What Can I Do About Recurrent Bacterial Vaginosis
If your symptoms come back and you did not have a test using a sample of your vaginal discharge taken initially, your doctor or nurse may suggest that they take swab tests now. This is to confirm that it is BV causing your symptoms.
BV may return if you did not complete your course of antibiotics. However, even if you have completed a full course of antibiotics, BV returns within three months in many women. If it does come back, a repeat course of antibiotics will usually be successful. A small number of women have repeated episodes of BV and need repeated courses of antibiotics.
If you have a copper coil for contraception – an IUCD – and have recurrent BV, your doctor or nurse may suggest that they remove your IUCD to see if this helps to improve your symptoms. You will need to consider alternative contraception measures.
If you have a same-sex partner then, even if she has no symptoms, treating both of you at the same time may reduce recurrence.
You should also take particular notice of the advice not to use douches, bath additives and vaginal deodorants. Long-term use of metronidazole gel is sometimes advised. Specialist guidelines in the USA recommend using twice-weekly for up to six months. UK specialist guidelines are less certain on the frequency and duration of preventative treatment, and your doctor may want to talk with a specialist for advice on this.
How Bv Is Spread
Although it is not clear how BV is transmitted, it is more common in women who are sexually active. It sometimes develops soon after intercourse with a new partner. Women who have female sexual partners may be at higher risk than women who have sex with only male partners. Research has not conclusively found a link between BV and specific sexual practices or acts. However, recent evidence supports the use of condoms to reduce the risk of this infection.
What Are The Signs & Symptoms Of Bacterial Vaginosis
Many girls don’t see any signs of BV. But those who do might notice:
- white or gray thin vaginal discharge
- a bad, fishy smell that’s more noticeable during a girl’s period or after sex
Itching and burning are not common signs of bacterial vaginosis. If a girl has those symptoms, the doctor will check for other conditions.
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What Should I Do If I Have Bv
BV is easy to treat. If you think you have BV:
- See a doctor or nurse. Antibiotics will treat BV.
- Take all of your medicine. Even if symptoms go away, you need to finish all of the antibiotic.
- Tell your sex partner if she is female so she can be treated.
- Avoid sexual contact until you finish your treatment.
- See your doctor or nurse again if you have symptoms that don’t go away within a few days after finishing the antibiotic.
When Should I Get Treatment For Bacterial Vaginosis
The body is often very good at getting back its own balance. The disruption in the balance of vaginal germs that causes BV may correct naturally, with time. So, if you have no symptoms or only mild symptoms, you may not need any treatment, particularly if you take some of the general healthy steps above?
You normally need treatment for BV if it is causing symptoms, or if the characteristic smell is noticeable to you. If you are pregnant, trying to become pregnant, or about to have a gynaecological procedure then you may be advised to get treatment for BV.
PregnancyIf you are pregnant and you are found to have BV then you will usually be offered antibiotic treatment with oral metronidazole .
If you are trying to conceive and you think you may have BV, it is a good idea to try to eradicate the BV through natural methods or treatment prior to conceiving. If you have symptoms then you should discuss having antibiotic treatment with your doctor.
Termination of pregnancyIf you are found to have BV and are undergoing a termination of pregnancy, treatment with antibiotics may be advised even if you do not have any symptoms. This is because there is otherwise a risk of BV causing infection of the womb or pelvis after the procedure. This could lead to later fertility problems.
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Which Antibiotics Treat Bacterial Vaginosis
Guidelines from the Centers for Disease Control and Prevention recommend the following antibiotics:
- metronidazole tablets
- metronidazole vaginal gel
- clindamycin vaginal cream
- clindamycin vaginal suppositories
- tinidazole tablets
They are only available with a prescription. Your healthcare provider will tell you for how long you need to take the treatment. It’s usually for between five and seven days.
Most women should try one of the first three antibiotics first. Treatment of BV is recommended for all women who have symptoms.
Treatment is especially important for pregnant women. If you have bacterial vaginosis while pregnant, your baby is more likely to be born prematurely or with a low birth weight .
There is a risk of relapse if the entire course of antibiotics is not finished. It’s important to finish all the pills in the prescription, even if symptoms start to disappear.
Both metronidazole and tinidazole can cause stomach upsets and nausea if you drink alcohol while using them — it’s best to avoid alcohol until a full 24 hours after completing the course.
Who Is At Risk Of Developing Bacterial Vaginosis
Experts are not sure what causes this imbalance of bacteria to occur in the first place but have identified a few risk factors that make some women a lot more likely to develop BV. These include:
- A history of multiple sex partners
- A new sexual partner
- Vaginal douching
- Presence of an intrauterine contraceptive device .
Although most risk factors are associated with sexual activity, women who have never had vaginal intercourse can also develop BV.
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What Are The Symptoms Of Bacterial Vaginosis
Up to 84% of people with bacterial vaginosis dont have symptoms. If you do, you may have:
- Off-white, grey or greenish color vaginal discharge .
- Discharge that smells “fishy.”
- “Fishy” smell that is strongest after sex or during the menstrual cycle.
BV symptoms are similar to other infections. Its important to visit your healthcare provider to determine if what you have is BV or another vaginal infection.
What Is The Treatment For Bacterial Vaginosis
Bacterial vaginosis often causes no symptoms, or the symptoms are mild. Also, there is a good chance that BV will gradually clear without treatment. There are various different treatments for bacterial vaginosis . There are also some things which you should avoid doing, which may help the problem to resolve itself.
These include avoiding the use of douches, vaginal deodorants, bath additives and harsh soaps. Refraining from intercourse for a couple of weeks, or using a condom and a water-based lubricant, can be helpful.
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Can Bacterial Vaginosis Recur
Yes, bacterial vaginosis can recur, sometimes within a few weeks. If this happens, see your nurse or doctor for further treatment. This may include a longer course of antibiotics and checking for any other infections.
To prevent bacterial vaginosis recurring you could consider temporarily avoiding sexual contact or, if you have sex with a new partner, making sure he uses a condom.
Management Of Sex Partners
Data from earlier clinical trials indicate that a womans response to therapy and the likelihood of relapse or recurrence are not affected by treatment of her sex partner . Therefore, routine treatment of sex partners is not recommended. However, a pilot study reported that male partner treatment of women with recurrent BV had an immediate and sustained effect on the composition of the vaginal microbiota, with an overall decrease in bacterial diversity at day 28 . Male partner treatment also had an immediate effect on the composition of the penile microbiota however, this was not as pronounced at day 28, compared with that among women. A phase 3 multicenter randomized double-blinded trial evaluating the efficacy of a 7-day oral metronidazole regimen versus placebo for treatment of male sex partners of women with recurrent BV did not find that male partner treatment reduced BV recurrence in female partners, although women whose male partners adhered to multidose metronidazole were less likely to experience treatment failure .
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What Is Bacterial Vaginosis
Bacterial vaginosis is a vaginal infection caused by bacteria. It is the most common cause of abnormal vaginal discharge that occurs in reproductive-age women .
Bacterial vaginosis may cause a “fishy” odor and cause vaginal irritation in some women. Others may not have any symptoms.
Bacterial vaginosis is associated with poor obstetrics and gynecologic outcomes such as preterm delivery, infection after surgeries such as a hysterectomy, and may make a woman more susceptible to sexually transmitted infections, especially HIV.
Check If You Have Bacterial Vaginosis
The most common symptom of bacterial vaginosis is unusual vaginal discharge that has a strong fishy smell, particularly after sex.
You may notice a change to the colour and consistency of your discharge, such as becoming greyish-white and thin and watery.
But 50% of women with bacterial vaginosis do not have any symptoms.
Bacterial vaginosis does not usually cause any soreness or itching.
If you’re unsure it’s BV, check for other causes of unusual vaginal discharge.
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How Long Does Bacterial Vaginosis Last
After seeing your doctor and starting treatment with a prescribed medication, your symptoms will likely start improving within 2 to 3 days.
However, its important to continue taking your medication for the prescribed period of time, even if your symptoms have gone away. This will help ensure that the infection has completely cleared up, which typically takes about 7 days.
Data Collection And Analysis
We selected all potential trials for eligibility according to the criteria specified in the protocol. Each of the authors independently abstracted the information necessary for the review from the report and, where necessary, we sought additional information from the authors.
We assessed all trials for methodological quality using the standard Cochrane criteria. As there are a sufficient number of trials in the review, we stratified the trials by quality to explore the robustness of the findings. We calculated summary Peto odds ratios when appropriate using the Cochrane Review Manager software .
Stratified analysis
As there are sufficient trials in the review, the comparisons are stratified to explore the effect of the intervention on the outcomes by the following factors:
It was not possible to stratify results into symptomatic versus asymptomatic bacterial vaginosis because in most trials, women with symptoms were treated with antibiotics and were therefore excluded.
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How Is Bacterial Vaginosis Diagnosed
If you have symptoms of BV or have a history of multiple or a new sexual partner, then make an appointment with your doctor. Your doctor or nurse practitioner will ask you about any symptoms and take a history and then perform an examination. A swab may be taken of your vaginal fluid which will be tested in a laboratory. Other possible causes will be ruled out before they arrive at a diagnosis of BV.
Bacterial Vaginosis In Pregnancy
If you develop bacterial vaginosis in pregnancy, there’s a small chance of complications, such as premature birth or miscarriage.
But BV causes no problems in the majority of pregnancies.
Speak to a GP or your midwife if you’re pregnant and your vaginal discharge changes.
Page last reviewed: 22 November 2018 Next review due: 22 November 2021
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What Can Happen If Bv Is Not Treated
If BV is untreated, possible problems may include:6
- Higher risk of getting STIs, including HIV. Having BV can raise your risk of getting HIV, genital herpes, chlamydia, pelvic inflammatory disease, and gonorrhea. Women with HIV who get BV are also more likely to pass HIV to a male sexual partner.
- Pregnancy problems. BV can lead to premature birth or a low-birth-weight baby . All pregnant women with symptoms of BV should be tested and treated if they have it.
What Are The Side Effects
Antibiotic treatment kills not only gardnerella , but also useful bacteria in the vaginal flora that work to keep other germs in check. This means that antibiotic treatment can sometimes end up causing a vaginal yeast infection . This happens to about 10% of women who use clindamycin or metronidazole. Itching and a thick, white discharge are typical signs of a yeast infection, and it can also be treated with medication.
Other side effects may also occur. Metronidazole tablets leave behind a metallic taste in about 10% of women. Less commonly, they cause nausea and vomiting. Clindamycin is very well tolerated when used as a cream, and aside from yeast infections it has no other known side effects.
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How To Prepare For A Doctors Appointment
People may wish to prepare a list of their symptoms, any medications, over-the-counter treatments or supplements they are taking, and consider a note-taking device for their appointment.
It may also be helpful if a person takes a list of questions they wish to ask the healthcare professional. Example questions include:
- What treatment options are there for BV?
- How effective are the treatment options?
- Are there any specific instructions for taking medication for BV?
- What should I do if I have recurrent BV?
- Is there a way to prevent BV?
- Are there any OTC treatments or lifestyle changes that may help reduce symptoms?
Below are answers to common questions about BV medications.
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Getty/Design by Cristina Cianci
Bacterial vaginosis, commonly known as BV, is the most common vaginal infection in the USwhich means it’s more prevalent than yeast infections. Affecting more than 21 million women between the ages of 14 and 49, according to the Centers for Disease Control , more likely than not, you’ve probably had BV at some point in your life. Caused by an overgrowth of vaginal bacteria, BV can be uncomfortable, with symptoms such as itching, odor, and discharge. Alternatively, sometimes BV doesn’t manifest symptoms, so people with the infection might not know they have it. Either way, treating BV is essential, especially if you’re pregnant. The CDC notes that left untreated, BV might lead to premature birth or low-birth-weight babies. Additionally, if left untreated in non-pregnant women, BV can increase the risk of other infections and cause a host of vaginal issues.
On that note, please note that the remedies provided ahead are meant to eliminate BV cases in conjunction with antibiotics, or to be used as preventative measures against the infection.
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Antibiotics For Bacterial Vaginosis
Oral antibiotics are the first-choice treatment in pregnant women with BV.
Metronidazole tabletsA full course of metronidazole tablets is the common treatment. Metronidazole is an antibiotic. This clears BV in most cases. It is important to read the leaflet that comes with these tablets for the full list of possible side-effects and cautions. The main points to note about metronidazole include:
- The usual dose is 400-500 mg twice a day for 5-7 days. A single dose of 2 grams of metronidazole is an alternative, although this may be less effective and may cause more side-effects. It is important to finish the course you have been prescribed, and not to miss any tablets.
- Some people feel sick or may be sick when they take metronidazole. This is less likely to occur if you take the tablets straight after food. A metallic taste is also a common side-effect.
- Do not drink any alcohol while taking metronidazole, nor for 48 hours after stopping treatment. The interaction of metronidazole with alcohol can cause severe sickness and vomiting, and may also cause flushing and an increased pulse rate.
- Metronidazole can get into breast milk in small amounts but will not harm your baby, although it may make the milk taste different. The manufacturer recommends that if you are breastfeeding you should take the 5- to 7-day lower dose course of metronidazole rather than the single large dose.
Can Bacterial Vaginosis Be Prevented
Most episodes of bacterial vaginosis occur for no apparent reason and they cannot be prevented. The following are thought to help prevent some episodes of bacterial vaginosis . The logic behind these tips is to try not to upset the normal balance of germs in the vagina:
- Do not add bath oils, antiseptics, scented soaps, perfumed bubble bath, shampoos, etc, to bath water.
- Do not use strong detergents to wash your underwear.
- Don’t use perfumed ‘intimate hygiene’ products.
- Using a condom and/or a water-based lubricant during intercourse may help protect you.
- Avoid thongs and tight nylon tights.
- Have showers rather than baths.
- Lighter periods seem to make BV less likely to return, so if you have heavy periods and were considering seeking treatment, this might be another reason to do so.
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How Are Antibiotics Used
Symptoms are usually treated with an antibiotic such as clindamycin or metronidazole as a cream, vaginal suppositories or tablets, or oral tablets. Treatment can last one to seven days depending on the exact drug used, its form and the dose, and the severity of the symptoms. Your doctor can help you decide what type of treatment is most suitable for you.
If you’ve been prescribed , it’s important to be careful about using them correctly. That especially means using the medicine regularly and for as long as prescribed: Stopping early, for instance if the symptoms have already cleared up, contributes to the development of resistant strains of .
