Bacterial Vaginosis

The vagina has a pool of resident bacteria. Bacterial vaginosis develops when the 'harmful' bacteria dwelling in the vagina increase while the 'good' decrease ending up in an imbalance. [1] It accounts for most cases of vaginal infection and is usually a mild condition but may lead to more severe problems in some cases.

Causes

The exact cause of bacterial vaginosis remains unclear. The usual feature is a reduced count of the normally occurring vaginal hydrogen peroxide-producing lactobacilli. Factors that increase chances of getting bacterial vaginosis are multiple or new sexual partners, intrauterine device (IUD) use, recent antibiotic therapy, douching, and smoking. Sexual activity as cause of bacterial vaginosis is not yet established. Many females who have not had sexual intercourse may get the disease. [3] Activities that have been proposed to increase the likelihood of getting bacterial vaginosis include having perfumed bubble bath, vaginal deodorant use and washing of underwear with strong detergents. The disease could not be acquired from toilet seats, beddings, swimming pools and from touching objects around. [4]

Signs and Symptoms

Most women affected do not have clinical manifestations. The most common symptom is avaginal discharge with unpleasant odour. [3] A fish-like odour maybe present particularly after sexual intercourse. The discharge is commonly white or grey. [5] It may also become watery and thin. Other less frequent symptoms are pain on urination and itching outside the vagina. [4]

Diagnosis

Diagnosis is based on history, examination of the vagina and microscopic exams of the vaginal discharge. [6] Pelvic exam is also performed where in the physician inspects the vaginal lining and cervix. Ovaries and uterus may also be assessed. An additional test called 'whiff test' might be performed. Positive sign is the development of fishy odour upon contact of potassium hydroxide (KOH) to the sample discharge of the patient. [3]

Complications

Bacterial vaginosis often does not result to complications. Associated complications include susceptibility to HIV when exposed, increased risk of transmitting HIV if affected, post-surgical infection and if patient is pregnant, may result to preterm delivery, late miscarriage and postpartum endometritis.[6]

Treatment

Antibiotics are used to treat bacterial vaginosis. The most commonly used are metronidazole andclindamycin. [2] Uncomplicated cases usually resolve after the antibiotic therapy. [6]

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Thuja (Eastern White Cedar, Thuja Occidentalis) [1, 2, 3, 4]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Little is known about the full effects of Thuja, so it is not recommended for medicinal use. Thuja can be poisonous if ingested in large amounts.

Recommendation: no recommendation (There is insufficient evidence to support claims that Thuja helps to treat vaginosis)

Grade of Evidence: very low quality of evidence

* www.gradeworkinggroup.org

References:

1. http://womenshealth.gov/publications/our-publications/fact-sheet/bacterial-vaginosis.cfm

2. http://www.webmd.com/sexual-conditions/tc/bacterial-vaginosis-topic-overview

3. http://www.medicinenet.com/bacterial_vaginosis/article.htm

4. http://www.medicalnewstoday.com/articles/184622.php

5. http://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm

6. http://emedicine.medscape.com/article/254342-workup

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.nlm.nih.gov/medlineplus/ency/article/002769.htm

3. http://plants.usda.gov/plantguide/pdf/cs_thoc2.pdf

4. http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=thuja&x=0&y=0