Bacterial Vaginosis (BV)- Causes and Treatment

What is Bacterial Vaginosis

Bacterial vaginosis (BV) is a mild infection in the vagina. It develops when there’s an imbalance between the “good” bacteria in the vagina that are helpful and the “bad” bacteria that can cause problems.

Bacterial vaginosis may cause pain, itching, and bad-smelling discharge. But most girls with BV don’t notice any symptoms and that’s not necessarily a good thing. Symptoms alert us to signs of trouble. Girls who don’t know they have BV might not get treated for it. BV may be mild, but if it isn’t treated it can lead to other problems.

BV is the most common vaginal infection affecting young women. Although it’s not considered a sexually transmitted disease (STD), the chances of developing bacterial vaginosis seem to increase with the number of sexual partners a woman has. You don’t need to be having sex to get BV, though. Girls who’ve never had sex also can get it.

Epidemiology

BV is the most common infection of the vagina in women of reproductive age. The percentage of women affected at any given time varies between 5% and 70%. BV is most common in parts of Africa, and least common in Asia and Europe. In the United States, about 30% of those between the ages of 14 and 49 are affected. Rates vary considerably between ethnic groups within a country.

Risk factors

Unprotected sexual activity with a new partner or multiple partners can increase your risk of getting bacterial vaginosis. That means sex without a condom or oral sex without a dental dam. Having a female sex partner may also increase your risk of bacterial vaginosis.

Frequent douching (using a cleanser or water to clean inside the vagina) or using medicated or perfumed soaps, shower gels or bubble baths also increase your chances of getting BV.

If you smoke you are also at increased risk of getting BV.

Causes

Not much is known about how women get BV. Any woman can get BV, but there are certain things that can upset the normal balance of bacteria in the vagina, raising your risk of BV:

• Having a new sex partner or multiple sex partners
• Douching
• Using an intrauterine device (IUD) for birth control
• Not using a condom

BV is more common among women who are sexually active, but it is not clear how sex changes the balance of bacteria. You cannot get BV from:

• Toilet seats
• Bedding
• Swimming pools
• Touching objects around you

Symptoms of bacterial vaginosis

The symptoms of BV may differ from patient to patient and according to the stage of the infection.

Vaginal Discharge

This is the most common and the first symptom to appear in infected women. The vaginal discharge ranges in consistency and color over time. It can look watery and whitish or thick and yellow. The discharge is very distinctive from normal vaginal discharge. It will also smell foul and putrid with a strong note of ammonia.

Itching

This is another common symptom of BV which occurs in most women. The patient will complain of itching in the vaginal area. This is especially experienced in the inner walls of the vagina and the clitoris. It is best to avoid scratching as much as possible. This is because scratching the area will aggravate the itching even more. It can even lead to bleeding.

Spotting

This is not seen very often but some women do complain of it. Light spotting may occur when the infection is more advanced. Bleeding may also occur when the area is irritated due to scratching or intercourse.

Discomfort

This is an obvious symptom of any infection. The patient will feel uncomfortable in the vaginal area because the skin is irritated by the bacterial activity. Some women say that they feel a peculiar discomfort while sitting or wearing very tight underclothes.

Some also say that the area feels very dry and scratchy internally. The infection may also cause slight inflammation of the vaginal walls which can cause undesirable symptoms like tenderness and sensitivity.

Discomfort during sexual intercourse

This happens because the region is already injured by the infection. Further friction due to sex will aggravate the discomfort even more. Some women find sex painful during infection while others suffer from vaginal dryness. It is usually advised to abstain from sex until the patient is completely free of infection.

Complications of Bacterial Vaginosis

Most of the time, BV goes away without any complications when properly treated. But if it’s not treated, BV can increase a girl’s chances of certain health problems:

Increased chance of getting an STD: Girls with BV are more likely to get STDs like herpes, chlamydia, gonorrhea, and HIV.

Increased chance of pregnancy complications: When BV isn’t treated; a woman may have more problems when she gets pregnant, such as premature birth, low birth weight, infection, and possibly miscarriage.

Infections like BV are one reason why girls who are having sex need to get regular gynecological checkups and STD tests. Even if a girl doesn’t know that she has an infection, doctors and nurse practitioners can diagnose and treat it to help prevent complications.

Diagnosis of bacterial infection

Your health care provider will check to see if you have at least 3 out of 4 of the following symptoms:

• Thin white discharge
• Clue cells
• pH>4.5
• Fishy odor (from discharge)

There are two tests that can help provide accurate results right away:

Vaginal pH test: The doctor will take a sample of your discharge and analyze the pH level. If it is higher than 4.5, you most likely have bacterial vaginosis.

Cotton swab sample: Your vaginal discharge will be analyzed to check if the bacterial infection is actually responsible for the symptoms because a yeast infection can have similar symptoms to bacterial vaginosis.

Treatment and medications

To treat bacterial vaginosis, your doctor may prescribe one of the following medications:

Metronidazole (Flagyl, Metrogel-Vaginal, others): This medicine may be taken as a pill by mouth (orally). Metronidazole is also available as a topical gel that you insert into your vagina. To reduce the risk of stomach upset, abdominal pain or nausea while using this medication, avoid alcohol during treatment and for at least one day after completing treatment — check the instructions on the product.

Clindamycin (Cleocin, Clindesse, others): This medicine is available as a cream that you insert into your vagina. Clindamycin cream may weaken latex condoms during treatment and for at least three days after you stop using the cream.

Tinidazole (Tindamax): This medication is taken orally. Tinidazole has the same potential for stomach upset and nausea as oral metronidazole does, so avoid alcohol during treatment and for at least one day after completing treatment.

It’s generally not necessary to treat an infected woman’s male sexual partner, but bacterial vaginosis can spread between female sexual partners. Female partners should seek testing and may need treatment. It’s especially important for pregnant women with symptoms to be treated to help decrease the risk of premature delivery or low birth weight.

Take your medicine or use the cream or gel for as long as your doctor prescribes it even if your symptoms go away. Stopping treatment early may increase the risk of recurrence.

Prevention of BV

BV is not completely understood by scientists, and the best ways to prevent it are unknown. However, it is known that BV is associated with having a new sex partner or having multiple sex partners.

The following basic prevention steps can help reduce the risk of upsetting the natural balance of bacteria in the vagina and developing BV:

• Be abstinent
• Limit the number of sex partners
• Do not douche
• Use all of the medicine prescribed for the treatment of BV, even if the signs and symptoms go away.