Bacterial Vaginosis Flashcards
1
Q
Definition
A
Commonest cause of abnormal vaginal discharge
- Sexually associated, not sexually transmitted (sex makes bacterial overgrowth more likely)
- Does not need to be treated if asymptomatic
2
Q
Risk factors
A
Risk factors:
- Smoking
- Vaginal Douching
- Bubble Bathing
- Sexual activity
- New sexual partner
- Other STIs
- Copper IUD
- Vaginal pH increase
Protective factors
- condoms
- circumcised partner
- COCP
3
Q
Pathophysiology
A
· Occurs and remits spontaneously; pathophysiology:
- Overgrowth of anaerobic bacteria (Gardnerella vaginalis, Prevotella spp., Mycoplasma hominis, Mobiluncus spp.)
- Loss of lactobacilli -> increased pH -> increased likelihood of BV
- Gardnerella commonly found but commensal in 30-40% women
4
Q
Signs and Sympotms & Investigations
A
Asymptomatic (50%)
Diagnosis = clinical + microscopy + offensive, fishy-smelling discharge (no soreness or irritation), high pH
HVS – microscopy (clue cells – vaginal epithelium cells coated with lots of bacilli)
Hay-Ison criteria or Amsel’s criteria
Amsel’s criteria = 3 out of 4 of…
- Thin, white, homogenous discharge
- Clue cells on microscopy
- Vaginal pH >4.5 (only BV and TV)
- Fishy odour on adding 10% KOH
Hay-Ison criteria applied to gram stain
- Grade 3 = BV
5
Q
Management
A
o 1st line – metronidazole, PO, 400mg BD, 7 days
o 2nd line – intravaginal clindamycin PV cream, 5g 2%, 7 days
o Avoid vaginal douching, shower gel, use of shampoo in bat
6
Q
Complications
A
- Associated with late miscarriage, preterm birth, PROM and postpartum endometritis
- Increases risk of acquiring and transmitting STIs
