Bacterial Vaginosis

Bacterial Vaginosis

Occurs primarily in sexually active adolescent & adult women
May be asymptomatic
A risk factor for preterm labor
Changed vaginal microbial flora
1. Decreased lactobacilli
2. Overgrowth of Gardnerella vaginalis, Mycoplasmahominis and anaerobic bacteria

Diagnosis (3 of the following)

Characteristic discharge
- Vaginal fluid pH > 4.5
- + “whiff test” with KOH
- Clue cells (usually > 20%) i.e. bacterial-coated squamousepithelial cells in which both the periphery and cytoplasm have a granular, irregular “moth-eaten” apperance

Treatment

Symptomatic & pregnant asymptomatic patients
Metronidazole oral x 7 days, Metronidazole gel x 5 days or clindamycin cream x 5 days

Infxn	Sx	Vag dc	whiff	micro	pH	%ID by direct microscopy
BV	foul smell, increased after intercourse	thin, homogenous, gray, white	+	>20% clue cells	>4.5	> 90%
Trich	frothery, foul smell, pruritis, discharge	purulent, profuses, irritating, frothy green yellow	+/-	incr WBCs, trichomonads	> 4.5, often >6	50-70%
Candida	pruritis, burning, dc	thick, adherent, white	neg	increased WBCs, budding yeast, pseudohyphae	4 to 4.5	50-60&