0:00 Bacterial vaginosis is the most common cause of abnormal vaginal discharge in 0:10 women of 0:11 childbearing age. 0:13 In this condition there is dysregulation or dysbiosis of the normal vaginal 0:19 flora, the 0:20 bacteria that normally lives within the vagina. 0:25 Bacterial vaginosis is an infection that occurs when there is a reduction of 0:31 lactobacillus 0:32 species, the specific type of bacteria, and the overgrowth of anaerobic 0:40 bacterial species 0:41 in the vagina, including gardenarella, vaginalis, and pre-votella species. 0:51 This causes a smelly, foul discharge that can lead to many complications if 1:01 left untreated. 1:03 Although bacterial vaginosis is not considered a sexual transatlantic infection 1:07 , it is thought 1:08 that the spread of the bacteria among people during sexual intercourse may 1:13 cause the change 1:14 in the normal vaginal flora, the change in the bacteria that normally resides 1:20 within 1:20 the vagina. 1:27 So the normal pH or the normal acidity of the vagina is about 4.5 pH or lower. 1:37 It is acidic. 1:39 This is important as it protects the female genital urinary system from many 1:44 bad infections such 1:45 as sexual transatlantic infections, yeast infections, and urinary tract 1:51 infections. 1:52 So the normal pH and the subsequent microbiome that lives within the area helps 2:00 protect the 2:01 vagina. 2:03 The vagina is actually acidic thanks to the vaginal bacteria or species, namely 2:11 the lactobacilli. 2:13 The lactobacillus species are dominant in the vaginal flora, and produce 2:18 hydrogen peroxide 2:19 and lactic acid, causing the vagina to be acidic to help defend the vagina 2:24 against many 2:26 other pathogens. 2:30 Bacterial vaginosis occurs when there is a disturbance of the normal vaginal 2:34 flora, 2:35 and a shift towards low concentrations of lactobacillus species, leading to the 2:40 overgrowth 2:41 of other anaerobic species such as gardenirella vaginalis and pre-vatellar 2:47 species. 2:47 The overgrowth of these other anaerobic bacteria allows for more breakdown of 2:54 vaginal peptides, 2:56 forming volatile and malodorous amines. 3:01 And this is what actually causes the foul smelling discharge seen in people who 3:06 have bacterial 3:07 vaginosis. 3:09 The altered microbiome, or dysbiosis, also reduces the amount of lactic acid 3:16 released 3:17 by the lactobacilli, leading to a rise in vaginal pH, to greater than 4.5, from 3:25 its 3:26 normal 4 to 4.5. 3:29 This rise in pH helps gardenirella vaginalis adhere to epithelial cells, 3:36 forming clue 3:37 cells, which are characteristic of bacterial vaginosis on microscopy. 3:44 Clue cells are essentially cells within the vagina that are covered with these 3:49 anaerobic 3:49 bacteria, the gardenirella vaginalis. 3:58 So the symptoms of bacterial vaginosis, well, majority of women are asympt 4:04 omatic. 4:04 However, people can develop malodorous smelly vaginal discharge that contains a 4:12 thin white 4:13 or grayish homogenous discharge as well. 4:21 The risk factors for developing bacterial vaginosis include new or multiple 4:26 sexual partners. 4:28 It is a primary risk factor, but again, bacterial vaginosis is not considered a 4:33 sexual transmitted 4:34 disease. 4:36 Vaginal douching, which is essentially where people wash the vagina with fluid 4:41 for medical 4:42 or hygiene purposes, this can alter the microbiome that normally resides in the 4:48 vagina, leading 4:49 to bacterial vaginosis. 4:52 Other risk factors include copper intrauterine devices, which intrauterine 4:57 devices are essentially 4:59 contraception devices inserted into the uterus. 5:04 Pregnancy and smoking are also considered risk factors. 5:12 The complications of bacterial vaginosis, well, bacterial vaginosis allows the 5:18 potential 5:18 for other vaginal pathogens, other bacteria, to gain access to the upper 5:24 genital tract. 5:26 And this can increase the risk of complications, such as preterm delivery and 5:31 spontaneous abortion 5:33 in pregnant women. 5:35 There is an association with infertility, endometriosis, postpartum fever and 5:41 infections 5:42 following gynecological surgery. 5:45 Bacterial vaginosis increases the risk of future sexual transmitted infections, 5:49 including 5:49 HSV, chlamydia, gonorrhea, and there's also a risk of recurrence of bacterial 5:59 vaginosis. 6:01 The differential diagnoses for bacterial vaginosis include mixed vaginitis, 6:08 where 6:08 ones vagina is infected with more than one pathogen, trichomoniasis, which is a 6:13 sexual 6:14 transmitted infection caused by a specific parasite, atrophic vaginitis, which 6:20 is basically 6:21 inflammation of the lining of the vagina because it's dry and inflamed, usually 6:27 in postmenopausal 6:28 women. 6:30 Candidal vulvo vaginitis, which is a vaginal yeast infection caused by Candida, 6:36 leading 6:37 to inflammation and pain and itchiness around the area. 6:42 The differential diagnoses to consider include irritation from over washing the 6:46 area, as 6:47 well as a retained foreign body, such as a tampon, condom, or tissue. 6:58 Investigations and Diagnosis Microscopy of a vaginal smear is key to the 7:03 diagnosis of 7:04 bacterial vaginosis. 7:07 A sample can be obtained with a speculum examination or a self-collected swab 7:10 by the patient. 7:13 Bacterial culture is not done because when you swab the vagina, it normally 7:16 contains 7:17 so much different types of bacteria anyway. 7:21 The amcel criteria can be used to diagnose bacterial vaginosis, where at least 7:26 three 7:26 of the following features are present. 7:30 So either presence of clue cells on the vaginal smear, which is most specific 7:35 microscopic 7:35 sign associated with bacterial vaginosis, and clue cells again are where you 7:41 have the 7:42 vaginal epithelial cells surrounded by all these anaerobic bacteria. 7:48 Having a vaginal pH greater than 4.5, a positive amine test of discharge, also 7:56 known as the 7:56 whiff test, where basically it's quite a malodorous smelioda, or a thin hom 8:05 ogenous grey white or 8:07 yellow discharge is present. 8:14 Treatment of bacterial vaginosis in asymptomatic people, bacterial vaginosis 8:19 resolves in up 8:20 to one third of patients, however if one develops symptoms, so what I mean by 8:26 this is the discharge, 8:28 the smelly discharge, the grey discharge, or irritation around the area, will 8:33 oral metronidosol 8:34 can be used, intravaginal metronidosol can be used, or intravaginal clindamycin 8:46 . 8:46 So in summary, bacterial vaginosis is really a condition where you get a 8:52 disturbance in 8:53 the normal microbiome within the vagina, where you have a reduction in what's 8:58 called the 8:59 lactobacillus species, and you have overgrowth of this anaerobic bacterial 9:04 species, mainly 9:06 the garden and umbrella of vaginalis, and the privetilla species, however there 9:10 are other 9:10 species that are involved. 9:13 And really what this causes is a malodorous discharge, which is usually grey in 9:18 colour. 9:19 It is not a sexual transmitted infection, thank you for watching.
