Bacterial vaginosis

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Bacterial vaginosis (BV) is the most common cause of vaginal infection.[citation needed] It is less commonly referred to as vaginal bacteriosis.[1] It is considered to be a sexually transmitted infection by the CDC.[2] BV is not transmitted through sexual intercourse but is more common in women who are sexually active.[3] 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.

Contents

Symptoms and signs

The most common symptom of BV is an abnormal homogeneous off-white vaginal discharge (especially after sex) with an unpleasant smell.[4] This malodorous discharge coats the walls of the vagina, and is usually without irritation, pain or erythema.

By contrast, Normal vaginal discharge will vary in consistency and amount throughout the menstrual cycle. A normal discharge is at its clearest about 2 weeks before the period starts.

Diagnosis

To make a diagnosis of bacterial vaginosis, a speculum examination and subsequent swabs from high in the vagina should be obtained. These swabs should be tested for:

  • A characteristic "fishy" odor on wet mount. This test, called the whiff test, is performed by adding a small amount of potassium hydroxide to a microscopic slide containing the vaginal discharge. A characteristic fishy odor is considered a positive whiff test and is suggestive of bacterial vaginosis.
  • Loss of acidity. To control bacterial growth, the vagina is normally slightly acidic with a pH of 3.8–4.2. A swab of the discharge is put onto litmus paper to check its acidity. A pH greater than 4.5 is considered alkaline and is suggestive of bacterial vaginosis.
  • The presence of clue cells on wet mount. Similar to the whiff test, the test for clue cells is performed by placing a drop of sodium chloride solution on a slide containing vaginal discharge. If present, clue cells can be visualized under a microscope. They are so-named because they give a clue to the reason behind the discharge. These are epithelial cells that are coated with bacteria.

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