Bacterial Vaginosis

• Overall M/c vaginitis
• This is due to the alteration of vaginal flora.
• Lactobacilli decrease whereas coccobacilli and  Gardnerella increases.
• It is not an STD.
• Gardnerella is the causative agent.
• Vaginosis is associated with minimal inflammatory response, the vaginal fluid reveals few leucocytes.
• The concentration of bacteria is increased manifold (100–1000 fold) as compared to normal women.

Symptoms

• M/C  complaint is Foul-smelling dirty white discharge.
• No inflammation-hence no itching.
• Dyspareunia.

Physical findings

• Congestion of vaginal walls.
• Microhaemorrhages.
• Presence of abnormal vaginal discharge.
• pH is raised.
• Tenderness/discomfort during examination.

Risk factors for Bacterial vaginosis

• Oral sex
• Douching
• Cigarette smoking
• Sex during menses
• Intrauterine device
• Early age of sexual intercourse
• New partner/multiple partners
• Sexual activity with other women.

Investigations

• IOC -Saline microscopy ‘Clue cells’, i.e. vaginal epithelial cells to which bacteria have adhered is seen.
• The gold standard investigation is a Gram stain.
• On gram staining -Nugent scoring is done.
• The Nugent score is calculated by assessing the Presence of lactobacillus (Gram +ve rods-scored as 0 to 4), Gardnerella vaginalis (scored as 0 to 4) and mobiluncus (Gram variable rods-scored as 0-2).
• A score of > 7 is consistent with bacterial vaginosis.
• Hanging drop examination—Reveals the presence of motile trichomonas organisms.
• KOH treated preparation of vaginal discharge—Reveals the presence of pseudomycelia and spores of candidal organisms.
• pH > 4.5
• Whiff test—The fishy odour is suggestive of the presence of bacterial vaginosis.
• Positive amine test.
• Note: Amine test/Whiff test. i.e. 10% KOH added to discharge Positive, i.e. on adding 10% KOH to discharge, fishy odour or amine like odour obtained.

Treatment

1. Non-pregnant females:Metronidazole (500 mg BD x 7 days) or clindamycin Cream  2%,  one full application (5g)  intravaginal at bedtime for 7 days or clindamycin 300 mg BID x 7 days
2. Pregnancy: DOC Metronidazole (250 mg TDS x 7 days) to be avoided in the first trimester.
3. Simultaneous treatment of male partners not needed as BV is not an STD Prevention—Use of barrier contraceptives.

Hazards of Bacterial Vaginosis

Women with BV are at increased risk for:

• PID
• Postabortal PlD
• Postoperative cuff infections after hysterectomy
• Abnormal cervical cytology.

Pregnant women with BV are at risk for:

• PROM
• Preterm delivery
• Chorioamnionitis
• Post cesarean endometritis