Bacterial vaginosis is a mild infection of the vagina. Although it is usually treated easily, it may be a sign that you have other, more serious conditions. It can also lead to complications, including the following:

• Pregnancy complications such as low birth weight and premature delivery

• Higher risk of pelvic inflammatory disease if the bacteria infect the uterus and fallopian tubes

• Higher risk of contracting HIV and other sexually transmitted diseases

It is important to contact your doctor if you think you may have bacterial vaginosis.

Causes

Bacterial vaginosis is caused when the balance of bacteria in the vagina is disrupted. Normally, the vagina has helpful bacteria (lactobacilli) as well as more harmful bacteria (anaerobes). Sometimes the harmful bacteria overgrow and not enough helpful bacteria are left in the vagina. The cause of this overgrowth is not understood, although in some cases it may be related to sexual activity.

Risk Factors

The cause of BV is not fully understood. BV is associated with an imbalance in the bacteria that are normally found in a woman's vagina. The vagina normally contains mostly "good" bacteria, and fewer "harmful" bacteria. BV develops when there is an increase in harmful bacteria.

Not much is known about how women get BV. There are many unanswered questions about the role that harmful bacteria play in causing BV. Any woman can get BV. However, some activities or behaviors can upset the normal balance of bacteria in the vagina and put women at increased risk including:

• Having a new sex partner or multiple sex partners,
• Douching, and
• Using an intrauterine device (IUD) for contraception.

It is not clear what role sexual activity plays in the development of BV. Women do not get BV from toilet seats, bedding, swimming pools, or from touching objects around them. Women that have never had sexual intercourse are rarely affected.

Symptoms

Some women with bacterial vaginosis do not have any symptoms. Others experience the following symptoms:

• Abnormal vaginal discharge

• • Color: white or gray

• • Consistency: thin

• • Odor: fish-like, especially after sex

• Burning feeling while urinating

• Itching around the vagina

• Vaginal irritation

• Pain during sex

If you experience any of these symptoms do not assume it is due to bacterial vaginosis. These symptoms may be caused by other conditions. If you experience any one of them, see your physician.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include the following:

• A pelvic exam to look for signs of bacterial vaginosis

• Taking a sample of fluid from the vagina to test for signs of infection

Treatment

Although BV will sometimes clear up without treatment, all women with symptoms of BV should be treated to avoid such complications as PID. Male partners generally do not need to be treated. However, BV may spread between female sex partners.

Treatment is especially important for pregnant women. All pregnant women who have ever had a premature delivery or low birth weight baby should be considered for a BV examination, regardless of symptoms, and should be treated if they have BV. All pregnant women who have symptoms of BV should be checked and treated.

Some physicians recommend that all women undergoing a hysterectomy or abortion be treated for BV prior to the procedure, regardless of symptoms, to reduce their risk of developing PID.

BV is treatable with antibiotics prescribed by a health care provider. Two different antibiotics are recommended as treatment for BV: metronidazole or clindamycin. Either can be used with non-pregnant or pregnant women, but the recommended dosages differ. Women with BV who are HIV-positive should receive the same treatment as those who are HIV-negative.

BV can recur after treatment.

Prevention

To help reduce your chances of getting bacterial vaginosis, take the following steps:

• Abstain from sex or remain monogamous (have only one sexual partner).

• Use condoms during sex.

• Do not use douches or feminine sprays.

• Visit your doctor for regular pelvic exams.

• To avoid a recurrence of bacterial vaginosis, finish all medication prescribed by your doctor, even if the symptoms go away.

• Wash diaphragms and other reusable birth control devices thoroughly after use.

• Avoid wearing panty hose and other clothing that can trap moisture in the vagina.

• After bowel movements, wipe from front to back (away from the vagina).

RESOURCES:

EngenderHealth
http://www.engenderhealth.org/index.html

The National Women’s Health Information Center
US Department of Health and Human Services
http://www.4women.gov

Sexually Transmitted Diseases Home Page
Centers for Disease Control and Prevention
http://www.cdc.gov/std/default.htm

CANADIAN RESOURCES:

BC Health Guide, British Columbia Ministry of Health
http://www.bchealthguide.org

Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm

References:

Bacterial vaginosis. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/BV/STDFact-Bacterial-Vaginosis.htm. Accessed September 22, 2005.

Bacterial vaginosis. DynaMed website. Available at: http://www.dynamicmedical.com/dynamed.nsf?opendatabase. Accessed September 22, 2005.

Bacterial vaginosis. EngenderHealth website. Available at http://engenderhealth.org/wh/inf/dbac.html. Accessed September 22, 2005.

Frequently asked questions about bacterial vaginosis. The National Women’s Health Information Center website. Available at http://www.4women.gov/faq/stdbv.pdf. Accessed September 22, 2005.

CDC