Bacterial Vaginosis Gardnerella vaginalis overgrowth in presence of vaginal anaerobes and scant lactobacilli (Bacteroides, Mo...
Bacterial Vaginosis
- Gardnerella vaginalis overgrowth in presence of vaginal anaerobes and scant lactobacilli (Bacteroides, Mobiluncus)
- especially susceptible when post-menstrual or post-coital, with IUD
Symptoms
- fishy odour especially after coitus
- profuse, thin greyish discharge
- vulva rarely itchy or inflamed not necessarily sexually transmitted, although can see “ ping-pong “ transmission
Diagnosis
- saline wet mount
- > 20% clue cells = squamous epithelial cells dotted with coccobacilli (Gardnerella bacilli)
- paucity of WBC
- paucity of lactobacilli
- amine ìwhiffî test = rotten, fishy odour with addition of KOH to slide
- pH 5-5.5
Treatment
- no treatment required in non-pregnant, asymptomatic women unless scheduled for pelvic surgery or procedure
- must treat all asymptomatic cases in pregnancy; higher incidence of PTL, PPROM and miscarriage if left untreated
- oral
- metronidazole 500 mg bid for 7 days or 2 g once
- clindamycin 300 mg bid for 7 days
- topical
- clindamycin 2% vaginal cream qhs x 7 days
- flagystatin vaginal suppository (also covers yeast)
- ampicillin or amoxicillin if pregnant
- for repeated infection one capsule or tablet of lactobacillus acidophilus daily in vagina
- controversy exists regarding treatment of partner
.
Trichomonas Vaginalis
- a flagellated protozoan, anaerobic
- often co-exists with bacterial forms
- sexually transmitted (men asymptomatic)
- more frequent with multiple sexual partners
- possibly via hot tubs, whirlpools, saunas
Symptoms
- profuse, thin, frothy yellow-green discharge
- may be foul-smelling discharge
- often seen post-menstrual
- occasionally irritated, tender vulva
- dysuria,abdominal pain
- petechiae on vagina and cervix (10%)
- asymptomatic (25%)
Diagnosis
- saline wet mount
- many WBC
- motile flagellated organisms
- inflammatory cells
- pH 5 - 6.5
Treatment
- metronidazole 500 mg bid for 7 days or 2 g once
- treat partner(s)
- also topical clindamycin or metronidazole
