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Bakteriell vaginos

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Definition:
Illaluktande flytningar från vagina på grund av förändrad bakterieflora.
Förekomst:
Finns hos över 20 % av dem som bokar tid hos allmänläkare för flytningar.
Symtom:
Symtomen är sällan särskilt uttalade och tillståndet är asymtomatiskt hos 50 %. Det dominerande besväret är en tunn flytning som luktar.
Kliniska fynd:
Gråvita, tunnflytande, i vissa fall skummande, flytningar. Obehaglig lukt. Som regel ingen uppenbar vulvit eller vaginit.
Diagnostik:
Vaginalt pH >4,5. Clue cells kan ses vid mikrosopi. Flytningarna reagerar med 10 % KOH och utsöndrar aminer och fettsyror med fisklukt.
Behandling:
Lokal antibiotika i första hand. Gardnerella som påvisas hos asymtomatiska kvinnor ska inte behandlas.
  1. Mitchell H. Vaginal discharge - causes, diagnosis, and treatment. BMJ 2004; 328: 1306-8. PubMed  
  2. Ugwumadu A, Manyonda I, Reid F, Hay P. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial. Lancet 2003; 361: 983-88. PubMed  
  3. Barbone F, Austin H, Louv WC, Alexander WJ. A follow-up study of methods of contraception, sexual activity, and rates of trichomoniasis, candidiasis, and bacterial vaginosis. Am J Obstet Gynecol 1990; 163: 510-4. PubMed  
  4. Sobel JD. Vaginitis. N Engl J Med 1997; 337: 1896-903. New England Journal of Medicine  
  5. Vodstrcil LA, Hocking JS, Law M, et al. Hormonal contraception is associated with a reduced risk of bacterial vaginosis: a systematic review and meta-analysis. PLoS One. 2013 Sep 4;8(9):e73055. doi: 10.1371/journal.pone.0073055. DOI  
  6. Joesoef M, Schmid G. Bacterial vaginosis. Clin Evid 2001; 6: 1208-15. Clinical Evidence  
  7. Schwebke JR, Morgan SC, Weiss HL. The use of sequential self-obtained vaginal smears for detecting changes in the vaginal flora. Sex Transm Dis 1997; 24: 236-9. PubMed  
  8. Helsedirektoratet (2021). Nasjonal faglig retningslinje for antibiotika i primærhelsetjenesten nettdokument. Oslo: Helsedirektoratet (sist faglig oppdatert 16. november 2021, lest 16. november 2021).
  9. Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74:14-22. PubMed  
  10. Vieira-Baptista P, Silva AR, Costa M et al. Diagnosis of bacterial vaginosis: Clinical or microscopic? A cross-sectional study. Int J Gynaecol Obstet. 2022 Mar;156(3):552-559. Epub 2021 Jul 12. PMID: 34160078.
  11. Lowe NK, Neal JL, Ryan-Wenger NA. Accuracy of the clinical diagnosis of vaginitis compared with a DNA probe laboratory standard. Obstet Gynecol 2009; 113: 89-95. PubMed  
  12. Colli E, Landoni M, Parazzini F. Treatment of male partners and recurrence of bacterial vaginosis: a randomised trial. Genitourin Med 1997; 73: 267-70. PubMed  
  13. Brocklehurst P, Gordon A et al. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database of Systematic Reviews 2013. PMID: 23440777. PubMed  
  14. Hillier SL, Nugent RP, Eschenback DA, et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. N Engl J Med 1995; 333: 1737-42. New England Journal of Medicine  
  15. Hauth JC, Goldenberg RL, Andrews WW et al. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. New Engl J Med 1995 Dec 28. PMID: 7491136. PubMed  
  16. Carey JC, Klebanoff MA, Hauth JC, et al. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 2000; 342:534-40. New England Journal of Medicine  
  17. Kekki M, Kurki T, Pelkonen J, Kurkinen-Raty M, Cacciatore B, Paavonen J. Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. Obstet Gynecol 2001; 97: 643-8. PubMed  
  18. Okun N , et al. Antibiotics for Bacterial Vaginosis or Trichomonas vaginalis in Pregnancy: A Systematic Review. Obstet Gynecol 2005; 105: 857-68. PubMed  
  19. Läkemedelsboken 2009-2010, Läkemedelsverket www.lakemedelsverket.se  
  20. Chen JY, Tian H, Beigi RH. Treatment considerations for bacterial vaginosis and the risk of recurrence. J Womens Health 2009; 18: 1997-2004. pmid:20044862 PubMed  
  21. Huang H, Song L, Zhao W. Effects of probiotics for the treatment of bacterial vaginosis in adult women: a meta-analysis of randomized clinical trials. Arch Gynecol Obstet. 2014 Jun;289(6):1225-34. doi: 10.1007/s00404-013-3117-0. dx.doi.org  
  22. Larsson PG, Stray-Pedersen B, Ryttig KR, Larsen S. Human lactobacilli as supplementation of clindamycin to patients with bacterial vaginosis reduce the recurrence rate; a 6-month, double-blind, randomized, placebo-controlled study. BMC Womens Health 2008; 8: 3. PubMed  
  23. Donaxyl (dekvaliniumklorid). Information från Läkemedelsverket 2015:(26)2. lakemedelsverket.se  
  24. INFPREG – Kunskapscentrum för infektioner under graviditet. www.medscinet.se  
  25. McDonald HM, O'Loughlin JA, Vigneswaran R, Jolley PT, Harvey JA, Bof A, et al. Impact of metronidazole therapy on preterm birth in women with bacterial vaginosis flora (Gardnerella vaginalis): a randomised, placebo-controlled trial. Br J Obstet Gynaecol 1997; 104: 1391-7. PubMed  
  26. Duff P, Lee ML, Hillier SL, Herd LM, Krohn MA, Eschenbach DA. Amoxicillin treatment of bacterial vaginosis during pregnancy. Obstet Gynecol 1991; 77: 431-5. PubMed  
  27. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Assessment of risk factors for preterm birth. Clinical management guidelines for obstetrician-gynecologists. Number 31, October 2001 (Replaces Technical Bulletin number 206, June 1995; Committee Opinion number 172, May 1996; Committee Opinion number 187, September 1997; Committee Opinion number 198, February 1998; and Committee Opinion number 251, January 2001). Obstet Gynecol 2001; 98: 709-16. PubMed  
  28. Afifirad R, Darb Emamie A, Golmoradi Zadeh R et al. Effects of Pro/Prebiotics Alone over Pro/Prebiotics Combined with Conventional Antibiotic Therapy to Treat Bacterial Vaginosis: A Systematic Review. Int J Clin Pract. 2022 Apr 21;2022:4774783. PMID: 35685517 PubMed  
  29. French JI, McGregor JA, Draper D, Parker R, McFee J. Gestational bleeding, bacterial vaginosis, and common reproductive tract infections: risk for preterm birth and benefit of treatment. Obstet Gynecol 1999; 93: 715-24. PubMed  
  • Barbro Larson, docent och specialist i gynekologi och obstetrik, Stockholm