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.
Epidemiology:
It’s the most common cause of vaginal discharge in women of childbearing age.
Etiology:
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.
Diagnosis:
Clinical diagnosis based on Amsel’s criteria (at least three of the following):
Homogeneous discharge.
pH of vaginal fluid >4.5.
Positive whiff test (fishy odor with 10% KOH).
Clue cells (vaginal epithelial cells coated with bacteria) on microscopic examination.
Nugent score from a Gram-stained slide can also be used.
Treatment:
Metronidazole or clindamycin, either orally or vaginally.
Treatment of sexual partners is not necessary as BV is not considered an STI.
Complications:
Associated with an increased risk of STI acquisition.
In pregnant women, BV can be associated with adverse outcomes like preterm birth.
