Bacterial Vaginosis

Bacterial vaginosis is a disorder brought on by an overabundance of the natural flora in the vagina. The most typical clinical sign of this is an increase in fishy-smelling vaginal discharge. Typically, the discharge itself is thin and either white or grey in color. Women who have been diagnosed with bacterial vaginosis are more likely to get additional STIs, and pregnant women are more likely to give birth before their due date.

Bacterial Vaginosis: Causes

One of the many bacteria that are normally present in your vagina causes bacterial vaginosis when it overgrows. Lactobacilli, the "good" bacteria, typically outweigh "bad" bacteria (anaerobes). However, an excess of anaerobic bacteria can lead to bacterial vaginosis by upsetting the normal balance of microorganisms in your vagina.

The function of transmissibility in bacterial vaginosis is still not well understood, even though it is not regarded as a sexually transmitted infection. Bacterial vaginosis appears to be caused by an imbalance in the normal bacterial flora of the vagina brought on by the transmission of germs between people during sexual activity.

This illness is typically brought on by an excess of anaerobic bacteria and a reduction in the usual Lactobacilli that normally produce hydrogen peroxide. Gardnerella vaginalis can spread between sex partners when mucous membranes come into close touch or when shared sex devices are used.

Gardnerella vaginitis was the name given to bacterial vaginosis in the past since it was thought that this bacterium was to blame for the illness. The term "bacterial vaginosis," which is more recent, emphasizes the possibility that a range of different bacteria that normally exist in the vagina may proliferate excessively and result in the illness.

Bacterial Vaginosis: Symptoms

The most common complaint of bacterial vaginosis in women is foul-smelling vaginal discharge. This frequently worsens following sexual activity. Dysuria, dyspareunia, and vaginal pruritus are possible additional symptoms; however, many afflicted women may not experience any of these.

To analyze the features of the vaginal discharge and to help rule out other illnesses that appear similar, such as candidiasis, cervicitis, chlamydia, gonorrhea, herpes simplex virus, and trichomoniasis, a complete physical examination must include a pelvic exam. A risk factor for pelvic inflammatory disease, HIV, STIs, and other obstetric diseases is also bacterial vaginosis itself. Therefore, it's crucial to evaluate cervical motion tenderness and friability as well.

To rule out the more dangerous illnesses still on the differential diagnosis, it is crucial to check for fever, pelvic discomfort, and a history of STIs. To check for the existence of chlamydia or gonorrhea infection, cervical swabs may be provided.

It will be important to analyze the vaginal fluid under a microscope since clue cells are considered to be the most accurate diagnostic indicator of bacterial vaginosis. This diagnostic procedure can also aid in eliminating the presence of trichomonads or yeast. The existence of clue cells must be checked across the entire material even if another illness has been discovered because several of these diseases can occur concurrently. The diagnosis of bacterial vaginosis can also be aided by measuring the pH of vaginal fluid.

Bacterial Vaginosis: Risk Factors

The major risk factors include −

  • A new sex partner or several sex partners  Although the connection between sexual activity and bacterial vaginosis is not entirely understood by medical professionals, the illness is more common in women who have several sex partners or a new sex partner. Additionally, women who have intercourse with other women are more likely to contract bacterial vaginosis.

  • Douching  Douching is a process that disturbs the natural equilibrium of your vagina by washing it out with water or a cleansing substance. Anaerobic bacteria may overgrow as a result, which can result in bacterial vaginosis. Douching is not required since the vagina cleans itself.

  • Lack of lactobacilli bacteria by nature  You are more prone to get bacterial vaginosis if your natural vaginal environment doesn't generate enough of the beneficial lactobacilli bacteria.

Bacterial Vaginosis: Diagnosis

To diagnose bacterial vaginosis −

  • Inquire about your medical background  Your doctor could inquire about any prior vaginal infections or STDs you may have had.

  • Examine the pelvis  During a pelvic exam, your doctor visually checks your vagina for indications of infection and inserts two fingers into your vagina while pushing with the other hand on your belly to feel for symptoms of the disease that might be present in your pelvic organs.

  • Gather some vaginal secretions for testing  This might be carried out to examine your vaginal flora for an overabundance of anaerobic bacteria. Your doctor may use a microscope to search for "clue cells," which are vaginal cells coated in bacteria and indicative of bacterial vaginosis.

  • Do a pH vaginal test  By inserting a pH test strip into your vagina, your doctor can determine how acidic it is there. Bacterial vaginosis can be identified by a vaginal pH of 4.5 or above.

Bacterial Vaginosis: Treatment

Bacterial vaginosis can be treated in the following ways −

  • Metronidazole  This medicine may be taken as a pill by mouth (orally). Metronidazole is also available as a topical gel that you insert into your vagina. To reduce the risk of stomach upset, abdominal pain, or nausea while using this medication, avoid alcohol during treatment and for at least one day after completing treatment — check the instructions on the product.

  • Clindamycin  This medicine is available as a cream that you insert into your vagina. Clindamycin cream may weaken latex condoms during treatment and for at least three days after you stop using the cream.

  • Tinidazole  This medication is taken orally. Tinidazole has the same potential for stomach upset and nausea as oral metronidazole does, so avoid alcohol during treatment and for at least three days after completing treatment.

  • Secnidazole  This antibiotic must be taken orally in a single dose. You sprinkle the medication's grains from a package onto a soft meal like applesauce, pudding, or yogurt. Within 30 minutes, you consume the combination, taking care not to chew or crunch the granules.

Male sexual partners of sick women often do not need to be treated, although bacterial vaginosis can transmit between female partners. Female partners should get tested, and they could need medical attention. Treatment is crucial for pregnant women with symptoms to reduce the risk of early delivery or a low birth weight baby.

Bacterial Vaginosis: Prevention

Despite therapy, bacterial vaginosis frequently returns within three to twelve months. Treatment options for recurrent bacterial vaginosis are being researched. Discuss treatment options with your doctor if your symptoms return soon after receiving treatment. Extended-use metronidazole treatment is one potential choice.

Lactobacillus colonization treatment is a self-help method that aims to increase the number of healthy bacteria in your vagina and restore a balanced vaginal environment. This can be done by consuming specific types of yogurt or other foods that contain lactobacilli. Probiotic treatment may have some benefits, according to recent studies, but further study is still required.

You can prevent the occurrence of bacterial vaginosis by −

  • Not having sex

  • Reducing the number of sex partners you have

  • Not crying

  • Using condoms properly each time you have sex


BV often manifests in clinical medicine. When working with patients who have BV, nurses and healthcare professionals should constantly check for the presence of additional STIs. Additionally, a significant prevalence of preterm births and spontaneous abortions are linked to BV during pregnancy. Hence, the significance of BV screening during pregnancy. Women who get treatment for BV often recover well, although delaying treatment increases the risk of morbidity.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha


Updated on: 03-Mar-2023


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