You may have heard about the gut microbiome. From television advertisements to posters dotted around supermarkets, you’re constantly reminded about the importance of bacteria in regulating our digestive systems. But, you may be surprised to find out that the vagina has its own bacterial guardians.

Bacteria found within the vaginal microbiota are important in regulating health and homeostasis. Bacterial Vaginosis (BV), or vaginal dysbiosis, is a vaginal condition associated with a disruption of the bacteria found within the vaginal microbiome (your vagina’s micro-ecosystem).

We know what you’re thinking, and no: BV is not a Sexually Transmitted Infection (STI). However, multiple studies suggest a strong correlation between the two. This comprehensive article will go through most of the possible causes of BV and discuss the various ways of testing and treating the condition.

Causes Of Bacterial Vaginosis: The Role Of Bacteria

Your body is full of bacteria (trillions!). Some of which are important in regulating our internal ecosystem, whereas some others may be harmful.

The bacteria found in the vagina are mostly “good” bacteria. One of the most important regulatory bacteria found in the vagina are called Lactobacilli. These bacteria produce lactic acid which gives the vagina its acidic nature and prevents the growth of any harmful bacteria.

When there is a disruption in the vaginal microbiota, the vagina can become less acidic. This allows for the multiplication or colonization of other bacteria which results in bacterial infections such as BV.

Risk Factors

We understand now that BV is caused by dysbiosis (when the levels of bacteria become unbalanced) in the vagina. However, the reasons for this are still largely unknown. That said, here is a list of risk factors that can make it more likely for you to develop BV:

• If you are sexually active (although women who are not sexually active can still get BV)

• You have a new sexual partner(s)

• You have had an intrauterine device (IUD)

• Using perfumed products around your vagina

• Smoking

Symptoms Of Bacterial Vaginosis

According to the Centers for Disease Control (CDC), 84% of women who have BV have no symptoms. However, when symptoms do occur, they present as vaginal discharge, burning and itching, and an unpleasant smell.

The vaginal discharge can be:

• Thin and watery

• White or grey

• Have a strong fish-like odour

Additionally, you may experience:

• Burning sensation when peeing

• Itching around the vagina

 

Can Symptoms Recur?

Statistics show that approximately 30% of women who improved after treatment of the initial BV infection experienced a recurrence of symptoms within three months, and more than 50% of women had symptom recurrence within twelve months.

Bacterial Vaginosis As An STI

As noted above, BV is not an STI. However, various studies confirm the association between BV and an increased risk of contracting STIs, due to the fact that the vaginal microbiome is disturbed during BV, which in turn allows or other potential vaginal infections to occur.

Additionally, one study suggests that BV is responsible for a reduction in the function of the innate immune system, which can ultimately lead to an increased risk of contracting STIs.

If you are unsure if you have contracted an STI, you can order one of our discrete testing kits.

Complications

When left untreated, BV has been linked to a variety of complications including:

• STIs: BV can increase your risk of contracting an STI.

• Pelvic Inflammatory Disease (PID): Some cases of BV have been shown to cause PID, which is a chronic inflammation of the female genital tract. PID can result in serious reproductive complications, including subfertility or infertility.

• Post-surgical infection: These infections are common complications resulting from obstetric and gynecological surgery. Developing these infections after surgery has been linked to the imbalance of vaginal PH associated with BV.

Pregnancy

The CDC estimates that around 1 million pregnant women develop BV each year. Hormonal changes that occur during pregnancy can indirectly cause a disruption in the vaginal microbiome and increase the risk of developing BV.

In most cases, BV during pregnancy generally causes no problems. However, there is a small chance that complications may arise, including:

• Premature birth (birth before 37 weeks)

• Miscarriage

• Post-delivery infections

Diagnosing Bacterial Vaginosis

BV is diagnosed clinically (using the Amsel criteria and in a laboratory, grading the infection using the Nugent scoring system). Both diagnostic methods require the use of clinical laboratories to identify changes within the vaginal microbiome.

Although several diagnostic tests exist to confirm the presence of BV, they all take a considerable amount of time to complete. Typically, BV is diagnosed at your GP practice. Your doctor will assess your symptoms and carry out a physical examination to confirm the diagnosis. Additionally, your doctor may perform a swab test to collect samples of cells from your vagina in order to test its pH levels (how acidic your vagina is).

Treatment

BV can sometimes resolve itself without treatment. However, treatment is typically highly recommended, especially if you’re symptomatic. BV is often treated using a course of antibiotics in the form of prescribed oral tablets, topical creams, or over-the-counter pessaries that insert into your vagina. Antibiotics typically used to treat BV are:

• Metronidazole: You will either be given a gel with an applicator for vaginal insertion or a course of oral tablets which must be completed

• Clindamycin: An intravginal cream

Once treated, BV symptoms tend to resolve within 2-3 days. However, even if symptoms subside you should always complete the course of antibiotics.

If your symptoms return after initial treatment (twice or more within 6 months), you may be prescribed continuous treatment for up to 6 months.

Prevention

There is no universally accepted method to completely prevent BV. However, a few basic recommendations for BV prevention include:

• Minimize irritation: Using unscented soaps, limiting the use of spas and hot tubs, and wearing cotton underwear to help reduce vaginal irritation

• Practice safe sex: Using latex condoms properly can help reduce your risk of developing BV

• Avoid douching: Douching can remove healthy bacteria from the vagina resulting in an imbalance that causes BV.

Conclusion

Bacterial vaginosis (BV) is a very common condition that typically occurs due to an imbalance of the bacteria in your vagina. Although BV may resolve on its own, treatment is still recommended to ensure complete eradication.

Remember, BV is NOT an STI but can lead to contracting other infections. If you are worried about contracting an STI, or suffer from recurrent BV and are worried about your risk of contracting an STI, you can order a discrete, at-home test kit. 

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Hassan Thwaini is a qualified Clinical Pharmacist who has completed his Master's degree at the University of Sunderland. Since then he has not only pursued community and clinical pharmacy, but has expanded to aid in humanitarian work across the less fortunate areas of the globe. Hassan is currently working as a medical writer and has successfully been published within various nutritional websites, produced unique content for his university board, and carried out research for renowned surgeons.