The key changes in this disease are a decrease in the normal acidity of the vagina, a marked derangement of the normal vaginal flora, and a substantial increase in the numbers of clue cells (figure 25.4). Clue cells are epithelial cells that have sloughed off the vaginal wall and are covered with masses of bacteria. The pH of the vaginal secretions is elevated above the normal of 4.5. No inflammation occurs unless there is another, concurrent vaginal infection. The strong fishy odor is due to metabolic products of the anaerobes, including the amines putrescine and cadaverine.
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