bacterial vaginosis

Question 1

caused by

Answer 1

polymicrobial dysbiosis chaaracterised by a change from a lactobacillus dominant state to one with high diversity and quantities of anaerobic bacteria

Question 2

is bacterial vaginosis sexually transmissable

Answer 2

sexaul transmission has not be established
strong association between acquision of BV and increased sexual partners, exposure to new sexual partners and lack of condom use

Question 3

symptoms

Answer 3

malodourous vaginal dischargee
thin whie or greyish homogenous veginal discharge
commonly asymptomatic

Question 4

complications

Answer 4

increased risk of
- spontenous abortion
- premature labour
- chorioamnionitis
- postpartum endometriosis
- PID
- aqcuision of chlamydia, gonorrhea, herpes
- tranmission of HIV

Question 5

diagnosis of BV

Answer 5

clinical diagnosis made using the amsel critera: if 3 of 4 of the following are present, presumptive treatment may be offered
1. thin white/grey homogenous discharge on speculum examination
2. elevated vaginal pH
3. malodour with addition of potassium hydroxide to vaginal secretions or genital malodour on examination
4. clue cells on microscopy of gram stain of high vaginal swab

Question 6

management of BV

Answer 6

metronidazole (oral or intravaginal gel nocte) or clindamycin (intravaginal cream or oral)

Question 7

BV with copper IUD

Answer 7

copper IUD is associated with increased risk of BV
if a patient has reepeated BV with the copper IUD, consider switching to an alternative method

Question 8

recurrent infection

Answer 8

intravaginal metronodazole gel twice per week for 4 months reduces recurrence during treatment, but benefit does not persist when discontinued
seek specialist advice if required

Question 9

condom use

Answer 9

intraveginal preparations may affect condom integrity