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BACTERIAL VAGINOSIS

Bacterial Vaginosis (BV) is an inflammation which occurs in the vagina and includes sevreal strains of bacteria. Many women mistakenly believe that yeast infections are the most common type of vaginal infection but bacterial vaginosis is the most frequently occuring vaginal infection.  It is sometimes accompanied by discharge, odor, pain, itching, or burning.

The primary cause of bacterial vaginosis is an overgrowth of anaerobic bacteria that is found naturally in the vagina and the Gardnerella organism. E. coli, a germ that is a normal inhabitant of the rectum can also cause BV if it is spread to the vaginal area. The vagina normally contains mostly "good" bacteria, and fewer "harmful" bacteria. When the vaginal balance is disrupted by the overgrowth of the "harmful" bacteria, another protective bacterium - lactobacilli is unable to adequately perform its normal function. Lactobacilli normally provide a natural disinfectant (similar to hydrogen peroxide) which helps maintain the healthy and normal balance of microorganisms and PH (measure of acidity) in the vagina.

Other factors which may contribute include:

  • Hot weather
  • poor health (lowered, natural resistence)
  • poor hygiene
  • use of an intrauterine device (IUD)
  • vaginal douching
  • multiple sex partners
  • menopause
  • diabetes

Women with BV may have an abnormal vaginal discharge with an unpleasant odor. Some women report a strong fish-like odor, especially after intercourse. Discharge, if present, is usually white or gray; it can be thin. Women with BV may also have burning during urination or itching around the outside of the vagina, or both. However, most women are unaware they are infected until they are diagnosed during a routine pelvic exam with a Pap smear. It is important that you do not use vaginal douches during the few days preceding your visit to your gynecologist as douching can hide signs of infections.

In most cases, BV causes no complications. But there are some serious risks from BV including:

  • Having BV can increase a woman's susceptibility to HIV infection if she is exposed to the HIV virus.
  • Having BV increases the chances that an HIV-infected woman can pass HIV to her sex partner.
  • Having BV has been associated with an increase in the development of an infection following surgical procedures such as a hysterectomy or an abortion.
  • Having BV while pregnant may put a woman at increased risk for some complications of pregnancy, such as preterm delivery.
  • BV can increase a woman's susceptibility to other STDs, such as herpes simplex virus (HSV), chlamydia, and gonorrhea.

The bacteria that cause BV can sometimes infect the uterus (womb) and fallopian tubes (tubes that carry eggs from the ovaries to the uterus). This type of infection is called pelvic inflammatory disease (PID). PID can cause infertility or damage the fallopian tubes enough to increase the future risk of ectopic pregnancy and infertility. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube which can rupture.

A health care provider must examine the vagina for signs of BV and perform laboratory tests on a sample of vaginal fluid to look for bacteria associated with BV.

Although BV will sometimes clear up without treatment, all women with symptoms of BV should be treated to avoid complications. Usually there is no need to treat a women's sex partner. However, if the woman has repeated infections, treatment of the partner may be helpful.

Treatment is especially important for pregnant women. All pregnant women who have ever had a premature delivery or low birth weight baby  (low birth weight is less than 5.5 pounds) should be considered for a BV examination, regardless of symptoms, and should be treated if they have BV. All pregnant women who have symptoms of BV should be checked and treated.

BV is treatable with antibiotics prescribed by a health care provider. Two different antibiotics are recommended as treatment for BV: metronidazole or clindamycin.  Either can be used with non-pregnant or pregnant women, but the recommended dosages differ.These medications can be taken by mouth or inserted into the vagina as a cream, ovule, or gel.

BV can recur after treatment. It may require long-term or repeated treatments. Sometimes when bacterial vaginosis keeps coming back it may mean that you have an STD and your doctor may test for other infections.

Tips for Vaginal Infection Prevention

  • Always wipe front to back after bowel movements to prevent E.coli from the rectum entering the vagina.
  • Use condoms during sex
  • Do not douche. It is better to let the vagina cleanse itself
  • Do not use feminine hygiene sprays or scented deodorant tampons or toilet paper 
  • Thoroughly clean diaphragms, cervical caps, and spermicide applicators after each use. 
  • Keep the vulvar (outer vagina) area clean and dry. Change wet or damp underwear or pads.
  • Wash before and after sex with water and a mild soap.
  • Avoid tight clothing and always wear white cotton underwear that help absorb moisture and allow air to circulate
  • Use all of the medicine prescribed for treatment of BV, even if the signs and symptoms go away.

Self-treatment with over-the-counter (OTC) remedies for yeast infections will NOT cure a bacterial infection and may increase your risks of complications.

Sources

American Congress of Obstetricians and Gynecologists. Vaginitis: Causes and Treatments. July 2005. www.acog.org.

Centers for Disease Control and Prevention.  Sexually Transmitted Diseases Treatment Guidelines, 2006.  MMWR 2006: 55 (No. RR-11)

Hillier S and Holmes K. Bacterial vaginosis. In: K. Holmes, P. Sparling, P. Mardh et al (eds). Sexually Transmitted Diseases, 3rd Edition. New York: McGraw-Hill, 1999, 563-586.





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