Oct 07 2009

Bacterial Vaginosis (BV)

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BV is one of the most common infections found in women. It is often not diagnosed until a women is pregnant and visits her doctor or clinic. For that reason, only statistics amongst the pregnant woman population are available. Race and ethnicity have a great impact on the expected occurrence rate. From the latest statistics gathered in the USA (CDC, 2000):

Group

Occurrence in Group

All Pregnant Women

16%

Asian Pregnant Women

6%

White Pregnant Women

9%

Hispanic Pregnant Women

16%

African American Pregnant Women

23%

(Source: CDC 2000)

These numbers are considered the minimum infection level and it is thought that at least 50% of infected women never gets diagnosed or know that they have BV. This number spans millions and millions of women.

Cause of BV

The cause of BV is unknown and not well understood. Because BV is not strictly a sexually transmitted disease (STD) and not life threatening, it is not reported and not a lot of research are done to determine the cause. Scientists are trying to look for pattern that could indicate a common cause between women reporting with BV.

A woman’s vagina contains a lot of bacteria, some good bacteria and some bad bacteria. When this balance between the good and bad bacteria gets disturbed and the bad bacteria multiplies, the condition known as Bacterial Vaginosis occurs. As BV occurs in both virgins (very seldom) and sexually active women and it is thought that personal hygiene habits and sexual activity may cause the imbalance in the vaginal flora and cause BV.  It is thought that you are more susceptible to BV when you start a sexual relationship with a new male partner and the risk increase as your number of partners increase. Nothing can be identified in men that will cause BV however.

It is important to note that BV can not be transmitted by toilet seats, blankets, pools, a bath, or by touching any object around you.

The causes are thought to be the following:

  • A new sex partner
  • Multiple sex partners
  • Not using condoms
  • Douching
  • Using an Intrauterine device (IUD) for birth control

Symptoms of BV

  • You may notice a white or grey-white milky secretion seep from your vagina. Even though this secretion is milky, it will stick to the vagina and vulva.
  • You might have an unusually strong and pungent "fishy" odor from your genitals. This smell might be especially strong after sex without a condom or during your period. Fresh semen does something to intensify the bacterial processes that cause BV.
  • You may have absolutely no outward symptoms of this condition. You may also be one of a small number of women that may experience a more profound discharge where the quantity is more profuse and the discharge odor is very strong and very obvious.
  • It is important for you to realize that this strong smell after ejaculation is not caused by or because of your partner. It is caused by the bad bacteria in your own vagina. BV is not transmitted by your partner. BV is not transmitted sexually from men to women.

Complications with BV

BV is often considered a nuisance infection. BV will often go away by itself but if it goes untreated, bacterial vaginosis may cause serious complications, such as

  • Increased susceptibility to get sexually transmitted infections including HIV, herpes simplex virus (HSV), chlamydia and gonorrhea when exposed to it.
  • Increased chances of passing on a sexually transmitted infections that you might be carrying like HIV, herpes simplex virus (HSV), chlamydia and gonorrhea to your partner.
  • Possible pregnancy complications like pre-term delivery.
  • Increased likelihood of developing Pelvic Inflammatory Disease (PID) following surgical procedures such as a hysterectomy or an abortion. PID affects the fallopian tubes and uterus and can cause infertility and ectopic pregnancies.

Diagnosing BV

  • Examination of vagina (look for tell tale secretions and ‘sniff test’) and laboratory tests of vaginal fluids for BV bacteria.
  • All women that had a pre-term or low birth weight baby should be examined regardless of BV symptoms, and treated for BV if found.

When you make an appointment with your doctor to be tested for BV, follow these guidelines:

  • Do not go to your doctor while you have your period
  • Do not douche for at least 24 hours before your visit
  • Do not use any spray to mask the smell
  • Avoid inserting anything into your vagina for 24 hours preceding your appointment (finger, medicine, sex, sex toy, tampon)

Treatment of BV

BV is treatable with antibiotics prescribed by a health care provider:

  • One of the following Antibiotics:
    • Metronidazole 500 mg (orally twice daily for 7 days)
    • Metronidazole Gel 0.75% (one full applicator, 5 g, intravaginally once a day for 5 days)
    • Clindamycin Cream 2% (one full applicator, 5 g, intravaginally at bedtime for 7 days)
    • Clindamycin 300 mg (orally twice a day for 7 days)
    • Clindamycin Ovules 100 g (intravaginally once at bedtime for 3 days
  • These medicines should be used until finished without regard for when the symptoms clears up.
  • AVOID alcohol consumption while using Metronidazole and 24 hours afterwards
  • Clindamycin is oil based and will affect latex based condoms.
  • Topical Clindamycin should be AVOIDED during the second halve of pregnancy
  • BV can recur after treatment.

BV cannot be spread to your male partner. Any female sexual partners should seek treatment with you.

Prevention of BV

  • Having a new sexual partner increase your risk. Multiple sexual partners will increase your risk further
    • Be abstinent
    • Limit your number of sexual partners
    • Use condoms
  • Never douche
  • Wash your vulva and anus every day with mild unscented soap or clean water.
  • When you go to the bathroom, wipe from your vagina to your anus (front to back).
  • Keep your genitals cool by wearing cotton or cotton-lined panties.
  • Avoid tight pants and skip the pantyhose in summer.
  • Complete the full course of treatment for BV, even if the symptoms are not present any more.

 

References:

1. Bacterial Vaginosis Centers for Disease Control and Prevention (CDC) – http://www.cdc.gov/std/bv/default.htm

2. Sexually Transmitted Diseases Treatment Guidelines2006 (CDC) – http://www.cdc.gov/std/treatment/2006/vaginal-discharge.htm#vagdis2

3. Bacterial Vaginosis  womanshealth.gov – http://www.womenshealth.gov/faq/bacterial-vaginosis.cfm

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