Bacterial Vaginosis Treatment

What is bacterial vaginosis?

Bacterial vaginosis (BV) is a common bacterial infection of the vagina. It is caused by an imbalance of the microbes that are found naturally inside the vagina. The vagina contains lactobacilli, a type of bacteria that produces lactic acid and helps to prevent other bacteria from growing. If other bacteria, such as gardnerella vaginalis, enter the vagina, they can harm the lactobacilli, allowing other more problematic bacteria to grow. This can lead to the symptoms of bacterial vaginosis i.e. irritation, fishy odor and vaginal discharge. Bacterial vaginosis is usually treated by antibiotics which can be taken orally e.g. Metronidazole or applied as a cream inside the vagina .e.g. Dalacin (Clindamycin) or Zidoval (Metronidazole) Cream.

A healthy vagina contains a number of lacto acidic environment inside the vagina that helps to prevent other bacteria from growing and causing an infection. Bacterial vaginosis is caused by other bacteria entering the vagina and damaging the lactobacilli. This alters the acidity of the environment allowing other bacteria to grow and producing the symptoms of irritation, fishy odor and vaginal discharge.

50% of women with bacterial vaginosis do not experience any symptoms and you do not have to experience all of these symptoms to have bacterial vaginosis. However, the signs and symptoms of bacterial vaginosis include:

• Fishy or ammonia-like vaginal odor - this often becomes apparent after sexual intercourse
• Mild to moderately increased vaginal discharge
• Greyish-white or thin and watery vaginal discharge
• Irritation of the vulva
• Pain during sex
• Pain when urinating

A diagnosis of bacterial vaginosis is made by asking about your symptoms, but often involves a physical examination and a swab test to rule out STIs that could cause similar symptoms.

Asking about your symptoms

You will be asked about which symptoms you are experiencing i.e. irritation, fish odor, vaginal discharge, when you noticed these symptoms and how long you have been experiencing them. You may also be asked questions about your sexual activity and how this could relate to your symptoms.

Physical examination

A doctor may want to examine your vagina to check for the following:

• Gray, clear and thin vaginal discharge that adheres to the vaginal walls
• Increased glistening of the vaginal walls, but little or no evidence of inflammation (redness, swelling etc.)

Swab test

A swab may be taken from inside the vagina - this is usually done to rule out STIs. A lab test may be done to test the acidity of the vagina, as a slightly more alkaline environment may indicate infection. There may also be microscopic examination of the discharge to look for cells from the surface of the vagina that have bacteria attached to their surface. 

There are various factors that may increase your likelihood of getting bacterial vaginosis. These risk factors include:

• Antibiotics: Antibiotics can harm the lactobacilli, that help to prevent bacterial vaginosis.
• Decreased estrogen production: Decreased estrogen production is often associated with menopause or breastfeeding and can lead to changes in the environment of the vagina, that alter the acidity and allow harmful bacteria to grow.
• Intrauterine devices (IUDs): It is thought that copper IUDs may alter the microbiome of the vagina, making it easier for bacteria to get out of control. Alternatively, IUDs may harbor bacteria and allow them to grow, out of reach of the usual defences of the immune system.
• Douching: The act of douching can introduce bacteria into the vagina as well as upsetting the natural balance of bacteria that protect you from bacterial vaginosis.
• Increased sexual activity or having multiple partners: Increased sexual activity makes you more likely to have more bacteria introduced into the vagina. In addition, having multiple partners is thought to increase your risk of bacterial vaginosis, although the reasons behind this are not yet fully understood
• Bubble baths or scented products: Having bubble baths can put you at greater risk of bacterial vaginosis, because the bubble bath and other scented hygiene products can enter the vagina and affect the microbiome that helps to protect you from bacterial vaginosis.
• Tampons: Using tampons can predispose you to bacterial vaginosis as tampons can sometimes alter the bacterial make-up of your vagina.
• Smoking: Smoking can have a negative effect upon your estrogen levels. Reduced estrogen can cause changes to the microbiome of the vagina, making it more likely that you will get bacterial vaginosis. It is also possible that some of the chemicals in cigarette smoke may also increase your chances of bacterial vaginosis.
• Obesity: It is thought that obesity can alter the microbiome of the vagina making you more likely to experience bacterial vaginosis.
• Prior Pregnancy: Hormones fluctuate throughout pregnancy. Hormonal changes can affect the acidity of the vagina, which can damage the healthy microbiome of the vagina, making it more likely that you will experience bacterial vaginosis.
• Prior Abortion: If you have recently had an abortion, your hormone levels may fluctuate. This can affect the acidity of the vagina, encouraging certain bacteria to grow, potentially resulting in bacterial vaginosis.  
• Current STI: STIs are often caused by pathogenic bacteria. The introduction of these bacteria can damage the balance of the microbiome of the vagina, allowing other bacteria to proliferate, causing bacterial vaginosis.
• Pelvic Inflammatory Disease (PID): PID is an infectious disease caused by bacteria. The bacteria involved in PID can overpopulate an area and take resources from the good bacteria - lactobacilli. With less lactobacilli, bacterial vaginosis becomes more likely.

The first step to combat bacterial vaginosis is to avoid any contributing factors such as douching, tampons, bubble baths etc. This should help make it easier for your body to return to its normal healthy state.

Antibiotics are the best treatment for bacterial vaginosis. Metronidazole and Clindamycin are the preferred medications. Both are available as topical creams that are applied directly inside the vagina. But oral tablets of Metronidazole are usually the first line treatment.

Probiotics containing lactobacilli have also shown some promise in resolving bacterial vaginosis for short periods of time, but avoiding risk factors and a course of antibiotics are usually required for recurrent bacterial vaginosis.

How can I tell the difference between bacterial vaginosis and a yeast infection?