Bacterial Vaginosis (BV)

It is a common misconception that bacterial vaginosis (BV) is sexually transmitted, however, it is understandable why many women jump to the conclusion that BV is caused by sex. For one reason, it only affects the vagina. Secondly, symptoms are similar to that of certain STIs such as trichomoniasis, including a change to vaginal discharge and irritation. Thirdly, symptoms can be provoked after sexual intercourse.

In reality, bacterial vaginosis is not an STI but a bacteria condition located in the vagina similar to yeast infections, such as thrush. There are a number of reasons as to why BV isn't classed as an STI. For example, there is no equivalent for men, you can get BV without having sex and the cases of BV differ among various ethnic groups.

In fact, BV is one of the most common conditions around that area yet one that is often misdiagnosed. Bvexplained.co.uk states that 66% of women with BV think the condition is thrush, and with over the counter treatments available for the latter, we don't tend to visit the doctor for a thorough diagnosis, choosing to instead use creams and tablets not specialised for the condition.

It is no surprise that bacterial vaginosis is so common, as it is an imbalance of bacteria in a very complex area; small alterations can cause a big difference. A certain change in your lifestyle, hygiene alterations, antibiotics or even your own menstrual cycle can result in BV. The main causes can be something easily avoided once you realise they are the triggers:

• Douching (excessive focal washing of the genitals)
• Perfume hygiene products (bubble baths and sprays)
• Specific vagina cleaning products
• Menstruation
• Certain antibiotics
• The intrauterine device (IUD)
• Sexual intercourse
• Semen
• Smoking

One of the main causes of BV is the use of vagina cleaning products, as they are simply not necessary. It's important to remember that the vagina is self-cleaning and should have discharge so you don't need to use any products at all and this could be the reason BV is provoked.

Some causes of BV are unknown. Whilst douching, perfumed products and antibiotics clearly all alter the bacteria balance directly, there is no reason as to why being sexually active or having multiple sexual partners can provoke the condition. Some professionals believe that the movement during sex can alter the bacteria levels, but also certain semen as well. You are also more likely to contract BV if you are a black woman, and again the reasons for this are unknown.

The vagina's bacteria balance

The bacteria balance in the vagina is very important. When the pH of the vagina - which is usually slightly acidic – changes, this causes the vagina to combat and attack whatever that change might be even if it isn't a threat.

This bacterium is called lactobacilli, otherwise known as lactic acid, hence the lean towards the vagina being acidic. Lactobacilli is also known as a hydrogen peroxide-producing bacteria. This prevents other harmful bacteria from flourishing, so once the lactobacilli reduce in numbers, this allows other unfriendly bacteria to grow. The result of this is bacterial vaginosis.

Other bacteria can be involved in the condition. This includes bacteroides, peptostreptococcus, fusobacterium and eubacterium.

The symptoms of BV aren't often classed as serious but they can be discomforting, especially if you notice a smell to the discharge.

• White or grey discharge
• Thin watery discharge
• Strong fishy smell

It's worth mentioning that vaginal discharge is normal and all women have it. It is also likely that certain points in the month produce more discharge, or it changes in consistency. For example, you may notice more discharge in the days before your period which is usual. This makes it difficult to distinguish what discharge indicates BV, however, if you notice anything out of the ordinary, this could signify bacterial vaginosis.

The timing of BV can also be a good indication as many women who treat the condition notice when symptoms arise after pinpointing the trigger. For example, many women notice a smell up to two days after having sex, or if they have changed their bubble bath.

Whilst information about bacterial vaginosis is on the rise, there is still much to learn about the condition. If you feel your symptoms lean towards BV, you should always book an appointment with your doctor and state that you feel that you may have this condition. The sexual health clinic or GUM clinic is also a recommended destination when seeking medical advice.

As the symptoms run parallel with certain STIs such as gonorrhoea and trichomoniasis, and sometimes yeast infections like thrush, the medical professional will perform a number of tests to exclude other possibilities.

Please be aware that the doctor may want to look at your vagina for further diagnosis, even after symptoms confirm BV, just to make sure. If the doctor is unsure, he or she may take a swab from the wall of your vagina. This doesn't hurt, although may feel uncomfortable. The sample can either be analysed then and there or sent to the laboratory for further clarification. When diagnosed then and there, the swab is often rubbed onto pH treated paper that changes colour depending on the acidic-alkaline levels of your vagina. You can always request a female doctor if you are more comfortable.

Antibiotics

A course of antibiotics is the proven treatment for bacterial vaginosis and the first port of call. Many women find this is the ideal treatment for BV and any recurrent bouts thereafter. This is in the form of metronidazole and can be taken in a number of ways.

• A single dose (one tablet with a larger dosage taken once)
• A standard dose taken twice a day for up to seven days
• If you are breastfeeding, you can use a metronidazole gel
• The gel is applied once a day for five days
• Some women need an extra dosage if the infection hasn't cleared completely

Most women take the standard dose as one tablet. As the dosage is higher, it could induce temporary side effects so It is also advised to take metronidazole during meals and to avoid alcohol completely. As with all antibiotics, even if the symptoms have clear; please continue to finish the dose to ensure the infection has gone. Metronidazole is fast-acting with limited side effects.

Probiotics

Some women claim probiotics can help prevent or treat bacterial vaginosis. This is present in certain yoghurts. There is no definite proof this works, however, if you find yourself experiencing frequent bouts, there is no harm in trying.

pH correction

If bacterial vaginosis is a continual issue for you, and you find the antibiotics don't work, there are pH correction treatments that you can explore. This involves a gel inserted into the vagina that alters the bacteria balance. These are over the counter medications. Do make sure you get treatment specific to bacterial vaginosis as other over the counter treatment for thrush or vaginal hygiene can make the situation worse.

Specialist treatment

This is the last port of call if BV is unmanageable for you and involves being referred to a specialist for further investigation. This may be at your doctor's surgery or most likely at a specialist clinic. This can be available on the NHS, but also privately if you prefer.

BV can go away by itself and sometimes symptoms are manageable without treatment. However, treating the condition with effective antibiotics means any unpleasant symptoms are minimised and eliminated quicker. Most women find the level of itching and irritation to be manageable, especially in comparison to thrush or cystitis, however, it is the odour that causes the most concern.

It is also known to have bacterial vaginosis again. Recurrent bouts are common as the causes are everyday lifestyle changes.

Is bacterial vaginosis dangerous?

BV isn't classed as dangerous however many women choose to take antibiotics to minimise discomfort especially if a strong odour is present. If you are pregnant, however, please see your doctor and arrange treatment because this can cause difficulties during pregnancy.

Are there any complications regarding bacterial vaginosis?

For the vast majority of women, BV causes no complications whatsoever. For pregnant women, if you develop the condition early in your pregnancy, you are more at risk of premature birth, miscarriage and postpartum endometritis so quick treatment is key. BV is also known to make the success of in vitro fertilisation (IVF) lower.

Some research has shown that contracting BV can make you more susceptible to contracting STIs as your immune system is effectively preoccupied with fighting bacterial vaginosis and not the other infection(s). It reduces resistance.

Lastly, the NHS suggests there could be a link between undiagnosed BV and pelvic inflammatory disease (PID) although the studies are yet to clarify in any great certainty.

Will I need to have an STI test?

As bacterial vaginosis is similar to certain sexually transmitted infections, and if you aren't 100% certain you have the bacterial condition, testing is recommended. STIs that are similar to bacterial vaginosis include chlamydia, gonorrhoea and trichomoniasis.

What's Gardnerella vaginitis?

Gardnerella vaginitis is the previous name of bacterial vaginosis so if both terms are intertwined, this is no cause for alarm. The term was changed to BV to represent a wider range of bacteria that causes the condition.

Is bacterial vaginosis contagious?

No, BV is not classed as contagious; males don't get the condition and it only seems to affect one individual in same-sex couples. It is also impossible to get BV from sharing objects like towels and clothes, and from toilet seats and swimming.

Will there always be symptoms?

No, for the majority of women, BV is asymptomatic. There is a delicate balance of bacteria in the vagina, and quite often the condition will sort itself out. Antibiotics are required if symptoms are uncomfortable or unpleasant.

Can any doctor help?

Gynecologists are specialised in this area and may be preferred. In addition, the sexual health clinic and GUM clinic will be very knowledgeable and can diagnose BV. It's important to note that sexual health clinics are free and open to all, and aren't just about STI check-ups, but contraception and conditions associated with the sex organs such as bacterial vaginosis. Alternatively, your local doctor's surgery may have the resources.

If you haven't been diagnosed with BV before, it is always advised to book an appointment with your doctor. He or she can then establish the best treatment for you.

Antibiotics are clinically proven and one of the quickest ways to combat bacterial vaginosis. This is available through prescription at your doctor or online. For recurrent bouts, buying metronidazole online saves the time and effort especially if the antibiotics are your ideal treatment.

Certain BV treatments can be purchased over the counter at pharmacies, although these won't be clinically proven. These will be arranged near other female products such a thrush creams. If you're confused about what will help, ask the pharmacist for assistance.

Figuring out your trigger(s) is a giant step to controlling future outbreaks of bacterial vaginosis. Adjustments can be as simple as altering your hygiene routine or a change in fabric softener. Further adjustments include the following:

• Stop douching
• Don't clean your vagina
• Avoid perfumed products
• Be wary of the time of the month
• Change the IUD if that is your contraceptive
• Use a condom
• Quit smoking
• Experiment with different foods