Flashcards in Bacterial Vaginosis Deck (36)
1
What is bacterial vaginosis?
A non-sexually transmitted infection of the lower genital tract in females
2
How common is bacterial vaginosis?
The most common cause of abnormal vaginal discharge in women of childbearing age
3
What happens to the normal vagina to lead to bacterial vaginosis?
There is a disturbance in the normal vaginal flora leading to a reduction in the number of lactobacilli bacteria
4
What type of bacteria are lactobacilli?
Large rod-shaped organisms that produce hydrogen peroxide to help maintain the acidic pH of the vagina
5
What is the normal pH of the vagina?
< 4.5
6
What is the result of the acidic nature of the vagina?
Prevents overgrowth of other microorganisms
7
What happens to the pH of the vagina when lactobacilli numbers are reduced?
pH increases
8
What does the increase in pH in bacterial vaginosis allow?
Overgrowth of other microorganisms
9
What are the most common organisms found in bacterial vaginosis?
- Gardnerella vaginalis
- Anaerobes
- Mycoplasmas
10
What are the risk factors for bacterial vaginosis?
- New or multiple sexual partners
- Use of IUD
- Receptive oral sex
- Presence of STI
- Vaginal douching
- Use of scented soaps/vaginal deodorants
- Recent antibiotic use
- Black ethnicity
- Smoking
11
What % of bacterial vaginosis cases are asymptomatic?
Up to 50%
12
What is the most common symptom of bacterial vaginosis?
Offensive, fishy smelling discharge
13
What symptoms are NOT usually associated with bacterial vaginosis?
- Soreness
- Itching
- Irritation
14
What are the examination findings in bacterial vaginosis?
Thin, white/grey homogenous vaginal discharge
15
What are the differentials for bacterial vaginosis?
- Other vaginal infections
- Other benign causes of vaginal discharge
- Tumours of the vulva, vagina, cervix or endometrium
- Atrophic vaginitis
16
What other vaginal infections can be differentials for bacterial vaginosis?
- Candida
- Trichomoniasis
- Chlamydia
- Gonorrhoea
- Herpes simplex
17
What benign causes of vaginal discharge are differentials for bacterial vaginosis?
- Physiological discharge
- Chemical irritants
- Foreign body
- Pregnancy
- Cervical ectropion
18
How is bacterial vaginosis diagnosed?
- History
- Vaginal examination
- Microscopy
19
How is a sample obtained for microscopic testing for bacterial vaginosis?
High vaginal swab
20
What will be seen on gram stained microscopy of bacterial vaginosis?
- Clue cells
- Reduced number of lactobacilli
- Absence of pus cells
21
What are the clue cells seen in bacterial vaginosis?
Vaginal epithelial cells studded with gram variable coccobacilli
22
Isolation of what is not sufficient to diagnose bacterial vaginosis?
Gardnerella vaginalis
23
Why is isolation of Gardnerella vaginalis not diagnostic of bacterial vaginosis?
It can be cultured from 50% of uninfected women
24
What are some other diagnostic investigations for bacterial vaginosis?
- pH >4.5
- KOH Whiff test
25
What is the KOH Whiff test for bacterial vaginosis?
Addition of potassium hydroxide (KOH) causes vaginal discharge to release a strong fishy odour
26
Do asymptomatic bacterial vaginosis patients require treatment?
Only if they are pregnant
27
What is the most common treatment for bacterial vaginosis?
Metronidazole
28
What regimes of metronidazole are available for bacterial vaginosis?
- 400mg BD for 5-7 days
- OR single dose of 2g
- OR gel applied to vagina
29
What are the alternative antibiotics for bacterial vaginosis?
- Clindamycin
- Tinidazole
30
How should breastfeeding women be treated for bacterial vaginosis?
Vaginal metronidazole
31
What should patients avoid after diagnosis of bacterial vaginosis?
- Vaginal douching
- Scented shower gels
- Anti-septic agents
- Shampoos in bath
32
What should be considered if bacterial vaginosis is present with an IUD?
Removal of IUD
33
What % of people with bacterial vaginosis have return of symptoms within 3 months of treatment?
>50%
34
What are the complications of bacterial vaginosis following TOP?
- Endometriosis
- PID
35
What are the potential complications of bacterial vaginosis in pregnancy?
- Late miscarriage
- Preterm delivery
- Premature rupture of membranes
- Low birth weight
- Post partum endometriosis
36