Understanding Patient Perceptions of Bacterial Vaginosis Treatments: Mixed Methods Sentiment Analysis Study of Online...

Bacterial vaginosis (BV) is the most common cause of vaginal discharge in people of childbearing age in the United States. More information about what patients do and do not like about the most common BV products and the extent to which they reduce BV symptoms is important for understanding patients' health and the current treatment landscape for BV.

Using data from online drug review forums, this study's objectives were to (1) quantitatively characterize the patient voice via sentiments (positive to negative) and emotions about the three most common Food and Drug Administration (FDA)-approved treatments for BV-oral metronidazole (OM), vaginal metronidazole (VM), vaginal clindamycin (VC)-and (2) qualitatively summarize themes characterizing the patient-perceived impact of BV and BV products.

Data for this mixed methods descriptive study came from 1645 users' reviews of BV products posted on WebMD.com and Drugs.com. Reviewer attributes, reviewer-submitted star ratings, and sentiment analysis (SA) using word-emotion association were analyzed with descriptive statistics and bivariate associations. A traditional qualitative analysis using qualitative description was also performed.

Most reviewers were female (n=629, 99.4%), between the ages of 18 and 44 years, and reported using BV products for less than 1 month, though qualitative results suggested most reported recurrent BV infections. Quantitative results revealed reviewers' preference for vaginal products. The mean star ratings for VC were significantly higher when compared to OM and VM. VC reviews had the highest proportion of positive emotion words compared to OM and VM. Qualitative results for VC supported the quantitative findings: favorable themes related to perceptions of value, effectiveness in alleviating symptoms, and minimal side effects. Additionally, despite some concerns related to the cost of VC, reviewers said they would use the medication again. Other qualitative findings supported BV medical education campaigns for patients and providers on BV treatment.

Overall, people want a BV treatment that is easy to use, quickly alleviates symptoms, and has minimal side effects. Patients use product reviews to inform their decision-making about BV treatment, ask and seek answers to health-related questions, and share their experiences, presenting a unique opportunity for comprehensive patient education through clinical encounters or public health outreach efforts.