Bacterial vaginosis

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Bacterial vaginosis ( BV ) is a vaginal disease caused by excessive bacterial growth. Common symptoms include increased whiteness that often smells like fish. Debit is usually white or gray. Burning with urination may occur. Itching is rare. Sometimes, there may be no symptoms. Having a BV is approximately double the risk of infection by a number of other sexually transmitted infections, including HIV/AIDS. It also increases the risk of early labor among pregnant women.

BV is caused by a bacterial imbalance that occurs naturally in the vagina. There is a change in the most common types of bacteria and an increase of one hundred to a thousand times the total number of bacteria present. Usually, bacteria other than Lactobacilli become more common. Risk factors include douching, new or multiple sex partners, antibiotics, and using intrauterine devices, among others. However, it is not considered a sexually transmitted infection. Diagnosis is suspected on the basis of symptoms, and can be verified by examining vaginal discharge and finding a higher than normal vaginal pH, and large amounts of bacteria. BVs are often confused with vaginal yeast infections or Trichomonas infections.

Usually treatment with antibiotics, such as clindamycin or metronidazole. These medications can also be used in the second or third trimester of pregnancy. However, this condition often recur after treatment. Probiotics can help prevent re-occurrence. It is unclear whether the use of probiotics or antibiotics affects pregnancy outcomes.

BV is the most common vaginal infection in women of reproductive age. The percentage of women affected at any given time varies between 5% and 70%. BV is most common in parts of Africa and most common in Asia and Europe. In the United States about 30% of women between the ages of 14 and 49 are affected. Tariffs vary between ethnic groups in a country. While symptoms such as BV have been described for many historical records, the first documented case clearly occurred in 1894.

Video Bacterial vaginosis

Signs and symptoms

Common symptoms include increased whiteness that usually smells like fish. Disposal is often white or gray. There may be burning with urination. Sometimes, there may be no symptoms.

Dirt coats the vaginal wall, and usually without significant irritation, pain, or erythema (redness), although occasionally mild itching may occur. In contrast, normal vaginal discharge will vary in consistency and amount throughout the menstrual cycle and most clearly at the time of ovulation - about two weeks before the period begins. Some practitioners claim that BV can be asymptomatic in nearly half of affected women, although others argue that this is often misdiagnosed.

Complications

Although previously thought to be a mere disorder infection, untreated bacterial vaginosis can lead to increased susceptibility to sexually transmitted infections including HIV and pregnancy complications.

It has been shown that HIV-infected women with bacterial vaginosis (BV) are more likely to transmit HIV to their sexual partners than those without BV. The diagnostic criteria for BV are also associated with female genital tract factors that induce HIV expression.

There is evidence of an association between BV and increased rates of sexually transmitted infections such as HIV/AIDS. BV is associated with a six-fold increase in HIV shedding. BV is a risk factor for viral shedding and herpes simplex virus type 2 infection. BV can increase the risk of infection or reactivation of human papillomavirus (HPV).

In addition, bacterial vaginosis as a coexisting disease in pregnancy may increase the risk of pregnancy complications, especially preterm delivery or miscarriage. Pregnant women with BV have a higher risk of chorioamnionitis, miscarriage, premature birth, premature rupture of membranes, and postpartum endometritis. Women with BV treated with in-vitro fertilization had lower implantation rates and higher early mortality.

Maps Bacterial vaginosis

Cause

A healthy vaginal microbiota consists of species that do not cause symptoms or infections, or have a negative impact on pregnancy. It is dominated mainly by the Lactobacillus species. BV is defined by disequilibrium in the vaginal microbiota, with a decrease in the number of lactobacilli. While the infection involves a number of bacteria, it is believed that most infections begin with Gardnerella vaginalis creating biofilms, allowing other opportunistic bacteria to thrive.

One of the major risks for developing BV is douching, which changes the vaginal flora and predisposes women to developing BV. Douching is strictly prohibited by the US Department of Health and Human Services and various medical authorities, for this and other reasons.

BV is a risk factor for pelvic inflammatory disease, HIV, sexually transmitted infections (STIs), and reproductive and obstetric disorders or negative outcomes. It may be for people who are not sexually active to develop bacterial vaginosis.

Bacterial vaginosis can sometimes affect women after menopause. Also, subclinical iron deficiency may correlate with bacterial vaginosis early in pregnancy. A longitudinal study published in February 2006, in the American Journal of Obstetrics and Gynecology, shows the relationship between psychosocial stress and bacterial vaginosis persisting even when other risk factors are taken into account. Exposure to nonoxynol-9 spermicides does not affect the risk of developing bacterial vaginosis.

Having a female partner increases the risk of BV by 60%. BV-related bacteria have been isolated from male genitals. BV microbiota has been found in the penis, coronal sulcus, and male urethra, in the male partner of the infected woman. Unbundled partners can act as 'reservoir' increasing the likelihood of contracting the infection after intercourse. Another way of transmitting BV related microbiota is to female sexual partners through skin-to-skin transfer. BV can be transmitted through perineal enteric bacteria from both female and male genital microbiota.

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Diagnosis

To make a diagnosis of bacterial vaginosis, a swab from within the vagina should be obtained. This swab should be tested for:

• Typical "fishy" smell on wet holder. This test, called the whiff test, is done by adding a small amount of potassium hydroxide to a microscopic slide containing vaginal fluid. A typical fishy smell is considered a positive odor test and is suggestive of bacterial vaginosis.
• Loss of acidity. To control bacterial growth, the vagina is usually slightly acidic with a pH of 3.8 to 4.2. A liquid is thrown into litmus paper to check its acidity. A pH of more than 4.5 is considered alkaline and is suggestive of bacterial vaginosis.
• The presence of the directive cell in the wet holder. Similar to a whiff test, a test for directive cells is performed by placing a drop of sodium chloride solution on a whitish slide. If any, the clue cells can be visualized under a microscope. They are so named because they provide guidance for the reasons behind the dismissal. It is an epithelial cell that is coated with bacteria.

Two positive results besides the discharge itself are sufficient to diagnose BV. If there is no debit, then all three criteria are required. The differential diagnosis for bacterial vaginosis includes the following:

• Normal Whitish.
• Candidiasis (mouth ulcer, or yeast infection).
• Trichomoniasis, an infection caused by Trichomonas vaginalis .
• Aerobic vaginitis

The Centers for Disease Control (CDC) defines STIs as "various clinical syndromes and infections caused by pathogens that can be acquired and transmitted through sexual activity." But the CDC does not specifically identify BV as a sexually transmitted infection.

Amsel Criteria

In clinical practice, BV can be diagnosed using Amsel criteria:

1. Thin, white, yellow, homogeneous decay
2. Clue cell on microscopy
3. pH of the vaginal fluid & gt; 4.5
4. The release of a fishy odor on the addition of alkali - 10% potassium hydroxide solution (KOH).

At least three of the four criteria must be present for a confirmed diagnosis. Modification criteria Amsel accepts the presence of two, not three factors and is considered the same diagnostic.

Gram stain

The alternative is to use a Gram-stained vaginal smear, with Hay/Ison criteria or Nugent criteria. Hay/Ison's criteria are defined as follows:

• Level 1 (Normal): Lactobacillus morphotype predominates.
• Grade 2 (Intermediate): A mixed flora with some Lactobacilli is present, but Gardnerella or Mobiluncus morphotypes are also present.
• Level 3 (Bacterial Vaginosis): Especially Gardnerella and/or Mobiluncus morphotypes. Little or no Lactobacilli. (Hay et al., 1994)

Gardnerella vaginalis is the main cause in BV. Gardnerella vaginalis is a short stem (coccobacillus). Therefore, the presence of clue cells and variable varicella coccobacilli is an indication or diagnostic of bacterial vaginosis.

Nugent Score

Nugent scores are currently rarely used by doctors because of the time it takes to read the slides and require the use of trained microscopists. A score of 0-10 results from combining three other scores. The scores are as follows:

• 0-3 is considered negative for BV
• 4-6 is considered an intermediate
• 7 is considered an indication of BV.

At least 10-20 high power (1000ÃÆ'â € "immersion oil field) is calculated and the average is determined.

DNA hybridization test with Affirm VPIII compared with Gram staining using Nugent criteria. Affirm VPIII tests can be used for rapid diagnosis of BV in symptomatic women but using expensive exclusive equipment for reading results, and not detecting other pathogens that cause BV, including Prevotella spp, Bacteroides spp, & amp; Mobiluncus spp.

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Prevention

Some of the recommended steps to reduce risk include: not doucheing, avoiding sex, or limiting the number of sex partners.

One review concluded that probiotics may help prevent reoccurrence. Other reviews find that while there is evidence while not strong enough to recommend its use for this purpose.

Preliminary evidence suggests that antibiotic treatment in male partners can rebuild normal microbiota from male urogenital tract and prevent recurrence of infection. However, Cochrane's 2016 review found high-quality evidence that treating female sexual partners with bacterial vaginosis has no effect on symptoms, clinical outcome, or recurrence in affected women. He also found that such treatment may lead to treated sexual partners to report increased side effects.

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Treatment

Antibiotics

Treatment is usually with metronidazole or clindamycin antibiotics. They can be given by mouth or applied in the vagina. About 10% to 15% of people, however, do not improve with the first antibiotic and the recurrence rate of up to 80% has been documented. Recurrence rates increase with sexual activity with the same pre-/post-treatment partner and inconsistent condom use even when estrogen-containing contraceptives decrease recurrence. When clindamycin is given to symptomatic pregnant women with BV before 22 weeks of gestation, the risk of preterm delivery before 37 weeks of gestation is lower.

Other workable antibiotics include macrolides, lincosamides, nitroimidazole, and penicillins.

Bacterial vaginosis is not considered a sexually transmitted infection, and the treatment of male sexual partners of a woman with bacterial vaginosis is not recommended.

Probiotics

A 2009 Cochrane review found temporary evidence but not enough for probiotics as a treatment for BV. The 2014 review reaches the same conclusion. Overview 2013 found some evidence supporting the use of probiotics during pregnancy. Preferred probiotics for BV are those containing high doses of lactobacilli (about 10 ⁹ CFU ) given in the vagina. Intravaginal administration is preferred to be taken by mouth. Prolonged recurrent treatment courses seem to be more promising than short courses.

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Epidemiology

BV is the most common vaginal infection in women of reproductive age. The percentage of women affected at any given time varies between 5% and 70%. BV is most common in parts of Africa, and most common in Asia and Europe. In the United States, about 30% of those aged between 14 and 49 are affected. Tariffs vary between ethnic groups in a country.

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References

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External links

Source of the article : Wikipedia