Bacterial vaginosis

Diagnosis

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Pelvic exam

Pelvic exam

During a pelvic exam, a doctor or other care provider inserts two gloved fingers inside the vagina and presses down on the stomach area. This is done to check the uterus, ovaries and other organs.

To diagnose bacterial vaginosis, your doctor may:

• Ask questions about your medical history. Your doctor may ask about any previous vaginal infections or sexually transmitted infections.
• Perform a pelvic exam. During a pelvic exam, your doctor visually examines your vagina for signs of infection, and inserts two fingers into your vagina while pressing on your abdomen with the other hand to check your pelvic organs for signs that may indicate disease.
• Take a sample of vaginal secretions. This may be done to check for an overgrowth of anaerobic bacteria in your vaginal flora. Your doctor may examine the vaginal secretions under a microscope, looking for "clue cells," vaginal cells covered with bacteria that are a sign of bacterial vaginosis.
• Test your vaginal pH. Your doctor may check the acidity of your vagina by placing a pH test strip in your vagina. A vaginal pH of 4.5 or higher is a sign of bacterial vaginosis.

Treatment

To treat bacterial vaginosis, your doctor may prescribe one of the following medications:

• Metronidazole (Flagyl, Metrogel-Vaginal, others). This medicine may be taken as a pill by mouth (orally). Metronidazole is also available as a topical gel that you insert into your vagina. To reduce the risk of stomach upset, abdominal pain or nausea while using this medication, avoid alcohol during treatment and for at least one day after completing treatment — check the instructions on the product.
• Clindamycin (Cleocin, Clindesse, others). This medicine is available as a cream that you insert into your vagina. Clindamycin cream may weaken latex condoms during treatment and for at least three days after you stop using the cream.
• Tinidazole (Tindamax). This medication is taken orally. Tinidazole has the same potential for stomach upset and nausea as oral metronidazole does, so avoid alcohol during treatment and for at least three days after completing treatment.
• Secnidazole (Solosec). This is an antibiotic you take orally in one dose. The medication comes as a packet of granules that you sprinkle onto a soft food, such as applesauce, pudding or yogurt. You eat the mixture within 30 minutes, being careful not to crunch or chew the granules.

It's generally not necessary to treat an infected woman's male sexual partner, but bacterial vaginosis can spread between female sexual partners. Female partners should seek testing and may need treatment. It's especially important for pregnant women with symptoms to be treated to help decrease the risk of premature delivery or low birth weight.

Take your medicine or use the cream or gel for as long as your doctor prescribes it — even if your symptoms go away. Stopping treatment early may increase the risk of recurrence.

Recurrence

It's common for bacterial vaginosis to recur within three to 12 months, despite treatment. Researchers are exploring treatments for recurrent bacterial vaginosis. If your symptoms recur soon after treatment, talk with your doctor about treatments. One option may be extended-use metronidazole therapy.

A self-help approach is lactobacillus colonization therapy — which attempts to boost the number of good bacteria in your vagina and re-establish a balanced vaginal environment — possibly accomplished by eating certain types of yogurt or other foods containing lactobacilli. While current research shows there may be some benefit to probiotic therapy, more research is needed on the subject.

Preparing for your appointment

Try to schedule your appointment on a day when you don't have your period. That way, your primary care doctor or gynecologist can observe and evaluate your vaginal discharge without menstrual discharge getting in the way. Avoid using tampons and vaginal deodorant sprays, and don't douche or have sex for 24 hours before your appointment.

What you can do

To make the best use of your time with your doctor and prevent you from forgetting an important question:

• Make a list of any symptoms you're experiencing. Include all of your symptoms, even if you don't think they're related.
• Make a list of any medications, vitamins, herbs or other supplements you take. Include how often you take them and the doses.
• Take a notepad or electronic device with you. Take notes of important information during your visit.
• Prepare a list of questions to ask your doctor. List your most important questions first, in case time runs out.

For bacterial vaginosis, some basic questions to ask your doctor include:

• Can I do anything to prevent bacterial vaginosis?
• What signs and symptoms should I look for?
• Do I need to take medicine?
• Does my partner also need to be tested or treated?
• Are there any special instructions for taking the medicine?
• Are there any over-the-counter products that will treat my condition?
• What can I do if my symptoms return after treatment?

Don't hesitate to ask questions during your appointment if you don't understand something.

Questions your doctor may ask

Be prepared to answer questions your doctor may have, such as:

• What symptoms are you experiencing?
• How long have you had your symptoms?
• Do you notice a strong vaginal odor?
• Have you ever been treated for a vaginal infection?
• Have you tried any over-the-counter products to treat your condition?
• Have you recently taken antibiotics for any reason?
• Are you sexually active?
• Are you pregnant?
• Do you use scented soap or bubble bath?
• Do you douche or use feminine hygiene spray?