14. bakterial vaginosis
TRANSCRIPT
Bacterial Vaginosis (1983)Bacterial Vaginosis (1983)((Older term: Gardnerella vaginitisOlder term: Gardnerella vaginitis))
M.FahdhyM.Fahdhy
Medan, 17 November 2008
Is the common cause of abnormal vaginal Is the common cause of abnormal vaginal discharge in women of child-bearing agedischarge in women of child-bearing age
It is the syndrome of unknown cause It is the syndrome of unknown cause characterized by characterized by depletion depletion of the normal of the normal Lactobacil lus Lactobacil lus populationpopulation and an and an overgrowth of vaginal anaerobes, overgrowth of vaginal anaerobes, accompanied by accompanied by loss loss of the usual vaginal of the usual vaginal acidityacidity
This recogized the fact that many anaerobic This recogized the fact that many anaerobic or facultative anaerobes bacteria are present or facultative anaerobes bacteria are present and that classical signs of inflammation are and that classical signs of inflammation are absentabsent
Farrow Sabastian, STD, 2007
Symptom :Symptom : OffensiveOffensive Fishy-smell ing dischargeFishy-smell ing discharge
About 50% of women About 50% of women asymptomatic asymptomatic Studies in the last decade have established Studies in the last decade have established
that BV is assosiated with pregnancy and that BV is assosiated with pregnancy and following gynecology surgery and may be following gynecology surgery and may be HIVHIV
EpidemiologyEpidemiology
Prevalence : 10 – 20%Prevalence : 10 – 20% 36% women attending STI clinics36% women attending STI clinics 28% elective termination of 28% elective termination of
pregnancypregnancy Black raceBlack race IUD useIUD use Not known BV occurs Not known BV occurs
postmenopausal womenpostmenopausal women
Aetiology and PathogenesisAetiology and Pathogenesis
Is probably multifactorial, sexually Is probably multifactorial, sexually assosiatedassosiated
Vaginal pH 3.5 – 4.5 to 7.0Vaginal pH 3.5 – 4.5 to 7.0 Reduce the inhibitory effect of HReduce the inhibitory effect of H 22OO22 an an
aerobic growthaerobic growth LactobacillusLactobacillus , , Gardnerella vaginalisGardnerella vaginalis
Bacteroides(prevotella) sppBacteroides(prevotella) spp Mobilincus sppMobilincus spp
Mycoplasma hominisMycoplasma hominis
DiagnosisDiagnosis OffensiveOffensive Typically fishy-smelling vaginal Typically fishy-smelling vaginal
dischargedischarge Speculum examination shows a thin, Speculum examination shows a thin,
homogenous white or yellow homogenous white or yellow discharge adheren to the wall of the discharge adheren to the wall of the vaginavagina
DiagnosisDiagnosis Vaginal pH > 4.5Vaginal pH > 4.5 Release of fishy-smell on addition of Release of fishy-smell on addition of
alkali (10% potassium hydroxide)alkali (10% potassium hydroxide) Characteristic discharge on Characteristic discharge on
examinationexamination Presence of ‘clue cells’ on Presence of ‘clue cells’ on
microscopymicroscopy
ManagementManagement
Standart :Standart : Metronidazole 400 mg 2x1 (5 days)/2 g Metronidazole 400 mg 2x1 (5 days)/2 g
single dose (95%)single dose (95%) Topical intravaginal 2% Clindamycin Topical intravaginal 2% Clindamycin
cream/0.75% Metronidazole gelcream/0.75% Metronidazole gel (Hay Phil ip, J of P, Obs & Gynecol, 2002)(Hay Phil ip, J of P, Obs & Gynecol, 2002)
(Clindamycin 3 day compared oral metronidazole 7 day twice daily, 68.1% - 66.7%). Paavonen J et al l . Obstet Gynecol 2000:96:256-260
Male partner :Male partner : Metronidazole, Tinidazole or Metronidazole, Tinidazole or
ClindamycinClindamycin 150 mg qds.150 mg qds.
Relaps :Relaps : Metronidazol 400 mg bd for 3 daysMetronidazol 400 mg bd for 3 days Starting 2 days Starting 2 days beforebefore menstruation menstruation
and again and again f if thfifth days of menstruation for days of menstruation for 3 months3 months
Patient advise & Self HelpPatient advise & Self Help
No vaginal douchingNo vaginal douching Not use of shower gel and bubble Not use of shower gel and bubble
bathbath Use condomUse condom
ComplicationComplication
Pregnancy Pregnancy associated with 2 associated with 2ndnd trimester trimester miscariage and preterm birth. miscariage and preterm birth. Chorioamnionitis Chorioamnionitis release of release of proinflammatory cytokines.proinflammatory cytokines.
Termination of pregnancy Termination of pregnancy Other gynecology surgeryOther gynecology surgery
IUD insertionIUD insertionHysteroscopyHysteroscopyDilatation & CurettageDilatation & Curettage
HIV & STIHIV & STI
Prevention and TreatmentPrevention and Treatment The best defence againts BV or any AVM The best defence againts BV or any AVM
is prevention, and this begins with is prevention, and this begins with screeningscreening
Women presenting for any gynecologic Women presenting for any gynecologic problem or annual examination should problem or annual examination should have an evaluation of the VEhave an evaluation of the VE
The VE can be viewed as a The VE can be viewed as a windowwindow not not only only to the vaginal health to the vaginal health but alsobut also the the general health of the patientgeneral health of the patient
The goal is to The goal is to restorerestore the pH 3.8 and 4.2 the pH 3.8 and 4.2