bacterial vaginitis; bacterial vaginosis; vaginal dysbiosis

Etiology

• Gardnerella vaginalis
• Mycoplasma hominis
• Mobiluncus
• Atopobium vaginae
• other gram-negative bacteria
• not a sexually transmitted disease

Epidemiology

• primarily sexually active women
• most common lower genital tract infection in reproductive age women

Pathology

• bacterial vaginosis is non-inflammatory

Clinical manifestations

• fishy odor of volatile amines, especially when mixed with KOH (whiff test)*
• thin, homogeneous, gray-white, adherent discharge*
• 50% of women are asymptomatic
• symptomatic women may not have bacterial vaginosis

* 3 of 4 criteria makes diagnosis (other 2 criteria in Laboratory)

Laboratory

• also see vaginitis
• vaginal fluid pH >= 4.5*
• microscopy: saline wet mount: > 20% epipthelial clue cells* (first step)

* 3 of 4 criteria makes diagnosis (other 2 criteria in Clinical manifestations)

* image of clue cells

• Atopobium vaginae DNA
• bacterial vaginosis associated bacterium 2 DNA
• bacterial vaginosis whiff test
• bacterial vaginosis interpretation in vaginal fluid

Complications

• see vaginitis

Management

• metronidazole
  • 500 mg PO BID for 7 days (95% cure rate)
  • 2 g single dose (84% cure rate)
  • metronidazole gel, 5 grams vaginally BID for 5 days
• clindamycin
  • preferred agent if pregnant
  • 2% cream, 5 grams vaginally BID for 5 days
  • 300 mg PO BID for 7 days
• dequalinium chloride 10 mg vaginal tablet once a day for 6 days
• only symptomatic women need be treated
• vaginal administration of Lactobacillus crispatus reduces risk for recurrent bacterial vaginosis by 34%
• treatment of male partners has NO effect on outcome
• screening for bacterial vaginosis not recommended for pregnant women

More general terms

• vaginitis
• urogenital infection
• bacterial infection