Bacterial vaginosis: Causes, symptoms, and treatments

Bacterial vaginosis, also known as vaginal bacteriosis, is the most common cause of vaginal infection for women of childbearing age.

It frequently develops after sexual intercourse with a new partner, and it is rare for a woman to have it if she has never had sexual intercourse.

Bacterial vaginosis (BV) also increases the risk of developing a sexually transmitted infection (STI). However, BV is not considered an STI.

BV is the vaginal infection most likely to affect women between the ages of 15 and 44 years.

Fast facts about bacterial vaginitis

Bacterial vaginitis (BV) is the most common vaginal infection among women aged 15 to 44 years.

Symptoms, if they appear, may include itching and a gray, watery discharge with a “fishy” smell.

Untreated BV can lead to serious complications.

Treatment is normally with antibiotics.

Some home remedies are suggested, but anyone with symptoms should see a doctor.

Symptoms

doctor hand with gloves holding petri dish with bacteria
An imbalance in vaginal bacteria can lead to bacterial vaginosis.

BV may be present without symptoms, but if symptoms occur, they include vaginal discharge, burning, and itching.

Vaginal discharge may:

be watery and thin

be gray or white in color

have a strong and unpleasant smell, often described as fishy

Less commonly, there may be:

a burning sensation during urination

itching around the outside of the vagina

Between 50 and 75 percent of women with BV have no symptoms. BV alone is not considered harmful, but complications can arise.

Complications

Complications that have been linked to BV include a higher risk of:

HIV infection, as BV increases susceptibility to the virus

STIs, such as the herpes simplex virus, chlamydia, gonorrhea, and human papilloma virus (HPV)

post-surgical infection, for example, after a termination or a hysterectomy

Possible complications of BV during pregnancy include:

early, or preterm, delivery

loss of pregnancy

the amniotic sac breaking open too early

postpartum endometritis, an irritation or inflammation of the lining of the uterus after delivery

tubal factor infertility, caused by damage to the fallopian tubes, which connect the ovaries to the uterus

chorioamnionitis, an inflammation of the membranes surrounding the fetus, known as the chorion and the amnion

Chorioamnionitis significantly increases the chance of an early delivery. If the newborn survives, they have a higher risk of cerebral palsy.

In-vitro fertilization (IVF) may be less likely to succeed if a woman has BV.

BV also increases the risk of pelvic inflammatory disease (PID), an infection and inflammation of the upper female genital tract that can have severe consequences, including infertility.

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Causes

BV is caused by an imbalance of naturally occurring bacterial flora, the usual bacteria found in a woman’s vagina. Why this happens is not clear.

It is different from candidiasis, a yeast infection, or Trichomonas vaginalis (T. vaginalis), or trichomoniasis, also known as trich. These are not caused by bacteria

The role of bacteria

All parts of the body have bacteria, but some are beneficial while others are harmful. When there are too many harmful bacteria, problems can arise.

The vagina contains mostly “good” bacteria and some harmful bacteria. BV occurs when the harmful bacteria grow in numbers.

A vagina should contain bacteria called lactobacilli. These bacteria produce lactic acid, making the vagina slightly acidic. This prevents other bacteria from growing there.

Lower levels of lactobacilli may cause the vagina to become less acidic. If the vagina is not as acidic as it should be, this can give other bacteria the chance to grow and thrive. However, exactly how these harmful bacteria are linked with BV is not known.

Risk factors

Any woman can develop BV, but some behaviors or activities can increase the risk.

These include:

douching, or using water or a medicated solution to clean the vagina

having a bath with antiseptic liquids

having a new sex partner

having multiple sex partners

using perfumed bubble baths, vaginal deodorants, and some scented soaps

smoking

washing underwear with strong detergents

BV cannot be caught from toilet seats, bedding, swimming pools, or touching objects.

Treatment

BV often clears up without treatment, but women with signs and symptoms should seek treatment to avoid complications.

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