Bacterial Vaginosis (BV)

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Bacterial vaginosis is the most common cause of vaginitis. It is characterized by an increase in vaginal discharge and vaginal malodour, caused by a change in the vaginal flora. Not strictly an STI.

Causes

  • Gardnerella vaginalis
  • Mycoplasma hominis
  • Mobiluncus curtisii

Signs and symptoms

  • Vaginal odour
  • Mild to moderate vaginal discharge (gray, thin, small bubbles in the fluid)
  • Vulva irritation, dysuria and dyspareunia (pain during sex)

Differential diagnosis

  • Trichomoniasis
  • Gonorrhoea

Complications

  • Acute salpingitis
  • Premature rupture of membranes
  • Endometritis
  • Pelvic inflammatory disease (PID)

Evaluation/investigations

Vaginal discharge

  • pH > 4.5 (pH > 6.0 highly suggestive)
  • Microscopic examination (clue cells- vaginal epithelial cells that appear fuzzy without sharp edges when they are coated with bacteria)
  • Potassium hydroxide(KOH) test: Drops of a KOH solution are added to a sample of the vaginal discharge. A strong fishy odour from the mix means bacterial vaginosis is present.
  • Vaginal cultures

Treatment objectives

  • Eliminate the organism
  • Restore normal vaginal secretions

Non-pharmacological treatment

  • Diet supplemented with Lactobacillus e.g. yogurt.
  • Advise patient to wash only with hypoallergenic bar soaps or no soap at all.
  • Avoid vaginal douching with liquid soaps and body washes.

Pharmacological treatment

Metronidazole oral

500 mg every 12 hours for 7days

OR

Metronidazole 0.75% intravaginal gel

Apply gel intravaginally two times daily for 7 days          

Pregnancy

Metronidazole oral

500 mg every 12 hours for 7 days

OR

250 mg every 8 hours for 7 days.

Prevention

  • Probiotic prophylaxis
  • Advise patient to use condom during sex 

Referral

  • Refer to a gynaecologist if there is recurrence of infection to prevent complications