What are the methods for preventing Bacterial Vaginosis (BV) in females?

From the Guidelines

To prevent bacterial vaginosis (BV) in females, maintain good vaginal hygiene and health practices, and avoid douching, as it disrupts the natural vaginal flora balance. The goal is to reduce the risk of BV and its complications, such as pelvic inflammatory disease (PID) and vaginal cuff cellulitis after invasive procedures, as noted in the 2002 guidelines for treating sexually transmitted diseases 1. Key prevention strategies include:

• Avoiding douching, which can remove beneficial bacteria and disrupt the natural vaginal flora balance
• Using unscented soaps and avoiding scented products that can irritate the vagina and alter its pH
• Wearing breathable cotton underwear and avoiding tight-fitting clothes that trap moisture
• Limiting sexual partners and using condoms consistently, as BV can be associated with sexual activity
• Considering probiotics containing Lactobacillus species, either orally or vaginally, to help maintain healthy vaginal flora, especially for those with recurrent BV
• Using boric acid vaginal suppositories (600mg inserted vaginally at bedtime for 7-14 days) for recurrent cases, as suggested by some healthcare providers It is essential to note that treatment of the male sex partner has not been found beneficial in preventing the recurrence of BV, as stated in the 2002 guidelines 1. If symptoms of BV occur, such as a fishy odor, thin grayish discharge, or itching, seeking prompt medical attention is crucial, as early treatment can prevent complications and recurrence. Maintaining a healthy diet and managing stress can also support overall immune function and help prevent BV. The diagnosis of BV can be made using clinical or Gram-stain criteria, and treatment should be based on established benefits, such as relieving vaginal symptoms and signs of infection, and reducing the risk of infectious complications after abortion or hysterectomy 1.

From the Research

Prevention of Bacterial Vaginosis (BV) in Females

• The current and only FDA-approved treatment regimens for BV are antibiotics, such as metronidazole and clindamycin 2.
• However, antibiotics provide a short-term cure for bacterial vaginosis and fail to provide a consistent long-term cure for many women, with 50 to 80 percent of women experiencing a BV recurrence within a year of completing antibiotic treatment 2.
• Behavioral modifications that may help prevent BV include smoking cessation, condom use, and hormonal contraception 2.
• Additional strategies considered for BV prevention include dietary modification, non-medical vaginally applied products, choice of lubricant, and treatments from medical practices outside of allopathic medicine 2.
• Probiotics, vaginal microbiome transplantation, pH modulation, and biofilm disruption are also being explored as potential approaches to BV management 2, 3.

Role of Probiotics in BV Prevention

• Evidence exists about the efficacy of probiotics for the management of BV, with certain strains of Lactobacillus showing promise in preventing recurrent BV 4, 5.
• A study found that a probiotic mixture containing Lactobacillus acidophilus GLA-14 and Lactobacillus rhamnosus HN001, in combination with bovine lactoferrin, was effective in preventing recurrent BV when used as adjuvant therapy to metronidazole 4.
• Another study found that Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, taken orally, were helpful in vaginosis and bacterial vaginitis treatment and in relapse prevention, as they can re-establish the vaginal ecosystem remarkably 5.

Current Understanding of BV

• BV is the result of a disturbance in the vaginal ecosystem, characterized by a sudden replacement of Lactobacilli by anaerobic bacteria such as Gardnerella vaginalis, Atopobium vaginae, Ureaplasma urealyticum, Mycoplasma hominis, and others 6.
• The etiology of this dysbiosis remains unknown, but its health consequences are significant, including obstetrical complications, increased risk of sexually transmitted infections and urogenital infections 6.
• The treatment of BV aims at restoring the balance of the vaginal flora to stop the proliferation of harmful microorganisms, with prescription of antibiotics such as metronidazole and clindamycin being recommended 6.