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Bacterial Vaginosis

Updated : January 31, 2024





Background

Bacterial vaginosis is a disorder brought on by an overabundance of the natural flora in the vagina. The most typical clinical sign of this is an increase in fishy-smelling vaginal secretions. Typically, the discharge is thin and can be either white or grey in color.

Women who have been confirmed with vaginosis are more likely to contract other STIs, & expectant women are more likely to give birth before their due date.

Epidemiology

The majority of genital infections in females of reproductive age, known as bacterial vaginosis, are thought to affect 5 to 70 percent of females. It’s interesting to note that, globally, this illness is shown to be least common in Europe and Asia and most common in several regions of Africa.

Around 30 percent of women in the USA between the ages of 14 and 49 are afflicted; however, rates vary among ethnic groups and are particularly prevalent among non-white women (32 percent Mexican Americans, 51 percent African Americans).

According to epidemiological research, women who have had several sex partners, are alone, started having sex at a young age, work as female sex workers, and regularly touch are more likely to report having bacterial vaginosis.

Anatomy

Pathophysiology

The disequilibrium of the naturally existing microbial composition that results in bacterial vaginosis is defined by changes in both the predominant kind of bacteria involved and an increase in the overall number of bacteria involved. The typical vaginal microbiome is dominated by Lactobacilli genera. A decrease in Lactobacilli, in general, is linked to bacterial vaginosis.

Gardnerella vaginalis is assumed to be the primary cause of the majority of bacterial vaginosis infestations; however, the exact cause is still unknown. Gardnerella vaginalis forms a biofilm that enables other opportunistic microbes to proliferate inside the vagina. The connection between BV and a higher risk of developing STIs is based on the fact that BV creates a window of opportunity for other genital bacteria to enter the upper reproductive tract.

In addition, BV causes an increase in the release of endotoxins that promote cytokine & prostaglandin synthesis in the vagina, as well as the accumulation of enzymes that hinder the ability of donor leukocytes to combat infection.

Etiology

The function of transmissibility in bacterial vaginosis is still not well understood, despite the fact that it is not regarded as an infection transmitted sexually. Bacterial vaginosis appears to be caused by an imbalance in the normal microbe flora of the vagina brought on by the transmission of bacteria between people during sexual activity.

This illness is typically brought on by an excess of anaerobes and maybe a decrease in the usual Lactobacilli that normally produce hydrogen peroxide. Gardnerella vaginalis can spread between sex partners when mucosa comes into close contact or when shared sex devices are used.

Gardnerella vaginitis was the name given to bacterial vaginosis in the past because it was thought that these bacteria were to blame for the illness. The term “bacterial vaginosis,” which is more recent, emphasizes the possibility that a variety of alternative bacteria that naturally exist in the vagina may proliferate excessively and result in illness.

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

  • Diagnosis: Bacterial Vaginosis is diagnosed based on clinical symptoms, such as a thin, white, or gray vaginal discharge with a characteristic fishy odor, and the presence of clue cells in vaginal fluid. 
  • Antibiotic Therapy: Oral metronidazole is often the first-line treatment for bacterial vaginosis.  
  • Follow-Up: Follow-up appointments may be scheduled to ensure the effectiveness of treatment and to address any persistent symptoms. 
  • Avoidance of Risk Factors: Patients may be advised to avoid certain risk factors associated with BV, such as douching, which can disrupt the natural balance of bacteria in the vagina. 

 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Use of Non-pharmacological approach for Bacterial Vaginosis

  • Probiotics: Probiotics are beneficial bacteria that can help restore the natural balance of microorganisms in the vagina. They may be taken orally as supplements or applied topically as vaginal suppositories. 
  • Maintain level of Vaginal pH: The normal pH of the vagina is slightly acidic, which helps inhibit the growth of harmful bacteria. Avoid using products such as douches or harsh soaps that can disrupt the natural pH balance. 
  • Avoid Irritants: Avoid using irritating products in the genital area, such as scented tampons, feminine sprays, and perfumed soaps. These products can disrupt the natural flora of the vagina and contribute to the development of BV. 
  • Follow Safe Sex Practices: Practicing safe sex by using condoms can help prevent the introduction of new bacteria into the vaginal environment and reduce the risk of sexually transmitted infections (STIs) that may contribute to BV. 
  • Regular Check-ups: Regular gynecological check-ups can help monitor and maintain vaginal health. If symptoms of BV or other vaginal infections reoccur, seek prompt medical attention. 
  • Use Cotton Underwear: Wear breathable, cotton underwear and avoid tight-fitting pants to promote good airflow and reduce moisture, creating an environment less conducive to bacterial overgrowth. 
  • Hydration: Staying well-hydrated is important for overall health, including vaginal health. It helps maintain the balance of fluids in the body, which can contribute to a healthy vaginal environment. 
  • Healthy Diet: A balanced and nutritious diet supports overall health, including the immune system. A strong immune system can help the body fight off infections, including those that affect the vagina. 

 

Use of antibiotics

The primary pharmaceutical agents used for the treatment of bacterial vaginosis (BV) are antibiotics. These drugs aim to eliminate the overgrowth of harmful bacteria in the vagina and restore a healthy balance to the vaginal microbiome.  

  • Metronidazole: This antibiotic is a first-line treatment for bacterial vaginosis.  

Metronidazole is a nitroimidazole antibiotic that disrupts the DNA structure of bacteria, leading to their death.  

  • Clindamycin: This antibiotic is another common choice for BV treatment.  

Clindamycin is a lincosamide antibiotic that inhibits bacterial protein synthesis, leading to bacterial death.  

  • Tinidazole: Tinidazole is an alternative to metronidazole and is available in oral form. 

Tinidazole is a nitroimidazole antibiotic like metronidazole, disrupting bacterial DNA and causing bacterial death. 

  • Secnidazole: Secnidazole is another nitroimidazole antibiotic, and it is available in oral form. 

Secnidazole acts by damaging the DNA of bacteria, leading to their destruction. 

 

Use of Intervention with a procedure in treating Bacterial Vaginosis

  • Vaginal Microbiome Transplant (VMT): VMT involves transferring a healthy donor’s vaginal bacteria to the recipient to restore a balanced microbiome.  
  • Bacteriotherapy: Bacteriotherapy involves the use of beneficial bacteria to restore the natural balance in the vagina. This may include the use of specific strains of lactobacilli. 

 

Use of phases in managing Bacterial Vaginosis

  • Diagnosis Phase: Accurate diagnosis is the first step in managing BV. A pelvic exam and pH testing may also be performed for confirmation. 
  • Treatment: Antibiotic therapy is the primary mode of treatment for BV. Commonly prescribed antibiotics include metronidazole and clindamycin. Treatment aims to eliminate the overgrowth of harmful bacteria and restore a healthy balance to the vaginal microbiome. 
  • Patient Education: Patients should be educated about the importance of completing the full course of antibiotics as prescribed by their healthcare provider.  
  • Follow-Up: Follow-up appointments may be scheduled to monitor the effectiveness of treatment and address any persistent symptoms. If symptoms persist or recur, further evaluation may be necessary. 
  • Prevention of Recurrence: Strategies to prevent the recurrence of BV may include ongoing use of probiotics, avoiding irritants, practicing safe sex, and maintaining good hygiene.  
  • Monitoring and Lifestyle Changes: Regular gynaecological check-ups and monitoring are important for individuals with a history of BV. Lifestyle changes, such as wearing breathable underwear and maintaining a healthy diet, can contribute to overall vaginal health. 

 

Medication

 

clindamycin 

300

mg

orally

twice a day

7

days



secnidazole 

1

packet

Orally 

daily



tinidazole 

2g/day orally for two days or 1g orally every day for five days



metronidazole 

500 mg per oral two times daily for seven days
if taking a single dose, 2 gm oral should be the dose per day



metronidazole 

500 mg per oral two times daily for seven days
if taking a single dose, 2 gm oral should be the dose per day



dequalinium 

Insert 1 tablet into the vagina daily at night before bedtime for 6 days
Pause the treatment during menstruation and continue afterward



fluconazole/tinidazole 

Take one tablet once a day



fluconazole/tinidazole 

Take one tablet once a day



clindamycin vaginal 

Clindesse Vaginal Cream: in patients who are not pregnant, one full applicator is placed intravaginally in a single dosage
Cleocin Vaginal Cream: For non-pregnant patients, one full applicator should be placed intravaginally every three or seven days at bedtime, and for pregnant patients, for one week
Cleocin Vaginal Ovules: one suppository is inserted into the vagina for every three consecutive days at bedtime
Xaciato: One full applicator used intravaginally in a single dosage (100 mg of clindamycin every 5 g of gel)



metronidazole vaginal 

Recommended for the management of bacterial vaginosis (formerly known as anaerobic vaginosis, Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, or Corynebacterium vaginitis)
It is advised to administer one applicator's worth of this 0.75% gel—roughly 5 grams, or 37.5 mg of active medication—intravaginally once or twice a day for five days
It is recommended to take this 1.3% gel before bedtime for a once-daily dosage



Dose Adjustments

N/A

 

secnidazole 

Age: >12 years:

1

packet

Orally 

daily



clindamycin vaginal 

Below 12 years: Safety & efficacy were not established
Above 12 years
Clindesse Vaginal Cream: in patients who are not pregnant, one full applicator is placed intravaginally in a single dosage
Cleocin Vaginal Ovules: one suppository is inserted into the vagina for every three consecutive days at bedtime
Xaciato: One full applicator used intravaginally in a single dosage (100 mg of clindamycin every 5 g of gel)



metronidazole vaginal 

Safety and efficacy are not seen in pediatrics who are less than 12 years
Recommended for the management of bacterial vaginosis (formerly known as anaerobic vaginosis, Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, or Corynebacterium vaginitis)
For children over 12, it is recommended to administer one applicator's worth of this 0.75% gel—roughly 5 grams, or 37.5 mg of active medication—intravaginally once or twice a day for five days
For a once-daily dosage, it is recommended to take this 1.3% gel before bedtime



 

Media Gallary

Bacterial Vaginosis

Updated : January 31, 2024




Bacterial vaginosis is a disorder brought on by an overabundance of the natural flora in the vagina. The most typical clinical sign of this is an increase in fishy-smelling vaginal secretions. Typically, the discharge is thin and can be either white or grey in color.

Women who have been confirmed with vaginosis are more likely to contract other STIs, & expectant women are more likely to give birth before their due date.

The majority of genital infections in females of reproductive age, known as bacterial vaginosis, are thought to affect 5 to 70 percent of females. It’s interesting to note that, globally, this illness is shown to be least common in Europe and Asia and most common in several regions of Africa.

Around 30 percent of women in the USA between the ages of 14 and 49 are afflicted; however, rates vary among ethnic groups and are particularly prevalent among non-white women (32 percent Mexican Americans, 51 percent African Americans).

According to epidemiological research, women who have had several sex partners, are alone, started having sex at a young age, work as female sex workers, and regularly touch are more likely to report having bacterial vaginosis.

The disequilibrium of the naturally existing microbial composition that results in bacterial vaginosis is defined by changes in both the predominant kind of bacteria involved and an increase in the overall number of bacteria involved. The typical vaginal microbiome is dominated by Lactobacilli genera. A decrease in Lactobacilli, in general, is linked to bacterial vaginosis.

Gardnerella vaginalis is assumed to be the primary cause of the majority of bacterial vaginosis infestations; however, the exact cause is still unknown. Gardnerella vaginalis forms a biofilm that enables other opportunistic microbes to proliferate inside the vagina. The connection between BV and a higher risk of developing STIs is based on the fact that BV creates a window of opportunity for other genital bacteria to enter the upper reproductive tract.

In addition, BV causes an increase in the release of endotoxins that promote cytokine & prostaglandin synthesis in the vagina, as well as the accumulation of enzymes that hinder the ability of donor leukocytes to combat infection.

The function of transmissibility in bacterial vaginosis is still not well understood, despite the fact that it is not regarded as an infection transmitted sexually. Bacterial vaginosis appears to be caused by an imbalance in the normal microbe flora of the vagina brought on by the transmission of bacteria between people during sexual activity.

This illness is typically brought on by an excess of anaerobes and maybe a decrease in the usual Lactobacilli that normally produce hydrogen peroxide. Gardnerella vaginalis can spread between sex partners when mucosa comes into close contact or when shared sex devices are used.

Gardnerella vaginitis was the name given to bacterial vaginosis in the past because it was thought that these bacteria were to blame for the illness. The term “bacterial vaginosis,” which is more recent, emphasizes the possibility that a variety of alternative bacteria that naturally exist in the vagina may proliferate excessively and result in illness.

  • Diagnosis: Bacterial Vaginosis is diagnosed based on clinical symptoms, such as a thin, white, or gray vaginal discharge with a characteristic fishy odor, and the presence of clue cells in vaginal fluid. 
  • Antibiotic Therapy: Oral metronidazole is often the first-line treatment for bacterial vaginosis.  
  • Follow-Up: Follow-up appointments may be scheduled to ensure the effectiveness of treatment and to address any persistent symptoms. 
  • Avoidance of Risk Factors: Patients may be advised to avoid certain risk factors associated with BV, such as douching, which can disrupt the natural balance of bacteria in the vagina. 

 

  • Probiotics: Probiotics are beneficial bacteria that can help restore the natural balance of microorganisms in the vagina. They may be taken orally as supplements or applied topically as vaginal suppositories. 
  • Maintain level of Vaginal pH: The normal pH of the vagina is slightly acidic, which helps inhibit the growth of harmful bacteria. Avoid using products such as douches or harsh soaps that can disrupt the natural pH balance. 
  • Avoid Irritants: Avoid using irritating products in the genital area, such as scented tampons, feminine sprays, and perfumed soaps. These products can disrupt the natural flora of the vagina and contribute to the development of BV. 
  • Follow Safe Sex Practices: Practicing safe sex by using condoms can help prevent the introduction of new bacteria into the vaginal environment and reduce the risk of sexually transmitted infections (STIs) that may contribute to BV. 
  • Regular Check-ups: Regular gynecological check-ups can help monitor and maintain vaginal health. If symptoms of BV or other vaginal infections reoccur, seek prompt medical attention. 
  • Use Cotton Underwear: Wear breathable, cotton underwear and avoid tight-fitting pants to promote good airflow and reduce moisture, creating an environment less conducive to bacterial overgrowth. 
  • Hydration: Staying well-hydrated is important for overall health, including vaginal health. It helps maintain the balance of fluids in the body, which can contribute to a healthy vaginal environment. 
  • Healthy Diet: A balanced and nutritious diet supports overall health, including the immune system. A strong immune system can help the body fight off infections, including those that affect the vagina. 

 

The primary pharmaceutical agents used for the treatment of bacterial vaginosis (BV) are antibiotics. These drugs aim to eliminate the overgrowth of harmful bacteria in the vagina and restore a healthy balance to the vaginal microbiome.  

  • Metronidazole: This antibiotic is a first-line treatment for bacterial vaginosis.  

Metronidazole is a nitroimidazole antibiotic that disrupts the DNA structure of bacteria, leading to their death.  

  • Clindamycin: This antibiotic is another common choice for BV treatment.  

Clindamycin is a lincosamide antibiotic that inhibits bacterial protein synthesis, leading to bacterial death.  

  • Tinidazole: Tinidazole is an alternative to metronidazole and is available in oral form. 

Tinidazole is a nitroimidazole antibiotic like metronidazole, disrupting bacterial DNA and causing bacterial death. 

  • Secnidazole: Secnidazole is another nitroimidazole antibiotic, and it is available in oral form. 

Secnidazole acts by damaging the DNA of bacteria, leading to their destruction. 

 

  • Vaginal Microbiome Transplant (VMT): VMT involves transferring a healthy donor’s vaginal bacteria to the recipient to restore a balanced microbiome.  
  • Bacteriotherapy: Bacteriotherapy involves the use of beneficial bacteria to restore the natural balance in the vagina. This may include the use of specific strains of lactobacilli. 

 

  • Diagnosis Phase: Accurate diagnosis is the first step in managing BV. A pelvic exam and pH testing may also be performed for confirmation. 
  • Treatment: Antibiotic therapy is the primary mode of treatment for BV. Commonly prescribed antibiotics include metronidazole and clindamycin. Treatment aims to eliminate the overgrowth of harmful bacteria and restore a healthy balance to the vaginal microbiome. 
  • Patient Education: Patients should be educated about the importance of completing the full course of antibiotics as prescribed by their healthcare provider.  
  • Follow-Up: Follow-up appointments may be scheduled to monitor the effectiveness of treatment and address any persistent symptoms. If symptoms persist or recur, further evaluation may be necessary. 
  • Prevention of Recurrence: Strategies to prevent the recurrence of BV may include ongoing use of probiotics, avoiding irritants, practicing safe sex, and maintaining good hygiene.  
  • Monitoring and Lifestyle Changes: Regular gynaecological check-ups and monitoring are important for individuals with a history of BV. Lifestyle changes, such as wearing breathable underwear and maintaining a healthy diet, can contribute to overall vaginal health. 

 

clindamycin 

300

mg

orally

twice a day

7

days



secnidazole 

1

packet

Orally 

daily