In women with BV it is thought that the vaginal administration of lactic acid can help restore the normal acidic pH of the vagina, encourage the growth of lactobacilli, and suppress the growth of the bacteria that cause BV. Lactobacilli play an important role in maintaining vaginal health. Lactobacillus rhamnosus and Lactobacillus reuteri are available for purchase as supplements for oral administration.
Bacterial vaginosis - NHS
It is thought that oral administration of lactobacilli can help improve the vaginal microbiome. In one clinical trial, women with BV were randomly assigned to receive the combination of 1 week of metronidazole plus oral Lactobacillus twice daily for 30 days or metronidazole plus placebo. In one trial, a single 2-g oral dose of secnidazole was as effective as a 7-day course of oral metronidazole mg twice daily. BV is a prevalent problem and often adversely impacts a woman's quality of life and love relationships.
BV recurrence is very common. Many women report that their BV was resistant to intermittet treatment and recurred, repetitively over many years. The 3 treatment options presented in this editorial may help to suppress the recurrence rate and improve symptoms. Share your thoughts! Send your Letter to the Editor to rbarbieri frontlinemedcom. Please include your name and the city and state in which you practice.
Recurring bacterial vaginosis
Skip to main content. From the Editor. Limited data are available regarding optimal management strategies for women with persistent or recurrent BV.
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Using a different recommended treatment regimen can be considered in women who have a recurrence; however, retreatment with the same recommended regimen is an acceptable approach for treating persistent or recurrent BV after the first occurrence For women with multiple recurrences after completion of a recommended regimen, 0. Limited data suggest that an oral nitroimidazole metronidazole or tinidazole mg twice daily for 7 days followed by intravaginal boric acid mg daily for 21 days and then suppressive 0.
Monthly oral metronidazole 2g administered with fluconazole mg has also been evaluated as suppressive therapy; this regimen reduced the incidence of BV and promoted colonization with normal vaginal flora Therefore, routine treatment of sex partners is not recommended. Intravaginal clindamycin cream is preferred in case of allergy or intolerance to metronidazole or tinidazole. Intravaginal metronidazole gel can be considered for women who are not allergic to metronidazole but do not tolerate oral metronidazole. It is advised to avoid consuming alcohol during treatment with nitroimidazoles.
To reduce the possibility of a disulfiram-like reaction, abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.
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Treatment is recommended for all symptomatic pregnant women. Studies have been undertaken to determine the efficacy of BV treatment among this population, including two trials demonstrating that metronidazole was efficacious during pregnancy using the mg regimen , ; however, metronidazole administered at mg twice daily can be used. Multiple studies and meta-analyses have failed to demonstrate an association between metronidazole use during pregnancy and teratogenic or mutagenic effects in newborns , Although older studies indicated a possible link between use of vaginal clindamycin during pregnancy and adverse outcomes for the newborn, newer data demonstrate that this treatment approach is safe for pregnant women Because oral therapy has not been shown to be superior to topical therapy for treating symptomatic BV in effecting cure or preventing adverse outcomes of pregnancy, symptomatic pregnant women can be treated with either of the oral or vaginal regimens recommended for nonpregnant women.
Although adverse pregnancy outcomes, including premature rupture of membranes, preterm labor, preterm birth, intra-amniotic infection, and postpartum endometritis have been associated with symptomatic BV in some observational studies, treatment of BV in pregnant women can reduce the signs and symptoms of vaginal infection. A meta-analysis has concluded that no antibiotic regimen prevented preterm birth early or late in women with BV symptomatic or asymptomatic.
However, in one study, oral BV therapy reduced the risk for late miscarriage, and in two additional studies, such therapy decreased adverse outcomes in the neonate Treatment of asymptomatic BV among pregnant women who are at high risk for preterm delivery i. Seven trials have evaluated treatment of pregnant women with asymptomatic BV at high risk for preterm delivery: one showed harm , two showed no benefit , , and four demonstrated benefit , , , Similarly, data are inconsistent regarding whether treatment of asymptomatic BV among pregnant women who are at low risk for preterm delivery reduces adverse outcomes of pregnancy.
Therefore, evidence is insufficient to recommend routine screening for BV in asymptomatic pregnant women at high or low risk for preterm delivery for the prevention of preterm birth Although metronidazole crosses the placenta, no evidence of teratogenicity or mutagenic effects in infants has been found in multiple cross-sectional and cohort studies of pregnant women Data suggest that metronidazole therapy poses low risk in pregnancy Request an Appointment at Mayo Clinic.
Share on: Facebook Twitter. References Bacterial vaginosis — CDC fact sheet. Centers for Disease Control and Prevention.
Bacterial vaginosis (BV)
Accessed April 22, Rochester, Minn. Pruthi S expert opinion. Mayo Clinic, Rochester, Jan. Obstetrics and Gynecology. Reaffirmed Frequently asked questions.
Gynecologic problems FAQ American College of Obstetricians and Gynecologists. Sexually transmitted diseases treatment guidelines, Sobel JD.