Patient's question:
Itching in the vagina is unbearable, and the discharge is thick.Doctor's answer:
Bacterial vaginosis is a clinical syndrome caused by the replacement of normal vaginal flora with a large number of anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis. It was previously known as Haemophilus vaginitis, Gardnerella vaginitis, and nonspecific vaginitis. The term "bacterial vaginosis" is used because there is a large number of different bacteria in the vagina, and both clinical and pathological features show no inflammatory changes.Etiology: In bacterial vaginosis, lactobacilli in the vagina decrease while other bacteria multiply in large numbers, primarily including Gardnerella vaginalis, Mobiluncus species, and other anaerobic bacteria. Some patients also have mycoplasma infections. Anaerobic bacteria are predominant, with their concentration being 100 to 1,000 times higher than in normal women. During the proliferation of anaerobic bacteria, they produce amines, which alkalinize the vagina, leading to increased vaginal discharge and a foul odor.
Clinical Manifestations: 10% to 40% of patients are asymptomatic. Symptomatic patients primarily exhibit increased vaginal discharge with a foul odor, which may be accompanied by mild external genital itching or burning sensation. The discharge is grayish-white, uniform, thin, and has low viscosity, making it easy to wipe off from the vaginal walls. The vaginal mucosa shows no signs of congestion or inflammation. Microbiological examination reveals no trichomonas, fungi, or Neisseria gonorrhoeae.
Diagnosis: Clinical diagnosis of bacterial vaginosis is made if at least three of the following four criteria are positive.
1. Homogeneous, thin vaginal discharge.
2. Vaginal pH > 4.5 (pH typically ranges from 5.0 to 5.5).
3. Positive amine odor test: A small amount of vaginal discharge is placed on a slide, and 1 to 2 drops of 10% potassium hydroxide are added. A foul, rotten fish-like odor indicates a positive result.
4. Clue cells: A small amount of discharge is placed on a slide, mixed with one drop of physiological saline, and examined under a high-power microscope. Clue cells (vaginal epithelial cells with adherent Gardnerella) account for 20% of the total cells.
Clue cells are vaginal epithelial cells that have numerous granular substances (Gardnerella) attached to their edges. The bacteria have indistinct margins.
Other: Bacterial vaginosis is commonly found in sexually active women and is associated with multiple sexual partners. It is rarely seen in women who are not sexually active. Whether this condition is caused by sexually transmitted pathogens remains unclear.
Treatment: Treating sexual partners has little value in preventing recurrence of bacterial vaginosis. The following methods can be used for treatment:
1. Oral medication: The first-line drug is metronidazole, 0.2 grams per dose, taken three times daily for 7 days; alternatively, amoxicillin can be used, 0.5 grams per dose, taken four times daily for 7 days.
2. Local treatment: During medication, a 1% lactic acid or acetic acid solution can be used for vaginal douching once or twice daily. While taking metronidazole orally, 0.2 grams can be inserted into the vagina at bedtime to kill bacteria.
3. If the wife is infected, the husband should also be treated simultaneously. Sexual activity must be avoided during the illness and until the condition is fully cured.