Friday, February 19, 2010
Bacterial Vaginosis
8:15 PM | 
Diposkan oleh
Hermanto
Definition
Bacterial vaginosis (BV) has previously been referred to as nonspecific vaginitis or Gardnella vaginitis.
It is an alteration of normal vaginal bacterial flora that results in the loss of hydrogen peroxide producing lactobacilli and an overgrowth of predominantly anaerobic bacteria.
Anaerobic bacteria can be found in less than 1% of the flora of normal women. In women with Bacterial Vaginosis, however, the concentration of anaerobes, as well as Gardnerella vaginalis and Mycoplasma hominis, is 100 to 1,000 times higher than in normal women. Lactobacilli are usually absent.
It is not known what triggers the disturbance of normal vaginal flora. It has been postulated that repeated alkalinization of the vagina, which occurs with frequent sexual intercourse or use of douches, plays a role. After normal hydrogen peroxide producing lactobacilli disappear, it is difficult to reestablish normal vaginal flora, and recurrence of Bacterial Vaginosis is common.
Diagnosis
It is diagnosed on the basis of the following findings :
· A fishy vaginal odor
· Vaginal discharge are present ( gray and thinly coat the vaginal walls).
· The pH of these secretions is higher than 4.5 (usually 4.7 to 5.7).
· Microscopy of the vaginal secretions reveals an increased number of clue cells, and leukocytes are conspicuously absent.
· The addition of KOH to the vaginal secretions releases a fishy, amine like odor.
· Culture of G. vaginalis is not recommended as a diagnostic tool because of its lack of specificity.
Complication
Women with Bacterial Vaginosis are at increased risk for :
· Pelvic inflammatory disease (PID)
· Post-abortal PID
· Postoperative cuff infections after hysterectomy
· Abnormal cervical cytology.
Pregnant women with Bacterial Vaginosis are at risk for :
· Premature rupture of the membranes (PROM)
· Preterm labor and delivery
· Chorioamnionitis
· Post-cesarean endometritis.
Treatment
The effective treatment are :
1. Metronidazole is the drug of choice for treatment of Bacterial Vaginalis.
This antibiotic with excellent activity against anaerobes but poor activity against lactobacilli.
Dose :
· Oral : 500 mg twice a day for 7 days.
· Gel : Metronidazolegel, 0.75%, one applicator (5 g) intravaginally once or twice daily for 5 days.
2. Clindamycin is effective regimen in treating Bacterial Vaginosis.
Dose :
· Oral : 300 mg twice daily for 7 days.
· Cream : Clindamycin 2% one applicator full (5 g) intravaginally at night before sleep for 7 days.
Treatment of the male sexual partner has not been shown to improve therapeutic response and therefore is not recommended
