Bacterial vaginosis (BV) is a common vaginal condition that often leads to confusion regarding its classification as a sexually transmitted infection (STI). While BV is frequently associated with sexual activity, it is primarily an imbalance of naturally occurring bacteria in the vagina, rather than an infection solely acquired through sexual contact.
What is Bacterial Vaginosis (BV)?
Bacterial vaginosis is a common condition characterized by an imbalance in the natural bacterial environment of the vagina. It occurs when certain bacteria overgrow, outnumbering the protective lactobacilli, which normally maintain a healthy vaginal pH.
Common indicators of BV include unusual vaginal discharge (thin, white, or grayish) and a strong, often “fishy,” odor, which can become more pronounced after sexual intercourse. Other symptoms can involve vaginal itching, irritation, or a burning sensation during urination. About half of those with BV may not experience any symptoms at all.
Factors that can contribute to this bacterial imbalance include douching, which disrupts the vaginal environment, and having new or multiple sexual partners. While sexual activity is a risk factor, BV can also occur in individuals who are not sexually active. The presence of an intrauterine device (IUD) and smoking are also associated with an increased risk of developing BV.
What are Sexually Transmitted Infections (STIs)?
Sexually transmitted infections (STIs) are a group of infections passed from one person to another primarily through sexual contact. This includes vaginal, anal, or oral sex, where bodily fluids or skin-to-skin contact can facilitate transmission.
STIs differ from other infections because they rely on direct sexual contact for their transmission, allowing pathogens like bacteria, viruses, or parasites to move between partners. While some STIs may present with clear symptoms such as discharge, sores, or pain, many can be asymptomatic, meaning an infected person may not show any signs but can still transmit the infection to others.
BV’s Link to STIs
Bacterial vaginosis is not classified as a sexually transmitted infection, although its development is often linked to sexual activity. The confusion arises because BV shares risk factors with STIs, such as new or multiple sexual partners, and can present with similar symptoms like unusual discharge. Despite these connections, BV is an alteration of the normal vaginal flora rather than an infection solely acquired through sexual contact.
However, the presence of BV can significantly increase a person’s susceptibility to acquiring other STIs. The altered vaginal environment in BV, characterized by a decrease in protective lactobacilli and a rise in pH, makes the vagina more vulnerable to STI pathogens. This less acidic environment and reduced natural defenses can allow STI-causing bacteria and viruses to colonize and thrive more easily.
BV has been shown to increase the risk of acquiring infections like chlamydia, gonorrhea, herpes, and trichomoniasis. It also elevates the risk of Human Immunodeficiency Virus (HIV) transmission and acquisition. If a person already has HIV, BV can increase the risk of transmitting HIV to their sexual partners.
BV can also make existing STIs more severe or lead to complications. It is associated with an increased risk of pelvic inflammatory disease (PID), a serious infection of the reproductive organs that can result from untreated STIs. Recent research suggests strong evidence that BV-associated bacteria can be sexually transmitted, prompting ongoing discussion among experts about whether BV should be reclassified as an STI. This emerging understanding indicates that treating male partners of individuals with BV could significantly reduce recurrence rates.
Managing and Preventing BV
Managing bacterial vaginosis typically involves a course of antibiotics, which can be prescribed as oral tablets or as gels or creams inserted into the vagina. Common antibiotics used include metronidazole, clindamycin, secnidazole, and tinidazole. It is important to complete the entire course of medication as prescribed, even if symptoms improve quickly, to ensure the infection is fully treated and to reduce the likelihood of recurrence. Consulting a healthcare provider for proper diagnosis and treatment is always recommended, as BV symptoms can resemble other vaginal conditions.
Several strategies can help reduce the risk of developing BV or experiencing recurrent episodes. Avoiding douching is often advised, as it can disrupt the natural balance of vaginal bacteria and pH. Practicing safe sex, such as consistent condom use, can also help reduce the risk, particularly if there are new or multiple sexual partners. Some research suggests that exposure to semen can affect vaginal pH, potentially contributing to BV.
Other preventive measures include avoiding perfumed products in or around the vagina, such as scented soaps or deodorants, which can irritate the area and upset the bacterial balance. Wearing breathable underwear, such as cotton, can also help maintain a healthy vaginal environment. For individuals experiencing recurrent BV, healthcare providers may suggest extended antibiotic regimens, or in some cases, boric acid suppositories. While probiotics are being explored, more research is needed to confirm their consistent effectiveness in preventing or treating BV.