Recurrent bacterial vaginosis–an old approach to a new problem Original paper
Researched by:
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Karen Pendergrass
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Karen Pendergrass
Karen Pendergrass is a microbiome researcher specializing in microbiome-targeted interventions (MBTIs). She systematically analyzes scientific literature to identify microbial patterns, develop hypotheses, and validate interventions. As the founder of the Microbiome Signatures Database, she bridges microbiome research with clinical practice. In 2012, based on her own investigative research, she became the first documented case of FMT for Celiac Disease—four years before the first published case study.
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Bacterial Vaginosis
Bacterial Vaginosis
Bacterial vaginosis (BV) is caused by an imbalance in the vaginal microbiota, where the typically dominant Lactobacillus species are significantly reduced, leading to an overgrowth of anaerobic and facultative bacteria.
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Divine Aleru
I am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.
Researched by:
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Karen Pendergrass
ID
Karen Pendergrass
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Divine Aleru
What was Studied?
The study evaluated the efficacy of 3% hydrogen peroxide as a single vaginal washout treatment for recurrent bacterial vaginosis (rBV). The primary aim was to assess how hydrogen peroxide affects the symptoms and microbiological profile of women with rBV, particularly focusing on the reduction of vaginal malodor, restoration of vaginal pH, and the absence of bacterial pathogens like Gardnerella vaginalis and other anaerobes.
Who was Studied?
The study involved 30 women with clinically confirmed recurrent bacterial vaginosis, defined as experiencing symptoms of vaginal malodour and discharge after having previously been treated for BV with metronidazole. These women were recruited from a clinical setting and included only those who were symptomatic with BV, had mixed anaerobes isolated in their vaginal swabs, and did not have other genital infections such as gonorrhea, chlamydia, or Candida. A total of 23 women completed the study.
What were the Most Important Findings?
The results demonstrated that the hydrogen peroxide vaginal washout was effective in reducing the malodorous vaginal discharge, with 78% of women reporting complete resolution of symptoms after three weeks. The treatment also led to improvements in vaginal pH, with 96% of women returning to a normal acidic pH. All women showed an absence of “clue cells” and a lack of mixed anaerobes in their vaginal cultures post-treatment. The presence of Lactobacillus species also improved, though to a lesser extent. The study found that hydrogen peroxide was well-tolerated by all participants, with no significant adverse effects such as irritation or inflammation.
However, while hydrogen peroxide improved discharge and malodour in most cases, the full restoration of vaginal lactobacilli colonies did not occur in all women, and two women still experienced mild symptoms. The treatment also failed to restore lactobacilli levels to the extent seen in other BV treatments, indicating that while hydrogen peroxide is effective for symptom relief, it may not be sufficient to fully re-establish the normal vaginal microbiota.
What are the Implications of this Study?
This study suggests that hydrogen peroxide vaginal washout could serve as an alternative or adjunct to antibiotics for treating recurrent bacterial vaginosis. It offers a non-antibiotic approach that is well-tolerated and effective in reducing the primary symptom of malodour. Given the lack of significant side effects and the complete absence of bacterial pathogens in post-treatment cultures, hydrogen peroxide may provide a useful option for women who experience frequent recurrences of BV and are reluctant to use antibiotics due to side effects or resistance concerns. However, the study highlights that hydrogen peroxide treatment may not fully restore vaginal microbiota, specifically Lactobacillus populations, which suggests the need for additional interventions to ensure long-term microbiota health and prevent recurrence.
Bacterial Vaginosis
Bacterial vaginosis (BV) is caused by an imbalance in the vaginal microbiota, where the typically dominant Lactobacillus species are significantly reduced, leading to an overgrowth of anaerobic and facultative bacteria.