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Overview

Bacterial vaginosis (BV) is characterized by the overgrowth of certain bacteria in the vagina, including Gardnerella vaginalis, Gardneralla mobiluncus, and Mycoplasma hominis. Bacterial vaginosis is grossly underdiagnosed because many women assume they have a yeast infection and treat symptoms with over-the-counter medications.

Incidence and Prevalence
Bacterial vaginosis accounts for 60% of vulvovaginal infections. Young adult women, particularly those who are sexually active, are most commonly affected.

Causes and Risk Factors

BV is caused by a change in the natural balance of bacteria in the vagina. Lactobacillus, helpful bacteria, metabolizes glycogen to lactic acid in the vagina and maintains normal vaginal pH, which provides a natural defense against unhealthy bacteria proliferation.

When the defense is weakened, other bacteria present in the vagina (e.g., Bacteroides sp, Peptostreptococcus sp, Gardnerella vaginalis, G. mobiluncus, Mycoplasma hominis) proliferate and cause symptoms. About 50% of women have G. vaginalis in their vaginal flora but do not develop infection.

Broad-spectrum antibiotics may destroy healthy bacteria, disrupt the vagina's normal flora, and promote infection. Douching, overused or retained tampons, intrauterine contraceptive devices (IUDs), diaphragms, contraceptive sponges, and products containing nonoxynol-9 may also disrupt the balance.

Bacterial vaginosis also is associated with having multiple sex partners, a new monogamous sexual relationship, and a history of STDs.

Signs and Symptoms

A fishy vaginal odor, itching, and irritation are common signs of BV and may be particularly noticeable after intercourse or menses. It may be accompanied by a smooth, sticky white or gray discharge 4 days to 4 weeks following exposure. Elevated vaginal pH level is also a symptom.

Complications
BV is associated with pelvic inflammatory disease (PID), female infertility, tubal (ectopic) pregnancy, premature birth, and low birth weight in infants born to infected mothers.

Diagnosis

Diagnosis is usually made by visual observation and by smell. A pelvic examination is performed to determine whether the cervix is producing abnormal secretions and to check for other diseases.

Vaginal fluid may be treated with a 10% solution of potassium hydroxide (KOH), which makes the characteristic odor more pronounced. A sample is usually taken for microscopic examination to confirm the presence of bacteria, and pH levels are checked. Most physicians recommend a full STD screening.

Treatment

Antibiotics such as metronidazole and clindamycin are generally prescribed, as oral (pill) or topical (cream) treatments. When used topically, these medications may cause side effects such as stinging, burning, and irritation. Douching should be avoided.

In May 2007, the Food and Drug Administration (FDA) approved tinidazole (Tindamax®) for the treatment of bacterial vaginosis. This medication, which also can be prescribed to treat trichomoniasis, is administered as once daily for either 5 days or 2 days, depending on the dosage.

Sex partners may require treatment if infection recurs.

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