Bacterial vaginosis (BV) is a common vaginal infection caused by an imbalance where certain bacteria overgrow, overpowering beneficial bacteria like lactobacillus. BV can cause symptoms such as unusual vaginal discharge, a “fishy” odor, and irritation, though many individuals experience no symptoms. This article explores bacterial vaginosis, focusing on its relationship with conception and pregnancy.
Bacterial Vaginosis and Conception
A common concern is whether bacterial vaginosis can prevent pregnancy. BV does not directly prevent conception, as it does not interfere with ovulation or the ability of sperm to reach an egg. While BV itself does not directly cause infertility, research indicates it can increase the risk of developing fertility issues indirectly.
Untreated BV can lead to more serious pelvic infections, such as Pelvic Inflammatory Disease (PID), an infection of the uterus and fallopian tubes. PID can cause scarring or blockages in the fallopian tubes, directly interfering with the meeting of sperm and egg, thus impacting fertility. This condition can also create an inflammatory environment in the reproductive tract, which may be detrimental to sperm function and fertilization.
BV has been linked to changes in cervical mucus quality, which facilitates sperm transport during ovulation. BV is more common in individuals experiencing infertility compared to those who conceive without issues, and it may also affect the success rates of in vitro fertilization (IVF). While BV does not directly hinder the immediate process of getting pregnant, its potential to lead to complications like PID highlights the importance of addressing the infection for overall reproductive health.
Potential Risks of BV During Pregnancy
For pregnant individuals, bacterial vaginosis carries risks, particularly if left untreated. BV is linked to an increased risk of preterm birth, defined as delivery before 37 weeks of pregnancy. Pregnant women with BV have about twice the risk of preterm birth compared to those without the infection, with the risk higher when BV occurs early in pregnancy. This association is due to the inflammatory response triggered by the bacterial imbalance, which can initiate uterine activity and lead to early labor.
Untreated BV also increases the risk of low birth weight (a baby born weighing less than 5 pounds, 8 ounces). This complication is often connected to preterm delivery, as earlier births typically result in lower birth weights. BV is also associated with premature rupture of membranes (PROM), where the amniotic sac breaks before labor begins. PROM can lead to complications, including infection of the placental tissues and increased risk of umbilical cord compression.
Beyond these immediate risks to the baby, untreated BV during pregnancy can also increase the mother’s risk of postpartum endometritis, an infection of the uterus after delivery. While many pregnant individuals with BV experience no adverse effects if treated, these complications underscore the importance of diagnosis and management. Approximately 10% to 30% of pregnant women may experience BV, making awareness and appropriate medical attention important.
Treatment and Management of BV in Pregnancy
Diagnosing bacterial vaginosis during pregnancy involves a healthcare provider assessing symptoms, performing a pelvic exam, and testing vaginal discharge. Tests may include a wet mount, pH test, or a “whiff test” to identify characteristics of BV, such as a pH level of 4.5 or higher and a “fishy” odor. Screening for BV is advised for symptomatic pregnant women and may also be considered for those with a history of preterm labor.
Once diagnosed, BV is treatable with antibiotics, which are considered safe for use during pregnancy. Common antibiotics include metronidazole and clindamycin, available as oral medications or vaginal gels/creams. Metronidazole is often prescribed as 250 mg orally three times a day for seven days, or clindamycin 300 mg orally twice a day for seven days. While metronidazole crosses the placenta, studies show a low risk of teratogenicity or mutagenic effects in infants.
It is important to complete the entire course of antibiotics as prescribed, even if symptoms improve or disappear, to ensure the infection is fully cleared. Although antibiotics can affect beneficial bacteria, the consequences of untreated BV during pregnancy outweigh this concern. Patients should always consult their healthcare provider for diagnosis and treatment rather than attempting self-treatment, as medical guidance ensures the safest and most effective approach for both the pregnant individual and the baby.