BACTERIAL VAGINOSIS DIAGNOSE

and TREATMENT

Coass :
J AYA
110 205 0056
Yusuf Muchtar 110 210 0153

Advisor :
dr. Karlina Novianti Kasim
Supervisor :
Dr. dr. Sri Vitayani, Sp.KK

Definition
Bacterial vaginosis (BV) is vaginal
inflammation caused by increased
concentration of anaerobic bacteria in
vaginal flora.

Epidemiology

BV is the most common vaginal infection in women of

childbearing age. It is estimated that approximately 16% of
pregnant women

Prevalence varies by population:

5%-25% among college students
12%-61% among STD patients

Widely distributed

G. vaginalis infection linked to race, promiscuity, marriage

stability, previous pregnancy history, and IUD use.
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Risk Factors
African American
Two or more sex partners in previous six
months/new sex partner
Douching
Hormonal changes during pregnancy and
menopause
Lack of H2O2-producing lactobacilli
Antibiotic
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Patogenesis
Overgrowth of bacteria species normally present in vagina
with anaerobic bacteria
BV correlates with a decrease or loss of protective
lactobacilli:
Vaginal acid pH normally maintained by lactobacilli through
metabolism of glucose/glycogen
Hydrogen peroxide (H2O2) is produced by some Lactobacilli,sp.
H2O2 helps maintain a low pH, which inhibits bacteria overgrowth
Loss of protective lactobacilli may lead to BV

Clinical Presentation and

Symptoms
50% asymptomatic
Signs / symptoms when present:
50% report malodorous (fishy smelling)
vaginal discharge, itch
Reported more commonly after vaginal
intercourse, after completion of menses,
and after sexual activities
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Wet Prep.: Bacterial Vaginosis

Clue Cells appereance in microscopy examination

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BV Diagnosis: Amsel Criteria

Vaginal pH >4.5

Amsel Criteria:
Must have at least
three of the
following findings:

Presence of >20% per HPF

of "clue cells" on wet mount
examination
Positive amine or "whiff" test
Homogeneous, non-viscous,
milky-white discharge
adherent to the vaginal walls
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Other Diagnostic Tools

Vaginal Gram stain (Nugents criteria)
Predominant Lactobacilli : 0-3 (negatif)
Mixed Flora
: 4-6 (intermediate)
Predominant gram negatif Coccobacilli : 7-10 (positif BV)

Culture
Cromatiography Examination
Biochemistry Examination
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BV Differential Diagnose
Normal

Primary symptom

Trichomoniasis

Candidiasis

Bacterial
Vaginosis

Itch, discharge

Itch, discomfort,
thick discharge

discharge, itch

Vaginal discharge

Clear to
white

Frothy, gray or yellowgreen; malodorous

Thick, clumpy, white

cottage cheese

Homogenous,
adherent,
thin,white - gray;
malodorous foul
fishy

Vaginal pH

3.8 - 4.2

> 4.5

< 4.5

> 4.5

Fishy odor (+)

Fishy odor (+++)

Epithelial
cell with
lactobacillus

Trichomonas motil, a
lot of PMN

KOH: yeast and

pseudohifa

Clue cell

metronidazole

Antifungi

Metronidazole

Smell
Microscopic
finding
Treatment

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Trichomoniasis

Bacterial vaginosis

Candidiasis

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Complications

Preterm birth in pregnancy

Transmission and acquisition of HIV
Cervical Intraepithelial Neoplasia
Postpartum Fever
Post operative gynecologic complications
Post abortal infections

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Treatment in Non Pregnancy

CDC-recommended regimens:
Metronidazole 500 mg orally twice a day for 7 days, or
Metronidazole gel 0.75%, one full applicator (5 grams) intravaginally,
once a day for 5 days, or
Clindamycin cream 2%, one full applicator (5 grams) intravaginally at
bedtime for 7 days
Alternative regimens:
Tinidazole 2 g orally once a day for 2 days, or
Tinidazole 1 g orally once a day for 5 days, or
Clindamycin 300 mg orally twice a day for 7 days, or
Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days,
or
Metronidazole 750 mg orally once a day for 7 days
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Treatment in Pregnancy
Metronidazole 250 mg orally 3 times a day for 7 days,
or
Metronidazole 500 mg orally twice a day for 7 days, or
Clindamycin 300 mg orally twice a day for 7 days

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Other condition
Allergic with Metronidazole :
Clindamycin cream intravaginally
Recurrent Infection :
Metronidazole gel 0,75%
(after this, continue to twice
intravaginally for 2 x Weeks)
Partnert management

day

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Probiotic Treatment
Produce antimicrobial compound such as Hydrogen
Peroxide, Lactic Acid, or Bakteriocin, which inhibits
pathogen growth.
Produce a biosurfactan containing a large number of
collagen binding proteins that could inhibit pathogen
adhesion and induce a competitive exclusion of the
pathogen on epithelial cell.
May cause a mucosal modulation that enhances the
host immune system response.

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