confused with bv

[confusedgirl333]

Dear doctor,
After 2 months of suffering from vaginal soreness and milky discharge and being misdiagnosed with yeast infection twice, I finally found out that I had BV instead. My doctor prescribed me to take 0.75% Metronidazole Vaginal Gel at bedtime for five days. I just finished my five-day regimen last night. However I was curious about bv and started browsing the Internet to find out that the more common treatment is to take the gel twice a day for 5 days. Can you please explain what difference does once a day versus twice a day make? Will once a day regimen make the medication less effective? Being in constant discomfort for 2 months and being prescribed fluconazole twice in addition to monistat when I did not have a yeast infection makes me slightly skeptical about all kinds of prescriptions now. I just really want the infection to be gone for good. I took metrogel as prescribed: before bedtime for 5 days. Do you think I should stick to the prescription or should I do a week instead since it's only once daily?
Also, after the first day I had a great relief in my soreness and painful vulva inflammation so I think the gel helped. However, now I experience slight vaginal irritation and I don't know if I should attribute it to the medication side effect or the possibility that the infection is not completely gone. I have some chunky discharge coming out...I don't know if it is the gel coming out in a slightly changed form or a yeast infection (looks more like the gel...since it is more of a wet paper-like mixed with clear gel discharge). Perhaps it is that discharge that creates the irritation. Is there any way to avoid a yeast infection at all while taking antibiotics or is it just a chance matter? I know I have a lot of questions...thank you for your admirable work on this website :)

[H. Hunter Handsfield, M.D.]

Thanks for the thanks about this website.  But I'm not sure you're going to like some of my responses to your question.

I am not convinced bacterial vaginosis is the only problem here.  BV is not associated with inflammation or irritation and generally does not cause vaginal soreness.  It sometimes appears in the presence of other conditions--i.e., the BV might have developed because of something else.  Depending on your sexual lifestyle (i.e., STD risks), herpes, chlamydia, and gonorrhea come to mind.  You need evaluation for those if that hasn't been done.  Other non-STD problems also are possible; for example, sometimes something as simple as a forgotten tampon could be responsible.  Also, although your description of "milky" discharge is typical for BV, "chunky" discharge is not--reinforcing my concern that BV might not be the only problem.

As for your hope of BV "being gone for good", be aware that recurrence is very common after all treatments.  Missing 1-2 doses or 1 day of treatment probably doesn't make much difference; and neither would taking more prolonged treatment.  I cannot judge whether the changing character of your discharge is related to the treatment itself or to some other problem, as suggested above.  You are correct in your concern that the metronidazole might increase the risk of a yeast infection, whether or not you had one before.

My advice is to follow the treatment as prescribed, i.e. stop treatment if you have finished the 5-day course of Metrogel.  Then wait a few days.  If your symptoms entirely clear up and all returns to normal, then all probably is well.  (You still should be tested for STDs if that hasn't been done.)  If your symptoms persist after stopping treatment, return to your health care provider for further evaluation.  Alternatively, ask for referral to a gynecologist who specializes in infectious diseases, who usually can be found in most metropolitan areas or large medical medical centers.

Best wishes--  HHH, MD

[confusedgirl333]

Thank you for your advice. I got tested for all the stds you list(herpes, syphilis, chlamydia/gonorrhea and HIV) and was negative for all of them. It all started with a fishy odor that i had once when having sex with my boyfriend, then it went away and the itchiness/irritation developed. I went to the clinic and got a sample of vaginal discharge taken. Back then they said I had a yeast infection and prescribed 1 pill of fluconazole. The feeling of vaginal irritation did not go away after a week. Then, thinking that I still had a yeast infection, I used 3-day monistat. Still no relief. Went back to the health services and they did not see anything except for still a little yeast and prescribed me fluconazole (1 pill) again. Still no change. Then I changed my gynecologist and tried a new doctor. She took another vaginal sample and found bv. So I assume it was bv in the first place and that's why the yeast medications made no difference in my condition. Do you think it is possible to miss bv infection in the wet mount? Can the irritation I am still experiencing (although it improved greatly) be attributed to so many medications that I have taken in the past 2 months, disturbing my vaginal balance? I just feel like I am running in circles, unsure what causes what.
Also the thicker discharge only appeared after taking metrogel...so hopefully it is the gel coming back out. What comes up, must come down, I guess haha. Knowing more information on me now, do you have any particular recommendations as to further testing or what can my irritation be...assuming metrogel wouldn't work? As for now, I am going to wait it out and hope for the best :)

[H. Hunter Handsfield, M.D.]

I really cannot help further. Your overall situation is too complex to rely on online opinions from me or anyone else. And it sounds like your current provider is pretty competent in this area.  As before, I recommend you complete the treatment as prescribed, wait a few days to judge symptoms, then return to your provider if things still don't seem normal.

Best wishes--  HHH, MD

[gracefromHHP]

As someone who's had bv issues for quite sometime now - I've found my experiences to be different from what HHH has posted and what some of the literature tells me I should be experiencing.  He and I don't always agree on everything but I really wanted to chime in on this regardless .  

Yes indeed I get very red and sore when I have bv.  Most gals I know who have bv issues do so too.  If you really  had symptomatic bv for 2 months that went untreated - no wonder you are sore down yonder sweetie!!  

The chunks you are getting now - are dead bacteria and dead skin cells making their way out of your body from using the medication. They too can be a bit irritating :(   Give it a few days and things should return to normal.  I usually use a barrier cream to my genital area to help protect it and reduce irritation from the discharge after I've treated my bv ( ie zinc oxide, desitin, a&d etc ) . I also try to go bottomless whenever I can ( and not because I"m a pervert...he he he ) - cool, drying air is not only comforting to our genital areas when they are sore - it also helps to discourage over growth of yeast and bacteria which is a good thing.  If you still have discharge say a week from now - return to the doctor to make sure that your ph wasn't over corrected and you now actually have yeast going on ( this sometimes happens ).   as for twice a day vs once daily treatment - the once a day for 5 days is usually adequate for someone who has their first bv episode. Should you be unlucky enough to have bv return multiple times then they might prescribe the twice a day treatment. there are also other options like one time clindesse and also oral flagyl ( which has more side effects than the vaginal form of it - avoid alcohol with both forms though! ).  

I think bv is far, far worse than anything my herpes has ever thrown at me :(  Hang in there - hopefully now that you are properly treating what is really going on down yonder you'll be back to normal soon :)

grace

[jp813]

I agree with grace.  I had major swelling, itchiness and burning when I've had BV.  But I do agree with the Dr in that there could be more going on down there, but nobody can seem to pinpoint what some of these vaginal issues are.  Just look on the "vaginal cuts" forum and you'll see that there are hundreds of women dealing with vaginal issues and getting no clear-cut answer.

[monkeyflower]

I think this is one of those things where you can decide whether you want to be miserable, or you want to be happy. Acceptance is everything. It's annoying, but it isn't going to kill you, so why not let go and move on? I bet once you do, your symptoms diminish and might even disappear :-)

[H. Hunter Handsfield, M.D.]

The data are clear:  BV, by itself, is not usually associated with irritation, just discharge with odor.  Undoubtedly there are exceptions, as in all things medical.  But someone with BV plus irritation, itching, pain, swelling etc. should be at least examined by a health professional to make sure something else also isn't going on--although not necessarily for every recurrence, once a pattern of symptoms is established, as it apparently is for gracefromHHP.

[jp813]

You're right.  And I do my best.  I've pretty much decided that no one knows why these cuts appear and disappear, therefore I'm not out spending a bunch of money on doctors for no reason. If it didn't effect my sex life, it wouldn't be such an ongoing concern and would be much easier to "let go". Trust me...the cuts and the BV are not something I welcome in my life.  I think I have the BV under control, but after a month or so of repsite from the cuts, they've appeared again.  Its just annoying not knowing what they are.  Oh well...

Thanks Dr for the comments on the data..I must be one of those exceptions.  

[gracefromHHP]

I also think some of us just have sensitive genital skin too.  One person might have bv and not even really know they have it while another gets it and gets red and irritated and feels miserable. Just one more thing not to love about being female :(  

grace

[jp813]

amen to that grace.  and just for the record, Monkeyflower, this is NOT in my head and I'm a very happy person!  Whats going on down there doesn't define me or run my life.  I'm just out there looking for some answers through people with similar symptoms.  And with that said, if we wish to duke it out any further, :)  it will have to be done on the patient-to-patient forum as I know the dr will be "excusing us" from posting any further on this thread.  (Sorry Doc! and thank you, btw, you're posts are what led me to question my HSV-2  positive results...which ended up being negative with a confirmatory test!  

[monkeyflower]

I don't think it's all in your head either; that's not what I meant. I was just speaking from my own experience. I've had my share of genital unhappiness, too (I had a constant yeast infection the entire 9 years I was on the pill, lol). I started out feeling frustrated and annoyed, and briefly let it really affect my sex life. Then I decided this seemed to just be the way it was gonna be. I wanted to stay on the pill and I wasn't going to die, so I figured I could let it make me crazy, or I could forget about it. I chose to forget about it, and I kept having sex and doing everything I'd normally do. It really was pretty okay, and it got even better when I stopped thinking about it all the time. 'Course, I admit I have a high tolerance for pain and ambiguity, so that made it a lot easier :-)

[monkeyflower]

Oh, and I forgot to mention that when I had BV, I had ample irritation/pain/burning, too  :-)

[Kieralynn]

A related discussion, Persistent BV was started.

[salatty02]

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