What is the symptoms of bacterial vaginosis

Topic Resources

Bacterial vaginosis is vaginitis due to a complex alteration of vaginal flora in which lactobacilli decrease and anaerobic pathogens overgrow. Symptoms include a gray, thin, fishy-smelling vaginal discharge. Diagnosis is confirmed by testing vaginal secretions. Treatment is usually with oral or topical metronidazole or topical clindamycin.

Anaerobic pathogens that overgrow include Prevotella species, Peptostreptococcus species, Gardnerella vaginalis, Mobiluncus species, and Mycoplasma hominis, which increase in concentration by 10- to 100-fold and replace the normally protective lactobacilli.

Bacterial vaginosis appears to increase the risk of pelvic inflammatory disease Pelvic Inflammatory Disease (PID) Pelvic inflammatory disease (PID) is a polymicrobial infection of the upper female genital tract: the cervix, uterus, fallopian tubes, and ovaries; abscess may occur. PID may be sexually transmitted... read more , postabortion and postpartum endometritis Postpartum Endometritis Postpartum endometritis is uterine infection, typically caused by bacteria ascending from the lower genital or gastrointestinal tract. Symptoms are uterine tenderness, abdominal or pelvic pain... read more , posthysterectomy vaginal cuff infection, chorioamnionitis Intraamniotic Infection Intraamniotic infection is infection of the chorion, amnion, amniotic fluid, placenta, or a combination. Infection increases risk of obstetric complications and problems in the fetus and neonate... read more , premature rupture of membranes Prelabor Rupture of Membranes (PROM) Prelabor rupture of membranes is leakage of amniotic fluid before onset of labor. Diagnosis is clinical. Delivery is recommended when gestational age is ≥ 34 weeks and is generally indicated... read more , preterm labor Preterm Labor Labor (contractions resulting in cervical change) that begins before 37 weeks gestation is considered preterm. Risk factors include prelabor rupture of membranes, uterine abnormalities, infection... read more , and preterm birth Preterm Infants An infant born before 37 weeks gestation is considered preterm. Prematurity is defined by the gestational age at which infants are born. Previously, any infant weighing < 2.5 kg was termed... read more .

Vaginal discharge due to bacterial vaginosis is malodorous, gray, and thin. Usually, a fishy odor is present, often becoming stronger when the discharge is more alkaline—after coitus and menses. Pruritus, irritation, erythema, and edema are not common.

• Clinical criteria

• Vaginal pH and wet mount

For bacterial vaginosis to be diagnosed, 3 of 4 criteria must be present:

• Gray discharge

• Vaginal secretion pH > 4.5

• Fishy odor on the whiff test

• Clue cells

• Metronidazole or clindamycin

The following treatments for bacterial vaginosis are equally effective:

• Oral metronidazole 500 mg twice a day for 7 days or 2 g once

• Metronidazole 0.75% gel 5 g (one applicator full) intravaginally once a day for 7 days

• 2% clindamycin vaginal cream once a day for 7 days

Oral metronidazole 500 mg twice a day for 7 days is the treatment of choice for patients who are not pregnant, but because systemic effects are possible with oral drugs, topical regimens are preferred for pregnant patients. Women who use clindamycin cream cannot use latex products (ie, condoms or diaphragms) for contraception because the drug weakens latex.

Treatment of asymptomatic sex partners is unnecessary.

For vaginitis during the 1st trimester of pregnancy, metronidazole vaginal gel should be used, although treatment during pregnancy has not been shown to lower the risk of pregnancy complications. To prevent endometritis, clinicians may give oral metronidazole prophylactically before elective abortion to all patients or only to those who test positive for bacterial vaginosis.

When treated, symptomatic bacterial vaginosis usually resolves in a few days but commonly recurs. If it recurs often, antibiotics may have to be taken for a long time.