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.