Bacterial vaginosis is a vaginal infection estimated to affect up to 70% of women of reproductive age. Clinical practice guidelines recommend using antibiotics for treating identified infections; unfortunately, 10-15% of women do not improve after the first course of prescribed antibiotics, and 80% of women will experience infection recurrence even when treatment is successful. (7)
Women struggling with recurrent BV require a more holistic approach to treatment that calls attention to identifying and correcting underlying imbalances that favor the overgrowth of harmful vaginal bacteria. This article will discuss top functional medicine labs to consider as part of a root-cause medicine approach to treating and preventing recurrent BV.
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What Is Reoccurring Bacterial Vaginosis?
Bacterial vaginosis (BV) is the most common vaginal condition in women ages 15-44, characterized by a shift in vaginal flora from the normal predominance of Lactobacillus to an overgrowth of anaerobic gram-negative bacteria.
This condition is treatable; however, in some women, the condition may recur or become chronic, requiring multiple and sometimes long-term treatments. In fact, recurrence rates have been reported as high as 30% within three months and over 50% within six months of treating an initial infection. BV recurrences most often arise within the first seven days of the menstrual cycle, frequently follow a yeast infection, and are highly correlated with new sexual contacts. (12)
Untreated BV is associated with various health complications extending beyond its immediate discomfort. Left unaddressed, BV disrupts the natural balance of vaginal bacteria, rendering the vaginal environment more susceptible to other infections, including sexually transmitted infections (STIs). Post-surgical infections following gynecological procedures are also a potential concern in individuals with untreated BV. Moreover, BV has been linked to developing pelvic inflammatory disease (PID), a serious condition that can lead to chronic pelvic pain, infertility, and even an increased risk of ectopic pregnancies. For pregnant individuals, untreated BV may contribute to pregnancy complications, such as preterm labor and low birth weight.
What Causes Reoccurring Bacterial Vaginosis?
BV is primarily caused by an imbalance in the normal vaginal flora, which is a complex community of microorganisms that naturally inhabit the vagina. The vaginal environment normally contains a healthy balance of different types of bacteria, with Lactobacillus spp. dominating. These bacteria help maintain an acidic pH and create a protective barrier against harmful microorganisms. In BV, there's a reduction in Lactobacillus and an overgrowth of other bacteria like Gardnerella vaginalis, Atopobium vaginae, and Prevotella spp., disrupting the balance (1).
While BV is not classified as an STI, sexual activity is a known risk factor for developing BV. BV is associated with having new or multiple sexual partners and a lack of condom use. (4)
Many other factors have been identified to disrupt the natural vaginal microbiota and increase the risk of BV. Vaginal douching, which involves cleaning the vagina with water or other solutions, can wash away beneficial bacteria and alter the vaginal pH. Hormonal changes, such as those occurring during menstruation, pregnancy, and menopause, can also affect the vaginal environment making it more susceptible to BV. Poor personal hygiene practices, such as using scented soaps, bubble baths, or harsh cleansers in the genital area, can upset the natural balance of the vaginal ecosystem. A weakened immune system can reduce the body's ability to control the growth of harmful bacteria. Finally, smoking has been associated with an increased risk of BV, possibly due to its impact on the vaginal environment and immune response. (7)
Reoccurring Bacterial Vaginosis Symptoms
Most women (84%) with BV have no symptoms and only discover the condition through a routine pelvic exam. For women who do experience symptoms, they most commonly include:
- Strong fishy or unpleasant vaginal odor, which may be stronger after sex or menstruating
- Increase in vaginal discharge
- Vaginal discharge that is thin in consistency and milky-white or gray in color
- Vaginal itching and burning
What Are The Benefits of Regular Lab Testing For Patients With Reoccurring Bacterial Vaginosis?
Reoccurring BV can sometimes be challenging to diagnose solely based on symptoms, as symptoms may vary, overlap with other vaginal infections, or may be absent. Regular lab testing, such as vaginal swabs or cultures, can provide a definitive diagnosis by identifying specific BV-associated bacteria. This ensures that appropriate treatment is initiated to avoid unnecessary use of antibiotics and prevent potential health complications. Lab testing also allows healthcare providers to assess the effectiveness of ongoing therapies for recurring BV. Periodic testing can help determine whether the prescribed interventions are effectively restoring the balance of vaginal bacteria and reducing the recurrence of BV, along with helping to identify trends, patterns, or triggers that may contribute to recurrent BV.
Lab tests can help uncover underlying factors contributing to recurring BV, such as hormonal imbalances, immune system dysfunction, or specific bacterial strains that may be more resistant to treatment. This information can guide personalized treatment plans that target the condition's root causes, which may involve selecting more targeted antibiotics or recommending specific probiotics to restore a healthy vaginal microbiome.
Top Labs To Run Bi-Annually On Patients With Reoccurring Bacterial Vaginosis
The following are functional medicine labs that can be ordered routinely for patients with reoccurring BV to diagnose infection and track treatment progress.
Vaginal Microbiome Analysis
A vaginosis panel combines microscopic analysis and gram-staining of vaginal secretions to identify gram-negative bacteria and clue cells characteristic of BV and screens for other infections like Candida and Trichomonas vaginalis that can occur alongside BV and exacerbate vaginal symptoms. Antimicrobial susceptibility testing to prescriptive and natural agents is performed for identified bacterial and fungal species to guide effective treatment recommendations.
For patients with chronic and recurrent BV, a more comprehensive vaginal culture that assesses the composition of the vaginal microbiome can provide more insight into underlying dysbiotic patterns predisposing to frequent infection. A lack of Lactobacillus and an overgrowth of anaerobic bacteria is a characteristic microbial pattern in patients with recurrent BV (4).
Comprehensive Stool Analysis
While it might seem unrelated, a growing body of evidence suggests that gut dysbiosis can contribute to recurrent BV. Gut dysbiosis can lead to an altered immune response and systemic inflammation; a compromised immune system may fail to control the growth of harmful bacteria in the vagina effectively. Gut dysbiosis has also been linked to disturbances in estrogen metabolism; fluctuations in estrogen levels can affect the vaginal pH and create an environment more conducive to the growth of harmful bacteria associated with BV. Using a comprehensive stool analysis to assess for gut dysbiosis, especially for patients with concurrent gastrointestinal symptoms or symptoms of hormonal imbalance, can be an important aspect of a holistic approach to managing recurrent BV.
Comprehensive Hormone Analysis
A study investigating the association between intrauterine devices and the risk of BV found that irregular vaginal bleeding was a significant risk factor for recurrent BV, further supporting the notion that hormonal imbalances contribute to BV risk. Imbalances in estrogen and progesterone levels can contribute to irregular menstrual periods, and using a comprehensive hormone panel can help to identify hormone levels outside of ideal reference ranges and guide hormone-balancing treatment recommendations to bring hormones into optimal range and support healthy menstruation and vaginal health.
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Summary
BV is the most common vaginal infection that affects the majority of women at least once at some point during their lives. High infection recurrence rates suggest that treating infections with a single course of antibiotics is insufficient in preventing recurrent BV. A functional medicine and integrative approach to treating BV can successfully target individual factors predisposing an individual to vaginal dysbiosis and the overgrowth of harmful bacteria associated with BV. Regular lab testing for vaginal and intestinal dysbiosis and hormonal imbalances is critical for managing recurrent BV and preventing unwanted health complications.
Bacterial vaginosis is a vaginal condition estimated to affect up to 70% of women of reproductive age. Clinical practice guidelines often recommend using antibiotics for managing identified infections; however, 10-15% of women may not see improvement after the first course of prescribed antibiotics, and 80% of women might experience recurrence even when management is initially successful. (7)
Women experiencing recurrent BV may benefit from a more holistic approach that focuses on identifying and addressing underlying imbalances that could favor the overgrowth of certain vaginal bacteria. This article will discuss top functional medicine labs to consider as part of a root-cause approach to supporting vaginal health and managing recurrent BV.
[signup]
What Is Reoccurring Bacterial Vaginosis?
Bacterial vaginosis (BV) is a common vaginal condition in women ages 15-44, characterized by a shift in vaginal flora from the normal predominance of Lactobacillus to an overgrowth of anaerobic gram-negative bacteria.
This condition can be managed; however, in some women, it may recur or become chronic, requiring multiple and sometimes long-term strategies. In fact, recurrence rates have been reported as high as 30% within three months and over 50% within six months of addressing an initial occurrence. BV recurrences most often arise within the first seven days of the menstrual cycle, frequently follow a yeast infection, and are highly correlated with new sexual contacts. (12)
Unmanaged BV is associated with various health complications extending beyond its immediate discomfort. Left unaddressed, BV disrupts the natural balance of vaginal bacteria, potentially making the vaginal environment more susceptible to other infections, including sexually transmitted infections (STIs). Post-surgical infections following gynecological procedures are also a potential concern in individuals with unmanaged BV. Moreover, BV has been linked to developing pelvic inflammatory disease (PID), a serious condition that can lead to chronic pelvic pain, infertility, and even an increased risk of ectopic pregnancies. For pregnant individuals, unmanaged BV may contribute to pregnancy complications, such as preterm labor and low birth weight.
What Causes Reoccurring Bacterial Vaginosis?
BV is primarily associated with an imbalance in the normal vaginal flora, which is a complex community of microorganisms that naturally inhabit the vagina. The vaginal environment normally contains a healthy balance of different types of bacteria, with Lactobacillus spp. dominating. These bacteria help maintain an acidic pH and create a protective barrier against harmful microorganisms. In BV, there's a reduction in Lactobacillus and an overgrowth of other bacteria like Gardnerella vaginalis, Atopobium vaginae, and Prevotella spp., disrupting the balance (1).
While BV is not classified as an STI, sexual activity is a known risk factor for developing BV. BV is associated with having new or multiple sexual partners and a lack of condom use. (4)
Many other factors have been identified to disrupt the natural vaginal microbiota and increase the risk of BV. Vaginal douching, which involves cleaning the vagina with water or other solutions, can wash away beneficial bacteria and alter the vaginal pH. Hormonal changes, such as those occurring during menstruation, pregnancy, and menopause, can also affect the vaginal environment making it more susceptible to BV. Poor personal hygiene practices, such as using scented soaps, bubble baths, or harsh cleansers in the genital area, can upset the natural balance of the vaginal ecosystem. A weakened immune system can reduce the body's ability to manage the growth of certain bacteria. Finally, smoking has been associated with an increased risk of BV, possibly due to its impact on the vaginal environment and immune response. (7)
Reoccurring Bacterial Vaginosis Symptoms
Most women (84%) with BV have no symptoms and only discover the condition through a routine pelvic exam. For women who do experience symptoms, they most commonly include:
- Strong fishy or unpleasant vaginal odor, which may be stronger after sex or menstruating
- Increase in vaginal discharge
- Vaginal discharge that is thin in consistency and milky-white or gray in color
- Vaginal itching and burning
What Are The Benefits of Regular Lab Testing For Patients With Reoccurring Bacterial Vaginosis?
Reoccurring BV can sometimes be challenging to identify solely based on symptoms, as symptoms may vary, overlap with other vaginal conditions, or may be absent. Regular lab testing, such as vaginal swabs or cultures, can provide a clearer picture by identifying specific BV-associated bacteria. This ensures that appropriate management strategies are initiated to avoid unnecessary use of antibiotics and prevent potential health complications. Lab testing also allows healthcare providers to assess the effectiveness of ongoing strategies for recurring BV. Periodic testing can help determine whether the prescribed interventions are effectively supporting the balance of vaginal bacteria and reducing the recurrence of BV, along with helping to identify trends, patterns, or triggers that may contribute to recurrent BV.
Lab tests can help uncover underlying factors contributing to recurring BV, such as hormonal imbalances, immune system function, or specific bacterial strains that may be more resistant to management. This information can guide personalized plans that target the condition's root causes, which may involve selecting more targeted antibiotics or recommending specific probiotics to support a healthy vaginal microbiome.
Top Labs To Run Bi-Annually On Patients With Reoccurring Bacterial Vaginosis
The following are functional medicine labs that can be ordered routinely for patients with reoccurring BV to identify imbalances and track progress.
Vaginal Microbiome Analysis
A vaginosis panel combines microscopic analysis and gram-staining of vaginal secretions to identify gram-negative bacteria and clue cells characteristic of BV and screens for other conditions like Candida and Trichomonas vaginalis that can occur alongside BV and exacerbate vaginal symptoms. Antimicrobial susceptibility testing to prescriptive and natural agents is performed for identified bacterial and fungal species to guide effective recommendations.
For patients with chronic and recurrent BV, a more comprehensive vaginal culture that assesses the composition of the vaginal microbiome can provide more insight into underlying patterns predisposing to frequent imbalances. A lack of Lactobacillus and an overgrowth of anaerobic bacteria is a characteristic microbial pattern in patients with recurrent BV (4).
Comprehensive Stool Analysis
While it might seem unrelated, a growing body of evidence suggests that gut dysbiosis can contribute to recurrent BV. Gut dysbiosis can lead to an altered immune response and systemic inflammation; a compromised immune system may fail to manage the growth of certain bacteria in the vagina effectively. Gut dysbiosis has also been linked to disturbances in estrogen metabolism; fluctuations in estrogen levels can affect the vaginal pH and create an environment more conducive to the growth of bacteria associated with BV. Using a comprehensive stool analysis to assess for gut dysbiosis, especially for patients with concurrent gastrointestinal symptoms or symptoms of hormonal imbalance, can be an important aspect of a holistic approach to managing recurrent BV.
Comprehensive Hormone Analysis
A study investigating the association between intrauterine devices and the risk of BV found that irregular vaginal bleeding was a significant risk factor for recurrent BV, further supporting the notion that hormonal imbalances contribute to BV risk. Imbalances in estrogen and progesterone levels can contribute to irregular menstrual periods, and using a comprehensive hormone panel can help to identify hormone levels outside of ideal reference ranges and guide hormone-balancing recommendations to bring hormones into optimal range and support healthy menstruation and vaginal health.
[signup]
Summary
BV is a common vaginal condition that affects many women at least once at some point during their lives. High recurrence rates suggest that addressing the condition with a single course of antibiotics may not be sufficient in managing recurrent BV. A functional medicine and integrative approach to managing BV can help target individual factors predisposing an individual to vaginal imbalances and the overgrowth of certain bacteria associated with BV. Regular lab testing for vaginal and intestinal dysbiosis and hormonal imbalances is important for managing recurrent BV and supporting overall health.
1. Bacterial Vaginosis. (2021). Centers for Disease Control and Prevention. https://www.cdc.gov/std/treatment-guidelines/bv.htm
2. Bacterial Vaginosis (BV) Statistics. (2019). Centers for Disease Control and Prevention. https://www.cdc.gov/std/bv/stats.htm
3. Christie, J. (2022, August 23). Signs You Aren't Metabolizing Estrogen Properly. Rupa Health. https://www.rupahealth.com/post/how-to-know-if-your-body-is-metabolizing-estrogen-properly
4. Cloyd, J. (2023, March 9). Top Labs to Test To Help Determine The Root Cause of Reoccurring Bacterial Vaginosis. Rupa Health. https://www.rupahealth.com/post/top-labs-to-test-for-root-cause-of-reoccurring-bacterial-vaginosis
5. Cloyd, J. (2023, July 13). A Functional Medicine Recurrent Bacterial Vaginosis Protocol: Comprehensive Testing, Supplements, and Nutritional Considerations. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-recurrent-bacterial-vaginosis-protocol-comprehensive-testing-supplements-and-nutritional-considerations
6. Elkafas, H., Wall, M., Al-Hendy, A., et al. (2022). Gut and genital tract microbiomes: Dysbiosis and link to gynecological disorders. Frontiers in Cellular and Infection Microbiology, 12, 1059825. https://doi.org/10.3389/fcimb.2022.1059825
7. Kairys, N., & Garg, M. (2019, May 4). Bacterial Vaginosis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459216/
8. Madden, T., Grentzer, J. M., Secura, G. M., et al. (2012). Risk of Bacterial Vaginosis in Users of the Intrauterine Device: A Longitudinal Study. Sexually Transmitted Diseases, 39(3), 217–222. https://doi.org/10.1097/OLQ.0b013e31823e68fe
9. Neibling, K. (2023, March 3). A Functional Medicine Protocol for Reoccurring Pelvic Inflammatory Disease. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-protocol-to-reoccurring-pelvic-inflammatory-disease
10. Recurrent Bacterial Vaginosis. Baylor College of Medicine. https://www.bcm.edu/healthcare/specialties/obstetrics-and-gynecology/ob-gyn-conditions/recurrent-bacterial-vaginosis
11. Sweetnich, J. (2023, February 23). DUTCH Cycle Mapping Test: 101. Rupa Health. https://www.rupahealth.com/post/dutch-cycle-mapping-test-101
12. Wilson, J. (2004). Managing recurrent bacterial vaginosis. Sexually Transmitted Infections, 80(1), 8–11. https://doi.org/10.1136/sti.2002.002733
13. Yoo, J., Groer, M., Dutra, S., et al. (2020). Gut Microbiota and Immune System Interactions. Microorganisms, 8(10), 1587. https://doi.org/10.3390/microorganisms8101587
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