Bacterial vaginosis

Manoo Tansakul ID.5360801012

Sarawut Butmata ID.5360801015
Medical student Of Princess of Naradhiwas university
INTRODUCTION
Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women
of childbearing age, accounting for 40 to 50 percent of cases . In the United States, the
National Health and Nutrition Examination Survey (NHANES), which included results
from self-collected vaginal swabs from over 3700 women, estimated the prevalence of
BV was 29 percent in the general population of women aged 14 to 49 years and 50
percent in African-American women . This included both symptomatic and
asymptomatic infection. Worldwide, BV is common among women of reproductive age,
with variations according to the population studied .
PATHOGENESIS
Represents a complex change in the vaginal flora
characterized
Reduction in concentration of the normally dominant
hydrogen-peroxide producing lactobacilli
increase in concentration of other organisms,
especially anaerobic gram negative rods. The major
bacteria detected are Gardnerella vaginalis
The mechanism by which the floral imbalance occurs
and the role of sexual activity in the pathogenesis of BV
are not clear, but formation of an epithelial biofilm
containing G. vaginalis appears to play an important
role
MICROBIOLOGY
Common causes:
Gardnerella vaginalis (95% of women with
bacterial vaginosis)
Other organisms
include Mobiluncus species, Mycoplasma
hominis , Peptostreptococcus ,Ureaplasma
urealyticum , Megasphaera ,
and Leptotrichia . Atopobium
vaginae , Chloroflexi ,Veillonella , and other
anaerobes ( eg , Prevotella , Bacteroides ,
and Fusobacteriu m species)

CLINICAL FEATURES
Fifty to 75 percent of women with bacterial vaginosis (BV)
are asymptomatic . Symptomatic women typically present
with vaginal discharge and/or vaginal odor . The discharge is
off-white, thin, and homogeneous; the odor is an unpleasant
"fishy smell" that may be more noticeable after sexual
intercourse and during menses.
BV alone does not cause dysuria, dyspareunia, pruritus, burning,
or vaginal inflammation (erythema, edema) . The presence of these
symptoms suggests mixed vaginitis (symptoms due to two
pathogens)
Although BV does not involve the cervix, the disorder may be
associated with acute cervicitis (endocervical mucopurulent
discharge or easily induced cervical bleeding)
CLINICAL FEATURES
Investigation
Wet-mount preparation
Normal saline Slide Vaginal dischage
Normal saline (
secretion ) cover slip

Clue cell superficial vaginal epithelial cell (
G.vaginalis)
granular stippled
appearance
Investigation
Wet-mount preparation
Investigation
Whiff test (Amine test)
10 % KOH secretion 1-2
(fishy amine like odor)
bacterial vaginosis vaginal trichomoniasis
Investigation
Whiff test (Amine test)

Investigation
Vaginal pH paper
pH paper
pH > 4.5 : bacterial vaginosis trichomoniasis
atrophic vaginitis
pH < 4.5 : fungal infection

Investigation
Vaginal pH paper

Investigation
Gram stain
Culture
Pap smear
Dx BV


Homogeneous, thin, grayish-white discharge that smoothly coats the vaginal walls
Vaginal pH >4.5
Positive whiff-amine test, defined as the presence of a fishy odor when a drop of 10
percent potassium hydroxide (KOH) is added to a sample of vaginal discharge
Clue cells on saline wet mount . Clue cells are vaginal epithelial cells studded with
adherent coccobacilli that are best appreciated at the edge of the cell. For a positive
result, at least 20 percent of the epithelial cells on wet mount should be clue cells.
The presence of clue cells diagnosed by an experienced microscopist is the single
most reliable predictor of BV .
Amsel criteria for diagnosis of BV (at least three criteria
must be present):
CONSEQUENCES
Pregnant women with bacterial vaginosis (BV) are at higher risk of preterm delivery .

BV is a cause of :
Endometrial bacterial colonization
Plasma-cell endometritis
Postpartum fever
Post-hysterectomy vaginal cuff cellulitis
Postabortal infection
BV is a risk factor for acquisition of herpes simplex virus type 2 (HSV-2), gonorrhea,
chlamydia, and trichomonas infection . Although BV is more common among women
with pelvic inflammatory disease (PID)

Treatment of symptomatic women with bacterial vaginosis is
indicated to reduce vaginal discharge and odor. We
recommend metronidazole or clindamycin (Grade 1A).
Options include:
Metronidazole 500 mg twice daily orally for 7 days
Metronidazole gel 0.75 percent (5 grams containing 37.5 mg metronidazole) once
daily vaginally for 5 days
Clindamycin 2% vaginal cream once daily at bedtime for 7 days
Clindamycin 300 mg twice per day orally for 7 days
Clindamycin 100 mg vaginal suppositories at bedtime for 3 days
Clindamycin bioadhesive cream (Clindesse) 2% as a single vaginal dose of 5 grams
of cream containing 100 mg of clindamycin phosphate.
Pregnant women with BV are at increased risk of preterm birth. We recommend not
screening all pregnant women for BV, given there is no evidence that screening and
treatment of asymptomatic infection reduces the risk of preterm birth (Grade 1A).
We treat pregnant women with symptomatic BV infection to relieve
symptoms. We prescribe clindamycin 300 mg orally twice daily for 7 days or
metronidazole 500 mg orally twice daily for 7 days.
We suggest treatment of asymptomatic women who are to undergo
pregnancy termination (Grade 2B). Preoperative treatment decreases the
frequency of postoperative infectious complications.