Q&A: Normalize seeking proper bacterial vaginosis diagnosis, treatment

Key takeaways:

• Bacterial vaginosis is a common infection that requires diagnosis and treatment by a health care provider.
• Health care providers should strive to eliminate stereotypes associated with vaginal infections.

Bacterial vaginosis is a common infection many U.S. women experience, but there continue to be knowledge gaps requiring research to help understand its development, risk factors and treatment.

Bacterial vaginosis affects about 21 million U.S. women annually with a 58% recurrence rate. Bacterial vaginosis is commonly misunderstood and it is important to normalize conversations with OB/GYNs and reduce stigmas surrounding bacterial vaginosis, according to Kameelah Phillips, MD, FACOG, a board certified obstetrician and gynecologist at Calla Women’s Health in New York City.

“It’s important that we expose bacterial vaginosis and talk about it openly, so women aren’t embarrassed to talk about their bodies and body odor and, most importantly, get back into the office so that we can properly diagnose bacterial vaginosis for them and treat them appropriately,” Phillips told Healio.

Healio spoke with Phillips about bacterial vaginosis symptoms, misunderstandings, risk factors, available treatment options and current research.

Healio: What are risk factors for bacterial vaginosis?

Phillips: When we talk about how it develops, I wish we knew, but we have a lot of information about risk factors, so that’s usually what I talk to patients about. Some of those risk factors relate to a change in the microbiome of the vagina. It could be anything from having your period, having multiple sexual partners, smoking, douching or condom use — these are well-known bacterial vaginosis triggers. But sometimes it can be none of these things, and just a disruption in the vaginal microbiome can lead to bacterial vaginosis development.

One thing both professionals and lay people see is vaginal discharge, and we assume, incorrectly, that it’s a yeast infection because that’s something that we see in commercials and it’s more in our conversation. I encourage people to understand that there are differences between yeast infections and bacterial vaginosis and not to assume what your symptoms might be, and make sure to visit the doctor’s office to get properly diagnosed and treated.

Healio: What are some symptoms that women experience?

Phillips: What my patients primarily complain about with bacterial vaginosis is discharge. You can have an overwhelming amount of discharge, and a hallmark of that discharge is that it also has a strong fishy odor. Anytime a patient doesn’t feel like themselves, I have bacterial vaginosis on my radar. The odor is distinctive, and because of all that discharge, you can have intense vulvar discomfort.

This is a little bit different than what we think about with yeast infections where the overwhelming symptoms are more a cheesy discharge and a lot of burning and itching. I encourage patients to come into the office and discuss what their symptoms are because two-thirds of people with bacterial vaginosis will need medical care and, instead of enduring the stress and discomfort associated with bacterial vaginosis, they should come into the office to get a proper diagnosis and treatment.

Healio: Are there any common misunderstandings about bacterial vaginosis diagnosis and treatment?

Phillips: This is an important time to normalize that our bodies go through changes, and sometimes those changes produce odor. It doesn’t make you a bad or unclean person. We should be normalizing body odor and the changes that we all go through.

Going back to bacterial vaginosis vs. yeast, women should try not to feel that they need to self-diagnose. That’s what the relationship with a doctor is for, so the symptoms you have can be properly managed. You don’t have to deal with the stress and discomfort of having ongoing bacterial vaginosis because two-thirds of these women need treatment and bacterial vaginosis isn’t going to go away by itself.

Healio: Are some groups of women more susceptible than others to contracting bacterial vaginosis?

Phillips: It can happen to anyone, but what we do know is that there is an overwhelming burden of bacterial vaginosis in the Black and Hispanic community. The microbiome of Black and Hispanic women is a little different compared with other races/ethnicities. This doesn’t mean that they are biologically different, but there are components of the vaginal microbiome that are different and can predispose Black and Hispanic women to a higher incidence of bacterial vaginosis.

Other things that make some groups of women more susceptible are douching, smoking and having multiple partners. These are all risk factors for women that can make them more susceptible to bacterial vaginosis. Another risk factor is condom use, but I tell patients to think about this. If you are having sex with multiple partners, you need to use condoms, but I also bring that up as an additional risk factor.

Healio: Can diet influence bacterial vaginosis development or help to treat it?

Phillips: The way that I explain the interaction between diet and vaginal health with patients is that there’s not a direct correlation. But, in general, eating as clean as you possibly can is better for the body, but there’s not a specific direct correlation. I encourage my patients to eat as plant-based, healthy and as non-processed as possible, but I can’t tell them that there’s a direct relationship to bacterial vaginosis, either for development or treatment. I don’t have a clear answer, and that’s an area where we need more research.

Healio: What treatments exist for bacterial vaginosis? Can it be cured or simply treated?

Phillips: With bacterial vaginosis I don’t use the word “cure” with patients because we know that 58% of people will have a recurrence. I want to talk to them in a way where we’re not using definitive words. We talk about the rate of recurrence, behavioral changes, the impact of new partners, the menstrual cycle, the natural state of the microbiome and that recurrence is possible.

Currently recommended treatment options for bacterial vaginosis include antibiotics, such as clindamycin and metronidazole, which may be used orally or vaginally.

What I also talk to patients about — and want to highlight — is that we have an additional treatment for bacterial vaginosis and that’s Xaciato (clindamycin phosphate vaginal gel, 2%; Organon). This is clindamycin, a familiar “tried and true” antibiotic, but Xaciato uses a novel method of action. The antibiotic is carried in a thermosetting gel. That allows the gel and the treatment to stay longer in the vaginal canal, so the patient is getting treatment for a longer time. It limits leakage, thereby increasing the time of the medication spends in the vagina and allows for one-time dosing . It’s also a colorless gel, which is important for people who are worried about staining their clothes.

Healio: What research is currently underway regarding bacterial vaginosis?

Phillips: Unfortunately, women’s health is woefully underfunded and under-researched. Because of this, I’m not familiar with any research as it relates to bacterial vaginosis, specifically. I mentioned that Black and Hispanic women are overburdened, and that there are differences in the microbiome that increase their rates of bacterial vaginosis, but we don’t know why. These are all excellent research topics.

Healio: Do you have anything else you’d like to add?
Phillips: It is important to normalize shifts in our body and odor and incorporate health care providers in that journey to understand what’s going on with your body. Women don’t have to sit with the physical and psychological stress of a bacterial vaginosis infection because there are treatments available.

In general, both on the health care side and the patient side, we all need to start these conversations, because there are millions of women who are dealing with this in silence, and it should be something we talk about a lot more. Staying silent just perpetuates this stereotype that our bodies are not clean or are dirty, and it is terrible to walk around feeling like that when these are normal biological things that have treatments available.