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Updated: Oct 10 2018

Gardnerella vaginalis

  • Snapshot
    • A 26-year-old G0 woman with last menstrual period 5 days ago who presents to her gynecologist for fishy-smelling vaginal discharge. She currently has multiple sexual partners and does not use consistent protection. She also requests to be tested for sexually transmitted diseases. On pelvic exam, she has a thin, malodorous gray vaginal discharge that coats the vaginal wall smoothly. Her vulva is not erythematous or edematous. On wet mount microscopy, clue cells are visualized. She is started on antibiotics.
  • Introduction
    • Classification
      • Gardnerella vaginalis
        • facultative anaerobic gram-variable pleomorphic rod
        • catalase-negative
        • oxidase-negative
        • causes bacterial vaginosis
        • not a sexually transmitted disease but is associated with sexual activity
    • Epidemiology
      • incidence
        • very common
      • demographics
        • women
      • risk factors
        • immunosuppression
        • use of antibiotics
        • vaginal douching
        • having multiple sexual partners
        • having unprotected sex
    • Pathogenesis
      • decreased percentage of normal vaginal flora with lactobacillus that produces hydrogen-peroxide
      • dominance of G. vaginalis and other anaerobic bacteria
    • Associated conditions
      • HIV infection
      • herpes simplex virus type 2
      • urinary tract infection
  • Presentation
    • Symptoms
      • often asymptomatic
    • Physical exam
      • thin and gray/white vaginal discharge
      • coats the vaginal wall
      • vaginal malodor (fishy)
      • vulva is normal
  • Studies
    • Labs
      • wet mount microscopy
        • > 20% clue cells in vaginal discharge
          • vaginal epithelial cells that are covered with bacteria
      • whiff test
        • fishy odor after addition of 10% potassium hydroxide
      • vaginal pH > 4.5
    • Making the diagnosis
      • based on clinical presentation and laboratory studies
  • Differential
    • Vulvovaginal candidiasis
      • distinguishing factors
        • thick white curd-like vaginal discharge
        • often very itchy with vulvar erythema and edema
    • Trichomoniasis
      • distinguishing factors
        • green vaginal discharge
        • burning sensation with dysuria and dyspareunia
        • postcoital bleeding
        • vulvar erythema
  • Treatment
    • Management approach
      • mainstay of treatment is antibiotics
      • encourage patients to avoid douching
    • Medical
      • metronidazole or clindamycin
        • indication
          • all patients
  • Complications
    • Endometritis after gynecologic procedures
    • Miscarriage
    • Spontaneous abortion
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