细菌性阴道炎（BV）
Disease Presentation
What is BV?
- BV is a common type of vaginal inflammation, causing considerable physical and psychosocial discomfort and associated with an increased risk of multiple adverse outcomes, including preterm birth, pelvic inflammatory disease, endometritis, and transmission and acquisition of HIV-1 and STD.
- It is now understood that BV is caused by vaginal dysbiosis – the overgrowth of anaerobic bacteria that disrupts healthy vaginal flora, which is dominated by hydrogen peroxide and lactic acid-producing Lactobacillus species.[1]
- The prevalence of BV is high globally among reproductive-age women, with an estimated $4.8 Bn USD global economic burden from treating symptomatic BV each year (~$15 Bn USD when including BV-associated preterm births and human immunodeficiency virus cases).[2]
Current Management & Patient Flow
Diagnosis
Majority of BV patients will likely seek treatment, but some patients may leave it unmanaged as BV is not a life-threatening condition.[5]
Initial Treatment
The initial cure rate is 50-60% in 30 days, but 58% of patients will have recurrent disease in 12 months.[6]
Recurrence Treatment
Using a different antibiotic regimen, or treating for a longer period of time are the only options to manage the recurrent disease.
Diagnosis
Majority of BV patients will likely seek treatment, but some patients may leave it unmanaged as BV is not a life-threatening condition.[5]
Initial Treatment
The initial cure rate is 50-60% in 30 days, but 58% of patients will have recurrent disease in 12 months.[6]
Recurrence Treatment
Using a different antibiotic regimen, or treating for a longer period of time are the only options to manage the recurrent disease.
Unmet Needs
58% of patients experience recurrent disease in 12 months.[7]
Antibiotic Concerns10% patients may experience resistance in BV, and frequent use (especially for recurrent patients) can lead to broader bacterial resistance concerns.[7]
Side EffectOral antibiotics also have common side effects (e.g., dizziness, headache, nausea, etc.) as a systemic drug, and the use of tinidazole should be cautious in pregnant women.
58% of patients experience recurrent disease in 12 months.[7]
10% patients may experience resistance in BV, and frequent use (especially for recurrent patients)
can lead to broader bacterial resistance concerns.[7]
Oral antibiotics also have common side effects (e.g., dizziness, headache, nausea, etc.)
as a systemic drug, and the use of tinidazole should be cautious in pregnant women.
Sources
[1]. Wilson J, Managing recurrent bacterial vaginosis, Sexually Transmitted Infections 2004;80:8-11.
[2]. Peebles, Kathryn MPH*; Velloza, Jennifer MPH*; Balkus, Jennifer E. PhD*†§; McClelland, R. Scott MD*‡§; Barnabas, Ruanne V. MBChB, DPhil*‡§ High Global Burden and Costs of Bacterial Vaginosis: A Systematic Review and Meta-Analysis, Sexually Transmitted Diseases: May 2019 – Volume 46 – Issue 5 – p 304-311. Pictures are from internet.
[3]. CDC, Bacterial Vaginosis (BV) Statistics.
[4]. Bacterial Vaginosis Guideline (2021), Chinese Journal of Obstetrics and Gynecology, 2021,56(01): 3-6.
[5]. Based on OBGYN interviews. [6]. Muzny CA, Kardas P. A Narrative Review of Current Challenges in the Diagnosis and Management of Bacterial Vaginosis. Sex Transm Dis. 2020 Jul;47(7):441-446.
[6]. Medicover hospital. Picture credits: https://www.medicoverhospitals.in/diseases/bacterial-vaginosis. All rights reserved for the original creator.
[7]. ACOG practice Bulleting: Vaginitis in Nonpregnant Patients (2020).
