Bacterial Vaginosis (BV)

Last updated 20.09.12

 

 

Definition

-  Disruption of normal vaginal flora promoting opportunistic bacterial growth

 

Features

-  Most common cause of vaginal discharge

 

Dx

-  Amsels method of Dx = 3+ of

-  Vaginal pH > 4.5 (due to loss of lactobacilli)

-  Grey, white adherent disharge

-  Saline Microscopy: Clue cells

-  Odour: Whiff amine test

-  Add 10% KOH

-  Fishy smell

 

Cause

-  Loss of normal vaginal flora

-  Less lactobacilli

-  Increased numbers of Garnerella vaginalis, mycoplasma & anaerobes

 

Risk Factors

-  Smoking

-  New sexual partner

-  Nil condom use

-  Female same sex partner

-  IUD

-  Vaginal douching

 

Associated S/S

-  Often asymptomatic

-  Vaginal discharge: grey, white & adherent

-  Vaginal odour

-  Vaginal/vulval itch

-  Dysuria

 

Complications

-  Endometritis (PID)

-  Particulary post TOP or IUD insertion

-  Increased risk of STIs: HSV, Chalmydia, Gornorrhoea

-  Pregnancy

-  Miscarriage (2nd trimester)

-  Preterm labour

-  Low birth weight

 

Ix

-  Vaginal pH > 4.5

-  HVS for MCS: BV

-  Saline Microscopy: Clue cells

-  Whiff amine test

-  +/- Endocervical MCS: Gonorrhoea, Chlamydia

 

Mx

-  Partners

-  No need to treat male partners

-  Rx female partners

-  Symptomatic

-  Metronidazole 400mg BD 7/7

-  OR Clindamycin 2% cream 7/7

-  Children consider Vinegar bath (1cup+/-)

-  Asymptomatic

-  Rx only if undergoing invasive procedure (TOP, IUD insertion)

-  Pregnancy

-  Rx all symptomatic women & those at risk of preterm labour

-  Metronidazole 400mg BD 7/7

-  OR Clindamycin 300mg BD 7/7

 

 

 

References