| June 2002 · Vol. 14, No. 6 UPDATE
BV update: eliminating diagnostic confusion
In the absence of universally accepted data, 3 leading authorities review the evidence on bacterial vaginosis and discuss their approaches to diagnosing and treating this common vaginal affliction.
SEBASTIAN
FARO,
MD, PhD;
WILLIAM
LEDGER,
MD;
SHARON
HILLIER,
PhD
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The panelists
William Ledger, MD, is chairman emeritus and professor of OBG at the New York Weill Cornell Medical Center in New York City.
Sharon Hillier, PhD, is professor of OBG and reproductive sciences at the University of Pittsburgh School of Medicine in Pennsylvania.
Sebastian Faro, MD, PhD, is clinical professor of OBG and reproductive sciences at the University of Texas-Houston Health Science Center in Houston.
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Key points
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Physicians should not diagnose BV with a culture. A standard culture will not identify the number of anaerobic bacteria.
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In diagnosing BV, an Ob/Gyn must perform a microscopic exam, along with a whiff test and pH.
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Metronidazole and clindamycin are only 66% effective in treating BV.
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Topical clindamycin causes a temporary overgrowth of E. coli and Enterococcus in the vagina.
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Women whose vaginal microflora is colonized with hydrogen peroxide-producing Lactobacillus are less likely to acquire BV.
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All women should be screened for BV during an annual exam.
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The number one reason women visit their gynecologists is for the treatment of vaginal infections. Yet a recent Gallup survey found that only 36% had ever heard of bacterial vaginosis (BV), the most common type of vaginal infection, affecting 1 in 4 American women. BV is a disease caused by an overgrowth of anaerobic bacteria and Gardnerella, all of which can be found in low numbers in the healthy vagina. In fact, women who have been diagnosed with BV have up to 1,000 times more anaerobic bacteria than normal women.
Studies have shown that many women confuse the symptoms of BV with a yeast infection and often self-medicate with over-the-counter preparations. Unlike Candida, however, BV has been associated with pelvic inflammatory disease (PID), as well as an increased risk of endometritis, cervicitis, and in pregnant women, premature delivery. Therefore, it is imperative that Ob/Gyns properly diagnose and treat BV while creating greater awareness of the signs and symptoms of this widespread disorder among their patients. Here, Sebastian Faro, MD, PhD, William Ledger, MD, and Sharon Hillier, PhD, respond to OBG Management editors’ questions on appropriate diagnosis, screening, and management modalities to combat this potentially dangerous yet treatable condition.
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