Treating Recurring Bacterial Vaginosis at Its Root Causes

Many clinical studies have been performed to evaluate the effectiveness of antibiotics in the treatment of bacterial vaginosis (BV). Usually 80-90% of women would show good response to the treatment in the initial stage. 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 recurrence cases happened in the first year, and one of the most obvious risk factors was 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.

Exactly how recurring bacterial vaginosis occurs remains to be studied. It is still unknown which of these takes place first - a reduction in lactobacilli, an increase in vaginal pH, or an overgrowth of the naturally occuring BV-causing bacteria. 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. Unfortunately, not all strains of lactobacilli are able to adhere well onto the vaginal wall.

The lactobacilli group found in yogurt doesn't seem to stick very well to the vaginal wall. The L crispatus and L jensenii showed better ability to adhere compared with other lactobacilli strains. A clinical study showed that, with a combination of oral and vaginal lactobacilli replacement, normal vaginal flora can be achieved after 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.

Using one of the above therapeutic options may help some women to end recurring bacterial vaginosis, but may not cure all cases. 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 necessary also adding complementary treatment to control bacteria overgrowth. Many bacterial vaginosis natural cures used today are based on these medical principles, and have shown satisfactory outcomes among women with recurrent BV.