What is it?

Bacterial vaginosis (BV), also called gardnerella, anaerobic vaginosis, nonspecific vaginosis, is the most common vaginal infection in women of reproductive age. It is caused by the overgrowth of several bacteria in the vagina. It is normal for most women to have a small amount of these bacteria in the vagina; it is only when there is an overgrowth that women may experience symptoms. Bacteria that cause BV include Gardnerella vaginalis, Mobiluncus and Mycoplasma hominis.

How is it spread?

Bacterial vaginosis is not considered an STD. Women who have sex with men are more prone to BV. However, women who have sex with women and sexually inactive women can also be infected. It should be thought of as a problem of balance which may cause symptoms on and off for months or years. These bacteria do not cause permanent damage.

What can cause BV?

Factors that can change the balance in our vaginas and put us at risk of having BV include douching (we do not recommend douching with sprays or over the counter preparations), using antibiotics, hormonal changes (e.g. some women notice symptoms after their periods), foreign bodies such as tampons, diaphragms and IUD’s and semen (as semen can change the environment of the vagina). Wearing unbleached, cotton underwear and avoiding synthetic underwear, pantyhose and tight clothing may also help reduce the chances of getting BV.

What are the Symptoms?

• Smelly, watery, grey or yellow vaginal discharge.
• Odour, often worse right after intercourse (with men) i.e. a fishy smell that comes from the discharge mixing with semen.
• Vaginal soreness after intercourse.
• Mild vulvar itching or burning.
• Many women have no symptoms.

Possible Complications

If a woman is pregnant and has BV, she may be more likely to have a pre-term birth, premature rupture of membranes, and endometriosis after delivery. There is also a higher rate (three times) of PID (Pelvic Inflammatory Disease) after abortions and gyne-surgeries in women who had BV during the procedure. There may be an increased risk for HIV infection because the vaginal area will be irritated and more likely to have tears or abrasions. BV has been linked with UTI’s (urinary tract infections) and cervicitis (an infection of the cervix).

Testing

Physical examination and looking at the discharge under a microscope can tell us if someone has BV. You can also be diagnosed with BV when you are checked for STD’s/infections by your healthcare worker and a culture is sent to the lab. Women are tested for this when they have check-ups at Hassle Free.

Treatment

We recommend that women be treated whether they have symptoms or not. Women should be treated if they are continuing their pregnancy, are going to have an abortion or are scheduled to have a gynecological procedure done. Treatment will reduce the chances of complications. Pregnant women must be treated with oral or intravaginal metronidazole (Flagyl) and should not rely on the natural remedies discussed below.

The first treatment option we suggest (for non-pregnant women) is a natural remedy that can be repeated whenever necessary. Put two capsules of Lactobacillus acidophilus (yogurt bacteria) into your vagina before bed for one week. These capsules are available at Hassle Free Clinic for free or at health food stores. Store in the refrigerator or a very cool place.

If symptoms do not improve, you can try repeating this treatment but with a douche before you insert the acidophilus. Use one tablespoon plain white vinegar in a quart of warm water. The acidic douche makes it difficult for the abnormal bacteria to grow and the acidophilus has a chance to build up healthy vaginal bacteria. This usually gives relief of symptoms, but they may recur at any time. You might have to work out a regular routine, for example, treating yourself every third day, one week per month, etc. Avoid routine douching and use the acidophilus alone as much as possible. Pregnant women should not douche.

If this remedy does not reduce your symptoms enough, you can take the antibiotic metronidazole (Flagyl is the best known brand). The most effective dose is a treatment for seven days. This drug can clear symptoms dramatically, but it is still possible that they will return. Metronidazole can cause nausea and vomiting, especially in combination with alcohol. Pregnant women and women about to have an abortion or gyne-surgery should be treated with metronidazole. There are also topical creams available that contain metronidazole such as Nidagel.

What about sexual partners?

As said before, BV is not considered an STD. It cannot be passed back and forth between partners. Male sexual partners of women with this condition usually show no symptoms. The recurrence rate in women is the same whether their partners are treated or not. However, women who have sex with men and have chronic BV may want to have sex using condoms to limit their exposure to semen (which can change the environment of the vagina). No studies exist regarding female sexual partners. This condition really is an imbalance, and we do not know why only some women are bothered or why they get better when they do.

No routine follow-up testing is necessary unless you just want to confirm that recurring symptoms are really BV and not a new STD.