Bacterial vaginosis - More questions than answers

Bacterial vaginosis is the commonest cause of abnormal vaginal discharge in women of reproductive age and is associated with serious pregnancy related sequelae and increased transmission of sexually transmissible infections, including HIV. The aetiology, pathology, microbiology and transmission of bacterial vaginosis remain poorly understood.

This article discusses the prevalence, clinical features and possible complications of bacterial vaginosis. It summarises what is known about the aetiology, pathophysiology and treatment of the condition and highlights directions for further research.

Bacterial vaginosis is characterised by a complex disturbance of the normal vaginal flora with an overgrowth of anaerobic and other micro-organisms and a corresponding decrease in important lactobacillus species. The cause is not known, but observational evidence suggests the possibility of sexual transmission. Bacterial vaginosis is diagnosed by the Amsel or the Nugent method. Recommended treatment is with 7 days of oral metronidazole or vaginal clindamycin. More than 50% of women will experience recurrence of bacterial vaginosis within 6 months. It is not known whether this represents relapse or re-infection. Further research is needed into the aetiology, pathogenesis and optimal treatment of this condition.