Preventing Bacterial Vaginosis

Back in the early 90s, Glamour magazine printed a story on treating vaginal infections with boric acid. It wasn't long before they printed another story on making sure the boric acid went in the vagina and not in the mouth! It was a shame that this snafu occurred because in the long run, Glamour was on to something.

Bacterial vaginosis (BV) is a vaginal infection caused by a variety of bacteria in the vagina.  When these normallly occuring vaginal bacteria become overgrown, they create an infection that produces a smelly irritating discharge. It's not uncommon for women to have bacterial vaginosis in their lifetime. Unfortunately, some women will have it over and over again. And that's where Glamour and boric acid come in. Since then our options haven’t changed much, but let’s take a look at what you can do to prevent or treat a BV infection.

What is bacterial vaginosis?

There have been several different types of bacteria identified as causes of BV. Those bacteria frequently reside in the vagina. When the vaginal pH becomes too alkaline, that bacteria can become overgrown and out of balance. Things that can contribute to the alkalinity of the vagina include semen, multiple sex partners, and new sex partners. While males have not been found to carry BV, sexual activity can be predisposing due to the alteration of the vaginal pH. The good bacteria in the vagina are the acid producing lactobacilli. Anything that decreases the lactobacilli population can also contribute.  Unfortunately some people are thought to be genetically predisposed to a lower production of lactobacilli. The most common complaint of BV is a thin grayish discharge that smells very fishy. It will actually smell worse when paired with soap. BV has also been linked with pelvic infections and pelvic inflammatory disease. 

How to treat BV?

If you have an episode of BV, it is important to go see your health care provider so that you may be treated with the proper antibiotic. The common treatments include oral metronidazole for 7 days, vaginal metronidazole for 5 days, and vaginal clindamycin for 3 to 7 days.  Other treatments include oral tinidazole and oral clindamycin. Once you have treated the bacterial vaginosis, you may be susceptible to a recurrence. Don't despair, recurrence is common. If you have repeated recurrences, it may be time to work toward prevention.

How can you prevent BV?

A few regimens have been studied as ways to prevent BV:

  • One way is to use vaginal metronidazole gel once weekly for 4 to 6 months. While this seems to be effective during therapy, there is concern as to how it works after the therapy is discontinued.
  • Another option is to treat the infection with oral metronidazole and then to immediately begin preventive therapy with vaginal boric acid. Boric acid powder can be purchased at the local pharmacy.  You then have to ask the pharmacist if you can also purchase some large capsules (tell the pharmacist that you will need to get 600 mg of boric acid in the capsule). Carefully pack the large capsules with the boric acid and insert them into the vagina. The boric acid capsules should be inserted vaginally daily for 21 days. Then vaginal metronidazole is initiated twice weekly for 4 to 6 months.  Don't let the box of boric acid scare you--it does have a skull and crossbones on it. Just don't take it orally!
  • Finally, some data suggests taking oral metronidazole once monthly.

Other helpful things that you can do routinely include consistent condom use and no douching. You'll need to work with your health care provider to find the regimen that is right for you. Just don't give up until you get the BV under control.

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