Bacterial Vaginosis

Bacterial vaginosis (BV) is a common yet poorly understood condition in which the balance of bacteria inside the vagina becomes disrupted.

Around one in three women will experience at least once episode of BV at some point.

This imbalance often triggers a change to the usual vaginal discharge, which results in a fishy smelling, greyish discharge from the vagina. However, half of women with bacterial vaginosis have no symptoms. 

See your GP if you notice any abnormal discharge from your vagina, especially if you are pregnant. It is important to get this type of symptom diagnosed quickly to rule out other infections and prevent complications.

If you do not have symptoms, there is no need to get tested as bacterial vaginosis without symptoms does not pose a threat to health or to pregnancy.

The main symptom of bacterial vaginosis (BV) is a change in your usual vaginal discharge.

Your discharge may:

• become thin and watery
• change to a white or grey colour
• develop a strong, unpleasant, fishy smell, particularly after sexual intercourse

Other symptoms of BV can include:

• pain during intercourse
• pain when passing urine
• some light bleeding from your vagina

BV does not usually cause itching or irritation.

Around half of all women with BV do not have any symptoms. This is known as asymptomatic BV.

Bacterial vaginosis (BV) occurs when there is a change in the natural balance of bacteria in your vagina.

Your vagina should contain bacteria called lactobacilli. These bacteria produce lactic acid. This makes the vagina slightly acidic, which prevents other bacteria from growing there.

However, if you have BV, you have less lactobacilli, which means your vagina is not as acidic as it should be. This allows other types of bacteria to grow.

It is still unclear what causes the change in the balance of bacteria, although the risk is increased if you:

• are pregnant
• have a new sexual partner
• have multiple sexual partners
• use an intrauterine device (IUD), a contraceptive device that fits inside the womb
• smoke
• use scented soaps or bubble bath
• put antiseptic liquids in the bath
• wash or clean out your vagina with water or other fluids
• use vaginal deodorant
• use strong detergents to wash your underwear
• have previously been infected with the human papilloma virus (HPV) – a group of viruses that can cause genital warts and, less commonly, cervical cancer
• eat a diet high in carbohydrates, such as lots of white bread, baked potatoes and processed food

Examination

Your GP or healthcare professional may diagnose BV from a description of your symptoms and by examining your vagina. In particular, they will look for:

• a thin, greyish discharge
• an unpleasant smell

In some cases, this may be enough to confirm your diagnosis. However, if you are sexually active and may have a sexually transmitted infection (STI) instead of BV, you may need further tests. 

Tests

A sample of cells may be taken from the wall of your vagina using a plastic loop or swab. A swab looks a bit like a cotton bud but is smaller, soft and rounded.

The swab or loop picks up samples of discharge and cells. It only takes a few seconds and is not usually painful, although it may be slightly uncomfortable for a moment.

The samples are examined to check for BV. The result may be available immediately or the sample may be sent to a laboratory, in which case the result will usually be available within a week.

The pH (alkaline/acid balance) of your vagina may also be measured. A swab will be taken from inside your vagina and wiped over a piece of specially treated paper. The paper changes colour depending on the pH level. A pH level higher than 4.5 is an indication that you may have BV.

These tests and all sexual health services are free on the NHS. They are available to everyone, regardless of age. Treatment is also free, but if you go to your GP, you may have to pay a prescription charge.

Bacterial vaginosis (BV) can be treated with antibiotics. If used correctly, treatment is effective in around 9 out of 10 cases.

There is currently no evidence that probiotics, such as those found in live yoghurt, are of any benefit in treating or preventing BV.

Metronidazole

Metronidazole is the most common and preferred antibiotic treatment for BV. It is available in three forms:

• as tablets to be swallowed twice a day for seven days
• as tablets to be taken as a single larger dose that you take only once
• as a gel that you apply to your vagina once a day for five days

The most effective way to take metronidazole is in tablet form over 5-7 days. This is also the preferred treatment if you are pregnant or breastfeeding.

As a precaution, the use of metronidazole (and most other types of medication) is not normally recommended during pregnancy. But an exception is made in the case of BV, as not treating it poses a far bigger risk to the pregnancy than taking the medication.

More women find that their BV is more likely to return if they take the single larger dose. 

BV has been linked to several other conditions. It is thought that BV may contribute to:

• pelvic inflammatory disease (PID), a condition that involves infection and inflammation (swelling) of the upper female genital tract, including the womb, fallopian tubes and ovaries
• tubal factor infertility, caused by damage to the fallopian tubes, which connect the ovaries to the womb

In-vitro fertilisation

Women who have BV and are using in vitro fertilisation (IVF) may have:

• a lower success rate
• an increased risk of early miscarriage

If you are having IVF and have symptoms of BV, see your GP or speak to your infertility specialist.

Recurrent BV

In around 20–25% of women who have been successfully treated, BV may return within one month. Over time, BV may reoccur in up to 80% of women.

If your BV reoccurs, return to your GP to discuss further treatment options.

HOME REMEDIES

• Wear cotton underwear and looser fitting clothes.
• Go to health food shop and buy Acidophillus tablet take orally twice a day while infected then once a day to prevent recurring.
• also take a folic acid tablet a day, helps with more than just pregnancy
• Find a plain live culture yoghurt and apply to inside of vagina with a tampon, wash after 10 minutes.
• DO NOT DOUCHE!
• Don't sit in a bath while you wash hair or body as soaps can make it worse by changing the PH in vagina.
• Cut back on sugar intake and drink more water
• Try not to use tampax during period
• Go to tesco or boots and pick up a pack of Balance-Activ, vaginal gel to treat BV that you squeeze in vagina at night
• Take a multi-vitamin daily to boost immune system
• Take a cranberry tablet daily or drink lots of cranberry juice, helps down there and stops urine infections
• Take a garlic tablet, yeast and bad bacteria cant live in the same place as garlic
• Put 2 cups of Apple Cider Vinegar in your bath and soak in it for a while, your vagina is meant to be acidic
• Put a few drops of tea tree oil in there too as it can help.