What is bacterial vaginosis?

Bacterial vaginosis, formerly known as nonspecific vaginitis, is the most common infection of the vagina and is a very common presentation in the gynaecological setting. It is characterized by an increase in vaginal discharge associated with an unpleasant odour. This is most likely due to an imbalance in the vaginal flora. The symptoms are often bothersome and it is also associated with an increased risk of catching sexually transmitted infections such as human immunodeficiency virus.

In bacterial vaginosis, the vaginal flora is disturbed through known and unknown mechanisms resulting in an increase in pH of the vagina. Lactobacilli is an organism that is normally found in the healthy vagina. The decrease in pH causes a decrease in the population of lactobacilli. This results in an increase in the population of other organisms that eventually lead to bacterial vaginosis.

Bacterial vaginosis is not a sexually transmitted infection, however, sexual activity is closely linked to the development of the infection. Several other gynaecological conditions can present with increased vaginal discharge. Therefore, proper evaluation should be done to rule out the other possible conditions. One third of adult women in the United States has had bacterial vaginosis. It is more common among women of reproductive age.

What causes and risk factors of bacterial vaginosis?

As explained earlier, decrease in pH of the vagina results into decrease in lactobacilli population as well as increase in other microorganisms. These microorganisms include Gardnerella vaginalis and other organisms. The following factors can cause the disturbance in the vagina:

• Vaginal douching
• Bubble baths
• Vaginal hygiene products that are available without pre ion
• Having multiple sexual partners
• Having sexual intercourse very frequently
• Use of an intrauterine device
• Having other sexually transmitted infections

What are the symptoms of bacterial vaginosis?

Bacterial vaginosis can manifest with the following symptoms:

• Unpleasant odour from the vagina which sometimes may be noticeable only after having sex. The odour is sometimes described as a fishy odour.
• Increased vaginal discharge
• Vulvar irritation
• Painful urination
• Painful sexual intercourse

How is the diagnosis of bacterial vaginosis made?

To make the diagnosis of bacterial vaginosis, your doctor will start by asking you a series of questions to know more about your symptoms. He/she will then examine you by doing a pelvic examination. This will enable observation of vaginal secretions and collection of samples for testing. This sample is sent for further analysis in a laboratory. It is done to check for the presence of “clue cells” which is characteristic for bacterial vaginosis. Further tests can be done to check the pH of the vagina. If the pH is 4.5 or higher, it is likely that bacterial vaginosis is present.

How is bacterial vaginosis treated?

It is important to seek medical help if you have the symptoms of bacterial vaginosis as treated should be initiated as soon as possible. Treatment of bacterial vaginosis involves antibiotics. These include:

• Metronidazole: This is available in the form of a vaginal gel which is applied at bedtime for 5 days. It is also available in the form of pills. The choice between the gel and pill depends on the woman’s preference. The oral form of the medication may be associated with the following side effects: metallic taste in the mouth, nausea and low blood count. It is strictly recommended not do drink alcohol when taking metronidazole pills. These side effects are not present with the use of the vaginal gel.
• Clindamycin: This is also an antibiotic that is available in the form of a vaginal gel. It is applied at bedtime for 7 days. It should not be used with latex condom as it can result in breakage of the condom. The oral form of the medication is also available.

Around 30% of women who had resolution of symptoms after treatment will have recurrence of the symptoms in the next 3 months. If you have several episodes within one single year, you may have to undergo longer treatments. If you are pregnant, the preferred treatment is oral metronidazole for 7 days.

What are the possible complications of bacterial vaginosis?

Bacterial vaginosis, if left untreated, can result in various complications. These include:

• Bacteraemia: One complication that may arise is the spread of bacteria into the bloodstream. This can affect other organs and can even lead to death if left untreated.
• Urinary infections: This occurs when the bacteria moves into the urethra and migrates up to the upper urinary tract.
• Preterm delivery: If a pregnant woman has bacterial vaginosis, she is at higher risk of ending up with a preterm delivery.
• Increased risk of having sexually transmitted infections including HIV, gonorrhoea, genital herpes and chlamydia.

How can bacterial vaginosis be prevented?

Some recommendations include the following:

• Do not douche as it can cause disturbance in the normal vaginal flora.
• Limit your number of sexual partners.
• When you have been prescribed a course of antibiotics for the treatment of bacterial vaginosis, make sure that you complete the whole course even if you see that your symptoms has improved.

Prognosis

Bacterial vaginosis is usually considered as a benign condition as uncomplicated cases usually resolve without any problem after the standard antibiotic treatment. The prognosis of uncomplicated cases is excellent. However, long-standing or untreated bacterial vaginosis can lead to serious complications such as endometritis, salpingitis, pelvic inflammatory disease as well as complications during pregnancy. It is also associated with an increased risk of acquiring other sexually transmitted diseases.

Girerd, P., n.d. Bacterial Vaginosis

Sobel, J., and Mitchell, C., 2020. Bacterial vaginosis: Clinical manifestations and diagnosis

Sobel, J., 2020 Bacterial vaginosis: Treatment