STUDY DESIGN: We prospectively evaluated vaginal fluid
mucinase and
sialidase and selected cervicovaginal bacteria along with pregnancy outcomes in 271 women. Within this study, women with
bacterial vaginosis (16 to 27 week' gestation) were treated with 2% clinadmycin
vaginal cream or placebo.
Enzyme, microbial findings, treatment effects, and pregnancy outcomes were compared among
drug- and placebo-treated women and control women without
bacterial vaginosis.
RESULTS: Presence of
bacterial vaginosis at intake was associated with increased risk of
preterm birth (relative risk 3.3, 95% confidence interval 1.2 to 9.1, p = 0.02), premature
rupture of membranes (relative risk 3.8, 95% confidence interval 1.6 to 9.0, p = 0.002), and preterm premature
rupture of membranes.
Mucinase and
sialidase activities were more commonly identified, and they occurred in higher concentrations, if present, in women with
bacterial vaginosis (
mucinase: 44.3% with
bacterial vaginosis vs 27.4% without, p = 0.007;
sialidase: 45% with
bacterial vaginosis vs 12% without p < 0.001).
Sialidase activity was associated with
bacterial vaginosis-linked organisms (Gardnerella vaginalis, Mobiluncus spp, and Mycoplasma hominis) and Chlamydia trachomatis and yeast species;
mucinase activity was associated only with
bacterial vaginosis-linked microorganisms.
Clindamycin, 2% cream, was effective treatment for
bacterial vaginosis and temporarily reduced
mucinase and
sialidase activities. Topical treatment of
bacterial vaginosis did not reduce risks of perinatal morbidity. Women with persistent or recurrent
sialidase 8 weeks
after treatment were at increased risk of
preterm birth (15.6% vs 7.4%) premature
rupture of membranes (30% vs 15%), and low birth weight (20% vs 3%, relative risk 6.8, 95% confidence interval 1.6 to 28.1).
CONCLUSIONS: