Bacterial Vaginosis: A Comprehensive Approach to Management in Reproductive-Aged Thai Women

Abstract

Bacterial vaginosis (BV) is the predominant condition of vaginal dysbiosis leading women to seek gynecologic care. Excessive genital cleansing, particularly through vaginal douching, appears to be a precipitating factor. BV does not induce any inflammatory response, with more than half of patients remaining asymptomatic.The chief complaints are an increased vaginal discharge volume and an altered odor. BV compromises the body’s natural defense mechanisms, thereby increasing susceptibility to local and ascending infections. BV also heightens the risk of sexually transmitted infections, including pelvic inflammatory disease. For many years before 2022, our institution employed a metronidazole regimen of 1,200 mg daily, which demonstrated favorable efficacy. Metronidazole commonly leads to side effects such as nausea, vomiting, and a metallic taste. Unfortunately, many women discontinue the medication once their symptoms alleviate, as they often perceive BV as a vaginal imbalance rather than an infectious disease. In 2022, the Royal Thai College of Obstetricians and Gynaecologists introduced a recommended treatment guideline for BV that emphasized a balanced approach to medications and lifestyle modifications. Consequently, the primary antibiotic now used in Thailand is metronidazole, administered as a single 2 g dose or 800 mg daily for 7 days. At the Siriraj Female Sexually Transmitted Infections Clinic, we have utilized various metronidazole treatment regimens accompanied by comprehensive educational sessions and counseling. This article shows a comprehensive approach to management of BV in reproductive-aged Thai women, particularly based on Siriraj experience.