From the Guidelines
Treatment is generally not required for Atropobium vaginae positive but BV negative patients unless they are experiencing symptoms. Atropobium vaginae can be present in the vaginal microbiome without causing bacterial vaginosis (BV) 1. If you have tested positive for Atropobium vaginae but negative for BV, treatment is not necessary unless you are experiencing symptoms such as abnormal discharge, odor, itching, or discomfort.
Key Considerations
- Atropobium vaginae is a bacterium commonly associated with BV but can exist as part of the normal vaginal flora in some women without causing problems.
- The presence of Atropobium vaginae without BV may indicate a shift in your vaginal microbiome that hasn't yet developed into full BV.
- Maintaining good vaginal health through proper hygiene, avoiding douching, and using condoms can help prevent disruption of your vaginal flora.
- Regular monitoring may be advised if you have a history of recurrent BV, as Atropobium vaginae can be associated with BV recurrence in some cases.
Treatment Options
If symptoms develop, your healthcare provider might recommend metronidazole (500mg orally twice daily for 7 days) or clindamycin (300mg orally twice daily for 7 days) if treatment becomes necessary, as these treatments have been shown to reduce post-operative infectious complications in patients with BV 1.
From the Research
Atopobium vaginae and Bacterial Vaginosis
- Atopobium vaginae is a bacterium that has been associated with bacterial vaginosis (BV) 2, 3, 4, 5.
- Studies have shown that A. vaginae is present in a majority of BV-positive patients, and its presence is thought to play a role in the pathophysiology of BV 2, 4.
- A. vaginae has been shown to be resistant to some antimicrobial substances, including metronidazole, which is a commonly used treatment for BV 3, 4.
- The presence of A. vaginae in BV-associated biofilms has been described, and its resistance to antimicrobial substances may have a major impact on treatment outcome 2.
Treatment Options
- Dequalinium chloride (Fluomycin®) has been shown to be effective against A. vaginae and other BV-associated bacteria, and may be a valid therapeutic option for BV treatment 2.
- Nifuratel has also been shown to be effective against A. vaginae, and may be a suitable alternative to metronidazole and clindamycin 3.
- Secnidazole, a 5-nitroimidazole, has been shown to have similar in vitro activity against BV-associated bacteria, including A. vaginae, compared to metronidazole and tinidazole 6.
- Clindamycin has been shown to have greater activity against A. vaginae and other BV-associated bacteria, but may also affect lactobacilli, which are beneficial bacteria in the vagina 6.
Diagnosis and Prevalence
- BV is the most common vaginal disorder in reproductive-age women, and is characterized by a change in vaginal flora away from predominantly Lactobacillus species 2, 5.
- The diagnosis of BV is based on Amsel's clinical criteria and/or a gram stain based on the Nugent score, but molecular biology-based methods are being developed as alternative diagnostic tools 5.
- A. vaginae has been detected in a majority of BV-positive patients, but its presence is not exclusive to BV, and it can also be detected in normal vaginal flora 4.