THE most common cause of pathological vaginal discharge.
Can be caused by an overgrowth of many types of bacteria, usually anaerobes. There is alos often a decrease in the number of lactobacilli.
Not sexually transmitted
- Affects 10% of women in the UK, but most cases are asymptomatic
- A smelly (fishy) discharge, usually white / gray in colour. This idscharge is made up of waste products produced by the colonising anaerobes.
- Vaginal itch (not in all cases)
- Not usually inflamed
- Whiff test (yes, really!) – potassium hydroxide (KOH) is added to a sample of the vaginal discharge. If a strong fishy odour is produced – the test is positive for bacterial vaginosis
- pH – >4.5
- Triple swabs (chlamydia, gonorrhoea, and a ‘general’ swab for culture)
- Microscopy – reduced levels of lactobacilli, and increased levels of other bacterial agents, leukocytes absent, presence of clue cells
- Culture – to define the predominant causatory agent
is the only other likely cause of an offensive discharge, but this is usually yellow, and on microsocpy shows the prescence of protozoa with flagella
- Increased risk of pre-term labour
- Intra-amniotic infection
- Increased susceptibility to HIV
- Post-termination sepsis
- Metronidazole PO – one-off dose – 2g
- Clindamycin – 2% cream – apply once at night to the vagina for 7 days
- If recurrent problems, then treating the partner may resolve the situation