Recurrent Bacterial Vaginosis: What are we missing?

Rosemary Guerguerian, MD
14 min readOct 9, 2019
Photo by Imani Clovis on Unsplash

Bacterial vaginosis (BV) is an imbalance of vaginal bacteria that can cause a foul odor and increased discharge. Women who experience frequent recurrences of BV are not just inconvenienced; they are tormented. It impacts their self-esteem, as well as their health. Researchers have recently discovered bacteria that better diagnose BV than the bacteria detected on traditional tests. Screening swabs are already available to detect these newly recognized bacteria. However, these bacteria offer more than a new way to diagnose BV. They help explain why certain women have recurrence and why typical antibiotics for BV fail. The bacteria are also found in male partners, which may contribute BV recurrence in those women. The new screening swabs provide enough information for some to have more targeted treatment. The CDC guidelines used by most physicians have not yet caught up to the forefront of this BV research.

The basics about bacterial vaginosis and its treatment:


Symptoms of BV include a foul or fishy odor, a thin or milky grey-white discharge, vaginal irritation, cramping, or spotting.


Normally several types of healthy bacteria, mainly Lactobacilli species, populate the vagina. Lactobacilli keep the vagina healthy by producing acids and antibacterial substances. That acidic environment helps prevent infection and keep undesirable bacteria under control.

In bacterial vaginosis, the vaginal ecosystem is out of balance. While many types of bacteria get disrupted, Gardnerella vaginalis is the main one blamed for the change. When Gardnerella increase in number, Lactobacilli decrease; then other undesirable bacteria flourish. This process, in turn, alters the vaginal acidity, or pH. An increase in undesirable bacteria both causes and results from the change in pH.


The traditional test for BV is a “wet prep” slide. A physician or lab technician looks at vaginal cells through a microscope. In BV, unwelcome bacteria stick to vaginal cells and give those cells a characteristic appearance. These are called clue cells. Presence of clue cells only reveals that the vaginal cells have bacteria sticking to them, not the type of bacteria involved.

Rosemary Guerguerian, MD

“Dr.G” is an ER physician and media consultant. She has a passion for empowering patients, healing not only the body but also the human soul.