Infective vaginitis

Question 1

BV - epi

Answer 1

1. BV is caused by an overgrowth of mixed anaerobes, including
   Gardnerella and Mycoplasma hominis, which replace the usually dominant vaginal lactobacilli
2. Commonest cause of abnormal vaginal discharge in women of
   childbearing age
3. Prevalence 5–15% white women, 45–55% black African-American
   women
4. Not sexually transmitted
5. About 12% of women will experience BV at some point in their lives, but what triggers it remains unclear

Question 2

BV - symptoms (3)

Answer 2

1. May be asymptomatic
2. Usually presents with profuse, whitish grey, offensive smelling vaginal discharge
3. Characteristic fishy smell due to presence of amines released by bacterial proteolysis and is often distressing to the woman

Question 3

BV - dx (Amsel criteria, 3 out of 4 required for dx)

Answer 3

1. Homogenous grey-white discharge
2. Increased vaginal pH>5.5
3. Characteristic fishy smell
4. ‘Clue cells’ present on microscopy (squamous epithelial cells with bacteria adherent on their walls)

Question 4

BV - complications (1)

Answer 4

1. Increased risk of pelvic infection after gynaecological surgery

Question 5

BV - mx

Answer 5

1. May resolve spontaneously and if successfully treated has a high recurrence
   rate. However, most women prefer it to be treated

Options

2. Metronidazole 400mg orally bd for 5 days; or
3. Metronidazole 2g (single dose)
4. Clindamycin 2% cream vaginally at night for 7 days
5. Lifestyle factors—avoidance of vaginal douching/overwashing which can destroy natural vaginal flora

Question 6

BV - implications in pregnancy

Answer 6

Increased risk of:

1. Mid-trimester miscarriage
2. Preterm rupture of membranes
3. Preterm delivery