Bacterial Vaginosis

What is Bacterial vaginosis?
• Bacterial vaginosis is the most

common cause of abnormal
vaginal odour and discharge.
• It is caused by a change in the
type of bacteria found in the
vagina.
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Pathophysiology
• Normally, bacteria belonging mostly to
the Lactobacillus family live harmlessly
in the vagina and produce chemicals
that keep the vagina mildly acidic.
• In bacterial vaginosis, Lactobacillus
bacteria are replaced by other types of
bacteria that normally are present in
smaller concentrations in the vagina.
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Risk factors
• Multiple sex partners
• Sexual relationship with a new partner
• Cigarette smoking
• Vaginal douching
• Use of the intrauterine contraceptive device (IUD).
• Natural lack of lactobacilli bacteria.
• Douche
Although most of these risk factors are related to

sexual activity, women who have never had vaginal
intercourse can also develop bacterial vaginosis.
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Sexual activity
The CDC states that any woman can develop
gardnerella, regardless of whether she is
sexually active. However, sexual activity and
level of sexual activity does seem to be a
factor. Women who have multiple sexual
partners are at a higher risk, and women
with new sexual partners are more prone to
develop gardnerella as well
Bacterial vaginosis & pregnancy
Bacterial vaginosis often occurs during
pregnancy. It may cause premature labor and
delivery, premature rupture of membranes,
and postpartum uterine infections. This is
why pregnant women with a history of
premature labor or other complications may
be checked for bacterial vaginosis even when
they don't have any symptoms.
Gardnerella Vaginitis
• Gram-variable-staining rod, facultative
anaerobic bacteria (actually has a Gram-
positive cell wall, but because the cell wall is
so thin it can appear either Gram-positive or
Gram- negative under the microscope).
• Small (1-1.5 µm diameter) non-spore forming,
non-motile coccobacilli.
• Previously classified as Haemophilus vaginalis
and afterwards as Corynebacterium vaginalis.
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Can be isolated from other
Areas
Typically isolated in
genital cultures. May
also be detected in
other samples from
blood, urine and
pharynx
Symptoms
Up to 50% of women diagnosed with
bacterial vaginosis do not have symptoms.
In others, it causes
• Thin, gray, white or green vaginal
discharge
• Foul-smelling "fishy" vaginal odor
• Vaginal itching
• Burning during urination
Observation of Vaginal Discharge
The discharge seen in
bacterial vaginosis tends to
be thinner than the
"cheesy," thick discharge
seen in vaginal yeast
(Candida) infections.
Bacterial vaginosis usually
does not cause significant
irritation of the vulva or
pain during intercourse. If
you have these symptoms,
your doctor will check for
other possible causes.
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Diagnosis
• There is no perfect test, but if you have three of the
following four criteria, it is highly likely that you have
bacterial vaginosis:
1. White, thin, coating on your vaginal walls during the
pelvic exam
2. pH test of vaginal discharge that shows low acidity (pH
greater than 4.5)
3. Fishy odor when a sample of vaginal discharge is
combined with a drop of potassium hydroxide on a
glass slide “Whiff test")
4. 4 Clue cells (vaginal skin cells that are coated with
bacteria) visible on microscopic exam of vaginal fluid
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Newer methods in diagnosis
of Genital Infections
DNA probes have been developed to directly detect
the presence of candida, trichomonas and
Gardnerella, thus providing a more objective
diagnosis. Since Gardnerella is a normal part of the
vaginal flora, the DNA probe test is designed to be
relatively insensitive, detecting only pathogenic levels
of Gardnerella. The Affirm VP III Microbial
Identification System (Becton Dickinson) is a
commercially available DNA probe office-based test kit
that simultaneously detects the presence of
Gardnerella, trichomonas and candida.
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Treatment
• Commonly treat bacterial vaginosis with
Metronidazole (Flagyl or MetroGel-Vaginal) or
Clindamycin (Cleocin). Either can be taken by
mouth or applied as a vaginal cream or gel.
However, the U.S. Centers for Disease Control and
Prevention (CDC) recommends that all pregnant
women with symptoms be treated with oral
medications because the medications are safe and
work better than vaginal creams or gels.
Treatment
Studies show that a seven-day treatment
with oral metronidazole or a five-day
treatment with metronidazole vaginal gel is
equally effective in non-pregnant women.
Clindamycin vaginal cream is slightly less
effective than either type of metronidazole.
Prevention
• Clean sex toys after every use.
• Don’t douche.
• Get tested for sexually transmitted diseases, and
make sure your sex partners are tested.
• Limit your number of sex partners.
• If your partner is male, put a condom on his penis
before it touches your vagina, mouth, or anus.
• Use only water or mild soap to wash your genitals.
• Wipe from front to back after you use the
bathroom.
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Complications
The bacterial vaginosis has been associated
with the development of pelvic
inflammatory disease and other infections
after endometrial biopsy, surgical abortion,
hysterectomy, intrauterine device
placement, Caesarean section and uterine
curettage.

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What is Bacterial vaginosis?

• Bacterial vaginosis is the most

Although most of these risk factors are related to

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