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Bacterial Vaginosis

Definition

Bacterial vaginosis (BV) is a type of vaginal infection in which the normal balance of bacteria in the vagina is disrupted, allowing the overgrowth of harmful anaerobic bacteria at the expense of protective bacteria.

Description

BV is the most, common and the most serious type of vaginal infection in women of childbearing age. As many as 10 to 26 percent of pregnant women in the United States have BV; BV has been found in 12 to 25 percent of women in routine clinic populations, and in 32 to 64 percent of women in clinics for sexually transmitted diseases (STDs). BV is different than vaginal yeast infections and requires different methods of treatment.

In most cases, BV does not have lasting effects on women. However, there can be risks associated with BV:

Causes and symptoms

Bacteria that dominate the vaginal flora in a BV infection include Gardnerella vaginalis or Mobiluncus, although other bacteria, such as Escherichia coli from the rectum have also been shown to cause the disease. The overgrowth of these harmful bacteria are at the expense of the protective bacteria lactobacilli, which secrete a natural disinfectant, hydrogen peroxide, that maintains the healthy, normal balance of vaginal microorganisms. The factors that upset the normal balance of bacteria in the vagina are not well-understood; however, the following activities or behaviors that have been associated with BV include:

having a new sex partner or multiple sex partners
stress
douching
using an intrauterine device (IUD) for contraception

BV is not transmitted through toilet seats, bedding, swimming pools, or touching of objects. Women who have not had sexual intercourse rarely have BV. However BV is not considered an STD, although it does appear to act like an STD in women who have sex with women.

The main symptom of BV is a thin, watery or foamy, white (milky) or gray vaginal discharge with an unpleasant, foul, fish-like or musty odor. The odor is sometimes stronger after a woman has sex, when the semen mixes with the vaginal secretions. Burning or pain during urination can also be present with BV. Itching on the outside of the vagina and redness can also occur, but are seen less frequently. However, many women with BV do not exhibit any symptoms.

Diagnosis

BV is diagnosed through a examination of the vagina by a health care provider. A woman who suspects that she may have BV should not douche or use a feminine hygiene spray before the appointment with the health care provider. Laboratory tests are conducted on a sample of the vaginal fluid to see if the bacteria present are those associated with BV. The health care provider may also check to see if there is decreased vaginal acidity. Potassium hydroxide, when added to a vaginal discharge sample, enhances vaginal odors and allows the health care provider to determine if the odor is fishy or foul.

Treatment

In a few cases, BV might clear up without treatment. However, all women with symptoms of BV should be treated to relieve symptoms and to avoid the development of complications such as pelvic inflammatory disease (PID). In most cases, male partners are not treated, but female sexual partners should be examined to see if they have BV and require treatment.

BV is treated with prescription antibiotics such as metronidazole or clindamycin creams or oral metronidazole (both are antibiotics that can also be used by pregnant women, although at different doses). Metronidazole kills anaerobic bacteria but does not harm the protective lactobacilli. Drinking alcohol should be avoided when taking metronidazole, for this medicine can cause severe nausea and vomiting when combined with alcohol.

Key terms

Anaerobic bacteria — Bacteria that do not require oxgyen, found in low concentrations in the normal vagina

Vaginal discharge — discharge of secretions from the cervical glands of the vagina; normally clear or white

For postmenopausal women, in addition to the use of antibiotics, the health care provider may also prescribe estrogen suppositories or topical cream to thicken and lubricate vaginal tissues. Sexual activity should be avoided during treatment; a condom should be used if the woman does have sexual intercourse. The woman should be tested after treatment to ensure that the infection has been cured.

Alternative treatment

Supplement therapies are available in addition to the use of prescription medicines to ease recovery.

Herbal therapies

Fresh garlic (Allium sativum) has antibacterial properties and can be added to a woman's diet. A fresh, peeled garlic wrapped in gauze can also be inserted into the vagina to help treat BV. The insert should be changed twice daily.

To soothe itching or irritation of the vaginal tissues, a woman can bathe the tissues in an infusion of fresh chickweed (Stellaria media). The infusion is made by pouring one cup of boiling water on one to two teaspoons of the herb, steeping for five minutes, and allowing the mixture to cool before use.

Prognosis

Pregnant women with BV often have babies of low birth weight (less than 5.5 pounds) or who are premature
Bacteria that cause BV may also cause pelvic inflammatory disease (PID), an infection of the uterus and fallopian tubes. The risk of a woman with BV developing PID is higher after the woman undergoes surgical procedures such as a hysterectomy or an abortion. PID can result in infertility and can also increase the risk of an ectopic pregnancy
BV may increase the risk of a woman becoming infected with HIV, the virus that causes AIDS
A woman with BV and HIV is more likely to pass HIV to her sexual partner
BV increases the chance that a woman will contract other STDs, such as chlamydia and gonorrhea

BV can be successfully treated with antibiotics.

practicing abstinence
delaying having sex for the first time, as younger people who have sex are more likely to contract BV and STDs
limiting the number of sexual partners
having a sexual relationship with only one partner who does not have an STD
practicing safer sex, which means using a condom every time when having sex

Prevention

Since the development of BV often appears to be associated with sexual activities, recommended ways to avoid BV include:

Other ways to prevent BV include:

discontinuing the use of tampons for six months
practicing good hygiene by wiping from front to back (away from the vagina) after bowel movements to avoid spreading bacteria from the rectum to the vagina
wearing cotton panties and panty-hose with a cotton crotch and avoiding tight or latex clothing to keep the vagina cool and dry
avoiding the use of perfumed soaps and feminine sprays
lowering stress levels
avoiding douching, as douching removes some of the normal bacteria in the vagina that protects women from infection
finishing the course of antibiotic treatment, even if the symptoms are relieved, to prevent reoccurrence of the disease
routinely being tested for BV during regular gynecological examinations

Some physicians recommend that all women who have a hysterectomy or an abortion be treated for BV, to reduce the risk of developing PID.

Resources

Books

Icon Health Publications. Bacterial Vaginosis—a Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: Icon Health Publications, 2003.

Parker, James N. and Parker, Philip M., editors. The Official Patient's Sourcebook on Vaginitis.San Diego, CA: Icon Health Publications, 2002.

Parker, James N. and Parker, Philip M., editors. The Official Patient's Sourcebook on Bacterial Vaginosis. San Diego, CA: Icon Health Publications, 2003.

Time-Life Books. Vaginal Problems The Medical Advisor.. Richmond, VA: Time-Life Books, 1996.

Periodicals:

Organizations

American Social Health Association, P.O. Box 13827, Research Triangle Park, NC 27709. Telephone: (919) 361-8400; Fax: (919) 361-8425; Web site: http://www.ashastd.org/.

3M National Vaginitis Association. 3M Center, 275-3W-01, P.O. Box 33275 Saint Paul, MN 55133-3275. Website: www3.3m.com/pdas-nva/

National Women's Health Information Center. U.S. Department of Health and Human Services. Telephone: (800) 994-9662: Website: www.4woman.gov

Other

3M National Vaginitis Association. Women's Guide to Vaginal Infections. Brochure available for download: www3.3m.com/pdas-nva/cons_addresources.html

bacterial vaginosis

Overgrowth of anaerobic vaginal flora (especially species of Bacteroides and Gardnerella) and loss of normal lactobacilli, often causing irritation and a discharge with a "fishy" odor, and increasing the risk of pelvic inflammatory disease and adverse pregnancy outcomes.