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What is bacterial vaginosis?

Bacterial vaginosis (BV) is a common bacterial infection experienced by women. It is caused by an imbalance of the natural, healthy bacteria which reside in the vaginal region. Those with BV have less Lactobacilli bacteria in their vagina, which normally resides in the vagina and produces lactic acid, maintaining an acidic environment and preventing overgrowth of other bacteria. When other bacteria, most commonly Gardnerella vaginalis, enter the vagina, they can reduce the number of Lactobacilli and allow other bacteria to grow, resulting in the symptoms of BV.

What causes bacterial vaginosis?

Bacterial vaginosis is caused by an imbalance of bacteria in the vagina. It is usually provoked when a bacteria called Gardnerella vaginalis enters the vagina and reduces the number of Lactobacilli, the healthy bacteria which keep the vagina acidic and inhospitable to foreign bacteria. This can allow other bacteria to grow, resulting in BV.

How to deal with bacterial vaginosis?

Bacterial vaginosis is usually harmless and often has no symptoms. However, it can be recurrent and unpleasant and there are various effective treatments available. BV can be treated with a course of oral antibiotics (metronidazole) or can be treated with intravaginal creams or gels. It’s important to avoid overwashing the vaginal area, or using scented products, as this can increase your risk of getting BV again soon after being treated. 

What are the complications of bacterial vaginosis?

Bacterial vaginosis can cause complications in pregnant women, and may even increase the risk of miscarriage or early delivery. If you are pregnant and think you may have BV, it is vital that you consult a doctor immediately.

Will bacterial vaginosis go away on its own?

In many cases, bacterial vaginosis goes away on its own. In fact, it often has no symptoms and goes unnoticed. However, it can be recurrent and develop again soon after treatment. If you are experiencing BV regularly, it is best to speak to your doctor to discuss preventative treatment.

Bacterial vaginosis symptoms

Bacterial vaginosis often presents no symptoms and can go unnoticed. The most common symptom is a change in vaginal discharge, which can develop an unpleasant, fishy odour, particularly following sex. Discharge may become white or grey or thin and watery and may increase in volume. BV does not usually cause soreness or itching, but some women may experience a burning sensation while urinating.

How is bacterial vaginosis diagnosed?

A doctor will begin by asking you about your symptoms and it’s often possible to make the diagnosis just from symptoms alone. BV can also be diagnosed by checking the vaginal pH – a measure of how acidic or alkaline your vaginal environment is. A healthy vagina is slightly acidic, with a pH of 3.5–4.5; and a pH higher than 4.5 is indicative of BV. Alternatively, a vaginal swab may be checked for the presence of clue cells, which are vaginal skin cells that have become coated with Gardnerella vaginalis that are visible under a microscope. Potassium hydroxide may be added to the swab or slide; which in cases of BV, results in a characteristic fishy odour. 

What increases your risk of getting bacterial vaginosis?

The exact cause of bacterial vaginosis is uncertain, but it can be triggered by a number of things such as:

• Vaginal douching
• Sex with a new partner or with multiple partners
• Unprotected sex
• Using an intrauterine device (IUD), also known as the coil
• Using perfumed soaps or sanitary products around the genital area
• Spending long periods of time in a bath with perfumed or antiseptic products
• Using strongly perfumed detergents to wash your underwear
• Smoking
• Hormonal changes during the menstrual cycle

How to tell if you have bacterial vaginosis or an STI?

Because the most common symptom of bacterial vaginosis is a change in vaginal discharge, it can be easily confused with chlamydia, gonorrhoea or other infections of the vagina. If you notice a change in your discharge and have had unprotected sex since your last sexual health test, it is definitely worth being checked for STIs to rule them out.

How to prevent bacterial vaginosis

Bacterial vaginosis can be recurrent, and there are some steps you can take to avoid it:

• Remember that the vaginal region is designed to clean itself. All you need to do is wash around the area with mild, unperfumed soap. Strongly perfumed soaps and products such as scented pads and tampons will increase the risk of irritation or infection. 
• Avoid vaginal douching, as this has been shown to cause bacterial imbalance.
• Practising safe sex is key to avoiding BV. Use a condom at all times and limit your number of sexual partners. If you think you might have BV, it is best to avoid having sex until your symptoms have resolved.
• Consuming probiotics may help prevent BV from occurring, however, there is limited evidence for this. 
• Use of intravaginal lactic acid gel may help prevent BV.
• Use of a metronidazole gel more frequently may prevent frequent recurrences. Speak to your doctor for more information about this.

How is bacterial vaginosis treated?

While bacterial vaginosis often clears up on its own, a doctor may prescribe antibiotics to prevent it from recurring. These are taken orally, or applied inside the vagina as a topical gel or cream. The most common antibiotics prescribed for BV are Clindamycin or Metronidazole.

What you can do about recurring bacterial vaginosis

It is common for bacterial vaginosis to recur, usually within 3 months. As well as taking measures to avoid upsetting the balance of bacteria in the vagina, your doctor may advise taking antibiotic treatment for longer if you continue to experience BV.

What are the risks of bacterial vaginosis?

Bacterial vaginosis itself is generally harmless and often clears up on its own. However, it can have more serious complications in pregnant women, causing them to suffer from urinary tract infections (UTIs) and increasing the risk of miscarriage or early delivery. BV can also be harmful if it occurs in combination with a sexually transmitted disease. If you are experiencing symptoms of BV, it is best to consult a doctor as soon as possible.

How to mask the smell of bacterial vaginosis?

The unpleasant, fishy odour that sometimes accompanies BV is caused by the discharge. This means that the best way to get rid of the smell is to treat BV so that your discharge returns to its normal state. If you notice changes to your discharge, consult a doctor to find out if you have BV and how to treat it. The use of perfumed products to “mask” the smell is likely to worsen your symptoms.

Risks of bacterial vaginosis during pregnancy

Bacterial vaginosis can be harmful to women during pregnancy, so you are advised to consult a doctor immediately if you notice symptoms. BV can increase the risk of miscarriage or early delivery.

Is bacterial vaginosis an STI?

Bacterial vaginosis is not an STI and can occur in women who are not sexually active, but sexual activity does increase the risk of a bacterial imbalance in the vagina. Since unusual discharge is often the only symptom of BV, it can be confused with chlamydia, gonorrhoea or other genital tract infections. Therefore if you have had unprotected sex since your last sexual health test, it is important to get checked for STIs if you are experiencing symptoms of BV.

It is extremely rare for BV to be passed from women to men, as the male reproductive system does not have an environment that encourages the growth of BV-causing bacteria. However, it is possible for BV to be passed between women, and both partners will need to be checked for the infection if it is experienced by one.

Can you have sex if you have bacterial vaginosis?

It’s advisable to avoid sex while you have symptoms of BV,  as sex can further disrupt the bacterial imbalance and prevent BV from clearing up. Women should also avoid having sex with female partners when they have BV, as the infection can be passed between the two.

Why does bacterial vaginosis smell?

Bacterial vaginosis can cause vaginal discharge to have a foul-smelling, fishy odour. This is because there is an overgrowth of anaerobic bacteria, which emits a characteristic odour.

Can antibiotics cause bacterial vaginosis?

A course of antibiotics can sometimes result in thrush, upsetting the natural balance of bacteria in the vagina. However, antibiotics are not a known cause of bacterial vaginosis.

Can bacterial vaginosis spread?

It is extremely rare for men to experience bacterial vaginosis, but it can be passed between women during sex. If you have BV, any female sexual partners you have had will also need to be checked for the infection.

Is bacterial vaginosis dangerous?

Bacterial vaginosis is usually harmless. However, it can be dangerous when experienced by pregnant women, often causing urinary tract infection and increasing the risk of miscarriage or early delivery.

Can bacterial vaginosis cause miscarriage?

In women who are pregnant, bacterial vaginosis can increase the risk of miscarriage. If you are pregnant and think you might have BV, you should consult a doctor immediately. 

Can bacterial vaginosis cause infertility?

If left untreated, there is a small risk that bacterial vaginosis can lead to pelvic inflammatory disease. Pelvic inflammatory disease can damage your reproductive system, leading to infertility. It is always best to see a doctor if you think you might have BV.