Bacterial vaginosis Flashcards
What is bacterial vaginosis?
Overgrowth of anaerobic bacteria in vagina
What causes bacterial vaginosis?
Loss of lactobilli - friendly bacteria
Increases risk of developing STIs
What causes bacterial vaginosis?
Loss of lactobilli - friendly bacteria
Increases risk of developing STIs
What is the role of lactobacilli
Produce lactic acid keeps vaginal pH low - under 4.5 - prevents other bacteria from overgrowing
What allows bacteria to multiply in BV
Reduced lactobilli allows pH to rise -> alkaline environment enables anaerobic bacteria to multiply
Anaerobic bacteria ass with BV
Gardnerella vaginalis (most common)
Mycoplasma hominis
Prevotella species
What other infections does BV often co-occur with
Candidiasis
Chlamydia
Gonorrhea
Risk factors for bacterial vaginosis
Multiple sexual partners
Excessive vaginal cleaning - douching, cleaning products, washes etc
Recent antibiotics
Smoking
Copper coil
What women are less at risk of BV
Combined pill
Using condoms effectively
Presentation of BV
Fishy smelling wateru grey or white vaginal discharge
50% asymtpomatic
What symptoms are not typically ass with BV and suggest alternative cause or co-occuring infection
Itching
Irritation
Pain
How confirm typical discharge
Complete high vaginal swab and exclude other causes of symptoms
Not required if typucal symptosm and low risk of UTI
What is normal vaginal pH
3.5-4.5
Investigations for BV
Standard charcoal vaginal swab - for microscopy
High vaginal swab - during speculum - test for chlamydia and gonorrhea
Self taken low vaginal swab
Findings on microscopy of BV
Clue cells - epithelial cells from cervix that have bacteria stuck inside them - gardnerella vaginalis
What bacteria is normally found inside clue cells
Gardnerella vaginalis
What do clue cells signal on microscopy
BV
What do clue cells signal on microscopy
BV
What is the antibiotic of choice fr BV
Metronidazole (for anaerobic bacteria)
Orally or vaginal gel
What is the alternative choice to metronidazole
Clindamycin
Less optimal
What should avoid on metronidazole
Avoid alcohol
What does alcohol and metronidazole cause
Disulfiram-like reaction - nausea and vomitting, flushing and sometimes severe symptoms of shock and angioedmea
Complications ass with BV in pregnant women
Miscarriage
Preterm delivery
PROM
Chorioamnionitis
Low birth weight
Postpartum endometritis
