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Management of sexually transmitted diseases
Published in Hilary Curtis, Tony Hoolaghan, Carey Jewitt, Sexual Health Promotion in General Practice, 2018
Hilary Curtis, Tony Hoolaghan, Carey Jewitt
Typically there is a fishy odour, and often a yellowy discharge. Anaerobic vaginosis may be implicated in premature labour. Women often mistake this condition for thrush, but the diagnosis is easy to make in general practice because the vaginal secretions lose their usual acidity. Placing some discharge on pH paper will quickly confirm the diagnosis - the normal pH of the vagina is about 4, whereas in anaerobic vaginosis it rises to 6 or 7. A high vaginal swab may reveal clue cells. This condition is not necessarily sexually transmitted, and is best described to women as an imbalance of the normal flora in the vagina. The ‘good’ bacteria that maintain the acidity of the vagina have been replaced with ‘bad’ ones, which prevent the ‘good’ ones growing. Oral metronidazole 2 g as a single dose kills the anaerobes, which usually allows the lactobacilli to reestablish. Occasionally, Aci-Jel is useful to maintain the vaginal pH while the normal flora re-establishes itself.
Basic Clinical Skills – Questions
Published in Rekha Wuntakal, Madhavi Kalidindi, Tony Hollingworth, Get Through, 2014
Rekha Wuntakal, Madhavi Kalidindi, Tony Hollingworth
Which one of the following statements is not true with respect to bacterial vaginosis (BV)? Isolation of Gardnerella vaginalis on high vaginal swab culture is diagnostic of BV.Vaginal pH is increased and is typically more than 4.5.Presence of ‘clue cells’ on microscopy is diagnostic of bacterial vaginosis.It is associated with preterm labour or miscarriage.It is the commonest cause of abnormal vaginal discharge in women of reproductive age.
Infections of the Genital Systems
Published in Keith Struthers, Clinical Microbiology, 2017
Gardnerella vaginalis is a gram-variable facultative organism associated with bacterial vaginosis. Other organisms include Mycoplasma hominis and the anaerobe Mobiluncus. They have the ability to overwhelm the lactobacillus population of the vagina, with the resulting inflammatory response producing the discharge. Gardnerella can be detected on gram-stained preparations adherent in large numbers to vaginal epithelial cells, termed ‘clue’ cells.
Clinical comparative study of optimized metronidazole loaded lipid nanocarrier vaginal emulgel for management of bacterial vaginosis and its recurrence
Published in Drug Delivery, 2021
Noha M. Badawi, Mona A. Elkafrawy, Rania M. Yehia, Dalia A. Attia
BV was confirmed at baseline during pelvic checkup using Amsel’s criteria and Gram stain. At least 3 out of 4 Amsel’s criteria must be fulfilled to make a diagnosis of BV (Chavoustie et al., 2015). They include:Vaginal pH more than 4.5.Fishy smell release upon addition of alkali (10% potassium hydroxide).Characteristic thin, grayish-white discharge on examination.Occurrence of clue cells on microscopy of vaginal fluid mixed with normal saline.
Bacterial vaginosis: a primer for clinicians
Published in Postgraduate Medicine, 2019
Suzanne Reiter, Susan Kellogg Spadt
Unlike lactobacilli, which prevent the overgrowth of anaerobes [23], the predominant bacterial species associated with BV produce malodorous volatile amines [24] and are associated with increased vaginal transudation and squamous epithelial cell exfoliation [25]. As vaginal epithelial cells are desquamated, they form the classic clue cells that are diagnostic for BV. Clue cells are desquamated epithelial cells that are covered by Gram-negative rods and other bacteria associated with BV [26], and are believed to develop due to exfoliation of the vaginal epithelium [27]. Typical vaginal pH ranges from 4.0 to 4.5, and increases to a level between 4.5 and 7 as BV progresses [28].