Complications
Bacterial vaginosis (BV) is a seemingly simple infection that can be easily controlled, but if left to itself can lead to serious complications including mortality. In the Unites States alone there are 21.2 million women between the ages of 14 and 49 (29.2%) with BV. 84% of women with BV are asymptomatic making it more difficult to tackle the complications at an early stage. The incidence rate of BV in pregnant women is around 25% and 31.7% in women who were pregnant at certain point of their lives. Hence the most critical thing is to immediately manage any symptoms of BV.
BV puts a patient at heightened risk of infection post-hysterectomy or abortion. BV has proven a critical contraindication for a number of serious obstetrical complications, inclusive of increased predisposition to sexually transmitted infections including HIV. A study showed that the incident risk for HIV infection was 26.7% among women suffering from bacterial vaginosis as compared to 14.2% in women without the disease. Of note, this difference was seen only among young adults below the age of 40 years and was not due to different patterns of sexual activity in women younger and older than 40 years. BV can also increase the risk of other sexually transmitted diseases (STDs) like gonorrhea, Chlamydia, and Herpes Simplex Virus (HPV). Other potent obstetric complications of bacterial vaginosis include spontaneous abortion, preterm labor or birth, premature rupture of membranes (PROM), amniotic fluid infection, postpartum endometriosis, and post cesarean wound infections. World Health Organization (WHO) estimated that the risk ratio of such complication varied between 1.1 and 7.3 and thus has major significance in managing risk factors during pregnancy.
Bacterial Vaginosis and Preterm Birth
Several studies have conclusively shown that BV during pregnancy carries the risk of birth at the lowest gestational ages. The pathophysiology for this correlation is barely understood. Incidence of BV in the mid-third trimester (~32.6 weeks) has the highest risk of causing preterm labor and/or PROM. Diminished risk association of preterm labor and/or PROM with BV is also present during 22-28 weeks of gestation. A study conducted in Denver, Colorado showed that up to 22% of association between preterm labor and BV. Needless to mention this is alarming and needs to be expertly and aggressively managed. The National Institute of Child Health and Human Development (NIHCD) constituted a Vaginal Infections and Prematurity Study Group to establish the casual link between BV and preterm labor and birth. This study candidly showed that 40% risk increase for preterm labor and 10% increase in preterm PROM in females with BV. But the good news is that there is increased awareness and better diagnostic tests and therapy available to screen, control and treat pregnant women suffering from BV. Standardized oral treatments for BV are most often sufficient in preventing preterm labor and PROM. But the common belief that antenatal intravaginal, midgestational treatment can prevent preterm birth is unfounded and wrong. Additional studies are of course required to understand the pathophysiology, correct timing for BV screening and improvised treatment regimen.
Postpartum and Intrapartum Infections
Postpartum or postoperative endometriosis and amniotic fluid infection (chorioamnionitis) seem to occur with consistent frequency in patients of BV. Further confirmation came from the aforementioned Vaginal Infections and Prematurity Study. Interestingly though the association of BV and risk of amniotic fluid infection was not reliant on duration of labor or rupture of the membranes or concomitant sexually transmissted diseases (STDs). 10-20% of cesarean deliveries and 2-5% of vaginal births give rise to postoperative and postpartum endometriosis, respectively; 80% of all endometriosis cases is caused by bacterial infection and 60% of the cases it is BV. Screening and aggressive management though can significantly downregulate postpartum infection and chorioamnionitis.
Pelvic Inflammatory Disease (PID)
BV Infection has the potential to spread the infection to the region of the fallopian tubes and the uterus. The condition is termed PID and is responsible for causing infertility and/or ectopic pregnancy. Ectopic (or tubal) pregnancy is a serious and life-threatening condition where the uterus is damaged and cannot house the fetus, which in turn grows within a fallopian tube. In most cases this will cause a rupture of the fallopian tube and consequential mortality for the fetus and the mother.
Impact on Lifestyle
BV normally pushes a woman to refrain from physical relationship, the outcome of which is a serious toll on mental and social health. BV will also prevent someone from performing the bicycle training in her fitness regimen due to progression of the disease and foul smell normally associated with BV. Very often, a lady with BV resort to different techniques of curing the disease without being dedicated to anyone in particular. The end result of such start-stop treatment regimen is that nothing has the desired effect. This causes the person to give up in trying treatment for BV, putting her to significant risk of complications from BV.
BV-Recurrent Infection
BV is a notorious disease in that it can recur even after being completely cured. The recurrence rate is as high as 50% within the first 12 months of treatment. The exact reason for this is not known and hence appropriate measures to prevent recurrence are also not available. Classically BV is treated with vaginal cindamycin ointment and oral mentronidazole. Of late, it has been shown that substituting the mentronidazole with tinidazole gives significant more protection over a longer duration.
