Bacterial vaginosis: impact of treatment and associated risk factors: a cross section study


  • Meeta Sharma Department of Obstetrics and Gynecology, Mahatma Gandhi Hospital and Medical University, Jaipur, Rajasthan, India
  • Meena Metre Akaash Hospital, Malviya Nagar, Skyline Diagnostics, ALKhaleej Diagnostic, New Delhi, India



Bacterial vaginosis, Resistance, Risk factors, Treatment


Background: Bacterial vaginosis (BV) is a condition caused by an overgrowth of normal vaginal flora. Many socio-demographic factors are associated with bacterial vaginosis. Antibiotic resistance to some organism is a challenge in treatment of bacterial vaginosis.

Methods: This cross-sectional study was conducted including 100 women with reproductive age group presenting with complain of vaginal discharge. After clinical examination, vaginal swab was collected of patients who gave consent for same. Socio-demographic characteristics were recorded and risk factors were assessed. The slide smears were prepared from vaginal swabs, and the slides were heat-fixed, gram-stained and examined under oil immersion objective. Each slide was then graded as per the standardized quantitative morphological classification method developed by Nugent. Identification of bacteria to genus and/or species level was done by employing an array of routine biochemical tests for Gram-positive bacteria for Gram-negative bacteria. In vitro antibacterial susceptibility testing of bacterial isolates was performed by the Kirby-Bauer disc diffusion method. Sensitivity test results were interpreted according to the Clinical and Laboratory Standards Institute.

Results: High incidence of bacterial vaginosis was found among 35 to 45 years age group (63.8%), married females (63.9%), illiterate (100%), females with more than 3 sexual partners (66.7%), those with any co-morbidity (80%) and females not using any method of contraception (100%). E coli (28%) was predominant organism causing bacterial vaginosis followed by Gardenella vaginalis (20%) among the gram-negative bacteria. Among gram positive bacterial S. pyogen (2%) and S. agalactiae (2%) were present. Drug resistance to trimethoprim/sulfamethxazole, erythromycin, cefoxitin, ceftriaxone and gentamycin was detected.

Conclusions: Higher age, illiteracy, multiple sexual partners and absence of contraception use can increase risk of bacterial vaginosis. Gram negative organisms are common cause of bacterial vaginosis and they are resistant to trimethoprim/sulfamethoxazole and erythromycin.



Greenbaum S, Greenbaum G, Moran-Gilad J, Weintraub AY. Ecological dynamics of the vaginal microbiome in relation to health and disease. Am J Obstet Gynecol. 2019;220(4):324-35.

Javed A, Parvaiz F, Manzoor S. Bacterial vaginosis: An insight into the prevalence, alternative treatments regimen and it’s associated resistance patterns. Microb Pathog. 2019;127:21-30.

Centeres for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Available at: Accessed on 20 October 2023.

Brocklehurst P, Gordon A, Heatley E, Milan SJ. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev. 2013;1:CD000262.

Beebout CJ, Eberly AR, Werby SH, Reasoner SA, Brannon JR, De S, et al. Respiratory heterogeneity shapes biofilm formation and host colonization in uropathogenic Escherichia coli. MBio. 2019;10(2):10-128.

Russo R, Karadja E, De Seta F. Evidence-based mixture containing Lactobacillus strains and lactoferrin to prevent recurrent bacterial vaginosis: a double blind, placebo controlled, randomised clinical trial. Benef Microbes. 2019;10(1):19-26.

Deese J, Pradhan S, Goetz H, Morrison C. Contraceptive use and the risk of sexually transmitted infection: systematic review and current perspectives. Open Access J Contracept. 2018;9:91-112.

Kairys N, Garg M. Bacterial Vaginosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.

Coughlin G, Secor M. Bacterial vaginosis: update on evidence-based care. Adv Nurse Pract. 2010;18(1):41-4.

Han C, Li H, Han L, Wang C, Yan Y, Qi W, et al. Aerobic vaginitis in late pregnancy and outcomes of pregnancy. Eur J Clin Microbiol Infect Dis. 2019;38(2):233-9.

Money D. The laboratory diagnosis of bacterial vaginosis. Can J Infect Dis Med Microbiol. 2005;16(2):77-9.

Bitew A, Abebaw Y, Bekele D, Mihret A. Prevalence of bacterial vaginosis and associated risk factors among women complaining of genital tract infection. Int J Microbiol. 2017;2017:4919404.

Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983;74(1):14-22.

Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29(2):297-301.

Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B. Aerobic vaginitis: Abnormal vaginal flora entity that is distinct from bacterial vaginosis. Int Congr Ser. 2005;1279:118-29.

Murta EF, Silva AO, Silva EA, Adad SJ. Frequency of infectious agents for vaginitis in non-and hysterectomized women. Arch Gynecol Obstet. 2005;273(3):152-6.

Mulu W, Yimer M, Zenebe Y, Abera B. Common causes of vaginal infections and antibiotic susceptibility of aerobic bacterial isolates in women of reproductive age attending at Felegehiwot referral Hospital, Ethiopia: a cross sectional study. BMC women's health. 2015;15(42):1-9.

Xueqiang F, Yingzhi Z, Yanfang Y, Yutao D, Huiqing L. Prevalence and risk factors of trichomoniasis, bacterial vaginosis, and candidiasis for married women of child-bearing age in rural Shandong. Japan J Infect Dis. 2007;60(5):257.

Ocviyanti D, Rosana Y, Olivia S, Darmawan F. Risk factors for bacterial vaginosis among Indonesian women. Med J Indo. 2010;19(2):130-5.

Yusuf MA, Chowdhury M, Islam KS, Eva EO, Sharif AR, Rahman MK, et al. Common microbial aetiology of abnormal vaginal discharge among sexually active women in Dhaka, Bangladesh. South East Asia J Publ Health. 2013;1(1):35-9.

Fredricks DN, Fiedler TL, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med. 2005;353(18):1899–911.

Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, et al. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sexual Transmit Dis. 2007;34(11):864-9.

Yen S, Shafer MA, Moncada J, Campbell CJ, Flinn SD, Boyer CB. Bacterial vaginosis in sexually experienced and non–sexually experienced young women entering the military. Obstet Gynecol. 2003;102(5):927-33.

Bump RC Buesching WJ. III Bacterial vaginosis in virginal and sexually active adolescent females: Evidence against exclusive sexual transmission. Am J Obstet Gyneco. 1988;158(4):935-9.

Klebanoff MA, Nansel TR, Brotman RM, Zhang J, Yu KF, Schwebke JR, et al. Personal hygienic behaviors and bacterial vaginosis. Sex Transm Dis. 2010;37(2):94-9.

Gardner HL, Dukes CD. Haemophilus vaginalis vaginitis: a newly defined specific infection previously classified non-specific vaginitis. Am J Obstet Gynecol. 1955;69(5):962-76.

Vodstrcil LA, Walker SM, Hocking JS, Law M, Forcey DS, Fehler G, et al. Incident bacterial vaginosis (BV) in women who have sex with women is associated with behaviors that suggest sexual transmission. Clin Infect Dis. 2015;60(7):1042-53.

Schwebke J, Desmond RA. Risk Factors for bacterial vaginosis in women at high risk for sexually transmitted diseases. Sex Transm Dis. 2005;32(11):654-8.

Marrazzo JM, Thomas KK, Fiedler TL, Ringwood K, Fredricks DN. Risks for acquisition of bacterial vaginosis among women who report sex with women: a cohort study. PLoS One. 2010;5(6):e11139.

Ryckman KK, Simhan HN, Krohn MA, Williams SM. Predicting risk of bacterial vaginosis: The role of race, smoking and corticotropin-releasing hormone-related genes. Mol Hum Reprod. 2009;15(2):131-7.

Hutchinson KB, Kip KE, Ness RB. Condom use and its association with bacterial vaginosis and bacterial vaginosis-associated vaginal microflora. Epidemiol. 2007;18(6):702-8.

Gallo MF, Warner L, King CC, Sobel JD, Klein RS, Cu-Uvin S, et al. Association between semen exposure and incident bacterial vaginosis. Infect Dis Obstet Gynecol. 2011;2011:842652.

Spiegel CG. Bacterial vaginosis. Clin Microbiol Rev. 1991;4:485-502.

Hillier S. The complexity of microbial diversity in bacterial vaginosis. N Eng J Med. 2005;353(18):1886–7.

Hill GB. The microbiology of bacterial vaginosis. Am J Obste Gynecol. 1993;169(2):450-4.

Muzny CA, Kardas P. A narrative review of current challenges in the diagnosis and management of bacterial vaginosis. Sex Transm Dis. 2020;47(7):441-6.

Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB, Moss LM, et al. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis. 2006;193(11):1478–86.

Coudray MS, Madhivanan P. Bacterial vaginosis-a brief synopsis of the literature. Eur J Obstet Gynecol Reprod Biol. 2020;245:143-8.

Faught BM, Reyes S. Characterization and treatment of recurrent bacterial vaginosis. J Womens Health (Larchmt). 2019;28(9):1218–26.

Swidsinski A, Mendling W, Loening-Baucke V, Ladhoff A, Swidsinski S, Hale LP, et al. Adherent biofilms in bacterial vaginosis. Obstet Gynecol. 2005;106(5 Pt 1):1013-23.

Swidsinski A, Loening-Baucke V, Swidsinski S, Verstraelen H. Polymicrobial Gardnerella biofilm resists repeated intravaginal antiseptic treatment in a subset of women with bacterial vaginosis: a preliminary report. Arch Gynecol Obstet. 2015;291(3):605-9.






Original Research Articles