GARDNERELLA

VAGINALIS
R.Varidianto Yudo T., dr
 CLASSIFICATION
 Kingdom : Bacteria
 Phylum : Actinobacteria
 Order : Bifidobacteriales
 Family : Bifidobacteriaceae
 Genus : Gardnerella
 Species : G. vaginalis
 MORPHOLOGY
 The organism appears as pleomorphic
bacilli approximately 0.5 µm in diameter
and 1.5 to 2.5 µm in length.
 It is gramnegative to gram-variable, with
retention of the Gram stain being more
pronounced in young cultures 8 to 12
hours old.
 Club forms and metachromatic granules
are often present.
 The organism is nonmotile and
nonencapsulated.
 G. vaginalis grows as small, circular,
convex, gray colonies on chocolate agar; it
will also grow on HBT agar. A selective
medium for G. vaginalis is colistin-oxolinic
acid blood agar
 CHARACTERISTIC
 Most strains of Gardnerella are
facultatively anaerobic and are fastidious
in their nutritional requirements.
 Unlike Haemophilus species, however,
Gardnerella requires neither hemin nor
nicotinamide adenine nucleotides.
 DISEASE
 Bacterial vaginosis or nonspecific vaginitis. It is
present in the vagina of 40 percent of
asymptomatic women but is found in large
numbers in over 95 percent of patients with
vaginitis. Masses of bacteria may be found on
the surface of epithelial cells in the discharge
 G. vaginitis has also been associated with septic
abortion, puerperal fever with bacteremia, and
neonatal bacteremia.
 PATHOGENESIS
 A healthy vagina normally contains many
microorganisms, one of the common ones
being Lactobacillus acidophilus.
Lactobacillus appears to help prevent
other vaginal microorganisms from
multiplying to a level where they cause
symptoms. The microorganisms involved
in BV include Gardnerella vaginalis,
Mobiluncus, Bacteroides, and Mycoplasma.
 In general reduction in the normal
bacterial flora, because of antibiotics or PH
inbalance, allows more resistant bacteria
to gain a foothold and multiply; in turn
these produce toxins which effect the
body's natural defences and make
recolonization of healthy bacteria more
difficult.
 LABORATORY DIAGNOSIS
 A wet mount preparation of physiologic
saline mixed with vaginal secretions should
be examined under low-power and high-
power objectives. There are few white
blood cells and lactobacilli. The
characteristic "clue cells" are identified as
numerous stippled or granulated epithelial
cells. This appearance is caused by
adherence of almost uniformly spaced G
vaginalis organisms on their surfaces.
 Clumps of G vaginalis organisms may also
be noted attached to the edges of
epithelial cells or floating free in the
preparation. Cultures are seldom
necessary to establish a diagnosis.
 The pH of the vaginal secretion should be
examine whereas pH is over 4.5 (normal
pH is < 4.5)
 Gardnerella vaginalis (bacterial vaginitis) (Papanicolaou).Small and short
Gram-negative rods are clusterd onto the squamous epithelium to form "clue
cells", pathognomonic of G. vaginalis infection. Doederlein bacilli are never
seen.
 Doederlein bacilli (Lactobacillus) (Papanicolaou). Long rods of this type
(Lactobacilli), the normal flora of the vagina in the premenopausal woman,
maintain the acidity of the vaginal lumen. Some are phagocytized by
neutrophils.
 TREATMENT
 The treatment of choice for G vaginalis is oral
metronidazole, 500 mg twice daily for 6 days. A
single dose of 2 g has proved effective in
treatment of adolescent patients, but in general
a 5- to 7-day course of treatment is more
effective.
 Although it is recommended that sexual partners
be treated simultaneously, it is unclear whether
this significantly decreases the incidence of
recurrent disease.
 Contraindications to metronidazole include
certain blood dyscrasias and central
nervous system diseases. An important
side effect is intolerance to alcohol. The
drug is contraindicated during early
pregnancy and lactation.