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Recurrent bacterial vaginosis (BV) causes discomfort for many women. Yet, learning how to apply an integrative approach to treatment can help decrease recurrence and provide lasting relief. I quickly discovered this during my late twenties after struggling with recurrent BV infections. It was only through integrative care that I could successfully improve my vaginal health and prevent reinfection.

What’s Bacterial Vaginosis and Why It’s Problematic

Bacterial vaginosis (BV) is a type of vaginal infection caused when an imbalance of bacterial strains disrupt the vaginal flora. Common strains that linked with bacterial vaginosis include Gardnerella vaginalisPrevotellaPreptostreptococcus, and Bacteroids. Some have this infection and do not exhibit any symptoms. Usually, in those instances, it resolves on its own with no need for medical intervention. However, in progressive cases, the presence of symptoms necessitates medical treatment to prevent complications.

Complications of Bacterial Vaginosis

If left untreated bacterial vaginosis can increase your risk of developing sexually transmitted infections such as HIV, herpes simplex virus, human papillomavirus (HPV), Chlamydia, and Gonorrhea. Furthermore, it leaves you susceptible to developing a pelvic inflammatory disease. Additionally, untreated bacterial infections can contribute to pregnancy complications in which miscarriage and pre-term delivery occur. 

Other side effects include having to manage uncomfortable symptoms such as itching, pain when urinating, unhealthy discharge that’s thin and watery with a gray or white color—and having an unpleasant strong unpleasant fishy odor. 

Conventional Treatments for Bacterial Vaginosis

Antibiotics are the most common treatment for progressive cases of bacterial vaginosis. Popular antibiotics that your doctor may prescribe are metronidazole; however, if your body fails to respond to this treatment or you have a recurrence, Clindamycin or Tinidazole may be prescribed instead. 


Why Traditional Treatments Fail

An unfortunate issue with bacterial vaginosis is its high rate of recurrence. Many factors may contribute to the reinfection of bacterial vaginosis that ranges from unidentified bacterial strains, overuse of antibiotics, and lifestyle behaviors. 

Unidentified Bacterial Strains

While most cases of BV involve the more common bacterial strains, Gardnerella vaginalis, prevotella, preptosterptococcus, and Bacteroides. Other bacterial strains have yet to be identified and cultured. Thus, increasing the failure of antibiotics when treating these strains. Furthermore, increasing the likelihood of recurrent infection. 

Overuse of Antibiotics

Due to BV’s high recurrence rate and the fact that antibiotics are the primary source of treatment, overuse of antibiotics can quickly become an issue. Specifically, failure to identify and address the root cause of recurrent BV. Yet, diagnosing the cause of BV for many can be complicated, primarily if it recurs despite preventative methods. Thus leaving antibiotic medication as the only option for treatment. 

Lifestyle Behaviors

On the other hand, there are certain habits and behaviors regarding hygiene and wellness practices that may trigger bacterial vaginosis. For instance, using scented feminine care products such as tampons, pantyliners, washes, sprays, and powders can disrupt vaginal flora. Additionally, douches and deodorizing vaginal suppositories cause imbalances in the vaginal flora. These products produce a pH imbalance that contributes to an imbalance of specific bacterial strains. Thus disrupting the vaginal microbiome and contributing to the onset of BV. Furthermore, habits such as smoking can increase bacterial infection susceptibility due to its ability to suppress a healthy immune system function. 


Why Integrative Care is Needed

Many practitioners are looking to fuse alternative treatments with traditional treatments when considering the failure rate of conventional bacterial vaginosis treatments. This approach can help with treating current BV outbreaks while preventing future recurrences. 

Combination Therapy

There is limited research regarding the benefit of combining antibiotic treatment with probiotic supplementation for BV treatment. And while further studies are needed, this approach has proven successful in limited studies. Combining probiotic treatment while taking an antibiotic helps prevent the removal of beneficial vaginal lactobacilli, known for its ability to defend the vaginal flora from pathogens. Furthermore, it counteracts the impact of specific BV strains such as Gardnerella vaginalis. 

A study testing the effectiveness of combination therapy observed 125 women in which an oral antibiotic of 500 mg (metronidazole) was taken twice per day for seven days. A random selection of this group received oral probiotics containing Lactobacillus rhamnosus GR-1, and lactobacillus reuteri RC-14 containing one billion colony forming units. Whereas, the remaining received a placebo for thirty days. The results revealed that 40% of the placebo group cured their BV, and 88% of the probiotic group cured their vaginal infection. Furthermore, those with a combination of antibiotics and probiotics had a 100% success rate, whereas those of the antibiotic and placebo group had a 70% success rate in curing BV. Thus, proving this as a viable treatment for use in treating bacterial vaginosis. 

Lifestyle Modifications

Making healthy lifestyle changes should be included as part of an integrative approach to treating BV. Decreasing your exposure to vaginal irritants that contribute to pH imbalances and disrupt healthy bacteria can help further reduce BV recurrence. Abstaining from scented tampons, pantyliners, feminine washes, sprays, douches, and fragranced suppositories can improve vaginal pH. 

Additionally, refraining from immune-suppressing activities such as smoking can help maintain a healthy vaginal flora and decrease the risk of bacterial vaginosis. 


Putting It All Together

Struggling with recurrent bacterial vaginosis is a common health complication for many women. However, studies are providing limited evidence that supports the success of combination therapy. Integrative treatments that fuse antibiotics and probiotics work together to restore balance to the vaginal microbiome. Furthermore, implementing lifestyle modifications that prevent vaginal irritants from altering the vaginal pH and immune-suppressing activities, such as smoking, also help prevent bacterial vaginosis recurrence. 

Yet, there’s a need for further research to determine how viable probiotics are in preventing BV. Additionally, more studies are necessary for identifying additional strains that contribute to BV infections, so proper treatment is administered. In the meantime, taking an oral probiotic supplement containing various strains of lactobacilli and up to one billion colony forming units can help preserve vaginal health. 


Medical News Today: What Is Bacterial Vaginosis?, medically reviewed by University of Illinois on November 23, 2017, written by Yvette Brazier

Interdisciplinary Perspectives on Infectious Diseases 2008, 2008: 256940 Published online 2009 March 29th Vaginal Microbiota and the use of Probiotics Sarah Cribby, Michelle Taylor, Gregor Reid

J Appl Microbiol. 2011 May; 110 (5): 1105-1128 published online 2011 March 14th The Etiology of Bacterial Vaginosis Yevgeniy Turovskiy, Katia Sutyak Noll, Michael L. Chikindas

Fred Hutch Organization Article: Study Identifies Several New Bacterial Species Associated with Common INfection in Women– November 3, 2005