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What Causes Recurrent Bacterial Vaginosis Infections?

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Posted on Tue, 6 May 2014
Question: I was diagnosed with BV and a yeast infection after I noticed a watery discharge. I was given one pill of fluconazole to take that same day and then I took Metradonozal for a week. After finishing the course I still noticed a watery discharge so I went back and yeast was present so I was given another dose of Fluconazole. It is day 6 and I'm still having this discharge. Any advice?
doctor
Answered by Dr. Shafi Ullah Khan (1 hour later)
Brief Answer: Needs management and modifications Detailed Answer: Thank you for asking! Recurrent bacterial vaginosis infections has one or more of the following reasons. Recent antibiotic use Decreased estrogen production of the host Wearing an intrauterine device (IUD) Douching Sexual activity that could lead to transmission (eg, having a new sexual partner or a recent increase in the number of sexual partners) Now the general basic principles for recurrent BV like in you case include following management. Antibiotics are the mainstay of therapy dietary supplementation with Lactobacillus (acidophilus) Asymptomatic women with G vaginalis colonization do not need treatment BV occurring in pregnant women should be treated Treatment before cesarean delivery, total abdominal hysterectomy, or insertion of an IUD is also recommended Uncomplicated cases typically resolve after standard antibiotic treatment BV that does not resolve after one course of treatment may be cured by giving a second course of the same agent or by switching to another agent (eg, from metronidazole to clindamycin or from clindamycin to metronidazole) Some women with recurrent BV may benefit from evaluation or treatment of G vaginalis colonization in their sexual partner (controversial) You are advised to stop douching or using bubble bath or any other over-the-counter vaginal hygiene products wash only with hypoallergenic bar soaps or no soap at all and should avoid liquid soaps and body washes Surgery is not indicated Testing for other infections (eg, N gonorrhoeae, C trachomatis, or herpes simplex virus [HSV]-1) may be appropriate Therapy with metronidazole or clindamycin may alter the vaginal flora and predispose the patient to development of vaginal candidiasis You should stop douching or using bubble bath or any other over-the-counter vaginal hygiene products.Wash only with hypoallergenic bar soaps or no soap at all. Avoid liquid soaps and body washes. Prophylaxis with vaginal probiotic product (8 billion units of Lactobacillus rhamnosus, L acidophilus, and Streptococcus thermophilus per capsule) for recurrent bacterial vaginosis prevention is advised. The dosage regimen should consist of short-term use of 7 days on, 7 days off, then 7 days on. Consult with an infectious disease specialist or obstetrician/gynecologist to sort out nonresolving and/or recurring BV or more serious infections, such as endometritis, pelvic inflammatory disease, and chorioamnionitis( in case of pregnancy only). I hope it helps. Dont forget to close the discussion please. Take care S Khan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shafi Ullah Khan (4 minutes later)
I meant when I got rechecked for still having discharge, there was no Bv present but still had a yeast infection so was given another tablet of flcondazole but its day 6 and I am still having discharge it seems as if I still have the yeast infection
doctor
Answered by Dr. Shafi Ullah Khan (27 minutes later)
Brief Answer: Wait for it, will resolve Detailed Answer: Thank you for getting back! As i mentioned some time vaginal discharge is resilient and it goes away slowly and gradually. Get the antifungal as prescribed, use topical metronidazole ointment, and avoid the coitus for a while with full hygiene and toilet rehab. If the discharge still persists seek a gynecologist for further management.As you are on day 6 and it may take 7 to 10 days for this yeast infection to resolve. Unless there is a stimulus and trigger for recurrence which needs to be removed for a complete cure. sometimes vaginal discharge continues for a while but the moment we start caring for it by good toilet, coital habits symptoms start resolving and they eventually go off permanently. No worries. Just be compliant with the medicines and do as i requested in my previous thorough answers. Remember prevention and precautionary measure are most important. You will be fine. stop worrying.If the issue persists despite all coital and precautionary measures, seek a gynecologist or infectious disease specialist for thorough assessment. And no sex at all for a week at least. Regards
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3613 Questions

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What Causes Recurrent Bacterial Vaginosis Infections?

Brief Answer: Needs management and modifications Detailed Answer: Thank you for asking! Recurrent bacterial vaginosis infections has one or more of the following reasons. Recent antibiotic use Decreased estrogen production of the host Wearing an intrauterine device (IUD) Douching Sexual activity that could lead to transmission (eg, having a new sexual partner or a recent increase in the number of sexual partners) Now the general basic principles for recurrent BV like in you case include following management. Antibiotics are the mainstay of therapy dietary supplementation with Lactobacillus (acidophilus) Asymptomatic women with G vaginalis colonization do not need treatment BV occurring in pregnant women should be treated Treatment before cesarean delivery, total abdominal hysterectomy, or insertion of an IUD is also recommended Uncomplicated cases typically resolve after standard antibiotic treatment BV that does not resolve after one course of treatment may be cured by giving a second course of the same agent or by switching to another agent (eg, from metronidazole to clindamycin or from clindamycin to metronidazole) Some women with recurrent BV may benefit from evaluation or treatment of G vaginalis colonization in their sexual partner (controversial) You are advised to stop douching or using bubble bath or any other over-the-counter vaginal hygiene products wash only with hypoallergenic bar soaps or no soap at all and should avoid liquid soaps and body washes Surgery is not indicated Testing for other infections (eg, N gonorrhoeae, C trachomatis, or herpes simplex virus [HSV]-1) may be appropriate Therapy with metronidazole or clindamycin may alter the vaginal flora and predispose the patient to development of vaginal candidiasis You should stop douching or using bubble bath or any other over-the-counter vaginal hygiene products.Wash only with hypoallergenic bar soaps or no soap at all. Avoid liquid soaps and body washes. Prophylaxis with vaginal probiotic product (8 billion units of Lactobacillus rhamnosus, L acidophilus, and Streptococcus thermophilus per capsule) for recurrent bacterial vaginosis prevention is advised. The dosage regimen should consist of short-term use of 7 days on, 7 days off, then 7 days on. Consult with an infectious disease specialist or obstetrician/gynecologist to sort out nonresolving and/or recurring BV or more serious infections, such as endometritis, pelvic inflammatory disease, and chorioamnionitis( in case of pregnancy only). I hope it helps. Dont forget to close the discussion please. Take care S Khan