BV

Question 1

BV biofilm made from?

Other bacterial overgrowth?

Answer 1

Gardenerella (can be a commensal too) and
Atopobium make biofilm which is main culprit.

Others: prevotella, mycoplasma hominid, mobiluncus.

Question 2

BV risk factors.

Answer 2

Smoking
New partner
Black
Receptive oral sex
Douche 
Other sti’s

Question 3

BV diagnosis?

Answer 3

Hay Ison criteria:
Normal (LB present)
Intermediate (some LB but mixed flora with GV or mobiluncus present)
BV- mostly gv/ mobiluncus with occasional LB.

Or Amsels criteria: (need 3 of 4)
Clue cells
Thin homog d/c
pH <4.5
Pps whiff test on adding alkali.

Question 4

BV Rx options

What if found and asymp?
What if pregnant?

Answer 4

Met 400 bd for 5d or 2g stat
Met gel 0.75% od for 5d
Clindamycin cream 2% od 7d

If asymp then women could be offered treatment but not really recommended?

If pregnant and asymp don’t rountinely treat. However consider if other RFs for preterm delivery.

If BFing, not harmful in low doses but may affect breast milk taste, so consider intravaginal Rx. This differs to TV as needs to be systemic as affects paraurethral glands not just vagina.