Bacterial Vaginosis is a clinical syndrome resulting from replacement of the normal hydrogen peroxide-producing Lactobacillus sp. in the vagina by high concentrations of anaerobic bacteria, such as Gardnerella vaginalis, Mycoplasma hominis, and Mobiluncus curtisii.
The cause of the microbial alteration is not fully understood.
The associated malodour is due to the release of amines produced by anaerobic bacteria that decarboxylate lysine to caverdine, and arginine to putrescine.
- Use of antiseptic/antibiotic vaginal preparations
- vaginal douching
- Malodorous and increased white vaginal discharge that is homogenous, low in
viscosity, and uniformly coats vaginal walls
- The fishy-smelling discharge is particularly noticeable after sexual intercourse; usually no
pruritus or inflamed vulvae
- Other causes of vaginal discharge e.g. Gonorrhoea.
- Acute salpingitis.
- Premature rupture of membranes
- Preterm delivery and low birth weight
- Homogeneous milky discharge with pH > 4.5 (pH > 6.0 highly suggestive)
- Fishy odour from the biogenic amines; altered by addition of 10% KOH (Sniff test)
- Clue cells on a wet mount
- Clue cells are normal vaginal epithelial cells studded with bacteria, giving the cells a granular appearance
- To eliminate the organisms
- Metronidazole 400 mg orally, every 12 hous for 7 days
- Metronidazole 2 g orally, as a single dose
- Metronidazole 0.75% gel 5 g intravaginally, twice for 7 days
Recommended regimen for pregnant women:
- Metronidazole 200 orally, every 8 hours for 7 days, after the first trimester
- 2g orally, as a single dose
If treatment is imperative in the first
trimester of pregnancy, Give metronidazole 2 g orally as a single dose
Notable adverse reactions, caution & contraindications
- Causes a disulfiram-like reaction with alcohol
- Avoid high doses in pregnancy and breast feeding
- May cause nausea, vomiting, unpleasant taste, furred tongue, and gastro-intestinal disturbances
- Generally not recommended for use in the first trimester of pregnancy
- Reduce or eliminate predisposing factors such as antiseptic/antibiotic vaginal preparations or vaginal douching
- Treat symptomatic pregnant women
- Screen pregnant women with a history of previous pre-term delivery to detect asymptomatic infections
- Retreat pregnant women with recurrence of symptoms
- Counselling, Compliance, Condom use and Contact treatment