CPD: Bacterial vaginosis
Bacterial vaginosis is a condition of the vagina which is caused by an abnormal growth of bacteria. It occurs as a result of an imbalance in the normal bacterial flora of the vagina.
Prevalence of bacterial vaginosis
Bacterial vaginosis is the most common vaginal infection in women of reproductive age and is responsible for up to 30% of vaginal discharge cases.
Symptoms of bacterial vaginosis
Around half of women with bacterial vaginosis will be asymptomatic. In symptomatic cases, a watery vaginal discharge is the predominant symptom. Discharge is usually white-grey in colour, has as a distinctive fishy odour and is often worst after sexual intercourse or menstruation. It is uncommon for women with discharge to suffer from tenderness or itching in, or around, the vagina
Causes of bacterial vaginosis
Although symptoms are often worse after sexual intercourse, bacterial vaginosis is not a sexually transmitted disease. Bacterial vaginosis is more common in sexually active women that non-sexually active women but no bacterium is passed between partners during sexual intercourse that is responsible for the development of the condition. With that said, there is some evidence to suggest that a change in sexual partner may increase bacterial vaginosis risk. So, whilst not sexually transmitted, bacterial vaginosis may be more prominent amongst women who change their sexual partner more often.
Additionally, bacterial vaginosis is more common in women who use vaginal deodorants, antiseptic washing products or those who smoke or practice vaginal douching
Complications of bacterial vaginosis
Since bacteria vaginosis is often self-limiting and is asymptomatic in about half of women, treatment is often not necessary for many women. However, bacterial vaginosis may have some potentially serious implications in pregnancy including increasing risk of preterm birth, early labour, miscarriage and developing an infection in the womb after birth.
Treatment of bacterial vaginosis
Treatment is not always necessary as bacterial vaginosis is often asymptomatic or symptoms are mild. Additionally, the disease is usually self-limiting and commonly clears without pharmacological treatment. However, in pregnant women, antibiotic treatment should be offered even if symptoms are absent.
Oral metronidazole at a dose of 400-500mg twice daily for 5 to 7 days is an appropriate treatment for bacterial vaginosis. It is important to advise patients to take metronidazole after food and refrain from drinking alcohol until at least 48 hours after stopping treatment.
Topical treatments including metronidazole vaginal gel or clindamycin vaginal cream may be considered if oral metronidazole is poorly tolerated