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A double-blind study of treatment for bacterial vaginosis (BV), using metronidazole tablets 500 mg 3 times daily for 10 days versus placebo in the same regimen, was performed on 42 outpatients with irregular bleeding episodes or discharge attending a gynecological clinic. All patients had motile rods in wet smears in addition to fulfilling the criteria for BV. Treatment gave a cure rate of 76% versus 5% in the placebo group. Mobiluncus sp. was identified in 81% of these cases before treatment, in 8% of the cured patients and in 50% of those not initially cured at follow-up. Repeated treatments, once or twice, resulted in a 100% cure rate. A 6-month follow-up was carried out on 39 of the 42 patients. There were 7 relapses after 6 months giving a cure rate of 82%. After successful treatment all bleeding disturbances disappeared. We conclude that it is important to treat BV in patients with symptoms other than malodorous discharge.

Numerical analysis of phenotypic data on 38 strains of anaerobic curved rods (CR) and 7 reference strains indicated that the curved rods could be split into two types, anaerobic long (LCR) and short curved rods (SCR). In addition, a subcluster was formed within the cluster of SCR by strains that are both morphologically and biochemically intermediate between the LCR and SCR group. None of the reference strains could be grouped into the clusters of CR. DNA-base composition was 52-54 mol% GC for LCR and 56-58 mol% GC for SCR. Serologically the two groups are distinct.

Women attending our Department for a first-trimester abortion were examined for the presence of Mobiluncus species. C. trachomatis or clue cells in vaginal discharge in an attempt to identify risk groups for development of pelvic inflammatory disease (PID) after first-trimester abortion. A correlation was found between the presence of Mobiluncus and clue cells in vaginal discharge and the incidence of PID after first-trimester abortions. These women were also older than those in whom C. trachomatis was identified. Our study indicates that screening for C. trachomatis and clue cells in vaginal discharge will identify two different risk groups for developing PID after first-trimester abortion.

The occurrence of motile anaerobic curved rods in vaginal discharge was studied in 94 samples from women attending an STD clinic. Almost all wet smear preparations of discharge contained motile rods. Anaerobic curved rods were isolated from 46% of the samples. Of 28 specimens studied by culture and immunofluorescence, 21 were confirmed to harbour motile anaerobic curved rods. Culture was performed with a dilution and sampling technique that is too time-consuming for diagnostic routines, but it enhanced the precision of information on motile anaerobic curved rods in vaginal secretion. More selective and rapid methods for identification of these bacteria are desirable.

Reference strains and clinical isolates of Mobiluncus species and bacteria in samples of vaginal discharge from patients with bacterial vaginosis were examined for resistance to alkaline solutions. A prolonged survival time in buffers of high pH was shown for Mobiluncus, especially for isolates designated as M. curtisii. In a clinical study, alkaline treatment increased the number of culture-positive samples four times as compared to conventional culture. The improved culture-yield in combination with a shortened time for processing the samples makes the method suitable for isolation of Mobiluncus in clinical samples.

51 strains, including clinical isolates, type and reference strains of Mobiluncus, were studied as to phenotype and reactivity with a set of monoclonal antibodies to defined Mobiluncus antigens. Numerical analysis of phenotypic data and the reactivity with monoclonal antibodies showed that the bacteria are clustered to form the two main species, M. mulieris and M. curtisii, although some atypical variants occur. In indirect immunofluorescence assay, the unique antigens were fully exposed on the cell surface and could therefore be used as markers for specific microscopic identification of Mobiluncus in mixed vaginal samples from women attending an STD clinic. The monoclonal antibodies identified M. mulieris and M. curtisii, showing a high correlation with the detection of motile curved rods in wet smears and curved rods in Gram-stained preparations. 70% of the samples harbouring Mobiluncus as seen by direct identification with monoclonal antibodies were culture-positive when an elaborate dilution technique for culture was used.

The simultaneous occurrence of Mobiluncus spp in the vagina and rectum was studied in women attending a sexually transmitted diseases (STD) department. Of 43 women with bacterial vaginosis (BV), 32 had Mobiluncus spp in the vagina and 23 in the rectum. In 20 women the same Mobiluncus species was found concomitantly in the vagina and the rectum. Mobiluncus spp were found in the rectum only in two women with BV, one with candidal vaginitis, and one healthy woman. In a treatment study of 23 women, BV was cured in nine out of 10 treated with metronidazole and six out of 13 treated with tetracycline. After treatment Mobiluncus spp persisted in the vaginas of two out of 19 women and in the rectums of two out of 10.