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Bacterial Vaginosis: Causes, Symptoms, Treatments And Prevention

Bacterial Vaginosis is a condition caused due to an imbalance in the bacteria that are normally present in the vagina. Vagina, due to its acidic nature, prevents the growth of bad bacteria and maintains the level of good bacteria known as lactobacillus. An imbalance in the pH levels can cause overgrowth of an anaerobic organism that replaces lactobacillus and causes bacterial vaginosis.

Bacterial Vaginosis

What is Bacterial Vaginosis?

Bacterial vaginosis is an abnormal condition characterized by vaginal discharge and inflammation due to a bacterial infection. It is a harmless condition usually results due to excess growth of the bacteria present in the vagina. Bacterial vaginosis can occur at any age, but it mostly affects the women with child-bearing age.

What Causes Bacterial Vaginosis?

Bacteria called lactobacillus usually are present in the vagina and keep it acidic so that bad bacteria can not grow. But if the level of lactobacillus reduces, the level of harmful bacteria increases causing bacterial vaginosis.

Bacterial vaginosis is mostly caused due to change in the balance of naturally growing bacteria in the vagina.

Symptoms of Bacterial Vaginosis:

Most of the women with bacterial vaginosis experience no symptoms. But some women may experience:

  • Thin white, grey, or green discharge from the vagina
  • Vaginal itching
  • Foul vaginal odour
  • Burning sensation while urinating
  • Pain during sexual intercourse
  • Abnormal vaginal discharge after sexual intercourse

The amount of vaginal discharge varies in every woman and should be evaluated.

Risk Factors for Bacterial Vaginosis:

Factors that increase the risk of developing bacterial vaginosis include:

  • Women with Multiple sexual Partners are at increased risk of bacterial vaginosis
  • Women with female sexual partners are also at increased risk of bacterial vaginosis.
  • Douching is the practice of washing the vagina with water or any cleaning agent. Douching alters the balance of bacteria and may also flush harmful bacteria into the upper genital tract.
  • Lack of lactobacilli bacteria in the vaginal environment increases the risk of bacterial vaginosis.

Complications of Bacterial Vaginosis:

If bacterial vaginosis left untreated, it might lead to severe complications, such as:

Sexually Transmitted Infections:

Women having bacterial infections are at increased risk of developing sexually transmitted infections, such as herpes simplex virus, HIV, chlamydia or gonorrhoea.

Post-surgical Infections:

Women having bacterial vaginosis are at increased risk of developing an infection after procedures, such as hysterectomy etc.

Pelvic Inflammatory Disease (PID):

The pelvic inflammatory disease is an inflammatory condition of the female reproductive system due to an infection of the uterus, the fallopian tubes or ovaries that increases the risk of infertility and ectopic pregnancy.

Complications During Pregnancy:

Pregnant women are at greater risk of having premature deliveries and low-birth-weight babies.

Diagnosis of Bacterial Vaginosis:

The doctor will initiate the diagnosis by assessing the signs and symptoms and medical history of the individual. The doctor also recommends certain tests, such as:

Pelvic Examination:

A pelvic examination involves examining the woman’s reproductive organs. During this test, the doctor examines the vagina and vulva visually for signs of infection, such as vaginal discharge, redness, and cysts.

The pelvic examination also involves manual examination of internal reproductive and sexual organs. During this procedure, the doctor will insert two fingers into the vagina by using lubricated gloves while the other hand is used to feel the abdomen.

This examination helps in determining the irregularities in the uterus, ovaries, or in the fallopian tubes.

Vaginal pH Test:

The doctor recommends this test to assess the acidity of the vagina by using a pH test strip. A vaginal pH of 4.5 or higher indicates the sign of bacterial vaginosis.

Amsel’s Criteria:

Amsel’s criteria are simple, easy, and cost-effective diagnostic criteria for providing fast and appropriate treatment.  For the accurate diagnosis of bacterial vaginosis, the criteria should meet at least three parameters, they are:

  • Homogenous vaginal discharge
  • Greater vaginal pH (i.e more than 5)
  • A positive whiff test: It is due to the presence of an intense and fishy odour when few drops of potassium hydroxide are added to the vaginal discharge sample.
  • Presence of clue cells: Clue cells are vaginal epithelial cells that are coated with cocobacillary organisms that become indistinct or stippled. The test is considered positive if the clue cells constitute more than 20% of the epithelial cells.

Gram’s Stain:

Gram’s stain is a common laboratory procedure for diagnosing bacterial vaginosis.

Treatment

Bacterial vaginosis will get cured on its own if the individual is asymptomatic. If the individual experience any symptoms the doctor may prescribe the following:

  • Metronidazole reduces the bacterial infection by inhibiting the nucleic acid synthesis by interfering with the synthesis of bacteria. Metronidazole is available both in oral and topical dosage forms.
  • Clindamycin acts by inhibiting the protein synthesis of the bacteria and reduces the infection. Clindamycin is available in the form of a cream.

This drug therapy is usually prescribed for five to seven days, and the individual is advised to complete the treatment, even if the symptoms disappear.

Treatment of Bacterial Vaginosis:

During Pregnancy:

The main aim of treating bacterial vaginosis during pregnancy is to reduce the risk of pregnancy-related complications due to the infection and to avoid preterm labor. The doctor usually prescribes oral and topical antibiotics.

Most of the doctors recommend appropriate treatment for bacterial vaginosis before undergoing total abdominal hysterectomy, insertion of an intrauterine device and cesarean delivery.

Recurring Bacterial Vaginosis

Bacterial vaginosis usually recurs within three to 12 months, even after treatment. If the symptoms re-appear immediately after the treatment, the doctor may extend the drug therapy. If the individual experience bacterial vaginosis for more than two times in six months then the treatment is given for longer duration (i.e. for more than six months).

Prevention of Bacterial Vaginosis:

It is not possible to always prevent bacterial vaginosis. However, certain measures should be taken to reduce the risk of infection and spreading they include:

  • Avoid douching
  • Limit the number of sexual partners
  • Complete the course of treatment
  • Male partner of a female with recurrent bacterial vaginosis is advised to use condom.

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