BACTERIAL VAGINOSIS Introduction Bacterial vaginosis (BV) is known by many terms, including nonspecific vaginitis, Gardnerealla vaginalis, bacterial vaginitis, Haemophilus vaginalis, Corynebacterium vaginalis, and anaerobic vaginosis. This condition is caused by an overgrowth of several species of vaginal organisms, which may be transmitted by sexual activity. Bacterial vaginosis is considered a sexually associated condition but not necessarily a sexually transmitted infection. Although Bacterial vaginosis does not usually cause complication on its own, it is considered to be a co-factor in the acquisition of other sexually transmitted .

Common complaints

1.       Vaginal discharge (thin, white, gray, or milky)

2.      Fishy vaginal odor

3.      Postcoital odor

Diagnosis of bacterial vaginosis

·         Clinical picture. The discharge is white (rarely gray), creamy, bubbly (rarely foamy).

·         pH value. With bacterial vaginosis, the pH is between 4.8 and 5.5 (pH strips from Merck, product No. 9542), whereas a normal lactobacillus flora is associated with a pH between 3.8 and 4.5, depending on lactobacilli numbers.

·         Amine test. The fishy odor associated with bacterial vaginosis is caused by amines produced by anaerobic bacteria. The odor is only noticeable when these bacteria are present in high numbers. Addition of one to two drops of 10% potassium hydroxide solution to the discharge on a cotton or microscopic slide intensifies the fishy odor.

·         Microscopy. Clue cells are visible in wet mounts and less clearly in gram-stained pre-parations. These are cells from the vaginal epithelium that are covered with a dense layer of small bacteria, most often Gardnerella vaginalis. The epithelial cells also be covered with other bacteria, for example, mobiluncus, fusobacteria, and cocci. They are especially easy to recognize in the wet mount after staining with 0.1% methylene blue solution. In addition to clue cells, a high count of small, morphologically distinguishable bacteria is also characteristic for bacterial vaginosis: for example, curved gram-negative bacteria like mobiluncus are easily identified in a wet mount by their spinning movements.