Understanding "Altered Flora Not Consistent with Bacterial Vaginosis"
This result means your vaginal microbiome shows a disruption from normal Lactobacillus-dominant flora, but does not meet the diagnostic criteria for bacterial vaginosis (BV)—essentially, you have an intermediate or mixed vaginal flora pattern that falls into a diagnostic gray zone. 1, 2
What This Actually Represents
Your vaginal flora exists on a spectrum, not as a simple binary of "normal" versus "BV." 3, 4 This result indicates:
Mixed bacterial populations are present with reduced or absent Lactobacillus species, but the pattern doesn't fulfill the Amsel criteria (which requires 3 of 4 findings: homogeneous white discharge, clue cells, pH >4.5, positive whiff test) 5, 1, 6
Intermediate vaginal flora states have been documented that show mixed bacteria speckling squamous cells without obscuring their edges, few lactobacilli, minimal to no inflammatory response, and only mildly elevated pH—this is termed "noninflammatory vaginosis" in research literature 3
You may have no symptoms despite the altered flora, as approximately 50% of women with disrupted vaginal microbiomes are asymptomatic 6
Clinical Significance
The importance of this finding depends on your clinical context:
If you are symptomatic (discharge, odor, irritation), this intermediate state may still warrant treatment even though it doesn't meet strict BV criteria, as these altered flora patterns represent a spectrum of severity 3
If you are asymptomatic, treatment is generally not indicated unless you are undergoing invasive gynecologic procedures (abortion, hysterectomy, IUD placement, endometrial biopsy) where altered flora increases risk of post-procedural infection 5, 6
If you are pregnant, even asymptomatic altered flora may warrant treatment consideration given associations with adverse pregnancy outcomes, though this remains an area where guidelines emphasize symptomatic BV treatment 1, 6
What Happens Next
Your clinician should:
Correlate with your symptoms and examination findings rather than treating the lab result in isolation 5, 2
Recheck vaginal pH if not already done, as pH >4.5 supports a diagnosis requiring intervention 1, 2
Consider repeat testing if symptoms persist, as vaginal flora is dynamic and fluctuates throughout your menstrual cycle 7
Avoid culturing for Gardnerella vaginalis, as this organism can be present in normal vaginal flora and is not specific for disease 5, 2
Common Pitfalls to Avoid
Don't assume this requires antibiotic treatment automatically—treatment is primarily indicated for symptomatic relief, not to normalize a lab result 5, 6
Recognize that normal vaginal flora varies significantly between women—some healthy women naturally lack appreciable Lactobacillus populations 4, 7
Understand that treating sexual partners is not beneficial for altered vaginal flora or BV, as this is not considered exclusively a sexually transmitted condition 5, 6