When should I consider referring a patient with bacterial vaginosis for specialist evaluation?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Consider referring a patient with bacterial vaginosis (BV) for specialist evaluation if:

  • The patient has confirmed BV that has not responded to a 7-day course of oral metronidazole treatment.
  • Symptoms recur frequently despite adequate management in primary care and are adversely affecting the woman.
  • There is diagnostic uncertainty about the condition or if symptoms are atypical or complicated.
  • The patient is pregnant and symptomatic but does not respond to initial treatment or if there is doubt about the diagnosis or management.

In these cases, discuss or refer to a gynaecologist or genito-urinary medicine (GUM) specialist for further assessment and management.

Educational content only. Always verify information and use clinical judgement.