Bacterial vaginosis

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Bacterial vaginosis
Other namesAnerobic vaginositis, non-specific vaginitis, vaginal bacteriosis, Gardnerella vaginitis
Micrograph of bacterial vaginosis — cells of the cervix covered with rod-shaped bacteria, Gardnerella vaginalis (arrows).
Medical specialtyGynecology, infectious disease
SymptomsVaginal discharge that often smells like fish, burning with urination
ComplicationsEarly delivery among pregnant women[1]
CausesImbalance of the naturally occurring bacteria in the vagina
Risk factorsDouching, new or multiple sex partners, antibiotics, using an intrauterine device
Diagnostic methodTesting the vaginal discharge
Differential diagnosisVaginal yeast infection, infection with Trichomonas
MedicationClindamycin or metronidazole
Frequency~ 5% to 70% of women

Bacterial vaginosis (BV) is a disease of the vagina caused by a large growth of bacteria.[2]

Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urination may occur

It also increases the risk of early delivery among pregnant women.[1][3]

Diagnosis[change | change source]

A pH indicator to detect vaginal alkalinization (here showing approximately pH 8), and a microscope slide to microscopically detect clue cells

To make a diagnosis of bacterial vaginosis, a swab from inside the vagina is taken. These swabs can be tested for:

  • Gram stain which shows the depletion of lactobacilli and overgrowth of Gardnerella vaginalis bacteria. Bacterial vaginosis is usually confirmed by a Gram stain of vaginal secretions.[4]
  • A characteristic "fishy" odor on wet mount. This test, called the whiff test, is performed by adding a small amount of potassium hydroxide to a microscope slide containing the vaginal discharge. A characteristic fishy odor is considered a positive whiff test and is suggestive of bacterial vaginosis.[source?]
  • Loss of acidity. To control bacterial growth, the vagina is normally slightly acidic with a pH of 3.8–4.2. A swab of the discharge is put onto litmus paper to check its acidity. A pH greater than 4.5 is considered alkaline and is suggestive of bacterial vaginosis.[source?]
  • The presence of clue cells on wet mount. Similar to the whiff test, the test for clue cells is performed by placing a drop of sodium chloride solution on a slide containing vaginal discharge. If present, clue cells can be visualized under a microscope. They are so-named because they give a clue to the reason behind the discharge. These are epithelial cells that are coated with bacteria.

Differential diagnosis for bacterial vaginosis includes the following:[5]

The Center for Disease Control (CDC) defines STIs as "a variety of clinical syndromes and infections caused by pathogens that can be acquired and transmitted through sexual activity."[7] But the CDC does not specifically identify BV as sexually transmitted infection.[8]

References[change | change source]

  1. 1.0 1.1 Queena JT, Spong CY, Lockwood CJ, eds. (2012). Queenan's management of high-risk pregnancy : an evidence-based approach (6th ed.). Chichester, West Sussex: Wiley-Blackwell. p. 262. ISBN 9780470655764.
  2. Clark, Natalie; Tal, Reshef; Sharma, Harsha; Segars, James (2014). "Microbiota and Pelvic Inflammatory Disease". Seminars in Reproductive Medicine. 32 (1): 043–049. doi:10.1055/s-0033-1361822. ISSN 1526-8004. PMC 4148456. PMID 24390920.
  3. "What are the treatments for bacterial vaginosis (BV)?". National Institute of Child Health and Human Development. 15 July 2013. Archived from the original on 2 April 2015. Retrieved 4 March 2015.
  4. Muzny CA, Kardas P (July 2020). "A Narrative Review of Current Challenges in the Diagnosis and Management of Bacterial Vaginosis". Sexually Transmitted Diseases. 47 (7): 441–446. doi:10.1097/OLQ.0000000000001178. PMC 7294746. PMID 32235174.
  5. "Diseases Characterized by Vaginal Discharge". Centers for Disease Control and Prevention. Archived from the original on 11 July 2017.
  6. Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B (January 2002). "Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis". BJOG. 109 (1): 34–43. doi:10.1111/j.1471-0528.2002.00432.x. hdl:10067/1033820151162165141. PMID 11845812. S2CID 8304009.
  7. Workowski KA, Bolan GA (June 2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and Reports. 64 (RR-03): 1–137. PMC 5885289. PMID 26042815.
  8. Cite error: The named reference was used but no text was provided for refs named (see the help page).