Bacterial Vaginosis:

Bacterial vaginosis represents a common yet often misunderstood condition affecting countless women worldwide. It is considered the most common cause of vaginal discharge. In India alone, more than 60% of women suffer from this condition in their lifetime. Marked by an imbalance in the vaginal bacteria, this condition can lead to discomfort and an increased risk of other health issues if not adequately addressed. Recognising the signs, understanding the bacterial vaginosis reasons, and exploring effective remedies are pivotal in maintaining vaginal health. This blog aims to demystify bacterial vaginosis, offering crucial information on symptoms, diagnosis, and treatment while underscoring the importance of medical intervention and home management strategies. Embarking on this journey, let's delve into the nature of bacterial vaginosis, highlighting its symptoms and the various factors contributing to its development. 

What is Bacterial Vaginosis?

Bacterial vaginosis (BV) is considered a common vaginal infection caused by an overgrowth of harmful bacteria. Every healthy vagina contains a balanced mix of "good" and "bad" bacteria. However, in BV, the "bad" bacteria proliferate excessively, outnumbering the "good" bacteria and disrupting the delicate bacterial balance.

Bacterial Vaginosis Symptoms:

The most common symptom of bacterial vaginosis is an abnormal vaginal discharge. This discharge is typically:

• Off-white, grey, or greenish in colour
• Thin and watery in consistency
• Accompanied by a strong, fishy odour, especially after sexual intercourse or during menstruation

However, it's important to note that up to 84% of women with bacterial vaginosis may not experience noticeable symptoms. If symptoms do occur, they may include:

• Vaginal itching or irritation
• A burning sensation during urination

Causes of Bacterial Vaginosis:

Several factors can contribute to this imbalance:

• Sexual Activity: Semen can impact the pH level inside the vagina, creating an environment conducive to increased bacterial growth and potentially contributing to the development of BV.
• Douching: The practice of douching or rinsing the vagina with water or other fluids can eliminate beneficial bacteria and cause inflammation, increasing the risk of bacterial vaginosis.
• Dietary Changes: Alterations in diet that affect the gastrointestinal tract or internal body systems can influence the normal balance of vaginal bacteria. A poor diet may also impair the body's ability to restore a healthy bacterial equilibrium.
• Tight Clothing: Wearing nylon underwear or tight-fitting clothing, such as yoga pants, can restrict air circulation in the vaginal area, creating a warm and moist environment that encourages bacterial overgrowth.
• Harsh Soaps: The use of heavily perfumed or antibacterial soaps can disrupt the vaginal flora, leading to an imbalance and potential overgrowth of harmful bacteria.
• Excessive Sweating: During physical activity or exercise, sweat can accumulate in clothing, creating a warm and moist environment that promotes bacterial growth and elevates the risk of developing BV.
• Pregnancy: Pregnancy leads to a rise in estrogen, which increases glycogen production in the vaginal lining. This can encourage the growth of certain bacteria, such as Gardnerella vaginalis, that can cause BV.
• Menopause: In menopause, estrogen levels drop, leading to thinning of the vaginal walls (vaginal atrophy) and a decrease in the production of glycogen. This can result in a less acidic environment, reducing the protective lactobacilli and increasing the risk of BV.

Diagnosis:

The diagnostic process of BV typically involves the following steps:

• Medical and Sexual History: The doctor will discuss the patient's medical history, including any previous vagina bacteria infections or conditions and their sexual history. This information helps provide context and identify potential risk factors.
• Physical Examination: The doctor will conduct a genital examination to check for the presence of bacterial vaginosis discharge. The doctor will assess the appearance, consistency, and odour of the vaginal discharge, which can be indicative of BV.
• Laboratory Tests: The following are several laboratory tests to confirm the diagnosis of bacterial vaginosis:
• Gram Stain Test: This test involves examining a vaginal smear under a microscope. If BV is present, the test will show an abundance of gram-positive and gram-negative cocci (bacteria) and a decrease in gram-positive lactobacilli (beneficial bacteria).
• Amsel Criteria: This diagnostic method involves assessing the presence of the following four criteria:
• White, homogeneous vaginal discharge
• Vaginal pH greater than 4.5 (measured using a pH test)
• Positive "whiff test" (a fishy odour when potassium hydroxide is added to the vaginal fluid)
• Presence of clue cells (vaginal epithelial cells coated with bacteria) on microscopic examination
• Wet Mount Test: In this test, doctors take a sample of vaginal discharge and mix it with a solution and examine it under a microscope for the presence of bacteria, WBCs, or clue cells.
• DNA Test (PCR): Although less commonly used due to its higher cost, this test involves checking the genetic material in the vaginal fluid sample for the presence of bacteria of bacterial vaginosis.

Bacterial Vaginosis Treatment:

Treatment for bacterial vaginosis (BV) typically involves:

• Antibiotics: Doctors may prescribe oral or topical antibiotics to restore the natural balance of bacteria inside the vagina. Take your medicine or use the cream or gel for as long as prescribed, even if your symptoms disappear.
• Probiotics: May help restore healthy vaginal flora.
• Avoiding Irritants: Doctors may advise avoiding irritants like douches and scented personal hygiene products. 

Complications:

Bacterial vaginosis does not cause severe health problems. However, if left unaddressed, it may increase the risk of several complications:

• BV can increase the chance of contracting sexually transmitted diseases (STDs) like herpes, chlamydia, gonorrhoea, and HIV. 
• In some cases, BV bacteria can infect the uterus or fallopian tubes, leading to pelvic inflammatory disease (PID). PID can result in infertility and increase the risk of ectopic (tubal) pregnancy, which can be life-threatening.
• BV may increase the risk of developing an infection after procedures on the female reproductive organs, such as cesarean section, abortion, or surgery on the cervix or uterus.
• If left untreated during pregnancy, BV can lead to premature labour or preterm birth. It is crucial for pregnant individuals to seek prompt BV treatment to minimise the risk of complications.

When to See a Doctor:

It is essential to seek medical attention if you experience any of the following signs or symptoms related to bacterial vaginosis (BV):

• New or unusual vaginal discharge, especially one with a strong fishy odour, itchiness or discomfort
• If you have tried over-the-counter medications for a suspected yeast infection, but the symptoms persist or worsen
• If you have multiple or a new sexual partner, it is recommended to get checked for sexually transmitted infections (STIs) or diseases (STDs) 
• If you experience a fever or pelvic pain along with vaginal discharge or other BV symptoms
• Untreated Bacterial vaginosis during pregnancy can elevate the risk of complications, like preterm labour or premature birth.

Prevention:

The following basic steps may help lower your risk of developing BV:

• Limit sexual partners 
• Avoid douching
• Practice safe sex
• Maintain good vaginal hygiene
• Choosing breathable cotton underwear

Conclusion:

Armed with knowledge about bacterial vaginosis, we stand better equipped to safeguard our vaginal health. By recognising early symptoms and understanding risk factors, we empower ourselves to take timely action. The best way to prevent bacterial vaginosis is going for a regular screening. This is particularly important for those who are at higher risk of developing this condition. Embracing medical guidance and lifestyle adjustments paves the way for effective management and prevention of this common condition. After all, our bodies deserve nothing less than informed care and unwavering attention.
 

FAQs:

1) Can bacterial vaginosis be cured?

Ans: Although bacterial vaginosis (BV) can sometimes clear up on its own, seeking treatment is recommended to lower the risk of complications and health risks. A doctor will typically prescribe antibiotic medications to treat BV effectively.

2) Do I need to take medicine?

Ans: Yes, taking prescribed medication is the fastest and most effective way to treat BV. A doctor may prescribe oral antibiotics for 7-14 days. Alternatively, they may recommend using a vaginal gel or cream for 5-10 days, followed by twice-weekly applications for 3-6 months to prevent recurrence.

3) Is Bacterial Vaginosis a Sexually Transmitted Infection (STI)?

Ans: This is one of the biggest myths associated with Bacterial vaginosis. It is not regarded as an infection that is transmitted through sexual intercourse (sexually transmitted infection), but sexual activity can elevate the risk of developing it. The condition can be passed between female partners during sex. 

4) Is bacterial vaginosis bad?

Ans: While mild cases of BV may resolve independently, seeking treatment is crucial to lower the risk of complications. Untreated BV can increase the likelihood of sexually transmitted diseases (STDs), pelvic inflammatory disease (PID), post-procedure infections, and pregnancy complications like preterm labour.

5) Can bacterial vaginosis be treated with over-the-counter yeast infection medications?

Ans: Another common myth associated with this condition is that this disease is treated by yeast infection medications. BV and yeast infections are caused by different types of organisms, so they require different treatments. BV is caused by an overgrowth of certain bacteria, while yeast infections are caused by fungi. Over-the-counter yeast infection treatments are ineffective against BV. If you suspect you have BV, it's important to see a doctor for the appropriate antibiotic treatment.

Dr. Sonal Lathi

MBBS, MD, DNB
United CIIGMA Hospitals (A unit of CARE Hospitals), Chh. Sambhajinagar

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