The principle organism in normal vaginal flora is lactic bacillus, a bacterium which produces lactic acid from glycogen and leads to an acid pH in vaginal secretions. The combination of large numbers of lactobacilli and the low pH is a protective mechanism against colonization with potential pathogens. Many important potential pathogens can be found in the vagina of healthy women. However, in normal healthy pregnancies the numbers of lactobacilli increase as pregnancy progresses. Bacterial vaginosis is an abnormality of the normal vaginal flora characterized by a reduced number of lactobacilli, a higher pH and increased numbers of potential pathogens including Gardenerella vaginalis, bacteroides, Escherichia coli, group B streptococcus and the anaerobes peptostreptococcus, bac-teroides and Mycoplasma hominis. Since the presence of large numbers of lactobacilli and a low vaginal pH are important mechanisms to protect against the growth of potential pathogenic organisms, bacterial...
Table 21.3 Identification of bacterial vaginosis (BV) Normal Gram stain shows a predominance of Lactobacillus acidophilus (3+ or 4+), with or without Gardnerella vaginalis Bacterial vaginosis Gram stain shows mixed flora (gram-positive, gram-negative or gram-variable bacteria) and absent or decreased L. acidophilus (zero to 2+) L. acidophilus (large gram-positive bacilli) G. vaginalis (small gram-variable rods) Scoring for each of the above bacterial morphotypes 0 No morphotypes per oil-immersion field 1+ Less than one morphotype per oil-immersion field 2+ One to five morphotypes per oil-immersion field 3+ Six to 30 morphotypes per oil-immersion field 4+ More than 30 morphotypes per oil-immersion field 1 overgrowth of potential pathogens in the vagina or cervix possibly associated with bacterial vaginosis More than 50 of patients in preterm labour will have more than one microorganism isolated from the amniotic cavity. Microorganisms can be identified in the fetal membranes of the...
A variety of assays for simultaneous detection of mollicutes and other pathogens have been described, e.g., a multiplex real-time PCR assay to detect M. pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila in respiratory samples. 17 In addition, a multiplex RT-PCR for the detection of M. pneumoniae and eight additional respiratory pathogens has been constructed.1-18-1 Simultaneous detection of M. hominis together with the bacterial vaginosis-associated pathogens Lactobacillus spp. and Gardnerella vaginalis by real-time PCR has been described. 19
Oral candidiasis recurrent salivary gland swelling nasal dryness with recurrent infections, hoarseness, and aphonia atrophic changes in the vulva and vagina, resulting in pruritus and vaginitis anal and rectal mucosal dryness Skin symptoms xerosis decreased sweating dry, sparse hair annular, red, scaly plaques, especially on face and neck cutaneous vasculitis
Screening for genital tract infection is helpful to identify pathogens which increase the risk of post-abortion infection and pelvic inflammatory disease, as well as the long-term sequelae of tubal factor infertility and ectopic pregnancy. The most important infecting organisms are C. trachomatis and N. gonorrhoea. Bacterial vaginosis is also associated with increased infection risk. Control group data from trials of prophylactic antibiotics for abortion suggests that infection complications occur in up to 1 in 10 termination cases. A full infection screen, including for sexually transmitted infections (STI), allows the opportunity for patient follow-up and partner notification and treatment to avoid reinfection. Prophylactic antibiotics at the time of abortion are advocated by some and a meta-analysis by Sawaya et al. 9 showed a reduction in risk for subsequent infective morbidity of around 50 . However, that approach still leaves the women at-risk from reinfection from an...
Once vaginitis is diagnosed, the primary treatment is pharmacologic. Patients are told to stop using any douches and feminine hygiene sprays, to observe good nutrition, and to maintain healthy exercise patterns. Single 2-g dose PO for patient and sexual partner 500 mg bid for 7 days for bacterial vaginosis Disrupts susceptible microorganisms and acts as a bactericidal drug used to treat trichomoniasis or bacterial vaginosis Other Drugs Bacterial vaginosis may also be treated with metronidazole vaginal gel, oral clindamycin, and clindamycin vaginal cream. Encourage the patient to get adequate rest and nutrition. Encourage the patient to use appropriate hygiene techniques by wiping from front to back after urinating or defecating. Teach the patient to avoid wearing tight-fitting clothing (pantyhose, tight pants or jeans) and to wear cotton underwear rather than synthetics. Explain to patients that the risk of getting vaginal infections increases if one has sex with more than one person....
Sexually transmitted diseases (STD) are a diverse group of viral, bacterial, protozoal, and ectoparasitic infections that have a common route of transmission through sexual intercourse. Infectious organisms associated with STDs include Chlamydia trachomatis Neisseria gonorrhoeae bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis syphilis herpes simplex papillomavirus (genital warts) genital herpes and HIV. Infection by each of the above organisms has its own pattern of clinical patterns medications treatments prognosis transmission dynamics host response to infection and patterns of sexual contact.
Vaginitis is an inflammation of the vagina that includes three infections Candidiasis, trichomoniasis, and bacterial vaginosis. Generally, it occurs with a hormonal imbalance and an infection with a microorganism. Vaginitis is associated with changes in normal flora, alkaline pH, insertion of foreign bodies such as tampons and condoms, chemical irritations from douches and sprays, and medications such as broad-spectrum antibiotics.
Problems affecting sexuality in women with diabetes are fatigue, changes in peri-menstrual blood glucose control, vaginitis, decreased sexual desire, decreased vaginal lubrication, and an increased time to reach orgasm. Even minor episodes of depression, which is twice more frequent than in men can result in a loss of libido. To which degree these symptoms are related to autonomic neuropathy has also been examined in a few studies, the results of which are at variance (73). The examination for a women with diabetes with sexual dysfunction should include the duration of symptoms, psychological state, concommitant, medications, presence of vaginitis, cystitis and other infections, frequency of intercourse, blood pressure, BMI, retinal status, pelvic examination, presence of discharge, and glycemic control (74).
Many women with PID also have bacterial vaginosis with an overgrowth of the normal commensual bacteria in the vagina and loss of vaginal lactobacilli. These same vaginal commensual bacteria are often isolated from the upper genital tract raising the possibility that bacterial vaginosis may lead to PID. Longitudinal studies do not support a direct causal association, although women who catch gonorrhoea or chlamydia infection are at higher risk of PID if they also have pre-existing bacterial vagi-nosis suggesting some synergy between the different infections 3 .
Clinical trichomoniasis in women varies from asymptomatic state in 10 to 50 of infected women to an obvious vaginitis, 15 which may be either acute or chronic in nature. Women with asymptomatic infection have a normal vaginal pH and flora 16 but during the following 6 months up to 50 of these patients will develop symptoms. Acute infection is characterized by diffuse vulvitis due to a copious leucorrhea the discharge is usually frothy, yellow or green, and mucopurulent.1-17-1 Small hemorrhagic spots may be seen in the vaginal and cervical mucosa, which is commonly referred as a ''strawberry appearance'' and is observed only in 2 of the patients. These signs and symptoms are cyclic and worsen around the time of menses. 4,17 In chronic infection symptoms are mild with pruritus and dyspa-reunia vaginal secretion may be scanty and mixed with mucus. 15,20 Although vaginitis is the most common manifestation of T. vaginalis infection the disease may also be associated with infertility,...
Critics of the cervical mucus method note that some women may have difficulty assessing their own discharge. It does take practice, and this is something that you might want to discuss with your doctor. Also, your cervical mucus may change if you have a vaginal infection or medical illness or if you are taking certain medications.
An IUCD only increases the risk of developing PID in the first few weeks after insertion and except for subacute infections with actinomyces, there appears to be no evidence of increased risk with the continuing use of an IUCD. Routine screening for chlamydia, gonorrhoea and bacterial vaginosis before insertion will therefore reduce the risk of PID in those women requiring an IUCD. The use of progesterone IUCDs has been associated with very low rates of PID.
The diaphragm (and cap) is much less popular than male condoms. Both must be fitted by a doctor or nurse and do not confer the same degree of protection against STI since the vaginal skin is not covered. Selecting the correct size of diaphragm is similar to selecting the right size of vaginal ring for the management of vaginal prolapse (a skill which appears to be a closely guarded secret). On vaginal examination with the middle finger in the posterior fornix, the point at which the symphysis pubis abuts the ulnar border of the index finger is noted. The distance between that point and the tip of the middle finger is a guide to the appropriate size of diaphragm. Latex allergy, recurrent vaginal infections such as bacterial vaginosis or candida and recurrent urinary tract infection (UTI) are the only side effects.
The majority of SABs are caused by chromosomal abnormalities that are incompatible with life the majority also have autosomal trisomies. Maternal infections, such as Mycoplasma hominis, Ureaplasma urealyticum, syphilis, HIV, group B streptococci, and second trimester bacterial vaginosis, increase the risk for an SAB. Inherited disorders or abnormal embryonic development resulting from environmental factors (teratogens) may also play a role. Patients who are classified as habitual aborters (three or more consecutive SABs) usually have an incompetent cervix that is, a situation in which the cervix is weak and does not stay closed to maintain the pregnancy. Occupation may also be a consideration if the woman is exposed to teratogens.
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Bacterial Vaginosis Facts
This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.