BASHH National Audit Group
Clinic Policy Audit on the Management of Bacterial Vaginosis
BASHH Clinical Effectiveness Group Auditable Outcome Measures (2006):
• Diagnosis of BV in clinical practice. Compare routine diagnosis with stored vaginal smears examined by
Gram stain
• Screening and treatment of women undergoing termination of pregnancy. This should also include screening for
Chlamydia trachomatis (see guideline for chlamydia)
Five essential questions are: Qs 3, 4, 5, 7, 9 highlighted in yellow
Q.1a: Type of clinic. Please tick all that apply:
District general hospital

Teaching hospital

Community-based service

Other
 Please specify:
Q.1b: Name of organisation:
Q.2a: Annual female clinic attendances (new and re-book episodes):
Q.2c: Total number of female patients seen with bacterial vaginosis (BV) in your clinic during
<please state audit interval>:
Screening and Testing
Q.3: To which of the following groups of women does your clinic routinely offer testing for
BV? Please tick all that apply:
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes, please specify:
Women without symptoms
Women complaining of vaginal discharge
Women with any genital symptom
Women complaining of vaginal malodour
Pregnant women
Women having termination of pregnancy
Other
Q.4: Which of the following findings does your clinic routinely use for the diagnosis of BV?
Please tick all that apply:
Nature of vaginal discharge
pH measurement of a vaginal swab
Gram stain of a vaginal swab
Wet preparation of a vaginal swab
Potassium hydroxide test
Culture of a vaginal swab for anaerobic bacteria
Hay/ Ison criteria (grading of vaginal flora 1-3 )
Nugent criteria(grading 1-10)
Other
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes, please specify:
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BASHH National Audit Group
Management of bacterial vaginosis
Q.5: To which of the following groups of women with BV does your clinic routinely offer
treatment for BV? Please tick all that apply:
All women, including those without symptoms
Only women volunteering relevant symptoms*
Women not volunteering relevant symptoms but from
whom relevant symptoms are elicted
First trimester of pregnancy (0 to 12 weeks)
Second trimester of pregnancy (13 to 26 weeks)
Third trimester of pregnancy (27 to 40 weeks)
Before medical termination of pregnancy
During medical termination of pregnancy
Before surgical termination of pregnancy
During surgical termination of pregnancy
 Yes
 Yes
 No
 No
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 No
 No
 No
 No
 No
 No
 No
 No
Other
*relevant symptoms means symptoms associated with BV
 Yes, please specify:
Q.6: Which of the following does your clinic routinely offer advice on, with regards to the
management of BV. Please tick all that apply:
 Avoidance of genital contact with possible skin irritants and allergens
 Avoidance of genital contact with agents with antiseptic properties when washing
 Showering instead of bathing in a tub
 Avoidance of vaginal douching
 Use of a soap substitute for genital skin washing
 Other, please specify:
Q.7a: Which of the following does your clinic routinely offer as a first line treatment for
bacterial vaginosis? Please tick all that apply:
Treatment
Dose
Duration
 Oral metronidazole
 Metronidazole pessaries
 Metronidazole gel
 Oral clindamycin
 Clindamycin tablets
 Other, please specify below:
Q.7b: Is it your clinic policy routinely to document what the patient should do if symptoms do
not resolve with first line treatment?
 Yes
 No
Q.8: To which of the following women does your clinic routinely offer tests of cure after
treatment for BV? Please tick all that apply:
Women with no symptoms after treatment for BV
Women with persistent vaginal discharge after treatment for BV
Other
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 Yes
 No
 Yes
 No
 Yes, please specify:
BASHH National Audit Group
Management of recurrent bacterial vaginosis
Recurrent bacterial vaginosis may be defined as three or more proved (clinically by Amsel’s criteria
or microscopically) episodes of BV in 12 months (There is no consensus definition of recurrent BV;
this definition is taken from Wilson, JD Sex Transm Infect 2004;80:8-11).
Q.9: Which of the following does your clinic routinely offer with regards to the management
of recurrent BV. Please tick all that apply:
 A longer course of a first line treatment
 Suppressive treatment with vaginal metronidazole gel
 Provision of vaginal metronidazole gel for perimenstrual treatment
 Provision of oral metronidazole courses for episodic patient initiation
 Provision of vaginal antibiotic treatments for episodic patient initiation
 Advice to use vaginal acidic gel
 Prescription of vaginal acidic gel
 Advice to use vaginal lactic acid gel
 Prescription of vaginal lactic acid gel
 Advice to use vaginal hydrogen peroxide producing strains of lactobacilli replacement
 Advice to use a probiotic (including live yohurt)
 Advice to use vaginal hydrogen peroxide treatment
 Combination treatments of any of the above, please specify:
 Other, please specify:
Q.10: Are patients treated for BV routinely offered written information on BV in your clinic?
Yes 
No 
Q.11a: Does your clinic have a written policy, protocol, treatment guideline, care pathway or
other document dealing with the management of BV?
Yes 
No 
Q.11b: If Yes, is this based on the BASHH Guideline for the management of BV?
Yes 
No 
Q.12: Please provide any additional comments about the management of BV in your clinic:
Last modified 18 March 2011. Hugo McClean.
Thank you for completing this questionnaire
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