What is BV? (bacterial vaginosis): Causes, Symptoms, Treatment

BV or bacterial vaginosis (BV) is a common problem experienced by women in their reproductive ages. It is due to abnormal changes in the flora of the vagina.

The vagina is normally made up of different kind of bacterial cells and other cells. The good bacteria of the vagina is the Lactobacillus. They ensure the normal pH of the vagina. However, other anaerobic organisms can cause a change in the pH of the vagina with reduction in the number of good lactobacillus bacteria.

In the United States, about 3 in 10 women are affected by bacterial vaginosis (BV). However, prevalence varies across countries and population groups.

Bacterial vaginosis increases the risk of acquiring HIV in women or other sexually transmitted infections such as trichomonas infection, chlamydia, gonorrhea and syphilis.

In addition, BV can be treated and cured in women, but it can come back. If you develop symptoms of BV you should see your doctor for testing and treatment.

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

BV simply means bacterial vaginosis. BV happens when the normal balance of bacteria in the vagina changes (less Lactobacillus and more BV-associated bacteria such as Gardnerella vaginalis, Bacteroides and Mycoplasma hominis). However, Gardnerella is commonly seen in some women without signs of the disease.

The vagina is made up of good and bad bacteria. Anything that affects this normal flora will kill the good bacteria with resultant increase in the number of bad bacteria. These bad bacteria can now cause symptoms of the disease.

Some of the ways to cause this shift to more bad bacteria are

• Douching. This is flushing or washing inside the vagina with water or other liquids. It can affect the normal balance of the vagina and lead to BV.

• BV is not usually classified as a sexually transmitted infection (STI). However, BV is more common in women who are sexually active, especially with a new or multiple partners or no condom use.

• However, there is an increased chance of women getting BV if they have a female sex partner.

What are the signs and symptoms of bacterial vaginosis (BV)?

Women with BV complain of foul smelling vaginal discharge. It is often described by women as fishy smell. Some women with BV have no symptoms. However, in women with BV, there is often little or no obvious inflammation. This means that women will only have abnormal discharge but usually no severe pain, marked irritation, redness or swelling of the vulva. Only a few will complain of mild itching of the vulva.

This abnormal vaginal discharge is usually common during and after your period. The color of vaginal discharge is thin greyish or creamy white discharge that usually coats the wall of the vagina.

If you experience any of these symptoms, you should see your doctor.

How is Bacterial vaginosis (BV) diagnosed?

Women that develop the above symptoms will have a clue if they have the disease. However, BV symptoms can mimic other vaginal infections. Therefore, testing and treatment is important for women.

The way to diagnose BV include

The whiff test. This is often done by adding 10% potassium hydroxide (KOH) to a sample of your vagina discharge. The presence of fishy smell or odor is likely due to Bacterial vaginosis.

By checking vaginal pH. The normal vaginal pH is between 3.8 to 4.5. During bacterial vaginosis infection there is an increase in the pH due to reduced good bacteria (lactobacillus). To detect this, a sample of your vaginal discharge is collected and tested with litmus. pH that is high is suggestive of BV.

Amsel criteria and testing

To detect BV, at least 3 amsel criteria is needed. They include

• Presence of clue cells. These are epithelial cells that are covered by bacterial cells

• Presence of fishy odor after adding 10% potassium hydroxide (KOH)

• Increased pH more than 4.5

• Naked eye examination of vaginal discharge is thin and homogeneous, greyish in color.

To diagnose bacterial vaginosis there should be at least 3 of these factors present.

Hay/Ison criteria

This have 3 grades

Grade 1. The good bacteria (lactobacillus) predominates.

Grade 2. The good bacteria is seen with the bad bacteria (Gardnerella vaginalis, Mycoplasma hominis)

Grade 3. This is bacterial vaginosis due to predominance of bad bacteria.

What is Bacterial vaginosis (BV) treatment?

During your visit to your doctor, history and examination is done. Samples will be collected and tested. If BV is diagnosed, it will be treated. The drug of choice is metronidazole (Flagyl) and clindamycin.

Flagyl is usually given orally or as a vaginal gel. Oral therapy is 500mg twice daily for 7 days. The vaginal gel can also be applied once daily for 5 days. Side effects can include nausea, a metallic taste, or stomach upset. If you experience any side effects of this drug inform your doctor.

Clindamycin is also used to treat BV. However, it is often used as an alternative to metronidazole. In addition, it can cause stomach upset, and clindamycin cream can weaken latex condoms and diaphragms for 5 days after use.

What are the complications of Bacterial vaginosis (BV) in women?

• BV in pregnancy has been linked with preterm birth, premature rupture of membranes, and low birth weight.

• Increased chance of acquiring sexually transmitted infections

• Pelvic inflammatory disease (PID)

In pregnancy, BV can be treated with metronidazole.

How can Bacterial vaginosis be prevented in women?

Stop douching as it affects the normal vaginal flora.
Avoid sex or use condoms, and limit sexual partners
Inform your doctor of any abnormal foul smelling vaginal discharge.
Avoid scented Vaginal soap wash or use of strong detergents.

Frequently asked questions about BV

Can a man become infected by this bacterial infection?

BV mainly affects the vagina. Men do not get BV, but BV-associated bacteria can sometimes be found on the penis without causing symptoms.

Can BV clear up on its own?

Yes. In some women BV can clear up on its own. However, BV can persist or come back, so it is important to see your doctor for testing and treatment.

Now its your turn. Have you experienced abnormal discharge that is foul smelling. Share your experiences.