Bacterial vaginosis: Difference between revisions
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− | == |
+ | == Background == |
+ | === Microbiology === |
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+ | |||
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+ | * Shift in vaginal flora from [[Lactobacillus]] to high bacterial diversity that includes facultative anaerobes |
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+ | * 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]] |
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+ | |||
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+ | === Pathophysiology === |
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+ | |||
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+ | * The new bacterial flora produce volatile amines, which increases the vaginal pH >4.5 (from the normal range of 4 to 4.5) |
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+ | |||
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+ | == Diagnosis == |
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+ | |||
+ | === Amsel Criteria === |
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+ | |||
+ | * Requires microscopy but not Gram staining |
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+ | * At least three of the following criteria: |
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+ | ** Characteristic vaginal discharge: homogeneous, thin, grayish-white discharge that smoothly coats the vaginal walls |
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+ | ** Elevated pH >4.5 |
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+ | ** Clue cells on saline wet mount, which are vaginal epithelial cells studded with adherent coccobacilli |
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+ | ** Positive whiff-amine test, where a fishy odor is detected after a drop of 10% KOH is added to a sample of vaginal discharge |
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+ | |||
+ | === Nugent Criteria === |
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+ | |||
+ | * Based on the Gram stain |
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+ | * Considered the gold standard, but is more resource-intensive than wet mount microscopy used for Amsel criteria |
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+ | |||
+ | {| class="wikitable" |
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+ | !Score |
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+ | !Lactobacillus |
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+ | !Gardnerella and Bacteroides |
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+ | !Curved gram-variable bacilli |
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+ | |- |
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+ | |0 |
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+ | |4+ |
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+ | |0 |
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+ | |0 |
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+ | |- |
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+ | |1 |
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+ | |3+ |
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+ | |1+ |
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+ | |1+ or 2+ |
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+ | |- |
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+ | |2 |
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+ | |2+ |
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+ | |2+ |
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+ | |3+ or 4+ |
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+ | |- |
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+ | |3 |
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+ | |1+ |
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+ | |3+ |
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+ | | |
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+ | |- |
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+ | |4 |
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+ | |0 |
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+ | |4+ |
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+ | | |
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+ | |} |
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+ | |||
+ | * Interpretation is based on total score: |
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+ | ** 0 to 3: normal |
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+ | ** 4 to 6: indeterminate |
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+ | ** 7 to 10: bacterial vaginosis |
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+ | |||
+ | === Others === |
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+ | |||
+ | * Culture is not relevant to diagnosis of bacterial vaginosis |
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+ | |||
+ | ==Management== |
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+ | |||
+ | === Non-Pregnant Woman === |
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+ | |||
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+ | |||
+ | === Pregnant Women === |
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+ | |||
+ | * [[Metronidazole]] 500 mg PO bid for 7 days |
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+ | * [[Metronidazole]] 250 mg PO tid for 7 days |
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+ | * [[Clindamycin]] 300 mg PO bid for 7 days |
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[[Category:Gynecologic infections]] |
[[Category:Gynecologic infections]] |
Revision as of 08:20, 6 May 2021
Background
Microbiology
- 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
Pathophysiology
- The new bacterial flora produce volatile amines, which increases the vaginal pH >4.5 (from the normal range of 4 to 4.5)
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
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