BASHH        Bacterial vaginosis                              S. Banerjee                              StR, Microbiology
How prevalent?5-50%Pregnant – 12%Women undergoing Termination of pregnancy – 30%                       Normal             ...
BVpH 4.5-6.0Gardnerella vaginalisAtopobium vaginalisPrevotellaMycoplasma hominisMobilincusClostridium spLeptotrichiaSneath...
Not STD but could be associated with STDRisk factorsVaginal douchingReceptive cunnilingusSmokingSTIRecent change in sex pa...
Hay/Ison Criteria (BASHH recommended)Gram stain vaginal smearGrade 1 – normal – Predominantly lactobacillusGrade 2 – Inter...
Clue cell
OSOM BV blue – measure sialidase levelProlinaminopeptidase cardDNA probe based testPCR – not available yet
MxTreat symptomatic patient,who is undergoing surgery,asymptomatic but wants to be treated.TxAvoid – douching, shampoo, sh...
PregnancySymptomatic – treatAsymptomatic – if additional risk factor for preterm birth – treat before 20 weeksLactationGel...
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Bashh bacterial vaginosis guideline summary

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Bashh bacterial vaginosis guideline summary

  1. 1. BASHH Bacterial vaginosis S. Banerjee StR, Microbiology
  2. 2. How prevalent?5-50%Pregnant – 12%Women undergoing Termination of pregnancy – 30% Normal Lactobacilli pH<4.5
  3. 3. BVpH 4.5-6.0Gardnerella vaginalisAtopobium vaginalisPrevotellaMycoplasma hominisMobilincusClostridium spLeptotrichiaSneathiaBiofilm – Gardnerella, Atopobium Offensive fishy smelly discharge Thin white homogenous No soreness, itching, irritation No sign of inflammation. 50% asymptomatic
  4. 4. Not STD but could be associated with STDRisk factorsVaginal douchingReceptive cunnilingusSmokingSTIRecent change in sex partnerBlack raceAssociationIncreased risk of HIVPrevalence is high in PIDCommon in elective TOP, associated with post TOP endometritis, PIDLate miscarriage, Premature birth, PROM, PP endometritisVaginal cuff cellulitis/abscess after vaginal hystrectomy
  5. 5. Hay/Ison Criteria (BASHH recommended)Gram stain vaginal smearGrade 1 – normal – Predominantly lactobacillusGrade 2 – Intermediate – Some lacto, some GardnerellaGrade 3 – BV – Pred Gardnerella/mobilincusGrade 4 GPC predAmsel criteria+ve if ¾ criteria presentThin white homogenous dischargeClue cellpH>4.5Fishy odour on adding 10% KOHNugent Criteria0-10relative proportion of bact morphology<4 / 4-6/ >6
  6. 6. Clue cell
  7. 7. OSOM BV blue – measure sialidase levelProlinaminopeptidase cardDNA probe based testPCR – not available yet
  8. 8. MxTreat symptomatic patient,who is undergoing surgery,asymptomatic but wants to be treated.TxAvoid – douching, shampoo, shwer gell, soapMetronidazole – 400mg BD 5-7 days/2 gm statMetronidazole gel – OD – 5 daysClindamycin gel – OD – 7 daysAlternativeTinidazoleClinda 300 mg BD 7 dCure rate70-80%
  9. 9. PregnancySymptomatic – treatAsymptomatic – if additional risk factor for preterm birth – treat before 20 weeksLactationGel prep preferredTOPScreen and treat BVPartnerTr Not recommendedScreening – Not recommended, some clinicians do in rec casesTest of cureNot recommended if symptom resolvesRecurrenceProblematicSuppresion with metro gel

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