What is BV in medical terms?
What is bacterial vaginosis?
Bacterial vaginosis is a mild bacterial infection of the vagina. The vagina houses many organisms, both good and bad. The good bacteria are known as the Lactobacilli and the bad ones are known as the anaerobes. The good bacteria keep the growth of the bad ones under control. Therefore, no infection arises in the vagina.
Normally, there is a balance between these Lactobacilli and anaerobes. In bacterial vaginosis, this balance is disrupted. The good bacteria reduce in number and lose their ability to keep the bad ones under control. Therefore the anaerobes multiply more and become powerful enough to cause an infection.
Bacterial vaginosis is not a serious condition. It is transient and will go away within a few days on its own. However, sometimes it can lead to more serious problems therefore it is wise to seek for treatment as early as possible.
Bacterial vaginosis is the most common vaginal infection in women aged between 15 to 44 years. It is also a common infection among pregnant women. It is more common among sexually active women. Although it is rare, it is possible to occur in sexually inactive women as well.
What are the causes of bacterial vaginosis?
The main reason behind bacterial vaginosis is due to the imbalance between the lactobacilli and anaerobes.
In a normally healthy adult woman, their vagina consists of naturally occurring bacteria known as Lactobacilli. These bacteria fight off with other infectious bacteria and prevent infection. These infectious bacteria are known as the anaerobes.
Normally, there is a balance between the lactobacilli and anaerobes. However, lactobacilli are strong and control the growth of anaerobes. In situations where the number of lactobacilli reduce, the anaerobes slowly multiply and increase in number as they have an opportunity to grow. So, when anaerobes overgrow, bacterial vaginosis results.
The exact cause for this imbalance is not yet known but several risk factors have been identified. These include:
- Unprotected sexual intercourse
- Multiple sexual partners
- Douching – This means washing or spraying water into the vagina
- Use of antibiotic
- Use of vaginal medications
- Cigarette smoking
How sex contributes to the development of bacterial vaginosis is not known. However, suffering with bacterial vaginosis also increases your risk of developing other sexually transmitted diseases.
Bacterial vaginosis do not usually transmit to your male partner as it is NOT a sexually transmitted disease. However, contaminated toilet seats, bedding and swimming pools are not found to be modes of transmission.
What are the signs and symptoms of bacterial vaginosis?
Most women, approximately 75% who develop bacterial vaginosis are asymptomatic. The rest develops symptoms such as
- Abnormal vaginal discharge which has a characteristic fish like foul smelling odor and has a thin, grey or white color. The fish like odor is due to the chemicals produced by the anaerobic bacteria.
- Itching or irritation of the vagina externally
- Pain in the vagina
- Burning sensation of the vagina
- Burning sensation during urination
The symptoms of bacterial vaginosis are aggravated during menstruation and sexual intercourse. This is because blood and semen react with bacteria which results in the release of odorous chemicals.
Can a man get bacterial vaginosis from a woman?
No, men usually do not get infected with bacterial vaginosis. It is a disease of the women. However, although it is not that common, it is possible for the bacteria causing bacterial vaginosis be deposited on the tip of the penis of men causing an infection of the tip of the penis known as balanitis.
Since males cannot get bacterial vaginosis, they generally do not need to be treated for bacterial vaginosis.
How is bacterial vaginosis diagnosed?
When you consult your health care professional, they will start by taking a full, detailed history from you. Some of the questions they may be interested in asking you will be
- What are the symptoms?
- Have you identified any factors that seem to aggravate the condition?
- Are you sexually active and if so are you confined to more than one partner?
- Do you smoke?
- Have you been using antibiotics for a long period of time?
- Are you taking any vaginal medications?
These questions are not asked to invade your private space, but to come to an accurate diagnosis and to find out the risk factors that would have led to this condition.
Next, your health care provider will carry out a complete physical examination of your vagina. Here, they will examine the vaginal discharge and the walls of the vagina and cervix. If a vaginal discharge is present at the time of examination, this will be collected on to a vaginal swab as a sample to be sent for laboratory confirmation of bacterial vaginosis.
⦁ Wet mount – The vaginal discharge is observed under the microscope for bacteria, white blood cells and clue cells. The presence of clue cells signifies that you have bacterial vaginosis.
⦁ Whiff test
⦁ Vaginal pH – Bacterial vaginosis increases the pH of vaginal discharge
What is the whiff test?
This is a test used in the diagnosis of bacterial vaginosis. Your doctor will collect a sample of your vaginal discharge onto a microscopic slide and add a drop of 10% KOH or ad KOH directly to the speculum after vaginal examination. KOH is an alkaline substance which reacts with the discharge and causes the release of certain volatile amines from the vaginal discharge. These amines are a product of the anaerobic bacteria in the vaginal discharge and it releases a characteristic fishy odor. The release of this fishy odor usually means that you have bacterial vaginosis.
The whiff test is positive in about 70% of the patients diagnosed with bacterial vaginosis.
Can BV clear up on its own? Is there a cure for bacterial vaginosis?
Yes, bacterial vaginosis is curable. As said earlier, bacterial vaginosis is a transient disease. Not all cases of bacterial vaginosis require treatment. Most cases of bacterial vaginosis go away on its own without any treatment. However if your symptoms persist for some time, visit your healthcare provider. Once you start treatment, the infection will go away within 2 to 3 days.
How is bacterial vaginosis treated?
Bacterial vaginosis is a bacterial infection therefore treatment is with antibiotics. They may be prescribed to you in the form of either pill to be taken by mouth or as a cream to be applied on the vagina. If you are pregnant, you will be given pills.
2 to 3 days after taking antibiotics, the infection usually goes off but the treatment will be continued up to a week. It is important that you follow the instructions as given by your doctor and complete the full round of antibiotics as prescribed, even if the symptoms go away. If you do not follow this, there is a high chance of recurrence of the disease and this time it will be harder to treat because then the bacteria may have developed resistance to these antibiotics. In such cases, you will need new antibiotic treatment.
The following antibiotics may be prescribed to you:
- Metronidazole – To be taken orally
- Tinidazole – To be taken orally
- Clindamycin – As a topical treatment to be inserted into the vagina.
Taking these antibiotics has an excellent outcome on the condition. However, as with any other drug, these ones also have side effects. All of the above drugs have similar side effects. Some of the common side effects include nausea, vomiting and headaches.
Bacterial vaginosis can recur a few weeks to years later and such cases will require long term treatment.
What happens if you do not treat bacterial vaginosis?
If you do not treat bacterial vaginosis, one of the 3 outcomes can occur. It may completely go away, recur again or may go on to produce serious complications.
Some of the serious complications that you may develop if bacterial vaginosis is left untreated are:
- Pregnancy complications: Untreated bacterial vaginosis during pregnancy may lead to early delivery or low birth weight babies.
- Sexually transmitted diseases: Leaving bacterial vaginosis untreated increases your risk of other sexually transmitted diseases such as Herpes Simplex Virus (HSV), Human Immunodeficiency Virus (HIV), Chlamydia and Gonorrhea.
- Pelvic inflammatory disease (PID): This is an infection of the reproductive organs which increases the risk of infertility.
These are some of the serious complications with sadistic outcome. So, treat bacterial vaginosis while it is still a mild and harmless infection.
How is bacterial vaginosis prevented?
Reduce the irritation on your vagina
- Do not use soap to clean your vagina.
- Avoid hot tubs and whirlpool spas.
- Wear cotton underwear to prevent irritation of you vagina.
Douching basically means to spray or shower your vagina with water. This is not advisable as it will only wash away the ‘good’ bacteria from your vagina making you more susceptible for bacterial vaginosis.
Although bacterial vaginosis is not a sexually transmitted infection, sex is known to be a major risk factor. Therefore practice safe sex.
- Ask your partner to use condoms during sexual intercourse.
- Limit the number of sexual partners
- Test yourself for sexually transmitted diseases every six months.