Bacterial Vaginosis - Causes, Risk Factors, Signs & Symptoms, Diagnosis, And Treatment

Summary

Bacterial vaginosis (BV) is a common, non-inflammatory infection caused by an imbalance of bacteria in the vaginal flora, often marked by a reduction in lactobacilli. It affects around one-third of women and can lead to complications such as pelvic inflammatory disease, premature labor, and postoperative infections. Symptoms include a fishy-smelling gray discharge, pain during urination or intercourse, and possible irritation. Diagnosis relies on clinical history, vaginal examination, and microscopic analysis, including the presence of clue cells. Antibiotics are the primary treatment, and managing risk factors, such as avoiding douching and minimizing multiple sexual partners, is crucial to prevention.

Takeaways

• 😀 Bacterial vaginosis (BV) is a polymicrobial infection caused by several bacterial species, with *Gardnerella vaginalis* being the most common organism found.
• 😀 BV affects approximately 1/3 of women, making it the most common gynecological infection, but it is not considered a sexually transmitted infection (STI).
• 😀 Risk factors for BV include cigarette smoking, vaginal douching, use of certain hygiene products, multiple sexual partners, and presence of STIs, among others.
• 😀 The condition typically involves a reduction in lactobacilli, especially hydrogen peroxide-producing ones, leading to an increase in vaginal pH.
• 😀 *Gardnerella vaginalis* forms a biofilm in the vagina, helping it survive the acidic environment and evade antibiotic treatment.
• 😀 The classic symptom of BV is a fishy-smelling vaginal discharge, which is gray, thin, and adherent to the vaginal mucosa.
• 😀 Other symptoms of BV may include pain during urination and sexual intercourse, but bulvar irritation is uncommon.
• 😀 BV is a non-inflammatory infection, and inflammation in the vagina could indicate a coexisting STI.
• 😀 Left untreated, BV can lead to complications like pelvic inflammatory disease, urinary tract infections, and adverse pregnancy outcomes.
• 😀 BV is diagnosed through clinical history, vaginal examination, and microscopic examination, where at least three out of four Amsel criteria are needed for confirmation.
• 😀 Antibiotics such as metronidazole and clindamycin are commonly used to treat BV, either orally or as vaginal gels, with treatment depending on the severity of the infection.

Q & A

What is bacterial vaginosis (BV)?

Bacterial vaginosis (BV), previously known as non-specific vaginitis, is a polymicrobial infection caused by several bacterial species. Gardnerella vaginalis is the most frequently found organism, along with others like Prevotella, Bacteroides, Peptostreptococcus, Fusobacterium, and Mycoplasma hominis.

What are the common risk factors for bacterial vaginosis?

Risk factors for bacterial vaginosis include cigarette smoking, vaginal douching, tub bathing (especially with bubble bath), using over-the-counter intravaginal hygiene products, having multiple sexual partners, high frequency of intercourse, using intrauterine contraceptive devices, obesity, previous pregnancy, and a history of induced abortion.

How does bacterial vaginosis affect the vaginal flora?

Bacterial vaginosis causes alterations in the normal vaginal flora. Specifically, the number of lactobacilli, particularly hydrogen peroxide-producing ones, is reduced. This results in an increased vaginal pH, creating a more favorable environment for harmful bacteria to thrive.

What is the role of Gardnerella vaginalis in bacterial vaginosis?

Gardnerella vaginalis forms a biofilm in the vagina, helping the organism survive in the acidic vaginal environment and evade antibiotic treatment. This biofilm also contributes to the persistence of the infection.

What are the typical symptoms of bacterial vaginosis?

The most common symptom of bacterial vaginosis is a malodorous vaginal discharge, described as fishy due to the presence of volatile amines. The discharge is gray, thin, homogeneous, and adherent to the vaginal mucosa. Other symptoms may include pain during urination and sexual intercourse, but bulbar irritation is less common.

How is bacterial vaginosis diagnosed?

Bacterial vaginosis is diagnosed through clinical history, vaginal examination, and microscopic examination of the discharge. The diagnostic criteria include the presence of clue cells on a saline smear, a vaginal pH greater than 4.5, a characteristic appearance of the discharge, and a positive whiff test.

What is a whiff test, and how is it performed?

A whiff test is performed by placing a drop of 10% potassium hydroxide on the vaginal fluid after a vaginal examination. This causes the release of volatile amines, which results in the characteristic fishy odor associated with bacterial vaginosis.

What complications can arise from untreated bacterial vaginosis?

If left untreated, bacterial vaginosis can lead to complications such as pelvic inflammatory disease, urinary tract infections, increased risk of endometritis, postoperative infections, and adverse pregnancy outcomes like preterm labor, premature rupture of membranes, and postpartum endometritis.

What treatment options are available for bacterial vaginosis?

The main treatment for bacterial vaginosis involves antibiotics, such as metronidazole and clindamycin. These can be administered orally or as a vaginal gel, depending on the severity of the infection and patient preference. Asymptomatic women with Gardnerella vaginalis colonization do not require treatment.

What preventive measures can be taken to reduce the risk of bacterial vaginosis?

To minimize the risk of bacterial vaginosis, women should avoid using soap or only use bar soaps for cleaning. Liquid soaps and body washes should be completely avoided, and attention should be given to minimizing other known risk factors like vaginal douching and the use of certain intravaginal products.