How bacterial vaginosis is diagnosed and treatment options

What is bacterial vaginosis?

Your vagina has a delicate balance of bacteria, and a range of things - like having sex, using perfumed soaps, and staying in wet clothes - can throw it off. Bacterial vaginosis is a common condition that happens when you have an imbalance in these bacteria. Normally, you'd have higher levels of lactobacilli, which are known as 'good' bacteria. But when levels drop, 'bad' bacteria can grow, causing problems.

While you can develop the condition after having sex, it's not considered a sexually transmitted infection (STI). You won't always have symptoms, but some people experience itchiness, unusual discharge, and a characteristic fishy odour.

If you do have signs of bacterial vaginosis, you should get advice from a doctor or pharmacist as soon as possible. Even if you think you have a mild case, it can have serious complications if left untreated. For example, you can develop pelvic inflammatory disease, and it can also cause premature birth if you're pregnant.

Symptoms of bacterial vaginosis

Bacterial vaginosis usually causes a distinct fishy smell, and you might also notice changes to your vaginal discharge. It can be white or grey and become thin and watery. These changes might be more pronounced after sex. Usually, you won't have any itching or irritation.

While you may have symptoms, about half of people with the condition have none at all.

Common causes

Bacterial vaginosis is caused by an imbalance in your vagina's good and bad bacteria. While experts don't fully understand why this happens, they have identified some common causes.

• Douching: Douching, or flushing out your vagina with water or soaps, can disrupt your natural vaginal flora. Using scented products can also alter the bacteria as well as irritate the sensitive area.
• Sex: You might be more likely to get bacterial vaginosis if you have sex with a new partner or have multiple sexual partners. Having unprotected sex can also increase your risk. However, bacterial vaginosis isn't an STI, and you don't need to have sex to develop it.
• Hormonal changes: Our bodies experience a range of hormonal changes during day-to-day life and as we age. Your monthly hormone fluctuations associated with the menstrual cycle can affect your vaginal bacteria, sometimes leading to bacterial vaginosis. You can also have these changes during pregnancy, perimenopause, and the menopause.
• Certain contraceptives: According to some research, using a coil (IUD) may make you more likely to get bacterial vaginosis. However, experts don't fully understand why this is.

Risk factors for bacterial vaginosis

Certain factors can make you more likely to get bacterial vaginosis, and it's helpful to be aware of them so you understand your risk. Remember that it's not your fault if you get it - bacterial vaginosis is very common, and it's often caused by things outside of your control. Your vagina's natural bacterial environment can be very sensitive to change.

Some risk factors to keep in mind include:

• Having multiple sexual partners
• Having a new sexual partner
• Being pregnant
• Douching or using scented soaps
• Using a coil

How is bacterial vaginosis diagnosed?

If you think you may have bacterial vaginosis, your nurse or doctor will start with a physical exam. On the day of your appointment, don't douche or use any fragranced soaps, sprays, or lotions. It's also a good idea to make sure you're not on your period.

First, they'll perform an internal exam. This shouldn't be painful, but it may be a bit uncomfortable. They may use a finger to gently feel inside your vagina, and they'll also use a swab to collect a fluid sample.

Sometimes, they won't take a sample and will diagnose you based on your symptoms alone. However, in some cases, they'll send a fluid sample to a lab to be tested to confirm your diagnosis. This test will identify the presence of harmful bacteria as well as a decrease in lactobacilli.

Having a sample tested can also be used to check for other STIs as well as other conditions like yeast infections and urinary tract infections (UTIs). Your doctor might also recommend a blood test if they want to test for additional STIs.

Treatment options

If you're diagnosed with bacterial vaginosis, your doctor will prescribe you antibiotics. Some common options include metronidazole and clindamycin. Be sure to complete your full course of treatment, even if you start to feel better before finishing your antibiotics.

While you recover, it can be helpful to avoid alcohol. You should also stick to healthy vaginal hygiene practices like not douching and avoiding fragranced soaps and sprays.

Be sure to tell your doctor if you're pregnant, nursing, or may become pregnant. This might change their treatment approach. It's also important to be vigilant with the infection if you're pregnant, as it can potentially cause complications like premature birth.

You don't need to tell all sexual partners about your diagnosis because bacterial vaginosis isn't an STI. If your partner is male, you won't be able to pass the infection to them. However, you might want to let them know so they can support you as you recover. Additionally, if your partner is female, you may be able to pass the infection through sex. In this case, it's important to let them know and take safe sex precautions like using dental dams and washing sex toys between use.

If you get recurrent infections, speak with your doctor. Having bacterial vaginosis multiple times per year means you might need an antibiotic gel that can be placed inside your vagina. You can use this for a few months to stop the infection from coming back.

How to prevent bacterial vaginosis

While you can't always prevent bacterial vaginosis, you can take steps to reduce your chances of getting it. They can also help you avoid a future infection.

You can:

• Avoid douching
• Avoid perfumed soaps, bath soaks, and shower gels
• Avoid vaginal soaps, douches, and deodorants
• Avoid strong or scented laundry detergents
• Reduce your number of sexual partners
• Practice safe sex
• Avoid sex or practice safe sex if your partner has bacterial vaginosis

Possible complications

Most bacterial vaginosis infections can be managed with a course of antibiotics. However, if you leave your infection untreated, it can potentially cause complications. For example, having bacterial vaginosis can increase your risk of getting other STIs.

Bacterial vaginosis increases your risk of pelvic inflammatory disease (PID), which is an infection and inflammation in your reproductive organs. This can cause symptoms like lower belly pain, fever, painful sex, and irregular bleeding. If you think you have PID, you should always get medical attention. Leaving it untreated can lead to serious complications like infertility and chronic pelvic pain.

If you're pregnant or think you may be pregnant, it's crucial that you let your doctor know. One of the possible complications is premature birth, so getting prompt treatment is essential to the health of both you and your baby.

Why choose Circle Health Group for bacterial vaginosis support?

Bacterial vaginosis is a common condition, and it doesn't always cause symptoms. However, if you're experiencing signs of an infection, it's important to get medical attention. Left untreated, bacterial vaginosis can be painful and uncomfortable. It can also lead to potentially serious complications.

Circle Health Group offers personalised treatment options for female health, and you'll be supported by our network of experienced providers every step of the way.

To learn more about our treatment options, book your appointment online today or call a member of our team directly.

Clinical review and sources

About bacterial vaginosis, CDC

Bacterial vaginosis, NHS

Bacterial vaginosis, OASH

Bacterial vaginosis, WHO

Bacterial vaginosis: A comprehensive narrative on the etiology, clinical Features, and management approach, PubMed