Bacterial Vaginosis

Vatsla Dadhwal (Assistant Professor)

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India

Summary

• Bacterial vaginosis (BV) is characterised by anaerobic bacterial overgrowth of the vaginal flora, but the exact aetiology and pathogenesis remain unclear.
  
  
• BV is associated with complications during pregnancy including chorioamnionitis, premature rupture of the membranes (PROM), and preterm labour and delivery, as well as with post-hysterectomy vaginal cuff cellulitis.
  
  
• Oral metronidazole remains the treatment of choice, although recurrences and relapses of infection are common.

Editor's Comment

BV is the most prevalent cause of vaginal infections in women of reproductive age. The demonstrated relationship between BV and complications of pregnancy such as chorioamnionitis, preterm labour and delivery, further emphasises the need for aggressive management of this disorder in all symptomatic women.

Prevention of Maternal-Child HIV Transmission

Atul K. Patel (Assistant Professor)

Department of Medicine, NHL Municipal Medical College, Ahmedabad, India

Summary

• Acquired immune deficiency syndrome (AIDS) has already doubled infant mortality in countries worst affected and is a growing problem in India and south-east Asia.
  
  
• Human immunodeficiency virus type 1 (HIV-1) the aetiological agent of AIDS can be vertically transmitted during pregnancy, childbirth, or breastfeeding.
  
  
• Key preventive strategies include family planning services for HIV-infected women as well as reducing transmission risk factors such as maternal vitamin A deficiency.
  
  
• Antiretroviral drugs are a further option for pregnant women, with zidovudine (AZT) and more recently nevirapine (NVP) effectively reducing transmission rates.
  
  
• NVP therapy offers a simple and affordable regimen and is therefore ideally suited for use in developing countries.
  
  
• Elective caesarean section (ECS) also decreases the risk of perinatal HIV transmission, although the benefit of this procedure to the infant must be weighed against the increased risk to the immunocompromised mother.

Editor's Comment

Prevention of HIV transmission from mother to child is an important target and is discussed herein with reference to the needs of developing countries in particular.

Vaginal Infections - A Pathological Appraisal

Karuna Ramesh Kumar (Associate Professor)

Department of Pathology, St John's Medical College, Bangalore, India

Summary

• Cytology plays a major role in screening for vaginal infections.
  
  
• In addition to the Papanicolaou (Pap) stain, Gram's stain, periodic acid-Schiff (PAS) stain, acid-fast bacilli (AFB) stain, and fungus stain are helpful in identifying the aetiologic agent.
  
  
• When the patient does not respond to standard treatment, unusual causes of vaginitis should be considered.
  
  
• A high degree of clinical suspicion combined with adequate clinical details will help the pathologist narrow the possibilities in the search for the aetiological agent.

Editor's Comment

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