Sialidase is produced by BV pathogens (Mashburn).
pH Level
The most reliable criterion for detecting BV is a pH>4.5 (Mashburn, 2007). A normal pH should, therefore, rule out BV. A pH >4.5 can also indicate trichomoniasis or muco-purulent cervicitis. Vaginal inflammation more strongly suggests trichomonas or muco-purulent cervicitis, in turn associated with gonorrhea or chlamydial trachomatis (Mashburn).
The patient's pH level is 6, indicating BV.
Wet Smears
These are an inexpensive and relatively easy screening procedure for the most common sexually transmitted diseases, such as BV (Iglesias, Alderman & Fox, 2000). The practitioner should be appropriately trained and experienced in using this procedure. Hence, the proper protocol and quality control are needed to insure accurate diagnosis. The wet smear is quite useful and reliable in diagnosing BV because of the presence of clue cells. These are epithelial cells, which have irregular borders, full of bacteria and appear granular. A diagnosis of BV, using wet smear, is made when three of four findings are present. These four are a vaginal pH greater than 4.5; an abnormal and homogeneous vaginal discharge, fishy odor and presence of clue cells (Iglesias, Alderman & Fox).
A study undertaken by Schmidt and Hansen showed that the wet smear criteria are suitable for general practice (Iglesias, Alderman & Fox, 2000). Accuracy, however, depends on the practitioner's level of education, training and experience in conducting the test properly. Another study compared the wet smear with Pap-stained vaginal smear and the Gram-stain smear. It used 107 women, 34 of whom were diagnosed with BV. The study showed that the Gram-stain test correlated well with the diagnosis and the presence of clue cells on wet smears. Vural and co-authors examined wet smears, cervical smears and biopsies of 131 patients for criteria on lower genital inflammation. They found a close correlation between clue cells on wet smear, on examination and with the grade of inflammation on examination (Iglesias, Alderman & Fox).
Data gathered by Judson and Ehret provided evidence that wet smears had a 54-80% sensitive and 96% specific in detecting C. albicans, 50-70% sensitive and 99-100% specific for T. vaginalis, and 72-80% sensitive and 71-95% specific for BV (Iglesias, Alderman & Fox, 2000). Chacko and Rosenfeld's review of the use of wet smears in the diagnosis of cervical infections showed that cultures were more sensitive to the cause of vaginal discharge. Culture techniques are, however, expensive and labor-intensive. The turnaround time can be long and not in routine use in diagnosing the conditions in many health facilities. Faster techniques need to complement wet smears (Iglesias, Alderman & Fox).
The patient was subjected to tests for sexually transmitted infections, inflammation and to speculum examination for vaginal discharge.
Gram Stain Criteria
Federal regulatory agencies now acknowledge that these criteria have partly replaced the wet-mount criteria as the most reliable diagnostic test for BV (Monif, 2001). This shift brought about two significant conceptual changes. It broadened the conditions of inducible odor, the presence of "clue cells,: and Gram Stain confirmation. It also gave less value to the presence of inflammatory cells. The Gram Stain test is considered excellent in documenting bacterial overgrowth. Poly-microbial flora found in women with BV is also called BV flora. BV flora is associated with abnormalities in pregnancy and after delivery, urinary tract infections, secondary fertility, ectopic pregnancies, upper female genital infections, pre-malignant cervical dysplasia and HIV infection. Demographic studies strongly suggest that BV is "one of the most important diseases of the 20th century (Monif)."
Management/Treatment
The oral regimen for BV consists of 500 mg of metronidazole daily for 7 days (Mashburn, 2007).The recommended intra-vaginal treatment is .75% metronidazole gel daily for 5 days or clindamycin cream 2% once a day for 7 days. Other treatments are 2 grams oral metronidazole as a single dose or ofloxacin 200 orally twice a day. Those who are allergic to metronidazole should be treated with clindamycin. Those with gastrointestinal complications should use intra-vaginal metronidazole, instead. This cream, however, can weaken latex condoms and diaphragms. Another form of contraception should be used as substitute while applying clindamycin vaginal preparations. HIV-positive women are treated the same way as those who are HIV-negative for BV. Oral metronidazole medicines cost much less than the two other recommended regimens (Mashburn).
The patient's oral treatment consists of 2 grams of metronidazole as a single dose or 400 mg metronidazole twice daily for seven days. She may substitute intra-veginal metronidazole or clindamycin cream in case of intolerance for oral metronidazole....
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