Bacterial Vaginosis

INTRODUCTION:

• 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.
• Gardnerella is the causative agent

GENERAL FEATURES:

• Symptoms—
• Pruritus, burning
• Malodourous discharge and dyspareunia.

Physical findings:

• Congestion of vaginal walls, 
• Microhaemorrhages,
• Presence of abnormal vaginal discharge
•  Increase in vaginal pH (alkacid papers).
• Tenderness/discomfort during examination.

INVESTIGATIONS:

• Hanging drop examination—Reveals presence of motile trichomonas organisms.
• KOH treated preparation of vaginal discharge—Reveals presence of pseudomycelia and spores of candidal organisms.
• pH > 4.5
• Whiff test—The fishy odour is suggestive of the presence of bacterial vaginosis.
• Gram’s stain—This may reveal presence of gram negative intracellular and extracellular diplococci suggestive of gonococci, Clue cells suggestive of bacterial vaginosis.
• Positive amine test

Culture:

• Chocolate Agar—Gonococci
• Sabouraud’s medium or Nickerson’s medium—Candida
• Special enriched medium—Trichomonas
• Trichomonas infection.

TREATMENT:

• Prevention—Use of barrier contraceptives.
• Medication—Treatment should include both partners.
• Oral Metronidazole—500 mg orally twice daily after meals for 7 days. Or 2 g stat.
• Advisable to defer treatment during first trimester of pregnancy.
• Side effects: nausea, metallic taste, antabuse – like reaction to alcohol.