Bacterial Vaginosis (BV): Causes, Symptoms, and Treatments

What is bacterial vaginosis (BV)?

Bacterial vaginosis (BV) is a vaginal infection caused by an imbalance of bacteria in the vagina. This can lead to symptoms such as abnormal vaginal discharge, odour, and irritation. 

It is one of the most common vaginal infections among women of reproductive age.

What are the causes of BV?

The exact cause of BV is not fully understood. However, it involves an imbalance of the vaginal microbiota, characterised by a decrease in beneficial Lactobacillus species and an overgrowth of harmful bacteria such as Gardnerella, Prevotella, Mobiluncus, Megasphaera, and Sneathia species.

Types of BV

Based on the severity and the persistence of your symptoms, BV can be classified into different types:

1. Acute BV 

   • Characterised by sudden onset of symptoms such as increased vaginal discharge with a fishy odour, itching, and irritation.

2. Recurrent BV 

   • Occurs when symptoms of BV recur within a short period after treatment, indicating persistent or recurrent infection. It’s important to follow up with your healthcare provider to manage and treat the condition effectively.

What are the signs and symptoms of BV?

Many people with BV often do not show symptoms. However, when symptoms do occur, they can include:

• Thin, watery vaginal discharge
• Grayish-white or greenish vaginal discharge with a fishy odour
• Vaginal itching or irritation
• Burning sensation during urination
• Discomfort or pain during sexual intercourse

BV symptoms can be similar to other vaginal infections. It is important to visit your doctor for a proper diagnosis.

What are the treatments for BV?

Treatment for bacterial vaginosis typically involves antibiotics to eliminate the overgrowth of harmful bacteria. Treatment options may include:

• Oral antibiotics (e.g., metronidazole or tinidazole)
• Intravaginal antibiotics (e.g., metronidazole gel or clindamycin cream)
• Probiotics or lactobacillus supplements may be used as adjunctive therapy to restore the balance of vaginal microbiota.

FAQs

Who is at risk of BV?

While anyone with a vagina can be susceptible to getting bacterial vaginosis, certain factors may increase the risk, including:

• Having multiple sexual partners or new sexual partners
• Vaginal douching or use of feminine hygiene products
• Smoking
• Hormonal changes (e.g. pregnancy, menstruation, menopause)
• Use of certain medications (e.g. antibiotics, corticosteroids)
• Presence of other vaginal infections or conditions (e.g. sexually transmitted infections)

How is BV diagnosed?

Your doctor may perform the following:

• Clinical examination 

  • May perform a pelvic examination to assess the appearance of the vaginal discharge and check for signs of inflammation or infection.

• Whiff test

  • A sample of vaginal discharge mixed with potassium hydroxide (KOH) may produce a characteristic fishy odour, known as a positive Whiff test.

• Microscopic examination 

  • Microscopic examination of vaginal discharge samples may reveal the presence of clue cells (vaginal epithelial cells coated with bacteria), which are suggestive of bacterial vaginosis.

• pH testing 

  • Measurement of vaginal pH may show an elevated pH (>4.5), which is characteristic of bacterial vaginosis.

These diagnostic tests help the doctors confirm the presence of bacterial vaginosis (BV), and tailor treatment accordingly.

Can BV be cured?

Yes, BV can be effectively treated and cured with appropriate medical intervention. It's essential to complete the full course of antibiotics as prescribed by doctor, even if your symptoms improve before completing the treatment. This helps ensure the complete eradication of the infection and reduces the risk of recurrence.

What are the complications of BV?

BV doesn’t typically cause complications. But, if left untreated, it can lead to complications such as:

• Increased risk of sexually transmitted infections (STIs), including HIV
• Pelvic inflammatory disease (PID)
• Increased risk of preterm birth or low birth weight in pregnant women
• Endometritis (inflammation of the uterine lining) following gynaecologic procedures or childbirth

How to prevent BV?

To reduce the risk of BV and prevent recurrence, you may take several preventive measures, including:

• Limiting the number of sexual partners and practicing safer sex
• Avoiding vaginal douching or use of irritating feminine hygiene products
• Abstaining from smoking, as it is associated with an increased risk of BV
• Practicing good hygiene, including wiping from front to back after using the bathroom
• Seeking prompt medical evaluation and treatment for vaginal symptoms or infections

What are the impact of BV on sexual health?

• Dyspareunia 

  • Bacterial vaginosis may cause discomfort or pain during sexual intercourse (dyspareunia) due to vaginal irritation or inflammation. Addressing BV symptoms and restoring vaginal health may improve sexual function and intimacy.

• Partner treatment 

  • While BV is not considered an STI, male partners of women with recurrent BV may harbour BV-associated bacteria on the penis or genital skin. Partner treatment with antibiotics may be considered in cases of recurrent or persistent BV to reduce the risk of reinfection.