Bacterial Vaginosis

Bacterial vaginosis (BV) only affects women. There is a natural balance of “good” and “bad” bacteria inside every woman’s vagina. Usually the “bad” bacteria (called anaerobes) are outnumbered by the “good” bacteria (called lactobacilli). When the natural balance of the vagina is upset, the “bad” bacteria can overgrow and become too numerous and BV occurs. BV is a type of vaginitis and can be spread through sexual activity or nonsexual activity.

BV symptoms can be experienced as a foul odor, vaginal discharge, vaginal pain or irritation, and pain during sex. Antibiotics and some creams or gels can cure BV.

Reporting

According to the Center for Disease and Control (CDC) in the United States, 16% of pregnant women had bacterial vaginosis (BV) in 2000. (source)
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Causes / Risks

Bacterial vaginosis (BV) is the result of an overgrowth of the “bad” bacteria in the vagina. The overgrowth can be caused by frequent douching, hot weather, poor health, poor diet, damp underwear, tight pants that trap moisture and heat, or vaginal products (lubricants, sprays, birth control devices).

E. coli can also cause BV. E. coli normally lives in the rectum and can be spread to the vaginal area, for example by wiping back to front with toilet paper or by going from anal sex then to vaginal sex without cleaning off in between.

New or multiple sexual partners can increase a woman’s risk of developing BV. Menopause also increases the risk. Women with diabetes, who are pregnant, or who have a weakened immune system have an increased risk as well.
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Symptoms

Many women can be unaware they have bacterial vaginosis (BV). However, sometimes the symptoms can make it obvious. An unpleasant, foul, fishy odor can develop from BV and can be more pronounced during vaginal intercourse. Other symptoms include a grey or white, foamy or watery discharge, vaginal burning or itching, vaginal inflammation, or pain or discomfort when urinating.
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Testing / Diagnosis

Bacterial Vaginosis (BV) can be diagnosed by laboratory testing and a physical examination by a health care provider. The health care provider could do a visual exam and/or take a sample of the discharge from the vaginal wall or cervix during a pelvic exam. A “whiff” test can be performed on the sample by checking to see if it has a fishy odor before or after the addition of potassium hydroxide (KOH) to it. The sample could also be viewed under a microscope to check for “clue cells” by the health care provider.

BV can also be diagnosed by checking for elevated pH levels in vaginal fluid or by performing a Gram stain to examine the vaginal flora.

It is important to note, women should not douche a few days before visiting their health care provider for a pelvic examination. Douching can hide signs of infection or make BV worse. Women should also not schedule the exam when they are menstruating.
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Treatment

Bacterial vaginosis (BV) can be treated and cured with antibiotics. The antibiotic metronidazole (Flagyl) and clindamycin are the most commonly prescribed. Vaginal creams or gels can also be used. A health care provider can recommend which of these treatment options is best.

In most cases, when a woman is infected, her male sexual partner will not need treatment.
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Complications

Bacterial vaginosis (BV) can cause pregnant women to give birth prematurely to their babies and/or cause babies to be born with a low birth weight (under 5 pounds). BV can also infect the fallopian tubes (tubes in which an egg moves from the ovaries to the uterus) and womb, causing pelvic inflammatory disease (PID). PID can lead to infertility or it can damage the fallopian tubes enough to increase the risk of ectopic pregnancy (pregnancy outside the uterus that can be potentially fatal).

BV can also increase a woman’s chances of being infected by HIV and other sexually transmitted diseases (STD).
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Prevention

Women who have never had vaginal sex, seldom get Bacterial vaginosis (BV). So abstaining from vaginal sex is the surest way to reduce the risk of BV. For those women who do have vaginal sex, limiting the number of sexual partners and making sure a latex condom is always wore, can also reduce the risk of BV.

To prevent E. coli from entering the vagina from the rectum and causing BV, always wipe front to back after bowel movements, and male sexual partners should wash off between anal and vaginal sex. Women should also always keep their vaginal area clean and dry. They should wash it before and after sex and thoroughly dry it to prevent moisture from creating a breeding ground for bacteria.

Douching should be avoided. It can upset the natural balance inside the vagina and allow “bad” bacteria to overgrow. It can also cause the “bad” bacteria overgrowth to be spread up into the reproductive tract, possibly resulting in pelvic inflammatory disease (PID) and permanent damage.

Women should also avoid tight clothing that traps moisture and heat and should always wear clean underwear. However, underwear should not be worn to bed, because it can help provide a moist environment that BV can thrive in.
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