Bacterial Vaginosis; Treatment.

As with other vaginal infections, the primary goal in treating bacterial vaginosis (BV) is to relieve signs and symptoms of infection. All women with symptoms should be treated. In addition, treatment is important to reduce post-surgical complications.

BV is treated with antibiotics. The most common therapy is metronidazole, also known as Flagyl. It is available in oral (pill) form, or in a gel (MetroGel-Vaginal) that you insert into the vagina.

If your symptoms disappear with treatment, you don't have to see your health care professional again. One round of treatment usually works in about 75 percent of cases. However, BV frequently recurs, and can be chronic in some women. For recurrent BV, a more powerful antibiotic, such as clindamycin (Cleocin), available in oral and intravaginal form, may be prescribed.

Don't drink any alcohol while using metronidazole (either oral or vaginal) because it may make you nauseous and/or lead to severe vomiting. Also, if you're using intravaginal forms of clindamycin, the oil-based medication may weaken latex condoms or diaphragms. Clindamycin may also cause colitis, a potentially life-threatening infection of the colon.

Talk to your health care professional about this risk and be sure to alert him or her if you experience severe diarrhea, stomach cramping, or blood in your stool while taking clindamycin or within a few weeks of stopping it. Over-the-counter treatments available for some vaginal infections (Candidiasis, or "yeast" infections) are NOT effective for BV.

While you're being treated for BV, you may be advised not to have sex; if you do have sex, your partner should wear condoms. Treating your male partner isn't necessary however, since studies find it doesn't help prevent another infection. Female partners may need treatment, however.

Treatment is more complicated for pregnant women. If you've previously delivered a premature infant, you should be tested for BV during your first prenatal visit. If you have the infection, you'll be treated in the earliest part of your second trimester of pregnancy.

Regardless of other risk factors for pre-term delivery, all symptomatic pregnant women should be tested and treated. However, most studies show no difference in risk of preterm delivery in asymptomatic women who don't get treated vs. those who get treated. Thus, pregnant women with asymptomatic BV don't require treatment.

In any case, pregnant women who are going to be screened should have this done during the first prenatal visit. Women at high risk for preterm delivery should be treated and re-evaluated one month after treatment. Pregnant women should be treated with oral rather than topical (intravaginal) medications.

References

Bacterial Vaginosis. National Women's Health Information Center. http://www.4woman.gov. Updated May 2005. Accessed September 2005.

STD Facts: Vaginitis (Most Common Causes: Yeast Infection, Trichomonas, Bacterial Vaginosis)." Minnesota Department of Health. 2004. Centers for Disease Control and Prevention National Prevention Information Network (NPIN). http://www.cdcnpin.org. Accessed September 2005.

"Bacterial Vaginosis." Feminist Women's Health Center. 2002. http://www.fwhc.org. Accessed September 2005.

Lactobacillus Organisms and Bacterial Vaginosis. Saint Joseph Mercy Health System. Updated May 19, 2004. http://www.sjmercyhealth.org. Accessed September 2005.

Secor, R. Mimi. "Bacterial Vaginosis." Clinician Reviews. 11(11):59-68, 2001.

Yen, Sophia, et al. "Bacterial Vaginosis in Sexually Experienced and Non-Sexually Experienced Young Women Entering the Military." Obstetrics & Gynecology. 102(5):927, November 2003.

Rakel, Robert, and Edward Bope, eds. Conn's Current Therapy 2004: Latest Approved Methods of Treatment for the Practicing Physician. 56th edition. St. Louis: Saunders, 2004. Page 119.

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR 2002;51(No. RR-6)

"Vaginitis Due to Vaginal Infections." National Institute of Allergy and Infectious Diseases. Health Matters. October 2004. http://www.niaid.nih.gov. Accessed September 2005.

Connett, H. What you need to know about bacterial vaginosis. STD Advisor, 1999; Vol. 2. Insert.

The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Institute of Medicine. Washington, D.C. National Academy Press, 1997.

Bacterial Vaginosis--CDC Fact Sheet. Centers for Disease Control and Prevention. http://www.cdc.gov. Last updated: May 2004. Accessed September 2005.

Bacterial Vaginosis. American Family Physician, March 15, 1998. http://www.aafp.org. Accessed September 2005.

Bacterial vaginosis and preterm birth: a comprehensive review of the literature. J Nurse Midwifery. 43(2):83-9, Mar-Apr 1998.

Urinary Tract Infections in Adults. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). NIH Publication 04-2097. November 2003. http://kidney.niddk.nih.gov. Accessed September 2005.

Keywords: bacterial vaginosis, bv, symptoms, symptoms of BV, treatment, treatment of bv, preterm delivery, pregnant women