KENNETH B. GOODRICH, M.D.
What is Bacterial Vaginosis and what are the symptoms?
Bacterial Vaginosis (BV) is a common condition of the vagina caused by an overgrowth of
various bacteria (germs). It is not just a simple infection caused by one type of bacterium.
The main symptom of BV is a vaginal discharge. BV is the most common cause of
vaginal discharge in women of childbearing age. The discharge is often a white-grey color,
and often has a fishy smell. The smell may be most noticeable when having sex.
The discharge tends to be heaviest just after a period, and after having sex.
The discharge of BV does not usually cause itch or soreness around the vagina and vulva.
Many women with BV do not have any symptoms (up to half of cases). These women may be
found to have BV by chance when vaginal swabs are taken during a routine pelvic exam.
Note: BV is not the only cause of a vaginal discharge. Various conditions can cause a
discharge. For example, the second most common cause of a discharge is due to infection
caused by a yeast called Candida. Unlike BV, yeast infection typically causes a thicker white
discharge which tends to cause itch and soreness around the vagina and vulva.
What causes Bacterial Vaginosis?
BV is not caused by a single bacterium (germ). In BV, an 'overgrowth' of various bacteria
occurs in the vagina. It is not clear why this happens. Normally, there are a number of different
types of harmless bacteria in the vagina. These bacteria help in the defense against
harmful germs (such as candida ). In BV, there is a change in the balance of the normal
bacteria in the vagina, and certain bacteria multiply and thrive much more than usual.
Some bacteria become much more prominent than they normally are.
Doctors describe these changes as " a change in the bacterial flora of the vagina from mainly
lactobacillus species to high concentrations of anaerobic bacteria."
BV is not caused by poor hygiene. In fact, excessive washing of the vagina may alter the
normal balance of bacteria in the vagina, which may make BV more likely to develop.
Who gets Bacterial Vaginosis and how common is it?
At least 1 in 10 women have BV at some time in their life. It may be much more common
than this as many cases are mild and cause no symptoms. (BV is at least twice as
common as vaginal thrush.) Any woman can be affected by BV. BV is more common in
women who have an intra-uterine contraceptive device (IUD). One study found that about
half of women using an intrauterine contraceptive device had at least one episode of BV
over a two year period.
Is Bacterial Vaginosis a sexually transmitted disease?
Most likely it is sexually transmitted, however, BV can affect any woman, including those
who do not have sex. No bacterium is passed on that causes this condition. Sexual partners
of women with BV are treated in this practice, and this process seems to decrease the
recurrent discharge rates in our patients. It may develop after a change in sexual partner.
However, a change in sexual partner may affect the balance of normal bacteria in the vagina.
How is Bacterial Vaginosis diagnosed?
The typical discharge, and its characteristic fishy smell, makes BV likely.
The discharge of BV has a typical acid level (pH) compared to other causes of discharge.
The overgrowth of the bacteria of BV causes the pH to change.) In addition, if an alkali is
added to a sample of the discharge, it often causes a characteristic fishy smell.
To help clarify the diagnosis, a sample (swab) of the discharge may be sent for testing.
Large numbers of various bacteria that occur with BV are seen under the microscope.
Vaginal cultures are usually performed if your insurance covers it.
What are the possible complications with Bacterial Vaginosis?
Pregnancy - If you have untreated BV during pregnancy, you have an increased risk of
developing some complications of pregnancy. For example, early labor, miscarriage, and
infection of the uterus (womb) after childbirth.
Surgery - If you have untreated BV, the chance of developing an infection of the uterus
is higher following certain operations. For example, following a termination of pregnancy
or a vaginal hysterectomy. However, antibiotics are given before various operations of
the uterus if you have BV which usually prevents these infections.
HIV - If you have untreated BV, you have an increased risk of developing HIV infection
if you have sex with someone who is infected with HIV.
What is the treatment for Bacterial Vaginosis?
Metronidazole
A course of metronidazole tablets is the common treatment. It clears BV in about 7-8 in
10 cases. Read the leaflet that comes with the tablets for a full list of possible side-effects
and cautions. However, main points to note about metronidazole include:
The usual dose is twice a day for seven days. A single dose of 2 grams is an alternative,
although this may be less effective and may cause more side-effects.
Some people feel sick, and may vomit when they take metronidazole. This is less likely
to occur if you take the tablets straight after food.
A metallic taste is also a common side-effect. Do not drink any alcohol while taking
metronidazole, and for at least 48 hours after stopping treatment. The interaction with
alcohol can cause vomiting and other problems.
Breastfeeding: metronidazole can get into breast milk, but is not thought to affect
breastfed babies. However, to play safe, the standard 7-day course with the lower
dose is preferred so as a baby does not get a large dose. If it is essential to use the
large 2-gram single dose then it should be taken after the last breastfeed of the evening,
at the start of the overnight breastfeeding break, to limit exposure to the baby.
Alternative antibiotic treatments
Metronidazole vaginal gel or clindamycin vaginal cream placed inside the vagina
can be used if you prefer a topical treatment, or have unpleasant side-effects with
metronidazole tablets. Note: clindamycin vaginal cream can cause weakening of
condoms. Therefore, during treatment and for five days after treatment with
clindamycin vaginal cream, do not rely on condoms to protect against pregnancy
and sexually transmitted diseases.
Not treating is an option if you are not pregnant.
BV often causes no symptoms or the symptoms are mild. Also, there is a good
chance that BV will gradually clear without treatment, as the balance of bacteria
in the vagina may correct itself. However, if you are pregnant you will usually be
advised to take antibiotic treatment to prevent the increased risks during pregnancy
if you have BV (described above).
Treating recurrences
BV recurs within three months in about half of women who have been successfully
treated. If it does recur, a repeat course of antibiotics will usually be successful. A small
number of women have repeated episodes of BV, and need repeated courses of antibiotics.
How can I prevent further episodes of Bacterial Vaginosis?
Most episodes of BV occur for no apparent reason, and cannot be prevented.
However, the following are thought to help prevent some episodes of BV. The logic
behind these tips is to try not to upset the normal balance of bacteria in the vagina.
- Do not push water into your vagina to clean it (douching).
- Do not add bath oils, detergents, bubble bath, etc, to bath water.
- Do not wash around your vagina too often. Once a day is usually enough.
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KENNETH GOODRICH, M.D. - OBSTETRICIAN- GYNECOLOGIST
Certified by the American Board of Obstetrics and Gynecology
Specializing in General Obstetrics and Gynecology, Minimally Invasive Gynecological Surgery- Hysterectomies
and Uterine Fibroids, HPV treatment for Women and Men, Surgery on Obese Women, Chronic Vaginal
Discharges, Sexually Transmiited Diseases, Menopause, Abnormal Bleeding ,Cellulite Reduction and
Aesthetic Services
