Complications

1. Pregnant women appear to be at higher risk of preterm delivery.

2. Bacterial vaginosis may cause plasma-cell endometritis, postpartum fever, post-hysterectomy vaginal-cuff cellulitis, and postabortal infection.

3. Bacterial vaginosis is a risk factor for HIV acquisition and transmission.

E. Diagnosis. Three of the four criteria listed below are necessary for diagnosis.

1. Homogeneous, grayish-white discharge

2. Vaginal pH greater than 4.5

3. Positive whiff-amine test, defined as the presence of a fishy odor when 10% KOH is added to vaginal discharge samples

4. Clue cells on saline wet mount (epithelial cells studded with coccobacilli)

F. Therapy. Treatment is indicated in women with symptomatic infection and those with asymptomatic infection prior to abortion or hysterectomy.

1. Metronidazole or clindamycin administered either orally or intravaginally will result in a high rate of clinical cure (70-80% at 4 weeks of follow-up). Oral medication is more convenient, but associated with a higher rate of systemic side effects than vaginal administration.

2. The oral regimen is 500 mg twice daily for 7 days. Topical vaginal therapy with 0.75% metronidazole gel (MetroGel, 5 g once daily for 5 days) is as effective as oral metronidazole.

3. Single-dose therapy with 2 g of metronidazole achieves a similar immediate rate of clinical response and is considered an alternative, slightly less effective regimen.

4. Side effects of metronidazole include a metallic taste, nausea, a disulfiram-like effect with alcohol, interaction with warfarin, and peripheral neuropathy.

5. Topical vaginal therapy with 2% clindamycin cream (5 g once daily for 7 days) appears to be less effective than the metronidazole regimens but is a reasonable choice. Pseudomembranous colitis has been reported with topical clindamycin. Clindamycin cream should not be used with condoms, which may be weakened.

Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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