Bacterial vaginosis - Revision history

Aidan: Text replacement - " species]]" to "]]"

2022-02-12T23:59:34Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 23:59, 12 February 2022
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	*Shift in vaginal flora from [[Lactobacillus]] to high bacterial diversity that includes facultative anaerobes		*Shift in vaginal flora from [[Lactobacillus]] to high bacterial diversity that includes facultative anaerobes
	*The new flora includes: [[Gardnerella vaginalis]], [[Prevotella ~~species~~]], [[Porphyromonas ~~species~~]], [[Bacteroides ~~species~~]], [[Peptostreptococcus ~~species~~]], [[Mycoplasma hominis]], [[Ureaplasma urealyticum]], [[Mobiluncus ~~species~~]], [[Megasphaera ~~species~~]], [[Clotridiales ~~species~~]], [[Fusobacterium ~~species~~]], and [[Atopobium ~~species~~]]		*The new flora includes: [[Gardnerella vaginalis]], [[Prevotella]], [[Porphyromonas]], [[Bacteroides]], [[Peptostreptococcus]], [[Mycoplasma hominis]], [[Ureaplasma urealyticum]], [[Mobiluncus]], [[Megasphaera]], [[Clotridiales]], [[Fusobacterium]], and [[Atopobium]]

	===Pathophysiology===		===Pathophysiology===

Aidan: /* Clinical Manifestations */

2021-05-06T12:57:21Z

Clinical Manifestations

@@ Line 10: / Line 10: @@
 *The new bacterial flora produce volatile amines, which increases the vaginal pH >4.5 (from the normal range of 4 to 4.5)
-== Clinical Manifestations ==
+==Clinical Manifestations==
-* Common cause of [[Causes::vaginal discharge]], classically copious thin, grey discharge
+*Common cause of [[Causes::vaginal discharge]], classically copious thin, grey discharge
 ==Diagnosis==
@@ Line 90: / Line 94: @@
 *[[Metronidazole]] 250 mg PO tid for 7 days
 *[[Clindamycin]] 300 mg PO bid for 7 days
 [[Category:Gynecologic infections]]

Aidan at 12:47, 6 May 2021

2021-05-06T12:47:54Z

← Older revision		Revision as of 12:47, 6 May 2021
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	== Background ==		==Background==

	=== Microbiology ===		===Microbiology===

	* Shift in vaginal flora from [[Lactobacillus]] to high bacterial diversity that includes facultative anaerobes		*Shift in vaginal flora from [[Lactobacillus]] to high bacterial diversity that includes facultative anaerobes
	* The new flora includes: [[Gardnerella vaginalis]], [[Prevotella species]], [[Porphyromonas species]], [[Bacteroides species]], [[Peptostreptococcus species]], [[Mycoplasma hominis]], [[Ureaplasma urealyticum]], [[Mobiluncus species]], [[Megasphaera species]], [[Clotridiales species]], [[Fusobacterium species]], and [[Atopobium species]]		*The new flora includes: [[Gardnerella vaginalis]], [[Prevotella species]], [[Porphyromonas species]], [[Bacteroides species]], [[Peptostreptococcus species]], [[Mycoplasma hominis]], [[Ureaplasma urealyticum]], [[Mobiluncus species]], [[Megasphaera species]], [[Clotridiales species]], [[Fusobacterium species]], and [[Atopobium species]]

	=== Pathophysiology ===		===Pathophysiology===

	* The new bacterial flora produce volatile amines, which increases the vaginal pH >4.5 (from the normal range of 4 to 4.5)		*The new bacterial flora produce volatile amines, which increases the vaginal pH >4.5 (from the normal range of 4 to 4.5)

	== ~~Diagnosis~~ ==		== Clinical Manifestations ==

			* Common cause of [[Causes::vaginal discharge]], classically copious thin, grey discharge
⚫	=== ~~Amsel~~ Criteria ===

			==Diagnosis==
	* Requires microscopy but not Gram staining
⚫	* At least three of the following criteria:
⚫	** Characteristic vaginal discharge: homogeneous, thin, grayish-white discharge that smoothly coats the vaginal walls
⚫	** Elevated pH >4.5
⚫	** Clue cells on saline wet mount, which are vaginal epithelial cells studded with adherent coccobacilli
⚫	** Positive whiff-amine test, where a fishy odor is detected after a drop of 10% KOH is added to a sample of vaginal discharge

	=== ~~Nugent~~ Criteria ===		===Amsel Criteria===

	* ~~Based~~ on ~~the~~ Gram ~~stain~~		*Requires microscopy but not Gram staining
		⚫	*At least three of the following criteria:
⚫	* Considered the gold standard, but is more resource-intensive than wet mount microscopy used for Amsel criteria
		⚫	**Characteristic vaginal discharge: homogeneous, thin, grayish-white discharge that smoothly coats the vaginal walls
		⚫	**Elevated pH >4.5
		⚫	**Clue cells on saline wet mount, which are vaginal epithelial cells studded with adherent coccobacilli
		⚫	**Positive whiff-amine test, where a fishy odor is detected after a drop of 10% KOH is added to a sample of vaginal discharge

		⚫	===Nugent Criteria===

			*Based on the Gram stain
		⚫	*Considered the gold standard, but is more resource-intensive than wet mount microscopy used for Amsel criteria

	{\| class="wikitable"		{\| class="wikitable"
Line 58:		Line 62:
	\|}		\|}

	* Interpretation is based on total score:		*Interpretation is based on total score:
	** 0 to 3: normal		**0 to 3: normal
	** 4 to 6: indeterminate		**4 to 6: indeterminate
	** 7 to 10: bacterial vaginosis		**7 to 10: bacterial vaginosis

	=== Others ===		===Others===

	* Culture is not relevant to diagnosis of bacterial vaginosis		*Culture is not relevant to diagnosis of bacterial vaginosis

	==Management==		==Management==

	=== Non-Pregnant Woman ===		===Non-Pregnant Woman===

	*First-line:		*First-line:
Line 81:		Line 85:
	**[[Tinidazole]] 1 g PO daily for 5 days		**[[Tinidazole]] 1 g PO daily for 5 days

	=== Pregnant Women ===		===Pregnant Women===

	* [[Metronidazole]] 500 mg PO bid for 7 days		*[[Metronidazole]] 500 mg PO bid for 7 days
	* [[Metronidazole]] 250 mg PO tid for 7 days		*[[Metronidazole]] 250 mg PO tid for 7 days
	* [[Clindamycin]] 300 mg PO bid for 7 days		*[[Clindamycin]] 300 mg PO bid for 7 days

	[[Category:Gynecologic infections]]		[[Category:Gynecologic infections]]

Aidan at 12:20, 6 May 2021

2021-05-06T12:20:55Z

← Older revision		Revision as of 12:20, 6 May 2021
Line 1:		Line 1:
	== ~~Management~~ ==		== Background ==

			=== Microbiology ===
⚫	* First-line:

⚫	** [[Metronidazole]] 500 mg PO bid for 7 days
			* Shift in vaginal flora from [[Lactobacillus]] to high bacterial diversity that includes facultative anaerobes
⚫	** [[Metronidazole]] gel 0.75% 5 g (one full applicator) intravaginally once daily for 5 days
			* The new flora includes: [[Gardnerella vaginalis]], [[Prevotella species]], [[Porphyromonas species]], [[Bacteroides species]], [[Peptostreptococcus species]], [[Mycoplasma hominis]], [[Ureaplasma urealyticum]], [[Mobiluncus species]], [[Megasphaera species]], [[Clotridiales species]], [[Fusobacterium species]], and [[Atopobium species]]
⚫	** [[Clindamycin]] 2% cream 5 g (one full applicator) intravaginally at bedtime for 7 days

⚫	* Alternatives:
			=== Pathophysiology ===
⚫	** [[Clindamycin]] 300 mg PO bid for 7 days

⚫	** [[Clindamycin]] ovule (vaingal suppository) 100 mg intravaginally daily for 3 days
			* The new bacterial flora produce volatile amines, which increases the vaginal pH >4.5 (from the normal range of 4 to 4.5)
⚫	** [[Tinidazole]] 2 g PO daily for 2 days

⚫	** [[Tinidazole]] 1 g PO daily for 5 days
			== Diagnosis ==

			=== Amsel Criteria ===

			* Requires microscopy but not Gram staining
			* At least three of the following criteria:
			** Characteristic vaginal discharge: homogeneous, thin, grayish-white discharge that smoothly coats the vaginal walls
			** Elevated pH >4.5
			** Clue cells on saline wet mount, which are vaginal epithelial cells studded with adherent coccobacilli
			** Positive whiff-amine test, where a fishy odor is detected after a drop of 10% KOH is added to a sample of vaginal discharge

			=== Nugent Criteria ===

			* Based on the Gram stain
			* Considered the gold standard, but is more resource-intensive than wet mount microscopy used for Amsel criteria

			{\| class="wikitable"
			!Score
			!Lactobacillus
			!Gardnerella and Bacteroides
			!Curved gram-variable bacilli
			\|-
			\|0
			\|4+
			\|0
			\|0
			\|-
			\|1
			\|3+
			\|1+
			\|1+ or 2+
			\|-
			\|2
			\|2+
			\|2+
			\|3+ or 4+
			\|-
			\|3
			\|1+
			\|3+
			\|
			\|-
			\|4
			\|0
			\|4+
			\|
			\|}

			* Interpretation is based on total score:
			** 0 to 3: normal
			** 4 to 6: indeterminate
			** 7 to 10: bacterial vaginosis

			=== Others ===

			* Culture is not relevant to diagnosis of bacterial vaginosis

			==Management==

			=== Non-Pregnant Woman ===

		⚫	*First-line:
		⚫	**[[Metronidazole]] 500 mg PO bid for 7 days
		⚫	**[[Metronidazole]] gel 0.75% 5 g (one full applicator) intravaginally once daily for 5 days
		⚫	**[[Clindamycin]] 2% cream 5 g (one full applicator) intravaginally at bedtime for 7 days
		⚫	*Alternatives:
		⚫	**[[Clindamycin]] 300 mg PO bid for 7 days
		⚫	**[[Clindamycin]] ovule (vaingal suppository) 100 mg intravaginally daily for 3 days
		⚫	**[[Tinidazole]] 2 g PO daily for 2 days
		⚫	**[[Tinidazole]] 1 g PO daily for 5 days

			=== Pregnant Women ===

			* [[Metronidazole]] 500 mg PO bid for 7 days
			* [[Metronidazole]] 250 mg PO tid for 7 days
			* [[Clindamycin]] 300 mg PO bid for 7 days

	[[Category:Gynecologic infections]]		[[Category:Gynecologic infections]]

Aidan: Created page with "== Management == * First-line: Metronidazole 500 mg PO bid for 7 days Metronidazole gel 0.75% 5 g (one full applicator) intravaginally once daily for 5 days **..."

2021-05-06T12:10:19Z

Created page with "== Management == * First-line: ** Metronidazole 500 mg PO bid for 7 days ** Metronidazole gel 0.75% 5 g (one full applicator) intravaginally once daily for 5 days **..."

New page

== Management ==

* First-line:
** [[Metronidazole]] 500 mg PO bid for 7 days
** [[Metronidazole]] gel 0.75% 5 g (one full applicator) intravaginally once daily for 5 days
** [[Clindamycin]] 2% cream 5 g (one full applicator) intravaginally at bedtime for 7 days
* Alternatives:
** [[Clindamycin]] 300 mg PO bid for 7 days
** [[Clindamycin]] ovule (vaingal suppository) 100 mg intravaginally daily for 3 days
** [[Tinidazole]] 2 g PO daily for 2 days
** [[Tinidazole]] 1 g PO daily for 5 days

[[Category:Gynecologic infections]]

Bacterial vaginosis - Revision history

Aidan: Text replacement - " species]]" to "]]"

Aidan: /* Clinical Manifestations */

Aidan at 12:47, 6 May 2021

Aidan at 12:20, 6 May 2021

Aidan: Created page with "== Management == * First-line: ** Metronidazole 500 mg PO bid for 7 days ** Metronidazole gel 0.75% 5 g (one full applicator) intravaginally once daily for 5 days **..."

Aidan: Created page with "== Management == * First-line: Metronidazole 500 mg PO bid for 7 days Metronidazole gel 0.75% 5 g (one full applicator) intravaginally once daily for 5 days **..."