Treatment of bacterial vaginosis usually involves antibiotics such as clindamycin. You can learn more about the risks and suspected causes of BV on this page. One of the things about BV that is most interesting is that although the exact cause(s) are not known, researchers agree that the end result is that the normal flora balance is upset and inflammatory chemicals produced by the body are present causing vaginitis.
Most researchers agree that the lactic acid bacteria species Lactobacillus should be the dominant bacteria in the vaginal flora, although some say that other lactic acid bacteria such as Bifidobacterium or others can also be dominant in normal, healthy women. In any case, beneficial bacteria dominate the vaginal microbiome in healthy women.
In women with BV, however, other species that are harmful take over and form dense biofilms. Biofilms are colonies of microorganisms that stick together and cover a solid surface. The decrease in beneficial bacteria correlates to the increase in BV Nugent scores, meaning that the lower the beneficial count, the higher the BV Nugent score.
The traditional therapy for bacterial vaginosis involves one of two antibiotics: metromidazole or clindamycin. According to the CDC, either can be used in pregnancy or with non-pregnant women, at different dosages. Women with BV who are HIV-positive should receive the same treatment as those who do not have HIV.
Unfortunately, not every women treated with antibiotics has her BV infection cured during treatment, and women who are treated with metromidazole or clindamycin often have the infection occur again and again. High failure rates were recorded in 54% of women within 3 months following treatment of bacterial vaginosis with metronidazole in a 2006 study.
A big reason for the high failure rate is that antibiotics don’t fare well against biofilms. Additionally, many pathogenic bacteria are resistant to antibiotics, but most probiotic bacteria are sensitive to them and are killed. So more of the good guys get killed than the bad guys.
Lastly, sometimes killing off the BV anaerobic bacteria in the vagina allows harmful aerobic bacteria, which are usually found in feces but can end up in the vagina, to flourish. This results in aerobic vaginitis.
Information on treating bv with probiotics is found here.
More information on BV is on this page.
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