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CLINICAL REVIEW: Des Spence and Catriona Melville Vaginal discharge BMJ 2007; 335: 1147-1151 [Full text]

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Treat or not to treat aymptomatic Bacterial Vaginosis in Pregnancy?

Dr N Bassi   (30 November 2007)

Primum non nocere

Biji T Kurien   (2 December 2007)

Consider GBS treatment in labour not pregnancy

Brendan T Moran   (9 December 2007)

Treat or not to treat aymptomatic Bacterial Vaginosis in Pregnancy? 30 November 2007
Dr N Bassi, GP Nottingham Send response to journal: Re: Treat or not to treat aymptomatic Bacterial Vaginosis in Pregnancy?	Dear Author, You implied in the article that asymptomatic BV in pregnancy should be treated.According to the NICE guidelines 2003 for ante-natal care asymptomatic BV does not require treatment as it does not reduce the risk of pre-term birth.So who is right? Competing interests: None declared
Primum non nocere 2 December 2007
Biji T Kurien, Senior Research Scientist Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA Send response to journal: Re: Primum non nocere	In the article “Vaginal discharge” it is not clear whether the statement “Vaginal pH testing (using narrow range pH paper) is a quick, cheap, and simple test that can help discriminate between the two most common causes of vaginal discharge—bacterial vaginosis (pH 4.5) and vulvovaginal candidiasis (pH <4.5)” by Spence and Melville implies the measuring of in-vaginal pH using pH paper strips. The authors also cite a study that performed pH testing for the diagnosis of bacterial vaginosis (Reference #22 in the article). This study describes the use of vaginal swabs and pH determination by smearing the swab contents on to pH paper strips, which is the right approach rather than inserting the pH paper directly into the vagina. It needs to be mentioned that it important to consider the safety of inserting a pH paper infused with lichens (http://www.madehow.com/Volume-6/Litmus-Paper.html)/treated with various harmful chemicals (in the case of Universal pH papers) (http://www.ausetute.com.au/indicata.html), including phenolphthalein banned by the US Food and Drug Administration on account of its tumor- and infertility-inducing potential (2,3) (http://ntp.niehs.nih.gov/?objectid=071D1613-04B4-DD88-0B81AC15C02061B8) into the vagina. A vaginal swab could be mixed with a small volume of water (pH 7), which could then be applied to the pH paper if difficulty in obtaining enough vaginal fluid is an issue (2). The patience of patients is phenomenal (4). However, the potential for harm to patients should not be overlooked. References 1)Spence D and Melville C. Vaginal discharge. BMJ 2007;335:1147- 1151. 2)Kurien BT. Reply to 'pH paper trumps expensive kits in measuring acidity'. Nat Med. 2007;13:1275 3)National Toxicology Program. Rep. Carcinog. 2002;10, 195–197. 4)Kurien BT. Patience of patients. Med. J. Aust. 2002; 179, 653. Competing interests: None declared
Consider GBS treatment in labour not pregnancy 9 December 2007
Brendan T Moran, ST2 O+G Oxford Radcliffe Hospitals NHS Trust Send response to journal: Re: Consider GBS treatment in labour not pregnancy	Regarding the statement: "Group B Streptococcus is often reported on vaginal swabs, but this organism is not usually thought to cause discharge and only needs treatment in pregnancy". Treatment should only be considered in labour. According to the Royal College of Obstetricians and Gynaecologists guidelines (Prevention of Early Onset Neonatal Group B Streptococcal Disease (36) - November 2003): Antenatal treatment with penicillin is not recommended. (B) Intrapartum antibiotic prophylaxis should be considered if GBS is detected incidentally in the vagina or the urine in the current pregnancy. (C) Competing interests: None declared