Microscopy of the vaginal secretions reveals an increased number of clue cells, and leukocytes are conspicuously absent. In advanced cases of BV, more than 20% of the epithelial cells are clue cells.
5.
The addition of KOH to the vaginal secretions (the “whiff” test) releases a fishy, aminelike odor.
Clinicians who are unable to perform microscopy should use alternative diagnostic tests such as a pH and amines test card, detection of G. vaginalis ribosomal RNA, or Gram stain (15). Culture of G. vaginalis is not recommended as a diagnostic tool because of its lack of specificity.
Treatment Ideally, treatment of BV should inhibit anaerobes but not vaginal lactobacilli. The following treatments are effective: 1.
Metronidazole, an antibiotic with excellent activity against anaerobes but poor activity against lactobacilli, is the drug of choice for the treatment of BV. A dose of 500 mg administered orally twice a day for 7 days should be used. Patients should be advised to avoid using alcohol during treatment with oral metronidazole and for 24 hours thereafter.
2.
Metronidazole gel, 0.75%, one applicator (5 g) intravaginally once daily for 5 days, may also be prescribed.
The overall cure rates range from 75% to 84% with the aforementioned regimens (16). Clindamycin in the following regimens is effective in treating BV: 1.
Clindamycin ovules, 100 mg, intravaginally once at bedtime for 3 days 2.
Clindamycin bioadhesive cream, 2%, 100 mg intravaginally in a single dose 3.
Clindamycin cream, 2%, one applicator full (5 g) intravaginally at bedtime for 7 days 4.
Clindamycin, 300 mg, orally twice daily for 7 days
Many clinicians prefer intravaginal treatment to avoid systemic side effects such as mild to moderate gastrointestinal upset and unpleasant taste. Treatment of the male sexual partner does not improve therapeutic response and therefore is not recommended (16).
Trichomonas Vaginitis Trichomonas vaginitis is caused by the sexually transmitted, ﬂagellated parasite, Trichomonas vaginalis. The transmission rate is high; 70% of men contract the disease after a single exposure to an infected woman, which suggests that the rate of male-to-female transmission is even higher. The parasite, which exists only in trophozoite form, is an anaerobe that has the ability to generate hydrogen to combine with oxygen to create an anaerobic environment. It often accompanies BV, which can be diagnosed in as many as 60% of patients with trichomonas vaginitis (17).
Diagnosis Local immune factors and inoculum size inﬂuence the appearance of symptoms. Symptoms and signs may be much milder in patients with small inocula of trichomonads, and trichomonas vaginitis often is asymptomatic (17,18).
1.
Trichomonas vaginitis is associated with a profuse, purulent, malodorous vaginal discharge that may be accompanied by vulvar pruritus.
2.
A purulent vaginal discharge may exude from the vagina.
3.
In patients with high concentrations of organisms, a patchy vaginal erythema and colpitis macularis (“strawberry” cervix) may be observed.
4.
The pH of the vaginal secretions is usually higher than 5.0.
5.
Microscopy of the secretions reveals motile trichomonads and increased numbers of leukocytes.
6.
Clue cells may be present because of the common association with BV.
7.
The whiff test may be positive.