Bacterial Vaginosis

Vaginas naturally contain a host of bacteria. This is normal and healthy, but when bacteria levels in the vagina are disrupted, bacterial vaginosis can occur.

It is an overgrowth of certain bacteria and happens to be more common in women who are sexually active, but it's not medically classed as an STI. Often women with bacterial vaginosis won't have symptoms or any complications.

BV is thought to be the most common reason for vaginal discharge in Australian women of childbearing age. It's also been linked to an increased risk of developing STIs including chlamydia, which is the most common STI in young Australian women.

Despite this, it's not properly understood. Some women develop it whereas others don't and experts do not know why this is the case.

Many women have BV, but it doesn't cause any symptoms in half of the reported cases. When symptoms do occur they include:

• A thin, watery discharge or a white / grey discharge
• Discharge may be accompanied by a strong fishy smell, particularly after sex

It does not cause itching, redness, soreness or bumps, blisters, and sores. If you have these symptoms you should have tests for STIs.

Although it doesn't cause symptoms in a lot of women, or cause particularly painful or distressing symptoms when it does, bacterial vaginosis should always be treated as it can affect pregnancy by raising the risk of complications.

Long-term complications of BV

Women having IVF treatment who are affected by bacterial vaginosis may experience a lower success rate. Otherwise BV does not appear to cause long term complications other than continued discharge and a raised risk of developing STIs.

Ways in which bacterial vaginosis can affect pregnancy are:

• Miscarriage
• Premature birth
• Early breaking of amniotic sac
• Chorioamnionitis (an infection of the amniotic sac's membranes and chorion and infection of amniotic fluid)
• A womb infection after giving birth

As it's not well understood the causes of bacterial vaginosis are not fully comprehensive. It's thought BV is caused by a change in the natural bacterial balance.

Vaginas contain bacterium called lactobacilli that makes the vagina slightly acidic. This acidic environment stops other bacteria growing there. BV may create a shortfall of lactobacilli that allows other bacterial growth.

The risk of developing BV is raised if you are sexually active, use the intrauterine device (IUD) or smoke. It is also more common in black women than other ethnicities.

Certain lifestyle choices may disrupt vaginal balance and lead to BV. This includes douching (washing out the vagina), using scented shower gels, vaginal washes, and bath foams. The vagina is self-cleaning and discharge is completely normal so douching and using products are definitely not needed!

Your doctor will ask about your symptoms and give you a physical examination to check for discharge. They may confirm BV or refer you to a clinic for extra tests because unusual discharge is a symptom of many STIs as well.

All abnormal vaginal discharge should be investigated. If you experience the signs of bacterial vaginosis it's always advised to investigate, particularly during pregnancy.

A vaginal swab is taken with a large soft cotton bud. It doesn't hurt and is over quickly. You may also have urine tests and blood tests if you need further STI tests. BV tests may also include a vaginal acidity test. This is done with a swab that's wiped on treated paper to measure pH. Higher readings are less acidic. Anything over 4.5 may indicate bacterial vaginosis.

Bacterial vaginosis is treated with antibiotic tablets or a gel. Pregnant women are advised to use the tablets as the gel can raise the risk of complications in pregnancy.

Treatment is usually successful however some women have regular bouts of BV. These women may be seen by a specialist to uncover why the infection returns.

You should take all of your antibiotic treatment to ensure BV is cleared up. Don't stop taking them if symptoms disappear, because the infection will rapidly re-establish. This can lead to antibiotic-resistant bacteria and compromise antibiotic use in the future.

You may find that the antibiotics kill all your vaginal bacteria including the good ones. This can mean the 'bad' bacteria grow back faster and BV is established. In this case, you will need further treatment. Around 30% of women have a second episode of BV.

A more recent treatment for BV is vaginal pH correction treatment. This involves using a gel to change your vagina's acidity balance so the 'bad' bacteria won't be able to grow there. These are available over-the-counter at pharmacies.

Some women suggest that probiotic drinks and yogurts have some benefit in treating BV but there is no clinical evidence this works.

There is some evidence BV can transfer from vagina-to-vagina contact so if you're in a same-sex relationship, inform your partner(s) in case they need to be tested.

It's not thought BV is sexually transmitted, but women who are sexually active, and those who have had multiple partners, are more likely to develop BV. However, you should always use condoms to protect yourself against sexually transmitted infections especially given that BV may increase your susceptibility to STIs.

If you have the symptoms of bacterial vaginosis see your doctor for diagnosis and treatment. BV can be successfully cleared up with antibiotics. This reduces your risk of contracting STI and lowers the risk of complications in pregnancy.