... Has anyone beat this? I just finished my fourth round of antibiotics for 2013. I've tried everything. I've just about fallen into a deep depression. I've tried every at home remedy, am loaded on probiotics, can't dress in cute clothes, stopped having sex, don't wear cute panties, don't workout. I'm miserable. I'm only 26 and am a prisoner of this. I can feel my boyfriend becoming as frustrated as I am and I'm so sad and upset. Is there anything that will help me?
you seem to be doing everything right. i have had bv twice in the past two months and i did not have sex in between those two times, have changed my soap (frangrance-free, hypoallergenic), wear only cotton underwear, take probiotics daily, everything they recommend. mine was a very uncomfortable case (constant burning). i have heard of extended therapy with metronidazole as an option. you take it three days before and three days after your period. keeping your vaginal pH acidic (<4.5) appears to be key in keeping the bad organisms away and things like your period, soap, semen can raise that pH. i have heard of rePhresh products but my gyno has not personally recommended them to me but they are supposed to help maintain healthy pH, too. i, too, feel like a prisoner and have experienced a lot of anxiety over my situation so i totally empathize with you. i wish you luck!
I am sorry that you are a victim to this awful situation. I was once plagued by this too. I don't know if you are still suffering from BV, considering it has been two years now that you have typed this forum however something that doctors will not tell you is that there is a cure over the counter. I will get to that in a moment. Let me just warn you that taking antibiotics will only make matters worse and the BV will come back with vengeance as I am sure you have encountered. Antibiotics help if you have a virus otherwise they weaken your body's immune system and resistance to fight off colds. That of course, is a whole other issue. Go to a health shop and get Reuteri. You can even do your own research on this wonderful medicine. I was like you and felt suicidal and did everything imaginable to treat the BV. Nothing helped until I did some research and discovered this! I hope this helps! I have been BV FREE for 2 years now, and could not be happier!!
I have beat chronic BV! I suffered my entire adult life, until this year. I have been to tons of doctors, even one that specialized in chronic vaginal infections. For many years I was told, "Make sure you wipe front to back." Now, even if I weren't a nurse, I learned that as a toddler. :/ Or, "Make sure you're not douching and use soaps and detergents for sensitive skin." I've been told to cut out sugar and breads from my diet. Also have tried countless antibiotics, both oral and vaginally. None of this worked anymore than 2 months at a time, it ALWAYS wound up coming back.
First- if you use tampons. STOP NOW! Second- get a really strong probiotic. I've tried many, Plexus Probio5 is the best and only one I recommend. Contact me if you need help finding it.
I've been symptom free for 11 months and counting, longest ever!
Warning: Very, very long post…but worth it, I promise!
I spent a several hours reading through multiple scientific studies through GoogleScholar, and my school library website which gives me access to scientific journals. I gathered information from two specific studies, and grouped them together into one document. Most of what I found seemed to show that isolated traditional treatments on their own do not work as well, and present a high probability for reoccurence. These studies have made clear that a multifaceted approach is most effective, meaning the traditional medical therapy to treat BV, specifically Metronidazole and Clindamycin, AS WELL AS a combination of alternative therapies seems to show a lot of promise. I've outlined the cliff notes, with personal comments in [[double brackets]]. These cliff notes mostly consist of direct verbiage that I copied and pasted from the studies, but also includes some paraphrasing that I did on my own. If you want to read the full studies on your own, I’ve included the full journal titles with names of researchers who conducted the studies, for your reference.
I really hope this helps! I looked for so long for a cure for my BV, and had heard similar stories from friends about multiple rounds of antibiotics. I didn’t want to go that route without figuring out the source of my problem first, because so many women experience reoccurences despite antibiotic treatment. I wanted to know more facts. By poring over scientific studies, I was able to isolate the specific bacteria that's the source of BV, and discovered that polymicrobial biofilm is the TRUE reason for recurrent outbreaks. I feel very thankful that scientists are actively working to find effective treatment for this problem that supposedly doesn't have a cure. Many women suffer with this problem, which affects so many aspects of life. It’s disappointing to be told over and over again that there is no cure. I’m going to share this information that I’ve found with my provider at my next visit, and ask why these options haven’t been explored more. I found a lot of success in following a multi-faceted approach as recommended in the studies, and haven’t suffered any BV symptoms since. I feel like a weight has been lifted, and my life has changed. I no longer have to worry, and I am thankful. Hope is on the horizon!
P.S. The full treatment regimen that I implemented for myself is listed at the bottom in case you want to skip the studies/cliff notes. I’ve included all information so that you can learn more about it, and/or pursue your own research if you prefer.
--- Cliff notes from two studies of proposed BV Treatment options. I copy and pasted most parts, and paraphrased others [[My personal comments are in these brackets]]---
Efficacy of Vitamin C Vaginal Tablets as Prophylaxis for Recurrent Bacterial Vaginosis: A Randomised, Double-Blind, Placebo-Controlled Clinical Trial; Vladislav N. Krasnopolskya, Vera N. Prilepskayab, Franco Polattic, Nina V. Zarochentsevaa, Guldana R. Bayramovab, Maurizio Caserinid, Renata Palmierid, e
-Treatment overview during trials: Within 24 hours of cure from a recent episode of BV by metronidazole or clindamycin, implement vitamin C for six consecutive monthly cycles. Each cycle consists of inserting one vaginal tablet for 6 consecutive days during each month following menses [[Do this at night before falling asleep. You can do it during the day if you want. I just find it more convenient to insert before bed]].
-Tablets are 250mg ascorbic acid in a silicone carrier that ensures prolonged action [[Twinlab C-500 Caps Crystalline Vitamin C capsules were what I used. This brand makes the C-250 Capsules too if you want to follow the exact recommendations of this study. I just opted for more milligrams as a personal preference, and didn’t notice any harsher side effects for doing so. This brand is a little more spendy, but I don’t recommend using anything else. It is the most pure, and contains the least amount of additives]].
-No statistical significance was noted within the 3-month period, only becoming apparent during month 5. Conclusion was that the regular use of the tablets for the suggested duration following the success of metronidazole treatment reduces the reoccurrence rate from 32.4% to 16.2%. [[I used the metronidazole gel]].
“A therapeutic approach in the treatment of BV relapse is to re-establish and maintain the physiological acidity of the vagina, as the growth of anaerobes and other faecal bacteria is inhibited by low pH. Attempts to achieve this via re-colonisation with exogenous lactobacilli have not been successful. Another, more accepted approach is to reduce vaginal pH, in order to create a negative environment for pathogen growth and to achieve long-lasting normalisation of vaginal flora using intravaginal ascorbic acid (vitamin C). The use of antibiotics may induce resistance in the pool of bacteria recognised to cause BV and, conversely, could affect the normal flora of lactobacilli, favouring recurrence within a few weeks in over 70% of women taking antibiotics for bacterial vaginosis. Ascorbic acid plays a vital role in maintaining low vaginal pH values and enhances healing processes in the vaginal ecosystem - recolonisation with lactic acid bacteria. The mechanism of action is simple: through the lowering of vaginal pH to the physiological level of 3.8 - 4.5, anaerobic overgrowth is inhibited and the conditions for the re-growth of physiological lactobacilli flora are re-established. “
“The results of the present study show that 250 mg ascorbic acid vaginal tablets taken 6 days per month safely halves the risk of BV recurrence from 32.4% to 16.2% during a 6-month prophylactic treatment. The O.R. confirms that subjects treated with placebo had a doubled risk of BV recurrence compared with the group of subjects treated with vitamin C. Considering the time to the first BV relapse, treatment of at least five cycles is necessary in order to reduce, at a significant level, the risk of BV recurrence. As this was a prophylaxis study, in women who at the screening visit were healthy and who terminated the study in case of relapse, a between-treatment difference in clinical parameters was not expected. At the same time, differences in pH were not expected but conversely, a reduction in pH was noted for 3-month and 6-month treatment. “
In conclusion, regular use of silicon-coated vitamin C (250 mg) tablets, after the standard antibiotic treatment for BV, protects women by reducing the risk of recurrence probably by re-establishing the normal lactobacilli flora that is able to maintain vaginal pH.”
Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions; Daniela Machado1, Joana Castro1,2, Ana Palmeira-de-Oliveira3,4, José Martinez-de-Oliveira3,5 and Nuno Cerca1*
“Being polymicrobial in nature, BV etiology remains unclear. However, it is certain that BV involves the presence of a thick vaginal multi-species biofilm, where G. vaginalis is the predominant species. Similar to what happens in many other biofilm-related infections, standard antibiotics, like metronidazole, are unable to fully eradicate the vaginal biofilm, which can explain the high recurrence rates of BV. Furthermore, antibiotic therapy can also cause a negative impact on the healthy vaginal microflora. These issues sparked the interest in developing alternative therapeutic strategies. This review provides a quick synopsis of the currently approved and available antibiotics for BV treatment while presenting an overview of novel strategies that are being explored for the treatment of this disorder, with special focus on natural compounds that are able to overcome biofilm-associated antibiotic resistance.”
Current available treatments
Metronidazole and clindamycin are shown to be effective against anaerobic microorganisms, though tinidazole was the most recently approved antimicrobial agent for BV treatment, and is considered an alternative antimicrobial agent, particularly whenever metronidazole and clindamycin are unavailable or not tolerated. Being a second generation nitroimidazole with a longer half-life than metronidazole, it requires lower dosages, to be taken less frequently than metronidazole.
Although antibiotics are effective against anaerobic microorganisms, they have an inability to completely eradicate the densely-structured polymicrobial BV biofilms-associated bacteria G. Vaginalis.
Probiotics have been shown to modulate vaginal microbiota” -
“In the human vagina, certain Lactobacillus strains can act as probiotics, preventing the growth of BV-associated bacteria through two main mechanisms: the inhibition of pathogens adhesion to vaginal epithelium (Machado et al., 2013); and the production of antimicrobial compounds like hydrogen peroxide (Mastromarino et al., 2002), lactic acid (Boskey et al., 2001) and bacteriocins (Aroutcheva et al., 2001b). Diverse pharmaceutical formulations containing probiotic lactobacilli strains have reduced BV symptoms, improved the vaginal microflora profile, being usually well-tolerated (Rossi et al., 2010;Hantoushzadeh et al., 2012; Facchinetti et al., 2013; Vujic et al., 2013; Vicariotto et al., 2014). “
“In contrast, despite their therapeutic potential, some clinical trials have not detected a significant improvement in BV management (Falagas et al., 2007). Alternatively, probiotics have been proposed as adjuvants to antibiotic therapy [[meaning, using probiotics DURING antibiotic treatment. I used the Nature’s Way brand Primadophilus Optima Women’s, 90 billion]]. Several combinations of metronidazole, clindamycin or tinidazole with lactobacilli probiotic preparations have displayed promising results in BV treatment since they have been associated with high cure rates, low recurrence or quick re-establishment of an healthy vaginal microflora (Marcone et al., 2010; Bodean et al., 2013; Recine et al., 2016).” [[This is why I chose to take probiotics during my antibiotic treatment]].
“Probiotics have also been used in an attempt to specifically deal with BV biofilms. Remarkably, in 2007, Saunders and colleagues showed that L. reuteri RC-14 was able to disruptin vitro G. vaginalis biofilms (Saunders et al., 2007). Later, McMillan and colleagues demonstrated that probiotic L. reuteri RC-14 and L. rhamnosus GR-1 were able to incorporate themselves into BV-biofilm, composed by G. vaginalis and A. vaginae, causing both the disruption of the biofilm structure and bacterial cell death (McMillan et al., 2011). These findings provide some evidence of how lactobacilli probiotics might interfere with an abnormal vaginal microflora, reinforcing the hypothesis that probiotics could eradicate vaginal pathogenic biofilms and restore the normal microflora in in vivo situations.”
“It has also been proposed that prebiotics [[such as the product Irwin Naturals Healthy Tract Prebiotic]], nutritional substances that stimulate the growth of probiotics, could be used as alternative to treat BV (Roberfroid, 2007). Interestingly, Rousseau and colleagues demonstrated that prebiotic preparations containing oligosaccharides were able to promote the growth of beneficial lactobacilli strains but not of the pathogenic microorganisms often found in urogenital infections including G. vaginalis (Rousseau et al., 2005). “
“Later, Zeng and colleagues compared the efficacy of a prebiotic gel containing sucrose with 0.75% metronidazole vaginal gel to treat BV (Zeng et al., 2010). In that study, the prebiotic gel displayed a similar therapeutic cure rate to metronidazole, having a major advantage of quicker restoration of the normal vaginal microflora. Recently, Coste and colleagues evaluated the efficacy and safety of another prebiotic gel, applied as adjuvant therapy [[combined with antibiotic treatment]], in women treated for BV and showed an improved recovery of the normal vaginal flora, reducing the risk of recurrences (Coste et al., 2012).
“Surprisingly, up to now only one study evaluated the capability of plant-derived compound to eradicate BV biofilms. Interestingly, Braga and colleagues showed that thymol, a molecule present in thyme essential oil, had an inhibitory effect upon both newly formed and mature G. vaginalis biofilms, which supports the importance of exploring essential oils and their main constituents as therapeutic alternative to treat BV (Braga et al., 2010). Furthermore, the expectations on essential oils as effective agents against BV-biofilms can be inferred from studies in other related vaginal biofilms (Palmeira-de-Oliveira et al., 2012; Bogavac et al., 2015).” [[The suggested delivery was through douche]].
-“Recently, Bahamondes and colleagues verified that a soap containing lactic acid and lactoserum could be used for external intimate hygiene, reducing BV recurrence after treatment with oral metronidazole (Bahamondes et al., 2011). “
-“Interestingly, vitamin C, when coated with silicon, allowed the constant release of the active agent, resulting in a long-lasting vaginal low pH and prevention of vaginal irritation (Polatti et al., 2006). Other studies reported an effective and safe use of vaginal vitamin C tablets in BV treatment (Petersen et al., 2011), contributing to improve abnormal vaginal pH and microflora, especially in pregnant women (Zodzika et al., 2013). Additionally, the regular use of vitamin C during 6 days per month, for 6 months after successful BV treatment, was shown to decrease the risk of BV recurrence (Krasnopolsky et al., 2013).
-“Another alternative comes in the form of buffering agents. Polycarbophil [[like the product Replens]] is a weak poly-acid that it is able to adhere to vaginal epithelial cells, acting as a buffer in the vaginal secretions (Milani et al., 2000). “
-“Another agent that has been long used in the treatment of vaginal infections is boric acid (Van Slyke et al., 1981) [[This could be the 600 mg tablets from brands pH-D, BoriCap, Bona Dea, or Boric Balance as of a recent Google search]]. Recently, Reichman and colleagues reported that the use of boric acid in combination with a nitroimidazole reduce the BV recurrence (Reichman et al., 2009), suggesting a potential impact on BV biofilms. However, this need to be further studied and in vitro biofilm experiments will elucidate the role of boric acid in BV prevention.”
Conclusions and future directions
BV current approved therapies are not sufficient to deal with this multi-species biofilm-related vaginal disorder. Future, research should address biofilm communities with a particular emphasis on multi-species biofilms, a topic that only recently emerged (Castro and Cerca, 2015). By properly addressing the complex interactions established in multi-species biofilms, novel strategies will hopefully overcome the high recurrence and relapse rates associated with BV.
My personal treatment:
******DISCLAIMER******: I am not a health provider! Please remember that the information I’ve provided is strictly through my own research and experience. All information from the studies I followed are available to view on the web, so I suggest reading those if you want to be thorough. I have no known allergies to any of these items, and I suggest proceeding with caution if you have allergies and are unsure if you will have any reactions. If this is a concern for you, do extensive research about all of these ingredients, and how they may affect your body. If you know that you’ll have reactions to any of the following items, then please do not follow this treatment. I currently do not have a backup method of treatment to offer as an alternative. Again, I have only provided information about my own experience, so please proceed with safety precautions for yourself.
First off, if anyone is curious about substituting brands, I’m not sure how to answer that. I used the Twinlab C-500 Caps Crystalline Vitamin C capsules, and Nature’s Way Primadophilus Optima Women’s 90 billion brands specifically because after doing lengthy research and comparisons, I found that these specific products are the most accurate for this course of treatment. The Twinlab Crystalline Vitamin C is the most pure, without additives or sugars (which you don’t really want to be introducing to the vagina anyway, to avoid a yeast infection). The Nature’s Way Primadophilus Optima Women’s probiotic is a very high concentration containing all of the specific strains that were mentioned in the studies that are needed to help restore vaginal flora. The Irwin Naturals prebiotics was the only brand I could find at the health store, so that’s why I got them, but I’m sure other brands would work fine. The brands of everything else don’t need to be specific, so just use what you prefer. The overall cost of everything is fairly expensive, but it’s worth it to know that the treatment is effective. It’s certainly more cheap than additional visits to the doctor for more antibiotics.
List of items needed for course of treatment:
1. Nature’s Way Primadophilus Optima Women’s 90 billion (It’s ~$40-50 for 30ct. bottle, and must stay refrigerated. I bought mine at the health food store)
2. Irwin Naturals Healthy Tract Prebiotic (prebiotics are basically “food” for the probiotics, allowing them to multiply as much as possible so that they reach the colon in greater numbers, ~$20-23 per bottle)
3. Twinlab C-500 Caps Crystalline Vitamin C capsules (~$15-25 for a 100 ct. bottle)
4. Metronidazole antibiotic gel 5 day treatment (got mine from my doctor)
Not required according to the studies, but I used these anyway:
-1 multivitamin per day
-1 Super B/Stress B Complex per day
-A total of 8,000 IU of vitamin D3 per day (IU levels vary depending on the brand. I have the 2000 IU, so I just took 4 of those a day)
1. First thing that I’ll mention: On the days that I did this treatment, I tried to stay as hydrated as possible, and ate more whole foods, cutting back on extra sugars and white flour, as well as avoiding alcohol. I thought of it this way, I spent all this money on supplements, why make them less effective by eating crappy food and drinking alcohol?
The directions in the study say to do the treatment for at least 5 months. I would say to go for 6 months, which is was the researchers did during the study trials. For the first month, you’ll do 5 days of metronidazole antibiotic treatment, directly followed by 6 days of vitamin C treatment. For the following months after that, there is no need to do additional metronidazole antibiotic treatments, so just continue with the vitamin C treatments only. Keep in mind, even if you notice a major improvement after the first treatment, keep up with it for the following months. The idea is to dissolve the resistant polymicrobial biofilm that causes recurrences PERMANENTLY, so I suggest following the directions of the study rather than cutting it short.
2. During my period, I started taking my multivitamin, Super B/Stress B complex, and vitamin D3 8000IU vitamins every day. Once the flow of my period stopped, I began my metronidazole gel 5-day course of antibiotics every night before bed.
Every day of the gel treatment, I took one prebiotic and one probiotic pill together, usually during lunch or dinner. Usually during antibiotic treatments I get a yeast infection, but it didn’t happen this time. It could have been luck, or it could have been because of the probiotics. In any case, I was very glad.
I avoided coffee for a couple of hours before or after the prebiotics and probiotics too. I’m not sure if the acid in coffee affects the probiotic strains at all, but I didn’t want to take any risks. Like I said, didn’t want to waste all that money I had spent on expensive supplements if coffee or alcohol was going to affect them.
3. When I was finished with the metronidazole antibiotic gel on day 5, I inserted one whole Vitamin C crystalline capsule on day 6. I did this before going to bed, placing it as far in as my finger could reach (don’t forget to wash your hands first!). The gel capsule will dissolve while you’re sleeping. Do this every night for 6 nights in a row. When the 6 days are done, carry on with life as usual.
4. That’s one treatment down for the 1st month, with 5 more months to go. The metronidazole antibiotic treatment is only done in the 1st month, so there is no need to repeat it again. For the following months, after the flow of your period stops, proceed with the 6-day vitamin C treatment only.
5. Some things that you will notice:
--- The powder may cause a bit of tingling at first, which is normal.
--- If you feel inside the vaginal walls, it may be a bit more dry than what you’re used to, this is also normal. It will feel like this throughout the day. Something that I did while in the shower, was “sweep” out the gobs of leftover gel capsule residue. I’d rinse my finger, reach in to do a “sweep” of the area of the upper vaginal wall near my cervix, checking for the gel capsule globs. Then I’d rinse my finger again, and reinsert to double check. Despite introducing the moisture with your finger, it won’t easily rinse away the vitamin C powder. It will just make it a little more pasty. Generally, the powder sticks to the vaginal walls pretty well, so it’s not as though it’s going to “fall” or “drip” out. You will have the usual amount of discharge.
--- You’ll notice that during treatment, your discharge may begin to smell and look a little different (in other words, much better!). Mine ranged from clear to yellow-ish clear. The dreaded BV smell seemed to disappear completely on the third day of vitamin C treatment.
--- Definitely use disposable pantyliners during the metronidazole antibiotic treatment. I didn’t want the medicine to be left behind on my underwear. Normally during my period, I use Thinx brand period panties, which are like pantyliners (the most amazing thing ever, by the way), and I noticed that the vitamin C was safe on those underwear, and didn’t ruin them at all, so I imagine that it’s also not an issue for the vitamin C to get on your regular underwear. I also have a bidet on my toilet, so this made cleanup a little easier for me each time I used the bathroom. However, baby wipes or flushable wipes are a nice touch, and quite helpful during treatment.
--- A final thing to note if you’re going to have sex during treatment: I chose not to have intercourse with my husband during the antibiotic treatment. However, we did have intercourse while I was doing the vitamin C treatment, and it didn’t affect us negatively at all. Since vitamin C powder is safe to ingest orally, this didn’t pose a risk either. Actually, he remarked that he didn’t mind the taste. Also, we normally use coconut oil as a lubricant, and I found that it did not cause any side effects. I cannot confirm if other lubricants/chemicals will cause any reactions with this treatment, so that is something to keep in mind. I usually avoided intercourse directly after inserting a pill, so if you want to get busy, it may be better to do so before inserting the pill.
Hope you find as much success with this as I did! Good Luck!
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