Bacterial Vaginosis Clinical Presentation

Updated: Oct 25, 2018
  • Author: Philippe H Girerd, MD; Chief Editor: Michel E Rivlin, MD  more...
  • Print
Presentation

History

Symptoms of bacterial vaginosis include the following:

  • Vaginal odor is the most common, and often initial, symptom of bacterial vaginosis (BV). Odor may be recognized only after sexual intercourse. The alkalinity of semen may cause a release of volatile amines from the vaginal discharge and cause a fishy odor.

  • Increased vaginal discharge is typically mild to moderate.

  • Vulvar irritation is less common.

  • Dysuria or dyspareunia occur rarely.

Inquire about risk factors that may predispose patients to developing BV. Predisposing factors can include the following:

  • Recent antibiotic use

  • Decreased estrogen production of the host

  • Wearing an intrauterine device (IUD)

  • Douching

  • Sexual activity that could lead to transmission, as evidenced by the patient having a new sexual partner, an increased number of sexual partners in the month preceding the onset of BV symptoms, or having an increased number of lifetime sexual partners

Next:

Physical

Vaginal discharge features include the following:

  • Most often gray, thin, and homogeneous

  • Adherent to the vaginal mucosa

  • May not visualize pooling of discharge in the posterior fornix because of adherence to the vaginal mucosa

  • May observe small bubbles in the discharge fluid

An increased light reflex of the vaginal walls may be observed, indicating a very wet appearance; however, typically, no or little evidence of inflammation is apparent.

The labia, introitus, cervix, and cervical discharge appear normal.

Evidence of cervicitis should prompt a workup for concomitant infection with Neisseria gonorrhoeae, Chlamydia trachomatis, or herpes simplex virus (HSV).

Previous