Bacterial vaginosis

27 May 2024
شركة لارا السعودية

Key facts

  • Bacterial vaginosis is the most common cause of vaginal discharge among women of reproductive age.
  • The prevalence of bacterial vaginosis varies between countries and population groups, but a recent systematic review and meta-analysis of the global prevalence of bacterial vaginosis among women of reproductive age suggests that the prevalence ranges from 23-29%.
  • Mostly, sexually active women are affected by the disease, and its occurrence is associated with inconsistent use of condoms and new and increasing number of sexual partners.
  • Bacterial vaginosis increases the risk of HIV infection, transmission and acquisition of other sexually transmitted diseases, and can lead to adverse effects on pregnancy if left untreated.

Overview

Bacterial vaginosis is a common condition in women. It occurs when the natural balance of microorganisms in the vagina is disturbed.

Bacterial vaginosis can be spread through sexual contact. The risk of developing bacterial vaginosis increases due to sexual contact with new partners and failure to use condoms correctly and consistently. Although it occurs globally, it is more common in low-resource settings and areas with limited access to health care.

Although the exact cause of bacterial vaginosis is unknown, many germs are linked to the disease. Many of these bacteria are usually found in a healthy vagina.

Bacterial vaginosis can be caused by an overgrowth of pathogens such as Gardnerella vaginalis, Prevotella, Mobilincus, Megasphaera, Synthia, and mixed anaerobic vaginal species, many of which facilitate the growth of pathogens and displace beneficial lactobacilli that help maintain a healthy vaginal environment. There is also high agreement in terms of the types of germs associated with bacterial vaginosis between sexual partners.


Symptoms

Symptoms can vary in severity. Some women with bacterial vaginosis may not notice any symptoms.

Common symptoms include:

  • Unusual vaginal discharge that may be thin, light gray or white;
  • Strong fishy or putrid odor from the vagina;
  • itching or irritation around the vagina;
  • Burning while urinating.

Bacterial vaginosis is a common condition that does not usually cause serious complications. However, if left untreated, it can lead to the following:

  • Problems with pregnancy (for example, spontaneous abortion, premature birth);
  • High risk of sexually transmitted infections, including HIV;
  • Pelvic inflammatory disease.

Vaginal cleansing and douching can increase the risk of bacterial vaginosis.


Diagnosis

To diagnose bacterial vaginosis, health care providers will discuss the patient's medical and sexual history and perform an examination of the reproductive system to check for the presence of vaginal discharge.

Diagnosis of bacterial vaginosis involves the use of laboratory tests along with clinical findings. One common method is the Gram stain test, which uses a light microscope to examine vaginal swabs. If bacterial vaginosis is present, the test shows an abundance of gram-positive and gram-negative cocci, along with a decrease in gram-positive lactobacilli (Nugent criteria). Bacterial vaginosis can also be diagnosed based on the presence of the following criteria (Ansel criteria):

  • The presence of homogeneous white vaginal discharge: Vaginal discharge is often gray or white, homogeneous, thin, and adheres to the vaginal wall (there is no obvious inflammation, which is why the disease is called vaginosis instead of vaginitis);
  • By measuring the level of acidity of vaginal secretions by performing a pH test: pH higher than 4.5;
  • An amine odor when potassium hydroxide is added to vaginal fluid (known as the WAVE test) may indicate the presence of bacterial vaginosis;
  • The presence of marker cells in microscopic examination of a wet vaginal swab of vaginal secretions.

Clinical and laboratory evaluations of bacterial vaginosis can be influenced by factors such as recent sexual activity, menstrual cycle, douching, and use of antimicrobial agents.

In contexts where laboratory diagnosis cannot be made, a syndromic approach is suggested for the diagnosis and treatment of vaginal discharge. Women who complain of vaginal discharge receive treatment for bacterial vaginosis and trichomoniasis. Metronidazole is prescribed for both bacterial vaginosis and trichomoniasis.


treatment

It is possible to treat and cure bacterial vaginosis.

The best medication to treat bacterial vaginosis is metronidazole.

Treatments include:

  • Metronidazole gel
  • Tinidazole
  • Clindamycin
  • Clindamycin gel.

Health care providers can diagnose bacterial vaginosis and test for other infections with similar symptoms, including:

  • Neisseria gonorrhoeae (which causes gonorrhea)
  • Chlamydia trachomatis (which causes chlamydia)
  • Mycoplasma genitalium (which can cause genital infections)
  • Trichomonas vaginalis (which causes trichomoniasis).

These infections may require different treatments.