Bacterial Vaginitis: How to deal with Bacterial Vaginitis ?

By | September 23, 2017
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DEFINITION

Bacterial vaginitis, also known as bacterial vaginosis (BV), is a polymicrobial infection affecting the vagina caused by anaerobic bacteria.

PHYSICAL FINDINGS & CLINICAL PRESENTATION

  • .50% of all women may be without symptoms.
  • Unpleasant, fishy, or musty vaginal odor in about 50% to 70% of all patients. Odor exacerbated immediately after intercourse or during menstruation.
  • Vaginal discharge is increased and may have a white or gray homogeneous appearance.
  • Vaginal itching and irritation occur.

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  • Fungal vaginitis
  • Trichomonas¬†vaginitis
  • Atrophic vaginitis
  • Cervicitis

WORKUP

  • Pelvic examination
  • Speculum examination
  • Normal saline and 10% KOH slide of discharge
  • Amsel criteria for diagnosis (three of four should be present):
  1. pH .4.5
  2. Clue cells (epithelial cells covered with bacteria) on saline solution slide
  3. Positive whiff test on 10% KOH (fishy odor when KOH added to vaginal sample)
  4. Homogeneous, white, adherent discharge

  • Sensitivity of Amsel criteria is >90%, specificity >75%.

TREATMENT

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ACUTE GENERAL Treatment

  • Metronidazole 500 mg PO bid 3 7 days, .90% cure rate
  • Metronidazole 2 g PO 3 1 day, 67% to 92% cure rate
  • Metronidazole gel 5 g, intravaginal bid 3 5 days
  • Clindamycin 2% cream 5 g, intravaginal qd 3 7 days
  • Clindamycin 300 mg PO bid 3 7 days; cure rate similar to those achieved with metronidazole
  • Good hygiene: avoidance of douching, harsh shower gels, bubble baths; cotton underwear

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