Bacterial Vaginosis

Question 1

What organisms cause Bacterial Vaginosis?

Answer 1

• Gardnerella Vaginalis (most common)
• Prevotella spp
• Mycoplasma Hominis

Question 2

What is the Px of BV?

Answer 2

1. Overgrowth of anaerobic bacteria
2. Replace Lactobacilli (dominant vaginal flora)
3. PH rises from 4.5 to 6

Question 3

Is BV a STD?

Answer 3

No

Question 4

What are the RF for BV?

Answer 4

• Sexually active
• New partner
• Other STI
• Vaginal douching
• Bubble bath
• Ethnicity - afrocarribean

Question 5

What are the protective factors of BV?

Answer 5

• Combined oral contraceptive pill (oestrogen encourages lactobacilli).
• Condom use
• Circumcised partner

Question 6

What is the most common cause of pathological vaginal discharge in child-bearing age ?

Answer 6

• BV

Question 7

What is the presentation of BV?

Answer 7

• Half are asymptomatic
• Offensive fishy smell
• No soreness or irritation
• Thin layer of white discharge

Question 8

What are the differential diagnosis of BV?

Answer 8

• Infections
  
  • Candida, trichomoniasis, chlamydia, gonorrhoea, herpes simplex
• Benign
  
  • Physiological, chemical irritants, pregnancy
• tumor
• postmenopausal vaginal discharge

Question 9

What criteria is used for BV?

Answer 9

• Amsel’s criteria
• Ison/Hay criteria

Question 10

Describe the Amsel’s criteria

Answer 10

At least three of the following

• Thing white discharge
• Microscopy showing vaginal epithelial cells coated with a large number of bacilli (‘clue cells’).
• Vaginal pH >4.5.
• Fishy odour on adding 10% potassium hydroxide to vaginal fluid

Question 11

Describe the Ison/Hay criteria used for grading microscopic appearance of vaginal discharge

Answer 11

• Grade 1: normal. Lactobacilli predominate.
• Grade 2: intermediate. Some lactobacilli, but other organisms present.
• Grade 3: BV. Other organisms predominate. Few or absent lactobacilli

Question 12

Why cant G.Vaginalis be used as a diagnostic crietria alone?

Answer 12

Its present in normal flora of up to 40% of women

Question 13

How would you mx BV?

Answer 13

Conservative

• avoid vaginal douching
• avoid using shower gel or bubble bath in bath
• asymptomatic x need tx unless pregnant

Medications

• Oral Metronidazole 400-500mg bd, 5-7 days
• Oral Metronidazole 2g stat. Avoid in pregnancy
• Metronidazole vaginal gel 0.75% once daily for five days.
• Clindamycin vaginal gel 2% once daily for seven days.
• Oral tinidazole 2 g stat.
• Oral clindamycin 300 mg bd for seven days

Question 14

What are the cx of BV?

Answer 14

• Inc. risk of acquiring and transmitting HIV and STD
• Late miscarriage
• Preterm delivery
• Premature rupture of membranes
• Low birth weight
• Postpartum endometriosis

Question 15

What is the prognosis of BV?

Answer 15

• May resolve w/o tx
• 70% have relapse 3 months after tx