Chronic and Recurrent Bacterial Vaginosis

What is Bacterial Vaginosis?

Bacterial Vaginosis (BV) is the most common vaginal infection in women of child bearing age. It occurs when a normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain kinds of bacteria. The vagina normally contains mostly ‘good’ bacteria and fewer ‘harmful’ bacteria. BV develops when there is an increase in harmful bacteria and fewer good bacteria.

The kinds of bacteria that can be involved in bacterial vaginosis are:

• Gardnerella
• Bacteroides
• Peptostreptococcus
• Fusobacterium
• Eubacterium

When these multiple species of bacteria that normally reside in the vagina become unbalanced it can produce vaginal discharge with an offensive odour. These bacteria are known as anaerobes.

Three or more infections within 12 months implies recurrent bacterial vaginosis.

What are the signs and symptoms of Bacterial Vaginosis?

Many women with BV have no signs or symptoms at all. When symptoms do occur the most common include:

• an abnormal amount of vaginal discharge
• vaginal discharge is thin and greyish white
• vaginal odour, an unpleasant or fishy odour
• vaginal discharge and odour are more noticeable after sexual intercourse
• very rarely, pain with intercourse or following or during urination

Symptoms of BV, if present, can occur at any time during the menstrual cycle. The amount of vaginal discharge that is considered normal varies from woman to woman therefore, any degree of vaginal discharge that is abnormal for a particular woman should be investigated.

What Causes Bacterial Vaginosis?

Researchers have always had difficulty determining exactly what causes BV. At present it seems to be that a combination of multiple bacteria must be present together for BV to develop. BV typically features a reduction in the number of the normal hydrogen peroxide producing lactobacilli in the vagina. Simultaneously there is an increase in concentration of other types of bacteria, especially anaerobic bacteria (bacteria that grows in the absence of oxygen). As a result, the diagnosis and treatment are not as simple as identifying and eradicating a single type of bacteria. Why the bacteria combined cause the imbalance is unknown.

We know one important causative factor is a change in the acidity of the vagina. Normally the vagina is acidic with a pH around 4.6. a more alkaline (less acidic) vagina promotes bacterial vaginosis.

Certain risk factors have been identified that increase your chances of developing BV.

These include:

• multiple or new sexual partners
• IUD
• recent antibiotic use
• vaginal douching

Is Bacterial Vaginosis an STD or Yeast Infection?

• BV is not the same thing as an STD or monilia infection
• BV is not dangerous but it can cause unpleasant symptoms
• any woman with an unusual discharge should be investigated so that more serious infections such as chlamydia and gonorrhoea can be excluded
• symptoms may also mimic those found in candida infections of the vagina and trichomonas (an STD) and these conditions must also be excluded in women with symptoms.

Is Bacterial Vaginosis Contagious?

BV is not considered to be a contagious condition. It is not possible to contract BV from toilet seats, swimming pools, hot tubs or from touching contaminated objects.

How is Bacterial Vaginosis diagnosed?

When a patient notices an unusual vaginal discharge and visits her doctor, she will be asked a series of routine questions to help distinguish mild from more serious conditions. A vaginal swab will be taken and this result is usually available within a couple of days.

Treatment for Bacterial Vaginosis

There are no home remedies or natural remedies for treating BV. Antibiotics are the only treatment. Studies of yoghurt lactobacilli probiotic preparations (either taken orally or inserted into the vagina) which are designed to help re-establish the lactobacilli population of the vagina, have not shown consistent results in treating BV.

Antibiotics are the recommended treatment as well as the use of boric acid pessaries or the use of Acigel which lowers the ph in the vagina. Even after a woman has been cured BV often recurs. A second course of antibiotics is necessary if a woman experiences recurrent BV that produces symptoms. More than half of those treated experience recurrent symptoms within 12 months. Treatment of BV in pregnant women is recommended to decrease the risk of pregnancy associated complications, especially the risk of premature labour related to infection. Whilst we know up to a third of cases of BV may resolve on their own it is recommended that medical treatment be given if symptoms are present or during pregnancy, to avoid development of complications.

Can Bacterial Vaginosis be prevented?

Due to the cause and development of BV being so misunderstood it can be difficult to make measures to prevent it from occurring. Reducing certain risk factors, such as avoiding the use of vaginal douches, and taking all medications directed when being treated for BV, can help reduce a woman’s risk of developing the condition again.

Recent studies show prophylactic (preventative) treatment of BV lasting six to 12 months can be particularly effective in cases of recurrent BV. Recurrent BV is best treated with a combination of oral and vaginal medications over 3 to 6 months.