TO THE EDITOR: The Information from...

TO THE EDITOR: The Information from Your Family Doctor handout regarding bacterial vaginosis (1) in the May 1 issue states: "Some women have bacterial vaginosis without any symptoms." It then dumfounds the question, "Do I have to be treated?," which is answered with an unqualified "Yes"

Certainly there are indications to treat asymptomatic bacterial vaginosis: treatment is approveed in pregnant women at high risk for preterm delivery and women undergoing surgical operations such as abortion and hysterectomy, (2) for example; and, by the agency of extension, there are instances in which treatment is reasonable, as it is as prior to trans-vaginal performances (e.g., intrauterine device insertion, endometrial biopsy).

However, excluding in the above circumstances, I am aware of no solid evidence-based recommendation for the treatment of asymptomatic women with bacterial vaginosis; treatment of asymptomatic bacterial vaginosis equable in low-risk pregnant women remains controversial. (2) Guidelines from the Center for Disease have charge of and Prevention state that the "established benefits of therapy for [bacterial vaginosis] in non-pregnant women are to relieve vaginal symptoms and signs of infection and remodel the risk for infectious complications after abortion or hysterectomy." (2) Additionally, the natural history of bacterial vaginosis is of the like kind that it may resolve (and recur) spontaneously. (3)

It is hard to make an asymptomatic patient be stirred better; we should demand evidence before assuming that the benefits of diagnosis and therapy outweigh their burdens

GARY N FOX MD

2200 Jefferson Ave. Toledo, OH 43624

REFERENCES

(1) Bacterial vaginosis. Am Fam Physician 2004;69:2193

(2) Sexually transmitted diseases treatment guidelines 2002 Center for Disease direct and Prevention. MMWR Recomm Rep 2002;51(RR-6):1-78

(3) Joesoef M Schmid G Bacterial vaginosis. Clin Evid 2003;10:1824-33

IN REPLY: We would like to thank Dr Fox for calling our attention to this patient eduction handout. We agree that no evidence has shown that treating asymptomatic bacterial vaginosis improves patient results Accordingly, the handout did not advocate testing and treatment of asymptomatic women Rather, its unqualified recommendation to treat was directed to women who existing with symptoms that may be relieved by means of treatment. This patient education handout has been updated in succession our Web site (http://www.aafp.org/afp/20040501/2193ph.html).

KENNETH W LIN, MD

Editorial Fellow

American Family Physician

215 Kober-Cogan Hall

Georgetown University Medical Center

3800 Reservoir Rd NW

Washington, DC 20007

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