Bacterial Vaginosis (1983)Bacterial Vaginosis (1983)((Older term: Gardnerella vaginitisOlder term: Gardnerella vaginitis))

M.FahdhyM.Fahdhy

Medan, 17 November 2008

Is the common cause of abnormal vaginal Is the common cause of abnormal vaginal discharge in women of child-bearing agedischarge in women of child-bearing age

It is the syndrome of unknown cause It is the syndrome of unknown cause characterized by characterized by depletion depletion of the normal of the normal Lactobacil lus Lactobacil lus populationpopulation and an and an overgrowth of vaginal anaerobes, overgrowth of vaginal anaerobes, accompanied by accompanied by loss loss of the usual vaginal of the usual vaginal acidityacidity

This recogized the fact that many anaerobic This recogized the fact that many anaerobic or facultative anaerobes bacteria are present or facultative anaerobes bacteria are present and that classical signs of inflammation are and that classical signs of inflammation are absentabsent

Farrow Sabastian, STD, 2007

Symptom :Symptom : OffensiveOffensive Fishy-smell ing dischargeFishy-smell ing discharge

About 50% of women About 50% of women asymptomatic asymptomatic Studies in the last decade have established Studies in the last decade have established

that BV is assosiated with pregnancy and that BV is assosiated with pregnancy and following gynecology surgery and may be following gynecology surgery and may be HIVHIV

EpidemiologyEpidemiology

Prevalence : 10 – 20%Prevalence : 10 – 20% 36% women attending STI clinics36% women attending STI clinics 28% elective termination of 28% elective termination of

pregnancypregnancy Black raceBlack race IUD useIUD use Not known BV occurs Not known BV occurs

postmenopausal womenpostmenopausal women

Aetiology and PathogenesisAetiology and Pathogenesis

Is probably multifactorial, sexually Is probably multifactorial, sexually assosiatedassosiated

Vaginal pH 3.5 – 4.5 to 7.0Vaginal pH 3.5 – 4.5 to 7.0 Reduce the inhibitory effect of HReduce the inhibitory effect of H 22OO22 an an

aerobic growthaerobic growth LactobacillusLactobacillus , , Gardnerella vaginalisGardnerella vaginalis

Bacteroides(prevotella) sppBacteroides(prevotella) spp Mobilincus sppMobilincus spp

Mycoplasma hominisMycoplasma hominis

DiagnosisDiagnosis OffensiveOffensive Typically fishy-smelling vaginal Typically fishy-smelling vaginal

dischargedischarge Speculum examination shows a thin, Speculum examination shows a thin,

homogenous white or yellow homogenous white or yellow discharge adheren to the wall of the discharge adheren to the wall of the vaginavagina

DiagnosisDiagnosis Vaginal pH > 4.5Vaginal pH > 4.5 Release of fishy-smell on addition of Release of fishy-smell on addition of

alkali (10% potassium hydroxide)alkali (10% potassium hydroxide) Characteristic discharge on Characteristic discharge on

examinationexamination Presence of ‘clue cells’ on Presence of ‘clue cells’ on

microscopymicroscopy

ManagementManagement

Standart :Standart : Metronidazole 400 mg 2x1 (5 days)/2 g Metronidazole 400 mg 2x1 (5 days)/2 g

single dose (95%)single dose (95%) Topical intravaginal 2% Clindamycin Topical intravaginal 2% Clindamycin

cream/0.75% Metronidazole gelcream/0.75% Metronidazole gel (Hay Phil ip, J of P, Obs & Gynecol, 2002)(Hay Phil ip, J of P, Obs & Gynecol, 2002)

(Clindamycin 3 day compared oral metronidazole 7 day twice daily, 68.1% - 66.7%). Paavonen J et al l . Obstet Gynecol 2000:96:256-260

Male partner :Male partner : Metronidazole, Tinidazole or Metronidazole, Tinidazole or

ClindamycinClindamycin 150 mg qds.150 mg qds.

Relaps :Relaps : Metronidazol 400 mg bd for 3 daysMetronidazol 400 mg bd for 3 days Starting 2 days Starting 2 days beforebefore menstruation menstruation

and again and again f if thfifth days of menstruation for days of menstruation for 3 months3 months

Differential DiagnosisDifferential Diagnosis

CandidiasisCandidiasis

BVBV

Giemsa

Trichomoniasis

Cervicit is

Neisseria gonorrhoeae

Chlamydia trachomatis

Patient advise & Self HelpPatient advise & Self Help

No vaginal douchingNo vaginal douching Not use of shower gel and bubble Not use of shower gel and bubble

bathbath Use condomUse condom

ComplicationComplication

Pregnancy Pregnancy associated with 2 associated with 2ndnd trimester trimester miscariage and preterm birth. miscariage and preterm birth. Chorioamnionitis Chorioamnionitis release of release of proinflammatory cytokines.proinflammatory cytokines.

Termination of pregnancy Termination of pregnancy Other gynecology surgeryOther gynecology surgery

IUD insertionIUD insertionHysteroscopyHysteroscopyDilatation & CurettageDilatation & Curettage

HIV & STIHIV & STI

Prevention and TreatmentPrevention and Treatment The best defence againts BV or any AVM The best defence againts BV or any AVM

is prevention, and this begins with is prevention, and this begins with screeningscreening

Women presenting for any gynecologic Women presenting for any gynecologic problem or annual examination should problem or annual examination should have an evaluation of the VEhave an evaluation of the VE

The VE can be viewed as a The VE can be viewed as a windowwindow not not only only to the vaginal health to the vaginal health but alsobut also the the general health of the patientgeneral health of the patient

The goal is to The goal is to restorerestore the pH 3.8 and 4.2 the pH 3.8 and 4.2