Summary of genitourinary medicine and sexual health conditions. Contains information about clinical features of each condition, as well as relevant diagnostic tests and investigations, risk factors, causes and management guidelines.
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, BACTERIAL VAGINOSIS
AETIOLOGY SUMMARY
- Imbalance of vaginal ecology Most common cause of vaginal discharge (studies
Lactobacilli are the dominant bacteria in a healthy have shown > 80% of women with + microscopy are
vagina. Maintain pH < 4.5 and ensure other asymptomatic)
bacteria cannot survive. Part of normal, healthy vaginal microbiome – only
If the pH rises (presence of blood/seminal fluid, problematic if persistent and symptomatic
certain washing practices), anaerobes which are
always present can increase in number
Anaerobes produce chemicals as they divide
RISK FACTORS FOR RECURRENCE
resulting in unpleasant smell
- Chemicals, skin washing products, genital
Organisms hygiene products, fabric softener, wet wipes
- Gardenerella vaginalis - Sitting in bath containing these products,
- Atopobium allowing products from above the waist to
- Mycoplasma wash over body
- Mobiluncus - Smoking
- Prevotella - Receptive oral sex
Organisms do not cause inflammation but they do - Black race
produce a biofilm which needs to be disrupted or - Recent change in sexual partner
symptoms with recur
SYMPTOMS AND SIGNS
DIAGNOSIS - Offensive vaginal discharge
Gram-stained vaginal smear using Hay Ison - Thin white/grey and homogenous
criteria - Coats walls of vagina and often seen at vulva
1 = normal - No soreness, itch, or vulvitis
2 = intermediate >50% are asymptomatic
3 = BV
Wet mount = clue cells (epithelial cell coated with
gram positive and gram negative organisms)
MANAGEMENT
No treatment if asymptomatic – not an STI and cannot pass to partner
- Genital washing practice
- Metronidazole 400mg for 1/52
- Relapse rate at 3/12 very high unless washing practices altered
- Relactagel – self-sourced from pharmacy to reduce vaginal pH and disrupt biofilm
Some studies have shown that BV in pregnancy and result in preterm birth or miscarriage. Only treat if
diagnosed in pregnancy and there has been hx of recurrent miscarriage < 20/40
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