Incidence: 50% of causes of abnormal vaginal discharge in childbearing period (most common)
♦♦♦ Causative organism:
* Gardnerella vaginalis incriminated in 70- 90% of cases.
– Gram- variable coccobacilli commensal that turns
pathogenic in the presence of anaerobic infection.
* Others: e.g. mycoplasma hominis, Ureaplasma urealyticum.
♦♦♦ Rout of infection: (Definitely unknown)
* Sexual route:
– It isn’t a STD as the organism isn’t transmitted from the husband.
– Sexual intercourse provide a suitable medium for anaerobic infection –effect
of alkaline semen- which provoke its growth
* Non-sexual routes:
– Excessive alkaline compounds vaginally e.g. vaginal douches & soap.
– Intra uterine device users.
– Phage virus destroying lactobacilli allowing growth of anaerobic bacteria.
– Intestinal flora transmitted from rectum to vagina through perineum.
♦♦♦ Predisposing factors:
– Any condition↓ vaginal acidity or destroying lactobacilli.
* Asymptomatic: up to 50 % of cases
* The only presenting symptom is vaginal discharge;
– Excessive amount (cup of milk poured in the vagina).
– Whitish grey colour.
– Thin & frothy.
– Offensive (fishy odour may be noticed during intercourse).
* N.B.: It is not inflammatory reaction, so no dyspareunia or pruritus vulvae.
* Vaginal mucosa is red & edematous (Not obvious as TV).
* Shows the characteristic discharge.
1. Fresh drop examination (wet film):
– Normal saline drop a drop of discharge,
– Clue cells: vaginal epithelial cells coated with
the organism masking its borders.
2. Stained film: by Gram stain
* Excessive gram-ve bacilli e.g. Gardnerella vaginalis.
*Scanty gram +ve bacilli e.g. lactobacilli.
3. Culture: Casman agar (blood agar at 10 % CO2).
4. Whiff test= amine test =sniff test: addition of 10
% KOH to the discharge result in a fishy odour.
5. Recent methods:
– Measurement of metabolic products of anaerobic bacteria.
– Use of DNA probes to detect the bacterial antigens.
* The diagnosis is commonly made in clinical practice using the composite
(Amsel) criteria (Three out of four is diagnostic):
– Vaginal pH > 4.5,
– Release of a fishy smell on addition of alkali (KOH 10%)
– A characteristic discharge on examination,
– Presence of ‘clue cells’ on microscopy.
♦♦♦ In Pregnant woman:
1. Second trimester pregnancy loss (Miscarriage).
2. PROM & preterm labour.
4. Postpartum & postabortive infection.
♦♦♦ In non pregnant women:
1. Parametritis after hysterectomy.
2. PID, UTI.
♦♦♦ General measures:
– Control predisposing factors e.g. no alkaline soap used.
– Local hygiene; shaving hair, keep dry, change clothes.
– Cotton made underwear and should be boiled.
– Vaginal douches acidic e.g. lactic acid.
♦♦♦ Local treatment:
1) Metronidazole: the drug of choice
– Vaginal tablet: 500 mg every night for 7 days.
– Vaginal cream: once daily for 7 days.
♦♦♦ Systemic treatment:
1) Metronidazole: – 500 mg bid for 7 days.
2) Clindamycin: – 300 mg bid for 7 days.
– During pregnancy Penicillin is sufficient.
– No need to treat partner.
– No need to use condom.
Bacterial vaginosis (Anaerobic vaginosis)
In this episode Dr. Sara Kim discusses the history, diagnosis, consequences, and treatment of bacterial vaginosis.
What is bacterial vaginosis? | Infectious diseases | NCLEX-RN | Khan Academy
These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any Khan Academy video. Created by Raja Narayan.
Bacterial vaginosis Prof. Aboubakr Elnashar Benha University Hospital
Non-specific vaginitis: Haemophilus vaginalis Gardnerella vaginitis: Gardnerella vaginalis Anaerobic vaginosis: Gardnerella vaginalis & anaerobic bacteria Bacterial vaginosis: polymicrobial alteration in vaginal flora causing an increase in vaginal pH, sometimes associated with an homogenous discharge, but in the absence of a demonstrable inflammatory response (Eschenbach et al, 1988) ABOUBAKR ELNASHAR