The commonest cause of abnormal vaginal discharge. Depletion of the lactobacilli dominant in the healthy vaginal flora, together with an elevation of vaginal pH to above 4.5. Gardnerella vaginalis and other species (causative organisms)
- Risk factors include
- Douching.
- Black race.
- Smoking.
- Symptoms include
- Offensive vaginal discharge with ‘fishy’ odour.
- Homogenous white vaginal discharge.
- High pH.
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Diagnosis
Is made by using Amsel’s criteria (3 of 4 are required):
- Homogenous discharge
- High pH, ‘clue cells’ on microscopy
- Fishy odour when 10% potassium hydroxide is added to a sample of discharge.
- BV is associated with a number of pathologies including:
- Pelvic inflammatory disease (PID).
- Post-hysterectomy vaginal cuff cellulitis and.
- Pregnancy.
- Preterm birth.
- Rupture of membranes.
- Miscarriage.
An increased risk of HIV acquisition is observed in women at risk with BV.
Treatment
- Oral or intravaginal treatments with metronidazole or clindamycin are indicated in women with symptoms.
- Prior to gynaecological surgical procedures.
Women with BV should be advised that vaginal douching or excessive washing should be avoided.