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Common Signs and Symptoms of Bacterial Vaginosis

What are the symptoms of bacterial vaginosis?

Bacterial vaginosis (also known as BV) can have mild symptoms or appear similar to a yeast infection. 50-75% of all bacterial vaginosis infections are asymptomatic. If symptoms are present, they may include:

  • Thin, off-white vaginal discharge
  • A fishy odor (most noticeable after intercourse and during menstruation)
  • Itching in or around the vagina

Bacterial vaginosis is usually not responsible for pain during intercourse, redness, swelling or painful urination.

What is bacterial vaginosis?

Bacterial Vaginosis (BV) is an infection caused by an imbalance in the bacteria population in the vagina. It is responsible for 40-50% of reported abnormal vaginal discharge cases. Normally, the bacteria in the vagina (known collectively as vaginal flora) regulate the pH level in the vagina to prevent infections. Lactobacillus bacteria make up 95% of the total bacterial population and are responsible for keeping pH in the 4-4.5 range, preventing other organisms and fungi from growing.

When the vaginal flora changes from 95% lactobacillus bacteria to a more diversified population, the pH of the vagina increases. Bacterial vaginosis occurs when the vaginal pH level rises above 4.5 as a result of the activities of the new bacteria. While bacterial vaginosis is not technically considered a sexually transmitted infection, it is rarely found in women who have had no sexual contact of any type. In addition, the specific bacteria associated with BV are found on the penis, urethra, urine and semen.

Who is at risk of a bacterial vaginosis infection?

Bacterial vaginosis is most common in women who have not reached menopause and African American women. Women who have multiple new sexual partners are at higher risk than women with a single monogamous partner. Women who have sex with women are significantly more likely to have bacterial vaginosis.

How is bacterial vaginosis transmitted?

No one knows exactly how bacterial vaginosis is transmitted. Normal vaginal flora effectively maintain the right pH levels unless they are disrupted somehow. For that reason, it’s best to avoid douching or washing your vagina with scented soaps as these can disrupt the balance. Hormonal changes due to certain medications, pregnancy and menopause can also change vaginal pH enough to cause bacterial vaginosis.

What are the long-term consequences of an untreated bacterial vaginosis infection?

Untreated bacterial vaginosis significantly increases a woman’s chances of contracting other sexually transmitted infections, most notably HIV, chlamydia, trichomoniasis and gonorrhea. It can also make it easier for these infections to be passed to a sexual partner. BV is associated with the development of pelvic inflammatory disease (PID), which can cause chronic pelvic pain, ectopic pregnancy, early deliver and infertility.

How does bacterial vaginosis impact pregnancy?

Bacterial vaginosis has been known to cause early delivery but is not transmitted to the infant. Read more here.

How can I prevent a bacterial vaginosis infection?

There is no sure way to prevent bacterial vaginosis, but the following recommendations can decrease the likelihood of developing BV:

  • Avoid douching (this can flush healthy bacteria out, making it easier for unhealthy bacteria to take hold)
  • Limit the number of different sexual partners
  • Shower after sweaty activities (exercise or even a hot day)
  • Use a condom during sex

Who should test for bacterial vaginosis?

Women should test for bacterial vaginosis when they are experiencing symptoms. Typically, these would include itching, abnormal discharge and a fishy odor most noticeable after sex. View our available tests here.

How is a bacterial vaginosis test administered?

A bacterial vaginosis test requires a vaginal swab that can be tested for the presence of abnormal cells.

How is bacterial vaginosis treated?

Bacterial vaginosis is either treated with prescription medications in pill, cream or gel form. All options require several days of treatment, but the oral medications are more likely to cause side effects. Metronidazole can be taken as a pill twice daily for one week or as a gel inserted into the vagina nightly for five days. Clindamycin cream can be inserted into the vagina every night for one week.

Is bacterial vaginosis curable?

Bacterial vaginosis is cured with prescription medication, usually within one week.

Is a bacterial vaginosis recurrence possible?

30% of women who improve with treatment are diagnosed with bacterial vaginosis again within 6 months. More than half will have symptoms again within a year. The best way to avoid recurring infection is to complete the entire course of medication when it was first prescribed. Failing to take the prescribed amount can leave some imbalance even though symptoms have disappeared.

The CDC recommends using a different form of treatment for recurrent infections (if you started with metronidazole, switch to clindamycin). If you have more than three BV infections within a year, your doctor may recommend using metronidazole twice weekly for several months to prevent more infections.

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