Managing Recurrent Bacterial Vaginosis: Insights for Busy Providers

Bacterial vaginosis (BV) is a common clinical condition that affects millions of women annually. Serious sequelae exist from untreated infection. Recurrent BV (RBV) is also common with few approved clinical treatment modalities. Review of the current recommendations yields practical tips to aid busy professionals.

To review the current treatment recommendations for recurrent bacterial vaginosis.

A literature review was conducted using the keywords: bacterial vaginosis, recurrent bacterial vaginosis, vaginal probiotics, vaginal reacidifiers, and trichomoniasis.

Patients with RBV should be treated with the approved suppressive antimicrobial regimen, but new modalities and adjuncts are currently under review and appear safe; however, rates of efficacy still need to be established.

There is no defined etiology of RBV, and thus, a curative treatment remains elusive. Sexual practices, hygiene practices, and the type of sexual partner all affect the rate of BV recurrence. Vaginal reacidifiers and probiotics may offer effective alternatives to the current antimicrobial regimens. Clinicians should obtain an in-depth history to have an accurate picture of the patient's pattern of infection, ensure they are using all clinical tools available to make the correct diagnosis, and educate the patient regarding simple behavioral changes they can make to prevent RBV.

More research is needed to explain and treat RBV. In the meantime, if clinicians maximize all current modalities, they will reduce the recurrence rate in certain patients. Marshall AO. Managing recurrent bacterial vaginosis: Insights for busy providers. Sex Med Rev 2015;3:88-92.