Mild inflammation, perivaginal irritation, dysuria, dyspareunia with a occasional fishy vaginal odor and a gray, thin, bubbly, homogeneous discharge. Vaginal pH is > 4.5; 10 to 20% KOH added to the discharge produces a fishy odor. A wet mount has clue cells.
Usually in sexually active women, including women who have sex with women (PubMed).
Hormonal contraception is associated with relapse (PubMed).
BV is primarily an ecologic/microbiome proble, "A careful analysis of the available data suggests that what we term BV is, in fact, a set of common clinical signs and symptoms that can be provoked by a plethora of bacterial species with proinflammatory characteristics, coupled to an immune response driven by variability in host immune function."(PubMed): there is a shift from a primarily Lactobacillus species (L crispatus, L. jensenii, and L. iners, different species than those found in yogurt or probiotics) of few types to a mixed microbiology of a wide variety of anaerobes, many of which can not be grown but can be detected by molecular techniques. It is not a problem with one bug, but a substitution of normal flora with multiple bugs.
G. vaginalis, Bacteroides, Prevotella, Mobiluncus, Mycoplasma hominis and Ureaplasma urealyticum have all been isolated. This disease is more of a change in the flora of the vagina than to any particular organism. Women who have sex with women may have different flora, Clostridiales bacteria, designated as BVAB1, BVAB2, or BVAB3m; Peptoniphilus lacrimalis; and Megasphaera phylotype 2 that is associated with increased failure of topical therapy (PubMed).
Metronidazole 500 mg po bid for 7 d OR 250 mg po tid for 7 d OR 750 mg extended-release tablet po qd for 7 d OR 2 g po single dose OR clindamycin 300 mg PO bid for 7 d OR Clindamycin 2% vaginal cream 5 g vaginally qhs for 7 d OR Metronidazole 0.75% vaginal gel 5 g vaginally bid or qhs for 5 d.
see http://www.cdc.gov/STD/treatment/ for complete information.