Bacterial vaginosis

Diagnosis

To diagnose bacterial vaginosis, the healthcare provider may perform the following procedures or examinations:

• Physical examination: The healthcare provider may inquire about the medical history, including previous occurrences of vaginal infections or sexually transmitted infections (STIs).
• Pelvic examination: As part of the examination, the healthcare provider will visually inspect the vagina for indications of infection. They will then perform a pelvic examination by manually inserting fingers into the vagina while simultaneously applying gentle pressure on the abdomen, in order to assess the condition of the pelvic organs.
• Vaginal discharge sample: During the examination, a healthcare provider will insert a speculum into the vagina to facilitate the collection of a fluid sample. This sample will be sent to a laboratory for analysis to identify the specific types of bacteria present. The laboratory testing will also check for the presence of “clue cells,” which are vaginal cells coated with bacteria and serve as an indication of bacterial vaginosis.
• Testing for vaginal pH: The acidity level of the vagina can be assessed using a pH strip. The pH strip is inserted into the vagina, and if the vaginal pH registers as 4.5 or higher, it indicates the presence of bacterial vaginosis.
• Others: Healthcare providers may diagnose bacterial vaginosis by conducting a wet mount, examining vaginal discharge under a microscope, and performing a whiff test to detect a fish-like odor.

Treatment

While some cases of bacterial vaginosis may resolve without medication, it is important to seek medical care if you experience symptoms. Bacterial vaginosis can increase the risk of acquiring sexually transmitted infections and may have implications for pregnancy.

To address bacterial vaginosis, healthcare providers may recommend the use of one of the following medications:

• Metronidazole is available in pill or topical gel form. The pill is taken orally, while the gel is inserted into the vagina. It’s important to avoid alcohol while using this medication and for a full day afterward, as it may cause nausea or stomach pain. Please refer to the product instructions for guidance.
• Clindamycin can be used as a cream inserted into the vagina or taken in pill or suppository form. The cream and suppositories might weaken latex condoms, so it’s recommended to abstain from sexual activity during treatment and for at least three days after stopping the medication. Alternatively, you can use another method of birth control.
• Tinidazole is taken orally. It may cause stomach upset, so it’s important to avoid alcohol during treatment and for at least three days after completing the treatment.
• Secnidazole is an antibiotic taken orally as a single dose with food. It comes in the form of granules that can be sprinkled onto soft foods like applesauce, pudding, or yogurt. The mixture should be consumed within 30 minutes, but be careful not to crunch or chew the granules.

Treatment is typically unnecessary for male sex partners, but bacterial vaginosis (BV) can be transmitted to female partners, requiring testing and treatment if symptoms are present. It is crucial to adhere to the prescribed medication, cream, or gel regimen for the full duration, even if symptoms improve. Prematurely stopping treatment may result in the recurrence of BV, known as recurrent bacterial vaginosis.

Recurrence

If you have bacterial vaginosis (BV), it often comes back within 3 to 12 months even after treatment. Researchers are looking for solutions to help with this recurring issue. If your symptoms return soon after treatment, talk to your healthcare team. They might suggest extended-use metronidazole therapy as a possible option. While some people believe probiotics could be helpful, a study found that they are not better than a placebo (a treatment without medicine) in preventing BV from coming back. So right now, probiotics are not recommended as a treatment for bacterial vaginosis.