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Bacterial Vaginosis (BV)

Overview

Your vagina contains some bacteria that reside normally and maintain an optimum environment. Bacterial vaginosis (BV) is a condition in which there is an alteration in the types and quantity of normal bacteria found in your vagina. One type of bacteria overgrows and disrupts the normal balance resulting in a vaginal infection. It is one of the commest infections of women in their reproductive ages. You may have a vaginal discharge of greyish white color and a fishy smell. Rarely, it can cause mild itching. However, most of the time, there are no symptoms. Some people need treatment with antibiotics, while in others, the infection goes away on its own. Once diagnosed, it warrants treatment as it predisposes to other infections like sexually transmitted diseases, HIV, etc. It can also lead to preterm delivery in pregnant females.

Your vagina contains some bacteria that reside normally and maintain an optimum environment. Bacterial vaginosis (BV) is a condition in which there is an alteration in the types and quantity of normal bacteria found in your vagina. One type of bacteria overgrows and disrupts the normal balance resulting in a vaginal infection. It is one of the commest infections of women in their reproductive ages. You may have a vaginal discharge of greyish white color and a fishy smell. Rarely, it can cause mild itching. However, most of the time, there are no symptoms. Some people need treatment with antibiotics, while in others, the infection goes away on its own. Once diagnosed, it warrants treatment as it predisposes to other infections like sexually transmitted diseases, HIV, etc. It can also lead to preterm delivery in pregnant females.

Causes

Just like in the gut, the vagina also harbors some bacteria, which are necessary to maintain an optimum environment. Due to some causes, there is an overgrowth of one type of bacteria, disrupting the normal milieu. Some studies have identified the overgrowth of the bacterium Gardnerella vaginalis and some other anaerobic bacteria over lactobacillus. Having multiple sexual partners, douching, decreased estrogen levels are some of the etiologic factors behind its evolution.

Just like in the gut, the vagina also harbors some bacteria, which are necessary to maintain an optimum environment. Due to some causes, there is an overgrowth of one type of bacteria, disrupting the normal milieu. Some studies have identified the overgrowth of the bacterium Gardnerella vaginalis and some other anaerobic bacteria over lactobacillus. Having multiple sexual partners, douching, decreased estrogen levels are some of the etiologic factors behind its evolution.

Risk Factors

The following risk factors may predispose you to the development of bacterial vaginosis:

Exercising frequent douching: Washing your vagina with cleaning agents may lead to bacterial vaginosis. It is not needed to douche the vagina.

Having new or multiple sexual partners: Many people might be suffering from some sexual infections that you may not know about and can cause different infections and bacterial vaginosis.

Recent antibiotic use: Recent use of a broad-spectrum antibiotic may affect the normal flora of the vagina and cause bacterial vaginosis.

Being pregnant: Pregnancy is accompanied by many changes in the body, hormones, and fluids to prepare the body to nurture a baby. These changes can lead to bacterial vaginosis.

Bubble baths: Taking bubble baths in the tubs is one of the risk factors.

Implanted IUD: women with an intrauterine contraceptive device are prone to suffer from BV.

Presence of other STD: Co-occurrence of other sexually transmitted diseases may lead to the development of bacterial vaginosis.

Female homosexuality: According to some studies, having sex with females may increase your chances of bacterial vaginosis as it may spread from one female to the other.

The following risk factors may predispose you to the development of bacterial vaginosis:

Exercising frequent douching: Washing your vagina with cleaning agents may lead to bacterial vaginosis. It is not needed to douche the vagina.

Having new or multiple sexual partners: Many people might be suffering from some sexual infections that you may not know about and can cause different infections and bacterial vaginosis.

Recent antibiotic use: Recent use of a broad-spectrum antibiotic may affect the normal flora of the vagina and cause bacterial vaginosis.

Being pregnant: Pregnancy is accompanied by many changes in the body, hormones, and fluids to prepare the body to nurture a baby. These changes can lead to bacterial vaginosis.

Bubble baths: Taking bubble baths in the tubs is one of the risk factors.

Implanted IUD: women with an intrauterine contraceptive device are prone to suffer from BV.

Presence of other STD: Co-occurrence of other sexually transmitted diseases may lead to the development of bacterial vaginosis.

Female homosexuality: According to some studies, having sex with females may increase your chances of bacterial vaginosis as it may spread from one female to the other.

Epidemiology

Bacterial vaginosis most commonly occurs in a woman of reproductive age. It is a very common disease worldwide. In the USA, it affects around 30% of women between the ages of 14-49. It is more common in African American women for unknown reasons. Some of the factors linked with increased prevalence are smoking cigarettes, obesity, induced abortion, being unmarried. 

Bacterial vaginosis most commonly occurs in a woman of reproductive age. It is a very common disease worldwide. In the USA, it affects around 30% of women between the ages of 14-49. It is more common in African American women for unknown reasons. Some of the factors linked with increased prevalence are smoking cigarettes, obesity, induced abortion, being unmarried. 

Signs And Symptoms

Most of the women do not show any symptoms, some of them may have:

  • Vaginal discharge, which may be grey to white.
  • The typical fishy smell of the discharge, especially after sexual intercourse. This might be the first and initial symptom noticed by a patient.
  • Mild vaginal itching or irritation,
  • Burning sensation while passing urine
  • Rarely, pain during sex.

Diagnosis

After taking a history of your symptoms, your doctor may perform a physical examination with special emphasis on pelvic examination to look for the presence and characteristics of a discharge, its smell, color, consistency. You may be advised laboratory tests which include testing for bacteria in the discharge by simple staining method and by growing bacteria in the lab (culture). Discharge may be tested for fishy odor by whiff test, its ph, which will be alkaline in this case, and presence of clue cells which are pathognomic of bacterial vaginosis.  

Urine may be collected to test for urinary tract infection. If you have risk factors, you may be tested for other STDs, especially gonorrhea, chlamydia, and HIV. 

After taking a history of your symptoms, your doctor may perform a physical examination with special emphasis on pelvic examination to look for the presence and characteristics of a discharge, its smell, color, consistency. You may be advised laboratory tests which include testing for bacteria in the discharge by simple staining method and by growing bacteria in the lab (culture). Discharge may be tested for fishy odor by whiff test, its ph, which will be alkaline in this case, and presence of clue cells which are pathognomic of bacterial vaginosis.  

Urine may be collected to test for urinary tract infection. If you have risk factors, you may be tested for other STDs, especially gonorrhea, chlamydia, and HIV. 

Differential Diagnosis

Following diseases may present like bacterial vaginosis:

Treatment

Bacterial vaginosis is a bacterial infection that will need a course of antibiotics. The most common antibiotics prescribed are metronidazole or clindamycin, which may be given in cream or gel form to be applied into the vagina. You may also be prescribed oral antibiotics to be taken by mouth, e.g., Tinidazole, Secnidazole, etc. Most people get treated by a single course of 7 days of antibiotics. Few may need two courses. Women with recurrent infections may benefit from extended courses of metronidazole. Although treating an infected woman's male sexual partner is usually unnecessary, bacterial vaginosis can spread between female sexual partners. Female partners should be tested and treated if necessary. Pregnant women with symptoms should be treated as soon as possible to reduce the risk of premature birth or low birth weight. Even if your symptoms go away, keep taking your medicine or applying the cream or gel as directed by your doctor. The risk of recurrence is increased if treatment is stopped too soon.

Bacterial vaginosis is a bacterial infection that will need a course of antibiotics. The most common antibiotics prescribed are metronidazole or clindamycin, which may be given in cream or gel form to be applied into the vagina. You may also be prescribed oral antibiotics to be taken by mouth, e.g., Tinidazole, Secnidazole, etc. Most people get treated by a single course of 7 days of antibiotics. Few may need two courses. Women with recurrent infections may benefit from extended courses of metronidazole. Although treating an infected woman's male sexual partner is usually unnecessary, bacterial vaginosis can spread between female sexual partners. Female partners should be tested and treated if necessary. Pregnant women with symptoms should be treated as soon as possible to reduce the risk of premature birth or low birth weight. Even if your symptoms go away, keep taking your medicine or applying the cream or gel as directed by your doctor. The risk of recurrence is increased if treatment is stopped too soon.

Prognosis

Bacterial vaginosis is a bacterial infection that is easily cured with antibiotics. If not cured, it can lead to complications like preterm delivery in pregnant women, increased chances of other sexually transmitted diseases, pelvic inflammatory disease, infections after gynecological surgery, etc. It is not contagious and is not transferred from one person to another or male partners. However, there are chances of its recurrence after treatment. 

Bacterial vaginosis is a bacterial infection that is easily cured with antibiotics. If not cured, it can lead to complications like preterm delivery in pregnant women, increased chances of other sexually transmitted diseases, pelvic inflammatory disease, infections after gynecological surgery, etc. It is not contagious and is not transferred from one person to another or male partners. However, there are chances of its recurrence after treatment. 

Prevention

You can prevent yourself from getting bacterial vaginosis by;

  • Avoiding douching or using cleaning agents for the vagina.
  • Keep things that have touched your anus away from your vagina, like your hand while washing poop, toilet paper, sex toys.
  • Adapting safe sex (using condoms)
  • Having limited sexual partners.
  • Not having sex with someone suffering from STD.
  • Avoid sex until completing your full course of antibiotics.

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