Bacterial Vaginosis

Bacterial Vaginosis:

It is an inflammation of the vagina caused by an overgrowth of anaerobic bacteria, which disrupts the balance of the natural bacteria in the vagina.

It is the most common cause of vaginal discharge, but it can also be asymptomatic.

Bacterial vaginosis can be associated with:

• Douching
• Smoking
• IUD use (more about IUD)
• Recent antibiotic use
• Newly married

Possible complications:

Higher risk of:

• Complications of pregnancy like preterm birth.
• Developing a post-surgical infection.

Symptoms:

• Gray/white/green thin vaginal discharge
• Foul fishy vaginal odor
• Burning when urination
• Painful sexual intercourse
• Itchiness, soreness (rare)

Treatment:
It is recommended for symptomatic bacterial vaginosis.
1. Antibiotics prescribed by the doctors:

• Metronidazole 500 mg orally twice a day for 7 days

OR

• Metronidazole gel, (5 g intravaginally, once a day for 5 days

OR

• Clindamycin cream 5 g intravaginally at bedtime for 7 days

2. Lifestyle changes: abstinence from sexual activity until healed, vitamin supplements, avoiding douches and antiseptic bath products, diet changes.

Treatment Alternatives:

• Tinidazole: 2 g orally once daily for 2 days
  OR
• Tinidazole: 1 g orally once daily for 5 days
  OR
• Clindamycin: 300 mg orally twice daily for 7 days
  OR
• Clindamycin ovules: 100 mg intravaginally once at bedtime for 3 days

Treatment during pregnancy:
It is recommended for all symptomatic pregnant women.
Tinidazole should be avoided.

Follow-ups:

• Not necessary if symptoms are resolved.
• It is advised to follow up if symptoms recur.

Persistent or recurrent bacterial vaginosis:

• Using a different treatment regimen.
• Retreatment with the same regimen after the first occurrence.
• Multiple recurrences:
  • Metronidazole gel twice weekly for 4–6 months.
  • Oral metronidazole or tinidazole 500 mg twice daily for 7 days, followed by intravaginal boric acid 600 mg daily for 21 days, then metronidazole gel twice weekly for 4–6 months.
  • Monthly 2g of oral metronidazole with fluconazole 150 mg

How can recurrent bacterial vaginosis be avoided?

• Using all of the medication prescribed even after the symptoms are gone.
• Avoid douching.