Bacterial vaginosis

Bacterial vaginosis (BV) is a condition characterized by the overgrowth of certain bacteria that normally live in the vagina. Bacterial vaginosis is the most common vaginal infection during the childbearing years.


Causes/associated factors
Bacteria normally present in the vagina help maintain a healthy vaginal environment with a normal pH (degree of acidity/alkalinity). If certain bacteria multiply and outnumber those that are usually the most numerous, you may develop bacterial vaginosis.
What causes this change is uncertain. Risk factors may include:

using an intrauterine device for contraception
changing sexual partners
having multiple sexual partners
douching

Transmission
Although not considered a sexually transmitted disease (STD), sexual intercourse may be a risk factor for developing bacterial vaginosis. Bacterial vaginosis is rare in women who are not sexually active.

Signs/symptoms
The most common symptoms of bacterial vaginosis include:
increased pasty, thin, white or gray vaginal discharge that coats the vaginal walls
an unpleasant vaginal odor, often "fishy" smelling, especially after sex
vaginal irritation, such as itching or burning
About half of all women who have bacterial vaginosis have no symptoms. Although men may have the same bacteria in their genital tracts, men rarely develop symptoms.


Diagnosis
The doctor will do a pelvic exam and note the characteristics of any vaginal secretions. To help the doctor determine the cause of your symptoms, you may need various tests. For example:
A wet mount or "wet prep" of vaginal secretions may be done to microscopically check for "clue cells" (vaginal epithelial cells, those that line the surface of the vagina, coated with organisms).

Vaginal secretions may be mixed with a 10 percent solution of potassium chloride on a glass slide to check for yeast.

The pH of vaginal secretions may be tested with a special nitrazine paper. When you have bacterial vaginosis, the pH is higher or more alkaline.

Another test called a gram stain may be done to detect the absence of lactobacilli and an overgrowth of other bacteria.

Treatment
Although recurrence is common, bacterial vaginosis responds well to antibiotics. If more than one organism is causing the infection, the doctor will prescribe medications to treat the specific organisms.
Oral metronidazole (Flagyl, for example) or clindamycin (Cleocin, for example) are typically effective. In some cases, etronidazole vaginal gel (MetroGel, for example) and clindamycin vaginal cream are prescribed. It's important to avoid alcohol while you're taking this medication through at least 24 hours after treatment is complete. Drinking alcohol while you're taking metronidazole orally or vaginally can cause symptoms such as stomach pain, nausea, vomiting and headache.

Don't have sex until treatment is complete. If you have recurrent vaginal symptoms, your doctor may recommend treatment for your sexual partner(s) as well.


Complications
Complications of bacterial vaginosis are uncommon. However, bacterial vaginosis can place you at higher risk for sexually transmitted diseases such as gonorrhea and HIV. Women who have bacterial vaginosis are more likely to develop pelvic inflammatory disease (PID), an infection of the female reproductive tract. PID can lead to:
infertility
ectopic pregnancy (when the fertilized egg implants itself outside the uterus)
infection after a hysterectomy (surgical removal of the uterus)
uterine infection after an abortion

Pregnancy-specific information
Bacterial vaginosis is associated with an increased risk of serious complications of pregnancy, including:
preterm labor and birth
premature rupture of membranes (when your "water breaks" early)
low birth weight infants
chorioamnionitis (infection of the amnitotic fluid and membranes, which protect the baby in the womb)
endometritis (infection of the lining of the uterus) after a cesarean delivery or vaginal birth
infection after a cesarean delivery
Currently, there's no consensus on screening for and treating bacterial vaginosis during pregnancy. Studies haven't conclusively shown whether treatment decreases the risk of preterm delivery. Depending on the circumstances, your doctor may recommend screening and treatment, if necessary, especially if youterial vaginosis isn't completely understood, prevention is based on avoiding known risk factors. As researchers learn more about bacterial vaginosis, the recommendations may change. Until then, avoid douching, limit your number of sexual partners or abstain from sex.