Bacterial Vaginosis

1 What Is Bacterial Vaginosis?

Bacterial vaginosis is a health condition that involves an overgrowth of bacteria naturally found in the vagina. It is a bacterial infection that causes the vagina to emit a strong, fishy smell. If you have this odor, it is very likely you have bacterial vaginosis. It is not normal, but the good news is that the condition is easy to diagnose and treat.

Bacterial vaginosis is thought to be a very common health complaint, and women experience it once or even several times a year. It is the most common health condition in reproductive-age women. Fortunately, it is a relatively harmless condition easily treated with antibiotics and has no long-term effects.

Compared to most sexually-transmitted infections, bacterial vaginosis is easily diagnosed, treated, and prevented. It is not considered a sexually-transmitted infection, because the condition is caused by many factors other than sexual contact. However, the condition can be passed to or acquired from others. Sex is a risk factor for bacterial vaginosis, although the condition can also occur in sexually inactive persons.

Bacterial vaginosis is very common due to the nature of the vagina. The vagina is actually a habitat for millions of various bacteria. These bacteria are termed vaginal flora, and they are a mix of benign, beneficial, and harmful bacteria. These bacteria feed on sugars and acids produced naturally in the vagina and live in balance with each other. The number of your vaginal flora is brought under control by the immune system, a limited food supply, and the number of good bacteria.

Bacterial vaginosis occurs when something disrupts the balance of your vaginal flora, causing bacteria numbers to grow and cause infection. It can be caused by many things, including the use of certain vaginal washes, sticking to certain sexual practices, and using certain medications. It happens to nearly every woman, because it has plenty of instigators.

The closest equivalent of bacterial vaginosis in males is bacterial penile infections, which are not caused by sexually-transmitted infections. It is very rare in males, because the penis does not secrete sugars or acids for bacteria to consume. In addition, urination basically flushes out bacteria that manage to get inside the penis. 

You can easily diagnose and treat bacterial vaginosis. Prescription medications and maintaining proper hygiene can treat and prevent it. In many cases, bacterial vaginosis resolves on its own.

Although the condition is easily treated, bacterial vaginosis can cause complications, especially in those with certain health issues. There are treatments and preventive measures for bacterial vaginosis which you can do at home. Almost all women can recall having signs and symptoms of bacterial vaginosis. You must have it treated right away, since it is easy to treat.

Bacterial Vaginosis vs. Yeast Infection

There is a big difference between bacterial vaginosis and a yeast infection, which are both common infections in women. Bacteria cause bacterial vaginosis, while yeasts cause yeast infections. The yeast Candida albicans is the main cause of yeast infections in women. Different medications are used to treat yeast infections.

Amongbacterial vaginosis symptoms, the most easily identifiable is a fishy odor in the vagina. All women have a unique vaginal scent, and it changes during the menstrual cycle. As any doctor will tell, the odor of the vagina is not always pleasant. That is true especially when you sweat a lot after exercise or while wearing underwear or pants made from synthetic fabrics. Having menses and using menstrual products also changes the odor of the vagina. However, the vagina should never have an odor that smells like fish.

Aside from the foul, fishy odor, the vagina may have a whitish or grey discharge that is thin and watery. It may also itch noticeably. Some may experience burning urination as well. However, some cases of bacterial vaginosis do not have signs and symptoms.

Most cases of bacterial vaginosis are uncomplicated and do not grow worse. However, you have to watch out for other symptoms that indicate a serious infection or the presence of complications. Those symptoms include:

  • High fever at 38°C or higher
  • New or different vaginal discharge
  • Having multiple sex partners
  • Persisting symptoms after trying home treatments and remedies

Suspected bacterial vaginosis symptoms need to be checked right away if you have sexually-transmitted infections, yeast infections, or are HIV-positive. In these cases, bacterial vaginosis may be caused by worsening infection. You also need to be checked by the doctor if you are pregnant or recently had pelvic surgery. 

Bacterial vaginosis often occurs due to the physiology of the vagina. The vagina has its own flora of different microorganisms, and they exist there because they feed on the sugars present in the vaginal discharge. The vaginal flora consist of good and bad bacteria. Anaerobic bacteria (bacteria that thrive without oxygen) tend to comprise the majority of bad bacteria in the vagina. These anaerobic types often thrive on additional moisture and lack of sufficient air circulation.

The good bacteria, especially the Lactobacillus species, keep the numbers of bad bacteria in check. Anything that disturbs this balance can cause the bad bacteria to proliferate and produce infection. In most cases, many things we do upset the balance of flora in the vagina. 

2 Symptoms

Most women with bacterial vaginosis may not have any signs or symptoms. If symptoms occur, they may include:

  • Increased amounts of abnormal vaginal discharge: The discharge can be watery or foamy, and grayish white in color.  
  • A strong foul-smell, often described as a "fishy"" vaginal odor, particularly after sexual intercourse
  • Itching or irritation around the vagina
  • Burning sensation while urinating

You will need to see your doctor if you develop new vaginal symptoms and:

  • You have never had a vaginal infection before: Consulting your doctor will help you know the cause and make you aware of the signs and symptoms.
  • You have had vaginal infections before, but the new symptoms seem to be different.
  • You have had multiple sex partners or a new partner recently.
  • You think you have a sexually transmitted infection. Signs and symptoms of some sexually transmitted infections resemble those of bacterial vaginosis.
  • You have done self-treatment with an over-the-counter anti-yeast medication to treat your fungal infection, but your symptoms persist, you develop a fever, or have a very unpleasant vaginal odor.

3 Causes

In most cases, the exact cause of bacterial vaginosis is not known. However, you are more likely to develop it if you have these risk factors:

  • Douching: Rinsing the vagina with douches used to be a common practice. Many women douche regularly to clean the vagina, remove odors, or do it during periods or after sex to reduce chances of pregnancy. However, doing so is associated with bacterial vaginosis and other vaginal infections. Douching changes the makeup of the vaginal flora, disturbing the balance that promotes the growth of bad bacteria. 
  • Using feminine washes: Most feminine products contain fragrances and antiseptics to clean and “perfume” the vagina. However, feminine products tend to disrupt the balance of vaginal flora. Most of these products are heavily marketed as safe, but they can actually cause bacterial vaginosis. Using bubble baths and heavily-scented soaps to clean the vagina also has the same effect.
  • Having an IUD: An IUD, or intrauterine device, is a contraceptive implant made of metal and plastic that is inserted into the uterus. For reasons that remain unclear, IUD users have higher rates of bacterial vaginosis compared to non-users. IUDs may increase the risk especially in users with irregular menses.
  • Having multiple sex partners: Having sex with two or more partners is a significant factor, because it increases the amount of bacteria entering the vagina when having sex, thus disrupting the balance of vaginal flora. “Multiple” is defined as having more than one partner in the last twelve months. Having unprotected sex with a woman or with an uncircumcised male partner greatly increases the risk.
  • Using antibiotics or certain contraceptive pills: Oral and intravenous antibiotics are prescribed to treat bacterial infections, but, in some cases, they cause bacterial vaginosis. Antibiotics kill a great deal of bacteria in the body, including those in the vagina that disrupt the balance of vaginal flora. On the other hand, some contraceptive pills change the makeup of vaginal discharge, which is conducive to the growth of bad bacteria.  
  • Lack of natural lactobacilli: Some women have poor or unbalanced vaginal flora, which have low numbers of lactobacilli, putting them at risk for infections.

There are so many risk factors for bacterial vaginosis that all women can have it once or more in a year. 

4 Making a Diagnosis

You need to go to the doctor, preferably a gynecologist, whenever you have problems “down there.” Doctors can easily tell if you have bacterial vaginosis or other infections in the vaginal tract.

The doctor can determine if you have bacterial vaginosis or a sexually-transmitted disease after a physical exam and lab tests. You might feel uncomfortable, as the doctor will ask you to remove your underwear and lay down on a specialized bed with legs apart to visualize your vagina. He or she may use a device called a speculum, which is inserted into the vaginal canal to visualize the inside of your vagina and look for the presence of inflammation, discharge, or check for sexually-transmitted diseases.

The doctor may also order tests on your discharge. In the lab, your discharge is examined for acidity (loss of acidity is highly suggestive of infection) and for the characteristic fishy smell (yes, the lab technician will take a “whiff” of the discharge). When examined under the microscope, discharge with bacterial vaginosis will show up as cells coated with bacteria.

Of course, your doctor will ask about your medical history and any drugs you took recently. You may have to bring some medical papers and previous prescriptions for the checkup. 

5 Treatment

Antibiotics are commonly used for bacterial vaginosis treatment. Although the condition is common, doctors will choose to treat bacterial vaginosis right away. Again, treatment is urgent if you are pregnant or have other health problems.

Depending on the type of bad bacteria, your doctor may prescribe certain antibiotics to deal with it. Here are the medicines commonly used to treat bacterial vaginosis:

  • Metronidazole: Known under the brand names Flagyl and Metrogel-Vaginal, this is a broad-spectrum antibiotic that kills a lot of bacteria in the body. Metronidazole is available in pills or as a gel that is inserted into the vagina. Note that you cannot consume alcohol while taking metronidazole.
  • Clindamycin: Also known as Cleocin and Clindesse, this is another antibiotic. For bacterial infections in the vagina, such as bacterial vaginosis, it is available in a cream that you put into the vagina. Note that, being a cream, it can weaken latex condoms, and therefore these should not be used.
  • Tinidazole: Also known as Tindamax, this is an antibiotic and anti-protozoal drug. It can be used if you have bacterial vaginosis and trichomoniasis (a sexually-transmitted infection caused by a protozoan) at the same time. You also need to avoid alcohol while taking tinidazole.

If you have a female sexual partner, she needs to be notified and treated as well. Make sure to finish the course of antibiotics as prescribed. Not taking or not finishing antibiotics can cause the bacteria to become resistant, making the infection harder to treat.

Bacterial vaginosis is known to have a high rate of recurrence. Many patients tend to have it again within three to twelve months, even with proper treatment. Note that the condition has many causes, which explains its high rate of recurrence. In case of recurrence, go to the doctor again and seek treatment.  

You may find over-the-counter medicines, creams, or supplements promising to treat bacterial vaginosis. However, there is no proof that they cure bacterial vaginosis, so you should not use them.

Home Remedies for Bacterial Vaginosis

There are some good natural remedies for bacterial vaginosis. You could try probiotics, which may help reduce recurrence. However, you have to take probiotics on a daily basis and you must use a premium supplement; ask your doctor for a good product.

You can reduce the likelihood of recurrence by maintaining basic hygiene. Avoid panties made from synthetic, non-breathable fabrics, tight-fitting clothing, feminine products, and douching. If you have problems with odor after sex, consider using a condom.

Wash your vagina with a mild soap and water, wipe the vagina from front to back, and stick to cotton underwear. Make sure to change underwear at least daily, and change when the undies become wet, soiled, or after exercise. To remove unpleasant smells, shower after exercise or sweating.

Bacterial vaginosis is a common health problem among women. Some find it disgusting because of its tendency to occur again. The good thing is that doctors can easily treat it.  

6 Prevention

It may not be possible to completely prevent bacterial vaginosis as its causes are not understood fully.

However, you can reduce your risk of developing this infection if you follow these steps:

  • Minimize vaginal irritation: Avoid hot tubs and whirlpool spas. Cleanse your outer genital area with warm water only, avoid using soaps as these can irritate your vagina. After bathing, dry the genital area well to prevent irritation. Always wipe from front to back that is from your vagina to your anus to avoid fecal material from entering your vagina.
  • Do not douche: Your vagina is self-cleansing, and does not need cleaning other than normal bathing. Repetitive douching removes some normal bacteria that reside in your vagina that actually fight against infections. Therefore, douching may raise your risk of bacterial vaginosis.
  • Practice methods that avoid sexually transmitted infections: Use a latex condom during sexual intercourse, completely abstain from intercourse, or avoid multiple sex partners to minimize your risk of getting bacterial vaginosis or sexually transmitted infections.

7 Risks and Complications

Although many women experience bacterial vaginosis often and it is easily treated, it does have complications. If you have it during pregnancy, you are at risk of pre-term birth and giving birth to a baby with low birth weight.

Bacterial vaginosis is particularly unwelcome after having surgery in the vagina or pelvis, as in the case of vaginal childbirth, hysterectomy, or caesarian section. It increases your risk of having a post-surgery infection, which requires hospitalization.

Bacterial vaginosis greatly increases your risk of sexually-transmitted infections. Having high numbers of bad bacteria does not protect you from microorganisms that cause diseases like gonorrhea, chlamydia, or HIV. In addition, it also increases your risk of pelvic inflammatory disease, a condition that features an infection in the uterus and fallopian tubes. Pelvic inflammatory disease reduces your fertility. 

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