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by
Rachel Westfall, 2003. If
you borrow this material, please cite this webpage.
What is bacterial vaginosis?
Our vaginas are naturally colonized by Lactobacillus bacteria, such as acidophilus. These
bacteria acidify the vaginal environment and suppress the growth of other organisms. A
disruption in the normal vaginal flora can happen for many reasons, possibly including
stress, poor diet, weakened immune system, and the use of antibiotics. What happens is the
Lactobacillus bacteria are no longer the primary organisms found in the vagina. A drop in
the level of Lactobacillus makes room for other, less benevolent organisms to grow. An
overgrowth of certain anaerobic bacteria (always present, but usually in much smaller
numbers) leads to the condition known as bacterial vaginosis. The organisms include
Gardnerella vaginalis and Mycoplasma hominis (Sweet, 1993) as well as other anaerobic
bacteria.
Bacterial vaginosis is often associated with an unpleasant fishy odour and thin, greyish
mucous. It is also often associated with vaginitis. However, approximately half the women
who are diagnosed with bacterial vaginosis have no symptoms (Shalev, 2000).
Why is bacterial vaginosis an issue for pregnant women?
In pregnancy, women are routinely screened for an overabundance of the organisms that
cause bacterial vaginosis. It is found in 15-23% of screened pregnant women (McCoy et al.,
1995). There is some concern among maternity care providers, because bacterial vaginosis
is associated with elevated rates of pre-term labour (Hefner, 1999; Hillier et al., 1995;
Meis et al., 1995), and it also increases one's risk of premature rupture of the
membranes, chorioamnionitis, and post-partum infections (Shaley, 2000). However,
asymptomatic women may not be at risk of preterm delivery (Halo, 1996).
Prevention and treatment
Conventional treatments of bacterial vaginosis include oral or vaginal antibiotics. These
treatments have varying degrees of success. Some studies have shown that treatment with
antibiotics did not improve outcomes for women who were otherwise considered low-risk
(Christopher et al., 2000; McDonald et al., 1997; Joesoef et al., 1995), whereas others
have found antibiotic treatment to be beneficial (McGregor et al., 1994, 1995).
For women who wish to avoid using antibiotics, a number of prevention and treatment
options exist.
Anecdotal
evidence suggests that refined and processed foods, coffee, alcohol, sugar, and saturated
animal fats in the diet increase one's risk of developing bacterial vaginosis. In
contrast, drinking lots of fresh water, and eating plenty of fresh fruits, vegetables,
whole grains, and high quality protein are said to help prevent the condition.
Once bacterial vaginosis has been diagnosed, in addition to the dietary modifications
mentioned above, one might consider trying the following:
* Eating
something that is a rich dietary source of vitamin C every day, or supplementing with
vitamin C (unproven);
* Using
acidophilus supplements and vaginal suppositories (be sure to get sugar-free acidophilus
powder, or use plain live yoghurt to avoid introducing yeast-feeding sugars into your
vagina). The effectiveness of yoghurt suppositories in treating bacterial vaginosis is
still not fully established, but clinical trials have shown promise (Neri et al., 1993;
Sharev et al., 1996);
* Using
warm Sitz baths containing tea tree oil (unproven).
References
Christopher CJ, Klebanoff MA, Hauth JC, et al. Metronidazole to prevent preterm delivery
in pregnant women with asymptomatic bacterial vaginosis. New England Journal of Medicine
2000;342:534-40.
Haefner HK. Current evaluation and management of vulvovaginitis. Clinical Obstetrics and
Gynecology 1999;42:184-95.
Hillier SL, Nugent RP, Eschenbach DA, et al. Association between bacterial vaginosis and
preterm delivery of a low-birth-weight infant. New England Journal of Medicine
1995;333:1737-42.
Hilo J, Keness Y, Shalev E. Association of bacterial vaginosis in pregnancy with preterm
delivery. Harefuah 1996;131:83-5.
Joesoef MR, Hillier SL, Wiknjosastro G, et al. Intravaginal clindamycin treatment for
bacterial vaginosis: effects on preterm delivery and low birth weight. American Journal of
Obstetrics and Gynecology 1995;173:1527-31
McCoy MC, Katz VL, Kuller JA, Killam AP, Livengood CH. Bacterial vaginosis in pregnancy:
An approach for the 1990s. Obstetric and Gynecol Survey 1995;50:482-8.
McGregor JA, French JI, Jones W, et al. Bacterial vaginosis is associated with prematurity
and vaginal fluid mucinase and sialidase: results of a controlled trial of topical
clindamycin cream. American Journal of Obstetrics and Gynecology 1994;170:1048-60.
McDonald HM, O'Loughlin JA, Vigneswaran R, et al. Impact of metronidazole therapy on
preterm birth in women with bacterial vaginosis flora (Gardnerella vaginalis): a
randomised, placebo controlled trial. British Journal of Obstetrics and Gynaecology
1997;104:1391-7.
McGregor JA, French JL, Parker R, et al. Prevention of premature birth by screening and
treatment for common genital tract infection: result of a prospective controlled
evaluation. American Journal of Obstetrics and Gynecology 1995; 173:157-67.
Meis PJ, Goldenberg RL, Mercer B, et al. The preterm prediction study: significance of
vaginal infections. American Journal of Obstetrics and Gynecology 1995;173:1231-5.
Neri A, Sabah G, Samra Z. Bacterial vaginosis in pregnancy treated with yoghurt. Acta
Obstetrica Gynecologia Scandinavica 1993;72:17-9.
Shalev E, Battino S, Weiner E, Colodner R, Keness Y. Ingestion of yogurt containing
Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent
candidal vaginitis and bacterial vaginosis. Archives of Family Medicine 1996;5:593-6.
Shaley, E. Ingestion of probiotics, optional treatment of bacterial vaginosis in
pregnancy. In: E. Lebenthal, Ed., Nutrition in the Female Life Cycle. Israel: Danone
Books, 2000, 96-103. http://www.danone-institute.org.il/danone/books/
Sweet,
Richard L. New approaches for the treatment of bacterial vaginosis. American Journal of
Obstetrics & Gynecology 1993;169 (2): 479-82.
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