BV

Question 1

WHat is BV (RF and aetiology)

Answer 1

commonest cause of vaginal discharge–
sexually associated-unclear if WLW STI

RF- smoking, new sex partnes, vaginal douching, unprotected sex (inside ejac), bubble baths, other STI, copper STI
Protective- condoms, circumcision, COCP

Occurps and remits spontaneously –
overgrowth of anearobic bacteria (GARDENELLA vaginalis) that replace Lactobacilli
This increases pH
(gardenella can be commensal -why grading)

4 grades – only 3 is BV

Question 2

Sx and Ix of BV

Answer 2

asymptomatic 50%/not grade 3
Diagnostic is clinical +microscope – offensive fishy smelling discharge, high pH (also TV)
micrscope - clue sells -vaginal epithelial cells coated in bacilli (high presence of anaerobe) -care for TV ofc
from swab from posterior cervix - do pH then wet slide

Amsels criteria -
3 out of 4 of - thin, white homogenous discharge
Clue cells microscopy
Vaginal pH 4.5
fishy odour- esp when adding KOH

Hay inson-
grade 1- lactobacilli
grade 2- Intemediate-mixed flora with presence
Grade 3- main gardenella/mobiluncus, low lactobacilli

Question 3

Mx and complications of BV

Answer 3

Mx-
1st line is PO Metrodinazole (400mg, BD, 7days)
2nd - Intravaginal clindamycin PV cream
avoid douchgin, shower gel, washing

complication- associated with late misscariage, preterm birth, PROM, postpartum endomitriosis
increase risk of STI