Bacterial vaginosis: clinical, epidemiologic and microbiological features

Bacterial Vaginosis (BV) is a polymicrobial clinical syndrome, whose etiology has not been fully understood. It occurs in approximately 30% of the women in childbearing age and is the result of the shift of protective resident microorganisms as Lactobacillus spp. by opportunistic pathogenic bacteria such as Gardnerella vaginalis. Patients with BV generally present copious, thin, homogeneous, milky, foul-smelling flow. Vaginal pH is > 4.5 and microscopy reveals bacteria-covered epithelial cells, termed “clue cells”. Around 50% of the patients are asymptomatic and the disease is associated with gynecologic complications, such as cervicitis, salpingitis, endometritis, post-operative infections and pelvic inflammatory disease; and obstetric complications, such as premature rupture of the membranes, preterm deliveries, chorioamniotitis and postpartum endometritis. Although the Nugent’s method is accepted as the “gold standard” for diagnosing BV, Amsel criteria are generally used for diagnosis in clinical practice. The Papanicolaou method is a valid diagnostic option, chiefly when it yields a positive result (mean specificity 95% when compared to gold standard). G. vaginalis has been almost universally recovered from women with BV, plays an important role in the pathogenesis of the disease, besides it may be detected in about 50% of healthy women. According to the literature, first-line drugs for BV treatment worldwide are metronidazole and clindamycin. However, regional studies on G. vaginalis drug susceptibility patterns are needed faced the so fast growing antimicrobial resistance phenomenon.