The main reason of abnormal vaginal discharge in women of reproductive age is bacterial vaginosis (BV). Population-specific prevalence ranges from 5% in asymptomatic students to 50% in rural Ugandan mothers.
Aetiology of Bacterial vaginosis
One definition of BV is an imbalance of the usual vaginal flora.
Anaerobic bacteria proliferate excessively in vaginal environments caused by BV.
The vaginal environment is dynamic; both sexually active and inactive women might spontaneously have BV.
Though the question of whether BV is spread sexually is up for debate, it is associated with sexual activity, including recent partner changes and concurrent STIs.
Virgins still do have it.
There is a higher chance of contracting HIV when one has BV.
Anaerobic bacteria that favour an alkaline environment (pH > 4.5) are the source of BV symptoms. A few women claim that an alkaline vaginal pH, such that of menstrual blood or semen, may be the cause of BV.
Condom use, a partner who has undergone circumcision, and getting the COC may all protect against BV.
Risk factors of Bacterial vaginosis
Vaginal douching, smoking, black ethnicity, and responsive cunnilingus
Though the relationship with the LNG-IUS is yet unknown, users of the Cu-IUD are more prone to get BV.
Symptoms and signs
Of all women, up to half will not show any symptoms.
Indications: Moderate to profuse, disagreeable-smelling vaginal discharge without pain or irritation (may coincide with VVC).
One sign is a gray or white discharge on the vaginal and vestibule walls that smells like fish. As shown on TV, speculum can ‘pool’ and get frothy. There isn’t often any irritation or erythema.
Diagnosis
pH measurement
Both specialists and non-specialists can benefit from this useful test. As long as the woman gives her permission, this test is useful in both professional and non-specialist context. A raised vaginal pH of 4.5–6.0 is the hallmark of BV.
Microscopy
BV is diagnosed by microscopically looking at a vaginal smear. Immediate microscopy is available in most advanced SRH configurations. A local laboratory can be contacted to do Gram staining and microscopy on an air-dried slide or swab (HVS).
Two fundamental diagnostic methods are Amsel’s criterion and the Hay/Ison criteria.
Vaginal epithelial cells covered in microscopic Gram variable bacilli (rods) are called clue cells.
Culture
BV cannot be diagnosed by culture since Gardnerella vaginalis is present in at least 50% of normal women’s vaginas.
Tests now accessible commercially: Though not widely accessible in the UK, point-of-care tests such as the OSOM BV blue test, which looks for elevated sialidase levels, are as good as microscopy.
Currently being developed to identify particular combinations of microorganisms linked to BV are NAATs.
Complications
Although BV is more common in women with PID, there is no proof of a causative relationship. Furthermore, no prospective studies exist to determine if treating asymptomatic BV lowers the risk of developing PID.
An infection of the vaginal cuff following a transvaginal hysterectomy has been associated with BV.
One study connected male partners’ BV to NGU.
Pregnancy
Preterm birth, postpartum endometritis, preterm rupture of the membranes, and late miscarriage have all been associated with BV during pregnancy. It is also associated with post-TOP endometritis and PID, hence women receiving this therapy need to be checked and/or given antibiotic prophylaxis.
Management of Bacterial vaginosis
General
Women should refrain from taking bubble baths or vaginal douches as well as from using scented shower gels and soaps to avoid vaginal infections.
If STIs are suspected, test for them; BV and STIs can coexist.
Treatment
Symptomatic women, those having specific surgical procedures (like TOP), and those choosing therapy even in the absence of symptoms are all advised to take this drug.
Both regimens produce cure rates of 70–80%, however the stat dosage of metronidazole may be somewhat less effective than the 5-7-day course.
Alcohol should be avoided both during and after metronidazole treatment.
Clindamycin cream can weaken condoms, and intravaginal medications are more expensive than oral metronidazole.
Use clindamycin cream if you have a rare metronidazole allergy.
Pregnancy: Not enough data exists to back up routine screening of expectant mothers. Expectant mothers with symptoms ought to receive standard care. To prevent changing the flavor of their milk, nursing women can use vaginal treatments.
Partner notification
It is not advised and does not lower relapse rates to treat male partners of women with BV. It’s unknown if treating female companions of BV sufferers works.
Follow up and TOC
Not required if the problems have gone away.
Recurrent of Bacterial vaginosis
Within three months of treatment, up to 30% of women experienced a recurrence; the reason is yet unknown. The normal vaginal flora might not have completely restored. Some ladies get recurrences quite often.
The diagnosis has to be verified under a microscope.
It is important to stress good genital hygiene habits (such as quitting douching).
An IUD user may need to look at other contraceptive options.
Though there isn’t enough evidence to back up their efficacy, vaginal acidifying gels like Balance Activ® or Relactagel® have been recommended. Also, helpful could be probiotic therapy.
Reprospot link