Bacterial vaginosis: current review with indications for asymptomatic therapy

Article Abstract:

This review discusses bacterial vaginosis (BV), the most common infectious cause of vaginitis (vaginal irritation), and its microbiology, risk factors, mode of transmission, diagnosis, complications, and treatment. BV is characterized by a greatly increased density of microorganisms in vaginal secretions. In various clinical settings, the incidence of BV has been estimated to be as high as 45 percent; in clinics for sexually transmitted diseases, it can range from 33 to 64 percent. Using an intrauterine device is a major risk factor for BV, as is having had multiple sex partners during the month before examination (but not the lifetime number of sex partners.) Whether the condition is sexually transmitted is not known: evidence for and against this mode is briefly reviewed. Women with BV consistently report a malodorous vaginal discharge, but more than half the patients have no symptoms at all. The following signs are considered in diagnosis: (1) presence of the clue cell (vaginal epithelial cells covered with bacteria); (2) homogeneous discharge that adheres to the vaginal walls but can be easily wiped off; (3) an elevated vaginal pH (indicating a less acid environment); and (4) certain results on the potassium hydroxide test for volatile amines. Some investigators consider the presence of clue cells and a positive amine test diagnostic. Women with BV are at risk for serious infection because bacteria that are present can also cause other diseases, and because the associated changes in vaginal flora make infection more likely. BV is related to pelvic inflammatory disease, urinary tract infections, endometritis (inflammation of the uterine lining), and preterm labor, among other sequelae. Although the Centers for Disease Control recommend that asymptomatic patients with BV should not be treated, this ignores the possibility of infectious complications. Antibiotics are indicated unless the woman is pregnant. The most effective agents are metronidazole and clindamycin. Recurrence of BV is common. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Vaginosis

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Statistical evaluation of diagnostic criteria for bacterial vaginosis

Article Abstract:

Bacterial vaginosis results from disturbances in the normal vaginal ecology. Normal vaginal bacteria may overgrow, and other organisms may gain a foothold. Bacterial vaginosis is one of the most common reasons for a woman to consult her primary care physician. There are a number of different indicators of the condition, including a homogenous, thin milk-like discharge, an increase in vaginal pH above 4.5, epithelial cells with borders obscured by bacteria, known as 'clue cells', and a fishy odor upon alkalinization of vaginal secretions. In addition, Gram staining vaginal discharge may be used to identify morphological types of bacteria. To determine which of these diagnostic criteria are of the most value, 500 vaginal secretions from consecutive patients were examined. Patients found to have yeasts, trichomonads, syphilis, gonorrhea; other pathological conditions were excluded, leaving 310 cases for evaluation. The single most reliable indicator of bacterial vaginosis was the presence of clue cells on examination of vaginal secretions under the microscope. The combination of clue cells and fishy odor upon alkalinization provided the most accurate indication of the condition. The time-consuming and inconvenient Gram stain was less accurate and added nothing to the accuracy or reliability of the diagnosis. Although bacterial vaginosis is generally chronic, treatment may be warranted since it may be a risk factor in pregnancy and surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Vaginal diseases, Bacterial vaginitis

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Is pH test paper as accurate as the electronic measurement of the pH of vaginal secretions?

Article Abstract:

Changes in the pH, a scale indicating the degree of acidity, are useful in diagnosing bacterial vaginitis and vaginal trichomonas infections. The pH of vaginal secretions can be measured using pH paper or instruments that measure pH. To see which method is the most reliable, two types of pH paper and a state-of-the-art pH instrument were compared. Vaginal secretions obtained from 64 women were immediately tested for pH using one of three methods. There was a statistical difference between pH as measured by ColorpHast pH paper and the pH measured by instrumentation and Nitrazine pH paper. Since one third of the women had a pH of 3.8 to 4.0 as determined by the instrument method, any pH of greater than 4.5 would be accurately tested by any of the three methods. Test paper is more convenient to use in the clinical setting. It is noted that five percent of the patients did not have enough secretions for an adequate pH paper determination. It is concluded that pH paper is as accurate as pH instrumentation when the pH is greater than the normal 4.5. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Product/Service Evaluation, Measurement, Vagina, Hydrogen-ion concentration, Reproductive organs, Female, Female genitalia, Acid-base imbalances, Acid-base imbalance, pH measurement, MI415 Microcombination pH probe (Medical instrument)

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