The Role of Dermatovenereology in the Diagnosis and Management of Bacterial Vaginosis: A Systematic Review

Authors

  • Eldy Department of Medicine, Tarumanagara University, Jakarta, Indonesia
  • Shania Rizky Amalia Department of Medicine, Universitas Muhammadiyah Malang, East Java, Indonesia
  • Flora Asri Wardianti Department of Medicine, Universitas Gadjah Mada, DI Yogyakarta, Indonesia
  • Mega Rahmani Sitanggang Department of Medicine, Brawijaya University, General Medicine, East Java (Jawa Timur), Indonesia
  • Nadhira Permata Hakiki Department of Medicine, Universitas Padjadjaran, West Java, Indonesia

DOI:

https://doi.org/10.19166/med.v13i1.10784

Keywords:

Bacterial vaginosis, Dermatovenereology, Microscopy, Recurrence prevention

Abstract

Background:

Bacterial vaginosis (BV) is a prevalent, recurrent cause of abnormal vaginal discharge with important sexual and reproductive health implications. Because symptoms overlap with candidiasis, trichomoniasis, cervicitis/STIs, and vulvar dermatoses, dermatovenereology services are central to accurate diagnosis and comprehensive care.

Methods:

A PRISMA-compliant systematic review searched PubMed, EMBASE, and Scopus from inception to September 1, 2023, using controlled vocabulary and keywords related to BV, diagnostic modalities (Amsel, Nugent/Gram stain, microscopy, molecular assays), and dermatovenereology/sexual health services. Screening, full-text eligibility, and narrative synthesis were performed; risk of bias was assessed using the Newcastle–Ottawa Scale.

Result:

From 729 records, 8 studies were included after deduplication, screening, and eligibility assessment. Studies consistently highlighted the value of objective diagnosis particularly in recurrent, atypical, or post-treatment presentations. NAAT-based testing was used mainly in referral settings and facilitated concurrent STI testing. First-line antibiotics (metronidazole or clindamycin) achieved short-term response, but recurrence was common; suppressive intravaginal metronidazole and newer recurrence-prevention approaches (e.g., astodrimer gel, Lactin-V) reduced relapse in selected populations.

Conclusions:

Dermatovenereology-led pathways that integrate objective testing, careful differential diagnosis, STI screening, and counseling can improve diagnostic precision and reduce BV recurrence.

References

1. Carlson K, Mikes BA, Garg M. Bacterial Vaginosis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Dec 22]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK459216/.

2. Bloom SM, Symul L, Elsherbini J, Xu J, Hussain S, Shih J, Sango A, Mitchell CM, Hemmerling A, Parks TP, et al. Microbiota effects and predictors of Lactobacillus crispatus colonization after treatment with a vaginal live biotherapeutic: results from a randomized, double-blinded, placebo-controlled trial. medRxiv. 2025;2025.08.18.25333897. doi: 10.1101/2025.08.18.25333897. Cited: in: : PMID: 40901072.

3. Muzny CA, Schwebke JR. Asymptomatic Bacterial Vaginosis: To Treat or Not to Treat? Curr Infect Dis Rep. 2020;22:32. doi: 10.1007/s11908-020-00740-z. Cited: in: : PMID: 33814990.

4. Abou Chacra L, Drouet H, Ly C, Bretelle F, Fenollar F. Evaluation of Various Diagnostic Strategies for Bacterial Vaginosis, Including a New Approach Based on MALDI-TOF Mass Spectrometry. Microorganisms. 2024;12:111. doi: 10.3390/microorganisms12010111.

5. Bradshaw CS, Sobel JD. Current Treatment of Bacterial Vaginosis-Limitations and Need for Innovation. J Infect Dis. 2016;214 Suppl 1:S14-20. doi: 10.1093/infdis/jiw159. Cited: in: : PMID: 27449869.

6. Bertini M. Bacterial Vaginosis and Sexually Transmitted Diseases: Relationship and Management. In: Serdaroglu S, Kutlubay Z, editors. Fundamentals of Sexually Transmitted Infections [Internet]. InTech; 2017 [cited 2025 Dec 22]. Available from: http://www.intechopen.com/books/fundamentals-of-sexually-transmitted-infections/bacterial-vaginosis-and-sexually-transmitted-diseases-relationship-and-management.

7. Rodríguez‐Cerdeira C, Pinto‐Almazán R, Saunte DML, Hay R, Szepietowski JC, Moreno‐Coutiño G, Skerlev M, Prohic A, Martínez‐Herrera E. Virulence and resistance factors of Nakaseomyces glabratus (formerly known as Candida glabrata ) in Europe: A systematic review. Acad Dermatol Venereol. 2025;39:377–388. doi: 10.1111/jdv.20273.

8. Nguyen BT, Liu L, Ibraheim MK, Elsensohn A, Kraus CN. Enhanced Diagnostic Accuracy in Vulvar Skin Disease: The Impact of Dermatopathology and Dermatology Collaboration for Second Opinions. Am J Dermatopathol. 2025;47:522–525. doi: 10.1097/DAD.0000000000002976. Cited: in: : PMID: 40314663.

9. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;n71. doi: 10.1136/bmj.n71.

10. Andres FJ, Parker R, Hosein I, Benrubi GI. Clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis: a prospective double-blind clinical trial. South Med J. 1992;85:1077–1080. doi: 10.1097/00007611-199211000-00006. Cited: in: : PMID: 1439943.

11. Cohen CR, Wierzbicki MR, French AL, Morris S, Newmann S, Reno H, Green L, Miller S, Powell J, Parks T, et al. Randomized Trial of Lactin-V to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med. 2020;382:1906–1915. doi: 10.1056/NEJMoa1915254. Cited: in: : PMID: 32402161.

12. Hillier SL, Nyirjesy P, Waldbaum AS, Schwebke JR, Morgan FG, Adetoro NA, Braun CJ. Secnidazole Treatment of Bacterial Vaginosis: A Randomized Controlled Trial. Obstet Gynecol. 2017;130:379–386. doi: 10.1097/AOG.0000000000002135. Cited: in: : PMID: 28697102.

13. Livengood CH, Ferris DG, Wiesenfeld HC, Hillier SL, Soper DE, Nyirjesy P, Marrazzo J, Chatwani A, Fine P, Sobel J, et al. Effectiveness of two tinidazole regimens in treatment of bacterial vaginosis: a randomized controlled trial. Obstet Gynecol. 2007;110:302–309. doi: 10.1097/01.AOG.0000275282.60506.3d. Cited: in: : PMID: 17666604.

14. Paavonen J, Mangioni C, Martin MA, Wajszczuk CP. Vaginal clindamycin and oral metronidazole for bacterial vaginosis: a randomized trial. Obstet Gynecol. 2000;96:256–260. doi: 10.1016/s0029-7844(00)00902-9. Cited: in: : PMID: 10908773.

15. Schwebke JR, Carter BA, Waldbaum AS, Agnew KJ, Paull JRA, Price CF, Castellarnau A, McCloud P, Kinghorn GR. A phase 3, randomized, controlled trial of Astodrimer 1% Gel for preventing recurrent bacterial vaginosis. Eur J Obstet Gynecol Reprod Biol X. 2021;10:100121. doi: 10.1016/j.eurox.2021.100121. Cited: in: : PMID: 33537666.

16. Sobel J, Peipert JF, McGregor JA, Livengood C, Martin M, Robbins J, Wajszczuk CP. Efficacy of clindamycin vaginal ovule (3-day treatment) vs. clindamycin vaginal cream (7-day treatment) in bacterial vaginosis. Infect Dis Obstet Gynecol. 2001;9:9–15. doi: 10.1155/S1064744901000035. Cited: in: : PMID: 11368263.

17. Sobel JD, Ferris D, Schwebke J, Nyirjesy P, Wiesenfeld HC, Peipert J, Soper D, Ohmit SE, Hillier SL. Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol. 2006;194:1283–1289. doi: 10.1016/j.ajog.2005.11.041. Cited: in: : PMID: 16647911.

18. Hildebrand JP, Carlson K, Kansagor AT. Vaginitis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Dec 22]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470302/.

19. Chen J, Tse J, Shi L, Cheng MM, Lillis R, Near AM. Real-world clinical burden of patients presenting with vaginitis symptoms in the United States. AJOG Global Reports. 2025;5:100504. doi: 10.1016/j.xagr.2025.100504.

20. Vodstrcil LA, Plummer EL, Fairley CK, Hocking JS, Law MG, Petoumenos K, Bateson D, Murray GL, Donovan B, Chow EPF, et al. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med. 2025;392:947–957. doi: 10.1056/NEJMoa2405404. Cited: in: : PMID: 40043236.

21. Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nat Rev Drug Discov. 2023;22:387–409. doi: 10.1038/s41573-023-00670-0. Cited: in: : PMID: 36973491.

22. Sousa LGV, Pereira SA, Cerca N. Fighting polymicrobial biofilms in bacterial vaginosis. Microb Biotechnol. 2023;16:1423–1437. doi: 10.1111/1751-7915.14261. Cited: in: : PMID: 37042412.

23. Tidbury F, Brülhart G, Müller G, Pavicic E, Weidlinger S, Eichner G, Von Wolff M, Stute P. Effectiveness and tolerability of lactic acid vaginal gel compared to oral metronidazole in the treatment of acute symptomatic bacterial vaginosis: a multicenter, randomized-controlled, head-to-head pilot study. BMC Women’s Health. 2025;25:7. doi: 10.1186/s12905-024-03513-1.

24. Arfiputri DS, Hidayati AN, Handayani S, Ervianti E. RISK FACTORS OF VULVOVAGINAL CANDIDIASIS IN DERMATO-VENEREOLOGY OUTPATIENTS CLINIC OF SOETOMO GENERAL HOSPITAL, SURABAYA, INDONESIA. Afr J Infect Dis. 2018;12:90–94. doi: 10.2101/Ajid.12v1S.13. Cited: in: : PMID: 29619437.

Downloads

Published

2023-10-01

How to Cite

Eldy, Amalia, S. R., Wardianti, F. A., Sitanggang, M. R., & Hakiki, N. P. (2023). The Role of Dermatovenereology in the Diagnosis and Management of Bacterial Vaginosis: A Systematic Review. Medicinus, 13(1), 109–118. https://doi.org/10.19166/med.v13i1.10784

Issue

Section

Clinical Article