Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study.

Jade Bilardi,Sandra Walker,Ruth Mcnair,Meredith Temple-Smith,Clare Bellhouse,Christopher Fairley,Marcus Chen,Catriona Bradshaw,Julie Mooney-Somers,Brenda A Wilson

doi:10.1371/journal.pone.0151794

Abstract

BackgroundFew data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women’s recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV.MethodsA descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews.ResultsThe majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women’s frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching.ConclusionIn the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.

Highlights

Bacterial vaginosis (BV) is the most common vaginal condition affecting women of reproductive age, with prevalence estimates of between 10–30% among women who have sex with men in developed nations [1, 2] and 20–50% of women who have sex with women (WSW) [3,4,5,6,7]
Clinical management of bacterial vaginosis (BV) could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors
The aetiology and whether BV is sexually transmitted remains unknown and current treatment options are associated with recurrence rates in excess of 50% within 12 months of treatment [14]

Summary

Introduction

Bacterial vaginosis (BV) is the most common vaginal condition affecting women of reproductive age, with prevalence estimates of between 10–30% among women who have sex with men in developed nations [1, 2] and 20–50% of women who have sex with women (WSW) [3,4,5,6,7]. Recommended first line treatment for BV includes oral metronidazole or topical clindamycin cream and while effective in the short term, adverse side-affects are common and include nausea, vomiting, an unpleasant taste in the mouth and vaginal candidiasis [14, 15] and symptom relief is often short lived. It remains unclear whether recurrence reflects reinfection or persistent infection [14, 16]. This study aimed to explore women’s recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV

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Results

Discussion

Conclusion