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한국부인의 질내정상균총(膣內正常菌叢)에 관한 연구

Other Titles
 Studies on vaginal normal flora of Korean women 
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[영문] Although the human vagina communicates with the outside it tends to maintain a characteristic flora and this condition is resistant to invasion from the outside. Adair(1940) stated that the main factors which maintained this normal flora were acidity of the vagina, flow of vaginal secretion, menstrual blood, a health condition both locally and generally and the degree of personal hygiene. He also felt that the variations in these factors tended to permit invasion and multiplication of bacteria from the outside. There are also changes in the flora which are related to changes in age, mechanical interference, cervical secretion, abnormal menstrual blood flow, lochia and hormonal and vascular changes. Schroder(1921) made one of the earliest studies on the relationship between the degree of vaginal cleanliness and the floral changes. Since then many others have studied this question. One of the problems related to interpreting these many studies is the significant variation in the type of study, in the group of persons included, in the culture technique employed and in the criteria of identification used on the isolated bacteria. This investigation was undertaken to provide basic informations on the vaginal normal flora of Korean women and on some factors which caused this to vary. Comparative bacteriological studies of the vaginal flora were conducted with the three fundamental conditions of normal, healthy married women in their reproductive ages, I. e., non-pregnant, pregnant and immediate postpartum status. In addition, influences of the factors such as vaginal pH, age, parity, economic status, educational level, proximity to sexual intercourse, leukorrhea, cervical erosion and/or cervicitis and day of menstrual cycle were also analysed. These parameters were used to establish the variation in normal which was observed and to select those factors which are related to pathologic conditions. The vaginal swabs from 975 married women were cultured. These 975 women were from 20 to 45 years of child-bearing age, in non-pregnant, pregnant or postpartum, and were seen between June, 1968 to July, 1970, either in the regular outpatient clinic or in one of the speciality clinics such as family Planning. The basic routine was to insert a sterilized speculum, measure the pH with sterile nitrazine paper at the mid-vaginal level and obtain samples of culture with sterile cotton swabs. Each specimen was cultured on the plates of blood agar, untrient agar, Eosin Methylene Blue(E.M.B) agar, Sabouraud's media, Okawa's media and Bromcresol Purple(B.C.P) media in an aerobic condition. The specimen was also cultured anaerobically in thioglycollate broth and on blood agar plate in Torbal jar. In general, the identifications of the isolates were made with colony morphology, Gram and acid-fast stains, selected appropriate tests for each organism including hemolysis test, coagulase test, mannitol test and pigment formation test for Staphylococci, hemolysis test and bacitracin test for Streptococci, IMViC test, sugar fermentation tests, growth characteristics on Triple Sugar Iron(T.S.I) agar, motility test and urease test for coliform bacilli, growth characteristic on cystine tellurite agar and sugar fermentation tests for diphtheroids, hemolysis test and motility test for B. subtilis, and sugar fermentation tests, growth characteristics on corn meal media, germ tube test and agglutinatio test for yeast-line organisms. The results of the study are summarized as follows; 1. In over 90% of the specimens cultured aerobically and anaerobically, growth of one or more bacterial species were observed with the most common being one, followed by those specimens with two and next by those with three species and finally a mixed infestation of four or more species. 2. The following table summarizes the major cultural findings. ------------------------------------------------------------------------------ Organisms Non-pregnant Pregnant Postpartum (%) (%) (%) ----------------+--------------------------------------------------------------
Staphylococci 58.5 69.0 56.4
Gram(+) bacilli 14.0 28.0 7.0 ----------------+-------------------------------------------------------------- 3. The identification studies of the isolated organisms showed that 13.7% of staphylococci were S. aureus and almost al of streptococci were either alpha or gamma hemolytic type. Only 1.5% of streptococci was beta hemolytic type. The main coliform bacilli were E. coli(68.7%) which the main yeast-line organism was Candida albicans(37.1%). 4. The average pH values of the vaginal; secretions were 5.7 in non-pregnant, 5.3 in pregnant and 7.0 in postpartum group. 5. With increasing pH there observed parallel increased in the culture rates of coliform bacilli and diphtheroids, while a decrease in pH resulted in more yeast-like organisms. 6. No significant differences were noted in culture rates of aerobic organisms among non-pregnant women by age, parity, economic status, educational level, proximity to sexual intercourse, leukorrhea, presence of cervical erosion and/or cervicitis, and day of menstrual cycle.
Gram(-) bacilli 46.0 26.0 66.0
Peptostreptococci 28.0 26.0 25.0 bacteria
Peptococci 21.0 15.0 21.0 Anaerobic
Yeast-like organisms. 10.0 25.7 2.2 ----------------+--------------------------------------------------------------
Lactobacilli 20.5 7.0 3.0
B. subtilis 9.0 16.2 1.1
Diphtheroids 11.2 6.8 29.3
Coliform bacilli 13.7 20.3 33.7 bacteria
Streptococci 40.8 16.2 13.0 Aerobic
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