Bashh bacterial vaginosis guideline summary
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Bashh bacterial vaginosis guideline summary
- 1. BASHH Bacterial vaginosis S. Banerjee StR, Microbiology
- 2. How prevalent? 5-50% Pregnant – 12% Women undergoing Termination of pregnancy – 30% Normal Lactobacilli pH<4.5
- 3. BV pH 4.5-6.0 Gardnerella vaginalis Atopobium vaginalis PrevotellaMycoplasma hominis Mobilincus Clostridium sp Leptotrichia Sneathia Biofilm – Gardnerella, Atopobium Offensive fishy smelly discharge Thin white homogenous No soreness, itching, irritation No sign of inflammation. 50% asymptomatic
- 4. Not STD but could be associated with STD Risk factors Vaginal douching Receptive cunnilingus Smoking STI Recent change in sex partner Black race Association Increased risk of HIV Prevalence is high in PID Common in elective TOP, associated with post TOP endometritis, PID Late miscarriage, Premature birth, PROM, PP endometritis Vaginal cuff cellulitis/abscess after vaginal hystrectomy
- 5. Hay/Ison Criteria (BASHH recommended) Gram stain vaginal smear Grade 1 – normal – Predominantly lactobacillus Grade 2 – Intermediate – Some lacto, some Gardnerella Grade 3 – BV – Pred Gardnerella/mobilincus Grade 4 GPC pred Amsel criteria +ve if ¾ criteria present Thin white homogenous discharge Clue cell pH>4.5 Fishy odour on adding 10% KOH Nugent Criteria 0-10 relative proportion of bact morphology <4 / 4-6/ >6
- 6. Clue cell
- 7. OSOM BV blue – measure sialidase level Prolinaminopeptidase card DNA probe based test PCR – not available yet
- 8. Mx Treat symptomatic patient, who is undergoing surgery, asymptomatic but wants to be treated. Tx Avoid – douching, shampoo, shwer gell, soap Metronidazole – 400mg BD 5-7 days/2 gm stat Metronidazole gel – OD – 5 days Clindamycin gel – OD – 7 days Alternative TinidazoleClinda 300 mg BD 7 d Cure rate 70-80%
- 9. Pregnancy Symptomatic – treat Asymptomatic – if additional risk factor for preterm birth – treat before 20 weeks Lactation Gel prep preferred TOP Screen and treat BV Partner Tr Not recommended Screening – Not recommended, some clinicians do in rec cases Test of cure Not recommended if symptom resolves Recurrence Problematic Suppresion with metro gel