Bacterial vaginosis (BV)

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Bacterial vaginosis
Micrograph showing normal vaginal flora versus bacterial vaginosis on Pap stain
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Vaginal discharge, fishy odor
Complications	Preterm birth, pelvic inflammatory disease
Onset	Reproductive age
Duration	Can be chronic
Types	N/A
Causes	Imbalance of vaginal flora
Risks	Multiple sexual partners, douching, smoking
Diagnosis	Clinical
Differential diagnosis	Vaginal candidiasis, trichomoniasis
Prevention	Safe sex, avoiding douching
Treatment	Antibiotics such as metronidazole or clindamycin
Medication	N/A
Prognosis	N/A
Frequency	Common
Deaths	N/A

Bacterial vaginosis

Clue cells in bacterial vaginosis

Bacterial vaginosis (BV) is a common vaginal infection affecting women of reproductive age. It is caused by an imbalance of the normal bacterial flora in the vagina, leading to an overgrowth of certain types of bacteria. While many women with bacterial vaginosis may not have any symptoms, those who do may experience an unpleasant odor, vaginal discharge, itching, or burning during urination.

Causes

The vagina is home to a diverse array of bacterial species, which help to maintain a healthy vaginal environment. In bacterial vaginosis, there is an overgrowth of certain types of bacteria, such as Gardnerella vaginalis, which can disrupt the balance of the normal flora. The exact reason why some women develop BV is not well understood, but certain factors may increase the risk, including:

Douching Having multiple sexual partners Using intrauterine devices (IUDs) for contraception

Symptoms

Some women with bacterial vaginosis may not experience any symptoms. However, when symptoms are present, they may include:

Vaginal discharge, often grayish-white in color A strong, fishy odor, especially after sexual intercourse Vaginal itching or irritation Burning during urination

Diagnosis

Bacterial vaginosis is diagnosed through a combination of clinical evaluation and laboratory testing. A healthcare provider will perform a pelvic examination and collect a sample of vaginal discharge for microscopic examination. The presence of "clue cells" (vaginal epithelial cells coated with bacteria) on a wet mount slide is a key diagnostic finding. Other diagnostic criteria include a positive "whiff test" (a fishy odor when a potassium hydroxide solution is added to the discharge) and an elevated vaginal pH.

Bacterial vaginosis workup

Normal and BV flora

Treatment

Bacterial vaginosis is typically treated with antibiotics, such as metronidazole (Flagyl) or clindamycin (Cleocin). These medications can be taken orally or applied directly to the vagina as a cream or gel. It is important for women to complete the full course of treatment, even if their symptoms improve before the medication is finished.

In addition to antibiotics, maintaining a healthy vaginal environment may help to prevent recurrences of bacterial vaginosis. Strategies to promote healthy vaginal flora include:

• Avoiding douching
• Using unscented soaps and feminine hygiene products
• Wearing breathable, cotton underwear
• Practicing safe sex

What is bacterial vaginosis?

Bacterial vaginosis (BV) is a condition that happens when there is too much of certain bacteria in the vagina. This changes the normal balance of bacteria in the vagina.

How common is bacterial vaginosis?

Bacterial vaginosis is the most common vaginal infection in women ages 15-44.

How is bacterial vaginosis spread?

Researchers do not know the cause of BV or how some women get it. We do know that the infection typically occurs in sexually active women. BV is linked to an imbalance of “good” and “harmful” bacteria that are normally found in a woman’s vagina. Having a new sex partner or multiple sex partners, as well as douching, can upset the balance of bacteria in the vagina. This places a woman at increased risk for getting BV.

We also do not know how sex contributes to BV.  There is no research to show that treating a sex partner affects whether or not a woman gets BV. Having BV can increase your chances of getting other STDs.

BV rarely affects women who have never had sex.

You cannot get BV from toilet seats, bedding, or swimming pools.

How can I avoid getting bacterial vaginosis?

Doctors and scientists do not completely understand how BV spreads. There are no known best ways to prevent it.

Bacterial vaginosis workup

The following basic prevention steps may help lower your risk of developing BV:

• Not having sex;
• Limiting your number of sex partners; and
• Not douching.

I’m pregnant. How does bacterial vaginosis affect my baby?

Pregnant women can get BV. Pregnant women with BV are more likely to have babies born premature (early) or with low birth weight than pregnant women without BV. Low birth weight means having a baby that weighs less than 5.5 pounds at birth.

Treatment is especially important for pregnant women.

How do I know if I have bacterial vaginosis?

Many women with BV do not have symptoms. If you do have symptoms, you may notice:

• A thin white or gray vaginal discharge;
• Pain, itching, or burning in the vagina;
• A strong fish-like odor, especially after sex;
• Burning when urinating;
• Itching around the outside of the vagina.

How will my doctor know if I have bacterial vaginosis?

A health care provider will examine your vagina for signs of vaginal discharge. Your provider can also perform laboratory tests on a sample of vaginal fluid to determine if BV is present.

Can bacterial vaginosis be cured?

BV will sometimes go away without treatment. But if you have symptoms of BV you should be checked and treated. It is important that you take all of the medicine prescribed to you, even if your symptoms go away. A health care provider can treat BV with antibiotics, but BV may return even after treatment. Treatment may also reduce the risk for some STDs.

Male sex partners of women diagnosed with BV generally do not need to be treated. BV may be transferred between female sex partners.

What happens if I don’t get treated?

BV can cause some serious health risks, including:

• Increasing your chance of getting HIV if you have sex with someone who is infected with HIV;
• If you are HIV positive, increasing your chance of passing HIV to your sex partner;
• Making it more likely that you will deliver your baby too early if you have BV while pregnant;
• Increasing your chance of getting other STDs, such as chlamydia and gonorrhea. These bacteria can sometimes cause pelvic inflammatory disease (PID), which can make it difficult or impossible for you to have children.

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