Bacterial Vaginosis

Question 1

What are the typical symptoms of bacterial vaginosis?

Answer 1

Thin gray or white vaginal discharge

Question 2

What is the primary causative organism in bacterial vaginosis?

Answer 2

Gardnerella vaginalis

Question 3

What causes bacterial vaginosis?

Answer 3

Overgrowth of anaerobic bacteria and Gardnerella vaginalis with loss of normal lactobacilli flora

Question 4

What is the vaginal pH in bacterial vaginosis?

Answer 4

Greater than 4.5

Question 5

What is the whiff test and what does a positive result suggest?

Answer 5

Addition of KOH to vaginal fluid produces a fishy amine odor

Question 6

What microscopic finding confirms bacterial vaginosis?

Answer 6

Presence of clue cells (epithelial cells coated with bacteria) on wet mount

Question 7

What are the Amsel criteria for diagnosing bacterial vaginosis?

Answer 7

Must meet 3 of 4: vaginal pH >4.5

Question 8

What is the first-line treatment for bacterial vaginosis?

Answer 8

Oral metronidazole

Question 9

What are alternative treatments to oral metronidazole for bacterial vaginosis?

Answer 9

Intravaginal metronidazole or clindamycin

Question 10

What advice should be given regarding alcohol while taking metronidazole?

Answer 10

Avoid alcohol during and for 24–48 hours after treatment due to disulfiram-like reaction

Question 11

How is bacterial vaginosis managed in symptomatic pregnant patients?

Answer 11

Treat with oral metronidazole

Question 12

Should asymptomatic bacterial vaginosis be treated during pregnancy?

Answer 12

Only if the patient is high risk for preterm delivery

Question 13

What are the complications associated with bacterial vaginosis?

Answer 13

Increased risk of preterm labor

Question 14

Is bacterial vaginosis considered a sexually transmitted infection?

Answer 14

No

Question 15

Should asymptomatic sexual partners be treated for bacterial vaginosis?

Answer 15

No

Question 16

What is the next best step if a woman presents with fishy odor

Answer 16

pH >4.5

Question 17

What is the next best treatment for a symptomatic nonpregnant woman diagnosed with bacterial vaginosis?

Answer 17

Oral metronidazole

Question 18

What is the next best treatment for a symptomatic pregnant woman diagnosed with bacterial vaginosis?

Answer 18

Oral metronidazole

Question 19

What is the next best step if a woman with bacterial vaginosis is scheduled for gynecologic surgery?

Answer 19

Treat the bacterial vaginosis to reduce postoperative complications