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JAMA Patient Page
April 7, 2020

Screening for Bacterial Vaginosis During Pregnancy

JAMA. 2020;323(13):1324. doi:10.1001/jama.2020.3690

The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for bacterial vaginosis during pregnancy.

What Is Bacterial Vaginosis?

The normal vaginal microbiome includes many “good” bacteria, mostly from the Lactobacillus genus. Bacterial vaginosis results when a shift in this microbiome occurs so that there are fewer Lactobacillus bacteria and more of other types of bacteria. These other bacteria can cause bothersome symptoms in some women, such as vaginal discharge and odor.

Many women who have bacterial vaginosis have no symptoms and do not need treatment. In pregnant women, bacterial vaginosis might increase the risk of preterm delivery. It is not clear if screening for and treating bacterial vaginosis during pregnancy reduces preterm delivery.

For pregnant or nonpregnant women who do have symptoms of bacterial vaginosis, treatment is usually an antibiotic medication either taken as a pill or applied topically to the vaginal area.

What Test Is Used to Screen for Bacterial Vaginosis?

Screening for bacterial vaginosis involves taking a swab of the vaginal area and looking for the presence of bacterial vaginosis–related bacteria. This can be done by looking under the microscope for these bacterial cells or by molecular testing the sample for bacterial components.

What Is the Population Under Consideration for Screening for Bacterial Vaginosis?

This recommendation applies to pregnant women who do not have signs or symptoms of bacterial vaginosis.

What Are the Potential Benefits and Harms of Screening for Bacterial Vaginosis During Pregnancy?

The theoretical benefit of screening for bacterial vaginosis is finding and treating pregnant women who do not know that they have it, thereby decreasing their risk of preterm delivery. It is not known if bacterial vaginosis causes an increased risk of preterm delivery, but it appears that treatment does not help prevent preterm delivery for most pregnant women. There are few potential harms of screening to diagnose bacterial vaginosis in women who do not have symptoms. The harms of screening include side effects of antibiotic treatment such as stomach discomfort or vaginal yeast infections.

How Strong Is the Recommendation to Screen for Bacterial Vaginosis?

Given current evidence, the USPSTF concludes with moderate certainty that screening for bacterial vaginosis in pregnant women who do not have symptoms of bacterial vaginosis and who are not at increased risk of preterm delivery has no overall benefit. It is not known if there is overall benefit or harm by screening for bacterial vaginosis in pregnant women at increased risk of preterm delivery. Increased risk of preterm delivery includes having had a preterm delivery in the past, a uterine cervix that does not work properly, having had genitourinary infections, or having a pregnancy with more than 1 fetus (such as twins).

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Article Information

Conflict of Interest Disclosures: None reported.

Source: US Preventive Services Task Force. Screening for bacterial vaginosis in pregnant persons to prevent preterm delivery: US Preventive Services Task Force recommendation statement. JAMA. Published April 7, 2020. doi:10.1001/jama.2020.2684

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