Bacterial vaginosis

Diagnosis

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Pelvic exam

Pelvic exam

During a pelvic exam, a doctor inserts one or two gloved fingers inside the vagina. Pressing down on the abdomen at the same time, the doctor can 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 vaginal infections or STIs you've had before.
• Perform a pelvic exam. First, your doctor will look at your vagina for signs of infection. Next, the doctor will feel your pelvic organs. This is done by inserting two fingers into the vagina while pressing on the stomach area, also called the abdomen, with the other hand.
• Take a sample of vaginal discharge. This sample will be tested for "clue cells." Clue cells are vaginal cells covered in bacteria. These are a sign of BV.
• Test your vaginal pH. The acidity of your vagina can be tested with a pH strip. You place the 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 medicines:

• Metronidazole (Flagyl, Metrogel-Vaginal, others). This medicine comes as a pill or topical gel. You swallow the pill, but the gel is inserted into your vagina. Avoid alcohol while using this medicine and for a full day afterward. It might cause nausea or stomach pain. Check the instructions on the product.
• Clindamycin (Cleocin, Clindesse, others). This medicine comes as a cream that you insert into the vagina. Or you can use the pill or suppository form. The cream and suppositories may weaken latex condoms. Avoid sex during treatment and for at least three days after you stop using the medicine. Or use another method of birth control.
• Tinidazole (Tindamax). You take this medicine by mouth. It can cause stomach upset. So avoid alcohol during treatment and for at least three days after completing treatment.
• Secnidazole (Solosec). This is an antibiotic you eat one time with food. It 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. But take care not to crunch or chew the granules.

Usually, treatment isn't needed for a sex partner whose sex is male. But BV can spread to partners whose sex is female. So testing and treatment may be needed if a female partner has symptoms.

Take your medicine or use the cream or gel for as long as prescribed, even if your symptoms go away. If you stop treatment early, BV may come back. This is called recurrent bacterial vaginosis.

Recurrence

It's common for bacterial vaginosis to come back within 3 to 12 months even with proper treatment. Researchers are exploring options for recurrent BV. If your symptoms return soon after treatment, talk with your care team. It might be possible for you to take extended-use metronidazole therapy.

There may be some benefit to probiotics, but more information is needed. In a random trial, probiotics were no better than a treatment that didn't contain medicine, called a placebo, in stopping recurrent BV. So probiotics are not recommended as a treatment option for bacterial vaginosis.

Preparing for your appointment

Try to schedule your appointment on a day when you don't have your period. Bleeding from a period may stop your doctor from seeing your vaginal discharge clearly. For 24 hours before your appointment, don't use tampons or vaginal sprays and don't douche or have sex.

What you can do

Here are some tips to make the best use of time with your provider:

• List your symptoms. Include all of them. Even if you don't think they're related.
• List your medicines and supplements. This includes vitamins and herbs. State how often you take them and how much you take.
• Take notes. Bring a notepad or device with you to track important information during your visit.
• Have questions ready. List your most important questions first.

For bacterial vaginosis, some basic questions to ask include:

• Can I do anything to prevent bacterial vaginosis?
• What symptoms should I look for?
• Do I need to take medicine?
• Should my partner be tested or treated?
• Are there any special instructions for taking the medicine?
• Are there any products that I can buy without a prescription to treat my condition?
• What can I do if my symptoms come back 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 products you can buy without a prescription 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?