Bacterial Vaginosis

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Bacterial vaginosis is an infection that occurs when too much of a certain bacteria change the normal balance of bacteria in the vagina. It is a fairly common condition; in fact, it is the most common type of vaginal infection in American women, with more than 3 million cases in the US each year. Any woman can get bacterial vaginosis, but is most often seen in women ages 15-44. It is also surprisingly prevalent in pregnant women, with about 25% of expectant mothers in the United States having bacterial vaginosis. This condition is also seen in approximately 60% of women with a sexually transmitted disease.

Although bacterial vaginosis itself it not a serious condition, it can lead to more dangerous symptoms and conditions, especially if left untreated.

What is Bacterial Vaginosis?

Bacterial vaginosis is an abnormal vaginal condition that results in an overgrowth of atypical bacteria in the vagina. The environment of the vagina normally contains many lactobacilli, or “good” bacteria, and a small number of other types of bacteria, known as anaerobes. Lactobacilli help to keep vaginal pH low and prevent an overgrowth of other types of organisms. An imbalance between these types of bacteria, leading to too many anaerobes, can result in bacterial vaginosis.

Bacteria that have been associated with bacterial vaginosis include:

  • Lactobacillus
  • Prevotella
  • Mobiluncus
  • Bacteriodes
  • Peptostreptococcus
  • Fusobacterium
  • Ceillonella
  • Eubacterium
  • Mycoplasma hominis
  • Ureaplasma urealyticum
  • Streptoccus viridans
  • Atopobium vaginae

Also known as BV, nonspecific vaginitis, and gardnerella, this condition affects mostly women of childbearing age. Bacterial vaginosis is typically a mild, short-term condition, and usually resolves within days to weeks.

If left untreated, bacterial vaginosis can lead to:

  • Pregnancy complications – such as premature or low-weight babies
  • Pelvic inflammatory disease (PID) – this may lead to infertility or ectopic pregnancy
  • Increased risk of contracting a sexually transmitted infection – such as HIV, gonorrhea, and chlamydia
  • Increased risk of infection – particularly a higher risk of infection following surgeries affecting the reproductive system, such as hysterectomy or abortion

After treatment of bacterial vaginosis, recurrence within 3-12 months is common, and may require additional treatment.

What Causes Bacterial Vaginosis?

Scientists have not determined the exact cause of bacterial vaginosis. While the condition is a result of an imbalance of bacteria in the vagina, experts are not quite sure what causes the bacteria to become out of balance.

Despite this, certain activities, conditions, and populations are at increased risk for bacterial vaginosis. Activities such as unprotected sexual intercourse, multiple sex partners, a new sex partner, having sex with someone who has bacterial vaginosis, or frequent douching can upset the balance of bacteria in the vagina and increase the risk of getting bacterial vaginosis. Women who do not use dental dams or whose partners do not use condoms during sex may also be at increased risk of bacterial vaginosis infection. Having an intrauterine device (IUD) may also increase your risk for bacterial vaginosis, especially if you also have irregular bleeding. While this condition is more common in women who are sexually active, it can also occur in women who are not sexually active as well.

This condition is common in pregnant women, most likely due to the hormonal changes that happen during pregnancy.

African American women also have a higher risk of getting bacterial vaginosis. This condition is twice as common in African American women than in Caucasian women.

Women who smoke are also twice as likely to get bacterial vaginosis when compared to women who are non-smokers.

Recent antibiotic use has also been associated with bacterial vaginosis.

Some women’s natural vaginal environment lacks an adequate number of lactobacilli bacteria, and this may predispose these women to bacterial vaginosis.

You cannot get bacterial vaginosis from toilet seats, bedding, swimming pools, or by touching contaminated objects.

Signs and Symptoms of Bacterial Vaginosis

Some patients – in fact, about half of women with bacterial vaginosis – do not experience any symptoms with this condition.

Other women may experience symptoms such as:

  • Abnormal vaginal discharge – it may look grayish-white or yellow
  • Vaginal itching
  • Vaginal odor – fishy smell, often worse after sex
  • Vaginal dryness
  • Vaginal inflammation
  • Vulval itch
  • Painful or burning urination

Prevention of Bacterial Vaginosis

Because the exact cause of the spread of bacterial vaginosis is not known, there are no known ways to prevent this condition. Despite this, several steps can be taken to reduce the risk of developing bacterial vaginosis. These include:

  • Abstaining from sexual intercourse
  • Limiting the number of sexual partners you have
  • Abstaining from douching
  • Refraining from smoking

Further, good hygiene can help reduce the risk of getting bacterial vaginosis. Several methods for maintaining proper hygiene include:

  • Washing the anus and vagina every day
  • Wiping from front to back after urination or defecation
  • Wearing cotton underwear
  • Wearing pants that loosely fit the crotch – this can aid in allowing air flow and preventing moist conditions that may foster infections and bacterial growth

In addition to the methods above, minimizing vaginal irritation by avoiding hot tubs and whirlpool spas, using mild, non-deodorant soaps, and unscented tampons or pads can help to prevent bacterial vaginosis.

A self-help approach to preventing bacterial vaginosis, particularly recurrence of an episode, involves methods that attempt to increase the number of “good” bacteria in your vagina and re-establish a balanced environment. One such method is probiotic therapy – eating certain types of yogurt, supplements, or other foods containing lactobacilli. While current research is inconsistent and does not show a clear benefit, some patients find probiotic therapy helpful in clearing up symptoms of bacterial vaginosis.

Treatment of Bacterial Vaginosis

Some cases of bacterial vaginosis may go away on their own within a few days. If symptoms continue to persist, speaking with a medical provider can help provide relief from symptoms.

When seeking treatment for bacterial vaginosis, your physician will likely want to rule out the possibility of other serious infections, such as the STDs gonorrhea and chlamydia. Symptoms of bacterial vaginosis may also mimic those found in yeast infections and the STD trichomoniasis, and these conditions should also be ruled out prior to diagnosing and treating bacterial vaginosis.

Treatments for bacterial vaginosis can include a prescription cream, gel, or other medication. Typically antibiotics are prescribed. Such medications include:

  • Metronidazole by mouth (Flagyl)
  • Metronidazole to the affected area (Vandazole)
  • Erythromycin (Ery-tab)
  • Clindamycin by mouth (Cleocin)
  • Clindamycin to the affected area (Clindesse)
  • Tinidazole

It is important to take all medications you are given, as directed, even if your symptoms go away. Antibiotic treatment usually lasts for 7 days, even though bacterial vaginosis typically clears up within 2 or 3 days with treatment.

Avoid having sexual intercourse during your course of treatment, and continue your course of treatment even during menses.

Avoid alcohol consumption with medications, especially if treated with metronidazole or tinidazole, as the combination of alcohol and these medications can cause severe nausea and vomiting.

Treating bacterial vaginosis can also help reduce your risk for STDs.

Male sex partners of females who get bacterial vaginosis do not need to be treated. However, bacterial vaginosis can be spread to female sex partners. Female sex partners of women with bacterial vaginosis should seek medical care as well.

When Should I Call a Doctor?

Any woman who is experiencing unusual vaginal discharge should be evaluated by a medical professional.

If you have never had a vaginal infection and are currently experiencing any vaginal symptoms, you should consult with a medical provider.

If you develop lower belly pain and a fever higher than 101 degrees Fahrenheit, contact your doctor right away.

Pregnant women should seek medical care as soon as possible, to avoid increased risks of pregnancy complications.

If you have experienced vaginal infections before, but symptoms are different, consult with a medical provider, who can help you identify symptoms and diagnose your condition.

Female sex partners of women with bacterial vaginosis also need to be treated, as the condition can spread through sexual contact.

You should seek additional medical care if you are still experiencing symptoms a few days after completing a course of antibiotics.