⚕️ FREE MSRA PODCAST – Bacterial Vaginosis
🎧 A clear, high-yield breakdown of this common vaginal condition caused by microbial imbalance – perfect for exam prep and clinical scenarios.
🧠 Key Learning Points
📌 Definition
• Bacterial vaginosis (BV) is a common vaginal condition caused by disruption of the normal flora, leading to overgrowth of anaerobic bacteria and reduced lactobacilli.
📌 Causes & Risk Factors
• New or multiple sexual partners
• Vaginal douching or irritants (e.g., soaps)
• Copper IUD
• Smoking
• Afro-Caribbean ethnicity
• Pregnancy or hormonal changes
💡 Protective factors: COCP, condom use, circumcised partner
📌 Pathophysiology
• Loss of lactobacilli → ↑ vaginal pH (>4.5)
• Anaerobic bacteria (Gardnerella, Prevotella, Mycoplasma) overgrow
• Leads to characteristic symptoms and odour
📌 Symptoms
• Thin, grey-white discharge
• Fishy odour (worse after sex/period)
• Mild irritation or dysuria
• 50% of cases are asymptomatic
💡 Mnemonic: “FISH” – Fishy smell, Irritation mild, Secretion grey, Half asymptomatic
📌 Differential Diagnosis
• Candidiasis
• Trichomoniasis
• Chlamydia, gonorrhoea, herpes
• Atrophic vaginitis (postmenopause)
• Foreign body or allergic reaction
📌 Diagnosis
• Clinical + Amsel’s criteria (need ≥3 of 4):
– Thin, grey discharge
– Vaginal pH >4.5
– Positive whiff test (KOH)
– Clue cells on microscopy
• Gardnerella alone is not diagnostic
• Empirical diagnosis if classic symptoms & low STI risk
💡 Microscopy: Clue cells = epithelial cells coated with bacteria
📌 Management
• Metronidazole or clindamycin (oral/topical)
• Avoid irritants (e.g., douching, soaps)
• Probiotics may help but limited evidence
• No partner treatment needed (unless female same-sex partner)
• Consider intravaginal over oral in pregnancy/breastfeeding
📌 Complications
• ↑ risk of HIV & other STIs
• PID, late miscarriage, preterm labour
• Premature rupture of membranes
• Postpartum endometritis
📌 Prognosis
• Often recurs – up to 50% relapse in 3 months
• Can resolve spontaneously in some
• Long-term management may involve repeat topical antibiotics or prophylaxis
📎 More MSRA Resources for Bacterial Vaginosis
📝 Revision Notes: https://www.passthemsra.com/topic/bacterial-vaginosis-revision-notes/
🧠 Flashcards: https://www.passthemsra.com/topic/bacterial-vaginosis-flashcards/
💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/bacterial-vaginosis-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/bacterial-vaginosis-rapid-quiz/
🎓 Full Course: https://www.passthemsra.com/courses/obstetrics-and-gynaecology-for-the-msra/
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