Bacterial vaginosis
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| Bacterial vaginosis | |
| ICD-10 | B96, N76 |
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| ICD-9 | 616.1 |
| MeSH | D016585 |
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Bacterial vaginosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Bacterial vaginosis On the Web |
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American Roentgen Ray Society Images of Bacterial vaginosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Historical Perspective
Pathophysiology
Epidemiology & Demographics
Risk Factors
Screening
Causes
Differentiating Bacterial vaginosis
Complications & Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics
Treatment
Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies
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. Condoms 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.[1] Rather, BV is a disordering of the chemical and biological balance of the normal flora. Recent research is exploring the link between sexual partner treatment and eradication of recurrent cases of BV. 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.[2] 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
Bacterial vaginosis can be treated with antibiotics such as metronidazole and clindamycin. However, there is a high rate of recurrence.[1]
Currently, there are very few 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.[3]
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 yeast infection, and delay proper treatment which may lead to complications.
In a randomized controlled trial,[4] 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
- ↑ 1.0 1.1 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.
- ↑ "STD Facts - Bacterial Vaginosis (BV)". Retrieved 2007-12-04.
- ↑ "Specific probiotic strains are effective for genitourinary infections Townsend Letter for Doctors and Patients - Find Articles". Retrieved 2007-12-04.
- ↑ Hanson JM, McGregor JA, Hillier SL; et al. (2000). "Metronidazole for bacterial vaginosis. A comparison of vaginal gel vs. oral therapy". J Reprod Med. 45 (11): 889–96. PMID 11127100.