STD Clinic Manual - STD by Disease - Bacterial Vaginosis

Sep 24, 2026

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STD Clinic Manual section covering bacterial vaginosis (BV), including clinical context, diagnostic approach, and treatment recommendations. Describes BV as resulting from alterations in vaginal flora, outlines history, physical exam, laboratory evaluation (clue cells, whiff test, vaginal pH), and diagnostic criteria requiring at least three findings. Provides first-line therapy for symptomatic non-pregnant women and guidance for persistent or recurrent BV, including retreatment strategies and possible suppressive therapy for frequent recurrences.

LanguageEnglish

CategoryForms

FormatPDF

Pages144

Reading Time50 min

AccessFree to download

Contents list

STDs by Disease

Bacterial Vaginosis

STDs by Syndrome

Supplemental Information

STD Clinic Manual Belongs Belongs to: to: STD Clinic Manual Contents list STDs by Disease 􀁸 Bacterial Vaginosis ……………………….....……………...…………………………2/ 11 􀁸 Candidiasis in Men ………………………..…...….11/06 (Reviewed 1/11 no changes) 􀁸 Candidiasis in Women ………………………………………………………………..2/ 11 􀁸 Chancroid ……………………….…………………12/07 (Reviewed 1/11 no changes) 􀁸 Chlamydia ………………………………….…………………………………………..2/ 11 􀁸 Gonorrhea ………………………………….... 2/11 (culture instructions updated 6/12) 􀁸 Granuloma Inguinale (Donovanosis)……………11/06 (Reviewed 1/11 no changes) 􀁸 Herpes ……………………………………...………………………………………...1/ 11 􀁸 HIV Testing ……………………………….…………………………………………..4/ 11 􀁸 Lymphogranuloma venereum (LGV)……………01/10 (Reviewed 1/11 no changes) 􀁸 Molluscum Contagiosum …………………………12/06 (Reviewed 1/11 no changes) 􀁸 Public Lice ………………………………….…………………………………………..2/ 11 􀁸 Scabies ……………………………………..…………………………………………..2/ 11 􀁸 Syphilis ……………………………………..…………………………………………..4/ 11 􀁸 Trichomonas ……………………………….…………………………………………..4/ 11 􀁸 Warts ……………………………………….…………………………………………..2/ 11 STDs by Syndrome 􀁸 Cervicitis ………………………………………………………………………………..2/ 11 􀁸 Epididymitis ………………………………..…………………………………………..2/ 11 􀁸 Genital Ulcer Disease …………………….…………………………………………..1/ 11 􀁸 Pelvic Inflammatory Disease …………….…………………………………………..2/ 11 􀁸 Proctitis ……………………………………..…………………………………………..1/ 11 􀁸 Urethritis …………………………………….…………………………………………..1/ 12 􀁸 Vaginitis ……………………………………..…………………………………………..2/ 11 Supplemental Information-See STD clinic resources Intranet site [http://intranet.laph.local/ph/PHDirector/ChiefDeputyDirector/CommunityHealthServices/STDClinic](http://intranet.laph.local/ph/PHDirector/ChiefDeputyDirector/CommunityHealthServices/STDClinic)[ ](http://intranet.laph.local/ph/PHDirector/ChiefDeputyDirector/CommunityHealthServices/STDClinic)[Resources.htm](Resources.htm) 􀁸 Cervical Cancer Screening Protocol 􀁸 Emergency Contraception Protocol 􀁸 Hepatitis Testing, Screening and Vaccination Information 􀁸 Patient Delivered Partner Therapy (PDPT) Protocol List of Resources Available on STD Clinic Resource intranet site STDs by Disease Bacterial Vaginosis Formerly called nonspecific vaginitis, Haemophilus vaginitis or Gardnerella vaginitis, bacterial vaginosis (BV) is the clinical result of alterations in the vaginal flora. It is not generally regarded as an STD except in women who have sex with women. It is asexually related disease because it is more common in women with frequent exposure to semen. Gardnerella vaginalis (a small gram-negative pleomorphic coccobacillus), Bacteroides sp. (anaerobic gram-negative bacilli), Mobiluncus sp. (motile, anaerobic, curved gram-positive bacilli), prevotella and genital mycoplasmas and ureoplasmashave all been implicated. BV is manifested by a malodorous vaginal discharge that is often most noticeable after intercourse. Women with BV are at increased risk for the acquisition of some STDs (e.g. , HIV, N. gonorrhoea,chlamydia and HSV- 2), complications after gynecologic surgery, complications of pregnancy, and recurrence of BV. A. Diagnosis 1. History: a. Patients often complain of a fishy malodorous vaginal discharge (usually not itchy) . b. Patients may be asymptomatic, but have all the signs of BV on exam. c. Many patients report recent and regular douching. 2. Examination: a. Classically, BV produces a homogeneous, thin, adherent, malodorous, white vaginal discharge. b. In the absence of other conditions, the remainder of the exam is normal. 3. Laboratory: a. Presence of clue cells on a saline preparation. Clue cells are epithelial cells with a granular appearance and over 70% of the edges obscured by adherent bacteria. b. Fishy odor noted immediately after KOH is added (positive whiff test) . c. pH of vaginal discharge >4 .5. 4. Diagnostic criteria (at least 3 must be present): a. Homogeneous thin gray or white, adherent discharge on the vaginal wall. b. pH of vaginal fluid higher than

FAQs

How is bacterial vaginosis diagnosed in this manual?

BV diagnosis uses history, examination, and laboratory testing. Criteria require at least three findings such as homogeneous thin adherent discharge, vaginal fluid pH > 4.5, a positive whiff test, and clue cells comprising >20% of epithelial cells.

What is the recommended first-line treatment for symptomatic BV?

For symptomatic women, the manual recommends metronidazole 500 mg orally twice daily for 7 days, or metronidazole gel 0.75% as one full intravaginal applicator at bedtime for 5 days.

What options are suggested for persistent or recurrent BV?

If symptoms persist or recur, the manual advises retreatment and counseling on prevention strategies. Options include retreating with the same regimen when compliance was poor, using a different regimen such as clindamycin cream for appropriate recurrences, and considering suppressive therapy for more than three episodes per year.

Sep 24, 2026

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