BACTERIAL VAGINOSIS

BACTERIAL VAGINOSIS

-formerly termed nonspecific vaginitis, Haemophilus vaginitis, anaerobic vaginitis, or Gardnerella-associated vaginal discharge
-Characterized by symptoms of vaginal malodour and increased white discharge
-MC cause of vaginitis
-Not sexually transmitted
- Increased risk of other infections like HIV,C.trachomatis,N.gonorrhea and risk of preterm delivery
-Culture of discharge- G.vaginalis,Mycoplasma hominis,several anerobic bacteria like Prevotella

-Absence of Lactobacillus which is the MC organism of normal vaginal microbiota

-Criteria-AMSEL’s(any 3 of 4)
1-objective signs of increased vaginal discharge
2-discharge of pH>4.5
3-distinct fishy odor when secretions mixed with 10%KOH(Whiff test+70%cases)
4-Clue cells and absence of WBCs on microscopy of secretions with normal saline 1:1(most specific criteria)

-Modified Amsels use any 2 of 4 criteria
-Fishy odour is due to volatile amines mainly trimethylamine
-Clue cells are vaginal epithelial cells coated with coccobacillary organisms(>20% diagnostic)
-NUGENTS score>7 is diagnostic of BV

-TT-Oral metronidazole 500mg twice daily for 7 days
2%clindamycin cream or 0.75%metronidazole gel can also be used.

-Newer test BVBLUE Rapid Diagnostic test for BV- detects sialidase activity
--Only Bacteria resistant to metronidazole treatment and recurrence of BV- Atopobium vaginae