Vaginosis, bacterialN76.81

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

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HistoryThis section has been translated automatically.

Gardner, 1955

DefinitionThis section has been translated automatically.

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

Occurrence/EpidemiologyThis section has been translated automatically.

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

EtiopathogenesisThis section has been translated automatically.

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 featuresThis section has been translated automatically.

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).

DiagnosisThis section has been translated automatically.

Diagnostic criteria (after Amsel 1983):

  1. Low-viscosity, homogeneous fluorine
  2. pH value > 4,5
  3. Fishy (amine) odor of vaginal secretion, which increases after addition of 10% potassium hydroxide
  4. "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 therapyThis section has been translated automatically.

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 therapyThis section has been translated automatically.

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.

LiteratureThis section has been translated automatically.

  1. Blackbird R et al (1983) Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. At J Med 74: 18-22
  2. 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.
  3. Egan ME et al (2000) Diagnosis of vaginitis. On Fam Physician 62: 1095-1104
  4. Gardner HL, Dukes CD (1955) Haemophilus vaginalis vaginitis: a newly defined specific infection previously classified "nonspecific" vaginitis. On J Obstet Gynecol 69: 962-976
  5. 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
  6. Hackel H et al. (1991) Importance of Gardnerella vaginalis culture in BV-score-secured bacterial vaginosis. dermatologist 42: 173-175
  7. Hartmann AA et al (1984) Gardnerella vaginalis infection-another STD. dermatologist 35: 512-516
  8. Lamont RF (2002) Antibiotics for the prevention of preterm birth. N Engl J Med 342: 581-583
  9. Leitich H (2003) Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. On J Obstet Gynecol 189: 139-147
  10. Manhart LE et al (2003) Mucopurulent cervicitis and Mycoplasma genitalium. J Infect Dis 187: 650-657
  11. 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

Authors

Last updated on: 29.10.2020

Author: Prof. Dr. med. Peter Altmeyer

Editor: Dr. Alexander Zumdick