Bacterial Vaginosis (Complete) Flashcards
What is bacterial vaginosis (BV)?
Increased vaginal discharge with a characteristic “fishy” odour secondary to abnormal increase in anaerobic bacteria
How does bacterial vaginosis occur?
Imbalance in the vaginal microbiome characterised by an overgrowth of anaerobic bacteria and a loss of lactobacilli,
What anaerobic organisms tend to overgrow in BV?
Gardnerella vaginalis
BV is associated with a gain and loss of which bacteria?
Gain: Gardnerella vaginalis (anaerobic bacteria)
Loss: Lactobaccilli
What risk factors are associated with BV? (5)
Factors which lead to imbalance in microbiome:
Sexually active (Especially if multiple panters)
Douching: Washing or cleaning inside the vagina
Inconsistent condom usage
Chilbearing age
Hormonal changes (e.g. pregnancy)
What are the signs and symptoms of BV?
Increased vaginal discharge
Grey-white watery discharge
Characteristic “fishy” smelling discharge, particularly after intercourse
Vaginal itching or irritation (present but is less common)
Assymptomatic (in 50%)
What differentials should be considered alongside BV?
Vulvovaginal Candidiasis
Trichomonas Vaginalis Infection
Chlamydia or Gonorrhoea infection
Atrophic Vaginitis
How does BV differ to vulvovaginal candidiasis (thrush)?
Discharge consistency: VVC typically has thick, white, clumpy discharge, while BV has thin, grayish-white discharge
Odor: BV often has a strong, fishy odor, especially after intercourse, whereas VVC discharge is usually odorless.
Itching and irritation: Intense itching and irritation are more characteristic of VVC, while BV may have mild or no itching.
Redness and Swelling: VVC commonly causes redness and swelling of the vulva and vagina, which is less common in BV.
Pain During Urination and Intercourse: These symptoms are more frequent and severe in VVC compared to BV.
How does BV differ to Trichomonas Vaginalis Infection (Trichomoniasis)
Discharge:
BV: Thin, grayish-white, homogenous.
Trichomoniasis: Frothy, yellow-green, and may be copious.
Odor:
BV: Strong, fishy odor, especially after intercourse.
Trichomoniasis: Foul-smelling, but not specifically fishy.
Itching and Irritation:
BV: Mild or no itching; many women are asymptomatic.
Trichomoniasis: Intense itching and irritation are common.
Pain:
BV: Generally no pain during urination or intercourse.
Trichomoniasis: Pain or discomfort during urination and intercourse are common.
Other Signs:
BV: No significant inflammation or redness.
Trichomoniasis: Significant inflammation, redness, and “strawberry cervix” may be observed.
How does BV differ to Chlamydia or Gonorrhoea infection
Discharge:
Chlamydia discharge is typically mucopurulent and odorless, Gonorrhea discharge is yellowish or greenish and purulent.
Odor: Chlamydia and Gonorrhea typically do not have a strong odor.
Pain During Urination: Common in Chlamydia and Gonorrhea, but not in BV.
Lower Abdominal Pain: More likely in Chlamydia and Gonorrhea, not typical of BV.
Pain During Intercourse: Can occur with Chlamydia and Gonorrhea, but is not typical of BV.
Bleeding: Post-coital and intermenstrual bleeding can occur with Chlamydia and Gonorrhea but is not associated with BV.
Asymptomatic Cases: All three can be asymptomatic, but this is more common with Chlamydia and Gonorrhea.
How does BV differ to atrophic vaginitis?
Age: Less commonly seen in postmenopausal women versus atrophic vaginitis
Discharge: atrophic vaginitis usually has scant or no discharge.
Odor: Atrophic vaginitis generally has no characteristic odor.
Itching and Irritation: BV may cause mild itching or be asymptomatic, while atrophic vaginitis often causes significant itching, burning, and irritation.
Pain and Discomfort: Atrophic vaginitis is more likely to cause pain during intercourse and urination, which is less common in BV.
Appearance of Vaginal Tissue: In BV, the vaginal tissue may appear relatively normal, whereas in atrophic vaginitis, the tissue is often pale, thin, and fragile.
Vaginal pH: Both conditions involve an elevated vaginal pH, but for different reasons: BV due to bacterial imbalance and atrophic vaginitis due to decreased estrogen levels.
What criteria is used to diagnose BV?
Amsel criteria (3/4 points)
What is the amsel criteria for BV?
Vaginal pH >4.5
Homogenous grey or milky discharge
Positive whiff test (addition of 10% potassium hydroxide produces a fishy odour)
Clue cells present on wet mount
What is clue cells on wet mount and why is it associated with BV?
The overgrown anaerobic bacteria adhere to the surface of vaginal epithelial cells.
Form a thick biofilm over the epithelial cells
They become “clue cells” which appear granular and stippled because the bacteria obscure the cell margins, giving the cells a characteristic “salt-and-pepper” appearance.
What is added to discharge in a positive whiff test?
Pottasium hydroxide
Why does intercouse lead to fishy odor in BV?
Sperm is alkaline so raises pH
Raised pH trigger release of foul smelling odor from anaerobic bacteria
What is management of BV?
If assymptomatic: No treatment
If Symptomatic…
Pharmacological: (Orally or intravaginally)
Metronidazole (5-7 days)
Clindamycin
What should be informed to the patient before starting management for BV?
Common for relapse of symptoms: >50% within 3 months
Sexual partners do not require treatment
What are some complications that can occur with BV in pregnant woman? (3)
Increase the risk for premature birth and low birth weight
Late miscarriage
Chorioaminitis (acute inflammation of the membranes and chorion of the placenta)
How is BV managed in pregnant women?
Screening for BV during regular antenatal care
Pharmacological:
Low-dose oral metronidazole: 5-7 days oral or topical (okay to use across pregnancy terms)
How is BV diagnosed assymptomatically?
Picked up on a swab done for different reasons
What should be done if assymptomatic pregnant woman is detected for BV during antenal screen?
Discuss with their obsterician to check if treatment is indicated
In which cases is assymptomatic treatment of BV requiured?
Woman undergoing termination of pregnancy (Due to increased risk of post-surgical complications).
Pregnant women: If reccomended by obsterician due to potential complications
