New treatments for common vaginal infection being studied

May 9 2005

Whether a two-week regimen using a stainless steel douching device can eradicate the most common vaginal infection is under study at the Medical College of Georgia.

MCG researchers want to know whether the device can eliminate bacterial vaginosis and the distinctive odor that typically accompanies the infection, says Dr. Daron G. Ferris, family medicine physician, director of the Gynecologic Cancer Prevention Center at MCG Medical Center and the study’s principal investigator.

MCG is the only site in the nation for a two-week test of the device that is based on the same premise as stainless steel bars chefs use to eliminate undesirable odors from their hands. Participants in a small pilot study who used the device for one week indicated they were beginning to see improvement, says Dr. Eileen D. Dickman, clinical researcher, coordinator of the Gynecologic Cancer Prevention Center and a co-investigator.

“Bacterial vaginosis is the most common type of vaginal condition that women experience and yet its etiology is poorly understood,” says Dr. Ferris. “Basically it’s an alteration of the vagina’s ecosystem. It gets that way because the lactobacilli, the good bacteria in the vagina, are wiped out.”

Good bacteria are critical to the vagina’s natural, continuous cleansing process. They secrete lactic acid, which makes the vagina very acidic, and hydrogen peroxide to kill bad bacteria. Dead cells are carried away in the normally clear discharge. When the system is disrupted, a woman’s natural defense against sexually transmitted diseases decreases, leaving her much more vulnerable to infections such as HIV, Chlamydia and human papillomavirus. Multiplying bad bacteria produce an undesirable odor and vaginal discharge may be thick and white.

All sexually active women are at risk for this imbalance; for some unknown reason black women have twice the risk. Regular vaginal douching may also be a factor, says Dr. Ferris, noting that his counterparts around the world might disagree. “In America we feel that douching is nonselective: it washes out the good and the bad bacteria,” says Dr. Ferris. “After you douche, if the good bacteria isn’t re-established first, the bad bacteria take over and you have a potential problem.” Studies and experience have shown that a major reason women douche is because their mothers did, Dr. Ferris says.

While many European physicians encourage the habit, Dr. Ferris is among the many American physicians who advise their patients against douching. He wonders if the cylindrical stainless steel device, developed collaboratively by researchers at Abbott Research Group, Inc. and Carnegie Mellon University in Pittsburgh, may one day be a douching technique he’d recommend.

Women can easily use the device in the shower. A compartment attached to the device via a tube is filled with body temperature tap water and placed at an elevated level so the natural force of gravity gently washes out the vagina for a few minutes.

“I didn’t believe this until they sent me a stainless steel chef’s bar to try,” says Dr. Ferris. “If you get garlic or onion on your fingers, you use this stainless steel bar to wash your hands without soap, and it gets rid of the odor. Since bacterial vaginosis is associated with this odor, it’s thought the stainless steel has some effect on the whole process and it could potentially eliminate the infection and the odor as well. This could be a non-pharmacologic, alternative medicine approach,” says Dr. Ferris.

“The standard treatment today is antibiotics to kill the bad bacteria so hopefully the good bacteria can resume dominance. The goal of the douching device is to clear the infection without antibiotics. We don’t know if it will,” says Dr. Ferris. “But, it might be an option other than antibiotics which are not 100 percent effective and can lead to secondary infections, including yeast.”

MCG also is participating in a multi-site study of the first potential new antibiotic for bacterial vaginosis in at least 25 years, a drug called tinidazole, which already has Food and Drug Administration approval to treat trichomoniasis vaginitis, another common vaginal infection.

Europeans have used tinidazole for years to treat bacterial vaginosis and experience has shown the drug causes less gastrointestinal side effects than two antibiotics used routinely in the United States. Its efficacy rate may be equivalent or better than the existing drugs, clindamycin phosphate and metronidazole, Dr. Ferris says.

“We have had the same two antibiotics for a long time so our treatment options are rather limited,” says Dr. Ferris, who is excited about the opportunity to find better treatments for this very common infection with a recurrence rate of about 80 percent.

Women age 18 and older with bacterial vaginosis are eligible for both studies. The douching study is sponsored by Abbott Research Laboratories and the antibiotic study by Presutti Laboratories.

For more information, call Dr. Ferris’ office at 706-721-2535.