Prevention of Bacterial Vaginosis
The most effective evidence-based prevention strategies for BV include probiotics containing Lactobacillus species (particularly L. crispatus) as complementary therapy, frequent changing of menstrual products, and avoiding unnecessary treatment of male sexual partners, which has been proven ineffective. 1
Understanding BV Risk Factors
BV prevention requires understanding modifiable risk factors:
- Multiple sexual partners significantly increase BV risk, as women who have never been sexually active rarely develop BV 1
- New sexual partners also elevate risk, making sexual activity a primary modifiable factor 1
- African-American ethnicity and low socioeconomic status are associated with higher BV rates, though these are non-modifiable factors 1
- Previous preterm birth history increases susceptibility to recurrent BV 1
Evidence-Based Prevention Strategies
What DOES Work
- Probiotic supplementation with Lactobacillus species significantly improves BV cure rates when used as complementary therapy with antibiotics (RR 1.53,95% CI 1.19-1.97), according to ACOG 2
- Lactobacillus crispatus-containing vaginal products show particular promise for preventing recurrent BV 3
- The combination of metronidazole with probiotics demonstrates strong microbiological cure rates (OR 0.09,95% CI 0.03 to 0.26) 2
What DOES NOT Work
- Treating male sexual partners is ineffective and not recommended, as partner treatment has not been shown to alter clinical course or prevent recurrence 4, 1, 5
- This remains true even though BV is associated with sexual activity and multiple partners 1
Menstrual Hygiene Considerations
BV recurrence is frequently related to menstrual cycles due to hormonal changes that affect vaginal flora:
- Change tampons and pads frequently during menstruation to reduce BV risk 1
- Consider avoiding tampons entirely if experiencing recurrent BV 1
- The bacteriostatic effect of cervical mucus is lowest at menses onset, reducing protection against pathogenic bacteria 5
- Hormonal changes during menses can disrupt the mechanical barrier preventing bacterial ascent 5
Behavioral Modifications
Additional strategies that may help prevent BV include:
- Smoking cessation reduces BV risk 6
- Condom use may provide protective benefits 6
- Hormonal contraception can help maintain vaginal pH stability 6
Critical Pitfalls to Avoid
- Do not assume all BV cases are symptomatic – up to 50% of women meeting clinical criteria have no symptoms 1, 2
- Do not waste resources treating sexual partners – this approach has been definitively shown ineffective in multiple CDC guidelines 4, 1, 5
- Do not rely on probiotics alone – they work best as complementary therapy with antibiotics, not as standalone prevention 2
Special Clinical Scenarios
Before invasive gynecologic procedures, consider screening and treating BV (even if asymptomatic) to reduce risk of post-procedure complications including endometritis, PID, and vaginal cuff cellulitis 4
A randomized controlled trial demonstrated that treating BV with metronidazole substantially reduced post-abortion PID 4