Asymptomatic Vaginal E coli: Is Therapy Warranted?

A young woman recently came to my office for contraception management and a Papanicolaou test; she complained of mild dyspareunia. I sent a vaginal sample for culture to rule out gonorrhea and chlamydial infection. The culture results were negative for these organisms but grew abundant Escherichia coli. The patient had no symptoms of vaginitis or urinary tract infection (UTI). Should she be treated?

-- Neeraja Ramachandra, MD
Warren, Mich



There is no reason to treat asymptomatic vaginal colonization with E coli. Such colonization is very common in healthy women, and rates are especially high in women with a history of recurrent UTIs. While vaginal E coli colonization might predispose a woman to subsequent UTI, the risk is very low and no data show that treatment is beneficial.

-- Thomas M. Hooton, MD
Professor of Clinical Medicine
University of Miami Miller School of Medicine
Miami, Fla