Bacterial vaginosis B V is a polymicrobial disorder characterized by an increase in Vaginal PH > 4.5, reduction of lactobacillus colonization (replacement of the normal hydrogen peroxide-producing Lactobacillus predominant vaginal flora with anaerobic bacteria, e.g. Gardnerella vaginalis, Mobiluncus species and Mycoplasma hominis) and overgrowth of several facultative and obligatory anaerobic bacteria (Eschenbach et al. 1989 , Hay et al. 1992 , Guise et al. 2001).
Bacterial vaginosis is the most prevalent form of vaginal disturbances in women of childbearing age (Hay, 2000).
The average incidence of B V varies and is reported to be 10%-35% in patients attending gynaecological clinics, 10%-30% in patients visiting obstetric clinics and 20%-60% in patients visiting services of sexually transmitted diseases (Dadhwal et al , 2000).
The over all prevalence of bacterial vaginosis in Banha gynecology clinic was 38.5 % . ( Ayman Azazy et al , 1993 )
Mohamed A. Elhadi - et al 2009 concluded bacterial vaginosis is considered as one of the most common vaginal infection in the reproductive age and it's prevalence in Banha gynecology clinic according to gram stain was 40.4 % among pregnant women , and 36 % among non pregnant women.
Cervical atypia and the occurance of pre- malignant lesions of cervix may occur in cases with genital tract infection like Human papilloma virus (HPV) infection, Herpes simplex virus (HSV) infection, Chlamydia trachomatis, and other bacterial genital tract infections. (Uthayakumar et al. 1998, Boyle et al. 1999).
Hudson et al (1997),described that in patients with cervical malignancy there is alteration in the normal vaginal environment by necrotic tissue and blood lead to changes in vaginal flora , also women with recurrent & persistent bacterial vaginosis B V are at high risk to develop cervical intra epithelial neoplasia CIN .
Infection with HPV is crucial for the development of CIN and cervical cancer .Bacterial vaginosis has been suggested to play a role in the development of CIN by increasing the risk of acquisition of HPV infection as depletion of lactobacilli limit production of hydrogen peroxide and other antibacterial activities which are protective against pathogenic organisms such as STDs and HPV (Watts et al, 2005 , Taha et al , 1998 ).
Recently, it was demonstrated that the initiating event in cervical dysplasia and carcinogenesis is likely to be infected with human papilloma virus HPV. However, most women who are infected with HPV are asymptomatic. Moreover, pretreatment HPV viral loads do not correlate with prognostic risk factors. (Kim et al. 2008).
It is suggested that additional cofactors play a role in cervical carcinogenesis. Factors that may have a role in this progression include smoking, Estrogen containing contraceptive ( COCP ) , undernutrition , infection with sexually transmitted diseases (STDs), such as Chlamydia trachomatis and trichomonas vaginalis. (Uthayakumar et al. 1998, Boyle et al. 1999).
As the abnormal vaginal flora can produce carcinogenic nitrosamines . Bacterial vaginosis is similar with cervical intraepithelial neoplasia in epidemiologic features, he hypothesized that bacterial vaginosis might have an important role in the development of CIN.
(Pavic ,1984)
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