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Infectious Diseases in Obstetrics and Gynecology
Volume 3 (1995), Issue 3, Pages 102-109
Clinical Study

Long, Uniform Lactobacilli (Döderlein's Bacteria): A New Risk Factor for Postoperative Infection After First-Trimester Abortion

1Department of Obstetrics and Gynaecology, University of Gothenburg, Gothenburg, Sweden
2Dept. of Obstetrics and Gynaecology, Central Hospital, Skövde S-54185, Sweden
3Department of Infectious Diseases and Clinical Microbiology, University of Uppsala, Uppsala, Sweden

Received 26 January 1995; Accepted 17 July 1995

Copyright © 1995 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective: The production of hydrogen peroxide (H2O2) from different strains of lactobacilli in the vagina has been proposed to play one of the most important protective roles in the vaginal defense system. New data have, however, suggested that Döderlein's bacteria, with the morphological appearance of long lactobacilli, have a low production of H2O2 . The purpose of the present study was to correlate the morphology of lactobacilli with the incidence of infection following legal abortion.

Methods: Seven hundred sixty-nine women with lactobacilli but without Chlamydia trachomatis or bacterial vaginosis in their vaginal wet smears who were to undergo legal abortions were divided into 6 different groups according to the morphological appearance of the lactobacilli. The postoperative infection rates in these different groups were compared. A phenotypic classification of some of the lactobacilli was performed.

Results: The presence of Döderlein's bacteria compared with a mixed flora of lactobacilli increased the risk of postoperative infection 3 times [relative risk (RR) = 3.0; 95% confidence interval (CI), 1.5-6.3]. After a logistic regression analysis, the only independent risk factors were the presence of Döderlein's bacteria and earlier gestational age.

Conclusions: We found that the lactobacilli regarded as commensal organisms and “normal, healthy lactobacilli” in the vagina were present in only 18% of these women and that their presence might be hazardous. Therefore, we must reconsider our concept of the “normal” lactobacilli in the vaginal wet smears of healthy women.