Vaginosis, bacterial N76.81

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

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Synonym(s)

Amine colpitis; bacterial vaginosis; Gardnerella vaginalis infection

History
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Gardner, 1955

Definition
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Frequently occurring dysbacteriosis of the vaginal flora with overgrowth of obligate anaerobic bacteria and Gardnerella vaginalis.

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Dermatology

Papel

Flat, spherical or pointed conical efflorescence protruding above the skin, up to 1.0 cm in diameter (note:...

Occurrence/Epidemiology
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Worldwide occurrence mainly among women of reproductive age. Estimated prevalence in women attending an STI clinic: 20-30%.
For women at higher risk of ST I, such as sex workers, the estimated prevalence is as high as 50-60% (Bautista Ct 2016)

The probability of developing bacterial vaginosis is higher if:

a higher number of sexual partners is indicated
for unmarried women
in women who have had their first sexual intercourse at a very early age
among sex workers
for regularly performed vaginal showers

Etiopathogenesis
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Probably the infection with Gardnerella vaginalis, a sexually transmitted, gram-negative to gram-variable, short, immobile rod, is the primary cause. The secondary cause is an increase in Gram-negative pathogens.

Clinical features
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Vulvovaginitis and colpitis with low-viscosity, homogeneous, grey-white fluorine vaginalis. Characteristic, penetrating, fish-like odour (caused by various amines formed by the overgrowing anaerobes).

Diagnosis
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Diagnostic criteria (after Amsel 1983):

Low-viscosity, homogeneous fluorine
pH value > 4,5
Fishy (amine) odor of vaginal secretion, which increases after addition of 10% potassium hydroxide
"Cue cells" or " key cells " (vaginal epithelia covered with bacteria and characteristically spotted) with a proportion of >20% of epithelial cells

the diagnosis of bacterial vaginosis is considered confirmed if at least three of the four criteria listed are met.

Cult detection is not recommended for primary diagnosis (G. vaginalis selective agar; the basis of this is Columbia blood agar containing 5-10% rabbit blood or human blood).

External therapy
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Vaginal irrigation with disinfectant additives, e.g. polyvidon iodine solution R203 or quinolinol (e.g. quinosol 1:1000 or R042 ). Disinfecting vaginal suppositories (e.g. Betaisodona vaginal suppositories) or vaginal suppositories with antibiotic additives such as metronidazole (e.g. Arilin vaginal suppositories).

Internal therapy
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Metronidazole (e.g. Clont, Flagyl) 2-3 times 400 mg/day p.o. or 2-3 times 500 mg/day i.v. over 5 days. Alternatively: Tinidazole (e.g. Simplotan) 2 g/day p.o. as single dose.

Remember! In men Gardnerella vaginalis can persist asymptomatically in the urethra for months.

Literature
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Blackbird R et al (1983) Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. At J Med 74: 18-22
Bautista CT et al.(2016) Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res 3:4.
Egan ME et al (2000) Diagnosis of vaginitis. On Fam Physician 62: 1095-1104
Gardner HL, Dukes CD (1955) Haemophilus vaginalis vaginitis: a newly defined specific infection previously classified "nonspecific" vaginitis. On J Obstet Gynecol 69: 962-976
Guaschino S et al (2003) Treatment of asymptomatic bacterial vaginosis to prevent pre-term delivery: a randomised trial. Eur J Obstet Gynecol Reprod Biol 110: 149-152
Hackel H et al. (1991) Importance of Gardnerella vaginalis culture in BV-score-secured bacterial vaginosis. dermatologist 42: 173-175
Hartmann AA et al (1984) Gardnerella vaginalis infection-another STD. dermatologist 35: 512-516
Lamont RF (2002) Antibiotics for the prevention of preterm birth. N Engl J Med 342: 581-583
Leitich H (2003) Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. On J Obstet Gynecol 189: 139-147
Manhart LE et al (2003) Mucopurulent cervicitis and Mycoplasma genitalium. J Infect Dis 187: 650-657
Nelson DB et al (2003) Self-collected versus provider-collected vaginal swabs for the diagnosis of bacterial vaginosis: an assessment of validity and reliability. J Clin Epidemiol 56: 862-866