Diagnosing and Treating BV

Bacterial vaginosis (BV) is a condition that occurs when there is too much of a certain bacteria in the vagina. This overgrowth changes the normal balance of bacteria naturally found in the vagina. Women in their reproductive years are most likely to get bacterial vaginosis, but it can affect women of any age. Researchers do not know the cause of BV or how some women get it. We do know that the infection typically occurs in sexually active women.

BV is linked to an imbalance of “good” and “harmful” bacteria that are normally found in a woman’s vagina. BV seems to occur in women with a new sex partner or multiple sex partners. We also do not know how sex contributes to BV. There is no research to show that treating a sex partner affects whether or not a woman gets BV. Women who have never had sex rarely get BV. You cannot get BV from toilet seats, bedding, or swimming pools. Bacterial vaginosis is not regarded as a sexually transmitted disease. Several different types of bacteria that are known causes of BV are Gardnerella vaginalis, Mycoplasma hominis, and Mobiluncus species.

Women who have intrauterine contraceptive devices for birth control seem to have an increased risk of BV. Also in that category are smokers, early age of first intercourse, new sexual partner, higher number of lifetime sexual partners, douching, recent use of antibiotics, and an increase in number of sexual partners in the month before diagnosis.

There are no specific preventative measures, however, using condoms with new sexual partners may help to protect against various infections. Other options include: keeping the genital area clean. Using plain unscented soap and having your partner also use the same kind of soap; take showers instead tub baths; wearing cotton underpants or pantyhose with a cotton crotch; not sitting around in wet clothing, such as wet bathing suits; after urination or bowel movements, cleanse by wiping from the front to the back (vagina to anus) and changing pads or tampons frequently.

The symptoms of bacterial vaginosis are slightly different for each woman. Approximately 50 percent of women don’t even have any symptoms. Those that do experience vaginal discharge that has increased in amount and is a milky white to grey in color. The discharge often has a foul odor that is referred to as a “fishy” smell. This smell is more noticeable after intercourse. Many women also experience vaginal itching and irritation.

Treating bacterial vaginosis is typically done through a specific antibiotic. Metronidazole (Flagyl) or clindamycin (Cleocin) are often used. They come in both pill form and vaginal cream form. The medication can be given anywhere from 2 to 7 days to treat the initial infection. It’s common for bacterial vaginosis to recur within three to 12 months despite treatment. Researchers are exploring treatments for recurrent bacterial vaginosis. If your symptoms recur soon after treatment, talk with your doctor about treatments. One option may be extended-use metronidazole therapy.                     

A self-help approach is lactobacillus colonization therapy, which attempts to boost the number of good bacteria in your vagina and re-establish a balanced vaginal environment, possibly accomplished by eating certain types of yogurt or other foods containing lactobacilli. While current research shows there may be some benefit to probiotic therapy, more research is needed on the subject.

Treatment is usually recommended for women who have symptoms, women undergoing surgical procedures, and some pregnant women. Testing and treating male sexual partners is usually not recommended. To diagnose bacterial vaginosis, your doctor may:

• Ask questions about your medical history. Your doctor may ask about any previous vaginal infections or sexually transmitted infections.

• Perform a pelvic exam. During a pelvic exam, your doctor visually examines your vagina for signs of infection and inserts two fingers into your vagina while pressing on your abdomen with the other hand to check your pelvic organs for signs that may indicate disease.

• Take a sample of vaginal secretions. This may be done to check for an overgrowth of anaerobic bacteria in your vaginal flora. Your doctor may examine the vaginal secretions under a microscope, looking for “clue cells,” vaginal cells covered with bacteria that are a sign of bacterial vaginosis.

• Test your vaginal pH. Your doctor may check the acidity of your vagina by placing a pH test strip in your vagina. A vaginal pH of 4.5 or higher is a sign of bacterial vaginosis.

Many patients ask “What happens if I don’t get treated?” BV can cause some serious health risks, including:

• Increasing your chance of getting HIV if you have sex with someone who is infected with HIV;

• If you are HIV positive, increasing your chance of passing HIV to your sex partner;

• Making it more likely that you will deliver your baby too early if you have BV while pregnant;

• Increasing your chance of getting other STDs, such as chlamydia and gonorrhea.

These bacteria can sometimes cause pelvic inflammatory disease (PID), which can make it difficult or impossible for you to have children. So if you think you are suffering from bacterial vaginosis, call and make an appointment with your healthcare provider now.

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Timothy J. Hardy, M.D.

Dr. Timothy Hardy, M.D. has been practicing medicine in the community for many years. He received his medical degree from Eastern Virginia Medical School and founded his own practice, Atlantic OB-GYN, in 1990, where he has been providing women with exceptional care ever since. Website: www.atlanticobgyn.com
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