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Bacterial VaginosisAka: Gardnerella Vaginitis, Non-specific Vaginitis, Haemophilus Vaginitis, Corynebacterium Vaginitis, Mixed bacterial vaginitis, Anaerobic Vaginitis

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  1. See also
    1. Vaginitis
  2. Epidemiology
    1. Accounts for 35-50% of Vaginitis
  3. Etiology
    1. Marked reduction in normally predominant lactobacillus
    2. Polymicrobial infection: facultative Anaerobic Bacteria
      1. Peptostreptococcus
      2. Corynebacterium vaginale (Haemophilus vaginalis)
      3. Bacteroides
      4. Mobiluncus species
      5. Mycoplasma hominis
  4. Symptoms
    1. Often asymptomatic, or mild
    2. Musty or fishy odor to genitalia or Vaginal Discharge
    3. Profuse thin gray-white, non-clumping Vaginal Discharge
  5. Signs: Amsel's Criteria (3 of 4 needed for diagnosis)
    1. Vaginal pH > 4.5 (more alkaline than normal)
      1. See Vaginal pH for differential diagnosis
      2. High sensitivity
      3. Poor Specificity
        1. False positive with Cervical Mucus, Menses or semen
    2. Clue Cells present (on >20% of cells)
      1. Bacteria adhered to vaginal epithelial cells
      2. Most reliable single indicator of bacterial vaginosis
      3. Images
        1. GynVaginitisClueCell.jpg
    3. Positive whiff test (Amine Test)
      1. Volatile amines produce a fishy odor with 10% KOH
      2. Also present with Trichomonal Vaginitis
    4. Discharge characteristics
      1. Thin, non-clumping, gray-white, adherent discharge
  6. Management
    1. Non-Pregnant
      1. First-Line: Oral Metronidazole (Flagyl)
        1. Flagyl 500 mg PO bid for 7 days ($5)
      2. Topical options (higher recurrence rate)
        1. MetroGel (0.75%) 5g PV qhs for 5 days ($29)
        2. Clindamycin Cream (2%) 5g PV qhs for 7 days ($31)
    2. Pregnancy:
      1. First Trimester
        1. Avoid treatment if possible in first trimester
        2. Clindamycin (Cleocin) 300 mg PO bid for 7 days
        3. Clindamycin Cream 5 grams PV qhs for 7 days
        4. Metronidazole Gel PV bid for 5 days
      2. After First Trimester
        1. Metronidazole (Flagyl) 250 mg tid for 7 days
          1. Consider with Erythromycin 333 mg tid x14 days
        2. Clindamycin 300 mg PO bid for 7 days ($28)
    3. Resistant or Refractory Cases
      1. Metronidazole 500 mg PO bid for 14 days (preferred)
      2. Consider treating sexual partner and patient
        1. Male urethra may be co-infected
        2. Based on anecdotal reports (evidence lacking)
      3. Other options
        1. Clindamycin at above dose
        2. Povidone-iodine gel OR suppository (Betadine)
          1. Apply vaginally bid for 14 to 28 days ($59)
    4. Recurrent Bacterial Vaginosis
      1. Treat as refractory cases above
      2. Consider maintenance therapy
        1. Induction: Metronidazole gel (0.75%) qhs x10 days
        2. Maintenance: When wet prep with no clues, pH lower
          1. Metronidazole gel twice weekly for 3 months
          2. Treat concurrent Candida if present
            1. Fluconazole 150 mg qWeek
  7. Complications
    1. Associated with preterm delivery (23-26 weeks)
      1. Hillier (1995) N Engl J Med 333:1737
      2. Hauth (1995) N Engl J Med 333:1732
    2. Early second trimester with better pregnancy outcomes
      1. Reduces preterm birth and late Miscarriage rate
      2. Study used Clindamycin
      3. Ugwumadu (2003) Lancet 361:983
  8. References
    1. (1998) MMWR Morb Mortal Wkly Rep 47:1
    2. Larimore (2000) Prim Care 27(1):35
    3. Majeroni (1998) Am Fam Physician 57(6):1285
    4. Miller (1997) Fam Pract 19(3):33

Bacterial Vaginosis (C0085166)

Definition (MSH)Polymicrobial, nonspecific vaginitis associated with positive cultures of Gardnerella vaginalis and other anaerobic organisms and a decrease in lactobacilli. It remains unclear whether the initial pathogenic event is caused by the growth of anaerobes or a primary decrease in lactobacilli.
ConceptsDisease or Syndrome (T047)
MSHD016585
EnglishAV - Anaerobic vaginosis, BACT VAGINITIDES, BACT VAGINITIS, Bacterial Vaginitides, Bacterial vaginitis, Bacterial Vaginoses, Bacterial Vaginosis, BV - Bacterial vaginosis, NONSPECIFIC VAGINITIS, NSV - Nonspecific vaginitis, VAGINITIDES BACT, VAGINITIS BACT
Spanishvaginosis bacteriana
Parent ConceptsBacterial Infections (C0004623), Vaginitis (C0042267), Infective vaginitis (C0404521), Bacterial genital infection (C0729525), Ambiguous concept (C1274012)
SourcesCOSTAR, DXP, LNC, MEDLINEPLUS, MSH, MTH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Gardnerella vaginitis (C1622505)

ConceptsDisease or Syndrome (T047)
EnglishGARDNERELLA ASSOCIATED VAGINAL DISCHARGE, Gardnerella infection, Gardnerella vaginalis infection, Gardnerella vaginitis, Vaginitis due to Gardnerella vaginalis
Spanishvaginitis por Gardnerella, vaginitis por Gardnerella vaginalis
Parent ConceptsInfective vaginitis (C0404521), Bacterial genital infection (C0729525), Ambiguous concept (C1274012), Disease due to Gram-negative bacteria (C1299529), Disease due to Gram-positive bacteria (C1299528)
SourcesDXP, MTH, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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