Bacterial vaginosis

Question 1

Define bacterial vaginosis

Answer 1

overgrowth of predominantly anaerobic organisms and a loss of lactobacilli. The vagina loses its normal acidity, and its pH increases to greater than 4.5.

Question 2

What are the causes of bacterial vaginosis

Answer 2

Gardnerella vaginalis
Prevotella species
Mobiluncus species
Atopobium vaginae
Megasphaera type 1

Question 3

What are the risk factors for bacterial vaginosis

Answer 3

Being sexually active
The use of douches, deodorant, and vaginal washes; menstruation; and presence of semen in the vagina.
Copper intrauterine device (hormonal = protective)
Smoking

Question 4

What are the symptoms and signs of bacterial vaginosis

Answer 4

50% asymptomatic

Vaginal discharge (thin, white)
Fishy odour
Otherwise painless

Pelvic examination
- Thin, white/grey, homogeneous coating of the vaginal walls and vulva that has a fishy odou

Question 5

When can you treat for BV without investigation

Answer 5

Low risk of STI
Not pregnant
No other symptoms of other conditions
Symptoms have no developed pre or post gynae procedure
Not postnatal or post miscarriage
Not pre or post TOP
This is a first episode of suspected BV, or if recurrent, a previous episode of recognizably similar symptoms was previously diagnosed to be BV following examination.

Question 6

What investigations should be done for BV

Answer 6

Usually clinical diagnosis

Bedside:
- Vaginal pH testing: >4.5 (alkaline)
- High vaginal swab for wet mount microscopy: clue cells
- Vaginal swab gram stain: lactobacillus reduced/absent
- “whiff” test: positive (addition of 10% potassium hydroxide)

Bloods: HIV serology, syphilis serology

Question 7

What is Amsel’s criteria for diagnosis of BV

Answer 7

3/4 should be present:
thin, white homogenous discharge
clue cells on microscopy: stippled vaginal epithelial cells
vaginal pH > 4.5
positive whiff test (addition of potassium hydroxide results in fishy odour)

Question 8

What is the management for bacterial vaginosis

Answer 8

Asymptomatic: hygiene advice, treatment not required
Symptomatic: oral metronidazole 2x a day for 7 days and GUM referral
Second line: intravaginal/oral clindamycin

Question 9

What hygiene advice should be given for bacterial vaginosis

Answer 9

Bubble Bathing
Sexual activity
Copper IUD
Vaginal pH increase
Avoid vaginal douching, shower gel, use of shampoo in bath