Bacterial Vaginosis Flashcards
Define bacterial vaginosis.
- Replacement of normal vaginal flora with 100 - 1000x concentrations of aerobic bacteria
- NOT an STD/STI,
= sexually-ASSOCIATED - Associated with:
- multiple sex partners
- new partners
- douching
- intrauterine contraceptives
Those with bacterial vaginosis are at an increased risk of which conditions?
- STD’s/STI’s
- UTI’s
- Post-gynecologic surgery infections
- Pre-term labor
What does the CDC recommend for patients with bacterial vaginosis?
Screening for STD’s/DTI’s
Describe assessment findings for bacterial vaginosis.
- About 50% asymptomatic
- Profuse grayish-white discharge
- Malodorous discharge/vagina:
- unpleasant
- fishy
- musty - Increased odor after intercourse
- Vulvovaginal burning and pruritus
What are Amsel’s criteria for diagnosing bacterial vaginosis?
Amsel’s Criteria: 3+ of the following:
- Homogenous white discharge coating vagina/vulva
- Vaginal pH > 4.7
- Positive “whiff test”: fishy odor of vaginal discharge before/after addition of KOH
- Microscopic exam shows:
- clue cells
- 1+ epithelial cells coated with bacteria
What is the primary treatment for bacterial vaginosis?
- Metronidazole 500 mg PO BID x 7 days
- Metronidazole gel 0.75%
1 full applicator (5 g) intravaginally QD x 5 days - Clindamycin cream 2%
1 applicator (5 g) intravaginally qHS x 7 days
What are alternate treatments for bacterial vaginosis?
- Clindamycin 300 mg PO BID x 7 days
- Clindamycin ovules 100 mg intravaginally qHS x 3 days
Avoid in pregnancy:
- Secnizadole 2 g oral granules x 1 dose (in unsweetened apple sauce. yogurt)
- Tinidazole 2 g PO QD x 2 days
- Tinidazole 1 g PO QD x 5 days
List non-pharmaceutical treatments for bacterial vaginosis.
No alcohol until:
- 24 hours after last dose of metronidazole
- 72 hours after last dose tinidazole
Condom use to increase cure rates
Avoid douching to prevent recurrences
Consider Vitamin D 1000 - 2000 IU QD
Consider ruling out HIV with recurrent BV
