Demystifying bacterial vaginosis: Understanding, treatment, and breaking stigmas

Demystifying bacterial vaginosis: Understanding, treatment, and breaking stigmas | Image Credit: © Arif Biswas - © Arif Biswas - stock.adobe.com.

Contemporary OB/GYN:

What are the most prevalent misunderstandings surrounding bacterial vaginosis (BV)?

Kameelah Phillips, MD, FACOG:

Despite being the most common vaginal condition among women of reproductive age, BV symptoms are often mistaken for a yeast infection. I treat many women who do not realize they have BV and delay coming in for help because they attempted to self-treat at home first. When speaking with patients, I find there are misconceptions about what causes BV. While there are some activities that can increase a woman’s risk of BV, such as sexual activity with multiple or new partners and/or unprotected sex, cigarette smoking, and douching, it doesn’t mean the patient will develop a BV infection from engaging in these activities. In my experience, I see that patients often have anxiety and shame with a BV diagnosis, but BV should not be a source of stigmatization. I remind my patients that BV is quite common and caused by an imbalance of the natural vaginal microbiome and should not be a source of shame or embarrassment.

Contemporary OB/GYN:

Please provide a brief overview of the BV treatment landscape, including recent advancements in the field.

Phillips:

There are both oral and topical medications for BV. What I often hear from my patients is concern regarding BV medications leaking and staining their underwear, which they say can be messy, embarrassing, and inconvenient.

I am particularly excited about an additional treatment option that uses clindamycin, an established antibiotic used for the treatment of BV, in a unique formulation technology. It is a complete treatment in a single dose administered intravaginally at any time of day with a unique thermosetting formulation which increases viscosity at body temperature causing it to coat and conform to the shape of the vagina. This leads to a gradual release of clindamycin over time which increases vaginal retention time and is formulated to limit leakage. XACIATO has also demonstrated robust efficacy in both new and recurrent BV, which we know is important given that BV has a high rate of recurrence—58% of women who have BV will get another BV infection within the next year.

Contemporary Ob/GYN:

What advice do you have for clinicians for speaking to patients about BV?

Phillips:

As clinicians, we need to make sure that we reiterate to patients that BV is not something women should be ashamed of. There is so much stigmatization and misinformation surrounding BV and it’s our job to educate our patients and create a safe space where they feel encouraged to discuss any of their vaginal changes. This open dialogue is what allows us to diagnose BV quickly and accurately, and from there, create an individualized treatment plan.

Contemporary Ob/GYN:

How are different patient populations impacted by BV, and how does this affect treatment?

Phillips:

While any woman can get BV, Black and Hispanic women are disproportionately impacted, though it is unclear why some women of color have higher rates of BV. The vaginal microbiome is a complex environment made up of different bacteria, and the balance between them is not the same for all women. This is why continued women’s health research, particularly among women of color, is critically important.

Contemporary Ob/GYN:

Is there anything you would like to add?

Phillips:

We need to normalize having open lines of communication between doctors and patients regarding any abnormal vaginal discharge or odor – sometimes our bodies experience changes, which can result in odor, but that doesn’t make you a bad or unclean person; we need to normalize bodies and odor. It is our job as physicians to ensure that our patients don’t feel judged and instead feel welcome coming to us to discuss the changes that their bodies are going through –this is critical to ensuring proper diagnosis and individualized treatment plans.