From the Guidelines
Bacterial Vaginosis (BV) can increase the risk of Pelvic Inflammatory Disease (PID) by disrupting the normal vaginal microbiome and creating an environment that allows pathogenic bacteria to ascend into the upper genital tract. The recommended treatment for BV is oral metronidazole 500mg twice daily for 7 days, or metronidazole gel 0.75% intravaginally once daily for 5 days, or clindamycin cream 2% intravaginally at bedtime for 7 days, as stated in the 2002 guidelines for treating STDs 1. BV occurs when the normal Lactobacillus-dominant vaginal flora is replaced by an overgrowth of anaerobic bacteria such as Gardnerella vaginalis and Mycoplasma hominis. This disruption reduces the protective acidity of the vagina and compromises the mucosal barrier, allowing bacteria to more easily ascend through the cervix into the uterus, fallopian tubes, and surrounding structures.
Some key points to consider in the treatment and management of BV and PID include:
- The bacterial flora that characterizes BV have been recovered from the endometria and salpinges of women who have PID, highlighting the link between the two conditions 1
- Treatment of BV with metronidazole can substantially reduce postabortion PID, as shown in two randomized controlled trials 1
- Anaerobic antimicrobial coverage, such as metronidazole, is recommended for routine operative prophylaxis before abortion and hysterectomy to reduce post-operative infectious complications 1
- Screening and treating women with BV before performing surgical abortion or hysterectomy may be beneficial in reducing the risk of post-operative infectious complications, although more information is needed to make a definitive recommendation 1
The inflammation caused by BV can also make tissues more susceptible to other sexually transmitted infections that can cause PID. Treating BV promptly is essential to restore normal vaginal flora and reduce PID risk. Sexual partners typically do not require treatment for BV, but patients should avoid sexual intercourse or use condoms during treatment, as stated in the 2002 guidelines for treating STDs 1. Recurrent BV may require extended or suppressive therapy under healthcare provider guidance.
From the Research
Bacterial Vaginosis and Pelvic Inflammatory Disease
- Bacterial Vaginosis (BV) is a common cause of vaginitis worldwide and is associated with serious reproductive health outcomes, including increased risk of preterm birth, sexually transmitted infections, and pelvic inflammatory disease (PID) 2.
- BV can increase the risk of PID, especially in women undergoing gynecological surgeries, and treatment of BV before surgery can reduce the frequency of post-operative pelvic infections 3.
Risk of PID with BV
- Studies have shown that BV is commonly found in women with PID, but it is unclear whether BV leads to incident PID 4.
- One study found that baseline BV was not associated with the development of PID, but dense growth of pigmented, anaerobic gram-negative rods in the 6 months before diagnosis did significantly increase a woman's risk of PID 4.
- Another study found that BV increases the risk of post-hysterectomy infections, including PID, and recommends testing for BV in women with increased risk for preterm delivery 3.
Treatment of BV to Prevent PID
- The American College of Obstetricians and Gynecologists recommends testing for BV in women with increased risk for preterm delivery, and women with symptoms should be evaluated and treated 3.
- Treatment of BV with antibiotics, such as metronidazole and clindamycin, can reduce the risk of PID, especially in women undergoing gynecological surgeries 5, 3.
- Patient counseling and education regarding treatment options, including adherence to prescribed treatments and appropriate hygienic practices, are crucial to optimize patient outcomes and prevent recurrence 6.