Bacterial vaginosis

Question 1

What is bacterial vaginosis?

Answer 1

Overgrowth of bacteria in the vagina, specifically anaerobic bacteria

Question 2

What causes bacterial vaginosis?

Answer 2

Loss of lactobacilli (main component of the healthy vaginal bacterial flora) - ‘friendly’ bacteria in the vagina

Question 3

Why are lactobacilli an important component of a healthy vaginal bacterial flora?

Answer 3

They produce lactic acid that keeps the vaginal pH low (under 4.5). The acidic environment prevents other (anaerobic) bacteria from overgrowing

Question 4

What is the commonest anaerobic bacteria associated with bacterial vaginosis?

Answer 4

Gardnerella vaginalis

Question 5

Name 3 risk factors for developing bacterial vaginosis

Answer 5

• Multiple sexual partners (although it is not sexually transmitted)
• Excessive vaginal cleaning
• Recent antibiotics
• Smoking
• Copper coil

Question 6

1) What is the standard presenting feature of bacterial vaginosis?
2) A standard charcoal vaginal swab can be taken for microscopy - what is the classic presentation of bacterial vaginosis on microscopy, and what are these?
3) What other investigation can be done to aid the diagnosis?

Answer 6

1) Fishy-smelling watery grey or white vaginal discharge
2) Clue cells - epithelial cells from the cervix that have bacteria stuck inside them, usually gardnerella vaginalis
3) pH - should be >4.5, speculum examination to confirm typical discharge

Question 7

1) If medication is required, what is the antibiotic of choice for bacterial vaginosis?
2) What is important to consider/tell patient when they’re given this antibiotic?

Answer 7

1) Metronidazole
2) Avoid alcohol - disulfiram like reaction (flushes, nausea, vomiting)

Question 8

1) What is the main complication of bacterial vaginosis?
2) Name 2 potential complications for pregnancy women?

Answer 8

1) STIs
2) Miscarriage, preterm delivery, premature rupture of membranes, low birth weight, postpartum endometritis