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Bacterial vaginosis
See also in: Anogenital
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Bacterial vaginosis

See also in: Anogenital
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Synopsis

The vaginal microbiome is constantly in flux because of menses, sexual contact, and other external reasons. Bacterial vaginosis (BV) results from a shift in the vaginal flora from predominantly H2O2-producing organisms (usually Lactobacillus spp.) to a variety of gram-negative and anaerobic organisms (such as Gardnerella vaginalis and Mycoplasma hominis and Prevotella, Peptostreptococcus, Mobiluncus, and Bacteroides spp.) with a dramatic increase in the total number of organisms. This shift has immunomodulatory consequences (changes in cytokine production, loss of secretory leukocyte protease inhibitor, decreased amounts of IgA) that reduce protection against sexually transmitted infections (STIs) and can lead to a vaginal discharge. 

BV is the most common etiology of vaginal discharge in women of childbearing age; however, a majority of patients are asymptomatic. In the United States, the estimated prevalence is anywhere from 11% to 33% of women, with some difference in prevalence among ethnicities (a higher rate in patients of African descent has been observed). 

The diagnosis and management of BV is important for several reasons, including: 
  • BV increases the risk of acquisition of STIs including HIV, gonorrhea, Chlamydia, Trichomonas, human papillomavirus (HPV), and herpes simplex virus type 2 (HSV-2).
  • BV has been associated with adverse pregnancy outcomes (premature membrane rupture, early labor, preterm birth, and post-partum endometritis).
There are several other disease entities associated with BV such as pelvic inflammatory disease (PID) (although this may occur secondary to acquisition of gonorrhea or Chlamydia) and cervical cancer; however, there is not as strong of a causal link compared with the conditions listed above.

Codes

ICD10CM:
N76.0 – Acute vaginitis

SNOMEDCT:
419760006 – Bacterial vaginosis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The major pitfall associated with diagnosis of BV would be failing to assess for other STIs.

Differential diagnosis includes:
Most of the items on the list can be evaluated based on history and physical examination along with subsequent laboratory testing.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 05/27/2014
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Bacterial vaginosis
See also in: Anogenital
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Bacterial vaginosis : Vaginal discharge
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