Dr Caitlin: The Problem Of Bacterial Vaginosis

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Dr Caitlin O’Connor of Tralee Medical Centre at St Brendan’s Park on Bacterial Vaginosis…

Bacterial vaginosis (BV) is common and causes a vaginal discharge, often with a noticeable smell.

BV is not a sexually transmitted infection. It is caused by an overgrowth of normal germs (bacteria) in the vagina.

Symptoms are often mild, and BV may clear without treatment. Other cases can be treated with antibiotic medication.

Continued below…

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What is bacterial vaginosis (BV) and what causes it?

BV is a common condition of the vagina caused by an overgrowth of various germs (bacteria). It is not just one simple infection caused by one type of germ (bacterium).

The vagina normally has a mix of bacteria, but in BV the balance changes. It is not clear why this happens. As a result, certain bacteria multiply and thrive much more than usual. Some bacteria become much more prominent than they normally are.

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 (BV) and how common is it?

It is not exactly known how common BV is, because it is often so mild that women may not go to the doctor. It may be that as many as about 1 in 3 women have BV at some time in their lives.

You are more likely to get BV if:

• You are sexually active. (Women who have never had sex can get BV too. However, it is more common in women who are having sex. You can have BV whether you have sex with women or with men.)
• You have recently changed your sexual partner.
• You have a past history of sexually transmitted infections (STIs).
• You smoke.
• You have a copper coil for contraception – an intrauterine contraceptive device (IUCD).
• Your family has Afro-Caribbean origins.
• You use bubble bath.

You are less likely to get BV if:

• You use the combined oral contraceptive pill.
• Your partner has had a circumcision.
• You use condoms.

What are the symptoms of bacterial vaginosis (BV)?

The main symptom of BV is a vaginal discharge. BV is one of the most common causes of vaginal discharge in women of childbearing age.

The discharge is often white-grey in colour, and often has a fishy smell. The smell may be more noticeable during sex.

The discharge tends to be heaviest just after a period, or after sex. The discharge 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).

Note: BV is not the only cause of a vaginal discharge. Various conditions can cause discharge.

For example, another common cause of vaginal discharge is an infection caused by a yeast called thrush (candida).

Unlike BV, thrush typically causes a thicker white discharge which tends to cause itching and soreness around the vagina and vulva. STIs, such as chlamydia, may also cause vaginal discharge.

Is bacterial vaginosis (BV) a sexually transmitted disease?

No, BV can affect any woman, including those who do not have (or who have never had) sex.

However, BV is more common amongst sexually active women than amongst non-sexually active women. No germ (bacterium) is passed on between sexual partners to cause this condition.

Sexual partners of women with BV do not need any treatment. However, some cases of BV seem to be sexually related.

It may develop after a change in sexual partner. In these cases, the infection is not caught from anyone. But a change in sexual

How is bacterial vaginosis (BV) diagnosed?

The typical discharge and its characteristic fishy smell make BV likely. If you are in a stable, long-term relationship, your doctor or nurse may be happy to diagnose BV just by its typical symptoms.

However, there are some tests available that can help to confirm the diagnosis. Also, if you are pregnant, it is important to make an accurate diagnosis if you have vaginal discharge so that any infection can be treated effectively.

This will mean having one or more of the tests below.

Testing the acid level of your vagina

The discharge of BV has a typical pH level (acid/alkaline balance) compared to other causes of discharge. (The overgrowth of the germs (bacteria) of BV causes the pH to change in the vagina so that it becomes more alkaline, ie the pH rises.)

If available, your doctor or nurse may suggest that they take a sample of your discharge and test it with some pH paper. In addition, if an alkali is added to a sample of the discharge, it often causes a characteristic fishy smell.

Taking a sample (a swab)

To confirm the diagnosis, your doctor or nurse may also suggest that a swab of your discharge be taken from your vagina and sent to the laboratory for testing.

Large numbers of various bacteria that occur with BV are seen under the microscope. Your doctor or nurse may suggest that they take more than one swab from your vagina to rule out other causes of vaginal discharge.

BV and pregnancy

If you have untreated BV during pregnancy, you have a slightly increased risk of developing some complications of pregnancy. These include:

• Early labour.
• Miscarriage.
• Having your baby early (preterm birth).
• Having a low birth-weight baby.
• Developing an infection of the womb (uterus) after childbirth (postpartum endometritis).
• BV and surgery

If you have untreated BV, the chance of developing an infection of the uterus is higher following certain operations (such as termination of pregnancy or a vaginal hysterectomy).

BV and other infections

If you have untreated BV, you may have an increased risk of developing HIV infection if you have sex with someone who is infected with HIV.

You may also be more likely to pass on HIV if you have HIV and BV together. There is also some evidence that women with untreated BV may be at an increased risk of developing pelvic inflammatory disease (PID). (See separate leaflets called HIV and AIDS and Pelvic Inflammatory Disease.)

What is the treatment for bacterial vaginosis (BV)?

Not treating is an option for some women. BV often causes no symptoms, or the symptoms are mild.

Also, there is a good chance that BV will gradually clear without treatment. Any disruption in the balance of vaginal germs (bacteria) may be corrected naturally, with time.

So, if you have no symptoms or only mild symptoms, you may not need any treatment.

Overall, there is no strong evidence at the moment that live yoghurt or Lactobacillus acidophilus (found in certain commercial probiotic products) is helpful in treating or preventing BV. Antiseptics and disinfectants do not help treat BV.

Treating recurrences

If you have a recurrence of symptoms and did not have a test using a sample of your vaginal discharge (a swab) taken initially, your doctor or nurse may suggest that they take swab tests now. This is to confirm that it is BV causing your symptoms.

BV may return (recur) if you did not complete your course of antibiotics. However, even if you have completed a full course of antibiotics, BV recurs within three months in many women.

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 (BV)?

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 germs (bacteria) in the vagina:

• Do not push water into your vagina to clean it (douching). The vagina needs no specific cleaning.
• Do not add bath oils, antiseptics, scented soaps, perfumed bubble bath, shampoos, etc, to bath water.
• Do not use strong detergents to wash your underwear.
• Do not wash around your vagina and vulva too often. Once a day is usually enough

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