A Patient's Primer on Bacterial Vaginosis
by James McGregor, M.D.
Patients and practitioners alike need to focus more attention on bacterial vaginosis, says the author, who recommends increased screening for this common condition.
To echo Rodney Dangerfield's plaintive dictum in more grammatical fashion, bacterial vaginosis (BV) often seems to be a form of vaginitis that just can't get any respect.
Women's magazines have carried article upon article on candidiasis, expounding in detail on its symptomology, diagnosis and treatment. Having exhausted that subject, many of these publications now are moving on to treat trichomoniasis, yet nary a word has been written about bacterial vaginosis.
In medical circles, meanwhile, the problem hasn't been the lack of word on BV; rather, it's been the excess of words.
Only in the last 10 years or so have we discarded the jumble of diagnoses previously used to characterize this condition - non-specific vaginitis, Gardnerella vaginitis, Haemophilus vaginitis and Corynebacterium vaginitis, among others - and settled on bacterial vaginosis.
I would submit that while Ob/Gyns have come to terms - quite literally - with the nomenclature involved, we're still far from consensus on how actively we should screen for and treat this common ailment.
To my mind, that consensus should center around a fairly aggressive protocol that makes screening for BV a part of every women's annual gynecological examination, as well as a component of every visit prompted by a vaginal complaint. There are two reasons for this aggressive approach.
The first is the prevalence of BV and the seriousness of the associated complications, especially during pregnancy. We've long known that BV is widespread and linked to significant disease, but new research continually adds depth to our understanding.
Recent studies have found the condition in 32 to 64 percent of women attending STD clinics, 10 to 26 percent of women visiting OB clinics, and 12 to 25 percent of women at general clinics. Those numbers show that BV is more prevalent than candidiasis. Research also is adding to the long list of complications associated with BV, including endometriosis and salpingitis; preterm labor; premature rupture of membranes; chorioamniotis, and postoperative and postabortal infections.
The second factor is the gap in patient knowledge. Many women fully conversant with the particulars of yeast infections haven't even heard of bacterial vaginosis. So patients experiencing symptoms of BV are less likely to make an inquiry.
It's incumbent upon us to help close that gap by discussing bacterial vaginosis with patients, teaching them the difference between BV and candidiasis, and instructing them to arrange an appointment should they note a suspicious odor or discharge.
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What You Should Know About Bacterial Vaginosis
Although many women have never heard of it, bacterial vaginosis is the most common type of vaginal infection and can lead to serious complications. Here are answers to basic questions about this widespread condition.
Women today Know more and do more about their health than ever before. As a result, they're able to avoid many illnesses, and to identify and seek professional care for other problems at an early stage when medical treatment is more effective.
But the growth of women's knowledge about health issues often has been uneven. For instance, while vaginal yeast infections have been the subject of widespread educational efforts, little attention has been paid to an even more common form of vaginal infection: bacterial vaginosis, or BV.
Q. What are the symptoms of bacterial vaginosis?
A. It's associated with a foul or fishy vaginal odor and a milky vaginal discharge. A woman with BV may have either or both symptoms or no symptoms at all.
Q. Beyond the odor and discharge, does bacterial vaginosis pose other problems for women?
A. Recent research has shown that bacterial vaginosis increases the risk of some serious complications. These problems include pelvic inflammatory disease, a serious infection that can lead to infertility; infection following pelvic surgery, and complications during pregnancy, such as preterm labor, premature rupture of membranes and infection of the amniotic fluid.
Q. What causes bacterial vaginosis?
A. An overgrowth of certain kinds of bacteria in the vagina, although scientists are still looking for the exact cause. Normally, the vagina contains protective bacteria called lactobacilli. These good bacteria help maintain a normal pH (acidic) level and hold down the growth of harmful microorganisms. If a lot of harmful bacteria find their way into the vagina, or if the pH level of the vagina changes, the harmful bacteria can take hold and flourish.
Q. How many women get bacterial vaginosis?
A. It's now thought to be even more common than yeast infections. In various scientific studies, it has been found in 32 percent to 64 percent of women attending clinics for sexually transmitted diseases, in 10 percent to 26 percent of women visiting obstetrics clinics, and in 12 percent to 25 percent of women in normal clinic populations.
Q. How do you get bacterial vaginosis?
A. Usually the cause can't be traced. BV may be transmitted through sexual contact, but that's not always the case. It may even be the exception. Having multiple sex partners appears to increase a woman's risk of getting bacterial vaginosis.
Q. If I have no symptoms, could I still have bacterial vaginosis?
A. Yes. Many women diagnosed with BV experience no symptoms. This can make bacterial vaginosis a serious hidden danger, especially because it can affect fertility and pregnancy.
Q. What's the difference between bacterial vaginosis and a yeast infection?
A. A yeast infection is usually caused by Candida albicans, a kind of yeast, rather than bacterial. Its symptoms include a cottage cheese-like discharge and itching. Yeast infections generally are odorless, and have not been associated with i ncreased risk of serious medical complications excpet for vaginal itching.
Q. Can I detect bacterial vaginosis myself?
A. A foul or fishy odor (especially after intercourse or douching) and a milk-like discharge are good indicators of BV. Remember, however, that these symptoms are not present in all cases. If you suspect you have bacterial vaginosis or some other kind of vaginal infection, you should consult your gynecologist for proper diagnosis and treatment.
Q. How will my practitioner tell whether I have bacterial vaginosis?
A. The first thing you gynecologist may do is check the appearance of your vagina. BV often makes the inside of the vagina look as though milk has been poured into it. Using pH paper, the physician also can test the pH level of vaginal secretions. Women with BV typically have vaginal pH levels above 4.5, while normal levels are in the 4.0 range. BV may cause vaginal secretions to have a bad odor, but sometimes this is hard to detect. To be certain, your doctor may do something called a KOH "whiff" (or "hanging drop") test. An additional test for BV is examination of vaginal secretions under a microscope. The docotor looks for clue cells - epithelial cells in the vagina coated with bacteria.
Q. How would bacterial vaginosis affect my sex life?
A. There is no scientific evidence that BV affects sexual relations. Yet, many women who have bacterial vaginosis and the fishy odor that often accompanies it say they are bothered by the odor, especially after intercourse. Some women say the odor makes them feel insecure and embarrassed.
Q. Is bacterial vaginosis considered a sexually transmitted disease?
A. No. BV has been found to be more common in women visiting sexually transmitted disease clinics than in the general population, but BV has also been reported in women who have not had intercourse and young girls.
Q. How is bacterial vaginosis treated?
A. With an antibiotic. You and your care provider have several options for treating BV. Two of these are in pill form, metronidazole 1 gram once a day or clindamycin 300 mg three times a day, each for seven days. The other two are topical medicines (metronidazol gel and clindamycin cream) that are applied by the woman directly into the vagina. Topical treatment usually last from five to seven days, and involves one or two doses of the medication each day.
Q. Once treated, could I get bacterial vaginosis again?
A. As with many infections, the answer is Yes. In fact, recurrences of bacterial vaginosis are fairly common.
Q. Can I continue to have sex during the time I'm being treated?
A. It's not recommended. If you do, be sure your partner wears a condom.
Disclaimer: The articles and information,
while with the best effort to be accurate and up-to-date, may not be.
Also, every physician and medical professional holds their own views on
certain diagnosis and advice. There truly are no textbook cases. It is
always best to consult with your personal physician regarding medical/health
related problems. The information is to be used as a general resource
and not as a substitute for trained medical advice and/or treatment.
