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 500mg PO BID x7d
  • 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