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Bacterial vaginosis (BV) is the most common cause of vaginal infection (vaginitis). For grammatical reasons, some people prefer to call it vaginal bacteriosis. It is NOT generally considered to be a sexually transmitted infection^[1] (see causes below). BV is caused by an imbalance of naturally occurring bacterial flora, and should not be confused with yeast infection (candidiasis), or infection with Trichomonas vaginalis (trichomoniasis) which are not caused by bacteria. Image File history File links Broom_icon. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // A00-A79 - Bacterial infections, and other intestinal infectious diseases, and STDs (A00-A09) Intestinal infectious diseases (A00) Cholera (A01) Typhoid and paratyphoid fevers (A010) Typhoid fever (A02) Other Salmonella infections (A03) Shigellosis (A04) Other bacterial intestinal infections (A040) Enteropathogenic Escherichia coli infection (A045) Campylobacter enteritis (A046) Enteritis due to Yersinia... // N00-N39 - Diseases of the genitourinary system: urinary system (N00-N08) Glomerular diseases Prefixes: .2 Diffuse membranous glomerulonephritis (N00) Acute nephritic syndrome (N01) Rapidly progressive nephritic syndrome (N02) Recurrent and persistent haematuria (N03) Chronic nephritic syndrome (N04) Nephrotic syndrome Lipoid nephrosis (N05) Unspecified nephritic syndrome (N06) Isolated proteinuria with specified... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Vaginitis is an inflammation of the vaginal mucosa and often associated with an irritation or infection of the vulva leading to vulvovaginitis. ... Sexually-transmitted infections (STIs), also known as sexually-transmitted diseases (STDs), are diseases that are commonly transmitted between partners through some form of sexual activity, most commonly vaginal intercourse, oral sex, or anal sex. ... Candidiasis, commonly called yeast infection or thrush, is a fungal infection of any of the Candida species, of which Candida albicans is probably the most common. ... Binomial name Trichomonas vaginalis (Donné 1836) Trichomonas vaginalis, an anaerobic, parasitic flagellated protozoan, is the causative agent of trichomoniasis, and is the most common pathogenic protozoan infection of humans in industrialized countries. ... Trichomoniasis, sometimes referred to as trich, is a common sexually transmitted disease that affects 7. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ...

Symptoms and signs

The most common symptom of BV is an abnormal vaginal discharge (especially after sex) with an unpleasant fishy smell. There is rarely itching.

Nearly half of all women with BV don't notice any symptoms.

By contrast, a 'normal' discharge will be odourless and will vary in consistency and amount with your menstrual cycle - a normal discharge is at its clearest about 2 weeks before your period starts.

Wikipedia does not have an article with this exact name. ... Diverse women. ... Look up Consistency in Wiktionary, the free dictionary. ... Menstrual cycle The menstrual cycle is a recurring cycle of physiological changes that occurs in the females of human beings and great apes. ...

Diagnosis: for patients

When you go to your healthcare provider with questions about vaginal discharge, he or she will have several diagnoses in mind to account for it. These may include:

• The discharge is normal for you
• Candidiasis (thrush, or a yeast infection)
• Trichomonas vaginalis (trichomoniasis)
• Bacterial vaginosis

To find out which of these is the case, a few simple tests are done. The provider will carry out a speculum examination and take some swabs from high in the vagina. These swabs will be tested for: Binomial name Trichomonas vaginalis (Donné 1836) Trichomonas vaginalis, an anaerobic, parasitic flagellated protozoan, is the causative agent of trichomoniasis, and is the most common pathogenic protozoan infection of humans in industrialized countries. ... Meanings of speculum include: A medical tool used for examing body cavities; see Speculum (medical). ...

• A characteristic smell—this is called the whiff test. A small amount of an alkali is added to a microscope slide that has been swabbed with the discharge—a 'fishy' odour is a positive result for bacterial vaginosis.
• Loss of acidity—the vagina is normally slightly acidic (with a pH of 3.8–4.2), which helps to control bacteria. A swab of the discharge is put onto litmus paper to check the acidity. A positive result for bacterial vaginosis would be a pH of over 4.5.
• 'Clue cells'—so called because they give a clue to the reason behind the discharge. These are epithelial cells (like skin) that are coated with bacteria. They can be seen under microscopic examination of your discharge.

Two positive results in addition to the discharge itself are enough to diagnose BV. If there is no discharge, then all 3 criteria are needed.^[2]

Wikibooks Transwiki has more about this subject: Microscope slide Microscope slides and cover slips. ... Acidity is a controversial novelette written for the popular South Asian website Chowk. ... The correct title of this article is . ... The term litmus test can be literal or metaphorical. ... In zootomy, epithelium is a tissue composed of a layer of cells. ...

Diagnosis: for health professionals

In clinical practice bacterial vaginosis (BV) is diagnosed using the Amsel criteria:^[2]

1. Thin, white, yellow, homogeneous discharge
2. Clue cells on microscopy
3. pH of vaginal fluid >4.5
4. Release of a fishy odor on adding alkali—10% potassium hydroxide (KOH) solution.

At least three of the four criteria should be present for a confirmed diagnosis.^[1] Clue cells are epithelial cells of the vagina that get their distinctive appearance by being covered with bacteria. ... This article or section is not written in the formal tone expected of an encyclopedia article. ... The correct title of this article is . ... In chemistry, an alkali (from Arabic: al-qalyالقلوي, القالي ) is a basic, ionic salt of an alkali metal or alkali earth metal element. ... The chemical compound potassium hydroxide, (KOH) sometimes known as caustic potash, potassa, potash lye, and potassium hydrate, is a metallic base. ...

An alternative is to use a Gram stained vaginal smear, with the Hay/Ison^[3] criteria or the Nugent^[4] criteria. The Hay/Ison criteria are defined as follows: ^[1]

• Grade 1 (Normal): Lactobacillus morphotypes predominate.
• Grade 2 (Intermediate): Mixed flora with some Lactobacilli present, but Gardnerella or Mobiluncus morphotypes also present.
• Grade 3 (Bacterial Vaginosis): Predominantly Gardnerella and/or Mobiluncus morphotypes. Few or absent Lactobacilli. (Hay et al., 1994)

What this technique loses in interobserver reliability, it makes up in ease and speed of use.
The standard for research are the Nugent^[4] Criteria. In this scale a score of 0-10 is generated from combining three other scores. It is time consuming and requires trained staff but is has high interobserver reliability: Species L. acidophilus L. brevis L. delbrueckii subsp. ...

• 0–3 is considered negative for BV
• 4–6 is considered intermediate
• 7+ is considered indicative of BV.

At least 10–20 high power (1000× oil immersion) fields are counted and an average determined.

Lactobacillus morphotypes — average per high powered (1000× oil immersion) field. View multiple fields.

• Score 0 for >30
• Score 1 for 5–30
• Score 2 for 14
• Score 3 for <1 (this is an average, so results can be >0, yet <1)
• Score 4 for 0

Gardnerella / Bacteroides morphotypes — average per high powered (1000× oil immersion) field. View multiple fields. Binomial name Gardnerella vaginalis Gardnerella is a genus of gram-variable bacteria of which Gardnerella vaginalis is the only species. ... Species etc. ...

• Score 0 for 0
• Score 1 for <1 (this is an average, so results can be >0, yet <1)
• Score 2 for 1–4
• Score 3 for 5–30
• Score 4 for >30

Curved Gram variable rods — average per high powered (1000× oil immersion) field. View multiple fields (note that this factor is less important — scores of only 0–2 are possible)

• Score 0 for 0
• Score 1 for <5
• Score 2 for 5+

A recent study ^[5] compared the gram stain using the Nugent criteria and the DNA hybridization test Affirm VPIII in diagnosing BV. The Affirm VPIII test detected Gardnerella in 107 (93.0%) of 115 vaginal specimens positive for BV diagnosed by gram stain. The Affirm VPIII test has a sensitivity of 87.7% and specificity of 96% and may be used for the rapid diagnosis of BV in symptomatic women. The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ...

Causes

A healthy vagina normally contains many microorganisms, some of the common ones are Lactobacillus crispatus and Lactobacillus jensenii. Lactobacillus, particularly hydrogen peroxide-producing species, appears to help prevent other vaginal microorganisms from multiplying to a level where they cause symptoms. (Note: Lactobacillus acidophilus is not one of the species of Lactobacillus identified as playing a protective role in vaginal flora.) The microorganisms involved in BV are very diverse, but include Gardnerella vaginalis, Mobiluncus, Bacteroides, and Mycoplasma. A change in normal bacterial flora including the reduction of lactobacillus, which may be due to the use of antibiotics or pH imbalance, allows more resistant bacteria to gain a foothold and multiply. In turn these produce toxins which effect the body's natural defenses and make re-colonization of healthy bacteria more difficult. A microorganism or microbe is an organism that is so small that it is microscopic (invisible to the naked eye). ... Binomial name Lactobacillus acidophilus (Moro 1900) Hansen & Mocquot 1970 Lactobacillus acidophilus is one of several bacteria in the genus Lactobacillus. ... Binomial name Gardnerella vaginalis Gardnerella is a genus of gram-variable bacteria of which Gardnerella vaginalis is the only species. ... Species etc. ... Species M. genitalium M. hominis M. pneumoniae etc. ...

Most cases of bacterial vaginosis occur in sexually active women between the ages of 15 and 44, especially after contact with a new partner. Condoms may provide some protection and there is no evidence that spermicide increases BV risk. Although BV appears to be associated with sexual activity, there is no clear evidence of sexual transmission.^[6] Rather, BV is a disordering of the chemical and biological balance of the normal flora. Recent research is exploring the link between sexual partner treatment and eradication of recurrent cases of BV. Pregnant women and women with sexually transmitted infections are especially at risk for getting this infection. Bacterial vaginosis does not usually affect women after menopause. A 2005 study by researchers at Ghent University in Belgium showed that subclinical iron deficiency (anemia) was a strong predictor of bacterial vaginosis in pregnant women. A longitudinal study published in February 2006 in the American Journal of Obstetrics and Gynecology showed a link between psychosocial stress and bacterial vaginosis independent of other risk factors. A condom is a device, usually made of latex, or more recently polyurethane, that is used during sexual intercourse. ... Spermicide is a substance that kills sperm, inserted vaginally prior to intercourse to prevent pregnancy. ... Sexual behavior is a form of physical intimacy that may be directed to reproduction (one possible goal of sexual intercourse) and/or to the enjoyment of activity involving sexual gratification. ... The human body contains a large number of bacteria, most of them performing tasks that are useful or even essential to human survival. ... This article needs additional references or sources for verification. ... Sexually-transmitted infections (STIs), also known as sexually-transmitted diseases (STDs), are diseases that are commonly transmitted between partners through some form of sexual activity, most commonly vaginal intercourse, oral sex, or anal sex. ... Menopause is the physiological cessation of menstrual cycles associated with advancing age in women. ... Ghent University (in Dutch, Universiteit Gent, abbreviated UGent) is one of the three large Flemish universities. ... Anemia (AmE) or anæmia (BrE), from the Greek () meaning without blood, is a deficiency of red blood cells (RBCs) and/or hemoglobin. ...

Complications

Although previously considered a mere nuisance infection, untreated bacterial vaginosis may cause serious complications, such as increased succeptibility to sexually transmitted infections including HIV, and may present other complications for pregnant women.^[7] It has also been associated with an increase in the development of Pelvic inflammatory disease (PID) following surgical procedures such as a hysterectomy or an abortion. Pelvic inflammatory disease (or disorder) (PID) is a generic term for infection of the female uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. ...

Treatment

Bacterial vaginosis can be cured by antibiotics such as metronidazole and clindamycin. However, there is a high rate of recurrence.^[6] Staphylococcus aureus - Antibiotics test plate. ... Metronidazole (INN) (IPA: ) is a nitroimidazole anti-infective drug used mainly in the treatment of infections caused by susceptible organisms, particularly anaerobic bacteria and protozoa. ... Clindamycin (rINN) (IPA: ) is a lincosamide antibiotic used in the treatment of infections caused by susceptible microorganisms. ...

Currently, there are very few over the counter products that address bacterial vaginosis. A vaginal gel product called RepHresh claims to regulate the pH level. Boric acid capsules inserted vaginally is considered a home treatment. Lactobacillus supplements may also be used; Fem-dophilus (Jarrow Formulas) is a lactobacillus product which specifically claims to help maintain healthy vaginal flora.^[8] Over-the-counter (OTC) drugs are medicines that may be sold without a prescription and without a visit to a medical professional, in contrast to prescription drugs. ... Boric acid, also called boracic acid or orthoboric acid or Acidum Boricum, is a mild acid often used as an antiseptic, insecticide, flame retardant, in nuclear power plants to control the fission rate of uranium, and as a precursor of other chemical compounds. ...

It should be noted that seeking medical attention is often necessary, because none of the over the counter products can claim to treat an active infection. More importantly, patients often inaccurately diagnose BV as a yeast infection, and delay proper treatment which may lead to complications. Candidiasis, commonly called yeast infection or thrush, is a fungal infection of any of the Candida species, of which Candida albicans is the most common. ...

In a randomized controlled trial,^[9] researchers found the efficacy of 0.75% metronidazole vaginal gel in treating bacterial vaginosis (cure rate 70.7%) was equivalent to that of standard oral metronidazole treatment (cure rate 71%). Treatment with vaginal metronidazole gel was associated with fewer gastrointestinal complaints. A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ...

Citations