|
|
| (26 intermediate revisions by 6 users not shown) |
| Line 1: |
Line 1: |
| '''For patient information, click [[Bacterial vaginosis (patient information)|here]]''' | | '''For patient information, click [[Bacterial vaginosis (patient information)|here]]''' |
| | __NOTOC__ |
| | {{Bacterial vaginosis}} |
| | {{CMG}}; {{AE}} {{SaraM}} |
|
| |
|
| {{Infobox_Disease | | {{SK}} Anaerobic vaginosis; Nonspecific vaginitis |
| | Name = {{PAGENAME}}
| |
| | Image =
| |
| | Caption =
| |
| | DiseasesDB =
| |
| | ICD10 = {{ICD10|B|96||b|95}}, {{ICD10|N|76||n|70}}
| |
| | ICD9 = {{ICD9|616.1}}
| |
| | ICDO =
| |
| | OMIM =
| |
| | MedlinePlus =
| |
| | eMedicineSubj =
| |
| | eMedicineTopic =
| |
| | MeshID = D016585
| |
| }}
| |
| {{Bacterial vaginosis}}
| |
| {{CMG}}
| |
|
| |
|
| ==[[Bacterial vaginosis overview|Overview]]== | | ==[[Bacterial vaginosis overview|Overview]]== |
| Line 24: |
Line 12: |
| ==[[Bacterial vaginosis pathophysiology|Pathophysiology]]== | | ==[[Bacterial vaginosis pathophysiology|Pathophysiology]]== |
|
| |
|
| ==[[Bacterial vaginosis epidemiology and demographics|Epidemiology & Demographics]]==
| |
|
| |
| ==[[Bacterial vaginosis risk factors|Risk Factors]]==
| |
|
| |
|
| ==[[Bacterial vaginosis screening|Screening]]==
| |
|
| |
|
| ==[[Bacterial vaginosis causes|Causes]]== | | ==[[Bacterial vaginosis causes|Causes]]== |
|
| |
|
| ==[[Bacterial vaginosis differential diagnosis|Differentiating Bacterial vaginosis]]==
| |
|
| |
|
| ==[[Bacterial vaginosis natural history|Complications & Prognosis]]==
| |
|
| |
|
| ==Diagnosis==
| |
| [[Bacterial vaginosis history and symptoms|History and Symptoms]] | [[Bacterial vaginosis physical examination|Physical Examination]] | [[Bacterial vaginosis laboratory tests|Laboratory tests]] | [[Bacterial vaginosis electrocardiogram|Electrocardiogram]] | [[Bacterial vaginosis x ray|X Rays]] | [[Bacterial vaginosis CT|CT]] | [[Bacterial vaginosis MRI|MRI]] [[Bacterial vaginosis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Bacterial vaginosis other imaging findings|Other images]] | [[Bacterial vaginosis other diagnostic studies|Alternative diagnostics]]
| |
|
| |
|
| ==Treatment== | | ==[[Bacterial vaginosis differential diagnosis|Differentiating Bacterial vaginosis from other Diseases]]== |
| [[Bacterial vaginosis medical therapy|Medical therapy]] | [[Bacterial vaginosis surgery|Surgical options]] | [[Bacterial vaginosis primary prevention|Primary prevention]] | [[Bacterial vaginosis secondary prevention|Secondary prevention]] | [[Bacterial vaginosis cost-effectiveness of therapy|Financial costs]] | [[Bacterial vaginosis future or investigational therapies|Future therapies]] | |
|
| |
|
| == Epidemiology and Demographics == | | ==[[Bacterial vaginosis epidemiology and demographics|Epidemiology and Demographics]]== |
| As many as one-third of pregnant women in the United States have BV.
| |
|
| |
|
| == Risk Factors == | | ==[[Bacterial vaginosis risk factors|Risk Factors]]== |
| BV is not a [[sexually transmitted disease]] ([[STD]]). Although it is less common in women who have never had sex, there is evidence that it could be linked to having a new sex partner or multiple sex partners. Also, douching appears to increase the risk of developing BV.
| |
|
| |
|
| == Screening == | | ==[[Bacterial vaginosis screening|Screening]]== |
| [[image:PHIL_3719_thumb.jpg|left|thumb|This photomicrograph reveals bacteria adhering to vaginal epithelial cells known as “clue cells”]] | |
| {{clr}}
| |
|
| |
|
| == Pathophysiology & Etiology== | | ==[[Bacterial vaginosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| BV is actually a syndrome resulting from an imbalance in the different types of bacteria in the vagina (also called vaginal "flora"). A healthy vagina has numerous organisms that naturally live there. The vast majority--about 95 percent--belong to a type of bacteria called lactobacillus.
| |
|
| |
|
| There are several different kinds of [[lactobacillus]], at least one of which is responsible for keeping the vagina's pH at normal levels. When these levels become unbalanced, certain microorganisms may overtake the normal flora leading to a low-grade infection that often produces an abnormal vaginal discharge.
| | ==Diagnosis== |
| | | [[Bacterial vaginosis Amsel criteria|Amsel Criteria]] | [[Bacterial vaginosis history and symptoms|History and Symptoms]] | [[Bacterial vaginosis physical examination|Physical Examination]] | [[Bacterial vaginosis laboratory findings|Laboratory Findings]] | [[Bacterial vaginosis other imaging findings|Other Imaging Findings]] | [[Bacterial vaginosis other diagnostic studies|Other Diagnostic Studies]] |
| ==Symptoms and signs==
| |
| The most common symptom of BV is an abnormal [[Mucopurulent discharge|vaginal discharge]] (especially after sex) with an unpleasant fishy smell. While some women do not experience symptoms, many women experience intense itching, swelling and irritation (which is why it is often misdiagnosed by women and even health care practitioners as a yeast infection). By contrast, a 'normal' discharge will be odourless and will vary in consistency and amount with the [[menstrual cycle]] - a normal discharge is at its clearest about 2 weeks before the [[menstruation|period]] starts.
| |
| | |
| == Diagnosis== | |
| A healthcare professional seeing a woman presenting with questions about vaginal discharge and irritation in the vagina and vulva will have several diagnoses in mind to account for it. These may include:
| |
| *The discharge is normal for the woman
| |
| *[[Candidiasis]] (thrush, or a yeast infection)
| |
| *[[Trichomonas vaginalis]] (trichomoniasis)
| |
| *Bacterial vaginosis
| |
| | |
| To find out which of these is the case, a few simple tests are done. The healthcare provider will carry out a [[Speculum (medical)|speculum]] examination and take some swabs from high in the vagina. These swabs will be tested for:
| |
| * A characteristic smell—this is called the whiff test. A small amount of an alkali is added to a [[microscope slide]] that has been swabbed with the discharge—a 'fishy' odour is a positive result for bacterial vaginosis.
| |
| * Loss of [[acidity]]—the vagina is normally slightly acidic (with a [[pH]] of 3.8–4.2), which helps to control bacteria. A swab of the discharge is put onto [[litmus paper]] to check the acidity. A positive result for bacterial vaginosis would be a pH of over 4.5.
| |
| * 'Clue cells'—so called because they give a clue to the reason behind the discharge. These are [[epithelial]] cells (like skin) that are coated with bacteria. They can be seen under microscopic examination of the discharge.
| |
| | |
| Two positive results in addition to the discharge itself are enough to diagnose BV. If there is no discharge, then all 3 criteria are needed.<ref name = Amsel>{{Citation | last1 = Amsel | first1 = R | last2 = Totten | first2 = PA | last3 = Spiegel | first3 = CA | last4 = Chen | first4 = KC | last5 = Eschenbach | first5 = D | last6 = Holmes| first6 = KK | year = 1983 | title = Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations | journal = Am J Med | volume = 74 | pages = 14–22}}</ref>
| |
| | |
| === In clinical practice ===
| |
| | |
| In clinical practice bacterial vaginosis (BV) is diagnosed using the Amsel criteria:<ref name = Amsel>{{Citation | last1 = Amsel | first1 = R | last2 = Totten | first2 = PA | last3 = Spiegel | first3 = CA | last4 = Chen | first4 = KC | last5 = Eschenbach | first5 = D | last6 = Holmes| first6 = KK | year = 1983 | title = Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations | journal = Am J Med | volume = 74 | pages = 14–22}}</ref>
| |
| | |
| # Thin, white, yellow, homogeneous discharge
| |
| # [[Clue cells]] on [[microscopy]]
| |
| # [[pH]] of vaginal fluid >4.5
| |
| # Release of a fishy odor on adding [[alkali]]—10% [[potassium hydroxide]] (KOH) solution.
| |
| | |
| At least three of the four criteria should be present for a confirmed diagnosis.<ref name="GCH2002">{{cite journal | author=Guideline Clearing House | title=2002 national guideline for the management of bacterial vaginosis | http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3032&nbr=2258 }}</ref>
| |
| | |
| An alternative is to use a Gram stained vaginal smear, with the Hay/Ison<ref name = HayIson>{{Citation | last1 = Ison | first1 = CA | last2 = Hay | first2 = PE | year = 2002 | title = Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics | journal = Sex Transm Infect | volume = 78 | pages = 413–415}}</ref> criteria or the Nugent<ref name="Nugent1991">{{cite journal | author=Nugent, R. P., M. A. Krohn, and S. L. Hillier | title=Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation | journal=J. Clin. Microbiol | year=1991 | volume=29 | pages=297–301 }}</ref> criteria. The Hay/Ison criteria are defined as follows: <ref name="GCH2002">{{cite journal | author=Guideline Clearing House | title=2002 national guideline for the management of bacterial vaginosis | http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3032&nbr=2258 }}</ref>
| |
| * Grade 1 (Normal): [[Lactobacillus]] morphotypes predominate.
| |
| * Grade 2 (Intermediate): Mixed flora with some Lactobacilli present, but Gardnerella or Mobiluncus morphotypes also present.
| |
| * Grade 3 (Bacterial Vaginosis): Predominantly Gardnerella and/or Mobiluncus morphotypes. Few or absent Lactobacilli. (Hay et al., 1994)
| |
| | |
| What this technique loses in interobserver reliability, it makes up in ease and speed of use.
| |
| | |
| The standard for research are the Nugent<ref name="Nugent1991">next</ref> Criteria. In this scale a score of 0-10 is generated from combining three other scores. It is time consuming and requires trained staff but is has high [[Inter-observer reliability|interobserver reliability]]:
| |
| * 0–3 is considered negative for BV
| |
| * 4–6 is considered intermediate
| |
| * 7+ is considered indicative of BV.
| |
| At least 10–20 high power (1000× oil immersion) fields are counted and an average determined.
| |
| | |
| {| class="wikitable"
| |
| |
| |
| Lactobacillus morphotypes — '''average''' per high powered (1000× oil immersion) field. View multiple fields.
| |
| ||
| |
| [[Gardnerella]] / [[Bacteroides]] morphotypes — '''average''' per high powered (1000× oil immersion) field. View multiple fields. | |
| ||
| |
| Curved Gram variable rods — '''average''' per high powered (1000× oil immersion) field. View multiple fields (note that this factor is less important — scores of only 0–2 are possible)
| |
| |-
| |
| |
| |
| * Score 0 for >30
| |
| * Score 1 for 15–30
| |
| * Score 2 for 14
| |
| * Score 3 for <1 (this is an average, so results can be >0, yet <1)
| |
| * Score 4 for 0
| |
| ||
| |
| * Score 0 for 0
| |
| * Score 1 for <1 (this is an average, so results can be >0, yet <1)
| |
| * Score 2 for 1–4
| |
| * Score 3 for 5–30
| |
| * Score 4 for >30
| |
| ||
| |
| * Score 0 for 0
| |
| * Score 1 for <5
| |
| * Score 2 for 5+
| |
| |}
| |
| | |
| A recent study <ref name="pmid17078859">{{cite journal |author=Gazi H, Degerli K, Kurt O, ''et al'' |title=Use of DNA hybridization test for diagnosing bacterial vaginosis in women with symptoms suggestive of infection |journal=APMIS |volume=114 |issue=11 |pages=784–7 |year=2006 |pmid=17078859 |doi=10.1111/j.1600-0463.2006.apm_485.x}}</ref> compared the gram stain using the Nugent criteria and the DNA hybridization test Affirm VPIII in diagnosing BV. The Affirm VPIII test detected Gardnerella in 107 (93.0%) of 115 vaginal specimens positive for BV diagnosed by gram stain. The Affirm VPIII test has a [[sensitivity (tests)|sensitivity]] of 87.7% and [[specificity (tests)|specificity]] of 96% and may be used for the rapid diagnosis of BV in symptomatic women.
| |
| | |
| ==Causes==
| |
| A healthy vagina normally contains many [[microorganisms]], some of the common ones are ''Lactobacillus crispatus'' and ''Lactobacillus jensenii''. ''Lactobacillus'', particularly hydrogen peroxide-producing species, appears to help prevent other vaginal microorganisms from multiplying to a level where they cause symptoms. (Note: ''[[Lactobacillus acidophilus]]'' is not one of the species of ''Lactobacillus'' identified as playing a protective role in vaginal flora.) The microorganisms involved in BV are very diverse, but include ''[[Gardnerella vaginalis]]'', ''[[Mobiluncus]]'', ''[[Bacteroides]]'', and ''[[Mycoplasma]]''. A change in normal bacterial flora including the reduction of lactobacillus, which may be due to the use of antibiotics or pH imbalance, allows more resistant bacteria to gain a foothold and multiply. In turn these produce toxins which affect the body's natural defenses and make re-colonization of healthy bacteria more difficult.
| |
| | |
| Most cases of bacterial vaginosis occur in sexually active women between the ages of 15 and 44, especially after contact with a new partner. [[Condom]]s may provide some protection and there is no evidence that [[spermicide]] increases BV risk. Although BV appears to be associated with [[sexual activity]], there is no clear evidence of sexual transmission.<ref name="Bradshaw2006">{{cite journal | author=Bradshaw CS, Morton AN, Hocking J, ''et al.'' | title=High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence | journal=J Infect Dis | year=2006 | volume=193 | issue=11 | pages=1478–86 }}</ref> Rather, BV is a disordering of the chemical and biological balance of the [[Human flora|normal flora]]. Recent research is exploring the link between sexual partner treatment and eradication of recurrent cases of BV. [[Pregnancy|Pregnant]] women and women with [[sexually transmitted infections]] are especially at risk for getting this infection. Bacterial vaginosis does not usually affect women after [[menopause]]. A 2005 study by researchers at [[Ghent University]] in Belgium showed that subclinical iron deficiency ([[anemia]]) was a strong predictor of bacterial vaginosis in pregnant women. A longitudinal study published in February 2006 in the American Journal of Obstetrics and Gynecology showed a link between psychosocial stress and bacterial vaginosis independent of other risk factors.
| |
| | |
| ==Complications==
| |
| | |
| Although previously considered a mere nuisance infection, untreated bacterial vaginosis may cause serious complications, such as increased succeptibility to sexually transmitted infections including HIV, and may present other complications for pregnant women.<ref name="titleSTD Facts - Bacterial Vaginosis (BV)">{{cite web |url=http://www.cdc.gov/std/bv/STDFact-Bacterial-Vaginosis.htm#Complications |title=STD Facts - Bacterial Vaginosis (BV) |accessdate=2007-12-04 |format= |work=}}</ref> It has also been associated with an increase in the development of [[Pelvic inflammatory disease]] (PID) following surgical procedures such as a hysterectomy or an abortion.
| |
|
| |
|
| ==Treatment== | | ==Treatment== |
| Bacterial vaginosis can be treated with [[antibiotic]]s such as [[metronidazole]] and [[clindamycin]]. However, there is a high rate of recurrence.<ref name="Bradshaw2006"/> | | [[Bacterial vaginosis medical therapy|Medical Therapy]] | [[Bacterial vaginosis surgery|Surgery]] | [[Bacterial vaginosis primary prevention|Primary Prevention]] | [[Bacterial vaginosis secondary prevention|Secondary Prevention]] | [[Bacterial vaginosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Bacterial vaginosis future or investigational therapies|Future or Investigational Therapies]] |
| | |
| Currently, there are very few [[Over-the-counter drug|over the counter]] products that address bacterial vaginosis. A vaginal gel product called RepHresh claims to regulate the pH level. [[Boric acid]] capsules inserted vaginally is considered a home treatment. Lactobacillus supplements may also be used; Fem-dophilus (Jarrow Formulas) is a lactobacillus product which specifically claims to help maintain healthy vaginal flora.<ref name="titleSpecific probiotic strains are effective for genitourinary infections Townsend Letter for Doctors and Patients - Find Articles">{{cite web |url=http://findarticles.com/p/articles/mi_m0ISW/is_280/ai_n16865224 |title=Specific probiotic strains are effective for genitourinary infections Townsend Letter for Doctors and Patients - Find Articles |accessdate=2007-12-04 |format= |work=}}</ref>
| |
| | |
| It should be noted that seeking medical attention is often necessary, because none of the over the counter products can claim to treat an active infection. More importantly, patients often inaccurately diagnose BV as a [[Candidiasis|yeast infection]], and delay proper treatment which may lead to complications.
| |
| | |
| In a [[randomized controlled trial]],<ref name="pmid11127100">{{cite journal |author=Hanson JM, McGregor JA, Hillier SL, ''et al'' |title=Metronidazole for bacterial vaginosis. A comparison of vaginal gel vs. oral therapy |journal=J Reprod Med |volume=45 |issue=11 |pages=889–96 |year=2000 |pmid=11127100 |doi=}}</ref> researchers found the efficacy of 0.75% metronidazole vaginal gel in treating bacterial vaginosis (cure rate 70.7%) was equivalent to that of standard oral metronidazole treatment (cure rate 71%). Treatment with vaginal metronidazole gel was associated with fewer gastrointestinal complaints.
| |
|
| |
|
| ==References== | | ==Case Studies== |
| {{reflist|2}}
| | [[Bacterial vaginosis case study one|Case #1]] |
|
| |
|
| [[de:Bakterielle Vaginose]]
| |
| [[es:Vaginosis bacteriana]]
| |
| [[it:Vaginosi]]
| |
| [[sr:Вагиноза]]
| |
| [[pl:Bakteryjne zapalenie pochwy]]
| |
|
| |
|
| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| Line 157: |
Line 43: |
|
| |
|
| [[Category:Disease]] | | [[Category:Disease]] |
| | [[Category:Up-To-Date]] |
| [[Category:Gynecology]] | | [[Category:Gynecology]] |
| | [[Category:Emergency medicine]] |
| [[Category:Infectious disease]] | | [[Category:Infectious disease]] |