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DipGUM > Bacterial Vaginosis > Flashcards

Bacterial Vaginosis Flashcards

1
Q

What is the commonest cause of abnormal discharge in women of childbearing age?

A

Bacterial vaginosis

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2
Q

What are the normal physiological components of a healthy vagina?

A

Lactobacilli (domain bacteria)
ph < 4.5
low levels of other bacteria

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3
Q

What is the vaginal pH in bacterial vaginosis (BV)?

A

4.5 - 6.0

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4
Q

What are the typical organism implicated in BV? (8)

A 
ANAEROBES:
Gardnerella vaginalis
Prevotella
Mycoplasma hominis
Mobiluncus
Atopobium vaginalis
Clostridiales
Leptotrichia
Sneathia
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5
Q

What are the risk factors for bacterial vaginosis?

A 
vaginal douching
receptive cunnilingus
Black race
recent change of sex partner
smoking
presence of an STI
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6
Q

What are the symptoms of bacterial vaginosis?

A

Offensive fishy smelling vaginal discharge

Asymptomatic (up to 50%)

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7
Q

What are the signs of bacterial vaginosis on examination?

A

Thin, white, homogeneous discharge, coating the walls of the vagina and vestibule

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8
Q

What symptoms or signs are NOT typically associated with BV?

A

Not associated with soreness, itching, or irritation

Not usually associated with signs of inflammation.

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9
Q

What are the risks of BV in pregnancy?

A

late miscarriage
preterm birth
preterm premature rupture of membranes (PPROM)
postpartum endometritis

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10
Q

What is the link between BV and HIV acquisition?

A

increased risk of HIV acquisition in pregnant women with BV

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11
Q

Which STI is the risk reduced for if a woman has BV?

A

decrease in acquisition of Chlamydia in women treated for asymptomatic BV

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12
Q

BV diagnosis:

Amsel’s criteria

A

3 of 4 criteria to confirm diagnosis:

1) Thin, white, homogeneous discharge
2) Clue cells on microscopy of wet mount
3) pH of vaginal fluid >4.5
4) Release of a fishy odour on adding alkali (10% KOH)

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13
Q

BV diagnosis:

Hay/Ison criteria

A

Gram stained vaginal smear:
grade 0 No bacteria present
grade 1 (Normal): Lactobacillus morphotypes predominate
grade 2 (Intermediate): Mixed flora with some Lactobacilli present, but Gardnerella or Mobiluncus morphotypes also present
grade 3 (BV): Predominantly Gardnerella and/or Mobiluncus morphotypes. Few or absent Lactobacilli
grade 4 Gram-positive cocci predominate

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14
Q

Which 2 criteria in the Hay/Ison criteria have not been correlated with clinical features?

A

grade 0

grade 4

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15
Q

What is the Nugent score?

A

Diagnostic criteria for BV
Derived from estimating the relative proportions of bacterial morphotypes to give a score between 0 and 10.
A score of <4 is normal, 4-6 is intermediate, and >6 is BV.

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16
Q

What is the preferred criteria for diagnosis of BV in GUM clinics?

A

Hay/Ison

17
Q

Which organism in high concentrations is associated with BV?

A

HIGH concentration of gardnerella vaginalis

18
Q

What is a DNA probe-based test designed to detect to diagnose BV?

A

HIGH concentrations of gardnerella vaginalis

19
Q

What general advice should be given to a women with symptomatic BV?

A 
AVOID:
vaginal douching
use of shower gel
use of antiseptic agents
shampoo in the bath
20
Q

What is the treatment for BV?

A

METRONIDAZOLE 400mg twice daily for 5-7 days
Metronidazole 2 g single dose
INTRAVAGINAL metronidazole gel (0.75%) once daily for 5 days
Intravaginal clindamycin cream (2%) once daily for 7 days

21
Q

Are there any alternative treatments for BV?

A

Tinidazole 2gram single dose

Clindamycin 300mg twice daily for 7 days

22
Q

What are the benefits of oral metronidazole for BV treatment?

A

treatment is established
usually well tolerated
inexpensive

23
Q

What antimicrobial effect is an advantage for metronidazole over clindamycin?

A

Metronidazole is less active against lactobacilli than clindamycin

24
Q

Conversely, what antimicrobial effect is an advantage for clindamycin over metronidazole?

A

clindamycin is more active than metronidazole against most of the bacteria associated with BV

25
Q

Risks of using clindamycin cream or oral clindamycin?

A

Clindamycin cream can WEAKEN CONDOMS

Pseudomembranous colitis has been reported with both oral clindamycin and clindamycin cream

26
Q

Which pregnant women should be treated for BV?

A

Symptomatic pregnant women

Women with additional RISK FACTORS FOR PRETERM BIRTH may benefit from treatment before 20 week gestation

27
Q

What is the best preparation for treatment of BV in breastfeeding women?

A

Intravaginal

28
Q

Termination of pregnancy and BV infection - what should we do? Why?

A

screen for and treat BV

reduce the incidence of subsequent endometritis and PID

DipGUM (39 decks)

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