Gardnerella Vaginalis

00:01 Gardnerella Vaginalis; a bacteria. Gardnerella are small pleomorphic gram-variable bacilli.

00:09 Pleomorphic because they can appear not just as caucus but sometimes as a more oval-shaped.

00:17 And gram-variable because the gram up take - gram stain uptake may be a dark purple as a gram-positive or a pink as a gram-negative and they can appear sometimes as both, sometimes in the same organism.

00:31 The image on the slide projects a single Gardnerella organism which in this instance looks quite caucus or caucal in shape; rounded.

00:40 But if one were to look at it by switching the image just 90°, it might appear much more elongated or rodlike.

00:49 Regardless, Gardnerella are none spore forming and they're nonmotile; they stay where they're placed when they grow.

00:56 They are facultatively anaerobic and they are one of the causes of bacterial vaginosis.

01:03 That particular entity frequently is polymicrobial caused by many different bacteria.

01:08 But as we'll see; the Gardnerella are fairly prominent component of the diagnosis of a bacterial vaginosis.

01:17 How does the pathogenesis occur? Typically, the organism will adhere to its receptor sites, penetrating through the outer layers of vaginal mucosa, via vaginolysin.

01:29 Once attached to underlying epithelium, the Gardnerella bacteria are able to multiply and then hyper secrete or form a biofilm; its own sort of proteinaceous and polysaccharide rich covering which further prevents it from immunologic discovery and immune response.

01:49 While there under the biofilm, the Gardnerella compete with normal vaginal flora such as Lactobacillus to dominate the overall vaginal flora.

02:00 Once that occurs, then escalation can occur in the vaginitis.

02:05 What are the clinical manifestations? Typically, as the Gardnerella emerges and starts to hyper produce and hyper secrete, a nonpainful, but a grayish vaginal discharge will develop.

02:18 And here's the icky part and the prominent part. It smells like dead fish.

02:23 Yes, Gardnerella is known for having a fishy smell and its presence while distinguished from Trichomonas which also can create that fishy smell is certainly a suggestion that a bacterial vaginitis or vaginalis is ongoing.

02:40 The images you see on the screen simply show a multiplication of the Gardnerella.

02:44 And here as multiplying, they appear more elongated, more in a rod shaped form.

02:51 How do we make the diagnosis? Well, we're fortunate, in being Sherlock Holmes that we have clue cells.

02:59 A clue sell is a vaginal epithelial cell which is coded by attached or bound Gardnerella bacteria such as you see in the image on the screen.

03:10 You can distinguish the clue cell, so noted with the arrow from other vaginal epithelial cells on the right side of the image which have only a few bacteria attached to them.

03:22 In addition, the amine whiff test is quite significant.

03:27 In this, one mixes that gray vaginal discharge with 10% potassium hydroxide and that will further enhance the fishy smell just in case anybody had any doubts about its presence in the first place.

03:40 Treatment for Gardnerella involves typically the antibiotic metronidazole as a drug with excellent anaerobic coverage.

03:48 Although, clindamycin also can be used as this continues the anaerobic coverage significantly.

03:56 So Gardnerella, the organism with a fishy smell and something to be quite aware of although distinguished from Trichomonas, but it contributes significantly to bacterial vaginitis.