Bacterial
vaginosis
‘Bacterial vaginosis’ is a very common condition in women. In fact, it is much more common than thrush. In the UK in 2007, more than 92,000 people attended a clinic because of bacterial vaginosis. If your genital area smells fishy, this is almost certainly the cause. It is an imbalance of the bacteria in the vagina. Its previous name was ‘anaerobic vaginosis’, and some medical textbooks still use this term.
What is bacterial vaginosis?
Every woman has many varieties of harmless bacteria in her vagina. In bacterial vaginosis, some of the bacteria multiply too much, so that more are present than is normal (especially Gardnerella and Mobiluncus bacteria) New England Journal of Medicine 2005;353:1899–911). And the numbers of other friendly bacteria, especially the ‘lactobacilli’ type, are decreased. In other words, bacterial vaginosis is not an infection caught from your partner – it is due to bacteria that are normally present in the vagina.
Symptoms of bacterial vaginosis
- The main symptom is a fishy smell in the genital area. You may notice that the smell is worse after sex and during your period.
- There is usually a discharge, which is watery and greyish-white in colour.
- Bacterial vaginosis does not cause soreness or irritation.
If untreated, bacterial vaginosis may possibly increase the risk of pelvic inflammatory disease (infection of the Fallopian tubes that lead from the ovaries to the uterus).
Why women get bacterial vaginosis
Putting antiseptic in your bath water, or using bubble baths, can make a bacterial imbalance more likely. Another cause is douching (squirting antiseptic or soapy liquid into the vagina). Some women douche the vagina because they think it is hygienic, but the opposite is true. The vagina cleans itself very effectively and douching makes infections more likely. Some research suggest that bacterial vaginosis is more likely in women who smoke, or who eat a high-fat diet (Journal of Nutritrion 2007;137:2128–33).
What you should do
If you think you have bacterial vaginosis, you need to see your doctor because the treatment, an antibiotic called metronidazole, is available only with a doctor’s prescription. Metronidazole cures the problem in 90% of women, but causes an unpleasant metallic taste in the mouth, though this disappears after the treatment is finished. It can also cause a slightly nauseous feeling. You should not drink alcohol while you are taking it. Metronidazole is usually prescribed as a tablet taken by mouth, but a gel form that is inserted into the vagina is sometimes used. Clindamycin vaginal cream is another possibility.
If it comes back. Unfortunately, the cure may not be permanent. The symptoms return in about half of women. In this situation, there are various possible courses of action.
- See your doctor again for a repeat of the metronidazole treatment, or to try another antibiotic. Make sure you take all the prescribed medication; a research study has found that bacterial vaginosis is most likely to come back in women who did not take the whole course of antibiotic treatment (Annals of Internal Medicine 2008;149:20–28).
- Try acetic acid vaginal jelly, which you can buy from a pharmacy without a prescription (such as Aci-Jel or Balance Activ). These restore the natural acidity of the vagina, which may encourage a return to the natural balance of bacteria. It is not known whether or not they damage condoms and contraceptive diaphragms.
- Try yoghurt. Make sure the container says ‘live yoghurt’, because this contains live lactobacilli bacteria. It is the friendly lactobacilli bacteria that are reduced in numbers in bacterial vaginosis. Gently smear a small amount of yoghurt over the vulva (the area around the opening of the vagina), and also put some inside the vagina. The easiest way to do this is to use a tampon with its applicator. Push the tampon back inside the applicator so you have a space for about a teaspoonful of yoghurt. Then insert the tampon in the usual way, which will push the yoghurt into the top of the vagina. Remove the tampon an hour later. Do this twice a day for a week. According to the medical journal Bandolier, which looks at the scientific evidence for treatments, some research has shown that women using yoghurt treatment felt their symptoms were improved (www.jr2.ox.ac.uk/bandolier/band60/b60-3.html).
- If you have an intrauterine contraceptive device (‘coil’) and bacterial vaginosis is very troublesome, consider having the device removed. Bacterial vaginosis is more common in women using this type of contraception.
- Stop smoking, as smoking seems to be linked with bacterial vaginosis.
If you have a partner. Your partner does not need to be treated, even if you keep getting bacterial vaginosis. There is no scientific evidence to suggest that treating your partner makes a difference.
If you are planning pregnancy. In the past, bacterial vaginosis was thought to be just a nuisance, but not harmful in any way. There is now evidence that it doubles the likelihood of a premature birth. So if you are intending to become pregnant, you should have bacterial vaginosis treated beforehand. If you have had premature labor in the past, your doctor will probably test you for anaerobic vaginosis during your pregnancy and treat you with antibiotics if necessary (Annals of Internal Medicine;148:220–33).
