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==Overview==
==Overview==
Most women found to have bacterial vaginosis (BV) reported no symptoms. In symptomatic patients, bacterial vaginosis may present with vaginal odor and white/gray vaginal discharge.<ref name=CDC-BV-Stat> Centers for Disease Control and Prevention. Bacterial Vaginosis (BV) Statisticshttp://www.cdc.gov/std/bv/stats.htm Accessed on October 18, 2016</ref>
If left untreated, bacterial vaginosis may lead to more serious sequelae, such as [[salpingitis]], [[endometritis]], [[bacteremia]], and [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]].
In most cases, BV causes no complications.
However, some complication of bacterial vaginosis may include [[endometritis]], [[cervicitis]], [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]], [[bacteremia]], and increase a woman's susceptibility to other [[STDs]].<ref name=CDC-ref1>Laxmi U, Agrawal S, Raghunandan C, et al. Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study. J Matern Fetal Neonatal Med 2012;25:64–7.</ref><ref name="pmid11354269">{{cite journal| author=Koumans EH, Kendrick JS, CDC Bacterial Vaginosis Working Group| title=Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda. | journal=Sex Transm Dis | year= 2001 | volume= 28 | issue= 5 | pages= 292-7 | pmid=11354269 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11354269  }} </ref><ref name="pmid8906013">{{cite journal| author=Persson E, Bergström M, Larsson PG, Moberg P, Platz-Christensen JJ, Schedvins K et al.| title=Infections after hysterectomy. A prospective nation-wide Swedish study. The Study Group on Infectious Diseases in Obstetrics and Gynecology within the Swedish Society of Obstetrics and Gynecology. | journal=Acta Obstet Gynecol Scand | year= 1996 | volume= 75 | issue= 8 | pages= 757-61 | pmid=8906013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8906013  }} </ref>
Additionally, one third of pregnant women found to have a bacterial vaginosis.
If left untreated, in pregnant women bacterial vaginosis may result in a serious complication of pregnancy, including [[premature rupture of membranes]], [[premature labor]], [[chorioamnionitis]], [[endometritis|postpartum endometritis]], and [[septic abortion]].<ref name=Chaim> Chaim, W., M. Mazor, and J. R. Leiberman. "The relationship between bacterial vaginosis and preterm birth. A review." Archives of gynecology and obstetrics 259.2 (1997): 51-58.</ref><ref name="pmid8357048">{{cite journal| author=Faro S, Martens M, Maccato M, Hammill H, Pearlman M| title=Vaginal flora and pelvic inflammatory disease. | journal=Am J Obstet Gynecol | year= 1993 | volume= 169 | issue= 2 Pt 2 | pages= 470-4 | pmid=8357048 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8357048  }} </ref>
==Natural History==
==Natural History==
Most women found to have bacterial vaginosis (BV) reported no symptoms. Women who have not had vaginal, oral, or anal sex can still be affected by Bacterial vaginosis.
Most women found to have bacterial vaginosis (BV) reported no symptoms. Women who have not had vaginal, oral, or anal sex can still be affected by bacterial vaginosis.
In symptomatic patients, bacterial vaginosis may present with thin white/gray malodor vaginal discharge. If left untreated, it may lead to more serious sequelae, such as [[salpingitis]], [[endometritis]], [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]], and [[bacteremia]].
In symptomatic patients, bacterial vaginosis may present as a ‘fishy’ vaginal odor and a gray/white vaginal discharge.<ref name=CDC-BV-Stat> Centers for Disease Control and Prevention. Bacterial Vaginosis (BV) Statisticshttp://www.cdc.gov/std/bv/stats.htm Accessed on October 18, 2016</ref>
If left untreated, bacterial vaginosis may lead to more serious sequelae, such as [[salpingitis]], [[endometritis]], [[bacteremia]], and [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]].  If left untreated, [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]] may lead to [[infertility]] or damage the fallopian tubes enough to increase the future risk of [[ectopic pregnancy]].<ref name=CDC-ref1>Laxmi U, Agrawal S, Raghunandan C, et al. Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study. J Matern Fetal Neonatal Med 2012;25:64–7.</ref><ref name="pmid11354269">{{cite journal| author=Koumans EH, Kendrick JS, CDC Bacterial Vaginosis Working Group| title=Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda. | journal=Sex Transm Dis | year= 2001 | volume= 28 | issue= 5 | pages= 292-7 | pmid=11354269 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11354269  }} </ref>


Around one third of pregnant women found to have a bacterial vaginosis. if left untreated, in pregnant women bacterial vaginosis may result in complication of pregnancy, including [[premature rupture of membranes]], [[premature labor]], [[chorioamnionitis]], [[endometritis|postpartum endometritis]], and [[septic abortion]].
====Bacterial Vaginosis during Pregnancy====
Approximately one third of pregnant women found to have a bacterial vaginosis.
Pregnant women with BV more often have babies who are born premature or with low birth weight (low birth weight is less than 5.5 pounds). If left untreated, in pregnant women bacterial vaginosis may result in a serious complication of pregnancy, including [[premature rupture of membranes]], [[premature labor]], [[chorioamnionitis]], [[endometritis|postpartum endometritis]], and septic abortion.<ref name=Chaim> Chaim, W., M. Mazor, and J. R. Leiberman. "The relationship between bacterial vaginosis and preterm birth. A review." Archives of gynecology and obstetrics 259.2 (1997): 51-58.</ref><ref name="pmid8357048">{{cite journal| author=Faro S, Martens M, Maccato M, Hammill H, Pearlman M| title=Vaginal flora and pelvic inflammatory disease. | journal=Am J Obstet Gynecol | year= 1993 | volume= 169 | issue= 2 Pt 2 | pages= 470-4 | pmid=8357048 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8357048  }} </ref>


==Complications==
==Complications==
In most cases, BV causes no complications. But there are some serious risks from bacterial vaginosis including:<ref name=CDC-ref1>Laxmi U, Agrawal S, Raghunandan C, et al. Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study. J Matern Fetal Neonatal Med 2012;25:64–7.</ref>
In most cases, BV causes no complications.  
 
However, some complication of bacterial vaginosis may include:<ref name=CDC-ref1>Laxmi U, Agrawal S, Raghunandan C, et al. Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study. J Matern Fetal Neonatal Med 2012;25:64–7.</ref><ref name="pmid11354269">{{cite journal| author=Koumans EH, Kendrick JS, CDC Bacterial Vaginosis Working Group| title=Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda. | journal=Sex Transm Dis | year= 2001 | volume= 28 | issue= 5 | pages= 292-7 | pmid=11354269 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11354269  }} </ref>
*Increased risk for infection following surgical procedures such as:
*[[Endometritis]]
**[[Hysterectomy]]  
*[[Cervicitis]]
**[[Abortion]]
*[[pelvic inflammatory disease|Pelvic inflammatory disease (PID)]]
* Increased risk for some complications of [[pregnancy]] such as:
*[[Bacteremia]]
**[[Chorioamnionitis]]
* Increase a woman's susceptibility to other [[STDs]], such as:<ref name="pmid8906013">{{cite journal| author=Persson E, Bergström M, Larsson PG, Moberg P, Platz-Christensen JJ, Schedvins K et al.| title=Infections after hysterectomy. A prospective nation-wide Swedish study. The Study Group on Infectious Diseases in Obstetrics and Gynecology within the Swedish Society of Obstetrics and Gynecology. | journal=Acta Obstet Gynecol Scand | year= 1996 | volume= 75 | issue= 8 | pages= 757-61 | pmid=8906013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8906013  }} </ref><ref name="pmid10558942">{{cite journal| author=Martin HL, Richardson BA, Nyange PM, Lavreys L, Hillier SL, Chohan B et al.| title=Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition. | journal=J Infect Dis | year= 1999 | volume= 180 | issue= 6 | pages= 1863-8 | pmid=10558942 | doi=10.1086/315127 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10558942  }} </ref>
**[[miscarriage|Midtrimester miscarriage]]
**Preterm birth
* Increase a woman's susceptibility to other STDs, such as:
**[[HIV]]
**[[HIV]]
**[[HSV|Herpes]]
**[[HSV|Herpes]]
**[[Chlamydia]]
**[[Chlamydia]]
**[[Gonorrhea]]
**[[Gonorrhea]]
* Increases the risk for HIV transmission to male sex partners
===Bacterial Vaginosis during Pregnancy===
Pregnant women with BV more often have babies who are born premature or with low birth weight (low birth weight is less than 5.5 pounds).


The bacteria that cause BV can sometimes infect the [[uterus]] (womb) and [[fallopian tubes]] (tubes that carry eggs from the ovaries to the uterus). This type of infection is called [[pelvic inflammatory disease]] (PID). PID can cause [[infertility]] or damage the fallopian tubes enough to increase the future risk of [[ectopic pregnancy]] and infertility. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube which can rupture.
====Complications following Gynecologic Procedures====
Some serious complications from bacterial vaginosis following surgical procedures (such as [[hysterectomy]] and [[Abortion|Iinduced abortion]]) include:<ref name="pmid8906013">{{cite journal| author=Persson E, Bergström M, Larsson PG, Moberg P, Platz-Christensen JJ, Schedvins K et al.| title=Infections after hysterectomy. A prospective nation-wide Swedish study. The Study Group on Infectious Diseases in Obstetrics and Gynecology within the Swedish Society of Obstetrics and Gynecology. | journal=Acta Obstet Gynecol Scand | year= 1996 | volume= 75 | issue= 8 | pages= 757-61 | pmid=8906013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8906013  }} </ref><ref name="pmid2037257">{{cite journal| author=Hamark B, Forssman L| title=Postabortal endometritis in chlamydia-negative women--association with preoperative clinical signs of infection. | journal=Gynecol Obstet Invest | year= 1991 | volume= 31 | issue= 2 | pages= 102-5 | pmid=2037257 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2037257  }} </ref><ref name=pmid=24768957> Moslemi-Kebria M| title=Predictors of surgical site infection in women undergoing hysterectomy for benign gynecologic disease: a multicenter analysis using the national surgical quality improvement program data. | journal=J Minim Invasive Gynecol | year= 2014 | volume= 21 | issue= 5 | pages= 901-9 | pmid=24768957 | doi=10.1016/j.jmig.2014.04.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24768957  }} </ref>
*Vaginal cuff [[cellulitis]]
*Pelvic abscess
 
====Complications in Pregnancy====
Some serious complications from bacterial vaginosis in [[pregnancy]] include:<ref name=Chaim> Chaim, W., M. Mazor, and J. R. Leiberman. "The relationship between bacterial vaginosis and preterm birth. A review." Archives of gynecology and obstetrics 259.2 (1997): 51-58.</ref><ref name="pmid8357048">{{cite journal| author=Faro S, Martens M, Maccato M, Hammill H, Pearlman M| title=Vaginal flora and pelvic inflammatory disease. | journal=Am J Obstet Gynecol | year= 1993 | volume= 169 | issue= 2 Pt 2 | pages= 470-4 | pmid=8357048 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8357048  }} </ref><ref name="pmid10417083">{{cite journal| author=Ralph SG, Rutherford AJ, Wilson JD| title=Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. | journal=BMJ | year= 1999 | volume= 319 | issue= 7204 | pages= 220-3 | pmid=10417083 | doi= | pmc=28171 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10417083  }} </ref>
*[[Chorioamnionitis]]
*[[miscarriage|first trimester miscarriage]]
*Premature rupture of membrane
*[[Preterm birth]]
*Occurrence of postpartum infections 
**[[Endometritis]]
**[[Bacteremia]]
**Wound infection


==Prognosis==
==Prognosis==
With treatment, bacterial vaginosis is associated with a good prognosis.
However, bacterial vaginosis may associated with adverse outcomes in pregnancy.<ref name="pmid11354269">{{cite journal| author=Koumans EH, Kendrick JS, CDC Bacterial Vaginosis Working Group| title=Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda. | journal=Sex Transm Dis | year= 2001 | volume= 28 | issue= 5 | pages= 292-7 | pmid=11354269 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11354269  }} </ref>
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Most women found to have bacterial vaginosis (BV) reported no symptoms. In symptomatic patients, bacterial vaginosis may present with vaginal odor and white/gray vaginal discharge.[1] If left untreated, bacterial vaginosis may lead to more serious sequelae, such as salpingitis, endometritis, bacteremia, and pelvic inflammatory disease (PID). In most cases, BV causes no complications. However, some complication of bacterial vaginosis may include endometritis, cervicitis, pelvic inflammatory disease (PID), bacteremia, and increase a woman's susceptibility to other STDs.[2][3][4] Additionally, one third of pregnant women found to have a bacterial vaginosis. If left untreated, in pregnant women bacterial vaginosis may result in a serious complication of pregnancy, including premature rupture of membranes, premature labor, chorioamnionitis, postpartum endometritis, and septic abortion.[5][6]

Natural History

Most women found to have bacterial vaginosis (BV) reported no symptoms. Women who have not had vaginal, oral, or anal sex can still be affected by bacterial vaginosis. In symptomatic patients, bacterial vaginosis may present as a ‘fishy’ vaginal odor and a gray/white vaginal discharge.[1] If left untreated, bacterial vaginosis may lead to more serious sequelae, such as salpingitis, endometritis, bacteremia, and pelvic inflammatory disease (PID). If left untreated, pelvic inflammatory disease (PID) may lead to infertility or damage the fallopian tubes enough to increase the future risk of ectopic pregnancy.[2][3]

Bacterial Vaginosis during Pregnancy

Approximately one third of pregnant women found to have a bacterial vaginosis. Pregnant women with BV more often have babies who are born premature or with low birth weight (low birth weight is less than 5.5 pounds). If left untreated, in pregnant women bacterial vaginosis may result in a serious complication of pregnancy, including premature rupture of membranes, premature labor, chorioamnionitis, postpartum endometritis, and septic abortion.[5][6]

Complications

In most cases, BV causes no complications. However, some complication of bacterial vaginosis may include:[2][3]

Complications following Gynecologic Procedures

Some serious complications from bacterial vaginosis following surgical procedures (such as hysterectomy and Iinduced abortion) include:[4][8][9]

Complications in Pregnancy

Some serious complications from bacterial vaginosis in pregnancy include:[5][6][10]

Prognosis

With treatment, bacterial vaginosis is associated with a good prognosis. However, bacterial vaginosis may associated with adverse outcomes in pregnancy.[3]

References

  1. 1.0 1.1 Centers for Disease Control and Prevention. Bacterial Vaginosis (BV) Statisticshttp://www.cdc.gov/std/bv/stats.htm Accessed on October 18, 2016
  2. 2.0 2.1 2.2 Laxmi U, Agrawal S, Raghunandan C, et al. Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study. J Matern Fetal Neonatal Med 2012;25:64–7.
  3. 3.0 3.1 3.2 3.3 Koumans EH, Kendrick JS, CDC Bacterial Vaginosis Working Group (2001). "Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda". Sex Transm Dis. 28 (5): 292–7. PMID 11354269.
  4. 4.0 4.1 4.2 Persson E, Bergström M, Larsson PG, Moberg P, Platz-Christensen JJ, Schedvins K; et al. (1996). "Infections after hysterectomy. A prospective nation-wide Swedish study. The Study Group on Infectious Diseases in Obstetrics and Gynecology within the Swedish Society of Obstetrics and Gynecology". Acta Obstet Gynecol Scand. 75 (8): 757–61. PMID 8906013.
  5. 5.0 5.1 5.2 Chaim, W., M. Mazor, and J. R. Leiberman. "The relationship between bacterial vaginosis and preterm birth. A review." Archives of gynecology and obstetrics 259.2 (1997): 51-58.
  6. 6.0 6.1 6.2 Faro S, Martens M, Maccato M, Hammill H, Pearlman M (1993). "Vaginal flora and pelvic inflammatory disease". Am J Obstet Gynecol. 169 (2 Pt 2): 470–4. PMID 8357048.
  7. Martin HL, Richardson BA, Nyange PM, Lavreys L, Hillier SL, Chohan B; et al. (1999). "Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition". J Infect Dis. 180 (6): 1863–8. doi:10.1086/315127. PMID 10558942.
  8. Hamark B, Forssman L (1991). "Postabortal endometritis in chlamydia-negative women--association with preoperative clinical signs of infection". Gynecol Obstet Invest. 31 (2): 102–5. PMID 2037257.
  9. Moslemi-Kebria M| title=Predictors of surgical site infection in women undergoing hysterectomy for benign gynecologic disease: a multicenter analysis using the national surgical quality improvement program data. | journal=J Minim Invasive Gynecol | year= 2014 | volume= 21 | issue= 5 | pages= 901-9 | pmid=24768957 | doi=10.1016/j.jmig.2014.04.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24768957 }}
  10. Ralph SG, Rutherford AJ, Wilson JD (1999). "Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study". BMJ. 319 (7204): 220–3. PMC 28171. PMID 10417083.

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