Overgrowth of anaerobic bacteria - not a STI
- Gardnerella vaginalis (most common)
- Mycoplasma hominis
- Prevotella species
Can occur along side other infections - candidiasis, chlamydia and gonorrhoea
- Multiple sexual partners (although it is not sexually transmitted)
- Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)
- Recent antibiotics
- Smoking
- Copper coil
Presentation
- Fishy-smelling watery grey or white vaginal discharge
- Itching irritation and pain are nottypically associated with BV and suggest an alternative cause
- Examination not always required if symptoms are typical but a speculum exam can be performed to confirm the discharge and exclude other causes
Investigations
- Vaginal pH - normal range is 3.5-4.5. BV occurs with a pH above 4.5
- Vaginal swab for microscopy - BV gives “clue cells” - epithelial cells with bacteria stuck in them
Management
- Asymptomatic does not require any treatment and may spontaneously resolve
- **Metronidazole**is the antibiotic choice as anaerobic bacteria targets. Given orally or by vaginal gel. Patients must avoid alcohol while taking
- Clindamycin is an alternative but not optimal
- Always assess the risk of pelvic infections with swabs - chlamydia and gonorrhea
Complications
Bacterial vaginosis can increase the risk of catching sexually transmitted infections, including chlamydia,gonorrhoeaand HIV.
It is also associated with several complications in pregnant women:
- Miscarriage
- Preterm delivery
- Premature rupture of membranes
- Chorioamnionitis
- Low birth weight
- Postpartum endometritis