Microbiologic studies identifying BV associated pathogens in the male urethra, the coronal sulcus and under the foreskin. The biofilm may be responsible for persistence of the organisms in the vagina and the high recurrence rate following conventional therapy.Īlthough controversial, there is strong evidence based on multiple studies worldwide in the last 5-10 years, indicating the sexual transmission of BV associate microorganisms. Of note, these organisms within the biofilm appear to be protected from both intravaginal as well as systemic, anti-anaerobic agents and might actually have higher MIC’s in this environment. With the disappearance of the aforementioned Lactobacillus species, there is an overgrowth of anaerobic microorganisms which constitute a polymicrobial vaginal microbiome which is characterized by excessive production of polyamines in particular trimethylamine.īacterial vaginosis is further associated with the creation of a vaginal biofilm on the surface of the epithelial cells and within the biofilm G.vaginalis and to a lesser extent Atopobium vaginae organisms can be found.
Lactobacillus iners, a relatively difficult organism to grow in vitro and previously unrecognized, is often present in bacterial vaginosis although its causal role is unclear. jensenii are absent or markedly reduced in women with bacterial vaginosis. Microbiome studies clearly document what has been known for three decades, namely that so called protective Lactobacillus species namely L. The causation of BV is highly complex and in spite of considerable progress in the study of the vaginal microbiome, pathogenesis remains unclear. In many epidemiologic studies, BV occurs at twice as frequently as Candida vulvovaginitis (VVC).
How did the patient develop bacterial vaginosis?īV is now widely recognized as the commonest cause of vulvovaginal symptoms in women worldwide and affecting women in all strata of society, There is nothing on physical examination that allows a confident diagnosis be made by simply observing the dischargeĭescribed as white, adherent and fairly frothy. Typical of the malodor is worsening after unprotected vaginal intercourse. The malodor tends to be worse during menses or may frequently start after menses. The malodor is frequently described as fishy, but this is not uniformly described.