Bacterial Vaginosis

Question 1

Vaginal discharge is a normal physiological response, so it is important to ask about if this has changed. What can affect vaginal discharge?

1 - age
2 - hormones
3 - pregnancy
4 - hygiene habits
5 - sexual activity
6 - all of the above

Answer 1

6 - all of the above

Question 2

Vaginal discharge is a normal physiological response. The vagina has a natural pH which is facilitated by the vaginal flora helping maintain a low pH, and produce natural antimicrobials such as Hydrogen Peroxide Bacteriocin like substances. What is the main bacteria that is part of the healthy vaginal flora that functions maintaining normal bacterial flora and health?

1 - escherichia coli
2 - gardnerella vaginalis
3 - mobiluncus species
4 - mycoplasma hominis

Answer 2

1 - escherichia coli

• others all lead to bacterial vaginosis

Question 3

A healthy vaginal flora is involved in maintaining a low pH, which acts as a barrier to infection. What is the normal vaginal pH?

1 - 1 - 3
2 - 3.8 - 5
3 - 2 - 5
4 - 4.8 - 6

Answer 3

2 - 3.8 - 5

Question 4

What is the most common cause of vaginal discharge in women of child bearing age in the UK?

1 - menstruation
2 - pregnancy
3 - bacterial vaginosis
4 - sexually transmitted infection

Answer 4

3 - bacterial vaginosis

Question 5

Which of the following is NOT a risk factor for bacterial vaginosis?

1 - multiple or new partners
2 - douching (cleaning inside vagina)
3 - washing practices
4 - smoking
5 - Intrauterine device (IUD)
6 - barrier method intercourse
7 - Intrauterine system (IUS)

Answer 5

6 - barrier method intercourse

• BV can occur in women who have not had sex
• IUS = progesterone only release
• IUD = copper release

Question 6

Bacterial vaginosis (BV) is when the natural flora become unbalanced and there is polymicrobial overgrowth of bacteria. Which bacteria is most commonly overgrown?

1 - gardnerella vaginalis
2 - mobiluncus species
3 - mycoplasma hominis
4 - all equally affect BV

Answer 6

1 - gardnerella vaginalis

• gram variable, can be both + or -
• typically stain purple before degradation of peptidoglycan wall and become gram negative and become pink

Question 7

Once the number of healthy flora begin to decline, mainly lactobacillus, there is an overgrowth of catalase negative organisms. These include gardnerella vaginalis, mobiluncus species and mycoplasma hominis. This in turn increases the production of ammonia, polyamines and trimethylamaine. This can then cayse which of the following?

1 - transudation of fluid
2 - increased pH
3 - fishy odur
4 - exfoliation of epithelial cells
5 - all of the above

Answer 7

5 - all of the above

• transudation of fluid = fluid moving across membranes and between cells
• exfoliation of epithelial cells = epithelial cells detaching from vaginal walls

Question 8

Are all patients with bacterial vaginosis symptomatic?

Answer 8

• no
• 50% are asymptomatic

Question 9

A women presents to the GUM clinic and identifies changes in her discharge. Which of the following is least likely to be present in a patient with suspected vaginal discharge due to bacterial vaginosis?

1 - pruritus and inflammation
2 - musty or fishy odour
3 - thin, grey-white vaginal discharge
4 - raised vaginal pH

Answer 9

1 - pruritus and inflammation
- BUT bacterial vaginosis can cause soreness and irritation during sex

Question 10

When trying to diagnose a patient with bacterial vaginosis (BV), we can perform gram staining from a vaginal smear. Which of the following can be found in the absence of BV?

1 - gardnerella vaginalis
2 - mobiluncus species
3 - mycoplasma hominis
4 - escherichia coli

Answer 10

1 - gardnerella vaginalis

Scored using the Hay/Ison Criteria based in gram staining
- I Normal, II Intermediate, III BV
- Culture not useful

Question 11

In patients with bacterial vaginosis (BV), what % of women do not need treatment as BV spontaneously sesolves?

1 - 3%
2 - 13%
3 - 30%
4 - 60%

Answer 11

3 - 30%
- only symptomatic women are treated

Question 12

What is the 1st line medication when treating a patient with a confirmed diagnosis of bacterial vaginosis?

1 - cephalexin 1g BD for 3 days
2 - ceftriaxone 1g TDS for 5 days
3 - doxycycline 100mg 400mg TDS for 3 days
4 - metronidazole 400mg BD for 5 days

Answer 12

4 - metronidazole 400mg BD for 5 days
- also given a single dose of metronidazole at 2g, BUT not in pregnancy

• topical metronidazole or topical clindamycin as alternatives