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Bacterial Vaginosis - Diagnosis and Treatment

Women's Health | August 10, 2014 | Author: The Super Pharmacist

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Bacterial Vaginosis - Diagnosis and Treatment

Bacterial vaginosis, as the name suggests, is a condition affecting the vagina that is associated with bacterial growth. The exact aetiology of vaginosis is not completely defined, but it is linked to an imbalance of the bacterial flora (the populations of numerous different bacteria that may inhabit an area of the body) and not a simple infection.

It may occur if one of these species is allowed to 'get out of control'. For example, Gardenella vaginalis is strongly associated with the development of vaginosis. G. vaginalis may not be harmful in itself, but a large population may form the basis of a 'scaffold' on the inner surface of the vagina, upon which other species can form colonies.

Vaginosis is also associated with a decrease in 'beneficial' Lactobacillus species and with an increase in a wide range of other bacteria, including Mobiluncus and Mycoplasma homilis bacteria. The condition may also be associated with an increased population of Haemophilus vaginalis.

Factors that may affect this include the inhibitory or competitive effects of other bacterial species, and the immune mechanisms of the host, which should keep bacteria under control.

Symptoms of Bacterial Vaginosis

Bacterial vaginosis has a number of characteristic symptoms. These include:

  • Vaginal odor
  • Vaginal pain
  • Itching or burning in or around the vagina
  • White or grey vaginal discharge
  • A strong fish-like vaginal odor after sex 
  • Burning sensation while urinating

Women with bacterial vaginosis may have some or all of these symptoms. The condition may also be asymptomatic. It may dissipate without treatment.

Consequences of Bacteria Vaginosis

Bacterial vaginosis can have serious consequences. These include: 

Consequences of Bacteria Vaginosis

Risk to baby. Pregnancy with simultaneous bacterial vaginosis may be associated with a higher risk of premature birth or reduced birth weight.

Infertility. The condition is also correlated with incidences of miscarriage and infertility, but it is not clear whether or not bacterial vaginosis is a causative factor in these cases. The prevalence of bacterial vaginosis in pregnant women may be as high as 22%. This may be associated with a deficiency in vitamin D.

Pelvic inflammatory disease. Bacterial vaginosis is also associated with an increased risk of pelvic inflammatory disease, a painful condition that indicates infection of the womb or fallopian tubes.

STD's. The increased risk of contracting the human immunodeficiency virus (HIV), or of passing HIV on to a partner. The condition is also associated with the increased risk of contracting other sexually transmitted diseases, such as gonorrhoea or chlamydia.

Risk Factors for Bacterial Vaginosis

  • Bacterial vaginosis can be a sexually transmitted disease, which means sexual intercourse is a risk factor for the condition. Men may carry G. vaginalis in their genital tracts, which means they may infect or reinfect a partner as a result of sex. A recent trial found these bacteria in all partners of patients with bacterial vaginosis.
     
  • The regular use of 'bidet-style' (or warm water-cleaning) toilets may be associated with a reduction of Lactobacillus populations, thus increasing the risk of vaginosis.
     
  • Some feminine hygiene products such as Vagisil (which inhibits the growth of Lactobacillus crispatus) may be associated with the increased risk of bacterial vaginosis.
     
  • Stress may also increase the risk of bacterial vaginosis.

Diagnosis of Bacterial Vaginosis

Early diagnosis of this condition may be important. This is achieved by microscopic analysis of vaginal flora in vaginal and/or vaginal mucus samples.

Diagnosis of Bacterial Vaginosis

Changes in the bacterial flora of patients may also be detected effectively by molecular analysis techniques such as polymerase chain reaction (PCR). This analysis may be done on vaginal smears, swabs or urine samples from the patient.

Microbiological tests, such as Gram stain analysis, may be used to distinguish certain types of bacteria from others. 

As bacterial vaginosis is associated with increased pH in that environment, this is also a diagnostic marker.

Treatments for Bacterial Vaginosis

Treatments for bacterial vaginosis include:

Metronidazole: This is an antibiotic included in various treatment applications for bacterial vaginosis.

  • Oral metronidazole may be given for seven days to effectively rebalance bacterial flora. A 2g dose once a day for two days has also demonstrated efficacy.
     
  • Metronidazole in vaginal tablet form (500mg, used once or twice daily for seven days) has also achieved positive results.  
     
  • An effective alternative to these is 0.75% vaginal gel, applied for five days.

Metronidazole can be taken safely during pregnancy (after the first trimester), but physicians may restrict treatment to vaginal tablets.

Clindamycin: This antibiotic is available as a 2% vaginal cream to treat infections.This application is effective, particularly if applied daily for seven days. Oral clindamycin is also effective.

These treatments may be applied after the first trimester of pregnancy, and are equal in effect to metronidazole treatment. A review of five trials found that treatment of pregnant patients with clindamycin at approximately 22 weeks was associated with the reduced risk of premature birth at approximately 37 weeks (but not at 33 weeks) and of late miscarriage.

Probiotic Lactobacilli: These are complementary treatments based on the theory that an influx of replacement Lactobacilli will restore the balance of vaginal flora, and therefore reverse vaginosis.

This is associated with the reduction of G. vaginalis (as antibiotic treatment may not achieve this) and thus the disruption of the 'scaffold' bacterial vaginosis may depend on.

A trial of vaginal probiotic capsules in 120 women with recurrent bacterial vaginosis showed significant prevention of both recurrence and G. vaginalis colonisation. However, a review of 11 studies of probiotics in active vaginosis showed little evidence that the treatment reversed the condition in these cases. This indicates that Lactobacillus probiotics may be effective as a prophylactic for this condition.

Benzoyl peroxide: This is a chemical treatment that destroys a wide range of bacteria, including G. vaginalis - but not vaginal Lactobacilli. A 1% hydrogel (similar to that used in skin treatments) was demonstrated to effectively reduce the population of this bacterium, while largely sparing those of four Lactobacillus species also tested in a microbiological trial. 

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