What is bacterial vaginosis?

Definition

Bacterial vaginosis is a mild infection of the vagina. Although it is usually
treated easily, it may be a sign of another, more serious condition. It can also
lead to complications during pregnancy, such as low birth weight and premature
delivery, and a higher risk of pelvic inflammatory disease if the
bacteria infect the uterus and Fallopian tubes.

There is an association between bacterial vaginosis and a higher risk of being infected with the human immunodeficiency virus (HIV) or other sexually transmitted diseases. If a woman has HIV and also bacterial vaginosis, she risks transmitting HIV to her partner during unprotected sex.

Causes

Bacterial vaginosis is caused when the normal balance of bacteria in the vagina is disrupted. Normally, the vagina has helpful or commensal bacteria (lactobacilli) and harmful bacteria (anaerobes), bacteria that do not need oxygen to live. Sometimes the harmful bacteria overgrow, reducing the amount of helpful bacteria in the vagina. The cause of this overgrowth is not understood. In some cases, it may be related to sexual activity through transfer of harmful bacteria from a sexual partner.

Risk Factors

The factors that increase the chance of developing bacterial vaginosis include smoking, using douches or feminine sprays, having unprotected sex (sex without a condom), having a new sexual partner or multiple partners, and using an intrauterine device (IUD) for birth control.

Symptoms

Some women with bacterial vaginosis do not have any symptoms. Others experience abnormal, white or gray vaginal discharge with a thin consistency and a fishy odor, especially after sex. Other symptoms include a burning feeling while urinating, itching around the vagina, vaginal irritation, and pain during sex.

If any of these symptoms appear, one should not assume they are caused by bacterial vaginosis. These symptoms may be caused by other conditions. However, one should contact a health care provider if these symptoms appear.

Screening and Diagnosis

A doctor will ask about symptoms and medical history and will perform a
physical exam. Tests may include a pelvic exam to look for signs of
bacterial vaginosis and obtaining a sample of fluid from the vagina to test for
signs of infection.

Treatment and Therapy

Bacterial vaginosis should be treated as soon as the patient experiences symptoms, or if the patient is pregnant, treatment should begin even without symptoms. Bacterial vaginosis is easily treated with antibiotics, in the form of pills or vaginal creams prescribed by a doctor.

Prevention and Outcomes

To help reduce the chance of getting bacterial vaginosis, one should abstain from sex or remain monogamous, use condoms during sex, avoid using douches or feminine sprays, and visit a doctor for regular pelvic exams. To avoid a recurrence of bacterial vaginosis, patients should finish all prescribed medication, even if the symptoms go away. One should also wash diaphragms and other reusable birth control devices thoroughly after use, avoid wearing panty hose and clothing that traps moisture in the vagina, and, after bowel movements, wipe oneself from front to back (away from the vagina).

Bibliography

Centers for Disease Control and Prevention. “Bacterial Vaginosis.” Available at http://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm.

EBSCO Publishing. “Bacterial Vaginosis.” DynaMed . Available through http://www.ebscohost.com/dynamed.

Martin, H. L., et al. “Hormonal Contraception, Sexually Transmitted Diseases, and Risk of Heterosexual Transmission of Human Immunodeficiency Virus Type 1.” Journal of Infectious Diseases 178 (1998): 1053-1059.

Martin, H. L., et al. “Vaginal Lactobacilli, Microbial Flora, and Risk of Human Immunodeficiency Virus Type 1 and Sexually Transmitted Disease Acquisition.” Journal of Infectious Diseases 180 (1999): 1863-1868.

Myer, L., et al. “Bacterial Vaginosis and Susceptibility to HIV Infection in South African Women: A Nested Case-Control Study.” Journal of Infectious Diseases 192 (2005): 1372-1380.

Myer, L., et al. “Intravaginal Practices, Bacterial Vaginosis, and Women’s Susceptibility to HIV Infection: Epidemiological Evidence and Biological Mechanisms.” Lancet Infectious Diseases 5 (2005): 786-794.

Taha, T. E., et al. “Bacterial Vaginosis and Disturbances of Vaginal Flora: Association with Increased Acquisition of HIV.” AIDS 12 (1998): 1699-1706.

Van de Wijgert, J. H., et al. “Bacterial Vaginosis and Vaginal Yeast, but Not Vaginal Cleansing, Increase HIV-1 Acquisition in African Women.” JAIDS: Journal of Acquired Immune Deficiency Syndromes 48 (2008): 203-210.