Bacterial vaginosis (BV) is a vaginal infection caused by an imbalance of good and bad bacteria in the vagina. It usually isn’t caused by a single bacterium but by several. Vaginal discharge is the most common symptom seen in bacterial vaginosis. There is a feminine odor that smells like fish. The discharge can be gray or white in color and is more commonly found during sexual activity or after a woman has her period. It tends not to cause itchiness or pain and some women have no symptoms whatsoever.
Other diseases cause vaginal discharge but the discharge tends to look a bit different from BV, and they have their own sets of symptoms. For example, Candida vaginitis has symptoms of a thick cottage cheese-like discharge and moderate to severe itching.
The cause of bacterial vaginosis is a true overgrowth of bacteria that interfere with the vagina. Normally, “good” bacteria predominate in the vaginal vault but, depending on certain circumstances, the “bad” bacteria take over and dominate the vagina. Bad bacteria are more predominant than good bacteria. Lactobacilli are diminished in the vagina and anaerobic bacteria seem to take over. Poor hygiene has nothing to do with getting bacterial vaginosis. In fact, those who wash more than others are more likely to get BV.
Bacterial vaginosis is very common. About one in three females have bacterial vaginosis at some time or another in their lives. Many have no symptoms. It is more common in those women who have an IUD in place and in women who are smokers. Menstrual cycle changes in hormones can cause BV symptoms at just about any time. Part of bacterial vaginosis can be hereditary.
Bacterial vaginosis is not a sexually transmitted disease so that women who are not sexually active can get the disease. It can, however, be caused by sexual activity but it is not the transmission of bacteria from one person to another. It appears that a change in sexual partner can trigger the changes that cause BV. Staying with the same sexual partner seems to be protective against bacterial vaginosis.
Bacterial vaginosis is sometimes diagnosed just by the smell. The fishy smell is fairly characteristic. The doctor may go on symptoms and the finding of the characteristic discharge before treating the disease. If there is some question that the condition may not be bacterial vaginosis, the doctor may go ahead and do some vaginal cultures to see if yeast, Chlamydia or other bacterium grows out. You need a careful diagnosis during pregnancy so treatment can be established.
The doctor may check the level of acid in the vagina. In bacterial vaginosis, the pH rises because of the bacteria in BV and the pH will be high or more alkaline. PH paper is used to see if the pH is alkaline or acidic. If it is acidic, it is not likely to be BV. This is when the fishy smell can be noticed by the doctor or nurse doing the test. A sample of the discharge is taken so that the bacteria can be looked at under the microscope. The pH level can be taken from a swab as well. Cultures can be taken from a swab of the vaginal vault that can show what types of bacteria or yeast are in the vagina.
Can BV have complications?
The answer is “yes”. Untreated bacterial vaginosis in pregnancy can cause complications of pregnancy. It can cause problems with preterm labor, low birth weight child or womb infection after you give birth. There is an increased risk of miscarriage.
Bacterial vaginosis can complicate operations of the uterus or vagina, including a vaginal hysterectomy or an abortion. Often these things can be controlled through the use of antibiotics given before the procedures are done. BV can also cause you to be at a greater risk of coming down with HIV if you are exposed to the virus. PID or pelvic inflammatory disease can be a result of having bacterial vaginosis.
What is bacterial vaginosis treatment?
BV treatment is something that can be done if a woman has symptoms of the disease. If they have no symptoms, it will probably clear up on its own and will not need any specific treatment. If a woman is found to have bacterial vaginosis, even without symptoms, she should be treated if she is pregnant. This is because of the possible side effects of BV on a pregnancy or on an unborn fetus. It isn’t clear whether or not treatment of bacterial vaginosis in pregnancy actually makes a difference. Most doctors agree that pregnant women with BV should be counseled around getting treatment for the disease and can be a part of the discussion on whether or not to treat the disease. This should also be the case if a pregnancy is going to be terminated or when a hysterectomy is planned. There can be a severe womb infection if a woman has an abortion and does not have her bacterial vaginosis treated. This is the case even if a woman has no symptoms of the disease. Sometimes doctors do a biopsy of the uterus to see if it is involved with bacterial vaginosis before making the decision to treat the disease.
The use of Metronidazole
Metronidazole is an antibiotic treatment that is commonly used in the treatment of BV. It is also called Flagyl. It is able to clear up the disease much of the time. You should always read the patient information sheet that comes to you from the pharmacist to make sure it is safe for you to take metronidazole. The most common dose is 400 milligrams two times daily for a week. Some doctors recommend a single dose of 2 grams at once. Doctors do not recommend the latter dosing schedule for women who are pregnant. You should take all of the patient doses and not skip any doses or stop the medication when you begin to feel better. Nausea and vomiting are possible when taking metronidazole but if you take the medication with food, you will feel better. Some people notice a metallic taste in their mouth after taking the medication. Metronidazole and alcohol do not mix. You will have an increased risk of nausea and vomiting after taking the medication with alcohol and can notice an increased heart rate and flushing with alcohol and metronidazole.
If you breastfeed while taking metronidazole, there can be metronidazole in the breast milk. The baby usually has no side effects from ingesting the medication, however. It is recommended to take the lower dose for a week rather than the single high dose of metronidazole at one time because it is safer for the baby. The pill should be taken just after the last nighttime feeding so the baby doesn’t get so much metronidazole. You should know, too, that taking metronidazole or other antibiotics for the treatment of bacterial vaginosis can interfere with birth control pills or patches. You should use an alternative form of birth control while taking the medication.
Other alternative bv antibiotic choices
They make vaginal gels or creams containing metronidazole or clindamycin. These can be put inside the vagina in order to treat the infection. These antibiotic choices work as well as the pill form of these antibiotics. Even with these antibiotic forms, in particular metronidazole gel, you shouldn’t drink alcohol while taking the medication. You can begin drinking alcohol forty eight hours after stopping the medication and you should have no trouble taking it. Clindamycin can cause latex condoms or diaphragms to weaken and break. You can’t rely on these forms of birth control while taking the medication or for up to five days after taking clindamycin cream. Condoms and diaphragms will not be as protective against pregnancy or STDs.
Some people eat live yogurt or put the yogurt in their vaginas to treat BV. Others take in live Lactobacillus acidophilus. Doctors don’t believe these treatments are as helpful as taking the antibiotics.
Proving a BVCure
If you are not pregnant, you don’t need to have a vaginal swab or other test to make sure you are cured from bacterial vaginosis, especially if you have no symptoms. If you are pregnant, you should be swabbed to make sure the bacterial infection is gone from your system. This is the safest thing to do to prevent complications of pregnancy.
If you think you have bacterial vaginosis symptoms all over again, you might need to be swabbed to see if you actually have BV all over again. You can get a recurrence if you didn’t take all of your antibiotic doses or if the bacteria weren’t sensitive to the antibiotic you were used. Recurrences happen in one out of three women who have BV. You may need another course of antibiotics, possibly with the same antibiotic or a different one. A few women will have multiple recurrences of the disease and will need several courses of antibiotics to treat the condition. You may need to have an IUD removed for a period of time so that the infection can be cleared up with antibiotics first. Alternate forms of birth control must be considered during this time.
Prevention of BV
BV usually comes out of the blue and can’t be prevented using any measures. Things that can ensure you don’t get the disease, especially if you get it a lot, include:
• Avoiding strong soaps to clean your clothes
• Forget using bath oils, scented soaps, bubble bath, antiseptics or perfumed shampoos when bathing or showering.
• Don’t douche with any kind of substance, including water.
• Don’t excessively wash the vaginal area. Just do it once per day.
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