Bacterial vaginosis

Background

• Accounts for up to 50% of cases
• Associated w/ preterm labor and premature rupture of membranes
• Treat all symptomatic women (including pregnant)
• Do not treat asymptomatic women (including pregnant)

Diagnosis

• Whitish-discharge and odor
  • Lack of discharge makes diagnosis less likely
• Wet mount shows clue cells

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

Treatment

• Do NOT need to treat sexual partner

• Metronidazole 2g PO once

<45kg

• 15 mg/kg/day PO divided q8h x 7 days
• First Dose: 7 mg/kg PO x 1

>45kg

• 2 g PO x 1

Pregnancy

• Alternative: 250mg PO q8h x 7 days in pregnant patients
• 2g PO x 1 is also acceptable in pregnancy
• Multiple studies have not demonstrated teratogenicity from metronidazole use

Prophylaxis (Sexual Assault)

• Metronidazole 2 g PO x 1 OR

Weight Based

<45kg

• 15 mg/kg/day PO divided q12h x 7 days
• First Dose: 7 mg/kg PO x 1
• Max: 1 g/day

>45kg

• 500mg PO divided q8h x 7 days
• First Dose: 500mg PO x 1
• Max: 2 g/day

Prophylaxis (Sexual Assault)

<45kg'

• 15 mg/kg/day PO divided q8h x 7 days
• First Dose: 7 mg/kg PO x 1

>45kg

• 2 g PO x 1

• • Single dose tx not as efficacious; not recommended by CDC
• Clindamycin 300mg PO BID x7d
• Metronidazole 250mg PO TID x7d - pregnancy treatment

See Also

• Vulvovaginitis

Source

Tintinalli