{"product_id":"bacterial-vaginosis-why-does-it-keep-coming-back-despite-antibiotic-treatment","title":"Bacterial Vaginosis: Why Does It Keep Coming Back Despite Antibiotic Treatment?","description":"\u003cp\u003eBacterial vaginosis (BV) is one of the most common infections among sexually active women, yet despite more than five decades of research, scientists still cannot fully explain why cure rates have steadily declined from 90% to just 50%–80% since metronidazole was first introduced. In this editorial commentary accompanying a major clinical trial, Dr. David A. Eschenbach from the University of Washington examines the ongoing debate over whether treatment failures stem from antibiotic resistance, reinfection, or undertreatment. The study under discussion, conducted by Schwebke and Desmond with 420 women, found that a longer 14-day course of metronidazole produced a substantially higher cure rate at one week (62%) compared with the standard 7-day regimen (43%), but this advantage disappeared by day 21, suggesting the effect was only temporary. The commentary highlights that BV may involve a complex mix of bacteria that antibiotics alone cannot fully eliminate, and points to sexual abstinence, condom use, and avoiding douching as factors that significantly improve cure rates.\u003c\/p\u003e\n\n\u003ch1\u003eBacterial Vaginosis: Why Does It Keep Coming Back Despite Antibiotic Treatment?\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#what-is-bv\"\u003eWhat Is Bacterial Vaginosis (BV)?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#why-matters\"\u003eWhy This Research Matters\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#study-methods\"\u003eInside the Study: How the Research Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#key-findings\"\u003eKey Findings: What the Study Revealed\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#cure-rate-decline\"\u003eWhy Have Cure Rates Declined Over Time?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#resistance-reinfection\"\u003eResistance, Reinfection, or Both?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#clinical-implications\"\u003eWhat This Means for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eStudy Limitations\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients and Researchers\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eCure rates for bacterial vaginosis have declined from about 90% to 50–80% since metronidazole was introduced.\u003c\/li\u003e\n\u003cli\u003eA 14-day metronidazole course cured 62% at one week versus 43% for 7 days, but the benefit disappeared by day 21.\u003c\/li\u003e\n\u003cli\u003eEven after a full 14-day antibiotic course, 38% of women failed treatment at one week and 57% by three weeks.\u003c\/li\u003e\n\u003cli\u003eWomen who used condoms or abstained from sex had a 50% higher cure rate; avoiding douching raised cure rates by 80%.\u003c\/li\u003e\n\u003cli\u003eAdding azithromycin to metronidazole provided little added benefit, so the solution likely requires better understanding of BV causes.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"what-is-bv\"\u003eWhat Is Bacterial Vaginosis (BV)?\u003c\/h2\u003e\n\n\u003cp\u003eBacterial vaginosis (BV) is a condition in which the normal balance of bacteria in the vagina is disrupted. Instead of being dominated by healthy \u003cem\u003eLactobacillus\u003c\/em\u003e bacteria, the vagina becomes overgrown with a mixture of other organisms, including \u003cem\u003eGardnerella vaginalis\u003c\/em\u003e and various anaerobic bacteria (bacteria that thrive in environments without oxygen).\u003c\/p\u003e\n\n\u003cp\u003eBV is remarkably common. At least 15% of sexually active women have BV at any given time. To put that number in perspective, this makes BV 3–4 times more common than urinary tract infections, and it is far more common than \u003cem\u003eTrichomonas vaginalis\u003c\/em\u003e infection (a sexually transmitted parasite) — even among patients visiting sexually transmitted disease clinics. BV is also much more common than vulvovaginal candidiasis (a yeast infection).\u003c\/p\u003e\n\n\u003cp\u003eOne of the key challenges in understanding BV is that scientists have not been able to identify a single bacterium that causes it. DNA technology has revealed the presence of a large number of bacteria that cannot be cultured (grown in a laboratory) or are very difficult to grow. No single organism has been proven to be the definitive cause. One leading theory suggests that the destabilization of the healthy \u003cem\u003eLactobacillus\u003c\/em\u003e species is the crucial event, and that \u003cem\u003eG. vaginalis\u003c\/em\u003e and the anaerobic bacteria are simply secondary invaders that move in after the protective bacteria are gone.\u003c\/p\u003e\n\n\u003ch2 id=\"why-matters\"\u003eWhy This Research Matters\u003c\/h2\u003e\n\n\u003cp\u003eBV is not just an inconvenience or a nuisance discharge. It is linked to a wide range of serious upper genital tract infections, which is why successful treatment is so important. The complications associated with BV include:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eAmniotic fluid infection (infection of the fluid surrounding the baby during pregnancy)\u003c\/li\u003e\n  \u003cli\u003eChorioamnionitis (infection of the fetal membranes)\u003c\/li\u003e\n  \u003cli\u003ePreterm delivery (giving birth before 37 weeks)\u003c\/li\u003e\n  \u003cli\u003ePostpartum endometritis (infection of the uterine lining after childbirth)\u003c\/li\u003e\n  \u003cli\u003ePost-Cesarean delivery wound infections\u003c\/li\u003e\n  \u003cli\u003ePost-hysterectomy infections (infections after removal of the uterus)\u003c\/li\u003e\n  \u003cli\u003ePost-abortion endometritis (uterine infection following an abortion)\u003c\/li\u003e\n  \u003cli\u003ePelvic inflammatory disease (infection of the female reproductive organs), though this is linked to a lesser degree\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThese serious consequences make research into BV treatment a compelling public health priority — especially because the infection often goes untreated in women who have no symptoms.\u003c\/p\u003e\n\n\u003cp\u003eYet, as Dr. Eschenbach points out, this article was published in 2006 — 51 years after Dr. Gardner first reported the condition we now call BV. Despite half a century of research, only limited and inconclusive evidence exists on three fundamental questions: whether BV is truly an infection, what microbial cause (or causes) are responsible, and what the most effective treatment actually is.\u003c\/p\u003e\n\n\u003ch2 id=\"study-methods\"\u003eInside the Study: How the Research Was Conducted\u003c\/h2\u003e\n\n\u003cp\u003eThe study that this editorial reviews, conducted by Schwebke and Desmond, was a randomized, double-blind clinical trial — meaning neither the patients nor the doctors knew who was receiving which treatment. This design is considered the \"gold standard\" in medical research because it eliminates bias.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers enrolled a large group of 420 women with symptomatic BV who returned for their first follow-up examination. The study examined three key questions about BV treatment:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDuration of therapy:\u003c\/strong\u003e Does taking the antibiotic for a longer period (14 days) work better than the standard shorter course (7 days)?\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDefinition of BV:\u003c\/strong\u003e Does it matter whether \"cure\" is defined by clinical symptoms or by laboratory Gram stain criteria (a method of staining and examining bacteria under a microscope)?\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eReinfection or suboptimal resolution:\u003c\/strong\u003e Does BV come back after treatment because women are being reinfected by a sexual partner, or because the original infection was never fully cleared?\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eThe women were randomly assigned to receive either a 7-day or a 14-day regimen of metronidazole (the most commonly used antibiotic for BV). Some women also received azithromycin, a second antibiotic, to test whether adding it would improve outcomes. Cure rates were measured at both 7 days and 21 days after the last dose of medication.\u003c\/p\u003e\n\n\u003ch2 id=\"key-findings\"\u003eKey Findings: What the Study Revealed\u003c\/h2\u003e\n\n\u003cp\u003eThe results were striking on several fronts. Let's walk through the key numbers:\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eLonger treatment produced better short-term results.\u003c\/strong\u003e One week after receiving the last dose of medication, the pooled cure rate was significantly higher among women who received the 14-day regimen of metronidazole than among those who received the 7-day regimen:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e14-day regimen: \u003cstrong\u003e62% cure rate\u003c\/strong\u003e at 1 week after treatment\u003c\/li\u003e\n  \u003cli\u003e7-day regimen: \u003cstrong\u003e43% cure rate\u003c\/strong\u003e at 1 week after treatment\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThis difference was highly statistically significant (P\u0026lt;.001), meaning there is less than a 0.1% chance that this result was due to random chance. For patients, this means the longer antibiotic course genuinely did produce better short-term outcomes.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eThe advantage did not last.\u003c\/strong\u003e However, when cure rates were measured 21 days after the last dose of medication, the picture changed dramatically. The two groups now had similar cure rates:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e14-day regimen: \u003cstrong\u003e43% cure rate\u003c\/strong\u003e at 21 days after treatment\u003c\/li\u003e\n  \u003cli\u003e7-day regimen: \u003cstrong\u003e51% cure rate\u003c\/strong\u003e at 21 days after treatment\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIn other words, the longer 14-day treatment produced a definite but temporary benefit. The women who took the longer course were more likely to be cured initially, but by three weeks after finishing the antibiotics, their advantage had evaporated. This raises an important question: was the temporary improvement due to undertreatment, antibiotic resistance, or reinfection — or some combination of all three?\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eA significant number of women failed treatment entirely.\u003c\/strong\u003e The 14-day metronidazole regimen failed to cure 38% of women at the 7-day follow-up visit. Two weeks later, the failure rate had climbed to 57%. This means that even with a full two-week course of the standard antibiotic, more than half of women eventually experienced a return of their BV.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAzithromycin did not help.\u003c\/strong\u003e The study conclusively demonstrated that adding azithromycin to the metronidazole treatment added little to the overall effect. The combination was not meaningfully better than metronidazole alone, so adding this second antibiotic is not an effective solution.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eGram stain vs. clinical criteria.\u003c\/strong\u003e The study also compared two different ways of defining \"cure.\" Whether the researchers used clinical criteria (symptoms and physical exam) or Gram stain criteria (microscopic examination of vaginal bacteria), the 14-day regimen was consistently superior to the 7-day regimen at the early follow-up point. The definition of cure did not change the overall conclusion about treatment duration.\u003c\/p\u003e\n\n\u003ch2 id=\"cure-rate-decline\"\u003eWhy Have Cure Rates Declined Over Time?\u003c\/h2\u003e\n\n\u003cp\u003eOne of the most puzzling observations highlighted in this editorial is that the reported cure rate for BV has actually \u003cem\u003edecreased\u003c\/em\u003e over the past three decades. When metronidazole was first introduced, antibiotics \"cured\" about 90% of cases. Today, cure rates range from 50% to 80%. The question is: how can cure rates steadily decline over 30 years?\u003c\/p\u003e\n\n\u003cp\u003eDr. Eschenbach offers several possible explanations:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eChanging definitions:\u003c\/strong\u003e The criteria used to define BV have changed over the years, moving from clinical criteria to Gram stain–based criteria. The definition of \"cure\" has also varied between studies. However, the author notes this is probably a \"theoretical\" rather than a real explanation for the decline.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIncreasing antibiotic resistance:\u003c\/strong\u003e The bacteria that cause BV — or the anaerobic bacteria responsible for the overgrowth — may have become relatively more resistant to metronidazole (the most common treatment) or to clindamycin (the other common treatment). This would explain why the same drugs that used to cure 90% of cases now cure far fewer.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eReinfection:\u003c\/strong\u003e The infection may be reintroduced back into the vagina after treatment as a result of sexual reinfection from a partner.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eImportantly, the failure of 38% of women to be cured even after a 14-day course of metronidazole strongly suggests that resistance to therapy is playing a role. Further evidence comes from the finding that the women with the most severe BV (as measured by Gram stain criteria) responded most poorly to treatment. Direct testing of antibiotic resistance has been difficult, however, because scientists still have not definitively identified the microbe (or combination of microbes) that causes BV.\u003c\/p\u003e\n\n\u003ch2 id=\"resistance-reinfection\"\u003eResistance, Reinfection, or Both?\u003c\/h2\u003e\n\n\u003cp\u003eThis editorial weighs the evidence for resistance versus reinfection, and the study provided important clues pointing to both possibilities.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eEvidence for reinfection:\u003c\/strong\u003e The study found that women who abstained from sex or consistently used condoms had a \u003cstrong\u003e50% higher cure rate\u003c\/strong\u003e than those who did not. This is a powerful signal that sexual activity — and possibly reinfection from a partner — plays a role in treatment failure. Interestingly, there is also evidence from earlier research that BV occurs in concordance among lesbian couples, meaning if one partner has BV, the other is likely to have it too, further supporting the idea that it can be transmitted sexually.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eEvidence related to douching:\u003c\/strong\u003e A curious finding was that women who did not douche had an \u003cstrong\u003e80% higher cure rate\u003c\/strong\u003e compared with those who did. This could be explained in two ways. First, douching may disturb the normal vaginal flora (the community of healthy bacteria), making it easier for BV-associated bacteria to thrive. Second, douching might reintroduce bacteria into the vagina if the same douching equipment is used repetitively, essentially self-reinfecting.\u003c\/p\u003e\n\n\u003cp\u003eDr. Eschenbach notes that to determine which explanation is correct, future treatment studies need to be designed so that no exposure occurs — neither to a sexual partner nor to douching — to eliminate, at least on a short-term basis, the possibility of reinfection.\u003c\/p\u003e\n\n\u003ch2 id=\"clinical-implications\"\u003eWhat This Means for Patients\u003c\/h2\u003e\n\n\u003cp\u003eSo what does all of this mean for women dealing with BV? There are several important takeaways.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFirst, the standard treatment may not be enough.\u003c\/strong\u003e The conclusion of this large, double-blind trial is that metronidazole — even when administered for 14 days — has limited effect on BV. A limited effect such as this would not be expected if BV were caused by a single bacterium that is susceptible to metronidazole. The infection appears to be more complex, likely involving multiple types of bacteria with varying degrees of antibiotic susceptibility.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eSecond, a longer course of antibiotics might help short-term but is not a cure-all.\u003c\/strong\u003e The 14-day regimen did produce significantly better cure rates at one week (62% vs. 43%), which could be helpful for women who need a quick resolution, such as those about to undergo a surgical procedure. However, by three weeks after treatment, the benefit had disappeared, meaning patients should not expect that simply taking antibiotics longer will solve the problem permanently.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eThird, lifestyle factors may matter more than previously thought.\u003c\/strong\u003e The finding that condom use or sexual abstinence was associated with a 50% higher cure rate suggests that reinfection from a partner may be a real phenomenon. For women who experience recurrent BV, this raises the question of whether male partners should be evaluated or treated as well. The finding about douching — an 80% higher cure rate among women who did not douche — suggests that women with BV should strongly consider stopping douching to give their treatment the best chance of working.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFourth, adding other antibiotics may not be the answer.\u003c\/strong\u003e The study showed that azithromycin added little to the effect of metronidazole. This means the solution to BV treatment failure probably won't come from simply stacking more antibiotics on top of the standard regimen. Instead, a more fundamental understanding of BV's cause is needed.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eStudy Limitations\u003c\/h2\u003e\n\n\u003cp\u003eThe authors of the study appropriately pointed out one major limitation: the high number of subjects who dropped out of the study. However, Dr. Eschenbach notes that this dropout rate was unlikely to change the overall conclusions.\u003c\/p\u003e\n\n\u003cp\u003eThere are also broader limitations that apply to BV research in general. Because the microbial cause of BV has not been definitively established, direct testing of antibiotic resistance has been impossible. Researchers cannot yet culture every bacterium involved or test each one for susceptibility to antibiotics. The study also could not fully separate the effects of resistance from those of reinfection; it remains unclear from the data whether the temporary effect of the 14-day regimen was related to undertreatment, resistance, reinfection, or a combination of these factors.\u003c\/p\u003e\n\n\u003cp\u003eAdditionally, this was a study of women with symptomatic BV. The findings may not apply fully to the large number of women who have BV without symptoms, and the question of whether to treat asymptomatic women was not directly addressed by this trial.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients and Researchers\u003c\/h2\u003e\n\n\u003cp\u003eBased on the findings discussed in this editorial, here are practical recommendations for patients and the scientific community:\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFor patients with BV:\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eComplete the full course of antibiotics\u003c\/strong\u003e exactly as prescribed, even if symptoms improve. The study shows that a longer course (14 days) may provide better short-term results than a 7-day course.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eConsider condom use or sexual abstinence during treatment.\u003c\/strong\u003e Women who abstained from sex or used condoms consistently had a 50% higher cure rate. This may help prevent reinfection.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAvoid douching.\u003c\/strong\u003e Women who did not douche had an 80% higher cure rate. Douching may disturb healthy vaginal bacteria or reintroduce harmful bacteria. In fact, the American College of Obstetricians and Gynecologists already recommends against routine douching for all women.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eTalk to your doctor about persistent symptoms.\u003c\/strong\u003e If BV returns after treatment, you are not alone — this is a very common problem. Ask your provider whether a longer course of antibiotics might be appropriate for your situation, and be aware that even this approach has limitations.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDo not expect that additional antibiotics like azithromycin will solve the problem.\u003c\/strong\u003e The study showed this combination added little benefit.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003eFor researchers:\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eMuch additional and difficult work is required to define the causative bacteria of BV and determine their susceptibility to antibiotics other than metronidazole and azithromycin. The identification of the specific microbes responsible is critical to advancing treatment.\u003c\/li\u003e\n  \u003cli\u003eFuture treatment studies should be designed to eliminate exposure to both sexual partners and douching, at least in the short term, to separate the effects of reinfection from treatment failure.\u003c\/li\u003e\n  \u003cli\u003eBasic research is needed on the role of sexual transmission and on the connection between BV and the disruption of healthy \u003cem\u003eLactobacillus\u003c\/em\u003e bacteria. Almost everyone would have to conclude that further basic research is required on BV before much effect can be expected on the rather dismal cure rates for this common and important infection.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is bacterial vaginosis and how common is it?\u003c\/h3\u003e\n\u003cp\u003eBacterial vaginosis is a disruption of the normal balance of bacteria in the vagina, with overgrowth of organisms like Gardnerella vaginalis. It is very common: at least 15% of sexually active women have it at any given time. It is more common than urinary tract infections, trichomoniasis, and yeast infections.\u003c\/p\u003e\n\u003ch3\u003eWhy did the study compare 7-day and 14-day antibiotic treatment?\u003c\/h3\u003e\n\u003cp\u003eThe study tested whether a longer 14-day course of metronidazole worked better than the standard 7-day course. Investigators wanted to see if a longer treatment could improve cure rates, which have declined over time. They also tested adding azithromycin to see if a second antibiotic helped, and it did not.\u003c\/p\u003e\n\u003ch3\u003eWhat were the cure rates for the 7-day versus 14-day metronidazole regimen?\u003c\/h3\u003e\n\u003cp\u003eOne week after treatment, the 14-day regimen cured 62% of women, while the 7-day regimen cured 43%. However, at 21 days after treatment, the cure rates were similar: 43% for the 14-day group and 51% for the 7-day group. So the longer course only gave a temporary benefit.\u003c\/p\u003e\n\u003ch3\u003eWhy does bacterial vaginosis keep coming back after antibiotics?\u003c\/h3\u003e\n\u003cp\u003eThe editorial suggests several reasons: antibiotic resistance in the bacteria, reinfection from a sexual partner, or undertreatment. The infection likely involves a complex mix of bacteria that antibiotics cannot fully eliminate. Even after a 14-day metronidazole course, more than half of women experienced a return of BV by three weeks.\u003c\/p\u003e\n\u003ch3\u003eDoes douching affect the chance of curing bacterial vaginosis?\u003c\/h3\u003e\n\u003cp\u003eYes. Women who did not douche had an 80% higher cure rate compared with those who did. Douching may disturb healthy vaginal bacteria or reintroduce harmful bacteria. The article recommends avoiding douching during BV treatment, and the American College of Obstetricians and Gynecologists already advises against routine douching for all women.\u003c\/p\u003e\n\u003ch3\u003eIs adding another antibiotic like azithromycin helpful for BV?\u003c\/h3\u003e\n\u003cp\u003eNo. The study found that adding azithromycin to metronidazole added little to the overall effect. The combination was not meaningfully better than metronidazole alone. The article concludes that simply stacking more antibiotics is not an effective solution, and a more fundamental understanding of BV's cause is needed.\u003c\/p\u003e\n\u003ch3\u003eShould I seek a second opinion if my bacterial vaginosis keeps coming back after antibiotic treatment?\u003c\/h3\u003e\n\u003cp\u003eBacterial vaginosis has cure rates of only 50–80%, even with standard antibiotic treatment. A 14-day metronidazole course improved short-term cure to 62% versus 43% for 7 days, but by 21 days the advantage disappeared. Adding azithromycin did not help. Condom use or sexual abstinence and avoiding douching significantly improve cure rates. If BV persists or recurs despite a full antibiotic course, a second opinion can help assess whether the diagnosis is complete, whether lifestyle factors such as reinfection or douching need addressing, and whether a longer regimen or other strategies are appropriate. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e E D I T O R I A L C O M M E N TA R Y\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor:\u003c\/strong\u003e David A. Eschenbach, Department of Obstetrics and Gynecology, University of Washington, Seattle\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication:\u003c\/strong\u003e \u003cem\u003eClinical Infectious Diseases\u003c\/em\u003e 2007; 44:220–221, published by the Infectious Diseases Society of America. Received 8 September 2006; accepted 11 September 2006; electronically published 13 December 2006.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAccompanying study reviewed:\u003c\/strong\u003e Schwebke JR, Desmond RA. \"A randomized trial of length of therapy with metronidazole plus or minus azithromycin for treatment of symptomatic bacterial vaginosis.\" \u003cem\u003eClinical Infectious Diseases\u003c\/em\u003e 2006; 43:213–9.\u003c\/p\u003e\n\n\u003cp\u003eThe editorial also references the following prior research: Criswell et al. (1969) on inoculation of \u003cem\u003eHaemophilus vaginalis\u003c\/em\u003e; Marrazzo et al. (2002) on vaginal flora in women who have sex with women; Fredericks et al. (2005) on molecular identification of bacteria associated with BV; Joesoef et al. (1999) on review of BV treatment options; Eschenbach et al. (1983) on a dose-duration study of metronidazole; and Sanchez et al. (2004) on intravaginal metronidazole gel versus metronidazole plus nystatin ovules.\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eNote: This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and should not replace personalized medical advice from a qualified healthcare provider. This article was written more than 15 years after the original publication; treatment recommendations for bacterial vaginosis may have evolved since that time.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47494443794588,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"url":"https:\/\/diagnosticdetectives.com\/es\/products\/bacterial-vaginosis-why-does-it-keep-coming-back-despite-antibiotic-treatment","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}