From the Guidelines
Bacterial vaginosis (BV) is a common vaginal infection caused by an imbalance of naturally occurring bacteria in the vagina, resulting from replacement of the normal H2O2-producing Lactobacillus sp. with high concentrations of anaerobic bacteria, G. vaginalis, and Mycoplasma hominis 1.
Causes and Risk Factors
The cause of BV is not fully understood, but risk factors include having multiple sex partners, douching, and lack of vaginal lactobacilli; it is unclear whether BV results from acquisition of a sexually transmitted pathogen 1. Women who have never been sexually active are rarely affected.
Preventive Measures
Preventive measures include:
- Practicing good hygiene
- Avoiding douching
- Wearing breathable clothing
- Using condoms during sex
- Avoiding scented soaps and bubble baths
- Wiping from front to back after using the bathroom
Signs and Symptoms
Signs and symptoms of BV may include:
- A thin, white or gray vaginal discharge with a fishy odor
- Itching or burning in the vagina
- Burning during urination If symptoms occur, it is essential to seek medical attention for proper diagnosis and treatment.
Treatment Options
Treatment for BV typically involves antibiotics, such as:
- Metronidazole (Flagyl) 500mg twice daily for 7 days
- Clindamycin (Cleocin) 300mg twice daily for 7 days In some cases, a single dose of metronidazole (2g) or clindamycin (300mg) may be prescribed 1. It is crucial to complete the full course of antibiotics as prescribed, even if symptoms improve before finishing the medication. Additionally, sexual partners do not need to be treated, but it is recommended to avoid sex until treatment is completed and symptoms have resolved 1.
From the Research
Causes and Risk Factors
- Bacterial vaginosis (BV) is associated with an imbalance in the vaginal microbiome, where the normal Lactobacillus-dominated flora is replaced by a diverse array of bacteria, including Gardnerella vaginalis and anaerobic bacteria 2, 3, 4.
- The exact causes of BV are not fully understood, but it is thought to be related to a combination of factors, including sexual behavior, hormonal changes, and the use of certain products that can disrupt the vaginal microbiome 5.
- Risk factors for BV include unprotected intercourse, multiple sexual partners, and the use of hormonal contraceptives 5.
Preventive Measures
- Behavioral modifications that may help prevent BV include smoking cessation, condom use, and hormonal contraception 2.
- Additional strategies that may be considered include dietary modification, non-medical vaginally applied products, choice of lubricant, and treatments from medical practices outside of allopathic medicine 2.
- Maintaining a healthy vaginal microbiome through the use of probiotics or vaginal microbiome transplantation may also help prevent BV 2, 3.
Signs and Symptoms
- BV is characterized by abnormal vaginal discharge, which can be thin and white or grayish in color, and may have a strong, fishy odor 4.
- Other symptoms of BV may include vaginal inflammation, itching, and burning during urination 4.
Treatment Options
- The current and only FDA-approved treatment regimens for BV are antibiotics, such as metronidazole and clindamycin 2.
- However, antibiotics may not provide a consistent long-term cure for many women, and recurrence rates can be as high as 50-80% within a year of completing treatment 2.
- Alternative or adjunct treatments, including probiotics, vaginal microbiome transplantation, pH modulation, and biofilm disruption, are being explored to improve treatment outcomes and reduce recurrence rates 2, 3.
- Partner treatment may also be considered to reduce the risk of reinfection, although the effectiveness of this approach is still being studied 6.