Sexually Transmitted Diseases - Bacterial Vaginosis

Question 1

What is Bacterial Vaginosis? (4)

Answer 1

1. Not an STI.
2. Overgrowth of Anaerobic Bacteria in Vagina e.g. Gardnerella vaginalis; Mycoplasma Hominid; Prevotella species.
3. Loss of Lactobacilli (main component in healthy vaginal bacterial flora) in Vagina - produce lactic acid (keeping vaginal pH lower than 4.5).
4. Increased risk of STIs.

Question 2

Risk Factors of Bacterial Vaginosis (5).

Answer 2

1. Multiple Sexual Partners.
2. Excessive Vaginal Cleaning - Douching, Cleaning Products, Vaginal Washes.
3. Recent Antibiotics.
4. Smoking.
5. Copper Coil.

Question 3

Clinical Presentation of Bacterial Vaginosis (3).

Answer 3

1. Fishy-Smelling Watery Grey/White Vaginal Discharge.
2. Asymptomatic.
3. No itching, irritation, pain.

Question 4

Investigations of Bacterial Vaginosis (3).

Answer 4

1. Speculum Examination : Typical Discharge.
2. High Vaginal Swab : Charcoal Vaginal Swab - Clue Cells (Epithelial Cells from Cervix with Bacteria (G. vaginalis) stuck inside them) on Microscopy.
3. Vaginal pH (swab and pH Paper) : Above 4.5 (should be 3.5-4.5).

Question 5

Management of Bacterial Vaginosis (4).

Answer 5

1. Asymptomatic - No Treatment.
2. Symptomatic - Metronidazole (Anaerobic) Vaginal or Oral.
3. 2nd Line : Clindamycin.
4. DON’T DRINK ALCOHOL with Metronidazole - Disulfiram-Like Reaction (Nausea, Vomiting, Flushing, Shock, Angioedema Symptoms).