Bacterial Vaginosis BV

Question 1

What is bacterial vaginosis (BV)?

Answer 1

BV is a condition characterised by an imbalance in the vaginal microbiota, with a reduction in lactobacilli and overgrowth of anaerobic bacteria.

Question 2

What is the prevalence of bacterial vaginosis?

Answer 2

BV is the most common cause of abnormal vaginal discharge in women of reproductive age.

Question 3

What are the common symptoms of bacterial vaginosis?

Answer 3

Symptoms include thin, grey-white vaginal discharge with a fishy odour, particularly after intercourse or during menstruation.

Question 4

Can bacterial vaginosis be asymptomatic?

Answer 4

Yes, many cases of BV are asymptomatic.

Question 5

What is the aetiology of bacterial vaginosis?

Answer 5

BV results from an imbalance in the vaginal flora, often triggered by factors such as douching, new or multiple sexual partners, or use of intrauterine devices (IUDs).

Question 6

What are the risk factors for bacterial vaginosis?

Answer 6

Risk factors include recent antibiotic use, smoking, multiple sexual partners, new sexual partners, and vaginal douching.

Question 7

What are the key organisms involved in bacterial vaginosis?

Answer 7

Organisms include Gardnerella vaginalis, Atopobium vaginae, and other anaerobic bacteria.

Question 8

How does bacterial vaginosis affect the vaginal pH?

Answer 8

BV increases the vaginal pH above 4.5 due to a reduction in lactobacilli and overgrowth of anaerobic bacteria.

Question 9

What is the characteristic clinical finding of bacterial vaginosis?

Answer 9

A thin, grey-white, malodorous discharge is the hallmark of BV.

Question 10

What is the diagnostic method for bacterial vaginosis?

Answer 10

Diagnosis is clinical and may include Amsel’s criteria or Nugent scoring from a vaginal swab.

Question 11

What are Amsel’s criteria for diagnosing bacterial vaginosis?

Answer 11

Amsel’s criteria include: (1) thin, homogenous discharge, (2) vaginal pH >4.5, (3) positive whiff test with 10% KOH, and (4) presence of clue cells on microscopy.

Question 12

What are clue cells?

Answer 12

Clue cells are vaginal epithelial cells covered with bacteria, visible under microscopy, and are diagnostic of BV.

Question 13

What is the Nugent score?

Answer 13

The Nugent score is a scoring system based on the presence of specific bacterial morphotypes on a Gram-stained vaginal smear.

Question 14

How is bacterial vaginosis treated?

Answer 14

First-line treatment is metronidazole, either orally or as a vaginal gel. Clindamycin is an alternative.

Question 15

What is the recommended dosage of metronidazole for bacterial vaginosis?

Answer 15

Metronidazole 400-500 mg orally twice daily for 5-7 days, or as a single 2g dose.

Question 16

What are the side effects of metronidazole?

Answer 16

Side effects include nausea, metallic taste, and potential interaction with alcohol causing a disulfiram-like reaction.

Question 17

What are the complications of untreated bacterial vaginosis?

Answer 17

Complications include increased risk of sexually transmitted infections (STIs), pelvic inflammatory disease (PID), and adverse pregnancy outcomes.

Question 18

How does bacterial vaginosis affect pregnancy?

Answer 18

BV in pregnancy is associated with preterm delivery, low birth weight, and late miscarriage.

Question 19

What are the differential diagnoses for bacterial vaginosis?

Answer 19

Differential diagnoses include vulvovaginal candidiasis, trichomoniasis, and STIs such as chlamydia or gonorrhoea.

Question 20

How can bacterial vaginosis be prevented?

Answer 20

Prevention strategies include avoiding douching, limiting the number of sexual partners, and using condoms.

Question 21

Is bacterial vaginosis sexually transmitted?

Answer 21

BV is not classified as a sexually transmitted infection, but sexual activity can influence the vaginal microbiota.

Question 22

Can bacterial vaginosis recur?

Answer 22

Yes, recurrence is common, often due to incomplete treatment or persistence of risk factors.

Question 23

How is recurrent bacterial vaginosis managed?

Answer 23

Management may include extended courses of metronidazole, probiotics, or consideration of suppressive therapy.

Question 24

Is bacterial vaginosis associated with other health conditions?

Answer 24

BV increases susceptibility to STIs, including HIV, and is associated with gynecological conditions like endometritis.

Question 25

Can asymptomatic bacterial vaginosis be treated?

Answer 25

Treatment of asymptomatic BV is typically not necessary unless the patient is pregnant or undergoing a procedure such as IUD insertion.