الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 122 |  |  |
| | | from | 122 | | |
Abstract
Bacterial vaginosis (BV) is considered to be one of the most common vaginal disorders in reproductive-age women. It represents a range from 4% of a symptomatic collage populations to 40-50% of all cases of vaginitis in sexually transmitted diseases clinics, surpassing both vaginal candidiasis and vaginal trichomanias.
Patients always present with malodorous vaginal discharge,
although 30-40% may be asymptomatic. It is responsible for
approximately one third of all cases of vulvo-vaginitis in women in
reproductive age.
Bacterial vaginosis is polymicrobial condition in which a decrease in a vaginal acidity and concentration of Lactobacilli is accompanied by an increase in the concentration of other microorganismis.
Amsel et al., (1983) described four clinical criteria from which alleast three should be present for diagnosis of BV:
1. Thin homogenous vaginal discharge
2. Vaginal pH> 4.5.
3. Fishy odor when alkali (10% KOH) is added to the specimen of vaginal secretion.
4. The presence of clue cells on saline wet mount.
A group of microorganisms are present in high concentration in the vagina of women with bacterial vaginosis. The major members of the group are Gardnerella vaginalis, anaerobic gram-negative rods, Mobiluncus,and Mycoplasma hominis. Facultative species of Lactobacilli are present in lower concentration and are less prevalent in bacterial vaginosis than in women with a normal vaginal examination. Gardnerella vaginalis is the most common prevalent microorganism in bacterial vaginosis cases.
Direct microscopy of a Gram -stained preparations of vaginal secretions is the ideal method of diagnosis suited to the general gynecologist in the office setting.
Other methods of diagnosis of BV include Vaginal cultures, Papanicolaou smears, Praline amino peptidase assay, DNA probe for detection of Gardnerella vaginalis, gas liquid chromatography, thin layer chromatography, acridine orange staining, aroma scan system.
Bacterial vaginosis is associated with preterm labour and delivery, late miscarriage and postpartum endometritis. Other gynecologic complications include pelvic inflammatory disease, post-hsterectomy vaginal cuff infection, cervical intra-epithelial neoplasia and Requisition of human immunodeficiency virus. Complications for which there is less convincing evidence of the role bacterial vaginosis are urethral syndrome, infertility and early pregnancy loss.
Many physicians regard bacterial vaginosisas a harmless abnormality and do not recommend treatment in the absence of symptoms
The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, the Cochrane Pregnancy and Childbirth Group, the British Association for Sexual Health and HIV/Clinical Effectiveness Group, and the American Academy of Family Physicians; All recommend against routine screening for bacterial vaginosis in asymptomatic pregnant women. With respect to women at high risk for preterm delivery, the Centers for Disease Control and Prevention, American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and British Association for Sexual Health and HIV state that there may be high-risk women
for whom screening and treatment may be beneficial. The Center for Disease Control and Prevention does not recommend the use of clindamycin vaginal cream in the second half of pregnancy.
Metronidazole and clindamycin achieve nearly equivalent cure rates when administrated orally or vaginally in patients at high risk of preterm labour and premature rupture of membranes. Oral metronidazole is considered the drug of choice in treating BV due to its high cure rate, better outcomes, and low cost. However, there is evidence that lactic acid vaginal gel (LVG) is safe and as efficious as metronidazole in the treatment of BV and moreover, lactic acid vaginal gel when combined with metronidazole is superior to metronidazole alone in promoting Lactobacilli colonization. LVG as an adjunct to metronidazole, having the least number of recurrent BV, appears to result in better long-term treatment effect on BV.