Diagnosis and Treatment of Bacterial Vaginosis: Survey of Family Physicians in West Virginia

Background: Vulvovaginitis is a common gynecologic complaint with millions of women seeking medical attention for this disorder. Bacterial vaginosis (BV) is the most common form of vaginal infection. Its nonspecific symptomatology and its diagnostic and therapeutic controversies pose many challenges. Methods: A 10-question self-administered survey was mailed to family physicians in West Virginia. The survey assessed the occurrence of BV, diagnostic criteria, and treatment options. The results were reported as descriptive statistics. Results: Overall, 107 physicians responded to the survey. Seventy-nine surveys were used in the tabulation of results. All respondents diagnosed vaginitis on a weekly basis. On average, BV is diagnosed in 25 percent of women with vaginal problems. Discharge, odor, and irritation were the most common signs/symptoms. History, physical examination, and microscopic examination of vaginal secretions were employed routinely for diagnosis. A detectable odor, a homogeneous discharge, and vaginal pH >4.5 were inconsistent objective clinical findings. However, the presence of clue cells was noted in the majority of patients. The preferred drug for the treatment of BV was metronidazole, usually administered in a dosage of 500 mg/d po bid for seven days. Fifty percent of the respondents treat men partners, and again, the drug of choice was metronidazole. The majority do not treat asymptomatic BV during pregnancy nor asymptomatic nonpregnant women during routine gynecologic examination. Recurrence was noted in fewer than 30 percent of treated women. Conclusions: On the basis of the results, BV is a common gynecologic diagnosis. Classic signs/symptoms were universally present and the diagnostic approach was consistent with established medical norms. The usual objective clinical findings were not always evident, although the presence of clue cells was a frequent finding. The therapeutic approach to the patient with BV was also consistent with contemporary medical practice in 1991. Whether the small sample size or inconsistent reporting affected the study results remains indeterminate. Future research will be directed toward larger patient populations and assessment of newer therapeutic modalities and their costs.