Prevention of Bacterial Vaginosis

Understanding Bacterial Vaginosis

Bacterial vaginosis is characterized by a replacement of normal hydrogen peroxide-producing Lactobacillus species with high concentrations of anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis, and it is the most prevalent cause of vaginal discharge and malodor, with up to 50% of women with BV being asymptomatic, according to the Centers for Disease Control and Prevention (CDC) 1, 2

Multiple sexual partners increase the risk of BV, as stated by the CDC 1, 3
New sexual partners also increase the risk of BV, as reported by the American College of Obstetricians and Gynecologists (ACOG) 4
Sexual activity is a significant risk factor, as women who have never been sexually active are rarely affected, according to the CDC 3, 2
African-American ethnicity is associated with a higher risk of BV, as noted by the National Institutes of Health (NIH) 4, 5
Low socioeconomic status is also a risk factor for BV, as stated by the NIH 4, 5
Previous history of preterm birth increases the risk of BV, as reported by the ACOG 4, 5

Treatment of male sexual partners has not been shown to prevent recurrence of BV, as stated by the CDC 1, 3, 2
Probiotics containing Lactobacillus species can help maintain healthy vaginal flora, according to the American College of Obstetricians and Gynecologists (ACOG) 6
Meta-analyses show that probiotic supplementation significantly improves BV cure rates when used as complementary therapy with antibiotics, as reported by the ACOG 6

BV recurrence may be related to menstrual cycles due to hormonal changes, as noted by the American College of Obstetricians and Gynecologists (ACOG) 7
Changing tampons and pads frequently during menstruation can help reduce the risk of BV, as recommended by the ACOG 7
Avoiding tampons may be considered for women with recurrent BV, as suggested by the ACOG 7

Assuming BV is always symptomatic is incorrect, as up to 50% of cases are asymptomatic, according to the CDC 1, 2
Treating sexual partners unnecessarily is not recommended, as partner treatment has not been shown to prevent recurrence, as stated by the CDC and the American College of Obstetricians and Gynecologists (ACOG) 3, 2, 8
Implementing evidence-based prevention strategies can reduce the risk of developing bacterial vaginosis and its associated complications, including increased susceptibility to STIs, PID, and adverse pregnancy outcomes, as recommended by the American College of Obstetricians and Gynecologists (ACOG) 6

The Centers for Disease Control and Prevention recommends screening and treating asymptomatic BV before surgical abortion or hysterectomy to prevent serious ascending infections, including post-abortion pelvic inflammatory disease, vaginal cuff cellulitis, and endometritis 9
The Centers for Disease Control and Prevention suggests considering screening before other invasive gynecologic procedures, such as IUD placement or hysterosalpingography, although evidence is less robust 9
The Centers for Disease Control and Prevention recommends testing and treating all symptomatic pregnant women for BV due to associations with premature rupture of membranes, preterm labor, preterm birth, and postpartum endometritis 9

The Centers for Disease Control and Prevention advises against treating male sexual partners for BV, as it does not prevent recurrence and is not recommended 9
The Centers for Disease Control and Prevention notes that treating male sexual partners does not affect a woman's response to therapy or likelihood of relapse 9

Bacterial vaginosis arises when the normal hydrogen‑peroxide‑producing Lactobacillus–dominant vaginal microbiome is displaced by high concentrations of anaerobic bacteria such as Prevotella, Mobiluncus, Gardnerella vaginalis, and Mycoplasma hominis — a polymicrobial dysbiosis that forms biofilms on the vaginal epithelium. 10

Up to half of individuals who meet diagnostic criteria for bacterial vaginosis have no symptoms, indicating that the microbial imbalance can exist silently in the population. 10