Bacterial vaginosis overview
|
Bacterial vaginosis Microchapters |
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Bacterial vaginosis overview On the Web |
|
American Roentgen Ray Society Images of Bacterial vaginosis overview |
|
Risk calculators and risk factors for Bacterial vaginosis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Bacterial vaginosis (BV) is the most common cause of vaginal infection (vaginitis). For grammatical reasons, some people prefer to call it vaginal bacteriosis. It is not generally considered to be a sexually transmitted infection[1] (see causes below). BV is caused by an imbalance of naturally occurring bacterial flora, and should not be confused with yeast infection (candidiasis), or infection with Trichomonas vaginalis (trichomoniasis) which are not caused by bacteria.
Bacterial vaginosis (BV) is the most common of three vaginal infections that fall under the category known as vaginitis. The other two infections are trichomoniasis, a sexually transmitted disease, and the fungal infection commonly known as a yeast infection.
BV is poorly understood and is often misdiagnosed. Untreated BV can lead to premature delivery, postpartum infections, clinically apparent and subclinical pelvic inflammatory disease (PID), post-surgical complications (after abortion, hysterectomy, cesarean section and other reproductive procedures), increased vulnerability to HIV infection and, possibly, infertility.
The condition is also known as BV, non-specific vaginitis and Gardnerella vaginalis vaginitis.
Historical perspective
n 1892, the hypothesis that bacterial flora may be a cause of vaginal infectious conditions was first described by Albert Döderlein. In 1955, Gardnerella vaginalis was named as a new genus as the cause of the foul-smelling watery vaginal discharge by Gardner and Dukes.[2][3]
Pathophysiology
Bacterial vaginosis is actually a syndrome resulting from an imbalance in the different types of bacteria in the vagina (also called vaginal "flora"). The healthy vaginal microflora has been described as being constituted mainly by Gram-positive bacilli of the genus Lactobacillus. Lactobacilli play an important role in maintaining the female genital tract health by keeping the vagina's pH at normal levels. When vagina's pH levels become unbalanced, certain microorganisms may overtake the normal flora leading to a low-grade infection that often produces an abnormal vaginal discharge.[4][5]
Causes
Common causes of bacterial vaginosis include Gardnerella vaginalis, Mycoplasma hominis, ureaplasma, and anaerobes.[2][6]
Differential Diagnosis
Bacterial vaginosis must be differentiated from other diseases that cause purulent, malodorous, thin vaginal discharge with elevatedvaginal PH (<4.5) such as trichomoniasis, atrophic vaginitis, and desquamative inflammatory vaginitis. Additionally bacterial vaginosis also must be differentiated other conditions such as from vaginal candidiasis, vaginitis and cervicitis.[7][8][9][10][11]
Epidemiology
Bacterial vaginosis is the most common cause of vaginal symptoms among women, but it is not clear what role sexual activity plays in the development of BV. The prevalence in the United States is estimated to be 21.2 million (29.2%) among women ages 14–49.[12]
Risk Factors
Common risk factors in the development of bacterial vaginosis include sexual activity, a new sex partner or multiple sex partners, woman who have sex with woman, presence of other sexually transmitted infections, douching, and cigarette smoking.[13][14]
Screening
General screening for bacterial vaginosis is not recommended. According to the United States Preventive Services Task Force, evidence is insufficient to recommend routine screening for bacterial vaginosis (BV) in asymptomatic pregnant women at high or low risk for preterm delivery for the prevention of preterm birth.[15]
Natural history, complications and prognosis
Most women found to have bacterial vaginosis (BV) reported no symptoms and in symptomatic patients, bacterial vaginosis may present with vaginal odor and white/gray vaginal discharge.[12] If left untreated, bacterial vaginosis may lead to more serious sequelae, such as salpingitis, endometritis, bacteremia, and pelvic inflammatory disease (PID). In most cases, BV causes no complications. However, some complication of bacterial vaginosis may include endometritis, cervicitis, pelvic inflammatory disease (PID), bacteremia, and increase a woman's susceptibility to other STDs.[16][17][18] Additionally, one third of pregnant women found to have a bacterial vaginosis. If left untreated, in pregnant women bacterial vaginosis may result in a serious complication of pregnancy, including premature rupture of membranes, premature labor, chorioamnionitis, postpartum endometritis, and septic abortion.[19][20]
Treatment
Medical Therapy
Treatment with appropriate antibiotics is recommended in all symptomatic women and high risk asymptomatic pregnant women.
References
- ↑ Guideline Clearing House. "2002 national guideline for the management of bacterial vaginosis". Unknown parameter
|http://www.guideline.gov/summary/summary.aspx?ss=ignored (help) - ↑ 2.0 2.1 Donders GG (2007). "Definition and classification of abnormal vaginal flora". Best Pract Res Clin Obstet Gynaecol. 21 (3): 355–73. doi:10.1016/j.bpobgyn.2007.01.002. PMID 17434799.
- ↑ GARDNER HL, DUKES CD (1955). "Haemophilus vaginalis vaginitis: a newly defined specific infection previously classified non-specific vaginitis". Am J Obstet Gynecol. 69 (5): 962–76. PMID 14361525.
- ↑ Machado D, Castro J, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, Cerca N (2015). "Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions". Front Microbiol. 6: 1528. doi:10.3389/fmicb.2015.01528. PMC 4718981. PMID 26834706.
- ↑ Borges S, Silva J, Teixeira P (2014). "The role of lactobacilli and probiotics in maintaining vaginal health". Arch Gynecol Obstet. 289 (3): 479–89. doi:10.1007/s00404-013-3064-9. PMID 24170161.
- ↑ Livengood CH (2009). "Bacterial vaginosis: an overview for 2009". Rev Obstet Gynecol. 2 (1): 28–37. PMC 2672999. PMID 19399292.
- ↑ Centers for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines. Bacterial Vaginosis. http://www.cdc.gov/std/tg2015/bv.htm Accessed on October 13, 2016
- ↑ Bachmann GA, Nevadunsky NS (2000). "Diagnosis and treatment of atrophic vaginitis". Am Fam Physician. 61 (10): 3090–6. PMID 10839558.
- ↑ Krieger JN, Tam MR, Stevens CE, Nielsen IO, Hale J, Kiviat NB; et al. (1988). "Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens". JAMA. 259 (8): 1223–7. PMID 2448502.
- ↑ Sobel JD, Reichman O, Misra D, Yoo W (2011). "Prognosis and treatment of desquamative inflammatory vaginitis". Obstet Gynecol. 117 (4): 850–5. doi:10.1097/AOG.0b013e3182117c9e. PMID 21422855.
- ↑ Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK (1998). "Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm". Obstet Gynecol. 92 (5): 757–65. PMID 9794664.
- ↑ 12.0 12.1 Centers for Disease Control and Prevention. Bacterial Vaginosis (BV) Statisticshttp://www.cdc.gov/std/bv/stats.htm Accessed on October 18, 2016
- ↑ Fethers KA, Fairley CK, Hocking JS, Gurrin LC, Bradshaw CS (2008). "Sexual risk factors and bacterial vaginosis: a systematic review and meta-analysis". Clin Infect Dis. 47 (11): 1426–35. doi:10.1086/592974. PMID 18947329.
- ↑ Yen S, Shafer MA, Moncada J, Campbell CJ, Flinn SD, Boyer CB (2003). "Bacterial vaginosis in sexually experienced and non-sexually experienced young women entering the military". Obstet Gynecol. 102 (5 Pt 1): 927–33. PMID 14672465.
- ↑ United States Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/bacterial-vaginosis-in-pregnancy-to-prevent-preterm-delivery-screening?ds=1&s=bacterial%20vaginosis Accessed on October 13, 2016
- ↑ Laxmi U, Agrawal S, Raghunandan C, et al. Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study. J Matern Fetal Neonatal Med 2012;25:64–7.
- ↑ Koumans EH, Kendrick JS, CDC Bacterial Vaginosis Working Group (2001). "Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda". Sex Transm Dis. 28 (5): 292–7. PMID 11354269.
- ↑ Persson E, Bergström M, Larsson PG, Moberg P, Platz-Christensen JJ, Schedvins K; et al. (1996). "Infections after hysterectomy. A prospective nation-wide Swedish study. The Study Group on Infectious Diseases in Obstetrics and Gynecology within the Swedish Society of Obstetrics and Gynecology". Acta Obstet Gynecol Scand. 75 (8): 757–61. PMID 8906013.
- ↑ Chaim, W., M. Mazor, and J. R. Leiberman. "The relationship between bacterial vaginosis and preterm birth. A review." Archives of gynecology and obstetrics 259.2 (1997): 51-58.
- ↑ Faro S, Martens M, Maccato M, Hammill H, Pearlman M (1993). "Vaginal flora and pelvic inflammatory disease". Am J Obstet Gynecol. 169 (2 Pt 2): 470–4. PMID 8357048.