Dopaminergic Drugs for the Treatment of Recurrent Persistent Bacterial Vaginosis: A Case Report

Bacterial vaginosis (BV) frequently presents with a malodorous vaginal discharge. The only approved treatments are antibiotics either vaginally or orally e.g., metronidazole or vaginal clindamycin. Unfortunately, despite antibiotics or other treatments the condition tends to be persistent or recurrent. The etiology is not known for sure especially as to why the normal predominant vaginal flora are replaced by minority bacteria that cause the symptoms. Many conditions, including, but not limited to, pelvic pain that have been resistant to standard therapy will show marked amelioration following treatment with dopaminergic drugs especially dextroamphetamine A 40-year-old woman had been treated for BV. The improvement would be the transient and she had frequent recurrence. She was treated with dextroamphetamine for orthostatic edema and weight gain. She noted that since starting the dextroamphetamine, the BV never returned over several years of treatment except a couple times when she was unable to obtain dextroamphetamine. Dopaminergic drugs have been found to completely eradicate long term vulvovaginitis which we attributed to its effect of decreasing cellular permeability preventing irritants from infusing into vaginal tissue causing inflammation and pain. Thus, we hypothesize that that the change in bacterial flora causing BV is in some way related also to increased cellular permeability allowing colonization of minority bacteria to become the predominant microorganism thus leading to BV. A larger clinical trial should be initiated to determine if dopaminergic drugs may be a very effective treatment for this condition that is usually recalcitrant to antibiotic treatment.