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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Women's Health Bacterial Vaginosis

Bacterial Vaginosis

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Bacterial vaginosis is caused by an imbalance btw the bacterial flora that occurs naturally, it should not be confused with yeast infection (candida), or infection with trichomoniasis which are not caused by bacteria.

 

Signs and symptoms

  • Abnormal, foul smelling, white vaginal discharge (especially after sex) with an unpleasant fishy odor.

  • Discharge sticks to the walls of the vagina, and without irritation, itching, and pain or erythema

  • Abdominal pain with lower back ache

Amsel criteria for bacterial vaginosis

  • Thin, white, yellow, unpleasant discharge.

  • Clue cells on microscopic examination.

  • PH of vaginal fluid is more than 4.5.

  • Release of a fishy odor on adding alkali-10% potassium hydroxide.

At least 3 out of the 4 criteria should be present for a confirmed diagnosis

Causes of bacterial vaginosis

  • Bacterial vaginosis are occurs more in sexually active women between the ages of 15 and 44, usually after contact with a new partner.

  • Although bacterial vaginosis is associated with sexual activity, there is no evidence that the disease is sexually transmitted.

  • Virgins get easily infected with bacterial vaginosis.

  • Bacterial vaginosis is a disturbance between the chemical balance and biological balance of the normal vaginal flora

  • Pregnant women and women with STIs are at high risk for getting this infection. Vaginosis may affect women even after menopause

Tests and diagnosis

  • Microscopic examination- demonstration of clue cells

  • Whiff test is positive

Differential diagnosis of Vaginosis

 

Clinical features

Bacterial vaginosis

Trichomoniasis

Vaginal candidiasis

Symptoms

Vaginal odor

+

+/-

-

 

Vaginal discharge

Thin, gray, and homogenous

Green yellow

White curdy

 

Vulvar irritation

+/-

+

+

 

Dyspareunia

-

+

-

 

Vulvar erythema

-

+/-

+/-

Signs

Bubbles in vaginal fluid

+

+/-

-

 

Strawberry cervix

-

+/-

-

Microscopy

Clue cells

+

-

-

 

Motile protozoa

-

+

-

 

Pseudohyphae

-

-

+

 

Whiff test

+

+/-

-

 

Ph

> 4.5

> 4.5

< 4.5

 

Complications

Treatment

Bacterial vaginosis is treated with anaerobic antibiotics such as Metronidazole/Tinidazole/Ornidazole or Clindamycin, either by vaginal route or oral route.

However, there is a high rate of recurrent attacks

Home based remedies

  • Eliminating unwanted bacterial flora- tea tree oil products helps to eliminate these bacteria

  • Adding buffer/acids to lower the vaginal ph. Ex- RepHresh

  • Adding lactic bacteria- Fem-dophilus is a lactobacillus which specifically to helps to  maintain healthy vaginal flora