Common condition
Bacterial Vaginosis (BV) is a common vaginal infection (inflammation) that occurs when there is an overgrowth of bacteria in the vagina. Bacterial vaginosis is not a sexually transmitted infection (STI) but rather is an imbalance of the naturally occurring bacteria in the vagina. This bacterial infection is easily treated with pH-balancing gels and creams or antibiotics.
What is Bacterial Vaginosis, and what causes it?
Bacterial vaginosis is inflammation of the vagina and is caused by an imbalance (overgrowth) of the naturally occurring bacteria in the vagina. The body may be able to clear the infection on its own; however, if it is left untreated, it could develop into other health issues. For this reason, if you experience symptoms of BV, you should talk to a healthcare professional (doctor, nurse, or pharmacist).
The natural environment of the vagina is slightly acidic. This is due to a bacteria called lactobacilli producing lactic acid. This lactic acid production creates an acidic environment that prevents other bacteria from growing inside the vagina. Women who present with BV most often tend to lack sufficient numbers of lactobacilli, which allows other bacteria to grow. This creates an imbalance of bacteria in the vagina, causing BV.
Bacterial unbalance in the vagina can occur for various reasons, including:
- Recently using antibiotics
- Douching
- Having sex with multiple people
- Having sex with a new partner
- Not using contraception such as condoms during sex
- Being pregnant
- Using an intrauterine device
Bacterial vaginosis is not an STI, but there is a risk that it can develop into an STI.
Risk factors for developing BV
While anyone with a vagina can develop BV, certain factors can increase their risk. These factors include:
- Smoking
- Using some scented soaps
- Having multiple sexual partners
- Having a new sexual partner
- Washing underwear with strong detergents
- Using certain feminine hygiene products
- Bathing in water that contains antiseptic
- Using a perfumed bubble bath
Symptoms of BV
Signs and symptoms of bacterial vaginosis may include:
- Burning during urination
- Unusual discharge from the vagina
- Thin, green, white, or grey vaginal discharge
- Foul-smelling “fishy” vaginal odour
- Some women may have itching or soreness in the vagina
Many women may develop bacterial vaginosis without experiencing any symptoms.
Complications of untreated BV may lead to or increase your risk of developing:
- Sexually transmitted infections (STIs) such as gonorrhoea, herpes, human papillomavirus (HPV), and chlamydia.
- A postsurgical infection, for example, after a hysterectomy or some type of abortion.
- HIV, as BV, increases the susceptibility to contracting this virus.
Complications of BV that may occur during pregnancy:
- Loss of pregnancy (miscarriage).
- Chorioamnionitis. Inflammation of the membranes surrounding the fetus.
- Early or preterm delivery.
- The amniotic sac may break open too early.
- Postpartum endometritis. Inflammation or irritation of the lining of the uterus after the baby has been delivered.
Possible complications that BV may have on fertility:
- Pelvic inflammatory disease.
- Tubal factor infertility.
- Unsuccessful in vitro fertilization (IVF)
When to see a doctor
It is recommended to see a doctor or healthcare professional if:
- If over-the-counter, self-treatment for a yeast infection does not clear the infection or reduce symptoms.
- You experience vaginal discharge that is new and present with a fever or odour. Your doctor will be able to help diagnose the cause.
- You have multiple sexual partners or have a new partner. Some sexually transmitted infections (STIs) present with similar signs and symptoms of bacterial vaginosis.
- You have a medical history of vaginal infections, but the consistency and colour of your discharge are different during this vaginal infection.
How is BV diagnosed?
A healthcare professional will be able to diagnose BV based on the following:
- Ask questions about your medical history. A medical history will be able to help your doctor establish if this is BV or an STI.
- Test your vaginal pH. A pH strip is placed in the vagina to check the acidity of your vagina. A vaginal pH of 4.5 or higher is an indication of BV.
- Perform a pelvic exam. During this exam, the vagina is examined for signs of infection. Two fingers are inserted into the vagina, while a hand presses on your abdomen to check the pelvic organs for signs of disease.
- Take a sample of vaginal secretions. This sample is examined under a microscope to check for signs of an overgrowth of anaerobic bacteria.
You can also self-diagnosis BV at home using a Canestest Home bacterial vaginosis test.
Treatment options for BV
To treat bacterial vaginosis, you may be prescribed one of the following medications by your doctor:
- Secnidazole (Solosec). This is a single-dose oral antibiotic treatment. Secnidazole comes as a packet of granules that can be sprinkled onto soft foods such as applesauce, yoghurt, or pudding. The soft food antibiotic mixture needs to be consumed within 30 minutes. Do not chew or bite into the granules.
- Metronidazole. It is an antibiotic that is available as a topical gel or as a tablet. The topical gel is inserted into the vagina. Metronidazole 400mg tablet is usually a seven-day course, taking one tablet twice daily.
- Tinidazole (Tindamax). It is an oral antibiotic tablet. Alcohol should be avoided for at least three days after completion of the antibiotic course.
- Clindamycin (Cleocin). This antibiotic is available as a cream that is inserted into the vagina. During treatment and for at least three days after treatment, the cream may weaken latex condoms.
Suppose it is suspected that BV is caused by an intrauterine device (i.e., contraceptive diaphragm). It may be recommended to remove the device, with an alternative means of contraception to be discussed.
How can BV be prevented?
As all the causes of bacterial vaginosis are not fully understood, it is difficult to prevent it from occurring. However, there are some measures and techniques that you can implement to help reduce your risk of developing BV.
These techniques include:
- Avoid vaginal douching
- Wash underwear with gentle detergents
- Avoid perfumed bubble baths
- Use a barrier method of protection during intercourse
- Avoid using scented soaps or vaginal deodorants
These techniques are less likely to disturb the pH balance inside the vagina, thus reducing the chance of developing bacterial vaginosis.
Alternative Treatments
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