Bacterial Vaginosis, defined as an imbalance in vaginal flora characterised by low levels of lactobacilli and an increased frequency of facultatively anaerobic bacteria, is one of the most common reproductive tract infections in women globally1.

According to the Journal of the American Pharmaceutical Association, prevalence studies have shown that 30 – 35% of patients with vaginitis present with Bacterial Vaginosis 2. Estimates of the prevalence of Bacterial Vaginosis in Africa vary, with estimates of between 20 – 50% 1.

According to Dr Corne Brink, gynaecologist and obstetrician from Fourways Life Hospital in Johannesburg, 50 – 75% of women with Bacterial Vaginosis will be asymptomatic.  “Those with symptoms will usually see an off-white thin homogenous discharge that has a bit of a fishy odour.  This “fishy smell” is often more pronounced after sexual intercourse,” she says.

She says that Bacterial Vaginosis is mostly seen in women of reproductive age, from approximately 15- 42 years of age, but can be present in older and younger women as well.

Unlike Candida or vaginal thrush which is a yeast infection that most often comes from the gut, Dr Brink explains that Bacterial Vaginosis is a bacterial infection, or even more precisely a shift in the normal balance of bacteria in the vagina.

She says that while some patients might misdiagnose themselves and use incorrect treatments, most will come for a checkup if their symptoms don’t improve with whichever treatment they are using.

“There are different criteria for diagnosis of Bacterial Vaginosis, but most commonly we will see a change in the pH of the vagina, with the discharge and a fishy odour when the discharge is mixed with a 10% potassium hydroxide solution.  I diagnose it based on Pap smear results or vaginal swabs,” Dr Brink explains.

Some of the risk factors for Bacterial Vaginosis include having more than one sexual partner, having changed partners in the last 30 days, having a female sexual partner, and douching at least once a month or within the previous seven days3.

Although Bacterial Vaginosis was initially thought to be of limited clinical significance, it has since been implicated in a variety of possible consequences including risks of preterm birth and the development of pelvic inflammatory disease1, as well as increased risk of upper genital tract infection including possible endometriosis after giving birth, wound infection, increased infection after hysterectomy and chorioamnionitis or intra-amniotic infection (IAI)3. Bacterial Vaginosis has also been linked to an increased transmission of HIV and other sexually transmitted infections4.

From a psychological point of view, Bacterial Vaginosis can have a substantial negative impact on a woman’s quality of life. Stress associated with living with the infection can potentially place a strain on romantic relationships and self-image. Bacterial Vaginosis can also have a negative impact on social and physical activities, which can impact productivity at work and/or school4.

According to the International Journal of Obstetrics and Gynecology, of the estimated 21 million women infected with Bacterial Vaginosis in the United States every year, only about four million will seek treatment, and 50% of women treated will experience a recurrence of symptoms within a year, a consequence of low awareness of this condition4.

Bacterial Vaginosis treatment is based on the culture and sensitivity of the bacteria, but options can include gels, creams and oral treatments4.

“Most of the time women with Bacterial Vaginosis react well to MetroGel V, and it is the most commonly prescribed treatment in my practice,” says Dr Brink.

MetroGel V is administered vaginally meaning that the infected area is treated directly. Furthermore, low systemic absorption results in better tolerability with fewer side effects than oral mediation7.

In fact MetroGel V from iNova Pharmaceuticals is the South African gynaecologist’s preferred choice in the treatment of Bacterial Vaginosis 5. It has a once daily dosing regime, recommended for five consecutive days at bed time. It is a water based gel formulation which stays in the vagina, is unlikely to stain clothes/linen, greaseless and is fragrance free6. It also contains no mineral oil therefore does not weaken latex contraceptives and is non-greasy. MetroGel V has also shown less incidence of building resistance therefore can be used for recurrent treatments8.

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DISCLAIMER: This editorial includes independent comment and opinion from an independent healthcare provider and is the opinion and experience of that particular healthcare provider and not necessarily that of iNova Pharmaceuticals.