Vaginitis

Case report:

A 40-year-old patient comes into practice and complains of existing for several weeks increased vaginal discharge, burning of the vagina and pain during intercourse. The patient is married and mother of two healthy children. Significant underlying conditions such as diabetes mellitus, hormonal imbalances or other metabolic disorders are not known. Fever or pain during urination are not specified.

Diagnosis:

The gynecological examination gives a discreet vaginal mucosa, a cervicitis can be ruled out. The significantly increased and unpleasant-smelling vaginal secretions is removed with a sterile cotton swab and smeared on a microscope slide. After addition of two drops of 10% KOH solution is microscopically. In addition, a Gram stain is applied. As a result, it follows that some Gram-positive lactobacilli are available, but plenty of gram negative, coccoid rods (Gardnerella vaginalis).

Pathogenesis:

This so-called bacterial vaginosis is caused by an overgrowth of anaerobic bacteria, which displace the normal lactobacilli colonization of the vagina. Ruled a trichomonas infection as well as a Candida vaginitis. It is also important that the pH is above 4.5, and by increasing amines fishy smell can be triggered.

Therapy:

Twice daily 0.5 g metronidazole (Clont) orally for seven days eliminated Gardnerella vaginalis and anaerobes. As a result, the repopulating the vagina is sponsored by lactobacilli. Alternatively, clindamycin (SOBELIN) 300 mg orally twice daily for seven days will be given. The sole local treatment with clindamycin cream (2%) or Metronidazole vaginal is compared to oral antibiotic therapy less effective. A co-treatment of the sexual partner is not needed.