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 1 BACTERIAL V A GINOSIS DIAGNOSE and TREATMENT Coass : J A Y A 110 205 0056  Yusu f Muchtar 110 21 0 0153 Advisor : dr. Karlina Novianti Kasim u!"rvisor : #r. dr. ri $ita%ani& !.KK

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1

BACTERIAL VAGINOSIS DIAGNOSE

and TREATMENT

Coass :

J A Y A 110 205 0056

 Yusuf Muchtar 110 210 0153

Advisor :

dr. Karlina Novianti Kasim

u!"rvisor :

#r. dr. ri $ita%ani& !.KK

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#"finition

Bacterial vaginosis (BV is vaginal

in!la""ation ca#sed $% increased

concentration o! anaero$ic $acteria invaginal !lora&

'

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9

)is* +actors

)  A!rican A"erican

) T+o or "ore se- ,artners in ,revio#s si-

"ont*s:ne+ se- ,artner ) Do#c*ing

) ;or"onal c*anges d#ring ,regnanc% and

"eno,a#se) Lac6 o! ;'O'4,rod#cing lacto$acilli

)  Anti$iotic

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,ato("n"sis

) Overgro+t* o! $acteria s,ecies nor"all% ,resent in vagina

+it* anaero$ic $acteria

) BV correlates +it* a decrease or loss o! ,rotective

lacto$acilli

 2 Vaginal acid ,; nor"all% "aintained $% lacto$acilli t*ro#g*

"eta$olis" o! gl#cose:gl%cogen

 2 ;%drogen ,ero-ide (;'O' is ,rod#ced $% so"e Lactobacilli 7s,&

 2 ;'O' *el,s "aintain a lo+ ,;7 +*ic* in*i$its $acteria overgro+t*

 2 Loss o! ,rotective lacto$acilli "a% lead to BV

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.

Clinical ,r"s"ntation and

%m!toms

) 3</ as%",to"atic

) Signs : s%",to"s +*en ,resent 2 3</ re,ort "alodoro#s (!is*% s"elling

vaginal disc*arge7 itc*

 2 Re,orted "ore co""onl% a!ter vaginalinterco#rse7 a!ter co",letion o! "enses7

and a!ter se-#al activities

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=

-"t ,r"!.: act"rial $a(inosis

Cl#e Cells a,,ereance in "icrosco,% e-a"ination

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>

$ #ia(nosis: Ams"l Crit"ria

 A"sel CriteriaM#st *ave at leastt*ree o! t*e!ollo+ing !indings

Vaginal ,; ?9&3

0resence o! ?'</ ,er ;0@o! cl#e cells on +et "o#nte-a"ination

0ositive a"ine or +*i!! test

;o"ogeneo#s7 non4visco#s7"il6%4+*ite disc*argead*erent to t*e vaginal +alls 

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/th"r #ia(nostic ools

) Vaginal Gra" stain (N#gents criteria 2 0redo"inant Lactobacilli : <4 (negati!

 2 Mi-ed @lora 94. (inter"ediate 2 0redo"inant gra" negati! Coccobacilli : =41< (,ositi! BV

) C#lt#re

) Cro"atiogra,*% E-a"ination) Bioc*e"istr% E-a"ination

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1<

$ #iff"r"ntial #ia(nos"

Normal richomoniasis Candidiasisact"rial

$a(inosis

,rimar% s%m!tom Itc*7 disc*argeItc*7 disco"!ort7t*ic6 disc*arge

disc*arge7 itc*

$a(inal dischar(" Clear to+*ite @rot*%7 gra% or %ello+4green "alodoro#s T*ic67 cl#",%7 +*itecottage c*eeseF

;o"ogeno#s7ad*erent7

t*in7+*ite 4 gra%"alodoro#s !o#l

!is*%F

$a(inal ! &> 4 9&' ? 9&3 9&3 ? 9&3

m"ll 4 @is*% odor (H 4 @is*% odor (HHH

Microsco!icfindin(

E,it*elialcell +it*

lactobacillus

Trichomonas "otil7 alot o! 0MN

O; %east and,se#do*i!a

Cl#e cell

r"atm"nt 4 "etronidaJole Anti!#ngi MetronidaJole

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Tric*o"oniasis Bacterial vaginosis

Candidiasis

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Com!lications

) 0reter" $irt* in ,regnanc%

) Trans"ission and acK#isition o! ;IV

) Cervical Intrae,it*elial Neo,lasia

) 0ost,art#" @ever 

) 0ost o,erative g%necologic co",lications

) 0ost a$ortal in!ections

1'

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r"atm"nt in Non ,r"(nanc%

C#Cr"comm"nd"d r"(im"ns:) MetronidaJole 3<< "g orall% t+ice a da% !or = da%s7 or 

) MetronidaJole gel <&=3/7 one !#ll a,,licator (3 gra"s intravaginall%7once a da% !or 3 da%s7 or 

) Clinda"%cin crea" '/7 one !#ll a,,licator (3 gra"s intravaginall% at

$edti"e !or = da%s

Alt"rnativ" r"(im"ns:

) TinidaJole ' g orall% once a da% !or ' da%s7 or 

) TinidaJole 1 g orall% once a da% !or 3 da%s7 or 

) Clinda"%cin << "g orall% t+ice a da% !or = da%s7 or 

) Clinda"%cin ov#les 1<< "g intravaginall% once at $edti"e !or da%s7or 

) MetronidaJole =3< "g orall% once a da% !or = da%s

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r"atm"nt in ,r"(nanc%

 2 MetronidaJole '3< "g orall% ti"es a da% !or = da%s7

or 

 2 MetronidaJole 3<< "g orall% t+ice a da% !or = da%s7 or 

 2 Clinda"%cin << "g orall% t+ice a da% !or = da%s

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/th"r condition

)  Allergic +it* MetronidaJole

 2 Clinda"%cin crea" intravaginall%

) Rec#rrent In!ection MetronidaJole gel <7=3/

(a!ter t*is7 contin#e to t+ice a da%

intravaginall% !or ' - 5ee6s 2 0artnert "anage"ent

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,roiotic r"atm"nt

 2 0rod#ce anti"icro$ial co",o#nd s#c* as ;%drogen

0ero-ide7 Lactic Acid7 or Ba6teriocin7 +*ic* in*i$its

,at*ogen gro+t*&

 2 0rod#ce a $ios#r!actan containing a large n#"$er o!

collagen 2 $inding ,roteins t*at co#ld in*i$it ,at*ogen

ad*esion and ind#ce a co",etitive e-cl#sion o! t*e

,at*ogen on e,it*elial cell&

 2 Ma% ca#se a "#cosal "od#lation t*at en*ances t*e*ost i""#ne s%ste" res,onse&

1.

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