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Bacterial vaginosis (Risk factors (Sexual activity Being sexually active …
Bacterial vaginosis
Risk factors
Sexual activity
Being sexually active
Sexual practices (oral)
WSW
Semen in vagina (inc pH)
Frequent partner change
Ethnicity
Blacks>Caucasian
Vaginal products
Douching, deodorant, vaginal washes,
antiseptics, bubble baths
Menstruation
Increases vaginal pH
Contraception
Copper IUD increases risk
COCP/POP and condoms reduce risk
Smoking
Epidemiology
Commonest cause of abnormal vaginal discharge
Blacks>Caucasians
WSW (women who have sex with women)
Clinical
presentation
Asymptomatic
50% women
Discharge
Thin, grey/white, fishy smelling
Vaginal irritation
Uncommon
Diagnosis
Examination
(often not needed)
External genital examination
No erythema/swelling, foul smelling discharge
on the vulva
Speculum examination
Normal vagina/cervix appearance
Smelly discharge coating the walls of vagina
Abdominal examination
Tenderness if PID, exclude malignancy
Investigations
Swabs
HVS (MCS, gram -ve cocci and Clue cells)
ECS/VVS (NG/CT NAAT)
Vaginal pH (distinguish candida [pH<5] vs BV/TV [pH>5])
Bloods
STI screen (HIV, syphilis, HBV/HCV)
History
Reproductive history
Gynae: menses, bleeding, contraception, smears
Obs: gravity/parity, deliveries, complications
DH
Current meds, recent abx, allergies
PMH
Previous BV, STIs
Chronic medical conditions
Abdo/pelvic surgery
SxH
Partners (casual/regular, gender, age)
Type of sex (vaginal, anal, oral, receptive/passive)
Contraception (barrier or UPSI)
Partners (3m and 12m)
BBV risk (HIV status, overseas, IVDU, paid for sex,
blood transfusions)
PC/HPC
Smelly discharge, no itch/discomfort
SH
Occupation (sex work), living arrangements,
smoking, alcohol, drugs
Pathophysiology
Mechanism
Trigger causes vagina to loses natural acidic pH, inc to >4.5
Favours overgrowth of anaerobes and loss of lactobacilli
Agents
Anaerobes (Gardnerella vaginalis, Prevotella,
mycoplasma hominis, mobiluncus)
Management
Conservative
Refer to GUM for investigation and treatment if high risk STI
Advise about triggers (washing, contraception, smoking)
Advise to return if symptoms persist/recur
Medical
Oral antibiotics
Indication: 1L symptomatic
E.g. metronidazole PO 5-7d
Topical abx
Indication: symptomatic, patient preference
E.g. metronidazole get, clindamycin gel
Complications
STI risk
Increased risk of transmitting/acquring HIV
Increased risk of acquiring CT, NG, TV, HSV
Increased risk of developing PID
Obstetric complications
Late miscarriage, spontaneous abortion
Preterm labour, PPROM, SGA
Postpartum endometritis, CS wound infections
Definition
Overgrowth of anaerobic bacteria
in the vagina, with loss of
lactobacilli and increased vaginal pH
Prognosis
Recurrence common (50% in 3m)