Bacterial vaginosis: Difference between revisions

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==Background==
==Background==
*Accounts for up to 50% of cases
*Accounts for up to 50% of cases of [[vaginitis]]
*Associated w/ preterm labor and premature rupture of membranes
*Associated with [[preterm labor]] and premature rupture of membranes
*Treat all symptomatic women (including pregnant)
*Do not treat asymptomatic women (including pregnant)


==Diagnosis==
==Clinical Features==
*Whitish-discharge and odor
*Whitish-gray [[vaginal discharge]] and odor
**Lack of discharge makes diagnosis less likely
**Lack of discharge makes diagnosis less likely
*Wet mount shows clue cells
*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}}


=Treatment=
==Evaluation==
*Do NOT need to treat sexual partner
===Work-up===
*2 Options: Metronidazole or Clindamycin
[[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.]]
==[[Metronidazole]]==
*Wet mount shows '''clue cells''': vaginal epithelial cells with "stippled appearance" due to coverage by bacteria
{{BV Metronidazole Adult}}
*Whiff Test: fishy odor with 10% KOH prep
*CDC recommends testing all women with BV for HIV and other STDs <ref name="cdc" />


===Weight Based===
===Diagnosis===
{{BV Metronidazole Weight Based}}
''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)


===Prophylaxis ([[Sexual Assault]])===
==Management==
{{BV Metronidazole Prophylaxis Weight Based}}
*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
===[[Antibiotics]]===
{{BV Antibiotics}}


==[[Clindamycin]]==
==Disposition==
{{BV Clindamycin Adult}}
*Discharge


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


==Source==
==References==
<references/>
<references/>
[[Category:OB/GYN]]
 
[[Category:OBGYN]]
[[Category:ID]]
[[Category:ID]]

Latest revision as of 17:27, 3 October 2019

Background

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

Evaluation

Work-up

A "clue cell": note effacement of borders by bacteria, as compared to normal epithelial cells below.
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 [1]

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[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

Prophylaxis (Sexual Assault)

Disposition

  • Discharge

See Also

References

  1. 1.0 1.1 1.2 1.3 CDC Pregnancy BV Treatment Guidelines.cdc.gov
  2. Cochrane Database of Systemic REviews. January 2013. Antibiotics for treating bacterial vaginosis in pregnancy. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010584/
  3. Workoski KA and Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommen and Reports. 2015; 64(3):1-140.