BACTERIAL VAGINOSIS (ANAEROBIC VAGINOSIS) – INVESTIGATION AND DIAGNOSIS; MANAGEMENT
The presence of N gonorrhoeae, yeasts or trichomonads should be excluded. G vaginalis can be isolated by culture. Microscopy of vaginal smears may reveal numerous small gram-negative coccobacilli with no inflammatory cells and an absence of lactobacilli. The ‘clue cell’ with its numerous adherent bacteria is a feature of bacterial vaginosis.
The pH of vaginal secretions on the tip of the speculum can be measured using indicator paper; in bacterial vaginosis the pH is usually between 5 and 6. The presence of semen, a cervical discharge or menstrual blood can raise the pH of vaginal secretions.
Vaginal fluid can be tested for amine using the ‘whiff test; vaginal discharge on a swab is mixed with a drop of potassium hydroxide with production of a putrescent odour.
The nitroimidazoles (e.g. metronidazole 400 mg twice daily for 5 days or
2 g per day for two days) produce a short term cure and are currently the treatment of choice. The nitroimidazoles should not be used in pregnancy and lactation; ampicillin 500 g four times each day for 5 days can be used.
Recurrence is common; treatment of male partners is of no proven value.
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