Clinical and Laboratory Diagnosis
To establish an accurate diagnosis, clinicians rely on specific criteria. The most critical finding is the microscopic appearance: the smear completely lacks significant leukocytosis, differentiating this process from classic inflammation. Concurrently, an alteration in acidity is recorded, with the vaginal pH exceeding 4.5.
A special place is held by the whiff (amine) test. The essence of the method is the addition of a 10% potassium hydroxide (KOH) solution to the vaginal discharge. The test is considered positive if there is an immediate, sharp enhancement of a characteristic 'fishy' odor.
Additional methods such as polymerase chain reaction (PCR), ELISA, direct immunofluorescence (DIF), or bacterial culture are used relatively infrequently. The golden rule when utilizing these tests is the strict quantitative evaluation of the detected microorganisms. This is because Gardnerella vaginalis can be present in low titers as part of the normal microflora. Only high concentrations of the bacteria hold diagnostic significance.
Therapeutic Approach
Management of the condition is built upon a comprehensive approach. The physician must provide etiotropic, pathogenetic, and symptomatic care.
- First stage (antibacterial): The pathogens demonstrate susceptibility to penicillins, lincomycin, clindamycin, and vancomycin. However, the absolute drugs of choice are nitroimidazoles (primarily metronidazole).
- Second stage (restorative): Upon completion of the antibiotic course, probiotics (e.g., Lactobacillus preparations) are strictly indicated. They are necessary to restore the normal vaginal biocenosis.
Specific prophylaxis (vaccines) has not been developed to date.
Characteristics of the Genus Mobiluncus
The genus Mobiluncus (main species being M. curtisii and M. mulieris) actively participates in the development of vaginosis as an associative bacterium during bacterial overgrowth.
Morphology and Physiology: These are thin, curved rods with tapered ends (measuring 0.4–0.6 × 1.2–4.0 µm). They do not form spores but are motile via lateral or subpolar flagella. In smears, they appear singly or in pairs, resembling 'seagull wings'. Although their cell wall structure is characteristic of Gram-positive microorganisms, they stain gram-variable.
Cultural Properties:
- Type of respiration: Obligate anaerobes. They possess extremely low resistance and perish instantly upon exposure to air.
- Cultivation: They grow only on complex nutrient media at 37 °C, forming smooth, transparent, and colorless colonies.
- Biochemistry: Fermentative metabolism (ferment glucose). Catalase, indole, and oxidase tests are strictly negative.