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4: Y4 - Gynaecology [8] > [6] Bacterial Vaginosis > Flashcards

[6] Bacterial Vaginosis Flashcards

1
Q

What is bacterial vaginosis?

A

A non-sexually transmitted infection of the lower genital tract in females

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2
Q

How common is bacterial vaginosis?

A

The most common cause of abnormal vaginal discharge in women of childbearing age

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3
Q

What happens to the normal vagina to lead to bacterial vaginosis?

A

There is a disturbance in the normal vaginal flora leading to a reduction in the number of lactobacilli bacteria

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4
Q

What type of bacteria are lactobacilli?

A

Large rod-shaped organisms that produce hydrogen peroxide to help maintain the acidic pH of the vagina

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5
Q

What is the normal pH of the vagina?

A

< 4.5

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6
Q

What is the result of the acidic nature of the vagina?

A

Prevents overgrowth of other microorganisms

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7
Q

What happens to the pH of the vagina when lactobacilli numbers are reduced?

A

pH increases

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8
Q

What does the increase in pH in bacterial vaginosis allow?

A

Overgrowth of other microorganisms

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9
Q

What are the most common organisms found in bacterial vaginosis?

A
  • Gardnerella vaginalis
  • Anaerobes
  • Mycoplasmas
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10
Q

What are the risk factors for bacterial vaginosis?

A
  • New or multiple sexual partners
  • Use of IUD
  • Receptive oral sex
  • Presence of STI
  • Vaginal douching
  • Use of scented soaps/vaginal deodorants
  • Recent antibiotic use
  • Black ethnicity
  • Smoking
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11
Q

What % of bacterial vaginosis cases are asymptomatic?

A

Up to 50%

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12
Q

What is the most common symptom of bacterial vaginosis?

A

Offensive, fishy smelling discharge

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13
Q

What symptoms are NOT usually associated with bacterial vaginosis?

A
  • Soreness
  • Itching
  • Irritation
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14
Q

What are the examination findings in bacterial vaginosis?

A

Thin, white/grey homogenous vaginal discharge

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15
Q

What are the differentials for bacterial vaginosis?

A
  • Other vaginal infections
  • Other benign causes of vaginal discharge
  • Tumours of the vulva, vagina, cervix or endometrium
  • Atrophic vaginitis
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16
Q

What other vaginal infections can be differentials for bacterial vaginosis?

A
  • Candida
  • Trichomoniasis
  • Chlamydia
  • Gonorrhoea
  • Herpes simplex
17
Q

What benign causes of vaginal discharge are differentials for bacterial vaginosis?

A
  • Physiological discharge
  • Chemical irritants
  • Foreign body
  • Pregnancy
  • Cervical ectropion
18
Q

How is bacterial vaginosis diagnosed?

A
  • History
  • Vaginal examination
  • Microscopy
19
Q

How is a sample obtained for microscopic testing for bacterial vaginosis?

A

High vaginal swab

20
Q

What will be seen on gram stained microscopy of bacterial vaginosis?

A
  • Clue cells
  • Reduced number of lactobacilli
  • Absence of pus cells
21
Q

What are the clue cells seen in bacterial vaginosis?

A

Vaginal epithelial cells studded with gram variable coccobacilli

22
Q

Isolation of what is not sufficient to diagnose bacterial vaginosis?

A

Gardnerella vaginalis

23
Q

Why is isolation of Gardnerella vaginalis not diagnostic of bacterial vaginosis?

A

It can be cultured from 50% of uninfected women

24
Q

What are some other diagnostic investigations for bacterial vaginosis?

A
  • pH >4.5

- KOH Whiff test

25
Q

What is the KOH Whiff test for bacterial vaginosis?

A

Addition of potassium hydroxide (KOH) causes vaginal discharge to release a strong fishy odour

26
Q

Do asymptomatic bacterial vaginosis patients require treatment?

A

Only if they are pregnant

27
Q

What is the most common treatment for bacterial vaginosis?

A

Metronidazole

28
Q

What regimes of metronidazole are available for bacterial vaginosis?

A
  • 400mg BD for 5-7 days
  • OR single dose of 2g
  • OR gel applied to vagina
29
Q

What are the alternative antibiotics for bacterial vaginosis?

A
  • Clindamycin

- Tinidazole

30
Q

How should breastfeeding women be treated for bacterial vaginosis?

A

Vaginal metronidazole

31
Q

What should patients avoid after diagnosis of bacterial vaginosis?

A
  • Vaginal douching
  • Scented shower gels
  • Anti-septic agents
  • Shampoos in bath
32
Q

What should be considered if bacterial vaginosis is present with an IUD?

A

Removal of IUD

33
Q

What % of people with bacterial vaginosis have return of symptoms within 3 months of treatment?

A

> 50%

34
Q

What are the complications of bacterial vaginosis following TOP?

A
  • Endometriosis

- PID

35
Q

What are the potential complications of bacterial vaginosis in pregnancy?

A
  • Late miscarriage
  • Preterm delivery
  • Premature rupture of membranes
  • Low birth weight
  • Post partum endometriosis
36
Q

What is a potential complication of bacterial vaginosis in all women?

A

Can increase the risk of acquiring HIV and other STIs

4: Y4 - Gynaecology [8] (52 decks)

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