Bacterial vaginosis overview
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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.
Bacterial vaginosis appears to be associated with sexual activity. However, there is no clear evidence of sexual transmission.[2]
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.[3][4]
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.[5][6]
Causes
Common causes of bacterial vaginosis include Gardnerella vaginalis, Mycoplasma hominis, ureaplasma, and anaerobes.[3][7]
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.[8][9][10][11][12]
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.[13]
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.[14][15]
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.[16]
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.[13] 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.[17][18][19] 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.[20][21]
Diagnosis
Amsel criteria
For clinicians, BV is a common vaginal condition characterized by at least three of the following four Amsel criteria include thin, gray/white discharge, malodorous “fishy” discharge upon adding 10 % potassium hydroxide, high vaginal pH (>4.5), and identification of clue cells.[22][23]
History and Symptom
It is necessary to obtain a detailed and thorough sexual history from the patient. Specific areas of focus when obtaining a history from the patient include number and type of sexual partners (new, casual, or regular) and previous history of STDs. 50-75% of women with bacterial vaginosis (BV) are asymptomatic. Common symptoms of bacterial vaginosis include thin white or gray vaginal discharge and unpleasant vaginal odor especially after sex.[23][24]
Physical Examination
Common genital examination of patients with bacterial vaginosis is usually remarkable for fishy-odor from the vagina, thin, white/gray vaginal discharge, and lack of significant vulvovaginal inflammation.[22]
Laboratory Findings
Bacterial vaginosis can be diagnosed by the use of clinical criteria (Amsel’s Diagnostic Criteria) or Gram stain. A Gram stain is considered the gold standard laboratory method for diagnosing bacteria vaginosis.[22]
Imaging findings
There is no imaging finding associated with bacterial vaginosis.
Other diagnostic studies
Other diagnostic studies associated with diagnosis of bacterial vaginosis (BV) include Affirm VP III test, chromogenic diagnostic test (OSOM BVBlue system), and quantitative polymerase chain reaction (PCR).[22][25][26][27]
Treatment
Medical Therapy
Treatment with appropriate antibiotics is recommended in all symptomatic women and high risk asymptomatic pregnant women.
Primary Prevention
Bacterial vaginosis appears to be associated with sexual activity. However, there is no clear evidence of sexual transmission.[2] Basic effective measures for the primary prevention of bacterial vaginosis include practicing abstinent, limit the number of sex partner, avoid douching and use of condoms and estrogen-containing contraceptives.[28][29][30]
Secondary prevention
Effective measure for the secondary prevention of infective conjunctivitis include maintaining vaginal pH at 4.5, bacteriotherapy, avoid douching and change in the method of contraception.[31][30][32][33]
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 Bradshaw CS, Morton AN, Hocking J; et al. (2006). "High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence". J Infect Dis. 193 (11): 1478&ndash, 86.
- ↑ 3.0 3.1 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.
- ↑ 13.0 13.1 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.
- ↑ 22.0 22.1 22.2 22.3 Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016
- ↑ 23.0 23.1 Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK (1983) Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 74 (1):14-22. PMID: 6600371
- ↑ Klebanoff MA, Schwebke JR, Zhang J, Nansel TR, Yu KF, Andrews WW (2004). "Vulvovaginal symptoms in women with bacterial vaginosis". Obstet Gynecol. 104 (2): 267–72. doi:10.1097/01.AOG.0000134783.98382.b0. PMID 15291998.
- ↑ Mulhem E, Boyanton BL, Robinson-Dunn B, Ebert C, Dzebo R (2014). "Performance of the Affirm VP-III using residual vaginal discharge collected from the speculum to characterize vaginitis in symptomatic women". J Low Genit Tract Dis. 18 (4): 344–6. doi:10.1097/LGT.0000000000000025. PMID 24832170.
- ↑ Rumyantseva T, Shipitsyna E, Guschin A, Unemo M (2016). "Evaluation and subsequent optimizations of the quantitative AmpliSens Florocenosis/Bacterial vaginosis-FRT multiplex real-time PCR assay for diagnosis of bacterial vaginosis". APMIS. doi:10.1111/apm.12608. PMID 27714844.
- ↑ Myziuk L, Romanowski B, Johnson SC (2003). "BVBlue test for diagnosis of bacterial vaginosis". J Clin Microbiol. 41 (5): 1925–8. PMC 154737. PMID 12734228.
- ↑ Ness RB, Hillier SL, Richter HE, Soper DE, Stamm C, McGregor J; et al. (2002). "Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina". Obstet Gynecol. 100 (4): 765. PMID 12383547.
- ↑ Bradshaw CS, Walker SM, Vodstrcil LA, Bilardi JE, Law M, Hocking JS; et al. (2014). "The influence of behaviors and relationships on the vaginal microbiota of women and their female partners: the WOW Health Study". J Infect Dis. 209 (10): 1562–72. doi:10.1093/infdis/jit664. PMID 24285846.
- ↑ 30.0 30.1 Bradshaw CS, Vodstrcil LA, Hocking JS, Law M, Pirotta M, Garland SM; et al. (2013). "Recurrence of bacterial vaginosis is significantly associated with posttreatment sexual activities and hormonal contraceptive use". Clin Infect Dis. 56 (6): 777–86. doi:10.1093/cid/cis1030. PMID 23243173.
- ↑ Wilson J (2004). "Managing recurrent bacterial vaginosis". Sex Transm Infect. 80 (1): 8–11. PMC 1758381. PMID 14755028.
- ↑ Reid G, Beuerman D, Heinemann C, Bruce AW (2001). "Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora". FEMS Immunol Med Microbiol. 32 (1): 37–41. PMID 11750220.
- ↑ Andersch B, Lindell D, Dahlén I, Brandberg A (1990). "Bacterial vaginosis and the effect of intermittent prophylactic treatment with an acid lactate gel". Gynecol Obstet Invest. 30 (2): 114–9. PMID 2245947.