What are the symptoms of bacterial vaginosis (BV)?

BV only has one major symptom and often doesn’t show any symptoms at all

What is BV and what causes it?

Bacterial vaginosis (BV) is a vaginal bacterial infection that is found in about 30% of U.S. women of reproductive age. It’s the most common vaginal infection and appears more often in women who are sexually active, but it’s not considered a sexually transmitted infection (STI). Women of some ethnic groups are more affected than others. In the U.S., BV is most frequently found among African American women.

BV is caused by different bacteria types in the vagina changing their relative quantities. This happens when the “good” bacteria (lactobacilli that protect the vagina) are outnumbered by “bad” bacteria, such as Gardnerella vaginalis. When the Gardnerella bacteria grow and multiply in number, they cover the inside of your vagina with a mucus layer that then becomes a breeding ground for other bad bacteria. Gardnerella opens the door for them.  

There are several triggers that can cause such a bacterial imbalance, although the precise workings of these microbiotic processes aren’t fully understood yet and the debate in the medical community is ongoing. These risk factors include douching or using aggressive soaps to wash the vagina, sexual activity (especially with new or more than one partner), and the use of unclean intrauterine devices (IUD). Essentially, it comes down to either too many good bacteria being removed from the vagina or too many bad bacteria being introduced into it.

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What are typical BV symptoms?

You may be surprised to learn that most women who develop BV will never know they had the infection. This is either because symptoms were entirely absent or only very mild. Therefore, some 85% of BV cases every year in the U.S. go unnoticed — and that’s not a problem, since a symptom-free or mild BV that clears on its own after a few days isn’t considered a serious medical issue.  For these symptom-free cases, only a vaginal swap test would reveal the presence of BV, but it’s not necessary.

It’s only when symptoms become apparent that you should get them checked out by a doctor. This is because at an advanced stage BV can cause secondary complications (especially for pregnant women) and thus needs to be treated. Moreover, suspected BV symptoms need to be checked to rule out that they were caused not by BV but by an STI.  

The most common BV symptom is white or grey-colored discharge that often has a fishy smell to it. This discharge liquid is the bacterial mucus that continuously accumulates along the vagina walls and then flows outward. It’s important to note that STIs like chlamydia, gonorrhea, and thrush can cause similar discharges. Only a swap test will provide clarity.     

Skin rashes and redness aren’t BV symptoms. Other than the foul-smelling discharge, there aren’t any skin irritations and also no pain. The affected skin areas also don’t turn redder than they normally look like. At the most, a mild itching may be felt, but this is rare.

Can and should BV be treated?

Most cases of BV disappear on their own within one week, often before they are detected. So, no treatment is needed. However, if the discharge and odor is very obvious and persists for several days without any signs of improvement, you’ll need to get it checked by a doctor. 

If a BV is diagnosed through a vaginal swab, the doctor will likely prescribe you an antibiotic treatment, especially if you are pregnant or otherwise at a risk of BV causing complications.

Metronidazole tablets (also known as Zidoval) and Dalacin gel are popular BV antibiotics. For hard cases, when tablets or gels don’t help to relieve the BV or if the BV keeps recurring, Metronidazole can also be prescribed for vaginal insertion.

While taking the antibiotics, don’t consume alcohol. Also try to reduce sexual activity and use condoms where applicable. If you keep getting recurring BV while being with the same-sex partner, it may be worth to have your partner tested for BV. Normally, since it’s not an STI, your partner doesn’t need to undergo any treatment because you have BV. In rare cases though, the partner can be the reason for getting recurring BV. Doctors then may consider treating him or her.

References

  1. Hay, Phillip. “Bacterial Vaginosis.” F1000Research, vol. 6, 27 Sept. 2017, p. 1761, www.ncbi.nlm.nih.gov/pmc/articles/PMC5621139/pdf/f1000research-6-12327.pdf, 10.12688/f1000research.11417.1. Accessed 12 May 2020.
  2. Brown, Joelle M., et al. “Intravaginal Practices and Risk of Bacterial Vaginosis and Candidiasis Infection among a Cohort of Women in the United States.” Obstetrics & Gynecology, vol. 121, no. 4, Apr. 2013, pp. 773–780, 10.1097/aog.0b013e31828786f8. Accessed 12 May. 2020.
  3. Jones, Ashley. “Bacterial Vaginosis: A Review of Treatment, Recurrence, and Disparities.” The Journal for Nurse Practitioners, vol. 15, no. 6, June 2019, pp. 420–423, 10.1016/j.nurpra.2019.03.010. Accessed 19 Mar. 2020.
     

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