Bacterial Vaginosis (BV) and its Latest Treatment

Bacterial Vaginosis (BV) and its Latest Treatment

Having some amount of vaginal discharge is normal, especially if you are of childbearing age. Glands in the cervix produce a clear mucus. These secretions may turn white or yellow when exposed to the air. These are normal variations.The amount of mucus produced by the cervical glands varies throughout the menstrual cycle. This is normal and depends on the amount of estrogen circulating in your body.


Normal vaginal discharge has several purposes: cleaning and moistening the vagina and helping to prevent and fight infections.. Normally, "good" bacteria, called lactobacilli, are in the majority and keep other kinds of bacteria in check. You end up with BV when there are too few lactobacilli, which allows other bacteria to grow out of control.

The cause of BV is not understood. It can develop when something, like sexual contact, disrupts the balance between the good bacteria that protect the vagina from infection and the harmful bacteria that don't. It is not clear what role sexual activity plays in the development of BV, but BV is more common among women who have had vaginal sex. But BV is not always from sexual contact. We do know that certain things can upset the normal balance of bacteria in the vagina and put you more at risk for BV.lactobacillus species are the dominant bacteria in women without bacterial vaginosis, whereas women with bacterial vaginosis have considerable microbial diversity.

Vaginal discharge that suddenly differs in color, odor, or consistency, or significantly increases or decreases in amount, may indicate an underlying problem like an infection. If abnormal vaginal discharge is due to a sexually transmitted disease (STD), your sexual partner(s) will likely require treatment as well.Bacterial vaginosis affects millions of women and is associated with several serious health conditions.

Vaginal infections, such as bacterial vaginosis, candidiasis (yeast infection), and trichomoniasis are common causes of abnormal vaginal discharge. Some infections are transmitted by having sex, such as gonorrhea. Other infections can occur with or without having sex, such as bacterial vaginosis or yeast infection. some experts recommend that women who have had a premature delivery in the past be screened and treated for bacterial vaginosis at the first prenatal visit. Even if a woman has been tested in the past, she should be tested again when she becomes pregnant.

Bacterial vaginosis appears to be caused by an overgrowth of several types of bacteria. It is normal to have these bacteria in the vagina. However, too many of them in the vagina can cause unpleasant symptoms.It is not known what causes the overgrowth of bacteria. Most cases of bacterial vaginosis occur in sexually active women. And women who have more than one sexual partner have a greater risk of developing the problem. However, women who are not sexually active can also have bacterial vaginosis.

Having BV when you're pregnant may raise your risk for preterm labor and birth. Some studies have also linked the infection to a higher risk of miscarriage, preterm premature rupture of the amniotic membranes (PPROM), and uterine infection after delivery.

The most common cause of vaginal odor is bacterial vaginosis, resulting from an overgrowth of organisms normally present in the vagina. The odor — usually a "fishy" smell — may be more obvious after sexual intercourse. Other signs and symptoms of bacterial vaginosis include vaginal itching or irritation, and a grayish-whitish vaginal discharge. Another common cause of vaginal odor is poor hygiene. It is a good idea to wash your external genital area during regular baths or showers. Use a very small amount of mild, unscented soap and lots of water.

Therapeutic effectiveness relies on accurate testing to identify patients who might benefit from therapy yet many physicians rely on syndromic diagnoses, which do not always correlate to laboratory findings. Thus, treatment based solely on symptoms will misdiagnose many women.Typically, the diagnosis of BV requires speculum examination to inspect and collect vaginal discharge, which is evaluated using Amsel's clinical criteria . For research, the scoring of the morphology and composition of the vaginal flora by Gram stain is considered widely to be the gold standard.

Genital mycoplasmas can cause infection of the genitourinary tract. These organisms are associated with bacterial vaginosis, pelvic inflammatory disease, endometritis, cervicitis, Nongonococcal urethritis. Spontaneous abortion, premature birth, neonatal pneumonia and meningitis, and infertility.Study showed that PCR method is more sensitive than culture for detection genital mycoplasma, Therefore polymerase-chain-reaction (PCR) is a rapid, sensitive and easy method to detect genital mycoplasmas in urogenital swabs.

The cause of bacterial vaginosis remains enigmatic. No single bacterium has been shown to cause the disease, and many cultivated bacteria linked to bacterial vaginosis, such as G. vaginalis, frequently colonize the vagina of women without bacterial vaginosis.22 Our study identified several new bacterial species associated with bacterial vaginosis, but such associations do not prove causation. Additional molecular evidence may be required to assess causal associations with uncultivated bacteria.23 Furthermore, the scenario of disease causation by a microbial community defies the traditional application of Koch's postulates. Bacterial vaginosis may be an example of polymicrobial disease causation due to the metabolic interdependence of several bacterial species in the vaginal niche.

Treatment Options-- Pros and Cons:

Metronidazole (brand name Flagyl). By mouth, 500mg, twice a day, for one week. This is the most common regimen. Medicine tends to upset the stomach, leading some women not to finish it. Using generic metronidazole in this way is the most cost-effective treatment. Price about $1.50
Metronidazole (brand name Flagyl) By mouth, a single 2gm dose. The single dose has a bit lower cure rate and the relapse rate is higher. But there is no risk of quitting before finishing. Using generic pills, this is the cheapest treatment.
Metronidazole Gel (Metrogel) 0.75% inserted vaginally twice a day for 5 days. Good as 7 day oral, no stomach upset, but messy and inconvenient. No generic at this point, so it is pricey. About $20.
Clindamycin By mouth, 300mg twice a day for 7 days orally. Clindamycin 2% vaginal cream once a day for 7 days For 100% cure rate: oral (500mg. Twice a day for 5 days) and vaginal ornidazole (500mg/day for 5 days) OR Oral secnidazole (2gm single dose) and vaginal metroniazole (500mg, twice a day for 7 days).

There is a recent reports show an in-vitro resistance and also the presence of a therapeutic failure using metronidazole in treating G. vaginalis infections, insistence of using a culture on an appropiate media in order to identify the germ and test sensitivity to antibiotics used in treating these infections must be performed following the simple way of laboratory detection.

The U.S. Food and Drug Administration has approved Tindamax (tinidazole) to treat bacterial vaginosis (BV), the most common vaginal infection among women of childbearing age, drug maker Mission Pharmacal said .

It's the first new oral therapy in a decade to treat BV, which affects almost one-third of women in the United States, the company said. Caused by an overgrowth of certain bacteria, BV often does not have symptoms. When they are present, symptoms may include vaginal discharge, burning during urination, and itching.

Tindamax treats the entire reproductive tract, including the upper tract where the bacteria have been shown to migrate. Left untreated, BV can increase a woman's risk of acquiring sexually transmitted diseases including chlamydia, gonorrhea and HIV, the drug maker said. Among pregnant women, BV can increase a woman's risk of early pregnancy loss and premature delivery.

During clinical testing, side effects of Tindamax included metallic taste and nausea. First FDA approved in 2004, the drug was previously sanctioned for trichomoniasis, giardiasis, and amebic liver abscess.

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