Vaginal flora is changed from Lactobacillus species to anaerobes. Not sexually transmitted. Affects 10–40% of
premenopausal women—about half are asymptomatic. Associated with:
• Increase risk of preterm delivery (and decrease risk if treated)
• Development of PID and endometritis following abortion or birth
• Infection post-hysterectomy
Presentation Grey/white, thin, fishy-smelling, offensive discharge with no vulval soreness. On examination, the cervix looks normal; pH of secretions is >4.5. HVS for M,C&S may confirm diagnosis but treat without swab if no examination is carried out, or pH is >4.5 and typical clinical picture.
Management: Without treatment, 50% remit spontaneously. Cure rate with all methods is 785%. There is no benefit from treating the woman’s partner. Treatment:
• Clindamycin 2% cream
• Recurrent infection—X suppressive therapy using metronidazole to cover each period.