Symptoms
The leading symptoms of bacterial vaginosis include:
- Thin, homogeneous vaginal discharge with a grayish-white color.
- Unpleasant odor of fish due to the release of volatile amines.
It is not accompanied by vaginal inflammation and immune response – therefore it is called vaginosis and not vaginitis. The disease is often asymptomatic. A burning sensation, itching and pain may occur. Bacterial vaginosis increases the risk for infection with sexually transmitted diseases (e.g., HIV infection, gonorrhea, chlamydia), pelvic inflammatory disease, and pregnancy complications such as premature birth and miscarriage. Like other urogenital diseases, vaginosis can be recurrent.
Causes
Bacterial vaginosis is an overgrowth of anaerobic bacteria in the vagina. These include , and – species, for example. The physiological flora with the hydrogen peroxide-forming lactobacilli is largely displaced. Vaginosis is probably a sexually transmitted disease. However, this point is controversial. What is proven, however, is that sexual intercourse is a relevant risk factor.
Diagnosis
Diagnosis is made in medical treatment on the basis of the patient’s history, physical examination, and with laboratory tests. The Amsel criteria are well known:
- Thin, homogeneous, gray-white discharge.
- Vaginal pH > 4.5
- Fish smell after adding potassium hydroxide solution 10%.
- Detection of Clue Cells in at least 20% of epithelial cells under the microscope.
Three of four criteria must be met. Bacterial vaginosis is less known by patients than a vaginal fungus and cystitis and is therefore confused with these syndromes. Self-tests are also commercially available for pH measurement.
Drug treatment
Nitroimidazoles:
- Nitroimidazole antibiotics such as metronidazole (Flagyl, generic), tinidazole, and secnidazole are available for treatment. They are administered either orally or topically (e.g., as ovules, vaginal gel). Metronidazole is available in many countries.
Lincosamides:
- The lincosamide antibiotic clindamycin is approved for treatment as a cream (Dalacin V). Clindamycin can also be given perorally.
Antiseptics:
- Such as dequalinium chloride (Fluomizin) or povidone–iodine (Betadine) are applied vaginally. Fewer adverse effects can be expected compared with oral antibiotic therapy.
Probiotics:
- Lactobacilli are ingested or administered topically to reduce the risk of recurrence. They are also prescribed following antibiotic or antiseptic therapy.
Organic acids:
- Like lactic acid are used for acidification, for example, in the form of gels or as vaginal suppositories.
Prevention
- Avoid aggressive intimate hygiene and vaginal douches.
- Use condoms
- Limit sexual intercourse and number of partners
- Administer lactobacilli (see above).
