Bacterial Vaginosis

Self-medication is a long-standing problem in the medical field as it has repeatedly resulted in resistance to various pathogenic strains due to the misuse and overuse of essential medicines in benign matters. While you might think that a particular medication will be able to address your presentations just because a friend told you that it worked for them, it doesn’t necessarily mean that it is right for you, nor does it guarantee that it will for you despite the similar symptoms.

The only way to ensure that you are protected is by being educated about the conditions that might affect your body relative to the several risk factors that you might have, and it starts with understanding first that you don’t know enough and you have to seek professionals for help in such cases. It doesn’t get better than that.

To start, let’s take a look at bacterial vaginosis and what you can learn from this condition.

Understanding Bacterial Vaginosis

Bacterial vaginosis is a condition that is relatively common in women and is perhaps the most common cause of presentations in the vaginal area for sexually active individuals. The following section describes the basics of bacterial vaginosis, from its common manifestations and pathophysiology to the preventive measures that you could employ to prevent bacterial vaginosis theoretically.

As previously mentioned, bacterial vaginosis is a condition that only affects the vagina primarily in sexually active females. The exact mechanism of its transmission is not widely known within the scientific community as it is relatively unclear as to how it is produced in the first place, but the assumption that sexual activity often leads to a higher susceptibility to developing such condition is supported by the current data that we have on the disease.

Bacterial vaginosis occurs when there is an imbalance of bacteria within the environment of the vagina. If you are not entirely familiar with the physiology of the female genitalia, typically, there is a good balance between the beneficial and harmful bacteria on the surface of the vagina. When these two categories of microorganisms interact in a balanced manner, the harmful bacteria are controlled and deterred, and no symptoms are generated that can be observed generally. Bacterial vaginosis is also coined as nonspecific vaginitis as there is no specific causative agent when it comes to the signs that it usually triggers, unlike other more particular cases of vaginitis or vaginal inflammation where there is a specific pathogenic strain that can be targeted during treatment. According to several studies, the bacteria that may cause BV symptoms may include Gardnerella vaginalis, Lactobacillus sp., Prevotella, Mobiluncus, Bacteroides Peptostreptococcus, Fusobacterium, and many other bacterial species that can cause symptomatic manifestations if the environment of the vagina does not control their proliferation.

In most cases, bacterial vaginosis is the most common cause of vaginal discharge in women of childbearing age. This is commonly characterized by a fishy odor that emanates from the genitalia itself. While this is not necessarily a distinguishing symptom, as many other conditions may also elicit a fishy smell, it does provide physicians with a potential differential diagnosis and, most importantly, a starting point for the diagnosis and management of your current presentations.

Bacterial Vaginosis Prevalence

As previously mentioned, the studies about BV are still widely limited mainly due to the condition being asymptomatic in most cases – leading to a high percentage of underreporting, misdiagnoses, and ultimately, the lack of statistics to fully understand the trend of BV in women of childbearing age. In addition to that, what makes this condition even more difficult to understand is that there is a severe lack of understanding as to how sexual activity relates to the susceptibility of women to this condition – leading many people to go back and forth in their decision as to whether BV is sexually transmitted or is just a condition that just happened to affect the genitalia of women.

With these variables in place, it is understandable that a look into its prevalence would not generate much of a response, much less an accurate representation of its spread within the community. However, given that we do have some data on its prevalence among those who have reported similar symptoms, some inferences can be made regarding the pathogenicity of the condition, albeit its accuracy is still subject to improvement.

According to the Centers for Disease Control and Prevention, there is an estimated 21.2 million cases in the United States among women aged between 14 to 49. It was also found that around 84% of these cases remain asymptomatic and have reported no symptoms during their consultation until their diagnosis, 18.8% who have not had any sexual contact within a certain period still had the condition, but the prevalence of the disease significantly increased with the number of sexual activities a person had within the same timeframe. In addition to that, it was also discovered that 25% of BV cases were found in pregnant women, while 31.7% has been reported in women who have never been pregnant before. What makes this data even more interesting is that data in women of color shows that there is a higher rate of BV within their population as compared to the data that has been observed in white women, albeit this could be associated with several other factors that may include underreporting and prevalence of asymptomatic cases within each subgroup.

Risk Factors for Bacterial Vaginosis

While BV is arguably still heavily misunderstood and data regarding its prevalence and overall pathophysiology is still limited, several inferences can be made regarding potential or probable causes for the condition that we can look at to, at the very least, be aware of the risk factors that pose the highest possibility in increasing the susceptibility of an individual. Please do note, however, that this is not necessarily the complete risk factors related to bacterial vaginosis, but it is a list of the risk factors that are somehow partially understood and has an established causality with BV cases in epidemiological studies.

Having Multiple Sexual Partners

There are several proposals or theories as to how sexual intercourse can either precipitate or transmit bacterial vaginosis as the condition itself is a simple imbalance in the normal vaginal flora of the patient, but no one mechanism has still been confirmed as the primary reason for why some women develop BV in their lifetime. However, one data point that many statisticians were able to obtain from the prevalence information that we were able to process from multiple hospitals is that the prevalence of BV increases with the number of sexual partners that a person has in the recent timeframe. While it is not entirely possible to explain how having multiple sexual partners directly causes an active BV case in a woman, it can be inferred that the normal flora of a penis may disrupt the flora of a woman’s vagina. This, on top of the repetitive strokes that may cause microtears within the surface of the vaginal walls that could then cause the harmful bacteria to take root in the patient's systemic circulation, are just some of the proposed mechanisms that might associate polygamy with such condition.

Excessive Douching

As previously discussed, bacterial vaginosis occurs when there is an imbalance between the beneficial and harmful bacteria of the vagina – causing the generation of symptoms that are mainly due to the over-proliferation of a particular pathogenic microorganism. This imbalance, while it can be generated through physiological means where the body itself has difficulty maintaining the right proportions, can also be caused by an external stimulus wherein a product unknowingly alters the environment of the vagina – making it more favorable for the harmful bacteria to grow. In this case, douching or the washing of the vagina with excessive frequency is considered a risk factor as it skews the pH of the vagina – one of the physiologic factors that maintain the harmful bacteria at bay.

Naturally Skewed Bacterial Balance in the Vagina

Similar to what was previously mentioned, there are instances wherein the skewed balance between good and harmful bacteria is precipitated from within, mainly rooted in the person’s body and immune system. For example, in cases where the patient is intentionally put on immunosuppressants to either prevent the rejection of new organ transplants or reduce the inflammation caused by the body’s natural immune response to trauma, the immune system of the patient’s body briefly becomes defenseless and has difficulties maintaining the normal balance within the body’s normal processes. Unfortunately, this may also include the balance in the vagina’s environment, and when the body’s natural defenses are currently crippled to prevent the proliferation of opportunistic bacteria, symptoms are then triggered due to the increased susceptibility of the patient to developing an active BV case.

The Use of IUD

Although the studies are not necessarily well established on the relationship between the use of contraceptive devices and the incidence of bacterial vaginosis cases, some studies have shown that there seems to be an incidental trend between intrauterine devices (IUD) use and the risk for the development of bacterial vaginosis. Some claim that its causality is rooted in the alteration of the vaginal environment during the mechanism of action of IUDs, but the exact process is not yet necessarily known.

Using Public Amenities

Considering that there is a specific balance in the bacterial environment of the vagina, using public amenities which may be covered with several bacteria and other pathogenic microorganisms and having them transmitted to the normal flora of the genitalia may cause problems in the sense that it can neutralize the good bacteria that is balancing out the pathogenic strains. In addition to that, it may also cause physiologic changes to the environment itself, such as with the vaginal pH – resulting in the proliferation of either the bacteria obtained from these amenities or the intrinsic colonies that were only waiting for an opportunity like such to expand their population within the area.

Recent Antibiotic Use

The vagina, as what was discussed multiple times in the previous sections, contains a natural balance between good and bad bacteria, and this is essentially the mechanism that helps the body prevent the proliferation of pathogenic strains that might lead to specific presentations within the genitalia. The use of antibiotics, specifically broad-spectrum antibiotics meant to target a wide array of bacterial strains in the body, may accidentally kill the natural bacteria that reside within the body. These bacteria often live in the gut and the genitalia, and once they are attacked by the antibiotics being taken by the patient, their normal function is impaired until the antibiotics are cleared out of the body, and they are allowed to return to their original strength and quantity. In the case of bacteria clearance in the genitalia, no other bacteria will maintain an environment that could deter the growth of harmful bacteria in the vagina. When this happens, they will then increase, resulting in bacterial infections such as BV that may be characterized by the precipitation of symptoms localized within the genital region.

Potential Complications of Bacterial Vaginosis

Since bacterial vaginosis, as its name suggests, is bacterial and therefore involves the presence of pathogenic microorganisms for its mechanism to proceed, there may be some complications that might occur once the infection itself spreads towards other regions of the body – causing systemic effects that would otherwise be absent if the bacteria are prevented from growing beyond the genital area. While these complications are relatively rare already, to ease you from worrying about contracting such conditions, you should not fret since these are often prevented when the condition is immediately and adequately treated with the appropriate medications and therapies.

Premature Birth

Pregnant women are naturally prone to infections within the urinary tract, and bacterial vaginosis is not an exception to this observed increased susceptibility rate. Bacterial vaginosis may usually occur in pregnant patients, but it is more critical in such populations as having such a condition may result in complications that may involve the baby of the patient.

In this case, bacterial vaginosis cases have also been found to cause premature deliveries and low birth weight babies – making it essential that mothers be tested for any urinary tract infections prior to the later parts of their pregnancy to ensure that their babies will not be affected by any unrecognized conditions within their genitalia. The chance of developing such a complication is still relatively small, but the risk is still there, and it should be addressed to prevent any unforeseen and unfortunate instances during delivery.

Postpartum Endometritis

During pregnancy, your baby is usually contained within an orifice/area known as the uterus, and this is the space that holds your baby for nine months following conception. There are instances wherein a pregnant patient, following delivery, and in the case where they have an active BV infection, where the lining of the uterus becomes inflamed or irritated, causing the complication known as postpartum endometritis.

Easy Contraction of Sexually Transmitted Conditions

When a patient has an active bacterial vaginosis case, the environment of the genitalia can already be assumed as susceptible or weakened since the area has already allowed the proliferation of bacterial species that could typically be contained with the physiologic conditions of the body, as well as with the help of the normal flora of the genitalia. As such, when it comes to other bacterial species that are fiercer in their pathogenesis and mechanism of infection, it is inferred that there is a greater chance that they will be infected immediately following contact as the defenses are already crippled, to begin with. When you have an active infection, you can consider other STIs a potential complication, especially if you are still sexually active, as your defenses are essentially down, and any contact with a pathogenic microorganism could immediately result in the infection taking root and causing manifestations throughout its duration.

Increased Risk for Post-Surgery Infection

Building on what the previous point has put forward, considering that the genitalia’s defenses and preventive mechanisms have already been crippled and weakened, as evidenced by the existing active BV infection, it might also be easier for a patient who recently had an operation within the area (urinary tract or any nearby area otherwise) to contract a post-operative infection with the highly-proliferating pathogenic microorganisms in the bacteria on top of the skin opening that these pathogens can utilize to invade the systemic circulation of the patient.

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease is a condition where a specific strain of pathogenic bacteria was able to colonize the upper urinary tract of the patient, causing symptoms such as pain within the pelvic region and further complications such as infertility and ectopic pregnancy if the condition is left to persist without any prior management strategy. Considering that the vagina is now swamped with overgrowing harmful bacteria, these pathogens may then use the patient's urinary tract to invade the upper regions – causing complications that could ultimately be life-threatening if not managed correctly and immediately by informed professionals.

Is Bacterial Vaginosis Considered a Sexually Transmitted Condition?

According to the Centers for Disease Control and Prevention, bacterial vaginosis is not classified under sexually transmitted conditions as the disease itself nor its causative agent can be transmitted directly through sexual contact. While it is possible to increase your risk of developing BV if you are sexually active, there is no direct causality between the two that could help classify BV under this category.

Preventive Measures Employed Against Bacterial Vaginosis Cases

In this or any condition for that matter, there are several things that one can do to ensure that you will be protecting yourself as much as possible from a potential active case or infection due to bacterial colonization of the genitalia.

• Abstinence: considering that sexual activity can increase the risk of someone developing BV, removing the patient from the equation eliminates the risk entirely
• Monogamy: higher risk rates have been associated with multiple partners, making monogamy a safe bet in minimizing the risk of BV
• Avoiding Excessive Douching: douching or washing the vagina excessively, particularly with pH-altering products, may cause changes in the environmental balance of the vagina, resulting in the overgrowth of pathogenic bacteria.
• Using Contraceptives: contraceptives may not necessarily protect you from an active BV case, but they can reduce the risk by minimizing the contact between your partner’s genital flora and yours – reducing the chances of having your vagina’s balance skewed due to your partner’s conditions.
• Minimizing Use of Vaginal Irritants: scented products and harsh soaps may similarly alter the pH of the vagina and kill off the good bacteria that maintain the balance of the flora.
• Employ Proper Vaginal Cleaning: washing after defecation by going from the vagina towards the anus and not the other way around ensures that the bacteria in your feces will not enter or come into contact with your vagina or your urinary tract.
• Wear Cotton or Cotton-Lined underwear: water and moisture are primary requirements for bacteria to proliferate. These fabrics ensure that the genital area will not accumulate the humidity necessary for pathogenic strains to grow.

Bacterial Vaginosis: Pathophysiology and Etiology

As we have previously mentioned, the exact pathophysiology and pathogenesis of bacterial vaginosis are still not entirely known, and several professionals around the globe are still studying the mechanism of the disease itself. However, one thing that they were able to find is that bacterial vaginosis is not contagious, albeit sexual activity can increase a person’s susceptibility to developing the condition.

The vagina itself has a natural bacterial environment known as a microbiome. When an external stimulus disrupts this balance, some of the bacteria within this environment tends to overgrow – resulting in a full-blown infection that might produce manifestations such as having an unpleasant fishy odor within the genitalia.

Likewise, there are several causative microorganisms for a BV case, as any pathogenic microorganism already living within the genital area may increase and cause symptoms if the balance of the normal flora is skewed. However, we must also keep in mind that a majority of patients with an active BV infection do not produce any symptoms – making it necessary for us to be routinely tested and examined to ensure that we do not have an underlying imbalance in the conditions of the genitalia.

Bacterial Vaginosis: Signs and Symptoms

Bacterial vaginosis may present several symptoms that you could look out for to determine if you currently have an active infection. However, note that its symptoms may be non-specific and may be mistaken with another condition if no professional diagnosis is obtained. Do not self-medicate by all means, even if you seem to know what the condition may be.

Presentations

There is a plethora of symptoms that you may experience when you have an active BV infection. This may include:

• Off-white, greyish, or greenish vaginal discharge
• Foul-smelling discharge that can be primarily described as “fishy.”
• Fishy odor that smells the strongest after intercourse or when a woman is on their period
• Itchy or sore genitalia in rare cases
• Painful or burning sensation in the vagina
• Burning sensation when peeing or pyuria
• Itchiness in the area surrounding the vaginal region

Difference between Bacterial Vaginosis from a Yeast Infection

Like most conditions affecting the genitalia, there is also an overlap between BV and a condition that mainly affects the genitalia, known as a yeast infection. What makes the two different is that BV commonly presents with its hallmark symptom of a foul-smelling discharge that appears more fluid than the discharge observed in yeast infections. Yeast infections would naturally produce discharge that looks like cottage-cheese contrary to the fluid discharge produced in BV.

On the one hand, you may also observe irritation and itchiness more commonly in yeast infections, and over-the-counter medications are usually available for this condition, whereas BV needs to be resolved with an antibiotic prescribed by a physician who was able to diagnose your condition successfully.

Bacterial Vaginosis: Diagnostic Procedures

To ensure that your therapy is appropriate for the presentations you have, three different types of diagnostic procedures can be employed to determine the condition you have and the recommended management strategy to resolve it immediately.

• History Taking: this is usually the easiest to do as your physician would only ask for specific information regarding your recent history, such as your symptoms and the nature of your discharge. In addition to that, they may also ask questions about any irritation, odor, pain, and other accompanying symptoms that you might have to create a more comprehensive outlook on your condition.
• Physical Examination: this would usually involve a direct examination of the patient’s vagina that primarily looks at discharge and any inflammation present in the vulvovaginal area to cross out any differential diagnoses.
• Microscopic Examination: this would entail using the patient’s vaginal discharge sample that is then smeared on a glass slide with saline solution and examined under the microscope to look for “clue cells” that could determine the presence of an active BV infection. A whiff test may also be performed on the sample wherein a 10% potassium hydroxide solution is added then examined for any fishy odor as a diagnostic criterion.

Bacterial Vaginosis: Treatment and Management

Considering that a bacterial infection causes BV within the genitalia, the most common treatment approach recommended by all doctors is the use of antibiotics, specifically broad-spectrum antibiotics in most cases, to address the disease while ensuring that the antibiotic has a great chance of working against the particular bacterial strain causing the presentations. The commonly prescribed antibiotics include the following:

• Clindamycin
• Metronidazole
• Secnidazole

Note that this section does not encourage self-medication as antibiotics are slowly becoming scarce due to their improper use. Consult your physician regarding your condition before taking these medications, as antibiotic resistance could do more harm in the long run, particularly in cases where you might need these medications again for another condition.

Frequently Asked Questions (FAQs)

Can BV go away without any treatment?

Yes, in some cases, BV can go away without any treatment, but this is not recommended, mainly if you are pregnant or planning to get pregnant due to its complications.

Do male partners of women with BV need to be treated or examined for BV as well?

No, since the condition cannot infect men with sexual intercourse.

Can BV occur again even if I was already treated for the condition before?

Yes. If the conditions of your vagina become skewed again, the proliferation of your normal microbiome may recur.

Can BV spread between female sex partners?

Yes. Since the physiology of both genitalia is similar, contact between the two may cause transmission of the condition.

What types of STDs can I get if I let my BV infection persist?

BV makes you susceptible to other infections due to the already-weakened defenses of the genitalia. Some STDs may take root easier, such as Chlamydia and Gonorrhea, if your BV is left untreated and you are still sexually active.