5/16/2017 Bacterialvaginosis

OfficialreprintfromUpToDate
www.uptodate.com2017UpToDate

Patienteducation:Bacterialvaginosis(BeyondtheBasics)
Author SectionEditor DeputyEditor
JackDSobel,MD RobertLBarbieri,MD KristenEckler,MD,FACOG

INTRODUCTION

Bacterialvaginosis(BV)isthemostcommoncauseofvaginaldischargeinwomen.Itcancausebothersome
symptoms,andalsoincreasestheriskofacquiringserioussexuallytransmittedinfections,suchasHIV.Itmaybe
difficulttoknowifdischargeiscausedbyBVorothercommonvaginalinfections,thusavisitwithahealthcare
providerisrecommendedinmostcases.(See"Patienteducation:Vaginaldischargeinadultwomen(Beyondthe
Basics)".)

BACTERIALVAGINOSISCAUSES

BVoccurswhenthereisachangeinthenumberandtypesofbacteriainthevagina.Lactobacilliareatypeof
bacteriathatarenormallyfoundinthevagina.InwomenwithBV,thenumberoflactobacilliisreduced.Thereason
forthesechangesisnotknown.

RiskfactorsRiskfactorsforBVincludemultipleornewsexualpartners,douching,andcigarettesmoking.BV
isnowthoughttobeasexuallytransmittedinfection,althoughmostrecurrencesarenotsexuallyrelated.

BACTERIALVAGINOSISSIGNSANDSYMPTOMS

Approximately50to75percentofwomenwithBVhavenosymptoms.Thosewithsymptomsoftennotean
unpleasant,"fishysmelling"vaginaldischargethatismorenoticeableaftersexualintercourse.Vaginaldischarge
thatisoffwhiteandthinmayalsobepresent.

Somepatientshaveitching.Painduringurinationorsex,redness,andswellingarenottypical.

Ifyouhaveconcernsaboutexcessiveorfoulsmellingvaginaldischarge,abnormalbleeding,orvulvarirritation,see
ahealthcareprovider.Selftreatmentwithoverthecounterproducts(eg,yeastcreams,deodorants)isnot
recommendedwithoutadefinitediagnosis.

BACTERIALVAGINOSISDIAGNOSIS

ThediagnosisofBVisbaseduponaphysicalexaminationandlaboratorytesting.Thephysicalexaminationusually
includesapelvicexamination,whichallowsthehealthcareprovidertoobserveandtestvaginalsecretions.Itcan
bedifficulttoknow,withoutanexaminationandtesting,ifvaginaldischargediscausedbyBVoranothervaginal
infection.Youshouldinsistthatyourproviderconfirmthediagnosiswithappropriatetests.

BACTERIALVAGINOSISCOMPLICATIONS

BVitselfisnotharmful,althoughithasbeenassociatedwithsomehealthproblems.

PregnantwomenwithBVareathigherriskofpretermdelivery(see'Bacterialvaginosisandpregnancy'
below).

UntreatedBVinawomanwhoundergoeshysterectomyorabortioncanleadtoinfectionofthesurgicalsite.

BVincreasestheriskofbecominginfectedwithandspreadingHIV.

BVincreasestheriskthatawomanwillbecomeinfectedwithgenitalherpes,gonorrhea,orchlamydia.(See
"Patienteducation:Genitalherpes(BeyondtheBasics)"and"Patienteducation:Gonorrhea(Beyondthe
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5/16/2017 Bacterialvaginosis

Basics)"and"Patienteducation:Chlamydia(BeyondtheBasics)".)

BACTERIALVAGINOSISTREATMENT

TreatmentofBVisusuallyrecommended.TherearetwoprescriptionmedicationsusedforthetreatmentofBV:
metronidazoleandclindamycin.Bothmedicationscanbetakeninpillformbymouth,orwithagelorcreamthatis
insertedinsidethevagina.Oralmedicationmaybemoreconvenient,butcausesmoresideeffects.

Ifsymptomsimproveaftertreatment,afollowupvisitisnotnecessary.

MetronidazoleMetronidazolevaginalgelisoneofthemosteffectivetreatmentsitisappliedinsidethevagina
atbedtimeforfivedays.Metronidazolecanalsobetakeninpillform,500mgtwicedailyforsevendays.The
choiceofpillversusvaginalgeldependsuponthewoman'spreference.Ingeneral,therearefewersideeffectswith
thevaginaltreatment.

Sideeffectsoforalmetronidazoleincludeametallictaste,nausea,andatemporaryloweredbloodcount.You
shouldnotdrinkalcoholwhiletakingmetronidazolepillsduetotheriskofaseriousinteraction,whichcancause
flushing,nausea,thirst,palpitations,chestpain,vertigo,andlowbloodpressure.Metronidazolepillsalsointeract
withwarfarin(Coumadin),potentiallyincreasingtheriskofbleeding.Thevaginalgeldoesnotcausetheseside
effects.

ClindamycinClindamycinisacreamthatisinsertedintothevaginaatbedtimeforsevendays.Aoneday
vaginalclindamycincreamandthreedayvaginalovulearealsoavailable.Clindamycincreamshouldnotbeused
withlatexcondomsduetotheriskofcondombreakage.

Clindamycincanalsobetakenbymouth,300mgtwicedailyforsevendays.

SexualpartnersTreatingthesexualpartnerdoesnotimprovethewoman'ssymptomsordecreasetheriskof
theinfectioncomingback,hencetreatmentofmalesexualpartnersisnotrecommended.

RelapseandrecurrentinfectionApproximately30percentofwomenwhoinitiallyimproveaftertreatmenthave
arecurrenceofBVsymptomswithinthreemonths,andmorethan50percenthavearecurrenceofsymptoms
within12months.Itisnotclearwhythisoccurs,althoughitmayberelatedtobacteriathatwerenotcompletely
treatedorlackofanormallevelofprotectivelactobacilli.Theroleoflactobacilliisdiscussedabove(see'Bacterial
vaginosiscauses'above).

Relapsecanbetreatedwithaprolongedcourseoforalorvaginalmetronidazoleorclindamycinforsevendaysthe
UnitedStatesCenterforDiseaseControlandPreventionsuggestsatreatmentregimendifferentfromtheinitialor
previoustreatmentregimen(eg,oraltreatmentifvaginaltreatmentusedpreviously).

Ifyou'vehadmorethanthreeepisodesofBVinthepast12months,youmaybenefitfromlongertreatment.This
mayincludevaginalmetronidazolegeltwiceweeklyforthreetosixmonths.Clindamycin(oralorvaginal)isnot
usuallyrecommendedasapreventivetreatment.ProbiotictherapyisofnovalueinpreventingrecurrenceofBV.

BacterialvaginosisandpregnancyPregnantwomenwithBVareatincreasedriskofpretermbirth.However,
thereisnobenefittotestingand/ortreatingallpregnantwomenforBVunlessthewomanhassymptomsof
infection.Someexpertsrecommendtestingonlypregnantwomenwhohaveahistoryofapreviouspreterm
delivery.

PregnantwomenwithsymptomsofBVinfectionareusuallytreated.Oraltreatmentwithsevendaysof
metronidazoleispreferredovervaginaltreatments.

BACTERIALVAGINOSISPREVENTION

ThebestwaytopreventBVisnotknown.However,afewbasicrecommendationscanbemade.

Donotdouche.Douchingistheuseofasolutiontorinsetheinsideofthevagina.Somewomendoucheto
feel"clean,"althoughthereisnoprovenbenefitofdouching.Thevaginaisnormallyabletomaintainahealthy
balanceofbacteriadouchingcanupsetthisbalanceandpotentiallyflushharmfulbacteriaintotheupper
genitaltracts(uterus,fallopiantubes).

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5/16/2017 Bacterialvaginosis

Limitthenumberofsexualpartners.Womenwithmultiplesexualpartnersareathigherriskofdeveloping
bacterialvaginosisandsexuallytransmittedinfections.

FinishtheentirecourseoftreatmentforBV,evenifthesymptomsresolveafterafewdoses.

Useofbirthcontrolpillsmaybehelpfulhowever,useofcondomsisadvisedformalepartnersofwomen
withrecurrentBV.

SUMMARY

Bacterialvaginosis(BV)cancause"fishysmelling"vaginaldischarge,whichmaybeworseaftersex.Some
womendonothavethisdischarge.

BVisconsideredbysomeexpertstobeasexuallytransmittedinfection.Sexualpartnersdonotneedtobe
treatedsincetreatmentofmalesisnoteffectiveforpreventinginfectionofthefemalepartner.Someexperts
recommendthatmalepartnersusecondoms.Femalepartnersshouldbetreatedwithstandardtherapy.

Donottreatyourselfforabnormalvaginaldischarge.Adoctorornurseshouldfirstperformanexamto
determinethereasonforthedischarge.

SeveralprescriptionmedicationsareavailabletotreatBVsomearevaginalgelsorcreamswhileothersare
pillsthatyoutakebymouth.Pillsmaybemoreconvenientbutusuallycausesideeffects(nausea,metallic
taste).

SomewomendevelopBVrepeatedly.Atreatmentmayberecommendedtopreventinfections.Thisincludes
avaginalgeltwiceperweekforthreetosixmonths.

PregnantwomenwithBVinfectionshouldbetreated.Thisusuallyincludespillsthataretakenbymouth.

WHERETOGETMOREINFORMATION

Yourhealthcareprovideristhebestsourceofinformationforquestionsandconcernsrelatedtoyourmedical
problem.

Thisarticlewillbeupdatedasneededonourwebsite(www.uptodate.com/patients).Relatedtopicsforpatients,as
wellasselectedarticleswrittenforhealthcareprofessionals,arealsoavailable.Someofthemostrelevantare
listedbelow.

PatientlevelinformationUpToDateofferstwotypesofpatienteducationmaterials.

TheBasicsTheBasicspatienteducationpiecesanswerthefourorfivekeyquestionsapatientmighthave
aboutagivencondition.Thesearticlesarebestforpatientswhowantageneraloverviewandwhoprefershort,
easytoreadmaterials.

Patienteducation:Vulvovaginalyeastinfection(TheBasics)
Patienteducation:Bacterialvaginosis(TheBasics)
Patienteducation:Vaginaldischargeinadults(TheBasics)
Patienteducation:Probiotics(TheBasics)

BeyondtheBasicsBeyondtheBasicspatienteducationpiecesarelonger,moresophisticated,andmore
detailed.Thesearticlesarebestforpatientswhowantindepthinformationandarecomfortablewithsomemedical
jargon

Patienteducation:Vaginaldischargeinadultwomen(BeyondtheBasics)
Patienteducation:Genitalherpes(BeyondtheBasics)
Patienteducation:Gonorrhea(BeyondtheBasics)
Patienteducation:Chlamydia(BeyondtheBasics)

ProfessionallevelinformationProfessionallevelarticlesaredesignedtokeepdoctorsandotherhealth
professionalsuptodateonthelatestmedicalfindings.Thesearticlesarethorough,long,andcomplex,andthey
containmultiplereferencestotheresearchonwhichtheyarebased.Professionallevelarticlesarebestforpeople
whoarecomfortablewithalotofmedicalterminologyandwhowanttoreadthesamematerialstheirdoctorsare
reading.
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5/16/2017 Bacterialvaginosis

Bacterialvaginosis
Acutecervicitis
Desquamativeinflammatoryvaginitis
Approachtowomenwithsymptomsofvaginitis
Pelvicinflammatorydisease:Pathogenesis,microbiology,andriskfactors
Screeningforsexuallytransmittedinfections

Thefollowingorganizationsalsoprovidereliablehealthinformation.

NationalLibraryofMedicine

(www.nlm.nih.gov/medlineplus/healthtopics.html)

NationalInstituteofAllergyandInfectiousDiseases

(www.niaid.nih.gov/diseasesconditions/stdresearch)

CentersforDiseaseControlandPrevention

(www.cdc.gov/STD/BV/default.htm)

AmericanSocialHealthAssociation

(www.ashasexualhealth.org/stdsstis/vaginitis/)

[14]

Literaturereviewcurrentthrough:Apr2017.|Thistopiclastupdated:May2,2017.

ThecontentontheUpToDatewebsiteisnotintendednorrecommendedasasubstituteformedicaladvice,diagnosis,ortreatment.Alwaysseek
theadviceofyourownphysicianorotherqualifiedhealthcareprofessionalregardinganymedicalquestionsorconditions.Theuseofthis
websiteisgovernedbytheUpToDateTermsofUse2017UpToDate,Inc.

References
Top

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SexTransmDis200431:433.
2.GutmanRE,PeipertJF,WeitzenS,BlumeJ.Evaluationofclinicalmethodsfordiagnosingbacterial
vaginosis.ObstetGynecol2005105:551.
3.McDonaldH,BrocklehurstP,ParsonsJ.Antibioticsfortreatingbacterialvaginosisinpregnancy.Cochrane
DatabaseSystRev2005:CD000262.
4.RiggsMA,KlebanoffMA.Treatmentofvaginalinfectionstopreventpretermbirth:ametaanalysis.Clin
ObstetGynecol200447:796.

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