A Family Doctor's Tale - BACTERIA VAGINOSIS

DOC I HAVE BACTERIAL VAGINOSIS

Bacterial Vaginosis (BV) is a condition in women where the normal balance of lactobacillus bacteria in the vagina is disrupted and replaced by an overgrowth of high concentrations of anaerobic bacteria (e.g., Prevotella sp. , Mobiluncus sp.), G. vaginalis, and Mycoplasma hominis. The condition is characterised by vaginal discharge, odor, pain and itching.

Bacterial Vaginosis is the most common vaginal infection in women after puberty.

 BV is associated with an imbalance in the lactobacillus bacteria in a woman's vagina. The cause of this imbalance is not known.
Some possible causes of this imbalnce are:
1.Having multiple sex partners or a new sex partner
2.Vaginal Douching which alter the pH and bacterial flora of vagina
3.Using an intrauterine device for preventing pregnancy.

Women that have never had sexual intercourse are rarely affected.

Women with typical Bacterial Vaginosis symptoms have:
1.an abnormal vaginal discharge with an unpleasant fish-like odor especially after intercourse.The discharge is usually greyish,semiadherent, homogeneous. Sometimes it can be thin,cream to green in colour and frothy.
2.burning sensation during urination
3.itching around the outside of the vagina,

More than 50% women with BV report no symptoms at all.

In most cases, there are no complications.
Some serious complications from BV include:
1.pelvic inflammatory disease (PID) especially after surgery like hysterectomy
2.endometritis,
3.increased susceptibility to other STDs, such as chlamydia, gonorrhea and HIV.
4.increased risk for some complications of pregnancy such as ectopic pregnancy and premature births.

1.vagina examination for homogeneous, thin, white discharge that smoothly coats the vaginal walls;
2.laboratory tests on a sample of vaginal fluid:
a.presence of clue cells on microscopic examination;
b.pH of vaginal fluid >4.5; 
c.fishy odor of vaginal discharge before or after addition of 1% KOH (the whiff test).
d.Gram stain is used to detect the relative concentration of lactobacilli (long Gram-positive rods), Gram-negative and Gram-variable rods and cocci ( G. vaginalis, Prevotella, Porphyromonas, and peptostreptococci), and curved Gram-negative rods (Mobiluncus) characteristic of BV.

All women suspected of BV should be treated to avoid such complications as Pelvic Inflammatory Disease.
Treatment is especially important for pregnant women. All pregnant women who have symptoms of BV should be checked and treated.

BV is treatable with antibiotics :
metronidazole 500 mg orally twice a day for 7 days
   OR
Metronidazole gel, 0.75%,5 g intravaginally, once a day for 5 days
   OR
Clindamycin 300 mg orally twice a day for 7 days
   OR
Clindamycin cream, 2%,5 g intravaginally at bedtime for 7 days

Either can be used with non-pregnant or pregnant women, but the recommended dosages differ.

Patients treated with metronidazole should be advised to avoid consuming alcohol for 24 hours.

BV can recur after treatment.

Since BV is seldom found in women who have never had intercourse.
and is associated with having a new sex partner or having multiple sex partners, prevention measures are aimed at sexual transmission:
Abstain from sex

Do not have multiple sex partners.

Do not use vaginal douche.

Take all of the medicine prescribed for treatment of BV even if there are no more symptoms.