Bacterial Vaginosis

Question 1

What is bacterial vaginosis?

Answer 1

BV is an overgrowth of anaerobic bacteria in the vagina, and a loss of lactobacilli

Question 2

What bacteria are associated with BV?

Answer 2

Gardenella vaginalis
Mycoplasma hominis
Prevotella

Question 3

What are the risk factors for BV?

Answer 3

Multiple sexual partners
Excessive vaginal cleaning
Recent antibiotics
Smoking
Copper coil

Question 4

What is the presentation of BV?

Answer 4

Grey or white watery discharge
Fishy smelling odour
50% of women are asymptomatic

Question 5

What is Amsel’s criteria for BV?

Answer 5

3 out of 4 symptoms must be present:
- Positive whiff test - fishy smell when potassium hydroxide is added
- Grey or white discharge
- Clue cells on microscopy
- Vaginal pH > 4.5

Question 6

What is the normal vaginal pH?

Answer 6

3.5-4.5

Question 7

What are the first line investigations for BV?

Answer 7

Vaginal pH using swab and pH paper
Charcoal vaginal swab for microscopy

Question 8

What are clue cells?

Answer 8

Epithelial cells from the cervix that have bacteria stuck inside of them

Question 9

What is the first line treatment of BV?

Answer 9

Asymptomatic BV does not require treatment
If symptomatic:
- Oral metronidazole for 5-7 days

Question 10

What are the complications of BV?

Answer 10

Increased risk of catching STIs
Complications in pregnant women:
- Miscarriage
- Preterm delivery
- Premature ROM
- Low birthweight
- Chorioamnionitis