Bacterial Vaginosis (BV)

What is bacterial vaginosis?

Bacterial vaginosis is the most common cause of vaginal discharge in women of childbearing age. It has been found in approximately 20% of women who visit student health clinics.

What causes bacterial vaginosis?

Many different bacteria inhabit the normal vagina, both “good” and “harmful”. Bacterial vaginosis occurs when the complex ecosystem of the vagina is disrupted and “harmful” bacteria increase in numbers. No one yet knows why this happens. Your provider will discuss some possible reasons with you. Women do not get bacterial vaginosis from toilet seats, bedding, or swimming pools.

Are there health risks?

There seems to be an association between bacterial vaginosis and pelvic inflammatory disease (infection in the fallopian tubes), which could cause infertility. Untreated bacterial vaginosis has also been associated with premature labor and with an increased risk of infection following gynecologic surgery. Bacterial vaginosis may make a woman more susceptible to infection with HIV, chlamydia, gonorrhea, and human papilloma virus, which can cause genital warts and abnormal Pap smears. Women with bacterial vaginosis are more likely to have an abnormal Pap smear.

Is bacterial vaginosis a sexual transmitted disease?

Although bacterial vaginosis is not an sexually transmitted disease by strict definition, it seems to occur more frequently in women with multiple sex partners or with a new sex partner. Most providers will not treat male sex partners, because no studies have shown this to be effective. Bacterial vaginosis can spread between female sex partners, in which case both need treatment. On the other hand, bacterial vaginosis can sometimes be found in women who have never been sexually active.

What are the symptoms?

The most common complaint is a strong foul or fishy-smelling vaginal odor. The odor is more prominent after unprotected intercourse. Other symptoms may include heavier discharge, itching, burning, or pain. Up to 50% of women will experience no symptoms at all. Sometimes the Pap smear will show a minor inflammatory reaction in the presence of bacterial vaginosis.

How is bacterial vaginosis diagnosed?

A qualified health provider can detect bacterial vaginosis by measuring the acidity of vaginal secretions and examining a sample of the secretions through a microscope. Since bacterial vaginosis may occur along with chlamydia or gonorrhea, a provider may want to test for these.

How is bacterial vaginosis treated?

There is no over-the-counter treatment for bacterial vaginosis. Since bacterial vaginosis may be associated with a pelvic infection, it is recommended you see a provider if you have symptoms. The main treatment for bacterial vaginosis is an antibiotic called metronidazole (Flagyl). It may be taken orally or given as a vaginal gel. An alternative drug is clindamycin (Cleocin) which is usually given as a vaginal treatment.

Can I get it again?

After therapy, about 30% of patients will have a recurrence of symptoms within 3 months. The reasons are unclear but thought to be related to failure to re-establish the normal protective vaginal bacteria. Relapses may require therapy for prolonged periods of time. Factors that may affect the vaginal ecosystem are antibiotics, smoking, spermicides, douches, perfumed bath oil and body washes, unprotected intercourse, sexually transmitted diseases, stress, change in partners, vitamin D deficiency, latex allergy, and self-treatment with over-the-counter medications.

Adapted from the University of South Carolina Student Health Services.