28 Feb 10 Treating Recurring Bacterial Vaginosis at Its Root Causes

Many clinical studies have been performed to evaluate the effectiveness of antibiotics in the treatment of bacterial vaginosis (BV). Usually 80-90% of women would show good response to the treatment in the initial stage. However, up to one-third of these women would have recurring bacterial vaginosis in 3 months’ time.

A long-term medical study found that more than half of women who were treated with antibiotics would be hit by at least another episode of BV. Most recurrence cases happened in the first year, and one of the most obvious risk factors was having new sexual partners.

For women who are at risk of recurring bacterial vaginosis, their risk can be greatly reduced by making some lifestyle changes, such as stop douching or replace IUD with another form of contraceptive.

So far, clinical observations suggest that recurrent bacterial vaginosis is not sexually transmitted, because treating the male sexual partner of a BV-affected woman didn’t seem to stop bacterial vaginosis from recurring. Current medical evidence seems to support the theory of relapse – something triggers the disruption of the vaginal flora and causes bacterial vaginosis symptoms to manifest.

The exact mechanism of recurring bacterial vaginosis remains a mystery – whether a reduction in lactobacilli happens first, or an increase in the vaginal pH or an overgrowth of BV-causing bacteria takes place first. Fortunately, there are therapeutic options available to treat recurrent bacterial vaginosis.

Bacteria replacement therapy (or known as bacteriotherapy)

This method uses harmless bacteria to replace BV-causing bacteria with lactobacilli, and is considered natural and safe. Lactobacilli bacteria are used, either given orally or applied vaginally. Unfortunately, not all strains of lactobacilli are able to adhere well onto the vaginal wall.

The lactobacilli group found in yogurt doesn’t seem to stick very well to the vaginal wall. The L crispatus and L jensenii showed better ability to adhere compared with other lactobacilli strains. A clinical study showed that, with a combination of oral and vaginal lactobacilli replacement, normal vaginal flora can be achieved after 60 days. There are now studies to examine the effectiveness of vaginal pessaries containing L crispatus in repopulating the vagina with lactobacilli.

Maintaining vaginal pH at 4.5 or less

Before the normal vaginal lactobacilli and other microflora are restored and once again able to maintain the vaginal pH themselves, using external aid to adjust the vaginal pH is important to prevent overgrowth of BV-causing pathogens. In a study that examined the effectiveness of intravaginal lactate gel usage, it was found that 88% of women who were on the vaginal maintenance treatment had their BV cured ompared to only 10% of those who didn’t.

Preventing overgrowth of BV-causing organisms

Bacterial vaginosis recurrences most often take place within the first 7 days of the menstrual cycle, and frequently followed a Candida infection. Medical experts propose the use of oral or vaginal metronidazole for the first 3 days of menstruation for 3-6 months. If there is a history of candidiasis, it is also advisable to add on anti-fungal treatment.

In some women, using either one of the above approaches will help to cure bacterial vaginosis, but in most women one type of treatment won’t be able to stop recurring bacterial vaginosis. A combination therapy seems to work more effectively for the majority of women. For example, in a study where women took a single dose of oral metronidazole followed by vaginal lactate tablets, there was an improved rate of normal vaginal flora in 94% of women, compared to only 71% of women if no vaginal maintenance treatment was used.

From what the medical evidence suggests, the best way to manage recurring bacterial vaginosis is to treat this vaginal disorder at its root causes by replenishing lactobacilli, keeping a vaginal pH of 4.5, and if required also adding supportive therapy to stop excessive growth of the BV-causing bacteria. Many bacterial vaginosis natural cures used today are based on these medical principles, and have shown satisfactory outcomes among women with recurrent BV.

Tags: bacterial vaginosis recurrence, recurrent bacterial vaginosis, recurring bacterial vaginosis