Bacterial Vaginosis: An Update on Diagnosis and Treatment

Hans Verstraelen; Rita Verhelst


Expert Rev Anti Infect Ther. 2009;7(9):1109-1124. 

In This Article

Abstract and Introduction


Bacterial vaginosis is the most common cause of vaginal complaints. Bacterial vaginosis is further associated with a sizeable burden of infectious complications. Diagnosis relies on standardized clinical criteria or on scoring bacterial cell morphotypes on a Gram-stained vaginal smear. A few point-of-care tests have not gained footage in clinical practice, but molecular diagnosis is now pending. Treatment remains cumbersome and clinicians are currently rather poorly armed to treat bacterial vaginosis in the long run. As an adjuvant to standard treatment with antibiotics, alternative treatments with antiseptics and disinfectants, vaginal-acidifying and -buffering agents, and probiotics hold some promise for long-term prevention.


Bacterial vaginosis (BV) is a condition characterized by the partial loss of the indigenous vaginal lactobacilli on the one hand, and massive polymicrobial anaerobic overgrowth of the vaginal mucosa on the other. The etiopathogenesis of this infestation remains largely elusive, although a limited number of risk factors have consistently been associated with BV, including black ethnicity, sexual intercourse and vaginal douching. Although BV often remains asymptomatic, it still is, along with vulvovaginal candidiasis, the most common cause of vaginitis, and hence among the most common reason for women to seek medical help. However, in recent years BV has emerged as a global issue of concern due to the vast infectious disease burden that results from the diminished colonization resistance with BV. Infections related to BV may broadly be categorized as opportunistic infections with BV-associated bacteria and as infections due to sexually transmitted agents. In the first category, ascending genital tract infection in the setting of BV implicates postabortion and postpartum endometritis, pelvic inflammatory disease (PID) and, in pregnancy, late fetal loss and spontaneous preterm birth. In the second category, where it has rather recently been recognized as a state of diminished colonization resistance, BV renders women particularly vulnerable to the acquisition of Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, HSV-2 and HIV-1. Moreover, it has been documented that BV propagates viral replication and vaginal shedding of the HIV-1 and HSV-2 viruses, thereby further enhancing the spread of these sexually transmitted diseases. Tackling the HIV burden through eradicating BV and restoring the vaginal microflora is therefore now considered one of the most promising answers to the HIV epidemic.


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