Bacterial Vaginosis

Bacterial vaginosis (BV) is quite a common condition, causing a vaginal discharge that often has a noticeable smell. It is not sexually transmitted and is caused by an overgrowth of the normal bacteria (germs) that live in your vagina. The BV symptoms are usually mild, and sometimes clear up without any treatment. However, BV often requires antibiotic medication.

Your IPSA bacterial vaginosis consultation

When you come to the IPSA clinic for your BV consultation, you will be examined by one of our female IPSA clinicians. Your IPSA clinic is a quiet and confidential environment and with a person-centred, holistic approach to your assessment and treatment, you will be fully involved in your consultation process. Your BV symptoms will be taken seriously.

Your female IPSA doctor will both explain and discuss with you the different available BV treatment options, prior to reaching an agreement with you regarding the best method of BV management/treatment for you.

During your BV consultation, your IPSA clinician will discuss your sexual history with you, as, if you are in a long-term stable relationship, she may diagnose BV from its typical symptoms (such as the characteristic fishy smell). She may carry out some tests to confirm the BV diagnosis, especially if you are pregnant, as it is important to accurately diagnose BV during pregnancy to effectively treat it. Your female IPSA practitioner may test the acidity level or your vagina and take a swab to send to the lab for confirmation. And because IPSA has a large on-site pharmacy, any medications you require can be sourced immediately.

What is bacterial vaginosis and what causes it?

BV is quite a common condition which is due to an overgrowth of various bacteria (germs) in your vagina. It is not merely a simple infection caused by only one type of bacterium. Your vagina normally has a mixture of bacteria and when the natural bacterial balance alters, you can develop BV, although it is unclear why this happens. When the balance is upset, certain bacteria then multiply and can thrive much more so than they usually can.

Poor hygiene does not lead to BV developing; excessive washing of your vagina might alter the normal bacterial balance of your vagina, which then makes BV more likely to develop.

Who gets bacterial vaginosis and how common is it?

It is not known how common BV is, as it is often mild and women may tend not go to the doctor. It might be that about 1 in 3 women experience BV at some point in their lives.

You are more likely to get BV:

If you are sexually active, although women who have not yet had sex can also get BV. However, it is more usual in women who do have sex. You can also develop BV if you have sex with either women or men.
If you smoke.
If you have recently changed to a new sexual partner.
If you use bubble bath.
If you have had sexually transmitted infections (STIs) in the past.
If you are using the copper coil for your contraception (an intrauterine contraceptive device or IUCD).
If your family is of Afro-Caribbean origin.

You are less likely to get BV:

If you are using the combined oral contraceptive pill.
If you are using condoms.
If your partner has been circumcised.

What are the symptoms of bacterial vaginosis?

The main BV symptom is vaginal discharge. It is one of the most usual reasons for vaginal discharge in those women who are of childbearing age. The vaginal discharge is usually whitish-grey in colour and usually has a fishy smell that can be more noticeable when having sex. The BV discharge often tends to be heavy following your period or after having sex. BV discharge usually does not lead to soreness around your vagina/vulva and does not usually cause an itch.

Up to half of women with BV do not exhibit any symptoms.

Vaginal discharge can be caused by other conditions, and not just by BV. For example, another common type of infection, called thrush, is caused by a kind of yeast (Candida). Thrush usually leads to a much thicker white vaginal discharge, causing soreness and itching around the vagina/vulva. Some STIs, like chlamydia, can also produce a vaginal discharge.

Is bacterial vaginosis transmitted sexually?

No. BV also affects women who are not currently sexually active and women who have not yet had sex. BV is more usual in sexually active women than it is in women who are not sexually active. No bacteria are passed on from sexual partners with BV, so if you have BV, your sexual partner does not require treatment. There are some BV cases that do seem to be sexually related, as it can develop when you change your sexual partner. However, in these cases, the BV infection is not caught from your partner. A change in sexual partner might affect the bacterial balance of your vagina. BV is more likely in same-sex female relationships when there has been a change in partner.

How is bacterial vaginosis diagnosed?

BV is diagnosed through the typical discharge and its characteristic fish-like smell. Additionally, both the acid level of your vagina can be tested during your IPSA BV consultation and/or your IPSA physician will take a swab to confirm a BV diagnosis.

Testing the acid level of your vagina

BV discharge has a specific pH level (acid/alkaline balance) when compared to other types of vaginal discharge. The overgrowth in the BV bacteria causes the pH to alter in your vagina, making it more alkaline (the pH increases). Your female IPSA physician might suggest taking a sample of your vaginal discharge so that she can carry out a pH test. When an alkali substance is then added to your sample of vaginal discharge, it often produces the characteristic BV fishy smell.

Taking a sample (a swab)

To confirm your BV diagnosis, your IPSA doctor might also suggest taking a swab of your vaginal discharge and sending it to the laboratory for BV testing, where, under a microscope, large numbers of bacteria that occur when you have BV can be seen. Your IPSA clinician may also take some further swabs to rule out any other causes (such as chlamydia) for your vaginal discharge.

Are there any possible complications from bacterial vaginosis?

BV and pregnancy

If you have untreated BV during your pregnancy, then you have a slightly increased risk of developing some pregnancy complications such as:

Early labour.
Miscarriage.
Having a low birthweight baby.
Having a preterm birth (having your baby early).
Developing an infection in your womb (uterus) after childbirth (which is called postpartum endometritis).

BV and surgery

If your BV is left untreated then you have a higher chance of developing an infection of your uterus after having certain operations (such as a vaginal hysterectomy or a pregnancy termination).

BV and other infections

If your BV is untreated you might increase your risk of developing an HIV infection if you have sex with an HIV-infected partner. You might also pass on HIV more easily if you have BV and HIV together. Some evidence exists that women with BV that is untreated might be at an increased risk for pelvic inflammatory disease (PID).

What is the treatment for bacterial vaginosis?

For some women, no treatment is needed, as BV often produces no symptoms, or any BV symptoms that you do have can be mild. There is a reasonable chance that it will gradually clear up without any specific treatment, as the imbalance in the vaginal bacteria can correct itself naturally over time.

However, if you are pregnant but you are found to have BV with no symptoms, your IPSA physician might advise you to take a course of antibiotics, but as the benefits of treating pregnant women with BV (with no symptoms) is unclear, your IPSA physician will discuss the pros/cons of this with you during your BV consultation.

All pregnant women with BV symptoms should be treated. If you have BV and are undergoing a pregnancy termination, your IPSA clinician may recommend antibiotic treatment (even if you have no BV symptoms). This is because the risk of BV causing a more serious uterus (womb) infection or pelvic infection increases following the procedure if left treated. If you are about to undergo another gynaecological procedure (such as a biopsy of your womb lining, called an endometrial biopsy), then your IPSA doctor might suggest antibiotic treatment for your BV (again, even if you have no symptoms).

Metronidazole tablets

Your IPSA physician may prescribe a course of metronidazole tablets (antibiotics). This antibiotic usually clears up BV. Your IPSA clinician will run through the possible side effects/cautions with you during your BV consultation. However, the following points are worth considering regarding metronidazole treatment:

The usual metronidazole dose is 400–500 mg, two times a day, for 5 to 7 days. The alternative single dose of 2 grams is possible, but may be less effective, cause more side effects, and is not recommended if you are pregnant. If you are prescribed the seven-day metronidazole course, you must finish the course and take all of the tablets.
Some people can feel sick or might actually be sick (vomit) when taking metronidazole. This is less likely if you take the tablets immediately after a meal.
A metallic taste in your mouth is a common side effect.
No alcohol should be consumed while taking metronidazole and for a minimum of 48 hours after completing your treatment. Metronidazole interacts with alcohol and leads to vomiting and problems such as an increased pulse rate/flushing.
Metronidazole can get into your breast milk if you are breastfeeding, but won’t harm your baby. Vaginal metronidazole or clindamycin is recommended rather than the oral version of metronidazole for breastfeeding women.

Alternative antibiotic treatments

If you have unwanted side effects from the metronidazole tablets, or if you prefer a vaginal treatment, then your IPSA physician can prescribe a vaginal gel (metronidazole vaginal gel) or a cream (clindamycin vaginal cream) to place inside your vagina. These treatments work just as well at clearing BV as the metronidazole tablets taken by mouth.

As with the metronidazole tablets, you need to avoid alcohol when using the metronidazole gel and for a minimum of 48 hours after finishing the treatment. Vaginal creams and gels can weaken diaphragms and latex condoms, so during treatment, and for five days following treatment with the clindamycin vaginal cream, do not rely on diaphragms or condoms to protect against STIs and pregnancy.

There are other antibiotic tablets that can sometimes be used when treating BV (areclindamycin tablets and tinidazole tablets).

Other treatments

There is no strong evidence as yet about live yoghurt (Lactobacillus acidophilus) that is found in some commercial probiotic products for treating or preventing BV. Antiseptics and disinfectants do not help to treat BV.

Do I need a test to see if I have been cured?

Women who are not pregnant

Following your treatment, you do not need to have any further tests undertaken to ensure that your BV has cleared up (this is called ‘a test of cure’) as long as your BV symptoms have gone.

Women who are pregnant

If you are pregnant, your IPSA physician will probably suggest having a test of cure for your BV carried out one month following your BV treatment to ensure that the BV infection is no longer present. A sample of your vaginal discharge is taken with a swab and sent to the lab to check that you no longer have BV.

Treating recurrences

If you have BV symptom recurrence and did not have the BV vaginal discharge test (swab) carried out initially, then your IPSA clinician might suggest having this test now to confirm that BV is the cause of your symptoms.

BV can recur (return) if you did not fully complete your antibiotic course. Unfortunately, in many women who have completed the full BV course of antibiotics, the condition often recurs within three months. A repeat course of antibiotics usually clears BV. For a small percentage of women, repeated BV episodes occur, and this needs repeated antibiotic courses.

Your IPSA physician will discuss alternative contraception with you if you currently have a copper coil (an IUCD) fitted for contraception and have recurrent BV, as removing the coil can sometimes improve your BV symptoms.

Preventing further episodes of bacterial vaginosis

Most BV episodes that occur cannot be prevented as there is no clear reason behind the overgrowth of bacteria with BV. However, your IPSA clinician will discuss maintaining a normal balance of bacteria in your vagina with you as this is thought to reduce the recurrence of BV episodes.

Do not douche (push water into your vagina) to clean your vagina as your vagina does not need specific cleaning.
Do not use antiseptics, bath oils, shampoos, scented soaps, perfumed bubble bath, and so in your bath water.
Do not wash your underwear in strong detergents.
Washing your vagina and vulva should not be done too often. Once a day is sufficient.

Book your same-day IPSA BV consultation by phone or online.