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Treating Recurring Bacterial Vaginosis at Its Root Causes

March 14th, 2010

Many clinical studies have been performed to evaluate the effectiveness of antibiotics in the treatment of bacterial vaginosis (BV). Generally, 80-90% of women showed good initial response to the treatments. However, about 15-30% of these women experienced recurring bacterial vaginosis within 3 months after treatment.

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 relapses occurred within the first year, and were obviously related to having new sexual partners.

For women who are prone to recurring bacterial vaginosis, making some lifestyle changes, including stopping douching and replacing IUD with another method of contraception, will greatly help to prevent another episode.

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 without side effects. Lactobacilli bacteria are used, either given orally or applied vaginally. However, scientists found that not all lactobacilli strains can stick on well to the vaginal lining.

Lactobacilli from yogurt seem to adhere less well to vaginal cells. The L crispatus and L jensenii showed better ability to adhere compared with other lactobacilli strains. A medical study reported that normal flora vagina can be regained following a combination of oral and vaginal lactobacilli replacement therapy for 60 days. There are now studies to examine the effectiveness of vaginal pessaries containing L crispatus in repopulating the vagina with lactobacilli.

Maintaining a vaginal pH of 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. One study showed that by using intravaginal lactate gel, 88% of women with recurring bacterial vaginosis were able to eliminate BV compared to only 10% of women who didn’t use the vaginal maintenance therapy.

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 combined approach appears to work better for most 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.

In short, it would be ideal if recurring bacterial vaginosis can be managed through bacteria replacing treatment and maintaining the vaginal pH at 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.