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

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.