Bacterial Vaginosis Follow-up

Updated: Oct 25, 2018
  • Author: Philippe H Girerd, MD; Chief Editor: Michel E Rivlin, MD  more...
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Follow-up

Further Outpatient Care

Uncomplicated cases of bacterial vaginosis (BV) typically resolve after the standard antibiotic treatment.

BV that does not resolve after one course of treatment may be cured by a second course with the same agent. Another option is to switch to another agent (ie, metronidazole to clindamycin, or clindamycin to metronidazole) as other concomitant organisms may respond better to an alternate medication. Metronidazole is favored because it allows faster return of colonization of H2 O2 -producing lactobacilli. [24]

Some women with recurrent episodes of BV may benefit from treatment of Gardnerella vaginalis in their sexual partner if colonization is demonstrated, although this is controversial and not usually supported by the data. A Cochrane review found that antibiotic treatment for sexual partners of women with bacterial vaginosis had no effect on the rate of improvement in the women. [25]  Repeating wet preps is useful because patients can develop new, non-BV infections such as Candida. Using other diagnostic modalities may prove helpful, such as the DNA tests that may allow for more specific delineation of bacterial species, which will allow for more specific antibiotic treatment. A temporary use of condoms with their partner may help prevent recurrent infections.

Testing for other infections, such as N gonorrhoeae, C trachomatis, and herpes simplex virus type 1 (HSV-1) may be appropriate in individuals with BV because the incidence of sexually transmitted diseases (STDs) may be increased in this population depending upon the risk factors and demographics.

Therapy with metronidazole or clindamycin may alter the vaginal flora and predispose the patient to development of vaginal candidiasis.

Discourage douching, bubble baths, and over-the-counter vulvovaginal hygiene products.

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Deterrence/Prevention

Predisposing factors that may contribute to development of bacterial vaginosis (BV) are listed below. Correction or modification of the following factors may help reduce the incidence or recurrence of BV:

  • Recent antibiotic use

  • Decreased estrogen production of the host

  • Wearing an IUD

  • Douching

  • Bubble baths

  • Feminine hygiene products (sprays and other vulvovaginal products marketed for feminine cleanliness)

  • Liquid soaps and body washes (hypoallergenic bar soaps are superior)

  • Sexual activity leading to transmission, as evidenced by the patient having a new sexual partner, an increased number of sexual partners in the month preceding the onset of BV symptoms, and an increased number of lifetime sexual partners

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