Prevention

All symptomatic pregnant women should be tested and treated. Bacterial vaginosis has been associated with adverse pregnancy outcomes (e.g., premature rupture of membranes, chorioamnionitis, preterm labor, preterm birth, postpartum endometritis, and post-cesarean wound infection).

Some experts recommend screening and treatment of BV in asymptomatic pregnant women at high-risk (those who have previously delivered a premature infant). One should screen and treat at the first prenatal visit, and follow up evaluation one month after completion of therapy.

Most professional groups do not recommend screening asymptomatic patients. Therapy may not be necessary for asymptomatic women with BV. Therapy is not recommended for male partners of women with BV. Female partners of women with BV should be examined and treated if BV is present. Screening of women with BV prior to a surgical abortion or hysterectomy is recommended.
 

Recurrence

BV recurs in 20%-40% of patients one month after treatment. Recurrence may be a result of persistence of BV-associated organisms and failure of Lactobacillus flora to recolonize. Neither yogurt therapy nor exogenous oral Lactobacillus treatment have been shown to be of benefit (they contain non-vaginal Lactobacillus species). Vaginal suppositories containing human Lactobacillus strains are currently under study.

Patient Counseling and Education

Patient counseling and education should cover the nature of the disease, transmission issues, and risk reduction.

Nature of the disease

• Normal vs. abnormal discharge
• Malodor
• Signs and symptoms of BV

Transmission issues

• High concordance in female same-sex partnerships
• Association with sexual activity

Risk reduction

• Consistent and correct condom use
• Avoid douching
• Limit number of sex partners

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