Understanding Bacterial Vaginosis

What is Bacterial Vaginosis?

Bacterial vaginosis (BV) is the term for an overgrowth of vaginal bacteria. As with the digestive system and other parts of the body, there are a variety of naturally occurring bacteria that reside in the vagina. Some of these bacteria (lactobacilli) are normal and helpful for normal biological functions; however, when the number of harmful bacteria (anaerobes) become greater than the lactobacilli, an imbalance is created. This overgrowth triggers an immune response that includes inflammation (vaginitis) and discharge. Bacterial vaginosis is the most common type of vaginal infection among women of reproductive age.

The inflammation that results from bacterial vaginosis is one of the ways the body tries to fight the overgrowth of bacteria. Although some women have no symptoms at all, one of the main symptoms of BV is vaginal itching, a common sensation with any kind of inflammation. Patients with BV also tend to experience a burning feeling during urination as well as vaginal discharge. The discharge is usually a thin consistency and a gray, white, or green color. Another notable symptom is a pungent fishy smell from the vagina.

Bacterial vaginosis is often confused with a yeast infection since the two conditions share some similar symptoms. One of the main differences is that BV has very thin discharge while a yeast infection can look like cottage cheese. The telltale sign of BV is the fishy smell whereas a yeast infection tends not to have any odor. For more information about bacterial vaginosis, take a look at the CDC fact sheet provided by the Centers for Disease Control and Prevention (cdc.gov).

What Causes Bacterial Vaginosis?

The main cause of the symptoms of bacterial vaginosis is the inflammation that results from the bacterial overgrowth. The underlying imbalance between lactobacilli and anaerobes, however, is due to an impairment of the normally beneficial acidic environment created by a higher ratio of lactobacilli. So when this level goes down, harmful bacteria that are already residing in the vagina—or have been newly introduced—can overgrow and cause BV. Below are some of these common risk factors:

• Sexual activity: Though the link isn’t fully understood by gynecologists, bacterial vaginosis tends to occur more frequently in women who have multiple sex partners, have a recent new sex partner, or have sex with other women. Also, even though BV occurs in the vagina, new bacteria can be introduced through either vaginal, oral, or anal sex.
• Douching: Douching, the practice of rinsing out the vagina with water or a cleansing liquid, is perceived as a helpful method of practicing good hygiene. The truth is, though, that douching can disturb the natural balance of bacteria (and it is additionally associated with a number of other health problems). Disturbing this balance predisposes women to develop BV because douching can make it easier for anaerobes to overgrow.
• Genetics: Unfortunately, some women are just naturally predisposed to develop BV because the vaginal environment has a lower level of lactobacilli. Women in this category may get BV multiple times and thus must be especially attentive to the other risk factors.

Bacterial Vaginosis Complications

BV itself doesn’t typically have direct complications, and it is often viewed as more of a nuisance than a serious concern. However, recent studies have uncovered a possible link between BV and several other health concerns if it goes untreated:

• STIs: The change in vaginal microbiota causes women to be more susceptible to sexually transmitted infections like HIV, gonorrhea, chlamydia, and herpes simplex. It also makes women more likely to pass on an infection to a sex partner.
• Preterm birth: In some pregnant women, a case of bacterial vaginosis can increase the chance that the baby will be born prematurely or at an abnormally low weight.
• Pelvic inflammatory disease (PID): PID is characterized by having an infection of the upper reproductive system. The same bacterial imbalance resulting from untreated BV can also lead to anaerobes migrating from the vagina to the uterus, fallopian tubes, or ovaries. PID can, in turn, lead to infertility.
• Surgery risk: This BV imbalance can also put women at a higher risk of developing an infection after gynecological surgery such as a hysterectomy or dilation and curettage (D&C).

Bacterial Vaginosis Diagnosis

The symptoms for BV can differ greatly from person to person, so doctors usually perform an examination before diagnosing it. In addition to standard questions about previous vaginal infections or sexually transmitted diseases (STDs), the doctor will perform a pelvic exam to look for signs of infection or inflammation. If necessary, vaginal secretions can be tested for anaerobic bacteria growth and the vaginal environment can be tested to determine acidity level.

Bacterial Vaginosis Treatment

Because BV is caused by bacteria overgrowth, it is treated with antibiotics like other bacterial infections. There are several different prescription options available to you and your doctor. For all antibiotics, it’s important to complete the whole course of medication; skipping doses or ending early just makes it more likely for the infection to come back. Below are a few of the most common BV medications:

• Metronidazole: available orally or as a topical gel
• Clindamycin: available as a cream
• Tinidazole: available orally
• Secnidazole: available in granular form that can be sprinkled on a soft food

After being diagnosed with bacterial vaginosis, and while treatment is ongoing, you shouldn’t have sexual contact with anyone in order to prevent spreading the infection. If your regular sex partner is also a woman, she should get evaluated by a doctor as well; male sex partners are not at risk. It is somewhat common for a case of BV to come back within a year of the original infection. Recurring incidents may require use of medication over a longer period of time.

Prevention Methods

As noted above, BV is a disease that arises out of bacterial imbalance in the vagina. For most women, this means that there are steps that can be taken to dramatically lower the risk of developing bacterial vaginosis. Below are some methods to consider:

• Don’t douche: simply avoiding douching is one of the best ways to prevent BV
• Anal contact: don’t let objects (like toilet paper or sex toys) that touch your anus come into contact with your vagina
• Limit sex partners: having multiple sexual partners puts you at increased risk of developing BV, so by limiting the number of sex partners you’re limiting the chance of BV
• Use protection: practice safe sex in general (latex condoms for example) because of the still not understood link between sexual activity and BV
• Stay dry: wearing cotton underwear helps keep moisture away, an environment that can cause bacteria to thrive

When to Call a Doctor

Because of the potential complications resulting from nontreatment, it’s best to contact a doctor if you experience any itching, discharge, or foul smell. With a quick diagnosis and prescription for antibiotics, you’ll be on your way to healing in no time. At TrustCare, we are dedicated to providing that kind of excellent health care as quickly as possible. Stop by one of our conveniently located urgent care facilities today to get checked out!