Bacterial vaginosis

Question 1

What is BV?

Answer 1

An overgrowth of anaerobic bacteria in the vagina caused by loss of lactobacilli in the vagina

Question 2

Is BV an STI?

Answer 2

NO but it can increase risk of STIs

Question 3

What is lactobacilli?

Answer 3

Part of healthy vaginal bacterial flora which produces lactic acid that keeps vaginal pH under 4.5 - the acidic environment prevents other bacteria from overgrowing

Question 4

What are examples of anaerobic bacteria associated with bacterial vaginosis?

Answer 4

• Gardnerella vaginalis (most common)
• Mycoplasma hominis
• Prevotella species

Question 5

What are the risk factors for BV?

Answer 5

• Multiple sexual partner
• excessive vaginal cleaning (douching, use of cleaning products)
• recent antibiotic
• smoking
• copper coil

Question 6

What is the presentation of BV?

Answer 6

Fishy smelling, grey or white discharge

Question 7

What investigations can you do for BV?

Answer 7

Vaginal pH can be tested using a swab and pH paper - normal vaginal pH is 3.5-4.5. BV occurs with a pH above 4.5 (due to loss of lactobacilli)

Vaginal swab can be taken for microscopy with a high vaginal swab during a speculum exam

Question 8

What does BV show on microscopy?

Answer 8

Clue cells which are epithelial cells from the cervix that have bacteria stuck inside them - Gardnerella vaginalis

Question 9

What is the management for BV?

Answer 9

• Asymptomatic BV → no treatment
• Metronidazole given orally or by vaginal gel for 5-7 days. - Assess for additional pelvic infections such as chlamydia and gonorrhoea

Question 10

What should you advise patients on metronidazole?

Answer 10

Avoid alcohol as it can cause nausea & vomiting, flushing and even angioedema and shock

Question 11

What are the complications of BV?

Answer 11

• Increases risk of STIs
• miscarriage
• premature rupture of membrane
• chorioamnionitis
• postpartum endometriosis