Women who present with bacterial vaginosis may have a vaginal discharge which has a foul odor, and after intercourse, they may note a fishy odor as well. Moreover, she may complain of burning on urination and itching of the vaginal opening. Naturally, the physician will perform a pelvic examination and obtain some laboratory tests to confirm the diagnosis.
Laboratory Evaluation
Useful laboratory examinations include microscopic view of vaginal fluid with Gram stain. There may be clue cells present in this medical condition, and the vaginal fluid may have undergone changes from its normal state. Additionally, the physician may note that the fluid has a foul odor and that the number of lactobacilli has decreased or are absent.
Some physicians allude to the “whiff test” in which they personally smell the foul odor of vaginal fluid in these patients.
Medical Therapy
Treatment of the condition is effective with either metronidazole or clindamycin; both of these agents are safe for pregnant patients. For most patients, the dose of metronidazole is 500 milligrams twice daily by mouth for seven days. An alternative regimen is the use of metronidazole gel 0.75 percent, one full applicator or five grams intravaginally once daily for five days (Centers for Disease Control, 2010).
The use of two percent clindamycin cream is also acceptable with one full applicator or five grams intravaginally at bedtime for seven days. One must keep in mind that clindamycin cream has an oil base and can damage the integrity of contraceptive devices such as the male latex condom and the diaphragm. Therefore, women who use clindamycin cream should not have sex for another five days after completion of this therapy.
Tinidazole is a useful alternative to metronidazole for the treatment of bacterial vaginosis; the same is true for the management of trichomoniasis. There are also intravaginal ovules and oral preparations of clindamycin. For pregnant women, the usage of any of these these agents will differ from that of nonpregnant women, and the physician should adjust their administration as necessary.
Sources
- Centers for Disease Control. (2010). Bacterial vaginosis. Retrieved November 1, 2011.
- U.S. Department of Health and Human Services. (2008). Bacterial vaginosis fact sheet. Retrieved November 1, 2011.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.
Michael Koger - Dr. Koger obtained his medical education at Meharry Medical College and specialized in Internal Medicine.
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