Bacterial Vaginosis

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What is bacterial vaginosis?

Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge. The condition results from an overgrowth of normal bacteria in the vagina. In the past, the condition was called Gardnerella vaginitis, after the bacteria that was thought to cause the condition. However, the new name, bacterial vaginosis, reflects the recent research establishing that there are a number of species of bacteria that naturally live in the vaginal area. The Gardnerella organism is not the sole culprit causing the symptoms. When these multiple species of bacteria become imbalanced, a woman can have a vaginal discharge that is associated with a foul odor. 

Bacterial Vaginosis

Bacterial vaginosis is not passed by sex and is not dangerous, but it can cause disturbing symptoms. Any woman with an unusual discharge should be evaluated so that serious infections, such as chlamydia and gonorrhea, can be excluded.

What are the symptoms of bacterial vaginosis?

The symptoms of bacterial vaginosis are vaginal discharge and odor. Usually, there are no other symptoms. The amount of vaginal discharge that is considered normal varies from woman to woman. Therefore, any degree of vaginal discharge that is abnormal for a particular woman should be evaluated.

About half of women with bacterial vaginosis actually have no symptoms at all. The other half experience an unpleasant fishy odor with vaginal discharge. The discharge is usually grayish white.

What causes bacterial vaginosis?

Researchers have had difficulty determining exactly what causes bacterial vaginosis. At present, it seems to be that a combination of multiple bacteria must be present together for the problem to develop. As a result, the diagnosis and treatment are not as simple as identifying and eradicating a single type of bacteria. Why the bacteria combine to cause the infection is unknown.

How is bacterial vaginosis diagnosed?

When a woman reports an unusual vaginal discharge, the doctor will ask her a series of routine questions to help distinguish mild from more serious conditions. Additional issues that might indicate the presence of a more serious condition include fever, pelvic pain, new or multiple sexual partners (especially with unprotected intercourse), and a history of sexually-transmitted infections.

In addition to these questions, the doctor will perform a pelvic exam. During the exam, the doctor notes the appearance of the vaginal lining and cervix. The doctor will also perform a manual exam of the ovaries and uterus. The cervix is examined for tenderness, which might indicate a more serious infection. The doctor may collect samples to check for chlamydia or gonorrhea infection.

Bacterial Vaginosis

Examining the vaginal discharge under the microscope can help distinguish bacterial vaginosis from yeast vaginitis (candidiasis) and trichomonas (a type of sexually transmitted infection). A sign of bacterial vaginosis under the microscope is an unusual vaginal cell called a clue cell. Clue cells are from the surface tissues of the vaginal area, which are coated with bacteria. There are so many bacteria on these cells that their normal borders and surfaces are covered with bacteria. Clue cells are believed to be the most reliable sign of bacterial vaginosis. In addition to clue cells, women with bacterial vaginosis have fewer of the normal vaginal bacteria, called lactobacilli.

Finally, the doctor may perform a "whiff test" with potassium hydroxide (KOH) liquid. When a drop of KOH testing liquid used in the "whiff test" contacts a drop of the discharge from a woman with bacterial vaginosis, a certain fishy odor can result.

What is the treatment for bacterial vaginosis?

Treatment for bacterial vaginosis consists of antibiotics. A few antibiotics are routinely used. Metronidazole taken by either oral (pill) form or by vaginal metronidazole gel is an effective treatment. Also available is the vaginal clindamycin cream. The oral metronidazole can cause some minor but unpleasant side effects, but is believed to be the most effective treatment. Metronidazole is not used in early pregnancy because of potential adverse effects on the babies. Metronidazole is not used by nursing mothers because of potential adverse effects on the babies. The gels do not typically cause side effects, although yeast vaginitis can result. Although treatment is generally successful, about 15% of women experience recurrent symptoms within a month. With recurrent symptoms, a second course of antibiotics is generally prescribed.

Bacterial Vaginosis

What are complications of bacterial vaginosis?

Bacterial vaginosis can resolve completely without complications after treatment. No special follow-up is necessary if the symptoms disappear. The infection is not transmitted sexually and sexual partners are therefore not treated.

In pregnancy, bacterial vaginosis can cause premature labor, premature birth, infection of the amniotic fluid, and infection of the uterus after delivery. For these reasons, it is currently thought that screening and treatment for bacterial vaginosis during pregnancy is reasonable.

Bacterial Vaginosis At A Glance

Bacterial Vaginosis

Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of normal bacteria in the vagina.
Bacterial vaginosis is not passed by sex and is not dangerous, but it can cause disturbing symptoms.
Symptoms of bacterial vaginosis are vaginal discharge and odor.
In diagnosing bacterial vaginosis, it is important to exclude other serious infections, such as gonorrhea and chlamydia.
Treatment options for bacterial vaginosis include oral antibiotics and vaginal gels.
Major serious complications of bacterial vaginosis can occur during pregnancy.

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