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Bacterial Vaginosis

Bacterial vaginosis, abbreviated as BV is a type of inflammatory disease of the vagina caused due to bacterial infection.


Presentation

In the initial stages, BV presents with mild signs and symptoms that are often overlooked by affected women. However, in the later stages the symptoms take a severe turn causing great discomfort. The following are the various signs and symptoms of bacterial vaginosis [5]:

Candidiasis
  • Twenty-one percent of treated women subsequently had vaginal candidiasis.[ncbi.nlm.nih.gov]
  • Few studies have specifically looked at the validity of self-taken low vulvovaginal swabs (LVS) for the diagnosis of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV).[ncbi.nlm.nih.gov]
  • Discussion An LVT offers the potential of a natural treatment for BV, vaginal itching, irritation and dryness and for protection against recurrent BV or vaginal candidiasis.[sti.bmj.com]
  • Vaginal pH is elevated ( 4.5) in most patients, unlike in vulvovaginal candidiasis when it is reduced below 4.5. The flora typical for bacterial vaginosis can be a normal finding in asymptomatic postmenopausal women.[dermnetnz.org]
Rigor
  • Rigorous hypothesis-driven studies are needed to ultimately determine the cause of BV. This information is vital for the prevention and control of this important infection and its adverse public health consequences. The Author 2016.[ncbi.nlm.nih.gov]
Plethora
  • A careful analysis of the available data suggests that what we term BV is, in fact, a set of common clinical signs and symptoms that can be provoked by a plethora of bacterial species with proinflammatory characteristics, coupled to an immune response[ncbi.nlm.nih.gov]
Distractibility
  • If the symptoms are driving you to distraction, make your life easier by ditching the tight pants and wearing looser clothing or a skirt. To treat an itch, apply a cold cloth directly to the vagina or splash with cold water in the shower.[std.about.com]
Vaginal Discharge
  • Bacterial vaginosis causes symptomatic vaginal discharge and has been associated with preterm birth and with the acquisition of human immunodeficiency virus.[ncbi.nlm.nih.gov]
  • Postmenopausal vaginal discharge due to atrophic vaginitis . Vaginal discharge after gynaecological surgery. Investigations [ 2 , 4 ] Diagnosis of BV in primary care can be logistically difficult.[patient.info]
  • Postmenopausal vaginal discharge due to atrophic vaginitis. Vaginal discharge after gynaecological surgery. Investigations [ 2, 4 ] Diagnosis of BV in primary care can be logistically difficult.[patient.info]
  • After 10 days of treatment the odor and the vaginal discharge had ceased and 12 months later no relapse had occurred. It seems to be reasonable to use this kind of treatment in recurrent BV.[ncbi.nlm.nih.gov]
  • Results In the 728 responders who had used the LVT, the most commonly reported reasons for use were vaginal discharge with/without malodour (73%/18%), vaginal itching or irritation (37%), and vaginal dryness (16%). 90% of women with self-reported vaginal[sti.bmj.com]
Dysuria
  • […] prevalence in pregnant US women is in the range of 16% to 29%, and up to 30% of women visiting infertility clinics may be affected by BV. [22] Clinical manifestations include discomfort and pungent odor, a gray, thin, homogenous discharge, but rarely dysuria[medscape.com]
  • Clinical findings Discomfort; thin, grey, pungent (fishy odour) vaginal discharge; occasionally dysuria; vagina or vulva are generally not inflammed.[medical-dictionary.thefreedictionary.com]

Workup

Past medical history of the woman is normally taken at the preliminary level of investigation. This would be followed by various diagnostic procedures which include:

  • Pelvic exam wherein a thorough physical examination of the pelvic region is carried out to study for the signs of infection. In this examination, the examiner would insert 2 fingers into the vagina, while pressing the abdomen with the other hand to check for unusual characteristics of the pelvic region [6].
  • A sample of the vaginal secretions is also tested for bacterial overgrowth.
  • Acidity level of the vagina is also tested by placing a pH strip in the vagina. If the pH value is 4.5 or above it indicates presence of bacterial infections.
Staphylococcus Aureus
  • Group B streptococci, escherichia coli, staphylococcus aureus and trichomonas vaginalis are frequently cultured.[ncbi.nlm.nih.gov]
  • Hydrophilic TPUs were most prone to biofilm formation by Candida albicans and Staphylococcus aureus, but the incorporation of metronidazole in the device prevented biofilm formation.[ncbi.nlm.nih.gov]

Treatment

Bacterial vaginosisis caused by bacterial infections. A strict antibiotic regime forms the basis of the treatment plan. The following medications are administered to treat BV:

  • Metronidazole is an antibiotic which is available to be taken orally or in the form of topical agent to be inserted into the vagina.
  • Clindamycin is available in the form of cream which needs to be applied on the affected area.
  • Tinidazole medicine needs to be taken orally and has certain side effects associated with it [7].

It is advised to all affected women that they religiously complete the antibiotic course to prevent the recurrence of bacterial vaginosis. Affected women are more likely to suffer from recurrent bouts of BV after 3 months.

Prognosis

Prognosis of the condition is usually favorable with prompt initiation of treatment. However, women are advised to follow certain steps to prevent the recurrence of bacterial vaginosis. It has been seen that women who could successfully get rid of the condition, are found to experience signs and symptoms of BV after 3 months.

Bacterial vaginosis may not be a life threatening condition. It can however lead to several debilitating complications if the condition is not promptly treated. The following are the several signs and symptoms of bacterial vaginosis.

  • Sexually transmitted disease (STD): Women with BV are more prone to contract STDs which include HIV, gonorrhea, herpes simplex virus and chlamydia.
  • Having BV also significantly increases the risk of developing infections after undergoing surgical procedures [4].
  • If pregnant women develop BV, then there are higher chances of preterm delivery of the baby.
  • Bacterial vaginosis can also increase the risk of developing pelvic inflammatory disease which in turn can also increase the risk of developing infertility.

Etiology

The exact cause behind development of BV is not understood. However, researchers believe that certain activities such as frequent douching or having unprotected sex with multiple partners can disrupt the natural bacterial balance of the vagina paving way for bacterial vaginosis.

Epidemiology

Women in the age group of 15 to 44 years are likely candidates of bacterial vaginosis. BV is a common condition affecting about 1 in every 3 women in the reproductive age group [2].

Sex distribution
Age distribution

Pathophysiology

Certain groups of bacteria are normal inhabitants of the vagina. The vagina normally consists of 2 types of bacteria: lactobacilli (good bacteria) and anaerobes (bad bacteria). When there is excessive growth of anaerobes the natural balance of the vagina gets disrupted giving rise to an array of unpleasant symptoms. Such a phenomenon causes bacterial vaginosis to develop [3].

Prevention

It is necessary to prevent the development of bacterial vaginosis as it can give rise to various other secondary complications. The following measures can be adopted to keep BV at bay.

  • Women need to comprehend the fact that they need nothing more than soap and water to rinse their vagina. Application of soap to the outer area of the genital regions and rinsing with water would be enough to keep vaginal infections are bay [8].
  • It is necessary to stay away from scented tampons and pads.
  • Douching is not good for women and its practice should be discontinued.
  • It is also advised not to have multiple sexual partners to prevent development of STDs.

Summary

Bacterial vaginosis (BV) is caused due to overgrowth of the bacteria which are normal inhabitants of the vagina. Due to such a situation, the natural balance of the bacteria in the vagina is greatly disturbed leading to development of bacterial vaginosis [1]. What triggers bacterial over growth is yet to be figured out; however certain activities are known to give rise to such a condition. Women who are in their reproductive years fall prey to BV.

Patient Information

Definition

Bacterial vaginosis (BV) is characterized by inflammation of the vagina due to bacterial overgrowth. It is common in women in the reproductive age group. It has been estimated that 1 in every 3 women would suffer from bacterial vaginosis at least once in their life time. The condition can be successfully treated with a strong antibiotic course.

Cause

The exact factor that causes bacterial overgrowth is not known. However, it is thought that certain activities such as frequent douching and having multiple sexual partners can predispose women to contract this condition [9].

Symptoms

BV presents with mild symptoms that often go unnoticed. In later stages, women experience vaginal itching, foul smell from vaginal discharge, and color of the discharge changes to white or grey and appear thin or watery.

Diagnosis

Diagnosis of bacterial vaginosis consists of physical examination of the genital region. It is also necessary to carefully examine the pelvic region to determine presence of unusual characteristics. Sample of vaginal secretions are also tested for bacterial overgrowth. In addition, pH of the vagina is also measured using pH strips. A vaginal pH of 4.5 or above, confirms the presence of bacterial vaginosis.

Treatment

A strong antibiotic regime for a specified period is recommended for treating bacterial vaginosis. In addition to oral pills, affected women are also administered topical agents such as antibiotic creams or gels to be applied on the affected area [10].

References

Article

  1. Tabrizi SN, Fairley CK, Bradshaw CS, Garland SM. Prevalence of Gardnerella vaginalis and Atopobium vaginae in virginal women. Sex Transm Dis. Nov 2006;33(11):663-5.
  2. Bradshaw CS, Walker SM, Vodstrcil LA, et al. The influence of behaviors and relationships on the vaginal microbiota of women and their female partners: the WOW Health Study. J Infect Dis 2014; 209:1562.
  3. Marrazzo JM, Fiedler TL, Srinivasan S, et al. Extravaginal reservoirs of vaginal bacteria as risk factors for incident bacterial vaginosis. J Infect Dis. May 15 2012;205(10):1580-8.
  4. Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59:1.
  5. De Backer E, Verhelst R, Verstraelen H, et al. Antibiotic susceptibility of Atopobium vaginae. BMC Infect Dis. Mar 16 2006;6:51.
  6. Sumeksri P, Koprasert C, Panichkul S. BVBLUE test for diagnosis of bacterial vaginosis in pregnant women attending antenatal care at Phramongkutklao Hospital. J Med Assoc Thai 2005; 88 Suppl 3:S7.
  7. Berardi-Grassias L, Roy O, Berardi JC, Furioli J. Neonatal meningitis due to Gardnerella vaginalis. Eur J Clin Microbiol Infect Dis. Jun 1988;7(3):406-7. 
  8. Hillier SL, Krohn MA, Rabe LK, Klebanoff SJ, Eschenbach DA. The normal vaginal flora, H2O2-producing lactobacilli, and bacterial vaginosis in pregnant women. Clin Infect Dis. Jun 1993;16 Suppl 4:S273-81.
  9. Martin HL, Richardson BA, Nyange PM, et al. Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition. J Infect Dis 1999; 180:1863.
  10. Martius J, Eschenbach DA. The role of bacterial vaginosis as a cause of amniotic fluid infection, chorioamnionitis and prematurity--a review. Arch Gynecol Obstet. 1990;247(1):1-13. 

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Last updated: 2018-06-22 04:13