Dr.

Sangita Sharma
 The organism was first described by Gardner
and Dukes in 1955
Named in honour of Hermann .L. Gardner
(1912-2005) American bacteriologist
Only one species G. vaginalis
Colonizes the vagina of normal women
Cause Bacterial vaginosis
 Small , 0.4*1-1.5 um , gram negative to gram
variable coccobacilli, pleomorphic
Angular and palisade (picket fence)
arrangements of cells
Non capsulated and non motile
Contains metachromatic (metaphosphate or
volutin) granules
 Facultative anaerobes
Growth enhanced with increased carbondioxide
and it grows well under anaerobic condition
Optimum pH of 6.0-6.5
Incubation at 35 to 37C for 48 h in a humidified
atmosphere of air plus 5 to 10% CO2
Grows on media enriched with blood
Human blood agar- round, around 0.5mm in
size, opaque, smooth, beta hemolytic colony
after 48hrs of incubation , hemolysis is
improved by anaerobic incubation
 Chocolate agar - small, circular, convex,
gray colonies
Selective media- by adding colistin ,
nalidixic acid and amphotericicn to human
blood agar for isolation from vaginal
secretion
 Catalase test negative
Oxidase test negative
Ferments different sugar with production of
acid
Presumptive identification
- characteristics colonies surrounded by zones
of clear hemolysis on Human blood agar - the
typical appearance of Gram-stained cells, -
negative catalase test
 Earlier called nonspecific vaginitis in recognition
of the absence of recognized agents of vaginitis,
such as Trichomonas vaginalis and Candida
species.
Bacterial vaginosis (BV), was named because
bacteria are the etiologic agent in this infection
and an associated inflammatory response is
lacking.
BV is defined by the disequilibrium in the vaginal
microbiota , with decline in the number
of lactobacilli and increase in other bacteria .
Commonest cause of vaginal discharge
Occurs mainly in women of child bearing age
 Normal vagina is colonized predominantly by
lactobacilli, which afford protection against
microbial pathogens
Bacterial vaginosis occurs when the vaginal
ecology is altered and there is subsequent shift
in the microbial flora
Synergistic polymicrobial infection.
Organisms associated- Gardnerella vaginalis,
anaerobic bacteria like Mobiluncus, Bacteroides,
Peptostreptococcus, Fusobacterium,
Veillonella, and Eubacterium species,
Mycoplasma hominis, Ureaplasma urealyticum.
Clinical feature
increased vaginal discharge that usually
smells like fish.
discharge is often white or gray in color and
coats the wall of vagina without significant
irritation, pain, or erythema
burning with urination may be present
mild itching can sometimes occur.
Complication
Increased risk of salpingitis , endometritis,
postsurgical infections (eg, postcesarean
endometritis, posthysterectomy vaginal cuff
cellulitis),
Adverse outcomes in pregnancy- premature
rupture of membranes, premature labor,
chorioamnionitis, and postpartum endometritis.
Mixed infection- Mixed infections
with Trichomonas and yeast can occur among
patients with BV.
Bacteremia- rare, occurs most commomly
folowing postpartum endometritis,
chorioamnionitis, septic abortion
I. AMSEL CRITERIA used to diagnose BV
Thin, white, yellow, homogeneous discharge
Presence of Clue cells ( epithelial cells that are
coated with bacteria) - place a drop
of sodium chloride solution on a slide containing
vaginal discharge- observe under microscope
pH of vaginal fluid >4.5
Positive Whiff test- Release of a fishy odor on
adding alkali i.e 10% potassium hydroxide (KOH)
solution to vaginal discharge .
At least three of the four criteria should be
present for diagnosis.
Fig: CLUE CELLS in Vaginal discharge
II. NUGENTS SCORE
For confirmation
Specimen vaginal swab
Gram stain
Normal vagina- large gram positive bacilli
BV- absence of lactobacilli and replacement
with mixed bacterial flora , presence of clue
cells squamous epithelial cells covered with
small gram variable bacilli
NORMAL VAGINAL EPITHELIAL CELL CLUE CELL
Nugent score gram stained smear , three bacterial
morphotypes are recognized
1. lactobacillus morphotype- large gram positive rods
2. G.vaginalis and Bacteroides spp. Morphotypes- small
gram negative to variable rods
3. Mobiluncus species morphotype- curved gram variable
rod
The amount of each morphotype detected on the smear is
graded and allocated a score
A score of 0-10 is generated from combining these three
scores and then reported
03 is considered negative for BV
46 is considered intermediate
7+ is considered indicative of BV.
At least 1020 high power (1000 oil immersion) fields are
counted and an average determined
 Metronidazole or Clindamycin (oral or vaginal
suppositories