View source for Bacterial vaginosis

==Background==
*Is a vaginal dysbiosis resulting from replacement of the normally dominant ''Lactobacillus'' species in the vagina, with high concentrations of [[anaerobic bacteria]].
*Is '''not''' an infection, nor is it sexually transmitted, although it is associated with sexual activity.
*Accounts for up to 50% of cases of [[vaginitis]]
*Associated with [[preterm labor]] and premature rupture of membranes

==Clinical Features==
*Whitish-gray [[vaginal discharge]] and odor
**Lack of discharge makes diagnosis less likely
*May have history of "physiologic whiff test" after contact with male ejaculate which is alkaline (like KOH)

==Differential Diagnosis==
{{Vulvovaginitis DDX}}

==Evaluation==
===Work-up===
[[File:Clue Cell.jpg|right|thumbnail|A '''"clue cell"''': note effacement of borders by bacteria, as compared to normal epithelial cells below.]][[File:Wet Mount Normal Cell.jpg|right|thumbnail|Normal vaginal epithelial cells on wet mount: note clean borders. Presence of lactobacilli (tiny rods) is normal.]]
*Wet mount shows '''clue cells''': vaginal epithelial cells with "stippled appearance" due to coverage by bacteria
*Whiff Test: fishy odor with 10% KOH prep
*CDC recommends testing all women with BV for HIV and other STDs <ref name="cdc">Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1</ref>

===Diagnosis===
''Amsel criteria (3/4 must be present)''
*Homogeneous, thin, gray-white discharge
*Positive whiff test
*Vaginal pH>4.5
*Clue cells on wet mount (at least 20% of epithelial cells)

==Management==
*No need to treat if asymptomatic
**In pregnant patients, consider treating to prevent preterm birth, though evidence is conflicting<ref>Cochrane Database of Systemic REviews. January 2013. Antibiotics for treating bacterial vaginosis in pregnancy. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010584/</ref>
*Consider partner treatment to reduce risk of recurrence<ref>Vodstrcil LA, et al. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med. 2025 Mar 6;392(10):947-957. doi: 10.1056/NEJMoa2405404. PMID: 40043236.</ref>
*Does ''not'' need a test of cure

===[[Antibiotics]]===
{{BV Antibiotics}}

==Disposition==
*Discharge

==See Also==
*[[Vulvovaginitis]]

==References==
<references/>

[[Category:OBGYN]]
[[Category:ID]]