Patient's question:
My classmate checked the gynecology department in November and found bacterial vaginosis. They haven't taken any medication yet. However, their discharge is yellow and quite abundant. There's a slight odor, and occasionally it contains blood streaks. Their weight hasn't changed much. Sometimes they get woken up by itching in the middle of the night. It might be due to using unqualified sanitary pads.Doctor's answer:
The occurrence of bacterial vaginosis is due to the disruption of the natural microbial balance in the vagina, leading to excessive bacterial proliferation, dominated by anaerobic bacteria. This alters the normal ecological environment of the vagina, resulting in a series of symptoms such as increased discharge with a foul odor. The most typical symptom is the discharge of large amounts of malodorous white vaginal secretions, which have a putrid or fishy smell. Due to the irritation caused by excessive abnormal discharge, some women may experience itching and burning sensations in the external genitalia. A significant portion of women may have no symptoms at all and are only detected during gynecological examinations. When examining women with bacterial vaginosis, it is observed that there is a large amount of uniform, thin, grayish-white discharge in the vagina. In some cases, a putrid or fishy odor can be detected during the examination. However, the vaginal mucosa does not exhibit the congestion or redness typically seen in other inflammatory conditions. Some women with tubo-ovarian abscess or pelvic inflammatory disease may have a close relationship with bacterial vaginosis. The primary cause of bacterial vaginosis is Gardnerella vaginalis. Gardnerella vaginalis is an anaerobic rod, and treatment primarily involves antibiotics targeting this condition. Common medications include:(1) Metronidazole: 0.2g per dose, three times daily, for 7 days. It can also be administered vaginally.
(2) Tetracycline: 0.5g per dose, four times daily, for 7 days. Tetracycline can also be administered vaginally concurrently, twice daily. Contraindicated in pregnancy.
(3) Trimethoprim: 0.2g per dose, twice daily, for 7 days.
(4) Sulfamethoxazole-trimethoprim is a nitroimidazole drug: 1g per dose, once daily, after meals, for 15 days.
(5) Amoxicillin: 0.5g per dose, four times daily, for 7 days.
(6) Cefoxitin: 0.5g per dose, four times daily, for 7 days.
When using any of the above medications, vaginal irrigation with a 0.5% lactic acid or acetic acid solution should also be performed to restore the acidic environment of the vagina and inhibit the growth of the bacteria.
1. Cured: Symptoms disappear, white discharge returns to normal, laboratory tests show normal pH value, normal amine test, and no clue cells.
2. Improved: Most clinical symptoms disappear. Homogeneous white discharge decreases by 30%, laboratory tests show pH value close to normal, and the amine test is positive.
3. Uncured: Symptoms and laboratory tests remain the same as before treatment.