Bacterial vaginosis: Literature review of treatment options with specific emphasis on non-antibiotic treatment

Bacterial vaginosis (BV) is a vaginal infection that occurs when the balance of bacteria in the vagina is altered. It is a common condition affecting millions of women. Although the syndrome is curable with standard drugs such as metronidazole and clindamycin, relapse rates are high. Many patients are asymptomatic and recurrence is difficult to differentiate from treatment failure. The infection can have gynaecological and obstetric complications. In addition, there is an association with the transmission of sexually transmitted infections (STIs) including HIV/AIDS. This review focuses on the epidemiology, aetiology, diagnosis, complications and treatment of BV, with emphasis on the role of non-antimicrobial treatment options. Firstly, the lowering of the vaginal pH is discussed as one possible treatment option. An overview is given of the use of acetic and lactic acid gels, boric acid suppositories, as well as studies that reported on the use of douches and tampons. Thereafter, the role of Lactobacillus (probiotic) supplementation as treatment is discussed. Literature sources recommend that more research on BV be conducted. Although standard pharmacological therapy is effective, there are limited treatment options available. Recent research indicating the presence of a structured polymicrobial Gardnerella vaginalis biofilm attached to the endometrium may have major implications for future research into the pathogenesis and treatment of BV.