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Bacterial Vaginosis

  • Bacterial vaginosis (BV) is a common vaginal condition caused by an imbalance in the vaginal microbiota, leading to a decrease in lactobacilli and an overgrowth of other types of bacteria.
  • It’s the most common cause of vaginal discharge in women of childbearing age.
  • Not completely understood but is associated with a shift from a Lactobacillus-dominated flora to a more diverse microbial profile.
  • Factors that may contribute include multiple or new sexual partners, douching, and changes in vaginal pH.
Clinical Features:
  • Many women are asymptomatic.
  • Symptomatic women may experience a thin, grey, homogeneous vaginal discharge.
  • A “fishy” odor, especially after sexual intercourse or during menstruation.
  • Itching and irritation are less common.
  • Clinical diagnosis based on Amselโ€™s criteria (at least three of the following):
    1. Homogeneous discharge.
    2. pH of vaginal fluid >4.5.
    3. Positive whiff test (fishy odor with 10% KOH).
    4. Clue cells (vaginal epithelial cells coated with bacteria) on microscopic examination.
  • Nugent score from a Gram-stained slide can also be used.
  • Metronidazole or clindamycin, either orally or vaginally.
  • Treatment of sexual partners is not necessary as BV is not considered an STI.
  • Associated with an increased risk of STI acquisition.
  • In pregnant women, BV can be associated with adverse outcomes like preterm birth.

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