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Bacterial vaginosis - Anogenital in
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Bacterial vaginosis - Anogenital in

See also in: Overview
Contributors: James Kim MD, James H. Willig MD, MSPH, Lowell A. Goldsmith MD, MPH, Mitchell Linder MD
Other Resources UpToDate PubMed


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 immunoglobulin A [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 people 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 Black patients has been observed).

The diagnosis and management of BV is important for several reasons, including:
  1. BV increases the risk of acquisition of STIs including HIV, gonorrhea, Chlamydia, Trichomonas, human papillomavirus (HPV), and herpes simplex virus type 2 (HSV-2).
  2. BV has been associated with adverse pregnancy outcomes (premature membrane rupture, early labor, preterm birth, intra-amniotic infection, and postpartum 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.


N76.0 – Acute vaginitis

419760006 – Bacterial vaginosis

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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:
  • Trichomoniasis
  • Atrophic vaginitis
  • Vulvovaginal candidiasis
  • Primary gonorrhea infection
  • Chlamydial infections
  • Genital herpes simplex virus
  • Mechanical or chemical irritation
  • Vaginal / cervical changes secondary to radiation exposure
Most of these can be evaluated based on history and physical examination along with subsequent laboratory testing. Abnormalities on bimanual examination are infrequent in patients with BV.

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Last Reviewed:10/13/2021
Last Updated:10/17/2021
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Bacterial vaginosis - Anogenital in
See also in: Overview
A medical illustration showing key findings of Bacterial vaginosis : Vaginal discharge
Lab image of Bacterial vaginosis - imageId=311617. Click to open in gallery.  caption: 'Clue cells seen on a wet mount.'
Clue cells seen on a wet mount.
Copyright © 2024 VisualDx®. All rights reserved.