The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Vaginal Infections

See also:

• Group B Strep (GBS) aka Beta Strep
• Preterm Labor

Subsections on this page:

• General
• Chlamydia
• Differential Diagnosis
• Candidiasis/Yeast Infections
• Bacterial Vaginosis
• About Boric Acid
• About Tea Tree Oil
• Herbal Treatment for Male Partners

General

See also: Probiotics

News flash!  Hydrogen Peroxide is not the best cure for BV

Bacterial Vaginosis Treatments Vary in Efficacy, Adverse Effects

Because pregnant women should avoid pharmaceuticals, it might make sense to try the hydrogen peroxide vaginal washes and the probiotics and then request a re-test.  If the non-pharmaceuticals haven't cured the BV, it might be best to go ahead with them.  Discuss your options with your healthcare provider!

[Hydrogen peroxide produced by Lactobacillus species as a regulatory molecule for vaginal microflora]
 Strus M, Brzychczy-Wloch M, Kochan P, Heczko P.
Med Dosw Mikrobiol. 2004;56(1):67-77.

A total of 33 strains of Lactobacillus belonging to 9 species, isolated from vagina, were tested for production of hydrogen peroxide. We observed that the following species: L. delbrueckii, L. acidophilus, L. crispatus, L. johnsonii and L. gasseri dominated over other species in secretion of hydrogen peroxide to the growth medium. Concentration of this substance amounted from 0.05 to 1.06 mM (in case of strong aeration the concentration increased up to 1.8 mM). Moreover, killing properties of the pure hydrogen peroxide exerted toward Escherichia coli and Candida albicans were less prominent than these of the supernatants of cultures of Lactobacillus strains producing H2O2.

Any time you take a round of antibiotics, it kills off the helpful vaginal flora (helpful germs) that normally live in the vagina, including acidophilus. Acidophilus is perfectly suited to the vaginal walls, and it produces hydrogen peroxide as a byproduct of its metabolism, so once you get a nice colony of acidophilus well established, it will continue to kill any nasty germs that come along, including yeast, Group B Strep, and germs that can cause bacterial vaginosis.

The Vaginal Wash is just to jumpstart the healing, and once the acidophilus are established, they should keep themselves going, as long as you're eating well (lots of vegetables and not too much sugar).  Of course, any time you take antibiotics, they're going to undo all of this, and you'll need to start over again.

Vaginal Wash

[NOTE - This treatment is generally considered safe during pregnancy, but you should check with your healthcare provider first, in case there's something unusual about your situation.  If your provider doesn't know anything about this treatment, you can suggest they educate themselves and let you know when they have the answer.  If they suggest that alternative remedies are worthless and you should use a pharmaceutical agent instead, they are what I would call a word that starts with an "F" and rhymes with "Cool", or else they just really enjoyed the last conference sponsored by the pharmaceutical companies, and they want to ensure continuing pharmaceutical profits and conferences.]

How to do a vaginal wash:

• First, engage common sense.  This is not rocket science, and the sizes and amounts listed here may not be the best for you.
• Obtain a new, sterile 30cc syringe - just the syringe, without a needle! (from Cascade Health Care Products, 800-443-9942, item # 0991 for $1.50 for 1 or $31 for 30 (plus shipping!) or from Moore Medical, 800-234-1464 - item # 59699, $26.99 for a box of 40 - give them as presents to all your female friends!)  [NOTE - A 30cc syringe is generally the right size for women who are sexually active; the vaginal wash works best with a syringe that is about the same size as anything else that might go in the vagina so the fit is somewhat snug and the hydrogen peroxide will come in contact with the vaginal walls as it flows out along the outside of the syringe.  Women who are not sexually active or who are smaller might prefer to try a 10cc syringe or something in between.]
• Obtain some standard, over-the-counter hydrogen peroxide, 3% solution, readily available at most pharmacies, drug stores or grocery stores
• Pour a small amount of hydrogen peroxide in a clean container - a glass or cup will do fine.  [NOTE - If you have a fairly serious vaginal infection or vaginal tissues that are inflamed or irritated for any other reason, you might want to dilute the hydrogen peroxide to minimize any burning sensation.  You could try diluting with 3 times as much plain water the first time, and gradually increase the concentration of hydrogen peroxide over a number of applications until you're using it full strength from the bottle.]
• Remove the cover from the tip of the syringe and draw up the hydrogen peroxide into the syringe by pulling up on the handle part
• Remove the excess air from inside the syringe by turning it upside down and pushing on the plunger until the air bubbles are gone
• In the shower or tub, gently insert the 30cc syringe into the vagina as far as is comfortable - for some women, this may be all the way; for others, it may be just a couple of inches.  Most vaginal infections are in the outer inches of the vagina, anyway, so partial insertion may be just as effective.  Comfort is important!
• Gently and slowly push on the plunger to push the hydrogen peroxide into the vagina, taking between 30 and 60 seconds to do this.  DO NOT EXERT TOO MUCH FORCE.  If it's such a snug fit that no fluid is flowing out, you may want to move the syringe around so fluid can flow out on one side.  There are benefits to a snug fit . . . the fluids will be forced to flow around the sides of the syringe so that all the hydrogen peroxide will come into contact with the vaginal walls on all sides, but you do not want to build up pressure that would force fluid into the cervix.  Especially if you are pregnant, and super especially if you are near term and your cervix may be starting to open, you do not want to force pathogens up into the cervix.  It's important to do this in an upright position and not push the hydrogen peroxide out with so much force that it will squirt into the cervix.
• Remove the syringe and rinse it off and let it air dry; the syringe is completely re-usable.  If you're concerned about sterilizing it, you can draw up the hydrogen peroxide and leave it there for 20 minutes - that will sterilize the inside.  And if you want to sterilize the whole thing, leave it soaking in hydrogen peroxide for 20 minutes.
• Start out with a single application per day, continue until symptoms disappear, and then use as needed
• NOTE - If you experience a burning sensation with a vaginal wash, this is a sign that the vaginal tissues are inflamed (presumably from infection), and that there is loose organic material (typically discharge from infection) that is being oxidized as the hydrogen peroxide (H₂O₂) releases an oxygen atom to become water (H₂O).  The amount of hydrogen peroxide in a 30cc syringe is not enough to raise temperatures to a point where it could literally burn the tissues, but if the burning sensation is painful, it makes sense to dilute the hydrogen peroxide half and half the first few times you use it.  Healthy tissues will not produce a burning sensation with the hydrogen peroxide douche.
• After bringing symptoms under control, focus your attention on a healthy balance with your microbial friends, probiotics.

Feedback

• This really works! Instead of a syringe, I pour the peroxide solution into a funnel and wash out the bacteria that way. After  3 days, symptoms began to disappear. [Ed.: You could also use an old-fashioned douche approach, which also requires lying down.]
• Using the hydrogen peroxide method once a day for 7 days, I noticed an improvement, but not a full cure, and after ceasing the treatment, there

was a  full return of the infection.  [Ed: Some women need to continue using hydrogen peroxide on a regular basis, either because they have another underlying health problem, or because they're being re-exposed to bacteria through sexual intercourse.  A naturopath or other holistic practitioner can help you re-establish overall health, and your partner may need to do a penile soak.]
• Please send me feedback about how this works for you.  [NOTE - Please do not ask me to serve as your personal health care provider by asking me questions about your personal health care.]

Thought I would throw in my 2 cents about persistent BV.  I recommend the "saline swish bath" to my clients for persistent BV: Fill a CLEAN bathtub with about 5-6 inches of bath temp water.  Add 1/2 cup of table salt (good old Morton's), dissolve it.  Then sit in the tub, hold the labia apart with one hand and gently "swish" the saline bath into the introitus.  If this is done every other night for 3 or 4 nights, it can help to balance the vaginal pH and normalize those "flora"!  I also recommend the swish bath after menses and after intercourse for women who experience recurrence routinely.  Most of my clients who have used this are very enthusiastic about it and say it really works.

Some people prefer a vinegar douche, about a tablespoon to a quart of warm water.

Vaginitis/Vaginal Infection from a naturopathic point of view.

Probiotics: "Living drugs" [Medscape registration is free] - this article includes treatment for UTI's.

ACOG Releases Technical Bulletin on Vaginitis / November 1, 1996.

Vaginitis Mistaken for UTI

Vaginitis Screening Test

From: C-upi@clari.net (UPI / LIDIA WASOWICZ, UPI Science Writer)

Organization: Copyright 1997 by United Press International

Date: Fri, 9 May 1997 0:50:48 PDT

FemExam TestCard pH and Amine Test was approved by the FDA for U.S. marketing, according to Litmus Concepts. The product is a
rapid, easy-to-use device designed to facilitate routine testing for vaginitis. The new, disposable device is the size of a credit card and allows
health-care providers to conduct initial testing quickly during an office examination. Immediate, colorimetric, qualitative results indicate
whether the patient tests normal or should be further evaluated. To use the product, the physician rubs a cotton swab containing undiluted
vaginal fluid over two circular test areas. One test indicates whether the pH is high or normal, and the second test detects volatile
odor-causing amines.

Litmus Concepts, Inc., Santa Clara, CA, is developing four patented diagnostic tests that comprise the FemExam TestCard System. These
tests, used primarily in the physician's office, screen and diagnose common vaginal infections such as bacterial vaginosis, yeast and
trichomonasis. The tests are performed by collecting vaginal fluid with a cotton swab and wiping it across the reagent section of the FemExam
card. While a typical vaginosis test performed at an outside laboratory costs about $25.00 to $30.00, the FemExam TestCards are expected
to cost under $10.00.

The Fem Exam card for BV screening is from Cooper Surgical, phone (800)243-2974. - Item number 52-7464-50 (the 50 part could be because that's the size box we got).  Cost for the box of 50 was $162, plus s&h (total $181).

Phem-Alert probes are a swab for measuring vaginal pH.  You can order them from
Imagyn MFG
3050 Redhill Ave.
Costa Mesa, CA 92626
May be charged under CPT code 83986

Miscellaneous Causes of Vaginitis Still within the realm of infectious etiologies are other causes of vaginal discharge. One is termed lactobacillosis or Döderlein cytolysis. This entity is characterized by an overgrowth of the commensal lactobacilli (Fig. 9 shows lactobacilli from vaginal fluid of normal patient); hence, on saline wet mount, one finds an excessive number of bacilli among the background flora. The pH is typically low-normal. Treatment, therefore, is directed at correcting the disruption of the vaginal ecosystem in order to limit the excessive proliferation of these protective organisms.[48] Broad-spectrum antibiotics may lower the proliferation of the lactobacilli, and alkaline (sodium bicarbonate) douches may raise the vaginal pH to restore the ecosystem.

The recognized key to vaginal health and prevention of vaginitis, as Dr. Plourde notes, is presence of H2O2-producing strains of Lactobacillus species. These normally account for >95% of vaginal microflora. Present understanding suggests that maintenance of healthy Lactobacillus and low vaginal pH are mutually-reinforcing factors which reduce infection with various sexually transmitted bacteria, protozoa, and viruses, including HIV-1. Lactobacilli maintain the healthy vaginal ecosystem by at least 3 mechanisms:

1. Their production of lactic acid maintains a normal vaginal pH of 4.0 (3.8-4.2). This acidic milieu is hostile against the proliferation of the aforementioned potentially pathogenic species.
2. Their production of hydrogen peroxide is toxic to the anaerobic microflora.
3. Their micropili (tiny projections from the cell wall) adhere to receptors on the vaginal epithelial cells, preventing adherence of potential pathogens. The transition from normal toward abnormal, particularly in the case of BV, entails an elevation of pH and a relative shift from a predominance of lactobacilli toward one of pathogenic organisms (mostly coccoid bacteria).

1. Douching is detrimental, as it essentially lavages out the lactobacilli, removing them from their protective role in the vagina. This occurrence has translated clinically to an increased rate of pelvic infections and ectopic pregnancies among women who douche.
2. The incidental finding, on Papanicolaou smear, of an occasional trichomonad or fungal organism is not necessarily a sign of pathologic infection.
3. The finding, on Papanicolaou smear, of a predominance of coccobacilli or an increased presence of normally occasional organisms is highly suggestive, although not diagnostic, of BV.
4. Cultures of the vagina are not routinely indicated in that, unless quantitative, they cannot distinguish between colonization and infection.
5. pH testing provides useful information in evaluating the patient with a vaginal discharge.

Chlamydia

Chlamydia and Pregnancy [Medscape registration is free]

New Diagnostic Methods for Chlamydial Infection in Women - Urine tests and other non-invasive tests are being developed.

Differential Diagnosis

It can be difficult to diagnose yeast.  Here's a tip from a trivia-mad medical student:

"In their initial stages, where there's little odor or discharge, it's occasionally difficult to tell early on if you're sporting a yeast infection or BV. However, it seems that even mildly hyperactive yeast colonies will strongly fluoresce under black light whilst bacterial infections generally don't. This was inadvertently discovered thanks to exotic dancers. They constantly come into the hospital hysterical about curing their yeast infections now now now- they're so black light visible, they drive the customers off. Funny, huh? Useful, too."

Quest Diagnostics offers a Bacterial Vaginosis / Vaginitis Panel (Quest Code: 16760), which is highly sensitive and specfic for Trichomonas, G. vaginalis, and Candida.  It uses the Affirm™ VPIII Ambient Temperature Transport System (ATTS).  Here's Quest Diagnostics' full list of STD/STI tests.

Candidiasis/Yeast Infections

see also: Breastfeeding/Thrush

NOTE - When trying to control an overgrowth of yeast in a newborn, they might do better with bifidus than acidophilus.  In particular, bifidobacterium infantis is helpful for all newborns.

Linda Page's book, Healthy Healing, is the most valuable holistic health reference book I've seen for non-professionals. Her nutritional supplements are well formulated and high quality and are especially helpful for people who are new to the use of herbs for holistic health.

Naturopaths tell me that caprylic acid is gentle enough for children and pregnant women.

Yeast Infections from Shonda Parker, author of Naturally Healthy Living eNewsletter

The WholeApproach Candida Program

I've found that Flax Oil prevents/cures my problems with yeast.

Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial. [Full text of article.]
Pirotta M, Gunn J, Chondros P, Grover S, O'Malley P, Hurley S, Garland S.
BMJ. 2004 Aug 27

"The use of oral or vaginal forms of lactobacillus to prevent post-antibiotic vulvovaginitis is not supported by these results."

[Maybe the study tested women too soon after abx... Day 4 after finishing the meds right?  It can take a while for oral lactobacilli to re-colonize the vagina and fight off yeast etc.]

Yeast Overgrowth

Yeastie Beasties FAQ

Candida Yeast

Sources for alternative treatment supplies:

GY-NA-TREN includes MEGADOPHILUS dairy-free capsules for oral use, and inserts for vaginal application.  [From Natren]

Fem-Dophilus - 100 Capsules Non-dairy JAR304 from Holistic International in Canada

Pro-Femm Kit - Pro-Biotic Suppositories (FEM-DOPHILUS™) by Jarrow Formulas, 10 Capsules and Applicator for Vaginal Use (Each 1 gram capsule contains 4 billion organisms.) and Citricidal® Vaginal Rinse Grapefruit Seed Extract by NutriBiotic, 100 mgs.   [Do a product search for Pro-Femm Kit.]  They may have other Candida products.

Thrush by Nikki Macfarlane

1. Use homeopathic calendula soap rather than normal soap. Wash genitals with hand rather than cloth.
2. Go without underpants or wear cotton boxer shorts.
3. Eat fresh garlic often, live yoghurt and pure unrefined olive oil. The olive oil contains oleic acid which can prevent candida growth, but it must be eaten raw - e.g.. on salads. It can be beneficial to take one tablespoon daily.
4. Live yoghurt onto a tampon then inserted into the vagina at night, washing it off in the morning.
5. A few tablespoons of bicarbonate of soda in the bath can ease itching and reduce acidity.
6. Chamomile cream applied to the vulva several times a day to ease itching. Alternatively sit in a bath of strong chamomile tea or wash the vulva with chamomile tea with 10 drops of calendula tincture added.
7. Sepia 6C (homeopathy) taken 3 times a day for up to one week, stopping when symptoms stop, can be beneficial.
8. Drink teas of chamomile, fennel or calendula 3 times daily.
9. Baths with salt added can ease the discomfort. Also, one tablespoon of lemon juice added to 300ml of water used to wash the vulva 2-3 times a day can help.
10. Reduce stress!!!!!!

An excerpt from a Mothering magazine article on the subject:

 Many times father and siblings require lower-level treatment as well. In cosleeping arrangements, all members who sleep in close contact with each other should be treated. Yeast infections can be challenging because treatment must be continued for two weeks after symptoms subside. Personal hygiene matters in yeast control. While antibacterial soaps are promoted for new parents, they may contribute to yeast overgrowth by killing "good" bacteria. Still, it is important to wash your hands with warm water and soap after diaper changes and using the bathroom. In addition, short-term switching to paper towels as a drying method (single use only) can help stop the spread. Temporary use of disposable diapers may help, too. Family members should use a spray bottle of vinegar solution (1/4 cup white distilled vinegar to 1 cup of water) to spray any areas on their bodies that stay or get moist (pubic areas, armpits, under breasts and under any folds of skin). This routine should be followed at least twice a day by those who are not symptomatic and four times a day by those who display symptoms, and continued for two weeks beyond the time that anyone shows symptoms. Bath towels should not be shared, and ideally should only be used once. If laundering after each u!  se seems extreme, then they must be allowed to thoroughly dry after every use. Additionally, items such as toothbrushes and makeup can also harbor yeast spores. Every family member should get a new toothbrush once the anti-yeast regimen is begun, and then again when all symptoms disappear. No cornstarch powders or deodorants should be used, as they are a food source for yeast.

My favorite remedy is for thrush/yeast infections. Because it is so new to the market there is not much information on it except one book (The Cure is in the Cupboard) that I could find. It is oil of oregano! It has been performing just as the book said it would on fungal, viral and bacterial infections.

Being a lactation consultant I mostly deal with breastfeeding problems and the number of yeast infections is just tremendous these days! Sore nipples from yeast have been responding almost immediately and some had already been through the Nystatin route without relief. Most use two drops under the tongue three times a day (it is really strong so a water chaser is helpful or it can be put in juice). Two drops in a teaspoon of olive oil and rubbed on baby's feet can treat them. That same solution can be applied topically to the nipple.

When I have used it my husband tells me I have the breath of a thousand pizzas or he at least accuses me of eating pizza mints!

The Candida Page - Candida Albicans/Candidiasis Web Sites

the yeast infection - homepage (Not for those easily offended!)

Guide to Yeast Free Living - from "The Marnie Ko Collection" on Nurturing Online

Yeast Infections section from Normal Changes of Pregnancy

From an Interview with Dr. Christiane Northrup

If it's a first time yeast infection, Monistat® or Gynolotrimon® is perfectly safe. If that doesn't work, I would use 500mg boric acid capsules, which your formulary pharmacy or any pharmacist can make up, in the vagina or a boric acid douche. Or you might use Tea Tree oil as a douche, just a small amount in water that's anti fungal. The old paradigm is seeing the yeast as the enemy so the yeast has to be eliminated. So we kill the yeast. The new paradigm says: what is it that is causing the imbalance in the body in the first place? What is allowing yeast which is normally there, to over grow?

Years ago, someone, maybe Valerie Hobbs, recommended motherwort for yeast infections, and it has always worked very well for me.  I use a strong tea (infusion?) to soak a couple of gauze 4x4s, and tuck them in like a tampon at bedtime,  Usually one night will do it, occasionally it's taken a couple nights if I've waited a while hoping that it really wasn't yeast and would go away on i's own.  I too have read that this is not good for pg, so don't use it then, but have often wondered if that amount of exposure would cause problems.

Yeast infections are a very common gynecological problem. It has been shown that garlic kills yeast in laboratory petri dishes
and it has been documented that garlic kills yeast infections in large animals like cows

INSTRUCTIONS FOR USE:

In the event that you think you are suffering from a vaginal yeast infection, here is what you do. As soon as you feel itchy, look at the type of discharge in your vagina. You can put a finger in and if you see white dots or clumps on your finger, You most likely have a yeast infection.  If the discharge is watery Yellow or green, then it is likely to be a different sort of infection,

Here is the PROTOCOL:

If you first noticed the infection now, and there is only slight irritation and not too much discharge, take a clove of garlic(One section of the bulb).  Cut it in half and peel it. Take one half and insert it into your vagina  as far as you comfortably can.  Do this at bedtime.  In the morning remove the clove of garlic, the infection should be gone.

If the infection has been there for a few days and there is a moderate amount of irritation and discharge, repeat the above instructions for one or two or three nights.

The reason that I instruct people to insert it at night, is that as soon as you insert it, you will get the taste of garlic in your mouth.
I think this would bother most people when they are awake, but it is not a bother when one is sleeping.

If the infection is very slight , an uncut clove of garlic may be enough to cure you .  The dose of garlic depends on how much of the inside of the clove is exposed to the yeast.

I have doubts about putting minced garlic on tissues that are irritated from a yeast infection, but one of my friends swears by this:

"This works great for yeast infections.... Minced garlic on a pantyliner...one clove or two depending on how bad the infection is.... should only take one or two days to subside mostly. To tackle the remaining infection I use about 1oz of grapeseed oil with 2 or 3 drops of Tea Tree essential oil mixed in and coat it on a tampon (ob works best since there is no applicator)"

Grapefruit seed extract works GREAT on yeast and to fight off a cold, sore throat etc.  This stuff taken internally works better than Monistat 7 externally. No kidding!  And it's safe in pregnancy, too, according to my resident doctor.

I take 10 drops in ORANGE JUICE since it's super super bitter 3 times a day. I'm not yelling just putting on the emphasis that orange juice seems to be the best medium to use since it covers up the taste. It comes in capsules as well but I like knowing the liquid form is passing over the mucous membranes when drinking it. It's an anti-microbial.

I just advise plain old salt or even baking soda baths. The idea is strong salty solutions are mildly germicidal and soothing to tissues. If they add baking soda it helps to make a change in the natural acidity/alkalinity and can add a knock-out blow to resident yeasts and nasties.

Using the principle that yeast doesn't grow well in a salty environment, I tried using a salt deodorant stick under my breasts and in some other folds of the skin that were harboring yeast.  This seemed to allow my body to focus more on controlling the overgrowth of vaginal yeast.  (NOTE - If the skin starts to burn, then you've used too much . . . cut back until you find the level that discourages the yeast but doesn't irritate your skin.)

Bacterial Vaginosis

Vitamin D Insufficiency Linked To Bacterial Vaginosis In Pregnant Women

ScienceDaily (May 21, 2009) ­ Bacterial vaginosis (BV) is the most common vaginal infection in US women of childbearing age, and is common in pregnant women. BV occurs when the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. Because having BV puts a woman at increased risk for a variety of complications, such as preterm delivery, there is great interest in understanding how it can be prevented. Vitamin D may play a role in BV because it exerts influence over a number of aspects of the immune system.

Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy.
Bodnar LM, Krohn MA, Simhan HN.
J Nutr. 2009 Jun;139(6):1157-61. Epub 2009 Apr 8.

Clindamycin Prolongs Gestation in Women With Bacterial Vaginosis [Medscape registration is free]

Late miscarriage and preterm birth after treatment with clindamycin: a randomised consent design study according to Zelen.
Larsson PG, Fahraeus L, Carlsson B, Jakobsson T, Forsum U; Premature study group of the Southeast Health Care Region of Sweden.
BJOG. 2006 Jun;113(6):629-37.

CONCLUSIONS: Clindamycin vaginal cream therapy was associated with significantly prolonged gestation and reduced cost of neonatal care in women with BV. Early screening for BV and treatment with clindamycin saved approximately 27 euro per woman. [Ed: This study compared treatment with clindamycin vaginal cream against no treatment.  Presumably, any effective treatment would have beneficial effects, including hydrogen peroxide vaginal washes.]

Novel bacterial vaginosis species identified

Molecular identification of bacteria associated with bacterial vaginosis.
Fredricks DN, Fiedler TL, Marrazzo JM.
N Engl J Med. 2005 Nov 3;353(18):1899-911.

CONCLUSIONS: Women with bacterial vaginosis have complex vaginal infections with many newly recognized species, including three bacteria in the Clostridiales order that were highly specific for bacterial vaginosis.

Cochrane Update - Feb., 2005 - Antibiotic treatment can eradicate bacterial vaginosis in pregnancy. However, this review provides little evidence that screening and treating all pregnant women with asymptomatic bacterial vaginosis will prevent preterm birth and its consequences. For women with a previous preterm birth, there is some suggestion that treatment of bacterial vaginosis may reduce the risk of preterm prelabour rupture of membranes and low birthweight.

The potential for probiotics to prevent bacterial vaginosis and preterm labor.
Reid G, Bocking A.
Am J Obstet Gynecol. 2003 Oct; 189(4): 1202-8.

TREATMENT FOR BACTERIAL VAGINOSIS DURING PREGNANCY -  [Medscape registration is free.]

Bacterial Vaginosis: A New Perspective - BV type II should be deemed an STD. To safeguard the health of women with this entity, concomitant infection caused by the major STD pathogens must be sought for and eradicated when identified. [Medscape registration is free.]

Single hydrogen peroxide vaginal douching versus single-dose oral metronidazole for the treatment of bacterial vaginosis: a randomized controlled trial.
Chaithongwongwatthana S, Limpongsanurak S, Sitthi-Amorn C.
J Med Assoc Thai. 2003 Jun;86 Suppl 2:S379-84

"CONCLUSION: Single hydrogen peroxide vaginal douching was less effective than a single oral dose of metronidazole in the treatment of bacterial vaginosis."

This is a really odd study in that they don't seem to be trying to find the best treatment for BV in a holistic sense, i.e. what makes most sense and works best for most women.  For example, it makes sense to me that you might need more treatments of a milder form of treatment, such as hydrogen peroxide.  But it seems much better to have more treatments of something that has NO bad side effects than to have even one treatment of a pharmaceutical agent that carries risk . . . substantial risk for pregnant women!

Hydrogen peroxide even in a single dose is almost as effective as metronidazole; it's cheaper; it's easily available without a prescription and it's safe for women to self-diagnose and self-treat with hydrogen peroxide for this condition.

The only purpose of this study seems to be to increase business for the medical or pharmaceutical industries.

Recurrent bacterial vaginosis--an old approach to a new problem.
Winceslaus SJ, Calver G
Int J STD AIDS 1996 Jul;7(4):284-7

Hydrogen peroxide (3%) used as a single vaginal wash was as effective as any other agent in current use in clearing the vaginal malodour of bacterial vaginosis at 3 weeks after treatment.

Metronidazole to Prevent Preterm Delivery in Pregnant Women with Asymptomatic Bacterial Vaginosis. [Medline entry]
Carey JC, Klebanoff MA, Hauth JC, et al.
N Engl J Med 2000 Feb 24;342(8):534-540

Conclusions: The treatment of asymptomatic bacterial vaginosis in pregnant women does not reduce the occurrence of preterm delivery or other adverse perinatal outcomes.

Client Handout for Bacterial Vaginosis by Daphne Singingtree, CPM, LM, Updated 12/99

Vaginal pH Test for Bacterial Vaginosis in Premenopausal Women.

Forty-six premenopausal women had both vaginal pH determinations and cultures (women with yeast were excluded). Of the 34 with a vaginal pH above 4.5, 33 were culture-positive for a bacterial pathogen. In contrast, none of the 12 with a pH of 4.5 or less had a bacterial pathogen. The pH test was not predictive of BV in postmenopausal women.

Comment: This study suggests that pH testing of the outer third of the vaginal wall accurately identifies BV in asymptomatic premenopausal women. It would be helpful to repeat the study in patients with symptomatic vaginitis.

AU.-Caillouette JC et al.

TI.-Vaginal pH as a marker for bacterial pathogens and menopausal status.

SO.-Am J Obstet Gynecol 1997;176:1270-7.

I think the thinking is the peroxide re-established the vaginal flora, and I would doubt it would have a problem with pregnancy.....you wouldn't be trying to use this and also have intercourse. Also implied this is a one time treatment that is highly effective. A good plan would be to do this immediately following a period, as this is a time when some women notice more BV.

Daphne also included this in her BV handout: Hydrogen peroxide douches: Instead of high pressure douches we recommend vaginal washes: Take a 30-cc syringe place three cc of hydrogen peroxide and fill the rest with distilled water. Insert (without the needle) the syringe in your vagina, about an inch and gently push the fluid in. Do this once a day for seven days.

Conference-Tx for BV- 3% Hydrogen Peroxide 30cc(1 T) put in vagina for 3 minutes(doing a hip tilt) supposedly cures 75% of women-one time only treatment.

I treat all BV in pregnancy:
1st trimester - clindamycin 300mg BID x 7
2nd & 3rd trimester - metronidazole 500mg BID x 7

It is OK now to use metronidazole in the first trimester. No teratogenesis.

Echinacea as a Vaginal Wash

I would like to know if any of you have an effective natural treatment for vaginal GBS. I have had women use hydrogen peroxide, vinegar and garlic, and golden seal douches. None of these have gotten rid of or even reduced the colony count. My thinking is I would like to reduce or obliterate our risk if possible. Any suggestions??

The reason that vaginal rx does not work is that the reservoir for GBS is the rectum. Since there is close proximity of the rectum and the vagina, it is impossible to get rid of vaginal GBS. In fact, the CDC protocols (regardless of which intrapartum arm one decides to follow) specifically state no treatment of GBS during pregnancy.....it's just a waste of time, alters the vaginal flora and ultimately does no good.

I've used echinacea as a vaginal wash (versus douche) for bacterial vaginosis with good success and feel that it will be equally effective against b strep--some nice proper studies need to be done, somebody! This is safe for pregnancy.

I recommend 2 droppersful of echinacea tincture in 1 cup warm water. I suggest to my clients that they get in the (empty) tub, scooch down, open their labia with their fingers and pour the warm solution into their vagina. (or they can use a short plastic funnel to direct it) then I tell them to put their fingers in and swoosh it around for a while, trying to get it into crevasses and folds (gently of course). After a while (your tailbone won't like the tub too long) just sit up, let whatever wants to run out do so, get out, wipe off! It can be repeated bid for a couple of days as nec, but for bacterial vaginosis, once is often adequate. I haven't done culture studies--the combination of also-used-antibiotics-somewhere-along-the-line and comes-back-negative-even -without-treatment is too bothersome for my non-research oriented mind, and it was not a treatment chosen by very many of our clients.(Oh, well) Now I'm not working and don't have access to a population for study- so somebody go for it.

If someone was + for strep and didn't choose antibiotics, vaginal washes q3days or so the end of pregnancy (or weekly, maybe) and then once in very early labor, (thoroughly and gently) would protect the baby quite nicely I would think--at least from vaginal exposure.

This is taken from "Herbal Healing for Women" by Rosemary Gladstar, a must have book for anyone interested in herbs!!

"Gardnerella is a yellow, white or mucusy discharge which may or may not have blood in it. It is usually accompanied by itching or vaginal irritation and sometimes cystitis-like symptoms...The odor can be especially strong-smelling and rather fishy. Some cases of gardnerella are asymptomatic and are only found by a pap smear. In much the same way as other yeast infections, gardnerella often begins when a woman's natural resistance is lowered by anxiety, tension, lack of sleep, poor diet, sexual activity with an infected partner, birth control pills and other medications and/or an imbalanced diet.

To combat bacterial infections, eat plenty of garlic - a safe natural antibiotic - and eat a diet rich in high-quality protein...Be sure to eat a diet rich in a full spectrum of vitamins and minerals. Concentrate on B vitamin complex and vitamin C, E and A. Comfrey/oatstraw tea is highly recommended, both as a preventative and a remedy. An excellent tonic high in protein, vitamins and minerals and rich in chlorophyll, comfrey/oatstraw tea is a natural cleanser of the system.

For the itching...apply a comfrey/St. John's Wort salve directly on the lips and inside the vagina. Medicinal Yoni Powder should be sprinkled over the area several times daily. This will not only help with the odor but, more important, help heal the infection. Cultured buttermilk or yogurt applied directly to the area of irritation is very soothing and healing. Insert the yogurt inside the vagina using your fingers or a tampon applicator. At first the yogurt may burn slightly, but the burning sensation will quickly pass...Gently douche with the following formula every 2 days until the infection clears.

*Apple Cider Vinegar Douche*
1 qt. warm water
2 tbls. apple cider vinegar
1-2 tsp. garlic oil

*Abstain from intercourse - it is easily spread...and avoids further agitation
*Help acidify your system by drinking 8oz of unsweetened cranberry juice every day.

Yoni Powder*
1 c. fine white clay
1/2 c. cornstarch
2 tbs. black walnut hull powder
2 tbs. myrrh powder
1 tbs goldenseal powder
1-2 drops of tea tree oil"

I personally found that tea tree oil works wonders on yeast infections and may have the same effect on gardnerella. Simply put 15-20 drops of the oil on a tampon and insert, leave in for 24 hours. You can also make a douche with tea tree oil: 8-10 drops per 1pint of water or 10 drops in a bath. There are also tea tree oil suppositories at the health food store. I highly recommend trying tea tree oil first because it is so effective. Your client will want to tell the whole world it is that great! Let me know what happens - I am always curious to hear results so I know that my recommendations are on track.

I am working a specific protocol and survey for "alternative" treatments, but been too busy to get it done. I will post here when it is ready (the summer went by too fast, I'm in love). In the meantime, here is what my research has shown to be effective. If you use this or anything else please document all methods you hear about, what method you use for diagnosis, and what works and let me know. I have a lot of references on this condition & the following treatments, I don't have time to post them tonight but e-mail me privately and I will send them soon.

I am currently using two methods; the first is hydrogen peroxide vaginal washes: It is easy, cheap & hydrogen peroxide is what the vagina produces naturally to clean bacteria. If that doesn't work I use tea tree oil suppositories 1xnight for 7 nights (I get mine from Eclectic 1-800-332-HERB). I also recommend echinacea & vit. C internally. If all that fails then I have them do the cleocin or the metrogel in the last trimester.

Directions for hydrogen peroxide washes:

Take a 30 cc syringe (without the needle) place 3 cc of hydrogen peroxide and fill the rest with distilled water. Insert the syringe in the vagina about an inch and push the fluid in. Do this once a day for seven days.

During treatment period the partner should wear condoms during intercourse. To prevent recurrences the partner should wash after intercourse with a mild antibacterial soap (like dial).

Flagyl is a heavy-duty drug, but nothing else really works for trich and it's very effective against BV, as well. I'm amazed that her doctor called Flagyl and Clindamycin "dangerous".

Flagyl had a terrible reputation around here, supposed to cause birth defects if used in pregnancy and on our initial risk assessment forms (taken directly from our local teaching hospital in 1981 --we used a "RISK FACTOR SCORING" system then) "use of flagyl in pregnancy" was rated a "5" - the highest score!

I never could get good info on why it was supposed to be so awful - but everybody "knew" it was[grin]... Can anyone enlighten???!

Flagyl (metronidazole) may be carcinogenic, and can cause birth defects and gene mutations (thus affecting more than one generation!). It enters the bloodstream and lowers the WBC, decreasing immune response. IT SHOULD NOT BE TAKEN BY A PREGNANT WOMAN OR A WOMAN WITH PEPTIC ULCERS. It should not be taken by anyone with an infection elsewhere in the body, anyone with a history of blood disease, or anyone with a disease of the CNS. Never drink alcohol or use vinegar at all until the course of treatment is completed. In combination with Flagyl, alcohol and/or vinegar can cause nausea, vomiting, sweating, and weakness.

An alternative pharmaceutical for trich is vag suppositories of Betadine. Make your own---it's cheaper!

Natural remedies include garlic vag suppositories and garlic oil capsules. To do a garlic supp, peel a clove of garlic (careful not to nick it or it burns!) and wrap it in gauze, twisting into a tail. Insert like a tampon. Replace every 4 hours or so. Also a good treatment for yeast.

Another is boric acid capsules. These can also burn but are very effective. Fill a size "00" capsule with boric acid powder and insert 2 capsules as deeply as possible in the vagina. Repeat once a day for 7 days. Wear a pad as there may be extra discharge. Many women report a burning sensation the first couple of days. DO NOT TAKE CAPSULES ORALLY!

Vinegar douches can be helpful because trich grows best in an alkaline environment. Herbal "tea" can be added for increased effect. Try making a tea of 2 parts sage, 2 parts raspberry leaf, 2 parts mullein and 1/4 part goldenseal root. Boil 1 quart water and steep herbs in it, tightly covered, for 1 hour. Strain and add 2 tablespoons apple cider vinegar, 1 tablespoon acidophilus culture or 1/4 cup yogurt, and a tiny drop of tea tree oil. Mix well and allow to cool to warm but not hot. Douche gently with a slow flow every couple of days.

Another formula is an oral capsule consisting of 2 parts chaparral powder, 1 part osha root powder, 2 parts pau d'arco powder and 1/2 part black walnut hull powder. Take 2 capsules 3x daily until symptoms disappear.

As with any natural or herbal remedy, the above-mentioned suggestions are merely offered as traditional women's wisdom and should be used carefully, with respect. One should never use any remedy one is not familiar with without competent supervision. [standard disclaimer...grin]

Does anyone have any homeopathic remedies for chronic gardnerella in non-pregnant or pregnant women? I have several non-pregnant patients who have been treated with metronidazole, metro-gel, clindamycin p.o. and vaginal cream, acidophilus p.o and baking soda douches.

I would like to point out something that I learned (or maybe re-learned?) at the conference I went to recently. The session was on vaginitis and a portion on the lecture was on Bacterial Vaginosis, which is what we now call what used to be called Gardnerella. The important point that the lecturer made, in my opinion, is that Gardnerella is now known to be only a co-factor in BV. It is not diagnostic!! Up to 50% of healthy women (i.e. no BV) have Gardnerella as part of their normal flora - in the absence of clue cells or other sx of BV, it should be ignored.

A client who transferred to my practice from another CNM in the area was really concerned about this. The other CNM had diagnosed BV based on an initial vaginal culture, though the client had no sx whatsoever and no wet mount was done to confirm. She was told how dangerous BV is and rx'd with Flagyl in the 1st trimester, but didn't take it. After coming home from the conference, I went back to her old records and sure enough, the culture picked up Gardnerella alone. We now feel pretty comfortable leaving it without tx.

If BV is diagnosed through sx and a wet mount showing clue cells with few or no WBC and decreased lactobacilli, the tx regimens she recommended are:

Metronidazole 500 mg orally BID x 7 days

Metronidazole gel 0.75%, 5 gms intravaginally BID x 5 days (may be dropped to a once daily dose soon)

Clindamycin 2% cream, 5 gms intravaginally qHS x 7 days

Clindamycin 300 mg orally BID for 7 days

She recommended against using Ampicillin, triple sulfa cream, acigel, iodine solutions, or other antibiotics. Recurrence rate is up to 80% in the first nine months, so it obviously has a tendency to be stubborn. Treating the partners has not been shown to decrease the recurrence rate.

Incidentally, in treating BV in pregnancy, using oral metronidazole rather than vaginal apparently leads to fewer cases of preterm labor. Might be esp. important in women with PTL risk factors. Shucks - I really hate using the oral stuff during pregnancy and probably continue to avoid it if possible.

I don't know about remedies for a "persistent" yeast infection, but for your standard garden-variety yeast infection I've had great success with application of essential oils of lavender and/or tea tree. Usually I've just poured about a tablespoon of carrier oil (e.g. sweet almond oil) into the palm of my hand, then added a few drops of said essential oils. Then I apply it both internally (vaginally, that is -- not orally) and around the vagina. After doing this morning and night for a day or two, I've been problem-free.

Try a sitz bath with four to six drops of tea tree oil in it swish water around vagina stay in tub for at least ten minutes. You can also add myrrh to this. Keep vagina dry. Try wearing a dress with no underwear for a few days. Also I make a oil with lavender and myrrh. 2 drops Myrrh, 4 drops lavender, to 1/2floz(15ml/2 1/tsp.) of carrier lotion or oil. I use apricot kernel oil for a carrier and use this on the outer lips of vagina it might burn a bit if vagina is very irritated. Try to avoid intercourse for a while. These recipes came from Aromatherapist Shirley Price. I have tried everything and I think ultimately the aromatherapy really helped. Give some of the oil to your partner too. Also I think standing meditation has really helped too.

Take odorless garlic, Citrimax (or other grapefruit seed extract capsules), acidophilus, and vitamin C 3 times a day. Also don't use any soap other than perhaps a very mild liquid baby soap (regular soaps are too alkaline), go without underwear, and CHANGE YOUR DIET! Eliminate all processed foods, white flour, white sugar, and nitrate-preserved meats. Concentrate on whole foods with a minimal amount of fruits. Avoid canned fruit juices. You can also use a douche of liquid Citrimax (or other comparable product), tea tree oil, and acidophilus.

In cases of persistent yeast infection, diabetes and immune-compromising conditions should be ruled out. Other common causes are antibiotics, stress, and vitamin b deficiency.

In addition to applying plain live yogurt topically, anyone who has a persistent yeast infection should eliminate sugar and yeast from her diet, at least temporarily. Taking acidophilus might also be helpful.

Anne McIntyre recommends sitting in a bowl of dilute vinegar or lemon juice (one part to three parts water) to correct pH imbalance. She also recommends eating plenty of garlic, cold pressed olive oil, and taking an anti-fungal caprylic acid supplement, and douching once a day with a tea made from thyme, calendula, golden seal, chamomile or myrrh. (Reference, The Complete Woman's Herbal)

There are a lot of books on this topic alone! Look under candida albicans at the library/bookstore.

About Boric Acid

I wanted to put out my experience with Boric Acid in pregnancy.  I used it myself quiet successfully non pregnant and asked another midwife about its use in pregnancy, with her support I went on to suggest it to my clients.  Three women in one year had PROM (37 and half weeks, 38, and 39) while using it late in their pregnancies. (Since then I have been reprimanded by a good friend midwife that I respect that I should have known better not to use it-oh well-live and learn)

It was quite clear that all membrane rupture occurred during the use of the Boric Acid and all without any labor or signs of labor.  I was lucky that we managed to get all three to birth at home, but not without Prolonged rupture and castor oil and every other natural induction we could think of to accomplish this.

Without a doubt I feel that Boric Acid works to get yeast infections under control, it is awfully stringent and leaves the tissue in great need of rebuilding its healthy flora.  It might have properties that break down the mucous and membranous tissues.  I always suggest some yogurt after only one or two doses.  Now for pregnancy I would not have women use it again with the experience I had with PROM certainly not in capsule form so close to the cervix.

Now how about having someone sit in a shallow bath with Boric Acid powder added and let it flow up into the vagina and then using yogurt suppository as an option?  I would feel that to be far less likely to disturbed the mucous or membranes.

I've heard that boric acid is effective against yeast without bothering the acidophilus.  Perhaps this is because acidophilus is ACID LOVING, thus the name ACIDO-PHILUS.

I HAVE written about this in MT and so...the beat goes on.  I think in solution it is ok, but not in a capsule.  Maybe a tsp in a cup of h2o.

I think it must have been some kind of fluke. I've  known DOZENS of women using boric acid capsules in pregnancy without problems -- certainly nothing as obvious as ROM!  Boric acid capsules are pretty much the first thing recommended here for stubborn yeast or BV.  Lots of experience in my region with it. I think if there were a problem we would have seen it already.

From reading your post on Boric Acid I was spurred to think about my experiences with it during pregnancy.  I am not so sure that I would not use it during late pregnancy as I am not sure which came first-- the infection that predisposes the ROM--- or the use of the Boric Acid.  I would really like to look into this issue at greater detail.  I myself have not had any increase in rupture with the use of Boric Acid.

If you're not pregnant and want to try boric acid, you can shop online.

About Tea Tree Oil

I am now prescribing a vaginal suppository of tea tree oil which is formulated for yeast.  Having tremendous success.

I recommend Tea Tree Oil suppositories.  Just the oil in cocoa butter. Work great.

Don't those suppositories burn like the dickens?  One of my clients said she almost cried.  Had to take it out.

Try "Tea Tree Vaginal Suppositories" by Thursday Plantation, and you can have your health food store order it through Natures
Plus.  It is 200mg tea tree oil in vegetable oil base.

I believe tea tree oil should always be diluted when used on the skin or mucous membranes.  The straight stuff would definitely burn.

While dilution on the mucous membranes is true, tea tree is one of the essentials that may be used "neat" (without dilution) on the skin with out fear of tissue damage.  The other is lavender.

Herbal Treatment for Male Partners

The recommendations below reference quite a few different herbs and essential oils, which can be overwhelming.  You can purchase a packet of Afterbirth Sitz Herbs, which is an herbal blend including Uva ursi leaf, yarrow flowers, sage leaf, comfrey leaf and root, plantain leaves, witch hazel bark, sea salt. They say "One 5 oz package provides enough herbs for 4-5 baths.", but since you're using much smaller amounts of water, you can use smaller amounts of herbs, too.  I would guess that a packet of herbs could be used for at least 15 penile soaks.

The essential oils can be a bit pricey, but they last a long time.  It's always good to have tea tree oil around, anyway, for minor skin infections, and the lavender smells nice.  You can buy those two at Whole Foods - I'm not sure about the Bergamot.  Be sure to get organic blends!!!

Penis Soaks -- The P.S. of couples' mutual health-care

"This technique for male hygiene and external herbal therapy was originated and is strongly suggested by a clinical herbal therapist named Cascade Anderson-Geller. One can think of this as a male (reverse) douche to be used if you itch, after making love, or any other time you suspect a problem. Without question, it is most important for a male whose female partner may have a vaginal malady to use these penis soaks. Many of these vaginal/uterine infections such as gardnerella, trichomonas, monilia (yeast and candida) chlamydia, urethritis, etc., are transmitted or re-infected by the male member during intercourse. The microorganisms are passed back and forth between partners to the chagrin of both, especially the female.  Most often the male, because he doesn't offer as perfect a breeding arena, doesn't experience the symptoms as intensely and uncomfortably as the female. At the same time both partners must work to bolster their immune systems.

To perform a penis soak simply hold a drinking glass filled with a strong infusion or decoction of appropriate herbs and hang in there for 5-10 minutes. (If you are not circumcised retract the foreskin throughout the soak). The tea should be as warm as possible. It is helpful to include the testicles in the soak, too, so you might graduate to a vase or a jar as a container.

In general, I recommend using combinations of strong aromatic herbs for this male herbal soak, such as equal parts of yarrow, sage, Lavender, and Chaparral. You can include one to two drops of Tee Tree oil, Lavender, and Bergamot. Disperse the oils well, soak for 5-10 minutes at least once but preferably 2-3 times a day.

......when communicable infection is involved between caring lovers, each partner has a responsibility to the mutual care.  No matter how absurd the image of this therapy strikes you, in time when your female partner is stressed with recurring vaginal infection, the most chivalrous act is a daily hygienic penis soak until the cycle of re-infection has been stopped. Words of love are merely promises."