Bacterial vaginosis (BV) is a common vaginal condition that often leads to questions about its origins and whether it can be acquired from a sexual partner. It arises from an imbalance in the natural bacterial environment of the vagina. This shift is key to addressing common misconceptions. While not classified as a traditional sexually transmitted infection (STI), sexual activity does play a role in its development and recurrence. This article explores the nature of BV, the influence of sexual partners, reasons for its frequent return, and management strategies.
What is Bacterial Vaginosis
Bacterial vaginosis occurs when the delicate balance of bacteria naturally present in the vagina is disrupted. Typically, the vagina is dominated by beneficial Lactobacillus species, which produce lactic acid to maintain an acidic environment. This acidity helps keep other bacteria in check. In BV, there is a decrease in these protective Lactobacillus bacteria and an overgrowth of various anaerobic bacteria, such as Gardnerella vaginalis and Prevotella species.
This bacterial shift increases vaginal pH, making the environment less acidic. This change can result in symptoms like a thin, off-white or gray vaginal discharge, often accompanied by a distinct “fishy” odor, which may become more noticeable after sex. BV is not considered a sexually transmitted infection, as it can occur even in individuals who are not sexually active.
The Role of Sexual Partners
Sexual activity can influence the vaginal environment and contribute to its development or recurrence. The introduction of new bacteria or changes in vaginal pH during sexual intercourse can disrupt the natural balance of vaginal flora. For instance, semen has a higher pH than the typical vaginal environment, and its presence can temporarily raise vaginal pH, creating a more favorable environment for the growth of BV-associated bacteria.
Male partners do not “get” BV themselves, but they can carry BV-associated bacteria on their penis or in their urethra. This can lead to the exchange of bacteria during sexual activity, potentially contributing to BV recurrence in female partners. Recent research has suggested that treating male partners with antibiotics in addition to the female partner can significantly reduce the rate of BV recurrence.
Why BV Keeps Coming Back
Recurrent bacterial vaginosis is common, with symptoms often returning even after successful treatment. This recurrence is often attributed to a combination of factors that disrupt the delicate vaginal microbiome, some of which are not directly related to sexual partners. Practices such as douching can significantly upset the natural balance of vaginal bacteria by washing away beneficial Lactobacillus species and altering vaginal pH. Similarly, the use of certain scented hygiene products, soaps, or harsh detergents in the genital area can irritate the vagina and contribute to an imbalanced environment.
Hormonal fluctuations, such as those occurring during menstruation, pregnancy, or menopause, can also influence the vaginal microbiome and increase the risk of BV. Genetic predispositions and lifestyle factors like smoking have also been identified as potential contributors to BV development and recurrence. Additionally, some types of intrauterine devices (IUDs) have been linked to an increased risk of BV.
Steps for Managing BV
Managing bacterial vaginosis involves prescription antibiotics to clear the infection. Common antibiotic treatments include metronidazole, clindamycin, tinidazole, and secnidazole, available in oral forms or as vaginal gels or creams. Complete the entire course of antibiotics as prescribed, even if symptoms improve, to ensure the infection is fully resolved and reduce recurrence risk.
Beyond antibiotic treatment, several strategies can help prevent BV from returning. Practicing proper hygiene, such as avoiding douching and using only mild, unscented soaps on the external genital area, helps maintain the natural vaginal balance. Wearing breathable cotton underwear can also promote a healthy vaginal environment.
For sexually active individuals, using condoms consistently can help reduce the introduction of bacteria and maintain vaginal pH. In cases of recurrent BV, a healthcare provider might suggest additional measures like boric acid suppositories or certain probiotic supplements to support a healthy vaginal microbiome. Consult a medical professional for diagnosis, treatment, and personalized advice on managing BV.