Hopp til hovedinnhold

Bakteriell vaginose

Sist revidert:
Sist revidert av:
Definisjon:
Endret vaginal bakterieflora med reduksjon av melkesyrebakterier og økning av anaerobe bakterier. Assosiert med økt risiko for senabort og for tidlig fødsel og gir økt risiko for seksuelt overførte infeksjoner og infeksjoner etter gynekologiske inngrep
Forekomst:
Hos 10-30%
Symptomer:
Økt, illeluktende, tynnflytende og homogen vaginal utflod. Asymptomatisk hos mer enn 50% 
Funn:
Kliniske funn kan være tyntflytende, melkaktig, noen ganger skummende utflod med ubehagelig lukt. Som regel ingen påfallende vulvitt eller vaginitt
Diagnostikk:
Vaginal pH > 4,5. Clue cells kan sees ved mikroskopi. Fiskelukt kan avdekkes ved KOH luktetest
Behandling:
Tilfeldig påvist BV hos asymptomatiske kvinner skal ikke behandles. Antiseptisk lokalbehandling, ev. antibiotika lokalt eller peroralt ved behandlingssvikt. Symptomgivende BV anbefales behandlet før graviditet.
  1. Helsedirektoratet (2021). Nasjonal faglig retningslinje for antibiotika i primærhelsetjenesten nettdokument. Oslo: Helsedirektoratet (sist faglig oppdatert 07. september 2022, lest 17. januar 2023).
  2. Kairys N, Garg M. Bacterial Vaginosis. 2022 July 4. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29083654. Accessed 2023 Jan 17 www.ncbi.nlm.nih.gov  
  3. Paavonen J, Brunham RC. Bacterial Vaginosis and Desquamative Inflammatory Vaginitis. N Engl J Med 2018; 379: 2246-54. doi:10.1056/NEJMra1808418 DOI  
  4. Vodstrcil LA, Hocking JS, Law M, et al. Hormonal contraception is associated with a reduced risk of bacterial vaginosis: a systematic review and meta-analysis. PLoS One. 2013;8 :e73055. doi: 10.1371/journal.pone.0073055. eCollection 2013.
  5. Peebles K, Velloza J, Balkus JE et al. High Global Burden and Costs of Bacterial Vaginosis: A Systematic Review and Meta-Analysis. Sex Transm Dis. 2019 May;46(5):304-311. PMID: 30624309.
  6. Deese J, Pradhan S, Goetz H, Morrison C. Contraceptive use and the risk of sexually transmitted infection: systematic review and current perspectives. Open Access J Contracept. 2018 Nov 12;9:91-112. PMID: 30519127 PubMed  
  7. Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74:14-22. PubMed  
  8. Vieira-Baptista P, Silva AR, Costa M et al. Diagnosis of bacterial vaginosis: Clinical or microscopic? A cross-sectional study. Int J Gynaecol Obstet. 2022 Mar;156(3):552-559. Epub 2021 Jul 12. PMID: 34160078 PubMed  
  9. Lowe NK, Neal JL, Ryan-Wenger NA. Accuracy of the clinical diagnosis of vaginitis compared with a DNA probe laboratory standard. Obstet Gynecol 2009; 113: 89-95. PubMed  
  10. Nodenes K, Gammelsrud KW, Findal-Drammen G. Bakteriell vaginose. Veielder i fødselshjelp. Norsk gynekologisk forening. Oslo, 2020 www.legeforeningen.no  
  11. Brocklehurst P, Gordon A, Heatley E, Milan SJ. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD000262. DOI: 10.1002/14651858.CD000262.pub4. DOI  
  12. Mendling W, Weissenbacher ER, Gerber S, et al. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch Gynecol Obstet 2016; 293: 469-84. pmid:26506926 PubMed  
  13. Amaya-Guio J, Viveros-Carreño DA, Sierra-Barrios EM, Martinez-Velasquez MY, Grillo-Ardila CF. Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD011701. DOI: 10.1002/14651858.CD011701.pub2 DOI  
  14. Myrhaug HT, Brurberg KG, Kirkehei I og Reinar LM. Klindamycin til gravide med asymptomatisk bakteriell vaginose . Rapport fra Kunnskapssenteret nr 11 - 2010.
  15. Subtil D, Brabant G, Tilloy E et al. Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. Lancet 2018. pmid:30322724 PubMed  
  16. Afifirad R, Darb Emamie A, Golmoradi Zadeh R et al. Effects of Pro/Prebiotics Alone over Pro/Prebiotics Combined with Conventional Antibiotic Therapy to Treat Bacterial Vaginosis: A Systematic Review. Int J Clin Pract. 2022 Apr 21;2022:4774783. PMID: 35685517 PubMed  
  17. Cohen CR, Wierzbicki MR, French AL et al. Randomized Trial of Lactin-V to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med 2020; 382:1906-1915. New England Journal of Medicine  
  18. van de Wijgert J, Verwijs MC. Lactobacilli-containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review and recommendations for future trial designs. BJOG. 2020 Jan;127(2):287-299. Epub 2019 Aug 8. PMID: 31299136 PubMed  
  19. Larsson PG, Stray-Pedersen B, Ryttig KR, Larsen S. Human lactobacilli as supplementation of clindamycin to patients with bacterial vaginosis reduce the recurrence rate; a 6-month, double-blind, randomized, placebo-controlled study. BMC Womens Health 2008; 8: 3. PubMed  
  20. Bradshaw CS, Morton AN, Hocking J, et al. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis 2006; 193: 1478. PubMed  
  21. Kahwati LC, Clark R, Berkman N et al. Screening for Bacterial Vaginosis in Pregnant Adolescents and Women to Prevent Preterm Delivery: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020 Apr 7;323(13):1293-1309. PMID: 32259235 PubMed  
  • Silje Folven Barlindhaug, spesialist allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Ingard Løge, spesialist i allmennmedisin, redaktør Norsk Elektronisk Legehåndbok