There is a microcosm of organisms in the genital tract that maintains a perfect balance; sometimes this is disrupted causing numerous problems. The predominant bacteria there are the lactobacilli which produce substances that keep the tissue at a low pH, protecting against potentially pathogenic organisms. When the lactobacilli are destroyed, the environment is more susceptible to new infection as well as vulnerable to specific bacterial overgrowth.
Bacterial infection, bacterial vaginosis, gardnerella or nonspecific vaginitis are the common terms used to describe the condition. Organisms that have been identified as the culprit in these infections include: Gardnerella, Bacteroides, Mobiluncus, Peptococcus, Eubacterium and Mycoplasma. No matter which bacteria are found on culture, the clinical findings are the same; a copious grayish-white discharge with the consistency of milk and a foul odor. Many women also report that the odor is worse after intercourse.
It appears that there are multiple causes of this infection. Many studies have identified factors that make a woman more likely to develop bacterial vaginosis. This includes douching, smoking, pregnancy, and having intercourse at the time of menstruation. The association with douching has been confirmed in many studies and a recent one reported that women who douche at least once a month is 1.4 times more likely to develop this infection.
On examination, the physician will see the typical discharge as described above. A confirmatory diagnosis is based on a combination of findings. These include a pH greater than 4.5, a fishy or amine like odor when 10% potassium hydroxide (KOH) is added to a sample of the discharge, clue cells seen under the microscope, absence of lactobacilli and a culture showing the predominant growth of one of the bacteria mentioned above. Clue cells are epithelial cells which are studded with coccobacilli and have a classic appearance on microscopic examination making it easy for a healthcare provider to make the diagnosis in the office.
The standard treatment has been oral metronidazole 500 mg twice daily for 7 days. This has an effectiveness of about 96%. Some women experience gastrointestinal upset and a metallic taste. In addition this medication should not be taken within 12 hours of consuming alcohol because it can amplify the alcohol effect leading to severe “hangover” type symptoms. An alternative is clindamycin 300 mg orally twice daily for 7 days. It has about a 94% success rate. It can cause diarrhea in a small percentage of women.
Local therapies in the form of ovules, creams and gels have been developed to avoid some of the side effects mentioned above. In addition this provides a safer treatment option for pregnant women. These medications include clindamycin ovules 100 mg for 3 nights, clindamycin 2% cream nightly for 7 nights and metronidazole gel twice daily for 5 days.
Tinidazole is a new oral medication that can be given as 1 gram daily for 5 days or 2 grams daily for 2 days. This shorter treatment period is appealing and the characteristics of the drug make it likely to be equally effective as the older therapies.
The treatment of this problem is relatively simple but many women develop recurrence, necessitating frequent trips to the doctor. This can be expensive and inconvenient. Even though this is a relatively innocuous infection, it can cause more severe problems in certain settings. Bacterial vaginosis has been associated with preterm labor, postpartum uterine infections, and pelvic infections after a hysterectomy. Thus it is important to be treated and to control recurrent infections. If you have any of the risk factors listed above, you should seek treatment if you develop any of the symptoms described in this article. In addition, some of the risk factors can be eliminated and it is within your power to make changes that may improve your health.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!
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