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Bacterial vaginosis
See also in: Anogenital
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Bacterial vaginosis

See also in: Anogenital
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Contributors: James Kim MD, James H. Willig MD, MSPH, Lowell A. Goldsmith MD, MPH, Mitchell Linder MD
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Synopsis

Bacterial vaginosis : Vaginal discharge
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: 
  • 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, 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.

Codes

ICD10CM:
N76.0 – Acute vaginitis

SNOMEDCT:
419760006 – Bacterial vaginosis

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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 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.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:10/13/2021
Last Updated:10/17/2021
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Bacterial vaginosis
See also in: Anogenital
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