Bacterial Vaginosis Flashcards
What is the commonest cause of abnormal discharge in women of childbearing age?
Bacterial vaginosis
What are the normal physiological components of a healthy vagina?
Lactobacilli (domain bacteria)
ph < 4.5
low levels of other bacteria
What is the vaginal pH in bacterial vaginosis (BV)?
4.5 - 6.0
What are the typical organism implicated in BV? (8)
ANAEROBES: Gardnerella vaginalis Prevotella Mycoplasma hominis Mobiluncus Atopobium vaginalis Clostridiales Leptotrichia Sneathia
What are the risk factors for bacterial vaginosis?
vaginal douching receptive cunnilingus Black race recent change of sex partner smoking presence of an STI
What are the symptoms of bacterial vaginosis?
Offensive fishy smelling vaginal discharge
Asymptomatic (up to 50%)
What are the signs of bacterial vaginosis on examination?
Thin, white, homogeneous discharge, coating the walls of the vagina and vestibule
What symptoms or signs are NOT typically associated with BV?
Not associated with soreness, itching, or irritation
Not usually associated with signs of inflammation.
What are the risks of BV in pregnancy?
late miscarriage
preterm birth
preterm premature rupture of membranes (PPROM)
postpartum endometritis
What is the link between BV and HIV acquisition?
increased risk of HIV acquisition in pregnant women with BV
Which STI is the risk reduced for if a woman has BV?
decrease in acquisition of Chlamydia in women treated for asymptomatic BV
BV diagnosis:
Amsel’s criteria
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)
BV diagnosis:
Hay/Ison criteria
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
Which 2 criteria in the Hay/Ison criteria have not been correlated with clinical features?
grade 0
grade 4
What is the Nugent score?
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.
What is the preferred criteria for diagnosis of BV in GUM clinics?
Hay/Ison
Which organism in high concentrations is associated with BV?
HIGH concentration of gardnerella vaginalis
What is a DNA probe-based test designed to detect to diagnose BV?
HIGH concentrations of gardnerella vaginalis
What general advice should be given to a women with symptomatic BV?
AVOID: vaginal douching use of shower gel use of antiseptic agents shampoo in the bath
What is the treatment for BV?
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
Are there any alternative treatments for BV?
Tinidazole 2gram single dose
Clindamycin 300mg twice daily for 7 days
What are the benefits of oral metronidazole for BV treatment?
treatment is established
usually well tolerated
inexpensive
What antimicrobial effect is an advantage for metronidazole over clindamycin?
Metronidazole is less active against lactobacilli than clindamycin
Conversely, what antimicrobial effect is an advantage for clindamycin over metronidazole?
clindamycin is more active than metronidazole against most of the bacteria associated with BV
Risks of using clindamycin cream or oral clindamycin?
Clindamycin cream can WEAKEN CONDOMS
Pseudomembranous colitis has been reported with both oral clindamycin and clindamycin cream
Which pregnant women should be treated for BV?
Symptomatic pregnant women
Women with additional RISK FACTORS FOR PRETERM BIRTH may benefit from treatment before 20 week gestation
What is the best preparation for treatment of BV in breastfeeding women?
Intravaginal
Termination of pregnancy and BV infection - what should we do? Why?
screen for and treat BV
reduce the incidence of subsequent endometritis and PID
