American Journal of Obstetrics & Gynecology
Volume 204, Issue 2 , Pages 120.e1-120.e5 , February 2011

Contemporary perspectives on vaginal pH and lactobacilli

  • Iara M. Linhares, MD, PhD

      Affiliations

    • Department of Gynecology and Obstetrics, University of Sao Paulo Medical School, Hospital das Clinicas, Sao Paul, Brazil
    • ,
  • Paul R. Summers, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT
    • ,
  • Bryan Larsen, PhD

      Affiliations

    • Iowa Center for Translational and Clinical Research, Des Moines University and Mercy Medical Center, Des Moines, IA
    • ,
  • Paulo C. Giraldo, MD, PhD

      Affiliations

    • The State University of Campinas School of Medical Sciences, Campinas, Brazil
    • ,
  • Steven S. Witkin, PhD

      Affiliations

    • Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY
    • Corresponding Author InformationReprints: Steven Witkin, PhD, Weill Medical College, 525 East 68th St., Box 35, New York, NY 10065

Received 9 March 2010 ,Revised 21 May 2010 ,Accepted 6 July 2010.

References 

  1. Szabadvary F. Indicators a historical perspective. J Chem Ed. 1964;285:
  2. Nugent RP, Krohen MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29:297–301
  3. Zhou X, Bent SJ, Schneider MG, Davis CC, Islam MR, Forney LJ. Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods. Microbiology. 2004;150:2565–2573
  4. Fredricks DN, Fiedler TL, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med. 2005;353:1899–1911
  5. Huggins GR, Preti G. Volatile constituents of human vaginal secretions. Am J Obstet Gynecol. 1976;126:129–136
  6. Eschenbach DA, Davick PR, Williams BL, et al. Prevalence of hydrogen peroxide-producing lactobacillus species in normal women and women with bacterial vaginosis. J Clin Microbiol. 1989;27:251–256
  7. O'Hanlon DE, Lanier BR, Moench TR, Cone RA. Cervicovaginal fluid and semen block the microbicidal activity of hydrogen peroxide produced by vaginal lactobacilli. BMC Infect Dis. 2010;10:120
  8. Weinstein L, Howard JH. The effect of estrogenic hormone on the H-ion concentration and the bacterial content of the human vagina with special reference to the Doderline bacillus. Am J Obstet Gynecol. 1939;37:698–703
  9. Weinstein L, Bogin M, Howard JH, Finkelstone BB. A survey of the vaginal flora at various ages with special reference to the Doederline bacillus. Am J Obstet Gynecol. 1936;32:211–218
  10. Han OS, Sung JY, Cha KA, Lee MH, Oh B. Supramolecular assembly and acid resistance of Helicobacter pylori urease. Nat Struct Biol. 2001;8:505–509
  11. Frienkel RK. Metabolism of the skin. In:  Frienkel RK,  Woodley DT editor. The biology of the skin. New York: Parthenon Publishing; 2001;p. 191
  12. Halprin KM, Ohkawara A, Adachi K. Glucose entry into human epidermis: concentration of glucose in the human epidermis. J Invest Dermatol. 1967;49:561–568
  13. In:  Elias PM,  Feingold KR editor. Skin barrier. New York: Taylor and Francis; 2006;
  14. Gross M. Biochemical changes in the reproductive cycle. Fertil Steril. 1961;12:245–262
  15. Ayre WB. The glycogen-estrogen relationship in the vaginal tract. J Clin Endocrinol Metab. 1951;11:103–110
  16. Bo WJ. The effect of progesterone and progesterone-estrogen on the glycogen deposition in the vagina of the squirrel monkey. Am J Obstet Gynecol. 1970;107:524–530
  17. Zhou X, Brown CJ, Abdo Z, et al. Differences in the composition of vaginal microbial communities found in healthy Caucasian and black women. ISME J. 2007;1:121–133
  18. Juarez Tomas MS, Bru E, Wiese B, de Ruiz Holgado AAP, Nader-Macias ME. Influence of pH, temperature and culture media on the growth and bacteriocin production by vaginal lactobacillus salivarius CRL 1328. J Appl Microbiol. 2002;93:714–724
  19. Giraud E, Champailler A, Raimbault M. Influence of pH and initial lactate concentration on the growth of Lactobacillus plantarum. Appl Microbiol Biotechnol. 1991;36:96–99
  20. Raskoff AE, Feo LG, Goldstein L. The biologic characteristics of the normal vagina. Am J Obstet Gynecol. 1943;47:467–494
  21. Boskey ER, Cone RA, Whaley KJ, Moench TR. Origins of vaginal acidity: high D/L lactate ratio is consistent with bacteria being the primary source. Hum Reprod. 2001;16:1809–1813
  22. Gorodeski GI, Hopfer U, Liu CC, Margles E. Estrogen acidifies vaginal pH by up-regulation of proton secretion via the apical membrane of vaginal-ectocervical epithelial cells. Endocrinology. 2005;146:816–824
  23. Preti G, Huggins GR. Cyclical changes in volatile acidic metabolites of human vaginal secretions and their relation to ovulation. J Chem Ecol. 1975;1:361–376
  24. Preti G, Huggins GR. Organic constituents of vaginal secretions. In:  Hafez ESE,  Evans TN editor. The human vagina. New York: North-Holland Publishing Co; 1978;p. 162–163
  25. Tsai CC, Semmens JP, Semmens EC, Lam CF, Lee FS. Vaginal physiology in postmenopausal women: pH value, transvaginal electropotential difference, and estimated blood flow. South Med J. 1987;80:987–990
  26. Wira CW, Fahey JV. The innate immune system: gatekeeper to the female reproductive tract. Immunol. 2004;111:13–15
  27. Wira CR, Fahey JV, Sentman CL, Pioli PA, Shen L. Innate and adaptive immunity in female genital tract: cellular responses and interactions. Immunol Rev. 2005;206:306–335
  28. Nasu K, Narahara H. Pattern recognition via the toll-like receptor system in the human female genital tract. Mediators Inflamm. 2010;976024
  29. Witkin SS, Linhares IM, Giraldo P. Bacterial flora of the female genital tract: function and immune regulation. Best Practice Res Clin Obstet Gynecol. 2007;21:347–354
  30. MacNeill C, Umstead TM, Phelps DS, et al. Surfactant protein A, an innate immune factor, is expressed in the vaginal mucosa and is present in vaginal lavage fluid. Immunol. 2004;111:91–99
  31. Mestecky J, Russell MW. Induction of mucosal immune responses in the human genital tract. FEMS Immunol Med Microbiol. 2000;27:351–355
  32. Wira CR, Rossoll RM, Kaushic C. Antigen-presenting cells in the female reproductive tract: influence of estradiol on antigen presentation by vaginal cells. Endocrinology. 2000;141:2877–2885
  33. Mauro TM. SC pH: measurement, origins, and functions. In:  Elias PM,  Feingold KR editor. Skin barrier. New York: Taylor and Francis; 2006;p. 225
  34. Weisberg E, Aytin R, Darling G, et al. Endometrial and vaginal effects of dose-related estradiol delivered by vaginal ring or vaginal tablet. Climacteric. 2005;8:83–92
  35. Kunin CM, Evans C, Bartholomew D, Bates G. The antimicrobial defense mechanism of the female urethra: a reassessment. J Urol. 2002;168:413–419
  36. Hachem JP, Crumrine D, Fluhr J, Brown BE, Feingold KR, Elias PM. pH directly regulates epidermal permeability barrier homeostasis and stratum corneum integrity/cohesion. J Invest Dermatol. 2003;121:345–353
  37. Fluhr JW, Kao J, Jain M, et al. Generation of free fatty acids from phospholipids regulates stratum corneum acidification and integrity. J Invest Dermatol. 2001;117:44–51
  38. Berg RW, Milligan MC, Sarbaugh FC. Association of skin wetness and pH with diaper dermatitis. Pediatr Dermatol. 1994;11:18–20
  39. Donders GG, Van Calsteren K, Bellen G, Reybruck R, Van den Bosch T, Riphagen I, et al. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG. 2009;116:1315–1324
  40. Hoyme UB, Saling E. Efficient prematurity prevention is possible by pH-self measurement and immediate therapy of threatening ascending infection. Eur J Obstet Gynecol Reprod Biol. 2004;115:148–153
  41. Ravel J, Gajer P, Abdo Z, et al. Microbes and Health Sackler Colloquium: vaginal microbiome of reproductive-age women. Proc Natl Acad Sci USA. 2010 Aug 19;[Epub ahead of print]

 Cite this article as: Linhares IM, Summers PR, Larsen B, et al. Contemporary perspectives on vaginal pH and lactobacilli. Am J Obstet Gynecol 2011;204:120.e1-5.

PII: S0002-9378(10)00876-8

doi: 10.1016/j.ajog.2010.07.010

American Journal of Obstetrics & Gynecology
Volume 204, Issue 2 , Pages 120.e1-120.e5 , February 2011

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