What Is Bacterial vaginosis?

Overview

Bacterial vaginosis is a mild infection of the vagina  caused by bacteria. Normally, there are a lot of “good” bacteria and some “bad” bacteria in the vagina. The good types help control the growth of the bad types. In women with bacterial vaginosis, the abalance is upset. There are not enough good bacteria and too many bad bacteria.

Bacterial vaginosis is a type of vaginal inflammation caused by the overgrowth of bacteria naturally found in the vagina, which upsets the natural balance.

Women in their reproductive years are most likely to get bacterial vaginosis, but it can affect women of any age. The cause isn’t completely understood, but certain activities, such as unprotected sex or frequent douching, increase your risk.

Bacterial vaginosis is usually a mild problem that may go away on its own in a few days. But it can lead to more serious problems. So it’s a good idea to see your doctor and get treatment.

• Bacterial vaginosis (BV) is an abnormal vaginal condition that is characterized by vaginal dischargeand results from an overgrowth of atypical bacteria in the vagina. It is not a true bacterial infection but rather an imbalance of the bacteria that are normally present in the vagina.
• Bacterial vaginosis is not dangerous, but it can cause disturbing symptoms.
• Most women do not experience symptoms of bacterial vaginosis, but when they do they are:
  • vaginal discharge, and
  • vaginal odor.
• In diagnosing bacterial vaginosis, it is important to exclude other serious vaginal infections, such as the STDsgonorrhea and Chlamydia.
• Treatment options for relief of bacterial vaginosis include prescription oral antibiotics and vaginal gels. Metronidazole(Flagyl) is one option for treating bacterial vaginosis.
• Serious complications of bacterial vaginosis can occur during pregnancy, and recurrence is possible even after successful treatment.

What is bacterial vaginosis?

Bacterial vaginosis also is referred to as nonspecific vaginitis, is a vaginal condition that can produce vaginal discharge and results from an overgrowth of certain kinds of bacteria in the vagina. In the past, the condition was called Gardnerella vaginitis, after the bacteria that were thought to cause the condition. However, the newer name, bacterial vaginosis, reflects the fact that there are a number of species of bacteria that naturally live in the vaginal area and may grow to excess, rather than a true infection with foreign bacteria, such as occurs with many sexually-transmitted disease (STDs).

The Gardnerella organism is not the sole type of bacteria causing the symptoms. Other kinds of bacteria that can be involved in bacterial vaginosis are Lactobacillus, Bacteroides, Peptostreptococcus, Fusobacterium, Eubacterium, as well as a number of other types. When these multiple species of bacteria that normally reside in the vagina become unbalanced, a woman can have a vaginal discharge with a foul odor.

Symptoms

Bacterial vaginosis signs and symptoms may include:

• Thin, gray, white or green vaginal discharge
• Foul-smelling “fishy” vaginal odor
• Vaginal itching
• Burning during urination

Many women with bacterial vaginosis have no signs or symptoms.

When to see a doctor

Make an appointment to see your doctor if:

• You have vaginal discharge that’s new and associated with an odor or fever. Your doctor can help determine the cause and identify signs and symptoms.
• You’ve had vaginal infections before, but the color and consistency of your discharge seems different this time.
• You have multiple sex partners or a recent new partner. Sometimes, the signs and symptoms of a sexually transmitted infection are similar to those of bacterial vaginosis.
• You try self-treatment for a yeast infection with an over-the-counter treatment and your symptoms persist.

Causes

Bacterial vaginosis results from overgrowth of one of several bacteria naturally found in your vagina. Usually, “good” bacteria (lactobacilli) outnumber “bad” bacteria (anaerobes). But if there are too many anaerobic bacteria, they upset the natural balance of microorganisms in your vagina and cause bacterial vaginosis.

Researchers have had difficulty determining exactly what causes bacterial vaginosis. At present, it seems to be that a combination of multiple bacteria must be present together for bacterial vaginosis to develop. Bacterial vaginosis typically features a reduction in the number of the normal hydrogen peroxide-producing lactobacilli in the vagina. Simultaneously, there is an increase in concentration of other types of bacteria, especially anaerobic bacteria (bacteria that grow in the absence of oxygen). As a result, the diagnosis and treatment are not as simple as identifying and eradicating a single type of bacteria. Why the bacteria combine to cause the unbalance is unknown.

Certain risk factors have been identified that increase the chances of developing bacterial vaginosis. These risk factors for BV include:

• multiple or new sexual partners,
• IUDs (intrauterine devices) for birth control,
• recent antibiotic use,
• vaginal douching, and
• cigarette smoking.

However, the role of sexual activity in the development of the condition is not fully understood, and although most experts believe that bacterial vaginosis does not occur in women who have not had sexual intercourse, others feel that the condition can still develop in women who have not had sexual intercourse.

Experts are not sure what causes the bacteria in the vagina to get out of balance. But certain things make it more likely to happen. Your risk of getting bacterial vaginosis is higher if you:

• Have more than one sexpartner or have a new sex
•  

You may be able to avoid bacterial vaginosis if you limit your number of sex partners and don’t douche or smoke.

Risk factors

Risk factors for bacterial vaginosis include:

• Having multiple sex partners or a new sex partner.Doctors don’t fully understand the link between sexual activity and bacterial vaginosis, but the condition occurs more often in women who have multiple sex partners or a new sex partner. Bacterial vaginosis also occurs more frequently in women who have sex with women.
• The practice of rinsing out your vagina with water or a cleansing agent (douching) upsets the natural balance of your vagina. This can lead to an overgrowth of anaerobic bacteria, and cause bacterial vaginosis. Since the vagina is self-cleaning, douching isn’t necessary.
• Natural lack of lactobacilli bacteria.If your natural vaginal environment doesn’t produce enough of the good lactobacilli bacteria, you’re more likely to develop bacterial vaginosis.

Complications

Bacterial vaginosis doesn’t generally cause complications. Sometimes, having bacterial vaginosis may lead to:

• Preterm birth.In pregnant women, bacterial vaginosis is linked to premature deliveries and low birth weight babies.
• Sexually transmitted infections.Having bacterial vaginosis makes women more susceptible to sexually transmitted infections, such as HIV, herpes simplex virus, chlamydia or gonorrhea. If you have HIV, bacterial vaginosis increases the odds that you’ll pass the virus on to your partner.
• Infection risk after gynecologic surgery.Having bacterial vaginosis may increase the risk of developing a post-surgical infection after procedures such as hysterectomy or dilation and curettage (D&C).
• Pelvic inflammatory disease (PID).Bacterial vaginosis can sometimes cause PID, an infection of the uterus and the fallopian tubes that can increase the risk of infertility.

Prevention

To help prevent bacterial vaginosis:

• Minimize vaginal irritation.Use mild, nondeodorant soaps and unscented tampons or pads.
• Don’t douche.Your vagina doesn’t require cleansing other than normal bathing. Frequent douching disrupts the vaginal balance and may increase your risk of vaginal infection. Douching won’t clear up a vaginal infection.
• Avoid a sexually transmitted infection.Use a male latex condom, limit your number of sex partners or abstain from intercourse to minimize your risk of a sexually transmitted infection.

Diagnosis

Pelvic exam

To diagnose bacterial vaginosis, your doctor may:

• Ask questions about your medical history.Your doctor may ask about any previous vaginal infections or sexually transmitted infections.
• Perform a pelvic exam.During a pelvic exam, your doctor visually examines your vagina for signs of infection, and inserts two fingers into your vagina while pressing on your abdomen with the other hand to check your pelvic organs for signs that may indicate disease.
• Take a sample of vaginal secretions.This may be done to check for an overgrowth of anaerobic bacteria in your vaginal flora. Your doctor may examine the vaginal secretions under a microscope, looking for “clue cells,” vaginal cells covered with bacteria that are a sign of bacterial vaginosis.
• Test your vaginal pH.Your doctor may check the acidity of your vagina by placing a pH test strip in your vagina. A vaginal pH of 4.5 or higher is a sign of bacterial vaginosis.

Treatment

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.

Recurrence

It’s common for bacterial vaginosis to recur within three to 12 months, despite treatment. Researchers are exploring treatments for recurrent bacterial vaginosis. If your symptoms recur soon after treatment, talk with your doctor about treatments. One option may be extended-use metronidazole therapy.

A self-help approach is lactobacillus colonization therapy — which attempts to boost the number of good bacteria in your vagina and re-establish a balanced vaginal environment — possibly accomplished by eating certain types of yogurt or other foods containing lactobacilli. While current research shows there may be some benefit to probiotic therapy, more research is needed on the subject.

How common is bacterial vaginosis?

• Bacterial vaginosis is a common condition.
• It is the most common vaginal complaint in women of childbearing age.
• Studies have shown that approximately 29% of women in the U.S. are affected.
• Bacterial vaginosis is found in about 25% of pregnantwomen in the U.S. and approximately 60% of women who have an STD.

Is bacterial vaginosis an STD or yeast infection?

• Bacterial vaginosis is not the same thing as an STD or yeast infection.
• Bacterial vaginosis is not dangerous, but it can cause disturbing symptoms.
• Any woman with an unusual discharge should be evaluated so that more serious infections such as Chlamydiaand gonorrhea can be excluded.
• Symptoms may also mimic those found in yeast infections of the vagina and trichomoniasis(an STD), and these conditions must also be excluded in women with vaginal symptoms.

Is bacterial vaginosis contagious?

Although bacterial vaginosis is not considered to be a contagious condition, the role of transmissibility of bacteria among individuals is not fully understood. Since having multiple or new sexual partners increases a woman’s risk of developing bacterial vaginosis, this suggests that spread of bacteria among individuals may alter the balance of bacteria in the vagina and potentially predispose to development of bacterial vaginosis. However, since bacterial vaginosis also occurs in celibate women, other causative factors must also play a role in its development.

It is not possible to contract bacterial vaginosis from toilet seats, swimming pools, or hot tubs, or from touching contaminated objects.

Is there a test to diagnose bacterial vaginosis?

When a woman notices an unusual vaginal discharge and reports this to her doctor, he or she will ask her a series of routine questions to help distinguish mild from more serious conditions. Additional issues that might indicate the presence of a more serious condition include:

• fever,
• pelvic pain,
• new or multiple sexual partners (especially with unprotected intercourse), and
• a history of sexually-transmitted infections (STDs).

In addition to these questions, the doctor will perform a pelvic exam. During the exam, the doctor notes the appearance of the vaginal lining and cervix. The doctor will also perform a manual exam of the ovaries and uterus. The cervix is examined for tenderness, which might indicate a more serious infection. The doctor may collect samples to check for Chlamydia or gonorrhea infection.

Examining the vaginal discharge under the microscope can help distinguish bacterial vaginosis from infections such as yeast vaginitis (vaginal yeast infection, Candidiasis) and trichomoniasis. A sign of bacterial vaginosis under the microscope is a vaginal cell called a clue cell. Clue cells are vaginal cells covered with bacteria and are believed to be the most reliable diagnostic sign of bacterial vaginosis. In addition to clue cells, women with bacterial vaginosis have fewer of the normal vaginal bacteria, called lactobacilli. A vaginal pH greater than 4.5 is also suggestive of bacterial vaginosis. Cultures of bacteria are generally not useful in establishing the diagnosis of bacterial vaginosis since it is caused by bacteria that are normally present in the vagina.

What home remedies help soothe and treat bacterial vaginosis (BV)?

There are no home remedies or natural remedies for bacterial vaginosis. Antibiotics are the only treatment. It is important to note that douching (rinsing the interior of the vagina) will not help with BV, and here is no proven medical benefit of douching. In fact, douching may flush bacteria farther up the genital tract into the uterus or Fallopian tubes, potentially worsening the condition.

Studies of yogurt/lactobacilli probiotic preparations (either taken orally or applied to the vagina), which are designed to help reestablish the lactobacilli population in the vagina, have not shown consistent results in treating bacterial vaginosis.

How is it treated?

Doctors usually prescribe an antibiotic to treat bacterial vaginosis. They come as pills you swallow or as a cream or capsules (called ovules) that you put in your vagina. If you are pregnant, you will need to take pills.

Bacterial vaginosis usually clears up in 2 or 3 days with antibiotics, but treatment goes on for 7 days. Do not stop using your medicine just because your symptoms are better. Be sure to take the full course of antibiotics.

Antibiotics usually work well and have few side effects. But taking them can lead to a vaginal yeast infection. A yeast infection can cause itching, redness, and a lumpy, white discharge. If you have these symptoms, talk to your doctor about what to do.

What is the prognosis for a person with bacterial vaginosis?

Bacterial vaginosis can be cured with antibiotics. Even after a woman has been cured, however, BV often recurs. A second course of antibiotics is necessary if a woman experiences recurrent bacterial vaginosis that produces symptoms.

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