What is bacterial vaginosis?
Bacterial vaginosis is a common cause of abnormal vaginal discharge and malodour in women of reproductive age. In some women however there will be no symptoms. It is not sexually transmitted or contagious. It was previously referred to as nonspecific vaginitis.
What is the cause of bacterial vaginosis?
Bacterial vaginosis is due to a disturbance of normal bacterial equilibrium in the vagina. Lactobacilli are usually the most common bacteria in the vagina. In bacterial vaginosis, there is an overgrowth of other bacteria, especially Gardnerella, Bacteroides, Peptostreptococci and Mobilunculus species. These are anaerobic bacteria, ie, they grow in the absence of oxygen.
Predisposing factors for bacterial vaginosis include recent antibiotic use, decreased oestrogen production, intrauterine device (IUD) and an increased number of sexual partners. It is associated with elevate pH within the vagina.
What are the clinical features of bacterial vaginosis?
The odour of the creamy white foamy discharge is the most common complaint in bacterial vaginosis, with a positive "whiff" test (malodour). It is sometimes greenish in colour, and can be sticky. The vulva and vagina are not inflamed. However, the discharge can be irritating, resulting in symptoms on the skin around the vagina.
- Contact sensitivity, eg to urine, clothing, bicycle-riding
In most women there are no complications from bacterial vaginosis. There are some risks in pregnancy including premature labour and inflammation around the fetus (chorioamnionitis). There may also be an association with pelvic inflammatory disease.
How is the diagnosis of bacterial vaginosis made?
In bacterial vaginosis, a vaginal smear shows the normal vaginal lactobacilli are replaced by multiple small cocci. These are small round bacteria whereas lactobacilli are elongated. "Clue" cells are also seen; these are epithelial cells from the lining of the vagina with many of the cocci adherent to their eg. Vaginal pH is elevated (>4.5) in most patients, unlike in vulvovaginal candidiasis when it is reduced below 4.5.
The flora typical for bacterial vaginosis can be a normal finding in asymptomatic postmenopausal women.
What is the treatment of bacterial vaginosis?
Bacterial vaginosis naturally fluctuates so treatment is not always necessary, particularly if there are no symptoms. Treatment of bacterial vaginosis is recommended during pregnancy to reduce the risk of complications related to infection.
Management of symptomatic bacterial vaginosis may include:
- Avoid douching and bathing using bubble bath or other detergents
- Reduce vaginal pH to encourage restoration of normal vaginal lactobacilli (eg, intravaginal Lactigel™ once daily at night for 7 days or Multi-Gyn Actigel® twice daily for 5 days)
- Boric acid 600 mg vaginal capsules or pessaries daily for 21 days
- Intravaginal clindamycin cream or metronidazole gel
- Oral antibiotics (metronidazole or tinidazole)
- Oestrogen cream in postmenopausal women.