Recurrent bacterial vaginosis

PURPOSE OF REVIEW: Bacterial vaginosis is a common condition that recurs frequently, adversely affecting women's lives, and is associated with complications including increased risk of sexually transmitted infections, HIV, and adverse pregnancy outcome. RECENT FINDINGS: New molecular techniques have increased our understanding of the numerous bacteria associated with bacterial vaginosis, and a biofilm containing mostly Gardnerella and Atopobium vaginae, which can persist after treatment has been described. Suppressive treatment with metronidazole gel can suppress recurrence. Physiological approaches such as acidification and probiotics have been investigated with variable results. SUMMARY: Advances in our understanding of the pathogenesis of bacterial vaginosis allow the opportunity to improve treatments to prevent recurrence, which may require a combination of modalities. We must find ways to help affected women and reduce the complications associated with bacterial vaginosis.