Letters to the Editor
Should Asymptomatic Bacterial Vaginosis Be Treated?
Am Fam Physician. 2005 May 1;71(9):1652.
to the editor: The Information from Your Family Doctor handout regarding bacterial vaginosis1 in the May 1 issue states: “Some women have bacterial vaginosis without any symptoms.” It then poses the question, “Do I have to be treated?,” which is answered with an unqualified “Yes.”
Certainly there are indications to treat asymptomatic bacterial vaginosis: treatment is recommended in pregnant women at high risk for preterm delivery and women undergoing surgical procedures such as abortion and hysterectomy,2 for example; and, by extension, there are instances in which treatment is reasonable, such as prior to transvaginal procedures (e.g., intrauterine device insertion, endometrial biopsy).
However, except in the above circumstances, I am aware of no solid evidence-based recommendation for the treatment of asymptomatic women with bacterial vaginosis; treatment of asymptomatic bacterial vaginosis even in low-risk pregnant women remains controversial.2 Guidelines from the Centers for Disease Control and Prevention state that the “established benefits of therapy for [bacterial vaginosis] in non-pregnant women are to relieve vaginal symptoms and signs of infection and reduce the risk for infectious complications after abortion or hysterectomy.”2 Additionally, the natural history of bacterial vaginosis is such that it may resolve (and recur) spontaneously.3
It is hard to make an asymptomatic patient feel better; we should demand evidence before assuming that the benefits of diagnosis and therapy outweigh their burdens.
1. Bacterial vaginosis. Am Fam Physician. 2004;69:2193.
2. Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002;51(RR-6):1–78.
3. Joesoef M, Schmid G. Bacterial vaginosis. Clin Evid. 2003;10:1824–33.
in reply:We would like to thank Dr. Fox for calling our attention to this patient education handout. We agree that no evidence has shown that treating asymptomatic bacterial vaginosis improves patient outcomes. Accordingly, the handout did not advocate testing and treatment of asymptomatic women. Rather, its unqualified recommendation to treat was directed to women who present with symptoms that may be relieved by treatment. This patient education handout has been updated on our Web site (https://www.aafp.org/afp/20040501/2193ph.html).
Send letters to firstname.lastname@example.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.
Copyright © 2005 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions