(P463) Do women with BV symptoms who are microscopy negative respond to treatment with metronidazole?

Wednesday, July 26, 2023

16:00 – 18:00 CST

Primary Presenter(s)

JR

Jonathan Ross, MB ChB MD FRCP

Professor of Sexual Health and HIV
University Hospital Birmingham NHS Trust
Birmingham, United Kingdom

Co-author(s)

OA

Oluseyi Ayinde, n/a

Dr
University Hospitals Birmingham NHS Foundation Trust, United States

Background: Bacterial vaginosis (BV) is a common condition but consistent and accurate diagnosis remains a challenge. We compared the treatment response in women with typical BV symptoms who did and did not have a diagnosis of BV based on microscopy of a gram stained vaginal smear.

Methods: 517 women (aged ³ 16 years) with symptoms of recurrent BV were recruited into the VITA randomised controlled trial (comparing metronidazole with lactic acid gel) in England between October 2017 and June 2019. Microscopy confirmation of BV was based on Ison-Hay grading of a gram stained vaginal swab in accordance with UK national guidelines. Multivariable analysis was used to explore the association between being microscopy positive or negative and symptom resolution 2-weeks after initiation of metronidazole treatment.

Results: 470/517 (91%) women presented with vaginal discharge and 440/517 (85%) with malodour The accuracy of patients’ symptoms in making a diagnosis of BV (taking microscopy as the ‘gold standard’ comparator) were —vaginal discharge sensitivity 91% and specificity 8%; vaginal malodour sensitivity 88% and specificity 18%. Overall, 143/204 (70%) participants reported symptom resolution 2 weeks after treatment with metronidazole. Symptom resolution occurred in 75% (83/111) of women who were symptom positive/microscopy positive compared to 65% (58/89) in those who were symptom positive/microscopy negative. The resolution rate did not differ significantly between those with or without a positive microscopy diagnosis of BV (adjusted relative risk 1.14 [0.95 to 1.37]).

Conclusion: BV symptoms correlated poorly with the microscopy based diagnosis of BV. Two-thirds of women who had typical BV symptoms but were microscopy negative experienced symptom resolution following metronidazole treatment. Further studies are needed to determine the optimal investigation and treatment for microscopy negative women with typical BV symptoms.