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Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of child-bearing age. A common symptom of this condition is a fishy-smelling vaginal discharge. Trimethylamine (TMA) is the substance which is primarily responsible for this distinctive odour. The ability to metabolize TMA is polymorphically distributed such that the majority of individuals metabolize a large part of the body burden of TMA to the odourless trimethylamine N-oxide (TMAO) which is excreted in urine with a small amount of TMA. However, in certain individuals, N-oxidation of TMA is impaired which results in the excretion of large amounts of TMA in the urine, breath, sweat and vaginal secretions. In the present study the metabolism of TMA to TMAO was determined in women with clinically diagnosed BV, women with fishy-smelling vaginal discharge but with no other evidence of BV and control women with no evidence of fishy-smelling vaginal discharge. An index of TMA N-oxidation was established for all subjects after analysis of a 24 h urine sample for free TMA and total TMA after reduction of TMAO. We show that, irrespective of diagnosis of BV or not, women with fishy-smelling vaginal discharge excrete significantly more free TMA and have a similarly significantly reduced capacity to N-oxidize TMA when compared to healthy control women. Thus, the results of this study suggest that a woman's ability to metabolize TMA to TMAO is an important factor which predisposes to a fishy-smelling vaginal discharge.

Human serum paraoxonase is a polymorphic enzyme that is capable of catalyzing the hydrolysis of paraoxon and other organophosphates, some carbamates and certain aromatic carboxylic acid esters. This enzyme is specified by two allelic genes at one autosomal locus (isozymes 'A' and 'B'). The purpose of this study was to examine the paraoxonase activity of 105 Turkish subjects. Paraoxonase activities ranged from 39.6 to 278.2 nmol p-nitrophenol formed per ml of serum per min. Paraoxonase phenotypes could be clearly identified by salt and paraoxonase:arylesterase activity ratio characteristics. The gene frequencies were 0.632 for the low activity allele (A) and 0.368 for the high activity allele (B).