Bacterial vaginosis

Gardner 1955.

Gardnerella vaginalis infection, amine colpitis.

Inbalance of the vaginal flora in favour of obligate anaerobic bacteria and Gardnerella vaginalis.

Frequent, up to 30% prevalence, among sex workers > 50%.

Risk factors are changing sexual partners, regular vaginal douches, etc.

Sexually transmitted infection with Gardnerella vaginalis. The proliferation of gram-negative.

Vulvovaginitis and colpitis with serous, thin, homogeneously whitish (no white stipples), discharge with a fishy odour. Amines are produced by anaerobic bacteria and smell like rotten fish.

• Anamnesis
  • Unprotected sexual intercourse?
  • Odorous, vaginal discharge?
• Bact. Smear
• Urethra smear?
  • Cultural evidence
• Note diagnostic criteria, namely 3 out of 4:
  1. Thin, homogeneous discharge
  2. High pH > 4.5 (normally the vagina is rather acidic, think Döderlein bacteria)
  3. 10% KOH on a sample of the discharge leads to increased fishy odour
  4. > 20% of the cells are "Clue-Cells"

Vulva, esp. vagina.

• Chronic inflammation in the vaginal area can favour HIV infection.
• Risk of premature birth increased by 2 to 4 times.

Condom.

General measures

• Co-treatment of the partner - in fact many men have G. vaginalis in the urethra!

Topical therapy

• Iodine-povidone solution, Vag Ovula
• Metronidazole Vag Ovula

Systemic therapy

• Metronidazole p.o. 400-500 mg 2x tgl. for 5-7 days (alternative: Metronidazole 2g p.o. as single treatment or Clindamycin 300mg 2xtgl. p. o. for 7 days).

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