Second trimester risk is higher .
Risk factors are premature rupture of membranes (PROM) ,prolonged labour, increased number of vaginal examinations.
After caesarean section it develops within 2 days known as early endometritis.Bacteria go inside the cavity of uterus during operation.
Women with vaginal delivery develop late endometritis upto 6 wks post natally due to ascending infection which takes time.
Cervical intraepithelial neoplasia (CIN)
Some vaginal flora such as anaerobes associated with BV are capable of producing carcinomatous substances like nitrosamines.
Possible role of BV in CIN is failure to control sexually transmited diseases particularly human papiloma virus HPV infection which is a risk factor for the carcinoma.
PID ( pelvic inflammatory disease )
Cervicovaginal fluids can be sucked inside the uterus and higher up during midcyclic contractions leading to PID and tubal blockage and future ectopic pregnancies.
Infertility and first trimester abortions
higher incidences of BV were found in women undergoing IVF. Vaginal flora may have an adverse effect on the sperm deposited in the vagina.Although there is no evidence.
first trimester abortions were associated with BV.
‘Clue cells’ were detected while doing the studies.
Post hysterectomy vaginal cuff cellulitis
Preoperative assesment of the vaginal flora should be done and properly treated.Women with BV have more chances of cuff infections.
PID following first trimester surgical abortions is due to infection with BV , N gonorrhoeae , C trachomatis.
Women having clue cells have higher incidence of the post abortal sepsis.
Preoperative treatment with clindamycin cream reduces the chances of infection.
Lactobacili are important in the prevention of urinary tract infections.
There is a possibility of association between BV and HIV.
Presence of hydrogen- peroxide- producing lactobacilli produce more acidic environment which is not only toxic to BV- associated flora but also to HIV.Lower vaginal pH may therefore block the production of CD4 lymphocytes whereas alkaline pH associated with BV may enhance HIV survival.
Lower vaginal pH may block the production of CD4 lymphocytes.alkaline pH may enhance the survival of HIV .
Cohen et al demonstrated that BV is linked to increased secretion of cytokine , IL-10 which in turn increases the susceptibilty to HIV-1 infection.
Especially M hominis increase the HIV-1 expression .
HIV may promote the abnormal flora in the vagina or BV may enhance the transmission of HIV . There is strong correlation between the two.
Orally or vaginally
Clindamycin 2% cream can be applied during pregnancy.
Clindamycin 2% , 5 gms daily applied for 7 days once daily.
In non pregnant women it can be given orally also.
Doses are 300 mgm twice daily for 7 days.
orally 400 mgm twice daily for 7 days.
This has a metallic taste.
Metronidazole vaginal gel-0.75% once daily for 5 days.
It should be given prior to surgery prophylactically.
Avoidance of washing of genital area with soaps , shower gel , and other alkaline detergents.
pH balanced products are also more alkaline and should be avoided.
Douching should be discouraged.
Natural youghrt or lactobacillus acidophilus gives short term relief.
(no doubt why Cleopetra used to have milk and curd bath)
Capsules or other products containing lactobacillus crispatus may give some relief.
Treatment of the male partners
Urethra of men may get colonised with bacteria after having relationship with woman having BV
Treatment of the male partner does not cure the disease.
Recurrence of BV
There are new episodes due to the treatment failure.
So one should be cautios.
BV ( Bacterial Vaginosis ) is very common and usually affects the majority of women at some point in their life.
It involves the replacement of normal lactobacilli- dominated vaginal flora with anaerobes and other organisms.
Direct microscopy of the Gram stained preparation of vaginal secretion is the ideal method for diagnosis.
It can cause malodourous discarge which is very distressing.
They can cause PTB ( Preterm births ) , HIV , post hysterectomy cuff cellulitis , PID ( pelvic inflammatory disease ) , infertility , endometritis and miscarriages.
Gynecologists and Obstetrician should be very well aware of it and should be able to diagnose the problem and treat effectively.