Of particular importance is the fact that both of these studies 2 , 3 demonstrated therapeutic efficacy for only pregnant women considered at high risk for preterm delivery.
It is not clearly understood if low-risk pregnant women with no underlying increased risk factors for preterm birth would benefit equally as well from treatment of bacterial vaginosis. Similarly, claims of benefit from treatment of asymptomatic pregnant women with bacterial vaginosis have not been properly substantiated. Recent guidelines from the Centers for Disease Control and Prevention CDC recommend treating asymptomatic high-risk pregnant women with bacterial vaginosis.
The effectiveness of screening patients to prevent potentially serious sequelae depends on the prevalence of the condition in the population at risk, readily available and accurate diagnostic tests, consequences of the untreated condition, effective therapy and the overall cost-effectiveness of such intervention.
In support of screening pregnant women for bacterial vaginosis are the following factors: the condition is exceedingly common a prevalence rate of up to 30 percent ; reasonably reliable tests are available; the potential consequences of not treating bacterial vaginosis are severe for the mother and the fetus; and moderately effective therapy is available. While these factors bolster screening, many questions regarding screening pregnant women for bacterial vaginosis exist.
If screening is done, when should it be conducted, second or third trimester? It appears that infection with bacterial vaginosis in early pregnancy second trimester conveys a greater risk for complications than infection with bacterial vaginosis in late pregnancy. Should all pregnant women be screened, or only women considered to be at increased risk for fetal-maternal complications? While treatment of high-risk pregnant women with bacterial vaginosis reduces the risks for fetal-maternal complications, 2 , 3 no data are available to compare bacterial vaginosis treatment outcomes for both women at low risk and women at high risk of fetal-maternal complications.
Therefore, currently only women determined to be at high risk for preterm delivery should be considered candidates for screening for bacterial vaginosis.
How should screening be performed—using simple clinical evaluation and Amsel's criteria, Gram stain, gas-liquid chromatography GLC or fibronectin assay? Screening by Amsel's criteria three of four findings: pH of more than 4. The other tests are considerably more expensive and are not readily available, but they offer more accurate diagnosis or assessment of increased risk for potential complications.
Whether screening would be cost-effective is controversial, 7 , 8 because data based on outcomes from randomized controlled screening trials are not available. As such, no guidelines currently recommend universal screening of pregnant women for bacterial vaginosis. Some limited data are available to help guide clinicians in the selection of antibiotics for bacterial vaginosis in pregnant women.
Topical clindamycin vaginal cream is ineffective in reducing the rates of preterm birth. Topical metronidazole gel Metrogel has not been evaluated in the context of bacterial vaginosis during pregnancy.
Topical antibiotics usually eradicate local bacterial vaginosis infection, but do not reduce prematurity sequelae because of the lack of access to the upper genital tract. Therefore, systemic antibiotics are probably required to adequately reduce the risk of pregnancy-related complications.
Oral metronidazole and metronidazole combined with erythromycin have been shown to reduce pregnancy complications associated with bacterial vaginosis. Alternatively, oral clindamycin Cleocin could be used, but limited data are available on its use, 12 particularly in the context of treating women without a current or past history of pregnancy-related complications. A test of cure evaluation one month following treatment of bacterial vaginosis may be beneficial because treatment failures are common.
In summary, women with bacterial vaginosis during pregnancy should be aggressively evaluated and effectively treated.
This is particularly true for women considered at high risk for pregnancy-related complications. Asymptomatic pregnant women with bacterial vaginosis may also benefit from therapy.
Systemic antibiotics appear to afford both effective treatment for bacterial vaginosis and minimization of pregnancy-related complications. Universal screening of pregnant women for bacterial vaginosis is not currently recommended, but women at high risk for preterm birth may benefit from early second trimester screening for bacterial vaginosis.
Casual clinical recognition of bacterial vaginosis in asymptomatic pregnant women should prompt proper diagnosis and treatment. Although pregnant women with bacterial vaginosis obviously have an increased risk for pregnancy-related complications, it is unknown whether therapeutic intervention decreases the rate of specific fetal-maternal problems for all pregnant women.
Evidence-based guidelines for proper management of pregnant women with bacterial vaginosis await the outcomes of clinical trials currently being conducted. Bacterial vaginosis: review of treatment options and potential clinical indications for therapy.
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Br J Obstet Gynecol ; : —7. Screening for bacterial vaginosis in pregnancy. Am J Prev Med ; 20 3 suppl : 62 — Guidelines for treatment of sexually transmitted diseases. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation.
Volume Nelson , Deborah B. Oxford Academic. Google Scholar. George Macones. Cite Cite Deborah B. Select Format Select format. Permissions Icon Permissions. Abbreviation: BV, bacterial vaginosis. Open in new tab Download slide. Curr Clin Top Infect Dis. Clin Obstet Gynecol. Obstet Gynecol Surv.
Am J Public Health. Genitourin Med. Am J Med. Am J Obstet Gynecol. N Engl J Med. Obstet Gynecol. Bacterial vaginosis BV is a common infection of the vagina. It can cause a change in your vaginal discharge. It can also cause your discharge to have an unusual odour smell. For most pregnancies, bacterial vaginosis does not cause any problems.
The cause of bacterial vaginosis is not fully understood. But it happens when the type of bacteria in your vagina changes. In your vagina you have a mixture of bacteria. This includes 'friendly' or 'good' bacteria called lactobacilli.
If the friendly bacteria die off, other types of bacteria begin to grow. These are called anaerobic bacteria. This change in bacteria upsets the acid balance of your vagina. This can cause more 'unfriendly' anaerobic bacteria to grow and cause BV. If you notice a change in the colour or smell of your vaginal discharge, talk to your GP, obstetrician or midwife. They may ask you some questions about the discharge. They may also examine you by looking at your vagina.
A vaginal swab is often the best way to confirm bacterial vaginosis. A vaginal swab looks like a long cotton bud or q-tip. It is inserted into your vagina and wiped against any discharge or the inside of your vagina. Most GPs, GP practice nurses and midwives use a speculum to take the swab. This is a small plastic device that is inserted into your vagina and opened gently.
Vaginal swabs do not usually hurt, but they may be a little uncomfortable.
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