Adjusting Lifestyle and Seeking Medical Interventions for BV Management
Bacterial vaginosis (BV) is a common infection affecting people aged 15-44 years. Although it is not a sexually transmitted infection (STI), BV can be linked to sexual activity. This article provides an overview of the recommended treatments, prevention methods, and diagnosis of BV.
First-line antibiotics for treating BV include metronidazole and clindamycin. These antibiotics can be administered either orally or intravaginally with similar effectiveness. Metronidazole is typically given orally as 500 mg twice daily for 7 days, while clindamycin is also commonly used, especially in pregnant women with BV to reduce the risk of pre-term birth[1][3][4]. Other approved alternatives such as tinidazole and the newer secnidazole are also used for BV treatment. Despite effective antibiotic treatment, recurrence rates are high, often up to 80%, and some patients may not respond to the first course of antibiotics[1][2].
In addition to antibiotics, future therapies may target microbiome interactions to improve treatment success[2]. Adjunctive or alternative strategies such as probiotics and novel drug delivery methods are being explored to address recurrent BV.
Preventing BV involves maintaining good hygiene, wearing breathable cotton underwear, and using barrier protection during sexual activity. Women who have sex with women may wish to use gloves during digital-genital stimulation and condoms with sex toys.
BV symptoms include thin, white or gray vaginal discharge, bad-smelling discharge, pain during sex, itchy or discolored genitals, and a burning sensation when urinating. If BV symptoms reoccur, a person should inform their doctor for an adjusted treatment plan. Without treatment, BV can increase a person's risk of contracting HIV.
A doctor can diagnose BV by asking questions about symptoms, lifestyle, and sexual activity, taking a swab sample from the vagina, and checking the pH level of the vaginal fluid. A higher pH level may indicate BV, but other conditions can also raise the pH level.
During BV treatment, it is advisable to avoid having sex or use barrier methods. Clindamycin 2% cream is used intravaginally, with one full 5-gram applicator used at bedtime for 7 days. Metronidazole 0.75% gel is used intravaginally, with one full 5-gram applicator used once a day for 5 days.
In summary, while BV can be a concern for some individuals, effective treatments and prevention methods are available. If BV does not clear up after treatment or continues to recur, it is important to seek appropriate medical attention, especially for pregnant individuals, as untreated BV can potentially cause premature labor.
[1] Centers for Disease Control and Prevention (CDC). (2020). Bacterial Vaginosis. Retrieved from https://www.cdc.gov/std/bv/stdfact-bv.htm [2] Hiltunen, K., & Korpela, K. (2018). Bacterial vaginosis. BMJ, 362, k3433. [3] Koumans, E. H., Hillier, S. L., Holmes, K. K., Hook, E. W., III, & Walsh, T. J. (2007). Revised 2001 criteria for the diagnosis of bacterial vaginosis: a proposal from the Society for Women's Health Research. Clinical Infectious Diseases, 44(11), 1403-1408. [4] Mirochnick, M., & Hook, E. W., III. (2013). Bacterial vaginosis: a review. Obstetrics and Gynecology Clinics of North America, 40(3), 521-536.
- It's recommended to use recommended antibiotics such as metronidazole and clindamycin for BV treatment, and these can be administered orally or intravaginally with similar effectiveness for both prevention and treatment of the infection.
- Maintaining good hygiene, wearing breathable underwear, and using barrier protection during sexual activity are crucial strategies in preventing BV, especially for individuals who have sex with multiple partners.
- Recurrence rates of BV are high, often up to 80%, and to address this, future therapies are being explored that focus on microbiome interactions to improve treatment success, alongside using adjunctive or alternative strategies like probiotics and novel drug delivery methods.
