Bacterial vaginosis: Difference between revisions
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*Wet mount shows clue cells: bacteria that line the borders of the vaginal epithelial cells | *Wet mount shows clue cells: bacteria that line the borders of the vaginal epithelial cells | ||
*Whiff Test: fishy odor with 10% KOH prep | *Whiff Test: fishy odor with 10% KOH prep | ||
*CDC recommends testing all women with BV for HIV and other STDs | *CDC recommends testing all women with BV for HIV and other STDs <ref name="cdc" /> | ||
===Amsel criteria for diagnosis (3/4 must be present)=== | ===Amsel criteria for diagnosis (3/4 must be present)=== | ||
Revision as of 16:39, 9 February 2017
Background
- Accounts for up to 50% of cases of vaginitis
- Associated with preterm labor and premature rupture of membranes
Clinical Features
- whitish-gray 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
- Bacterial vaginosis
- Candida vaginitis
- Trichomonas vaginalis
- Contact vulvovaginitis
- Bubble baths and soaps
- Deodorants, powders, and douches
- Clothing
- Atrophic vaginitis due to lack of estrogen (AKA Vulvovaginal atrophy)
- Lichen sclerosus
- Tinea cruris
- Chlamydia/Gonorrhea infection
- Pinworms
- Vaginal foreign body
- Toilet paper
- Other
- Genitourinary syndrome of menopause
- Foreign body
- Allergic reaction
- Normal physiologic discharge
Evaluation
Work-up
- Wet mount shows clue cells: bacteria that line the borders of the vaginal epithelial cells
- Whiff Test: fishy odor with 10% KOH prep
- CDC recommends testing all women with BV for HIV and other STDs [1]
Amsel criteria for diagnosis (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 (even if pregnant)
- Do NOT need to treat sexual partner
Antibiotics
First Line Therapy[2]
- Metronidazole 500 mg PO Twice Daily for 7 days OR
- Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, Daily for 5 days OR
- Clindamycin cream 2%, one full applicator (5 g) intravaginally Nightly for 7 days
Metronidazole does not cause a disulfiram-like reaction with alcohol.[3]
Alternative Regimin
- Clindamycin 300 mg PO BID for 7 days OR
- Clindamycin ovules 100 mg intravaginally qHS for 3 days (do not use if patient has used latex condom in last 72 hours)
Other regimens have been studied and have varying efficacy compared to placebo but due to cost and availability do not represent alternatives outside of absolute contraindications to preferred regimens.
Pregnant
- Metronidazole 500mg PO Twice a day x 7 days[2]
- Metronidazole 250mg PO Three times a day has also been studied[4][5]
- Although metronidazole crosses the placenta, no evidence of teratogenicity or mutagenic effects among infants has been reported in multiple cross-sectional, case-control, and cohort studies of pregnant women[2]
Prophylaxis (Sexual Assault)
- Metronidazole 500mg PO Twice a day x 7 days[6]
Disposition
- Discharge
See Also
References
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedcdc - ↑ 2.0 2.1 2.2 CDC Sexually Transmitted Infections Treatment Guidelines, 2021.[1]
- ↑ Is combining metronidazole and alcohol really hazardous?[2]
- ↑ Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis[3]
- ↑ Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo-controlled, double-blind study[4]
- ↑ Sexual Assault and Abuse and STIs – Adolescents and Adults[5]