COCCOID FLORA: CHARACTERISTICS, GENERA, PATHOLOGIES, DIAGNOSIS - BIOLOGY - 2025

Coccoid flora is a term used to describe the microbial community or the set of bacteria in the vaginal area that have a morphological “coccoid” appearance (one of the characteristic forms of bacteria). These microorganisms can be found in a greater or lesser proportion depending on the person or the physiological conditions of the genital organ.

Generally, sexually active women are those with significant increases in the coccoid flora of the genital area and different researchers attribute this to unhygienic sexual relations or exposure to sexually transmitted diseases.

Staphylococcus epidermidis, a species commonly present in vaginal coccoid flora (Source: Photo Credit: Janice CarrContent Providers (s): CDC / Segrid McAllister via Wikimedia Commons)

The presence of abundant coccoid flora has been correlated with the socioeconomic level of women, believing that this is due to a lack of information about the benefits and implications of having hygienic and safe sexual relations.

Based on the analysis of clinical data obtained from different hospitals in Latin American countries, a relationship has been found between patients who present a high proportion of coccoid flora with suffering from pathologies such as leucorrhea (49%), dyspareunia (16%), bleeding during intercourse (4%) and vulvar itching (29%).

Orally administered contraceptives tend to increase the coccoid flora in the vagina, in fact, characterization studies have been carried out on the microorganisms present in the atypical coccoid flora sampled in patients subjected to contraceptive pills.

When the coccoid flora presents high values, there is a certain predisposition to infections by microbial species of the Trichomona, Gardnerella or Kingella genera and fungi of the Candida genus, which can have serious implications on the genital health of women.

characteristics

It is estimated that about 20% of women of reproductive age suffer an increase in coccoid flora and that in four out of ten women in whom this increase is observed, it is due to benign changes in the vaginal flora or to transitory hormonal changes.

Gynecologists consider that a normal vaginal flora should have less than 10% representatives of genders with coccoid morphologies. The normal thing is to find more than 80% of bacterial species of the genus Lactobacillus, specifically Lactobacillus crispatus and Lactobacillus acidophilus.

Usually, the species found in the vaginal coccoid flora come from the anus, so they are almost always anaerobic Gram-positive Enterobacteriaceae. However, pathogenic agents of external origin can also be found, which implies a high probability of contracting diseases.

Representative genres

The species of bacteria that are most commonly found in the coccoid flora of vaginal cytologies (linking the endocervix and ectocervix) belong to the genera Staphylococcus, Peptococcus, Enterococcus and Streptococcus, the most common species being Staphylococcus epidermidis, Staphylococcus aureus and Enterococcus aureus.

Staphylococcus

They are species of bacteria with the appearance of spheres grouped in heaps or granular in shape that are found distributed throughout the mucous membranes and body fluids and in the epidermis of the skin.

Up to 17 different species of these microbes can be found on human skin, in contrast to the three species that have been reported in vaginal coccoid flora: Staphylococcus epidermidis, Staphylococcus aureus, and, in some cases, Staphylococcus faecalis.

Enterococcus

These bacteria are in the form of pairs of spheres (cocci) joined by a central point or chains of cocci. They are generally difficult to distinguish from Streptococcus.

They are distributed in the saliva, the gastrointestinal tract and the genitourinary cavity. These bacteria are the main causes of urinary tract infections, bacteremia and endocarditis.

Streptococcus

Bacteria of this genus are grouped into chains or pairs of cocci. They are distributed in the mouth, skin, and gastrointestinal and respiratory tracts of humans.

Many of the species of this genus cause serious infectious diseases in humans such as tonsillitis or pneumonia.

Peptococcus

Bacteria of the genus Peptococcus are also found as chains of cocci and have been found primarily throughout the gastrointestinal cavity. However, it is not yet known for sure whether they live permanently in the oral and vaginal flora.

These bacteria have been linked to abscesses in the brain, ear, and jaw.

Related pathologies

An increase in the coccoid flora can cause bacterial vaginosis in most women since, by increasing the presence of these bacteria, the relative abundance of species of the genus Lactobacillus can be altered, producing changes in the regular vaginal ecosystem.

Doctors affirm with certainty that if the coccoid flora exceeds in relative abundance the lactobacillary flora of the vulvo-vaginal region, it is possible to speak of a bacterial vaginosis. This disease is caused mainly by an alteration of the acidic pH of the genital organ.

Bacterial vaginosis causes inflammation in the cervico-vaginal area, excessive secretion of fluids, burning in the genitals, burning when urinating and even, in more serious conditions, can present feverish symptoms and general malaise.

The problem when diagnosing bacterial infections based on the increase in coccoid flora is that, in some people, "abnormal" vaginal microflores are asymptomatic or "non-pathological," so they cannot be classified as infections.

In fact, these so-called "abnormal" microfloras may, rather, "intermediate" floras that become transiently evident during some stages of women's sexual development.

Diagnosis

Despite the above, the presence of coccoid flora in most women is usually very low, so an increase in the amount of coccoid bacteria in the vaginal cavity is attributed to infections, pathologies, injuries or other types of disorders. pathological.

Specialist gynecologists have considered that women with an increased proportion of the vaginal coccoid flora are more susceptible to sexually transmitted diseases, the human immunodeficiency virus (HIV), postoperative infections, premature abortions and other diseases.

The diagnoses of these alterations in the vaginal flora are usually made by means of direct cytology of vaginal secretions, which are subjected to a Gram stain.

However, more in-depth studies involve a combination between analysis of secretions and a cervical cytology processed with a Papanicolaou stain, in order to be able to analyze and identify all native species of the vaginal tract.

The polymerase chain reaction (PCR) is usually used for investigational purposes only to detect abnormal increases in coccoid flora. However, this tool could be used as a common alternative for the rapid and accurate detection of coccoid bacteria in the vaginal flora.

References

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2. Donders, GG, Vereecken, A., Bosmans, E., Dekeersmaecker, A., Salembier, G., & Spitz, B. (2002). Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG: An International Journal of Obstetrics & Gynaecology, 109 (1), 34-43
3. Donders, GG, Bellen, G., & Ruban, KS (2018). Abnormal vaginal microbiome is associated with severity of localized provoked vulvodynia. Role of aerobic vaginitis and Candida in the pathogenesis of vulvodynia. European Journal of Clinical Microbiology & Infectious Diseases, 37 (9), 1679-1685.
4. Gutman, RE, Peipert, JF, Weitzen, S., & Blume, J. (2005). Evaluation of clinical methods for diagnosing bacterial vaginosis. Obstetrics & Gynecology, 105 (3), 551-556.
5. Priestley, CJ, Jones, BM, Dhar, J., & Goodwin, L. (1997). What is normal vaginal flora ?. Sexually Transmitted Infections, 73 (1), 23-28.
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7. Yoshimura, K., Morotomi, N., Fukuda, K., Hachisuga, T., & Taniguchi, H. (2016). Effects of pelvic organ prolapse ring pessary therapy on intravaginal microbial flora. International urogynecology journal, 27 (2), 219-227.