Bacterial Vaginosis (BV)

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Bacterial Vaginosis (BV) is a common condition where the normal balance of bacteria inside the vagina becomes disrupted. In most cases BV does not cause any pain or itching. The most common symptom is an unusual vaginal discharge. A sufferer of bacterial vaginosis may present with vaginal discharge that:

• Has a strong fishy smell that is particularly strong after sexual intercourse.
• Is white or grey in colour.
• Is thin and watery.

Bacterial vaginosis does not pose a serious threat to health for the majority of sufferers. Around half of those affected with BV do not present with any symptoms at all. BV should only be treated as a concern should the condition develop during pregnancy and there is a history of pregnancy-related complications.

The vagina is naturally a slightly acidic environment. This is due to a bacteria called lactobacilli. Lactobacilli produce lactic acid and the resulting acidity prevents other bacteria from growing inside the vagina. Women presenting with bacterial vaginosis tend to lack sufficient numbers of lactobacilli, which means the vagina isn’t acidic enough to prevent other bacteria from growing. It’s this imbalance of bacteria that causes BV.

It is not clear what exactly causes the imbalance that results in bacteria vaginosis, although certain factors are known to increase the chances of developing BV. These include:

• Being sexually active. Especially if you have a new or multiple sexual partners.
• Using an intrauterine device such as a contraceptive that fits inside the womb.
• Using scented soaps, bubble baths or antiseptic bath liquids.
• Using vaginal deodorants.
• Using a strong detergent to wash your underwear.

Generally, bacterial vaginosis isn’t considered a sexually transmitted infection as the condition can sometimes occur in women who aren’t sexually active. Also, the rates of BV are significantly varied within different ethnic groups, which cannot be explained by sexual activity alone. However, it is apparent that occurrences of bacterial vaginosis are much higher in women who are sexually active, especially in those with multiple partners. In contrast, the rates of BV are lower in women who practice safe sex. From this it is safe to conclude that sexual activity can play a role in developing bacterial vaginosis, although other unrelated factors are also probably responsible for the condition. 

Bacterial vaginosis will usually presents as an unusual discharge from the vagina. This discharge may be thin and watery and appears white or grey in colour. It may also develop a strong, fishy odour, particularly after sex.

BV does not usually present with any itching or soreness of the vagina.

Your first case of BV should always be diagnosed by your doctor or a healthcare professional. They will be able to rule out other causes of the symptoms such as thrush, chlamydia or gonorrhoea and ensure you get the correct treatment. Once your first case of BV has been diagnosed, subsequent episodes can be self-diagnosed as long as the symptoms are exactly the same as the previously diagnosed case. Repeated BV infections should be examined by your doctor to treat any underlying cause.

A GP or healthcare professional will be able to diagnose bacterial vaginosis from a description of the symptoms coupled with a visual examination of the vagina, if necessary. In the examination they will be looking for a thin, greyish discharge as well as an unpleasant smell. In most cases this will be enough to confirm a diagnosis. However, further testing may be necessary if you are sexually active. This is because the symptoms of BV can resemble the symptoms of some sexually transmitted infections (STIs), such as gonorrhoea and trichomoniasis. Further testing will usually involve a sample of cells being taken from the vaginal wall. This will be done using a plastic loop or swab. This sample is then examined in a laboratory to look for signs of bacterial vaginosis.

Another method of diagnosing BV may include performing a pH (acidity) test of the vagina. A swab will be used to take a sample from inside the vagina. This sample will then be wiped over a piece of specially treated paper. The paper will change colour depending on the pH level of the sample. If the paper indicates a pH higher than 4.5 then this will be a strong indication that bacterial vaginosis is the cause. You can use a Canestest home BV test to diagnose your condition in the privacy of your own home.

Bacterial vaginosis can be successfully treated using antibiotics. The antibiotic of choice for BV treatment is metronidazole. The first-line treatment for BV is normally Metronidazole 400mg tablets for a seven day course, taking one 400mg tablet twice a day. There is also the option for metronidazole vaginal gel - Zidoval - which is a five day course. Occasionally a different antibiotic may be more suitable if the patient is allergic or has had a bad reaction to metronidazole in the past. Clindamycin cream is usually used as an alternative treatment if this is the case.

When taking Metronidazole 400mg tablets for BV it is very important to complete the course, even if the symptoms have subsided. Finishing the course will help reduce the risk of the symptoms persisting or returning. When taking Metronidazole 400mg Tablets it is very important not to drink any alcohol during the course, and for at least 48 hours after completing the course as this can cause serious nausea and sickness.

Some women may require an additional course of Metronidazole should the initial course be unsuccessful. This is quite normal. It is important to check that the medicine was taken correctly as a further course or an alternative treatment will be required.

If the bacterial vaginosis is believed to be the result of an intrauterine device, such as a contraceptive diaphragm, then it may be advised to have it removed and an alternative means of contraception should be used instead.

There are treatments available known as vaginal pH correction treatments. These topical gels are available over-the-counter and are designed to rebalance the pH levels inside the vagina. An example of a pH balancing gel is Balance Activ gel. It is generally acknowledged that treating bacterial vaginosis with Metronidazole is more effective than using a pH balancing gel.

Not fully understanding the causes of bacterial vaginosis means it is very difficult to completely prevent it. However, there are self-help techniques that can reduce your risk of developing the condition. These include:

• Avoid using scented or perfumed soaps, antiseptics or bubble baths.
• Avoid using vaginal deodorants.
• Avoid washing your underwear in strong detergents.
• Avoid vaginal douching.

By following the recommendations above you will be less likely to disturb the natural bacterial balance inside the vagina. This will reduce the chances of developing bacterial vaginosis.

Non-prescription treatments are also available to purchase online.

Canesbalance Vaginal Gel and Balance Activ Gel help to relieve the odour and abnormal discharge associated with BV.