Bacterial vaginosis

Bacterial vaginosis is the commonest cause of abnormal vaginal discharge in women of childbearing age, with a prevalence as high as 50% in some communities. The symptoms of discharge and offensive smell can cause considerable distress, although 50% of women are asymptomatic when diagnosed. Microbiologically the usually dominant lactobacillus flora is overwhelmed by an overgrowth of predominantly anaerobic organisms, accompanied by a rise in pH. A biofilm containing predominantly Gardnerella vaginalis and Atopobium vaginae has been described recently. Metronidazole is the antibiotic of choice for treatment, but relapse within 1 or 2 months is common. Bacterial vaginosis is a risk factor for acquisition of sexually transmitted infections including HIV, and for post-abortion endometritis and adverse pregnancy outcomes such as late miscarriage and preterm birth. Studies of antibiotics in pregnancy have not consistently shown reduced adverse outcomes so better strategies need to be studied to improve pregnancy outcome.