, 188 Sequencing, 182, 188 Serologic, 29, 188 Serology, 20, 188 Serotonin, 154, 188 Serum, 14, 19, 22, 158, 170, 174, 180, 188, 193 Sex Characteristics, 149, 188 Sexual Partners, 40, 43, 73, 188 Shedding, 6, 17, 188 Shock, 10, 188, 192 Side effect, 32, 121, 137, 149, 188, 191 Signs and Symptoms, 187, 188 Skeleton, 183, 188 Skull, 177, 188, 191 Sneezing, 188, 189 Social Environment, 185, 189 Somatic, 149, 157, 176, 189 Specialist, 135, 138, 162, 189 Specificity, 15, 21, 189 Spectrum, 13, 55, 103, 104, 106, 107, 189 Sperm, 6, 157, 189 Spermatozoa, 188, 189 Spinal cord, 156, 157, 177, 189 Spinal tap, 174, 189 Spirochete, 189, 191 Spleen, 160, 174, 189 Spontaneous Abortion, 8, 16, 70, 182, 189 Spores, 33, 189 Standardize, 19, 189 Sterility, 171, 189

Index 205

Steroid, 160, 189 Stillbirth, 14, 182, 189 Stimulus, 172, 190, 191 Stomach, 149, 162, 164, 166, 169, 172, 177, 189, 190 Strand, 182, 190 Streptococci, 42, 190 Streptococcus, 11, 190 Stress, 19, 23, 28, 30, 55, 63, 156, 160, 166, 177, 190 Stroke, 93, 126, 190 Stromal, 163, 190 Subacute, 171, 190 Subclinical, 24, 170, 190 Subcutaneous, 156, 190 Subspecies, 189, 190 Substance P, 164, 175, 187, 188, 190 Substrate, 4, 190, 193 Supplementation, 85, 190 Suppositories, 53, 82, 86, 166, 175, 190 Suppression, 17, 190 Suppurative, 156, 167, 190 Surfactant, 177, 190, 195 Symbiosis, 38, 190 Sympathomimetic, 151, 162, 164, 178, 190, 193 Symptomatic, 13, 29, 33, 34, 42, 66, 103, 105, 191 Synergistic, 23, 191 Syphilis, 11, 12, 109, 128, 129, 191 Systemic, 6, 19, 20, 102, 154, 155, 164, 171, 191, 192 T Tachycardia, 153, 191 Tachypnea, 153, 191 Temporal, 31, 191 Therapeutics, 25, 39, 122, 191 Thermal, 182, 191 Thorax, 149, 174, 191 Threshold, 101, 191 Thrombin, 165, 181, 184, 191 Thrombomodulin, 184, 191 Thrombosis, 22, 153, 184, 190, 191 Thromboxanes, 152, 191 Thymus, 170, 174, 191 Thyroid, 4, 172, 191, 193 Tinidazole, 49, 54, 191 Tissue Culture, 30, 191 Topical, 25, 26, 33, 60, 63, 102, 103, 110, 117, 157, 169, 182, 191 Toxic, iv, 11, 170, 185, 191, 192, 194 Toxicity, 102, 162, 177, 187, 191

Toxicology, 128, 192 Toxins, 152, 170, 192 Toxoplasmosis, 153, 192 Trachea, 191, 192 Transfection, 154, 192 Transfer Factor, 170, 192 Translation, 164, 192 Translocation, 164, 192 Transmitter, 162, 174, 178, 192, 193 Transplantation, 163, 170, 192 Transurethral, 166, 192 Transurethral resection of the prostate, 166, 192 Trauma, 177, 192, 195 Trichomonas, 6, 12, 15, 18, 68, 73, 76, 77, 96, 105, 178, 191, 192 Trichomonas Infections, 18, 178, 192 Trichomonas vaginalis, 6, 15, 68, 73, 77, 191, 192 Trichomonas Vaginitis, 15, 96, 192 Trichomoniasis, 20, 34, 47, 55, 61, 96, 99, 105, 109, 111, 128, 175, 192 Tricuspid Atresia, 160, 192 Tumor marker, 154, 192 Tumor Necrosis Factor, 23, 58, 193 Tyramine, 154, 193 Tyrosine, 162, 193 U Ulcer, 156, 180, 193 Ulceration, 110, 193 Ultrasonography, 65, 167, 193 Umbilical Cord, 150, 157, 193 Unconscious, 170, 193 Ureaplasma, 39, 70, 71, 74, 193 Ureters, 193 Urethra, 26, 180, 184, 192, 193 Urethritis, 40, 167, 193 Urinary, 4, 15, 18, 20, 33, 77, 106, 166, 193 Urinary tract, 4, 15, 20, 33, 77, 106, 166, 193 Urinary tract infection, 4, 15, 20, 33, 77, 106, 193 Urine, 4, 8, 15, 18, 22, 32, 154, 164, 193 Urogenital, 86, 87, 88, 89, 98, 106, 166, 167, 193 Urogenital Diseases, 98, 193 Uterus, 7, 10, 137, 156, 161, 162, 163, 170, 180, 193 V Vaccination, 13, 193 Vaccine, 13, 20, 184, 193

206 Bacterial Vaginosis

Vaginal Discharge, 26, 31, 32, 33, 34, 54, 75, 86, 99, 105, 110, 136, 192, 194 Vaginal Smears, 30, 38, 50, 194 Valganciclovir, 17, 194 Vancomycin, 106, 194 Vascular, 22, 150, 170, 171, 181, 194 Vasodilator, 162, 169, 194 Vein, 172, 178, 193, 194 Venereal, 191, 194 Venous, 153, 184, 192, 194 Ventral, 23, 169, 178, 194 Ventral Tegmental Area, 23, 194 Ventricle, 153, 160, 170, 178, 185, 192, 194 Ventricular, 160, 192, 194 Veterinary Medicine, 127, 194 Viral, 16, 117, 129, 177, 194, 195 Virulence, 191, 194 Vital Statistics, 154, 194 Vitamin U, 18, 194 Vitro, 6, 37, 76, 194

Vivo, 30, 195 W Warts, 169, 195 Wetting Agents, 177, 195 White blood cell, 151, 173, 174, 176, 177, 195 Windpipe, 191, 195 Womb, 193, 195 Wound Healing, 174, 195 Wound Infection, 10, 195 X Xenograft, 151, 195 X-ray, 165, 178, 195 Y Yeasts, 61, 155, 165, 195 Yolk Sac, 165, 195 Z Zygote, 159, 195 Zymogen, 184, 195

Index 207

208 Bacterial Vaginosis

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