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What is bacterial vaginosis?

A bacterial vaginosis (BV) infection is quite common, leading to a discharge from your vagina, often with a noticeable smell. BV is not a sexually transmitted disease and is due to an overgrowth of normal bacteria that usually live in your vagina. BV symptoms, which are usually quite mild, sometimes clear up on their own. However, this type of infection often requires antibiotic medication.

Your IPSA Medical bacterial vaginosis consultation

When you come to the IPSA Medical clinic for your bacterial vaginosis consultation, you will be seen and examined by one of IPSA Medical’s female clinicians. Your IPSA Medical clinic is a respectful and confidential environment, and with IPSA Medical’s client-centred, holistic approach to both your assessment/treatment, you will always be informed and involved in your BV consultation process.

Your female IPSA Medical practitioner will explain clearly the different current BV treatment options, prior to determining the best possible form of BV management/treatment for you.

During your IPSA Medical BV consultation, your IPSA Medical specialist will discuss/run through your sexual history with you, because, if you are currently in a long-term relationship, she might diagnose BV via its typical symptoms (such as its characteristic fish-like smell). She might carry out some further tests to confirm her BV diagnosis, especially if you happen to be pregnant, because an accurate BV diagnosis is important during pregnancy so that your IPSA Medical clinician can effectively treat it. Your female IPSA Medical practitioner might also test your vagina’s acidity level and/or take a swab for laboratory confirmation. Moreover, as IPSA Medical has its own large on-site pharmacy, medications can be immediately sourced for you.

What is bacterial vaginosis? What causes bacterial vaginosis?

BV is a reasonably common condition that is due to the overgrowth of various naturally occurring bacteria in your vagina. BV is not a simple single-bacterial infection. Your vagina is usually home to a mixture of different bacteria, and it is when your natural bacterial balance changes that you can then develop a BV infection; it is still unclear as to why this happens. When your natural bacterial balance is disturbed, certain bacteria multiply and thrive.

Poor hygiene is not linked to BV but excessive washing can alter your normal bacterial balance in your vagina, with BV then more likely to develop.

Who gets bacterial vaginosis? How common is it?

We don’t know how common BV is, because it is mostly a mild infection, and women might tend not go to their clinic for treatment, but perhaps 1 in 3 women will experience a BV episode at some point during their life.

You are more likely to get BV if:

  • You smoke
  • You use bubble bath
  • You have changed to a new sexual partner recently
  • You have had previous STIs: sexually transmitted infections
  • You are of Afro-Caribbean origin
  • Your contraceptive choice is a copper coil: an IUCD or intrauterine contraceptive device
  • You are sexually active (with men or women), although women can develop BV even when they have never had sex

You are less likely to get BV if:

  • You use condoms
  • Your partner is circumcised
  • Your contraceptive choice is the combined oral pill

Common symptoms of bacterial vaginosis

The main BV symptom, vaginal discharge, is one of the most common reasons for an unusual vaginal discharge during the childbearing years. BV causes a fishy smelling, whitish or grey vaginal discharge, which is often heavier and has a stronger smell when having sex. BV vaginal discharge is also often heavier following your period. The discharge usually doesn’t cause any soreness or itching around your vagina/vulva.

Around 50% of women are asymptomatic (they do not exhibit any symptoms) when they have BV.

A vaginal discharge can be due to conditions other than BV, with another common vaginal infection (thrush) being caused by a yeast-type organism (Candida). Thrush results in a whiter, much thicker type of discharge, with soreness/itching around your vagina/vulva. Some sexually transmitted infections like chlamydia can also result in vaginal discharges.

Can bacterial vaginosis be transmitted through sex?

No, it cannot. BV:

  • Affects women who are not presently sexually active
  • Affects women who have not yet had sex
  • Is more usual in sexually active women
  • Is less usual in non-sexually active women
  • Is more frequent in same-sex female partners when they change to a new partner

How is bacterial vaginosis diagnosed at my IPSA Medical clinic?

Your BV will be diagnosed by your IPSA Medical clinician based on what is typical for BV discharge with its distinctive fish-like smell. Also, your vagina’s acid level can be tested at your IPSA Medical BV consultation and/or your IPSA Medical physician will take a vaginal swab to confirm her BV diagnosis.

Testing your vagina’s acidity level

Your BV discharge will have a very specific pH level, or acid–alkaline balance, compared to other kinds of discharges. The BV bacterial overgrowth alters your vagina’s pH level, with it becoming more alkaline as your vaginal pH level increases. Your IPSA Medical specialist might suggest carrying out a pH test with a sample of your vaginal discharge. When she adds an alkali substance to your discharge sample, it usually produces the characteristic fish-like BV smell.

Taking a sample of your vaginal discharge with a swab

In order to confirm a BV diagnosis, your IPSA Medical clinician may also suggest having a swab taken of your discharge and then sending this for BV testing at our laboratory where the excessive bacteria that are common for BV infections can be seen through a microscope. Your IPSA Medical specialist may also take further swabs so as to discount other vaginal discharge causes (e.g. chlamydia).

Are there complications with a bacterial vaginosis infection?

Pregnancy and BV

If you do not have your BV infection treated when you are pregnant, then your risk of complications is slightly raised for an early labour, preterm birth, miscarriage, a low birthweight baby and womb infections (postpartum endometritis) following childbirth.

Surgery and BV

If you don’t have your BV infection treated, then your chances increase of developing uterine infections after having some types of operation (e.g. vaginal hysterectomies or pregnancy terminations).

Other infections and BV

Untreated BV infections might increase the risk of contracting HIV if your sexual partner is infected with HIV. You can also transmit HIV more easily when you have both BV and HIV together. Some scientific evidence also links untreated BV with a heightened risk of pelvic inflammatory disease (or PID).

What treatments are available at my IPSA Medical clinic for bacterial vaginosis?

Some women will not need any BV treatment because their BV is asymptomatic (with no symptoms) or their BV symptoms are quite mild and can gradually clear without treatment, as any imbalance in your vaginal bacteria can self-correct naturally given time.

However, if you are asymptomatic for BV but are pregnant, then your IPSA Medical doctor may advise you to undertake an antibiotic treatment, but because the benefits are unclear of treating BV asymptomatic pregnant women with this protocol, your IPSA Medical specialist will discuss all of the pros/cons of this approach with you at your IPSA Medical BV consultation.

All BV non-asymptomatic pregnant women should be treated. If you do have BV and are terminating your pregnancy, then your IPSA Medical doctor might recommend you have antibiotic treatment even when you don’t have any BV symptoms because the risk of more serious uterus/womb infections or of other pelvic infections increases after the procedure if your BV is not treated. If you are undergoing other gynaecological procedures (e.g. a womb-lining biopsy – an endometrial biopsy), your IPSA Medical clinician might also suggest taking antibiotics for your BV infection, even if you are asymptomatic.

Metronidazole tablets

Your IPSA Medical clinician might prescribe metronidazole tablets (an antibiotic) that usually clears up any BV infections. Your IPSA Medical clinician will also run you through the possible side effects and cautions of this treatment at your IPSA Medical BV consultation. The following points are perhaps worth considering before having metronidazole treatment:

  • The usual dose for metronidazole is 400–500 mg, twice a day, over 5–7 days. The alternative is a single dose of 2 grams, but this might be less effective, produce more side effects, and it is not recommended when pregnant. If your IPSA Medical physician prescribes the 7-day course for you, then you must finish the entire course of tablets.
  • Some people can either feel sick or be sick (vomit) on metronidazole and the risk reduces if you take your tablets after eating.
  • A common side effect is a metallic taste (in your mouth).
  • You cannot consume any alcohol when on the tablets or for 48 hours post-treatment so as to avoid the risk of vomiting, and of an increase in your pulse rate/flushing.
  • For women currently breastfeeding, the antibiotic can enter your milk supply (but will not cause any harm to your baby), but to be safe, clindamycin or vaginal metronidazole should be prescribed rather than the oral tablets.

Alternative antibiotic treatments

If you have any side effects from taking the metronidazole tablets, or if you have a preference for vaginal treatments, then your IPSA Medical clinician can prescribe a vaginal gel for you (metronidazole vaginal gel) or a vaginal cream for you (clindamycin vaginal cream) which you place inside your vagina. These treatments do work as efficiently as the oral tablets at clearing BV infections.

When taking the gel or cream treatments, you also need to avoid drinking alcohol during your treatment period and for at least a 48-hour period after finishing your treatment. Vaginal creams/gels can affect both diaphragms and latex condoms; during your treatment, and for five days after your completed treatment (if using clindamycin vaginal cream), you cannot rely on diaphragms/condoms for protection against STIs/pregnancy.

Your IPSA Medical physician can prescribe other antibiotic tablets for BV treatment: areclindamycin or tinidazole tablets.

Other possible BV treatments

There is no scientific evidence about using live yoghurt called Lactobacillus acidophilus (present in a few commercial probiotic products) for either treating or preventing your BV infection, with antiseptics/disinfectants not helping in the treatment of BV.

Do I need another BV test to confirm I have been cured?

Women who aren’t pregnant

Following your BV treatment, you don’t need any further testing to ensure your BV infection has cleared (which is known as a ‘test of cure’) if your BV symptoms have fully gone.

Pregnant women

If you are currently pregnant, then your IPSA Medical specialist will suggest a BV ‘test of cure’ to be carried out a month after finishing your BV treatment to confirm that your BV infection has fully cleared. A vaginal discharge sample will be taken using a swab and it will be sent to our lab to confirm you are clear of BV.

Treating BV recurrences at your IPSA Medical clinic

If you experience recurring/repeat bouts of BV and you didn’t undergo the BV discharge test (the swab sample) initially, then your IPSA Medical clinician may well suggest you have this test at this point to confirm your symptoms are from a BV infection.

BV can reappear/recur when you don’t complete your BV antibiotic course. Unfortunately, even when completing the full BV treatment course, the condition often returns within 3 months in many women. A repeat antibiotic course will usually clear your BV. For the unlucky minority of women, recurring BV bouts require repeat antibiotics.

Your IPSA Medical clinician will discuss alternative forms of contraception with you if you are using a copper coil (an IUCD) and have recurrent bouts of BV, because removing your coil can sometimes lead to your BV symptoms improving.

Preventing further bacterial vaginosis episodes

Most BV bouts can’t be prevented because there isn’t a clear reason for the bacterial overgrowth with BV infections. Your IPSA Medical physician will discuss how to keep a normal vaginal bacterial balance with you, because this might reduce BV recurrence:

  • Do not push any water into your vagina (called douching) to clean it: your vagina does not require this type of cleaning.
  • Only wash your underwear in mild detergents.
  • Wash your vagina/vulva only once a day, no more.
  • Avoid any bath oils, scented soap, antiseptics, shampoos or perfumed types of bubble bath.

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