What is bacterial vaginosis?

Bacterial vaginosis (BV) is a common condition which is caused by changing bacteria in the vagina. This disruption to the natural balance of the vagina can change the discharge women normally produce. This might become more noticeable or have an unpleasant, sometimes fishy smell.

There are several types of bacteria that are linked to this condition. In some women, BV doesn't cause any symptoms and isn't a cause for concern. For others, it can cause symptoms and you may want to consider tests and treatment. It can be effectively treated with antibiotics. But it can also be effectively treated with certain antibiotics. 

BV is not a sexually transmitted infection (STI), but you're more likely to have it if you're sexually active.

What is BV?

The vagina has a balance of different bacteria. Normal vaginal bacteria (lactobacilli) aren't harmful. BV occurs when other types of bacteria (anaerobic bacteria) begin to grow more. 

Lactobacilli usually maintain a slightly acidic environment in the vagina, which prevents other types of bacteria from growing. If these lactobacilli begin to reduce in number the vagina is slightly less acidic than normal, meaning more anaerobic bacteria can grow. Anaerobic bacteria are bacteria that grow in environments without air. This change in the balance of bacteria and acidity is the cause of BV. 

What causes this change?

The cause of the changing levels of bacteria in the vagina is not fully understood. However, you’re more likely to get BV if:

• You’re sexually active - women who’ve not had sex can get BV, but it is less common. 
• You’ve recently changed your sexual partner, you change sexual partners often or have multiple sexual partners.
• You’ve had an STI in the past. 
• You smoke.
• You’ve got the copper coil.
• You use medicated or perfumed body wash, bubble bath or soap.
• You use vaginal deodorant. 
• You use strong detergents to ash your underwear. 
• You wash the inside of your vagina with water and/or soap - this is known as vaginal douching. 

It’s also thought that hormonal changes in the menstrual cycle, oral sex, semen staying in the vagina after sex and genetic factors can also play they’re part in making you more prone to BV. 

What are the symptoms of BV?

Up to half of people won’t experience any symptoms of BV or may not notice them. Typically the first thing you might notice is a change to your vaginal discharge - it may become thin and watery, change to white or grey colour, and begin to smell unpleasant or fishy. 

Other STIs causing similar symptoms

Thrush, trichomonas, chlamydia, gonorrhoea and genital herpes can all cause unusual vaginal discharge. It’s also possible to have more than one of these conditions at the same time.  Trichomonas is particularly easy to confuse with BV, as it can cause discharge to have a fishy smell.

If your discharge does not smell fishy but is watery, lumpy, cloudy, yellow or green, or there is more of it than usual then this could be a sign of chlamydia, gonorrhoea or herpes. You should speak to your clinician about this and any long-lasting changes to your vaginal discharge.

What is the treatment for BV?

If you don’t have any symptoms for BV, you don’t need treatment and your partners won’t need any screening. 

BV can be effectively treated by antibiotics. You may be prescribed oral antibiotics such as metronidazole or a gel version of the treatment which can be applied directly to the vagina. 

Please note some gels can weaken latex condoms, diaphragms and caps. So it’s best to speak to your clinician when you get prescribed treatment, if you use any of these types of contraception. 

There’s some evidence to suggest that taking the combined contraceptive pill and using condoms during sex can reduce the risks of BV. Also there are some behavioural changes you can make to reduce your chances of getting BV, such as:

• Stop vaginal douching
• Have showers instead of baths
• Avoid shower gel or shampoo in the bath
• Stop smoking

What are the complications of BV?

While lots of people might not experience symptoms, for those that do treatment is usually effective if used correctly. It’s common for BV to return and some people do get it multiple times. 

There is some evidence to suggest that BV may be present in people who’ve had a miscarriage, premature delivery of their baby or a low birth weight. If you've got symptoms of BV and are pregnant or breastfeeding, it's important to speak to your clinician.

If you’re worried you’ve got BV, call your GP surgery or visit your local sexual health clinic to get the advice and support you need. They will also be able to offer treatment if needed. 

Here at Online Doctor we have a range of STI tests for people who have no symptoms, but would like to get themselves checked. We also have some treatment options for people who’ve been diagnosed with an STI.

References

www.nhs.uk/conditions/bacterial-vaginosis/
patient.info/sexual-health/vaginal-discharge-female-discharge/bacterial-vaginosis
www.fpa.org.uk/sites/default/files/thrush-bacterial-vaginosis-information-and-advice.pdf