Gardnerella Vaginalis

by Carlo Raj, MD

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    00:01 Here we have our third and important cause as well of vaginosis.

    00:06 What you do not have to worry about on your boards is which one's number one, which one's number two and which one's number three in terms of incidence and such.

    00:12 What you do have to know is all three.

    00:14 So keep them together.

    00:16 We have a fungal infection causing vaginosis, that was candidal.

    00:20 Number two, we had a protozoal, that was trichomonas.

    00:24 And thirdly, we have a bacterial.

    00:26 Allow the name to perhaps help you out a little bit.

    00:29 We have a Gardnerella vaginalis.

    00:32 So here, you have now laid out a garden full of gram-negative bacteria.

    00:39 The garden has now gotten old the everything in the garden has died and giving you a malodorous, thick-gray -- well, in this case, it will be vaginal discharge if that helps you.

    00:52 This is the one in which you would expect to smell something malodorous with a bacterial vaginosis called Gardnerella vaginalis.

    01:02 Some would say this would be the most common, but as I told you earlier, this would not be your focus.

    01:08 The three major types of vaginosis, know them all.

    01:12 Not truly considered to be an STI or STD.

    01:16 And here, decreases in hydrogen peroxide producing lactobacilli and cause -- Well, that increase in pH is the environment that this organism loves to thrive in.

    01:28 There are different reasons as to why the pH within the vagina would increase.

    01:33 Well, you have a female who's been repeatedly douching.

    01:37 And if she's douching then perhaps her pH increases.

    01:41 Perhaps, perhaps, when her and her male partner are having sexual intercourse, there's deposition of semen in the vagina, therefore causing a rise in pH.

    01:54 Our point is this, any trigger or any cause in which there's an increase in pH within the vaginal canal, predisposes your female to, unfortunately, perhaps develop a bacterial vaginosis.

    02:06 What we're seeing here in the image would be something called and, specifically for Gardnerella vaginalis, and these are called clue cells.

    02:18 The clue cells, vaginal epithelial cells, covered with the bacteria is exactly what you 're seeing.

    02:23 So it literally looks like a swarm of bacteria which then attacks vaginal epithelial cell.

    02:29 Now, I told you and I was just having a little bit of fun with this, meaning to say that you have a garden that's gone bad.

    02:36 And so therefore, you have malodorous.

    02:39 It's called a positive "whiff test." The 10% KOH added to the discharge yields what's known as a "fishy" odor.

    02:50 Trichonomas can also be positive, so it must be ruled out and that?s' quite easy.

    02:54 With trichomonas, remember those organisms are flagellated and they will be motile or mobile.

    02:59 Here, however, not at all.

    03:01 These are bacteria, and they do not have flagella, but they will swarm upon your epithetial cell.

    03:07 And you call them clue cells.

    03:10 High incidence of preterm deliveries is something that you're paying attention to with Gardnerella.

    About the Lecture

    The lecture Gardnerella Vaginalis by Carlo Raj, MD is from the course Sexually Transmitted Diseases (STDs).

    Included Quiz Questions

    1. Vaginal itching, a watery discharge with "fishy" odor that may be more pronounced after having intercourse
    2. Vaginal itching with white, curd-like, odorless discharge
    3. Pelvic pain, fever, bloody vaginal discharge
    4. Dyspareunia with no other specific symptoms
    5. Vulvovaginal pain, pruritis with red vesicular eruption in the area
    1. Decrease in H2O2 producing lactobacillus causing an increase in vaginal pH
    2. Diabetes mellitus
    3. Recurrent UTIs
    4. Polycystic Ovaries
    5. OCP use
    1. Preterm labor
    2. Prolonged labor
    3. Postpartum hemorrhage
    4. Eclampsia
    5. Septic shock and DIC

    Author of lecture Gardnerella Vaginalis

     Carlo Raj, MD

    Carlo Raj, MD

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