What is Bacterial Vaginosis?
Bacterial vaginosis is a health issue that occurs when there’s an excessive growth of normal bacteria in the vagina. Mainly, the condition shows up with increased vaginal discharge that smells fishy. The discharge is often thin and is usually gray or white. After being diagnosed with bacterial vaginosis, individuals have a higher chance of getting sexually transmitted infections (STIs). Additionally, if a pregnant woman gets bacterial vaginosis, it might increase the risk of giving birth early.
Bacterial vaginosis was previously referred to as Gardnerella vaginitis because it was thought to be caused only by Gardnerella bacteria. However, the name was changed to bacterial vaginosis to reflect that it’s not just one, but various types of bacteria naturally found in the vagina that can overgrow and cause this condition. The new name emphasizes that the main cause of bacterial vaginosis is an imbalance of numerous bacteria in the vagina that have grown too much.
What Causes Bacterial Vaginosis?
Bacterial vaginosis usually occurs when the number of good bacteria, called lactobacilli, in the vagina decreases, and bad bacteria grow too much. Yet, it’s still not fully known why this overgrowth of bacteria such as Gardnerella and other harmful types happens. Gardnerella vaginalis, one of the bacteria involved, isn’t usually thought to spread from person to person, but it’s not certain. If it does spread through sexual activity, it could disrupt the natural balance of bacteria in the vagina. This disruption could create conditions that allow harmful bacteria to flourish, potentially leading to bacterial vaginosis.
Research has found that almost half of women without any symptoms have Gardnerella vaginalis in their vagina, which suggests it might be part of the vagina’s normal mix of bacteria. Several things can increase a woman’s chances of getting bacterial vaginosis, including frequent baths, douching, smoking, having multiple sexual partners, using vaginal cleaning products sold in stores, high stress, and having sex often. The bacteria can also spread between women who have sex with other women, possibly through direct contact of the soft, moist tissues of the body or shared sex toys. Women with female sexual partners have a 60% higher chance of getting bacterial vaginosis.
Risk Factors and Frequency for Bacterial Vaginosis
Bacterial vaginosis is a common health condition that primarily affects women of childbearing age. The range of occurrence is quite broad, with between 5% and 70% of women experiencing it. The rate of occurrence changes from one country to the next – generally between 20% and 60%. It’s most commonly found in Africa, less so in Asia and Europe, with the United States noting about 30% of women experiencing it. Instances of bacterial vaginosis differ among various ethnic groups. It’s found most often in non-white women, with 51% in African American and 32% in Mexican American women. Australia, New Zealand, and Western Europe have the lowest rates.
It’s also important to note certain factors that can increase a woman’s likelihood of getting bacterial vaginosis. These include having multiple sexual partners, being unmarried, starting sexual activity at a young age, engaging in commercial sex work, or regular douching. Therefore, douching is generally not recommended. The bacteria named Gardnerella is often connected with bacterial vaginosis, suggesting it’s quite prevalent in affected populations.
Finally, it’s crucial to realize that bacterial vaginosis is not classified as a sexually transmitted infection (STI). STI’s are caused by external sources, while bacterial vaginosis is caused by an overgrowth of normal bacteria found in the vagina. Hence, it can occasionally occur in women who have never engaged in sex.
Signs and Symptoms of Bacterial Vaginosis
Bacterial vaginosis is a common condition that primarily affects women. It is characterized by a foul-smelling vaginal discharge, which may become more noticeable after sexual intercourse. Some women may also experience pain during urination or sexual intercourse, as well as itching in the vaginal area. However, some women may not have any symptoms at all.
To diagnose bacterial vaginosis, a medical history should be taken, including any previous infections and potential risk factors such as douching, multiple sexual partners, recent antibiotic use, smoking, and the use of an intrauterine device. During a medical exam, a pelvic exam will be performed to analyze the vaginal discharge and rule out other diseases with similar symptoms, such as yeast infections, cervicitis, and sexually transmitted infections like chlamydia, gonorrhea, herpes simplex virus, and trichomonas.
Cervical swabs can be taken to test for infections like chlamydia or gonorrhea, and the cervix should be examined for tenderness or signs of inflammation. At-home swabs or swabs done without a speculum exam are unreliable and should be avoided. Personal history, pap smear, or culture alone are also not reliable methods for diagnosing bacterial vaginosis.
Examining the vaginal discharge under a microscope can reveal “clue cells,” which are a reliable indicator of bacterial vaginosis. It is also important to look for signs of yeast or trichomonads, as these diseases can coexist. A pH test of the vaginal fluid can also aid in diagnosing bacterial vaginosis. It is crucial to rule out more serious conditions by checking for fever, pelvic pain, and any history of sexually transmitted infections. Bacterial vaginosis increases the risk of pelvic inflammatory disease, HIV, other sexually transmitted infections, and certain childbirth complications.
Testing for Bacterial Vaginosis
To diagnose bacterial vaginosis, a doctor may perform several tests. These include checking the vaginal pH level, looking for clue cells on a slide, and conducting a whiff test. Typically, two positive tests, along with the presence of typical discharge, are enough to diagnose the condition. Doctors may also use the Amsel criteria, which involves checking for specific symptoms, or the Nugent process, which assigns a score based on the type of bacteria present. Commercial molecular diagnostic assays can also be used for accurate results.
Treatment Options for Bacterial Vaginosis
About 30% of bacterial vaginosis cases can resolve on their own without treatment. Treatment is recommended for those experiencing symptoms, and it can be done with oral or vaginal medication. The most commonly used drugs are clindamycin or metronidazole. Initial treatment is effective in curing 80% to 90% of patients within a month. However, bacterial vaginosis can recur in up to 80% of women within 9 months. If symptoms persist, a second round of antibiotics is usually prescribed. Treating sexual partners is not necessary, as bacterial vaginosis is not classified as an STI. There is some evidence suggesting that pregnant individuals with symptoms should be treated before 22 weeks to reduce the risk of preterm labor. Screening and treatment for bacterial vaginosis in the general population is not currently recommended, but those with symptoms should be tested and treated. In 2017, a single-dose oral treatment called secnidazole was approved by the FDA, and in 2021, a single-dose vaginal gel of clindamycin was also approved. There are various treatment schedules available, including metronidazole and clindamycin, and alternative treatments such as tinidazole and secnidazole.
What else can Bacterial Vaginosis be?
When a doctor is trying to diagnose bacterial vaginosis, there are many other conditions that may have similar symptoms. These conditions include thinning and drying of the vaginal walls (atrophic vaginitis), yeast infection (candidiasis), inflammation of the cervix (cervicitis), sexually transmitted infections like chlamydia and gonorrhea, inflammatory conditions of the vagina (desquamative inflammatory vaginitis), parasitic infection (trichomoniasis), and infection in the female reproductive organs (pelvic inflammatory disease).
To determine the right diagnosis, a doctor will perform a physical exam and might carry out some tests. For instance, the doctor may use a device called a speculum to check if the cervix is inflamed. They can also examine a sample of the vaginal discharge under a microscope to see if there is a yeast infection or parasitic infection. Moreover, swabs might be taken to test for chlamydia and gonorrhea.
What to expect with Bacterial Vaginosis
Bacterial vaginosis can often come back after treatment because antibiotics fail to restore the balance of good bacteria in the vagina. This is due to a shield formed by the bacteria that prevents the antibiotic from working effectively. Around 80% of women may experience a recurrence within three months of treatment. Some strains of bacterial vaginosis are resistant to traditional treatments. A recent study found that using a powder containing the good bacteria Lactobacillus crispatus CTV-05 after treatment with metronidazole significantly reduced the recurrence of bacterial vaginosis for up to 24 weeks. However, this treatment method is not yet FDA-approved. Other products are being tested to reduce recurrence rates. Bacterial vaginosis increases the risk of sexually transmitted infections and can potentially affect fertility. Vaginal suppositories with boric acid have been suggested for managing recurring bacterial vaginosis, but should not be used during pregnancy. The CDC recommends several treatment options for multiple recurrences of bacterial vaginosis.
Possible Complications When Diagnosed with Bacterial Vaginosis
Bacterial vaginosis might cause a number of potential complications if it’s not diagnosed and treated in time. These complications include an increased risk of various infections and conditions, harmful effects on pregnancy, and an increased risk of neonatal meningitis.
- Increased risk of endometritis and salpingitis (infections in the uterus and fallopian tubes)
- Increased susceptibility to sexually transmitted infections
- Higher likelihood of getting infections after surgery
- Negative effects on pregnancy including premature labor, early membrane rupture, and postpartum endometritis (uterus infection after childbirth)
- Potential to develop pelvic inflammatory disease
- Increased risk of neonatal meningitis (a severe infection that targets the newborn’s brain)
Preventing Bacterial Vaginosis
It’s important to have strategies in place to limit the impact of bacterial vaginosis and any problems it may cause. While we don’t fully understand what causes the pH imbalance and bacterial build-up that leads to bacterial vaginosis, there are steps women can take to lessen the growth of certain bacteria. Doctors and nurses should make sure women understand the risks associated with the condition, like having many sexual partners, douching, not using condoms, smoking, and being in same sex relationships.
Regular check-ups and checks for bacterial vaginosis are crucial, especially for those at high risk or those with a history of frequent infections. This helps locate the issue early so it can be dealt with promptly. Applying these precautions empowers people to actively maintain their vaginal health and lower the chance and recurrence of bacterial vaginosis. It could also contribute to reducing sexually transmitted infections and minimize complications.