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.
- Fungal vaginitis
- Trichomonas vaginitis
- Atrophic vaginitis
- Pelvic examination
- Speculum examination
- Normal saline and 10% KOH slide of discharge
- Amsel criteria for diagnosis (three of four should be present):
- pH .4.5
- Clue cells (epithelial cells covered with bacteria) on saline solution slide
- Positive whiff test on 10% KOH (fishy odor when KOH added to vaginal sample)
- Homogeneous, white, adherent discharge
- Sensitivity of Amsel criteria is >90%, specificity >75%.
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