Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features ++ Defined as a polymicrobial infection of the vagina caused by an imbalance of the normal bacterial vaginal flora The altered flora has a paucity of hydrogen peroxide–producing lactobacilli and increased concentrations of anaerobic bacteria (Prevotella sp and Mobiluncus sp), Gardnerella vaginalis, Ureaplasma, and Mycoplasma Whether bacterial vaginosis is sexually transmitted is unclear, but it is associated with having multiple sex partners and increased risk of other sexually transmitted infections Associated with premature labor, preterm delivery, intra-amniotic infection, and postpartum endometritis in pregnant females Associated with PID and urinary tract infections in nonpregnant individual +++ Clinical Findings ++ Most common symptom is a copious, malodorous, homogeneous thin gray-white vaginal discharge Patients may report vaginal itching or dysuria A fishy odor may be most noticeable after intercourse or during menses +++ Diagnosis ++ Clinical criteria Presence of thin, white discharge that smoothly coats the vaginal walls Fishy (amine) odor before or after the addition of 10% KOH (whiff test) pH of vaginal fluid > 4.5 determined with narrow-range pH paper Presence of "clue cells" on microscopic examination; clue cells are squamous epithelial cells that have multiple bacteria adhering to them, making their borders irregular and giving them a speckled appearance Diagnosis requires three out of four criteria, although many female patients who fulfill these criteria have no discharge or other symptoms +++ Treatment ++ Recommended Metronidazole, 500 mg orally twice a day for 7 days or Metronidazole, 0.75% gel, 5 g intravaginally once daily for 5 days or Clindamycin cream, 2%, one applicator intravaginally at bedtime for 7 days Alternatives Clindamycin, 300 mg orally twice a day for 7 days or Clindamycin ovule, 100 mg intravaginally once at bedtime for 3 days or Tinidazole, 2 g orally once daily for 2 days or Tinidazole, 1 g orally once daily for 5 days Follow-up visits Unnecessary if symptoms resolve Recommended for high-risk patients 1 month after treatment Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth