Bacterial vaginosis (BV) involves:
Microbial Imbalance: Disruption of the normal vaginal flora, with a decrease in beneficial Lactobacillus species and an increase in anaerobic bacteria (e.g., Gardnerella vaginalis, Prevotella spp., Mobiluncus spp.).
Altered pH: Shift in vaginal pH to >4.5, creating an environment conducive to the growth of pathogenic bacteria.
Biofilm Formation: Formation of bacterial biofilms on vaginal epithelial cells, contributing to persistent infection.
Complications: BV increases the risk of preterm birth, pelvic inflammatory disease (PID), and susceptibility to sexually transmitted infections (STIs).
Clinical Evaluation
Symptoms: Assessment of symptoms such as thin, grayish-white vaginal discharge with a fishy odor (particularly after intercourse or during menstruation), vaginal itching, and irritation.
Physical Examination: Examination findings may include vaginal pH >4.5, presence of clue cells (vaginal epithelial cells coated with bacteria), and absence of inflammation (lack of significant erythema or swelling).
Diagnostic Tests: Wet mount microscopy to identify clue cells, pH testing of vaginal fluid, and measurement of vaginal discharge amines (whiff test).
Thin, homogenous grayish-white vaginal discharge.
Fishy odor, particularly noticeable after intercourse or during menstruation (amine odor test positive).
Vaginal itching, burning, or irritation.
Absence of significant inflammation (lack of erythema or swelling in the vaginal mucosa).
Treatment aims to restore the balance of vaginal flora and alleviate symptoms:
Antibiotics: Oral or topical antibiotics such as metronidazole or clindamycin to eradicate pathogenic bacteria.
Probiotics: Use of Lactobacillus-containing vaginal suppositories or oral probiotics to promote the growth of beneficial bacteria.
Preventive Measures: Practices to maintain vaginal health, including avoiding douching, using mild soap for hygiene, and practicing safe sex.
Follow-up: Monitoring for recurrence and reevaluation if symptoms persist or recur despite treatment.