Bacterial vaginosis

CASE 1

• A 26 year old woman has developed a grayish vaginal discharge that has an unpleasant odor. She has had no fever, genital ulceration, or pelvic pain. She is married, and both she and her husband claim to have been faithful to one another.

• On examination, she has a malodorous, light gray discharge at the vaginal introitus. Application of a pH strip to vaginal wall indicates a pH of 7.0. The addition of 10% KOH to a sample of the discharge on a slide produces an intense “fishy” amine odor. A saline preparation of the discharge showed epithelial cells coated with bacteria:

Questions:

1. Why is the discharge malodorous?
2. What causes the “fishy” odor in ther presence of KOH?
3. What is the significance of the vaginal pH?
4. What is the significance of bacteria-coated cells (“clue” cells)?
5. Is this a sexually transmitted disease? Should her husband be examined and treated??
6. What bacteria are associated with this disorder? Can any single one of these be considered the "cause" of bacterial vaginosis?
7. How should this patient be treated?