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Introduction of Gardnerella vaginalis

Gardnerella vaginalis is formerly known as Haemophilus vaginalis or Corynebacterium vaginale. It is normally isolated from the normal female genital tract in low numbers. It causes a condition called bacterial vaginosis.

Morphology of Gardnerella vaginalis

Haemophilus vaginalis is gram-negative but appears gram variable in smears. Non-motile, small pleomorphic rod, which shows metachromatic granules. Gardnerella vaginalis produces minute hemolytic colonies on blood agar, incubated aerobically under 5% CO2 for 24-48 hours. It is catalase, oxidase, indole, and urease negative.

Bacterial vaginosis organisms associated:

It affects women of reproductive age. It is associated with an alternation of the normal vaginal flora, which is as follows. Increase in the concentration of

  • Gardnerella vaginalis.
  • Mobiluncus (motile, curved, gram-variable, or gram-negative, anaerobic rods).
  • Several other anaerobes (Prevotella and some Peptostreptococcus)
  • Mycoplasma hominis.

Decrease in the concentrations of lactobacilli (lactobacilli usually maintain the acidic pH of the vagina, thereby inhibiting the growth of pathogenic organisms).

Risk factors

  • Coexisting other infections like HIV, Chlamydia trachomatis, & Neisseria gonorrhoeae.
  • Recent unprotected vaginal intercourse.
  • Vaginal douching.
  • Premature rupture of membranes and preterm labor.

Laboratory diagnosis of Gardnerella vaginalis

No associated inflammation. It is clinically diagnosed by Amsel’s criteria.

Amsel’s Criteria:

Bacterial vaginosis is diagnosed if any 3 of the following 4 findings are present:

  1. Profuse thin (low viscous), white homogeneous vaginal discharge uniformly coated on the vaginal wall.
  2. a pH of vaginal discharge more than 4.5.
  3. Accentuation of distinct fishy odor (attributable to volatile amines such as trimethylamine) immediately after vaginal secretions is mixed with 10% solution of KOH (Whiff test).
  4. Clue cells: They are vaginal epithelial cells coated with coccobacilli, which have a granular appearance and indistinct borders observed on a wet mount.

Nugent’s score:

It is a scoring system followed for the diagnosis of bacterial vaginosis; done by counting the number of Gardnerella vaginalis, Mobiluncus, and lactobacilli present in the Gram-stained smear of vaginal discharge. A score of more than or equal to seven is diagnostic characteristics.

Treatment

Oral metronidazole, given 500 mg twice daily for 7 days.

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