Gardnerella, a genus of Gram-variable bacteria, is primarily recognized in the context of bacterial vaginosis (BV), an infection that leads to an imbalance of natural bacteria in the vagina. Chronic Gardnerella infection, otherwise known as recurrent bacterial vaginosis (RBV), can be quite challenging to manage and significantly impacts the quality of life of those affected. Here, we will delve into the causes, symptoms, diagnostic methods, and treatment options for chronic Gardnerella infection.

Overview of Gardnerella

The vaginal microbiome is a complex and dynamic ecosystem. In healthy conditions, it is predominantly colonized by a variety of Lactobacillus species, which help to maintain an acidic environment. This acidic environment inhibits the growth of pathogenic organisms, thus providing a natural defense mechanism.

However, in bacterial vaginosis, the balance is disrupted. A significant decrease in Lactobacillus colonies is noted, accompanied by an overgrowth of diverse anaerobic bacteria, among which Gardnerella is commonly found. It’s important to note that Gardnerella is often present even in a healthy vagina, but problems arise when it proliferates excessively.

Causes and Symptoms of Chronic Gardnerella Infection

While the exact cause of chronic Gardnerella infection is not completely understood, several risk factors have been associated with this condition. These include multiple sexual partners, intrauterine device (IUD) use, and douching. The infection does not typically affect men or women who are not sexually active.

Symptoms of chronic Gardnerella infection are similar to those of BV and may vary in intensity. They include a thin, white or gray vaginal discharge, a strong, fish-like odor, particularly after sexual intercourse, vaginal itching, and burning during urination. Some women with Gardnerella do not exhibit any symptoms.


A healthcare provider may suspect bacterial vaginosis based on the patient’s symptoms and a physical examination. However, for a definitive diagnosis, laboratory tests are required. A common test is a vaginal pH measurement. In bacterial vaginosis, the pH is typically higher than 4.5.

Microscopic examination of vaginal discharge may reveal „clue cells,“ vaginal epithelial cells covered with bacteria, which is a hallmark of BV. Polymerase chain reaction (PCR) and DNA probe-based tests can also be used for more accurate detection of Gardnerella and other bacteria associated with BV.

Treatment Options

The mainstay of treatment for chronic Gardnerella infection is antibiotic therapy. The Centers for Disease Control and Prevention (CDC) recommends oral metronidazole, oral clindamycin, or metronidazole gel as first-line treatments. However, in recurrent cases, treatment can be more complex. Treatment protocols may include extended use of antibiotics, alternating different antibiotics, or using them in a step-down approach to prevent recurrence.

Probiotics, specifically those containing Lactobacillus species, have shown promising results in re-establishing the healthy vaginal microbiota and may be beneficial in the management of chronic Gardnerella infections.

Moreover, lifestyle modifications, such as avoiding douching and reducing the number of sexual partners, are often recommended as part of a comprehensive treatment approach.


Chronic Gardnerella infection can be a significant source of distress, often due to recurrent symptoms and the impact on sexual health. Despite this, with the right combination of medical treatment, probiotics, and lifestyle modifications, management of the condition can be achieved. Continued research is necessary to further explore the pathogenesis of this condition and discover more efficient treatment approaches.