Bacterial vaginosis facts

• Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.
• Bacterial vaginosis is not dangerous, but it can cause disturbing symptoms.
• Most women do not experience symptoms of bacterial vaginosis, but when they do they are:
  • vaginal discharge, and
  • vaginal odor.
• In diagnosing bacterial vaginosis, it is important to exclude other serious infections, such as the STDs gonorrhea and Chlamydia.
• Treatment options for bacterial vaginosis include prescription oral antibiotics and vaginal gels.
• Serious complications of bacterial vaginosis can occur during pregnancy, and recurrence is possible even after successful treatment.

What is bacterial vaginosis?

Bacterial vaginosis is a vaginal condition that can produce vaginal discharge and results from an overgrowth of certain kinds of bacteria in the vagina. In the past, the condition was called Gardnerella vaginitis, after the bacteria that were thought to cause the condition. However, the newer name, bacterial vaginosis, reflects the fact that there are a number of species of bacteria that naturally live in the vaginal area and may grow to excess. The Gardnerella organism is not the sole culprit causing the symptoms. When these multiple species of bacteria that normally reside in the vagina become unbalanced, a woman can have a vaginal discharge with a foul odor.
Bacterial vaginosis is not dangerous, but it can cause disturbing symptoms. Any woman with an unusual discharge should be evaluated so that more serious infections such as Chlamydia and gonorrhea, can be excluded. Symptoms may also mimic those found in yeast infections of the vagina and trichomoniasis (a sexually-transmitted disease or STD), and these conditions must also be excluded in women with vaginal symptoms.
Bacterial vaginosis is a common condition. It is the most common vaginal complaint in women of child bearing age. Studies have shown that approximately 29% of women in the U.S. are affected. Bacterial vaginosis is found in about 25% of pregnant women in the U.S. and approximately 60% of women who have a sexually-transmitted disease (STD).

What is causes bacterial vaginosis?

Researchers have had difficulty determining exactly what causes bacterial vaginosis. At present, it seems to be that a combination of multiple bacteria must be present together for the problem to develop. Bacterial vaginosis typically features a reduction in the number of the normal hydrogen peroxide-producing lactobacilli in the vagina. Simultaneously, there is an increase in concentration of other types of bacteria, especially anaerobic bacteria (bacteria that grow in the absence of oxygen). As a result, the diagnosis and treatment are not as simple as identifying and eradicating a single type of bacteria. Why the bacteria combine to cause the infection is unknown.
Certain factors have been identified that increase the chances of developing bacterial vaginosis. These include:

• multiple or new sexual partners,
• IUDs (intrauterine devices) for birth control,
• recent antibiotic use,
• vaginal douching, and
• cigarette smoking.

      However, the role of sexual activity in the development of the condition is not fully understood, and although most experts believe that bacterial vaginosis does not occur in women who have not had sexual intercourse, others feel that the condition can still develop in women who have not had sexual intercourse.

What are symptoms of bacterial vaginosis?

      Many women with bacterial vaginosis usually have no symptoms. When symptoms do occur, the most common include:

• Vaginal discharge that is usually thin and grayish white
• Vaginal odor (foul-smelling or unpleasant fishy odor)
• The vaginal discharge and odor are often more noticeable after sexual intercourse.

       The amount of vaginal discharge that is considered normal varies from woman to woman. Therefore, any degree of vaginal discharge that is abnormal for a particular woman should be evaluated.

Is bacterial vaginosis contagious?

       Although bacterial vaginosis is not considered to be a contagious condition, the role of transmissibility of bacteria among individuals is not fully understood. Since having multiple or new sexual partners increases a woman's risk of developing bacterial vaginosis, this suggests that spread of bacteria among individuals may alter the balance of bacteria in the vagina and potentially predispose to bacterial vaginosis. However, since bacterial vaginosis also occurs in celibate women, other causative factors must also play a role in its development.
It is not possible to contract bacterial vaginosis from toilet seats, swimming pools, or hot tubs, or from touching contaminated objects.

Can you get bacterial vaginosis from a sexual partner?

        Vaginosis is a vaginal abnormality; therefore a male cannot “get” bacterial vaginosis. However, female sex partners of women with BV may want to consider being evaluated because it can spread to female partners.

How is bacterial vaginosis diagnosed?

       When a woman notices an unusual vaginal discharge and reports this to her doctor, he or she will ask her a series of routine questions to help distinguish mild from more serious conditions. Additional issues that might indicate the presence of a more serious condition include:

• fever,
• pelvic pain,
• new or multiple sexual partners (especially with unprotected intercourse), and
• a history of sexually-transmitted infections (STDs).

          In addition to these questions, the doctor will perform a pelvic exam. During the exam, the doctor notes the appearance of the vaginal lining and cervix. The doctor will also perform a manual exam of the ovaries and uterus. The cervix is examined for tenderness, which might indicate a more serious infection. The doctor may collect samples to check for Chlamydia or gonorrhea infection.
Examining the vaginal discharge under the microscope can help distinguish bacterial vaginosis from yeast vaginitis (vaginal yeast infection, Candidiasis) and trichomoniasis (a type of sexually-transmitted disease or STD). A sign of bacterial vaginosis under the microscope is a vaginal cell called a clue cell. Clue cells are vaginal cells covered with bacteria and are believed to be the most reliable diagnostic sign of bacterial vaginosis. In addition to clue cells, women with bacterial vaginosis have fewer of the normal vaginal bacteria, called lactobacilli. A vaginal pH greater than 4.5 is also suggestive of bacterial vaginosis. Cultures of bacteria are generally not useful in establishing the diagnosis of bacterial vaginosis.
Finally, the doctor may perform a "whiff test" with potassium hydroxide (KOH) liquid. When a drop of KOH testing liquid used in the "whiff test" contacts a drop of the discharge from a woman with bacterial vaginosis, a certain fishy odor can result.

What is the whiff test?

       During the diganosis of bacterial vaginosis the doctor may perform a "whiff test" with potassium hydroxide (KOH) liquid. When a drop of KOH testing liquid used in the "whiff test" contacts a drop of the discharge from a woman with bacterial vaginosis, a certain fishy odor can result.

What is the treatment for bacterial vaginosis?

       While up to 1/3 of cases of bacterial vaginosis may resolve on their own, it is recommended that medical treatment be given if symptoms are present or during pregnancy to avoid the development of complications.
Antibiotics are the recommended treatment for bacterial vaginosis. A few antibiotic remedies are routinely used and include:

• metronidazole (Flagyl) taken by either oral (pill) form or vaginally metronidazole gel (Metrogel). The oral metronidazole can cause some minor but unpleasant side effects, but is believed to be the most effective treatment. The gels do not typically cause side effects, although yeast vaginitis can occur as a side effect of the medication.
• vaginal clindamycin cream (Cleocin)
• tinidazole (Tindamax) is an antibiotic that appears to be effective in treating bacterial vaginosis, and may have fewer side effects than metronidazole.

       Recurrence of bacterial vaginosis is possible even after successful treatment. More than half of those treated experience recurrent symptoms within 12 months. It is unclear why so many recurrent infections develop. With recurrent symptoms, a second course of antibiotics is generally prescribed.

Are there over-the-counter (OTC) medications or home remedies for bacterial vaginosis?

       Bacterial vaginosis is treated with antibiotics (see treatment section). There are no effective OTC treatments, or natural or home remedies that have been proven to resolve the condition, although sometimes it may resolve on its own without treatment.
The use of probiotics has been attempted in the treatment of bacterial vaginosis, but results have been inconsistent and do not show a clear benefit.

Can bacterial vaginosis be prevented?

        Because the cause and development of bacterial vaginosis is poorly understood, it can be difficult to take measures to prevent it from occurring. Reducing certain risk factors, such as limiting the number of sex partners, avoiding the use of vaginal douches, and taking all medications as directed when being treated for bacterial vaginosis, can help reduce a woman's risk of developing bacterial vaginosis.

What are the complications of bacterial vaginosis?

       Bacterial vaginosis can resolve completely without complications after treatment. No special follow-up is necessary if the symptoms disappear.
Women with bacterial vaginosis are at increased risk for contracting HIV infection as well as other STDs including genital herpes, gonorrhea, and Chlamydia.
In pregnancy, bacterial vaginosis has been linked to premature labor, but the relationship is still not clear. Treatment is often recommended prior to hysterectomy, C-section (Cesarean birth), or IUD insertion in order to avoid spread of the disease into the pelvic organs.
However, treatment of bacterial vaginosis during pregnancy that is not causing symptoms has not been shown to decrease the incidence of premature births in most studies. For these reasons, screening and treatment for bacterial vaginosis during pregnancy is controversial, and research is still being conducted to determine its utility and value. Currently, routine screening of all pregnant women is not recommended. However, screening and treatment of bacterial vaginosis is sometimes recommended for women with a history of a preterm birth.

What is the prognosis (outlook) for bacterial vaginosis?

       Bacterial vaginosis can be cured with antibiotics. Even after a woman has been cured, however, the condition often recurs. A second course of antibiotics is necessary if a woman experiences recurrent bacterial vaginosis that produces symptoms.

SOURCES:
http://www.CDC.gov. Bacterial Vaginosis.

WomensHealth.gov. Bacterial Vaginosis Fact Sheet.