Bacterial vaginosis: Difference between revisions
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==Background== | ==Background== | ||
*Accounts for up to 50% of cases of vaginitis | *Accounts for up to 50% of cases of [[vaginitis]] | ||
*Associated | *Associated with [[preterm labor]] and premature rupture of membranes | ||
==Clinical Features== | ==Clinical Features== | ||
*whitish-gray discharge and odor | *whitish-gray discharge and odor | ||
**Lack of discharge makes diagnosis less likely | **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== | ==Differential Diagnosis== | ||
{{Vulvovaginitis DDX}} | {{Vulvovaginitis DDX}} | ||
== | ==Evaluation== | ||
===Work-up=== | ===Work-up=== | ||
*Wet mount shows clue cells: | [[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 | *Whiff Test: fishy odor with 10% KOH prep | ||
*CDC recommends testing all women with BV for HIV and other STDs <ref name="cdc" /> | |||
===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== | ==Management== | ||
*No need to treat if asymptomatic | *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> | |||
*Do NOT need to treat sexual partner | *Do NOT need to treat sexual partner | ||
===[[Antibiotics]]=== | ===[[Antibiotics]]=== | ||
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<references/> | <references/> | ||
[[Category: | [[Category:OBGYN]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 01:14, 23 October 2018
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
- Atrophic vaginitis
- Lichen sclerosus
- Tinea cruris
- Chlamydia/Gonorrhea infection
- Vaginal foreign body
Evaluation
Work-up
- 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 [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
- In pregnant patients, consider treating to prevent preterm birth, though evidence is conflicting[2]
- Do NOT need to treat sexual partner
Antibiotics
First Line Therapy[3]
- Metronidazole 500 mg PO BID for 7 days OR
- Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days OR
- Clindamycin cream 2%, one full applicator (5 g) intravaginally qHS for 7 days
Alternative Regimin
- Tinidazole 2 g PO qd for 2 days OR
- Tinidazole 1 g PO qd for 5 days OR
- 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 hrs)
Pregnant
- Metronidazole 250mg PO q8h x 7 days[1]
- Metronidazole 2g PO x 1 dose is also acceptable[1]
- Multiple studies have not demonstrated teratogenicity from metronidazole use[1]
Prophylaxis (Sexual Assault)
- Metronidazole 2 g PO x 1 OR
- Tinidazole 2 g PO x 1
Disposition
- Discharge
See Also
References
- ↑ 1.0 1.1 1.2 1.3 CDC Pregnancy BV Treatment Guidelines.cdc.gov
- ↑ Cochrane Database of Systemic REviews. January 2013. Antibiotics for treating bacterial vaginosis in pregnancy. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010584/
- ↑ Workoski KA and Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommen and Reports. 2015; 64(3):1-140.