Bacterial Vaginosis Treatment & Management

Updated: Sep 25, 2017
  • Author: Philippe H Girerd, MD; Chief Editor: Michel E Rivlin, MD  more...
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Treatment

Approach Considerations

Inpatient care is not necessary for patients with bacterial vaginosis.

Obtain cultures of blood and infected tissue (if feasible) from inpatients who develop obstetric/gynecologic postoperative fever or signs of infection to try to elucidate the infectious etiologic organism. Blood cultures may not demonstrate growth of Gardnerella vaginalis unless gelatin is added to the media to prevent inhibition from the anticoagulant, sodium polyethanol sulfonate (SPS).

Surgery is not indicated for bacterial vaginosis.

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Medical Care

Note the following:

  • Antibiotics are the mainstay of therapy for bacterial vaginosis (BV), but asymptomatic women with Gardnerella vaginalis colonization do not need treatment.
  • Studies of topically applied and orally administered yogurt/lactobacilli preparations, which are used to help reestablish the lactobacilli population in the vagina, have demonstrated inconsistent results.
  • Some women with recurrent cases of BV may benefit from evaluation and/or treatment of G vaginalis colonization in their sexual partner. This approach is controversial.
  • Treat BV occurring in pregnant women to reduce the risk of pregnancy-associated complications related to infection. Although not tested by clinical trials, treatment prior to cesarean delivery, total abdominal hysterectomy, and insertion of an IUD is also recommended.
  • Advise patients to stop douching or using bubble bath or any other over-the-counter vaginal hygiene products.
  • Wash only with hypoallergenic bar soaps or no soap at all. Avoid liquid soaps and body washes.

Consultations

Consultation with an infectious disease specialist or obstetrician/gynecologist may be warranted for patients with nonresolving and/or recurring BV or more serious infections, such as endometritis, pelvic inflammatory disease, and chorioamnionitis.

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Diet and Activity

Studies are conflicting regarding the efficacy of a diet supplemented with Lactobacillus (acidophilus).

Ya et al conducted a placebo-controlled trial to assess the effectiveness of a vaginal probiotic product (8 billion units of Lactobacillus rhamnosusL acidophilus, and Streptococcus thermophilus per capsule) for recurrent bacterial vaginosis prevention. The dosage regimen consisted of short-term use of 7 days on, 7 days off, then 7 days on. Probiotic prophylaxis resulted in lower recurrence rates for bacterial vaginosis and Gardnerella vaginalis for 2 months. A lower incidence was also reported during follow-up (2-11 months) in women in the probiotic group. [20]

Restriction of activities is not necessary for patients with bacterial vaginosis. Other, more serious Gardnerella infections may require restriction of activity based on the severity and nature of the illness.

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