Bacterial vaginosis (BV) is a common vaginal condition caused by an imbalance of bacteria normally found in the vagina. This disruption leads to an overgrowth of certain bacteria. Gardnerella vaginalis is a specific bacterium frequently associated with this imbalance, though it is not the only bacterial species involved in BV.
Understanding Bacterial Vaginosis
Bacterial vaginosis arises from a shift in the vaginal microbial environment, where beneficial Lactobacillus bacteria decrease in number. Lactobacillus species normally produce lactic acid, which helps maintain an acidic vaginal pH, typically ranging from 3.8 to 4.5. When these protective bacteria diminish, anaerobic bacteria, such as Gardnerella vaginalis, can overgrow. Gardnerella vaginalis is a facultative anaerobic bacterium, meaning it can survive with or without oxygen.
BV is not considered a sexually transmitted infection (STI), but sexual activity can be a contributing factor to its development. Other risk factors include douching, having new or multiple sex partners, and using an intrauterine device (IUD). Common symptoms of BV include unusual vaginal discharge, often thin and white or gray. A characteristic “fishy” odor, particularly noticeable after sexual intercourse or during menstruation, is also a frequent complaint. Some individuals may also experience itching or a burning sensation during urination.
Identifying and Treating Bacterial Vaginosis
The diagnosis of bacterial vaginosis involves a medical evaluation, including a pelvic exam. During this exam, a healthcare provider may observe the vaginal discharge for its characteristic thin, homogeneous, grayish-white appearance that coats the vaginal walls. A sample of vaginal fluid is then collected using a swab for further testing.
Microscopic examination of the vaginal fluid, known as a wet mount, is a common diagnostic tool. This test can reveal “clue cells,” which are vaginal epithelial cells covered with bacteria, and a decrease in Lactobacillus bacteria. Vaginal pH testing is also performed; a pH greater than 4.5 often indicates BV. Additionally, a “whiff test” may be conducted, which can produce a strong fishy odor if BV is present.
Treatment for bacterial vaginosis primarily involves antibiotics to restore the balance of vaginal bacteria. Common antibiotic options include metronidazole and clindamycin, which can be prescribed as oral tablets or vaginal gels/creams. It is important to complete the entire course of medication as prescribed, even if symptoms improve, to ensure the infection is fully resolved and to reduce the likelihood of recurrence.
Preventing Bacterial Vaginosis and Managing Recurrence
Preventing bacterial vaginosis and managing its recurrence involves several strategies aimed at maintaining a healthy vaginal environment. Douching should be avoided, as it can disrupt the natural pH and bacterial balance in the vagina. For external cleaning, rinsing with water or using a mild, unscented soap is sufficient. Opting for breathable underwear, such as cotton, can help prevent moisture buildup and promote airflow, which discourages bacterial overgrowth.
While BV is not an STI, sexual activity can influence vaginal flora, so practicing safer sex, including consistent condom use, may help. Scented feminine products, including sprays, wipes, and tampons, can also cause irritation and disrupt the vaginal microbiome, and their avoidance is often recommended. Recurrent BV is a common challenge, with recurrence rates potentially ranging from 15% to 30% within a few months of treatment. In cases of frequent recurrence, longer courses of antibiotics or other strategies, such as boric acid suppositories, may be considered under medical guidance to help manage the condition.