Make an Appointment
Talk to DoctorOverview
Bacterial vaginosis (BV) is a condition that can cause discomfort and pain in the vagina. It occurs when the natural balance of bacteria in the vagina is disrupted. Normally, a balanced level of bacteria helps maintain vaginal health. However, an overgrowth of certain bacteria can lead to BV. One common symptom of BV is a “fishy” odor in vaginal discharge. Some individuals may also experience vaginal irritation, while others may not have any symptoms at all.
BV can occur at any age but is most commonly seen during the reproductive years. Additionally, BV is more prevalent among sexually active individuals, although the reasons for this association are not fully understood. Engaging in unprotected sex and douching are known to increase the risk of developing BV.
Symptoms
Bacterial vaginosis is frequently asymptomatic in many individuals. However, when symptoms do manifest, common indicators of bacterial vaginosis include:
- Thin vaginal discharge, which may appear gray, off-white, or green in color.
- Foul-smelling vaginal odor often described as “fishy.”
- Vaginal itching or irritation
- Burning sensation during urination
If you’re experiencing an unusual odor and discomfort in your vaginal discharge, it’s important to schedule an appointment with a healthcare professional. They can assess your symptoms and determine the underlying cause. This is especially crucial if you’ve had vaginal infections in the past but notice a difference in your current discharge. Additionally, if you have recently engaged in sexual activity with a new partner or multiple partners, it’s essential to seek medical attention as symptoms of sexually transmitted infections (STIs) can sometimes overlap with those of bacterial vaginosis. Lastly, if you believed you had a yeast infection and attempted self-treatment but are still experiencing symptoms, consulting a healthcare provider is advisable to ensure proper diagnosis and appropriate treatment.
Causes
Bacterial vaginosis (BV) can be asymptomatic in up to 84% of individuals, but if symptoms do occur, they may include off-white, gray or greenish-colored vaginal discharge, a fishy odor from the discharge, particularly after sexual intercourse, vaginal itching or irritation, and a burning sensation during urination. It’s crucial to seek medical attention to distinguish BV from other vaginal infections, as the symptoms can resemble those of other conditions.
Risk factors
Bacterial vaginosis typically affects individuals who are sexually active, and it is rare for it to occur in individuals who have never engaged in sexual activity. Some individuals may naturally produce an excess amount of the bacteria associated with BV.
Factors that can increase the risk of developing bacterial vaginosis include:
- Age: This condition is common among female at the age of 15 to 44 years old.
- Multiple sex partners or a new sex partner: The relationship between sexual activity and bacterial vaginosis is not fully understood. However, it has been observed that bacterial vaginosis occurs more frequently in individuals with different or new sexual partners. BV is more common among individuals engaging in sexual relationships where both partners are female.
- Douching: There is no need to rinse the vagina with water or other substance because it is self-cleaning. Such behaviors can actually be harmful since they disturb the normal bacterial balance in the vagina. The natural bacterial balance is specifically disturbed by douching, which could result in an excess of anaerobic bacteria and the emergence of bacterial vaginosis.
- Insufficient lactobacilli bacteria: Insufficient production of lactobacilli in the vagina increases the likelihood of developing bacterial vaginosis.
Diagnosis
To diagnose bacterial vaginosis, the healthcare provider may perform the following procedures or examinations:
- Physical examination: The healthcare provider may inquire about the medical history, including previous occurrences of vaginal infections or sexually transmitted infections (STIs).
- Pelvic examination: As part of the examination, the healthcare provider will visually inspect the vagina for indications of infection. They will then perform a pelvic examination by manually inserting fingers into the vagina while simultaneously applying gentle pressure on the abdomen, in order to assess the condition of the pelvic organs.
- Vaginal discharge sample: During the examination, a healthcare provider will insert a speculum into the vagina to facilitate the collection of a fluid sample. This sample will be sent to a laboratory for analysis to identify the specific types of bacteria present. The laboratory testing will also check for the presence of “clue cells,” which are vaginal cells coated with bacteria and serve as an indication of bacterial vaginosis.
- Testing for vaginal pH: The acidity level of the vagina can be assessed using a pH strip. The pH strip is inserted into the vagina, and if the vaginal pH registers as 4.5 or higher, it indicates the presence of bacterial vaginosis.
- Others: Healthcare providers may diagnose bacterial vaginosis by conducting a wet mount, examining vaginal discharge under a microscope, and performing a whiff test to detect a fish-like odor.
Treatment
While some cases of bacterial vaginosis may resolve without medication, it is important to seek medical care if you experience symptoms. Bacterial vaginosis can increase the risk of acquiring sexually transmitted infections and may have implications for pregnancy.
To address bacterial vaginosis, healthcare providers may recommend the use of one of the following medications:
- Metronidazole is available in pill or topical gel form. The pill is taken orally, while the gel is inserted into the vagina. It’s important to avoid alcohol while using this medication and for a full day afterward, as it may cause nausea or stomach pain. Please refer to the product instructions for guidance.
- Clindamycin can be used as a cream inserted into the vagina or taken in pill or suppository form. The cream and suppositories might weaken latex condoms, so it’s recommended to abstain from sexual activity during treatment and for at least three days after stopping the medication. Alternatively, you can use another method of birth control.
- Tinidazole is taken orally. It may cause stomach upset, so it’s important to avoid alcohol during treatment and for at least three days after completing the treatment.
- Secnidazole is an antibiotic taken orally as a single dose with food. It comes in the form of granules that can be sprinkled onto soft foods like applesauce, pudding, or yogurt. The mixture should be consumed within 30 minutes, but be careful not to crunch or chew the granules.
Treatment is typically unnecessary for male sex partners, but bacterial vaginosis (BV) can be transmitted to female partners, requiring testing and treatment if symptoms are present. It is crucial to adhere to the prescribed medication, cream, or gel regimen for the full duration, even if symptoms improve. Prematurely stopping treatment may result in the recurrence of BV, known as recurrent bacterial vaginosis.
Recurrence
If you have bacterial vaginosis (BV), it often comes back within 3 to 12 months even after treatment. Researchers are looking for solutions to help with this recurring issue. If your symptoms return soon after treatment, talk to your healthcare team. They might suggest extended-use metronidazole therapy as a possible option. While some people believe probiotics could be helpful, a study found that they are not better than a placebo (a treatment without medicine) in preventing BV from coming back. So right now, probiotics are not recommended as a treatment for bacterial vaginosis.
