Recurrent bacterial vaginosis.

ABSTRACT: Bacterial vaginosis increases the risk of sexually transmitted infections, including HIV, and treatment is crucial to avoid complications. This article reviews the evidence-based options for treating bacterial vaginosis to improve patient outcomes.

Recurrent bacterial vaginosis.

Bacterial vaginosis recurrence is common but can lead to frequent bothersome symptoms associated with infection. This article reviews evidence-based options for practicing providers to improve patient outcomes. Bacterial vaginosis increases the risk of acquiring sexually transmitted infections, including HIV. Adequate treatment is essential to help avoid adverse patient outcomes.

Common Sexually Transmitted Infections in Women.

The spread of sexually transmitted infections (STIs) remains a significant public health issue in the United States. Social, economic, and behavioral implications affecting the spread of STIs have been identified. The most important social factor in the United States is the stigma associated with discussing sex and STI screening. In this article, specific recommendations for women are included regarding screening, diagnosing, and treating common vaginal and cervical infections. Screening women for infections of the vagina and cervix is essential because untreated infections may result in complications that have current and long-term health consequences and impact quality of life.

What's the treatment for bacterial vaginosis?

A 28-weeks-pregnant patient complained of vaginal irritation and a malodorous white discharge that didn't improve after she used an over-the-counter cream indicated for yeast infections. What's a more effective treatment?

A descriptive correlational study of bacterial vaginosis in pregnancy and its association with preterm birth: implications for advanced practice nurses.

PURPOSE: To expand on prior (often contradictory) research implicating maternal infection as a cause of preterm birth, specifically exploring whether bacterial vaginosis (BV) in pregnancy caused preterm birth in a sample of 103 women in a rural Mississippi obstetric-gynecologic clinic. DATA SOURCES: This descriptive correlational study explored the relationship between BV and preterm birth, using retrospective chart data from a purposive sample of 103 women (for a power level of 95%) from one rural obstetric-gynecologic clinic. CONCLUSIONS: Contrary to the majority of published research, this study did not find a positive correlation between BV and preterm birth. This unexpected result raises questions, particularly given that the preponderance (86%) of women who tested positive for BV during their pregnancy were African American, a population in which both BV and preterm birth are more prevalent. IMPLICATIONS FOR PRACTICE: Whether to screen for BV in pregnancy is a clinically important question not only in terms of the health of mother and child but also in terms of responsible use of resources. Clear findings supporting beneficial health results for screening would dictate screening regardless of the cost. But research continues to lack consensus on the efficacy of BV screening during pregnancy in preventing adverse pregnancy outcomes. In this study, as in some of the literature, the risk of preterm birth did not correlate positively with BV during pregnancy. In the absence of that correlation, cost gains importance. Nurse practitioners (NPs) must use resources wisely, including time, laboratory tests, and medications. Although some specialists recommend screening or treating all pregnant patients for BV, the current practice of not screening or treating all pregnant patients seems warranted until definitive findings establish a conclusive correlation between BV and preterm birth.

Gynecologic care for women with HIV infection.

The purpose of this article is to review the gynecologic conditions encountered among women with HIV and to outline elements of gynecologic care for these women. The most prevalent problems are vulvo-vaginal candidiasis and cervical dysplasia; however, other sexually transmitted diseases, pelvic inflammatory disease, genital ulcer disease, and menstrual abnormalities are also seen. Drug interactions may limit the effectiveness or increase the toxicities associated with hormonal contraception. Intrauterine devices are contraindicated.

The role of the midwife when the pathology report states your pregnant client has bacterial vaginosis.

Bacterial vaginosis (BV) has been associated with preterm labour, preterm prelabour rupture of membranes and preterm birth. Organisms in high concentrations in BV may ascend from the vagina into the uterine cavity causing infection. Many factors may change the vaginal pH and microflora increasing the risk of BV, and midwives need to recognise signs and symptoms of BV. The vaginal pH is a useful tool for BV screening. Midwives may play a future role in pH testing, especially in pregnant women at high risk, for example, those with a previous preterm birth.

Patient group directions in nurse-led sexual health clinics.

BACKGROUND: This article details an audit of the supply of medications by specialist nurses at a genitourinary medicine clinic. CONCLUSION: The use of patient group directions resulted in a reduced number of prescriptions being required from doctors, thus saving time for them, the nurses and patients.

The vagina as an ecologic system. Current understanding and clinical applications.

Recent advances in understanding the mechanisms of dominance of the healthful microecology by Lactobacillus acidophilus through microbicidal enzyme systems has led to renewed interest in ecologic approaches to vaginal health maintenance and treatment of vaginosis and vaginitis. Review of pertinent research suggests that due to inadequate adherence of lactobacilli from dairy sources, contaminants in commercial sources, and lack of evidence of effectiveness in sparse clinical trials, intravaginal applications of L. acidophilus cannot be recommended. Bacterial vaginosis is described in this article as a microecologic shift in the dominant organism of the microecology from L. acidophilus to Gardnerella vaginalis. This results in conditions favorable to vaginal establishment of many anaerobic organisms. The ability to identify and nurture healthful lactobacilli in the vaginal microflora is suggested as a future direction for health-enhancement-oriented research, practice, and screening.

Bacterial vaginosis: a subtle yet serious infection.

Bacterial vaginosis, previously designated nonspecific vaginitis, is the most common vaginal infection in reproductive-aged women. It is properly diagnosed using three of the four following criteria: (1) presence of homogenous, thin, milklike vaginal discharge; (2) vaginal pH > 4.5; (3) fishy odor on alkalinization of the vaginal secretions; and (4) presence of clue cells on microscopic examination of vaginal secretions. In recent years, numerous gynecological and obstetrical complications have been linked to this disease. Treatment of choice remains oral metronidazole, with clindamycin vaginal cream offering promise of similar efficacy with fewer side effects. Thorough and individualized treatment of asymptomatic women and sexual partners remains controversial. Patient education should be a pivotal part of effective therapy.

Cytolytic vaginosis: a common cause of cyclic vulvovaginitis.

Cytolytic vaginosis (CV) infection is a little recognized but common cause of cyclic vulvovaginal complaints in women of reproductive age. Often misdiagnosed as candidiasis, most women have tried myriad antifungal medications to little or no avail. The history and physical examination is often similar to that seen in women with vaginal candidiasis. However in CV infection there is a luteal phase pattern of symptom recurrence. An astute clinician can make this diagnosis on vaginal microscopic examination and by meticulously ruling out other infections. Management consists of discontinuing all antifungal agents, using pads instead of tampons with menses, and taking baking soda sitz baths. Baking soda douches may also be helpful. As clinicians become familiar with CV infection, more women will be diagnosed and managed appropriately, leading to a long awaited resolution of their chronic vaginal complaints.