Monday, July 2, 2012

Is Bacterial Vaginosis ,really a Sexually transmitted disease

A young Lady came to me earlier this year with certain complains and my diagnosis was bacterial vaginosis.......which is a concern but in my opinion not such a great concern to loose sleep over it.I gave her treatment for bacterial vaginosis and her symptoms were gone.Then she went ahead with a routine PAP smear at another good gynaecologist.Her Pap smear showed clue cells.There was a huge scare,that Lady was advised 8 monthly pap smear as the gynaecologist feared that her bacterial vaginosis will repeat it again and again.She was advised Ciplox TZ,clindamycin and cotrimazole pessaries and few other medicines and HPV vaccines.This girl was alarmed.Her partner needed treatment.Too much for her to handle,I guess!!
Now I wish to write about BV as I feel not just the patients but the treating gynaecologists are not very clear on the management.Let us all revise what is BV

  • BV is overgrowth of anaerobic bacteria in vagina which outnumber the helpful Lactobacillus,because of which vaginal pH increases from 4.5 to 7. 
  • It can happen spontaneously in sexually active as well as not sexually active ladies
  • More common in blacks,smokers and with intrauterine contraceptive device.
  • It isnot a sexually transmitted disease and it's etiology is unknown.
  • It is the commonest cause of vaginal discharge in the women of child bearing age,
  • Though BV is more common in women who have pelvic inflammatory disease but at the same time there is no evidence that a Lady without any symptom needs any treatment .(Just like this girl)
  • Those who complain of BV related symptoms that are fishy smelling vaginal discharge,Vaginal itching and soreness and thin white homogenous discharge.
  • Pregnant Ladies with BV can have higher chance of preterm labour pain,miscarriages,Premature rupture of membranes.After hysterectomy one can have vaginal cuff cellulitis.
Amsel's criteria for diagnosisng BV (At least 3 out of 4 should be present)
  • thin white homogenous discharge
  • clue cells on microscopy
  • pH of vaginal>  4,5
  • Release of fishy odour on adding KOH(a;kali to the discharge
In asymptomatic women there is no need of routine Vaginal swab testing, as 50% 0f asymptomatic women will have clue cells which doesn't need any treatment at all.

Vaginal douching withantiseptic bath gels
If symptoms are present .Metronidazole tablets/Metronidazole gel/Clindamycin ointment and tablets are the treatment of choice.

Male partner shouldn't be made to have antibiotic as it never helps

Pregnant Ladies with a H/O BV shoud have her high vaginal swab more often as they are at increases risk of preterm pains,premature rupture of membranes and other complications.

The optimal management of people with recurrent symptomatic BV remains unresolved.


Lisa said...

Very well explained and made me proactive! Bacterial Vaginosis

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