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STDs (Expert Forum)
confused with bv
Answered by
University of Washington
Seattle - WA
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This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
confused with bv
by confusedgirl333, Aug 25, 2007 12:07PM
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 :)
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 :)
Doctor's Answer
by H. Hunter Handsfield, M.D., Aug 25, 2007 01:01PM
, Aug 25, 2007 01:01PM
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
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
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 :)
Best wishes-- HHH, MD
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