Bacterial vaginosis | |
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Other names | Anaerobic vaginositis, non-specific vaginitis, vaginal bacteriosis, Gardnerella vaginitis[1] |
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Vaginal squamous cell with normal vaginal flora versus bacterial vaginosis on Pap stain. Normal vaginal flora (left) is predominantly rod-shaped Lactobacilli whereas in bacterial vaginosis (right) there is an overgrowth of bacteria which can be of multiple species. | |
Specialty | Gynecology, infectious disease |
Symptoms | Vaginal discharge that often smells like fish, burning with urination[2] |
Complications | Early delivery among pregnant women[3] |
Causes | Imbalance of the naturally occurring bacteria in the vagina[4][5] |
Risk factors | Douching, new or multiple sex partners, antibiotics, using an intrauterine device[5] |
Diagnostic method | Testing the vaginal discharge[6] |
Differential diagnosis | Vaginal yeast infection, infection with Trichomonas[7] |
Prevention | Probiotics[6] |
Medication | Clindamycin or metronidazole[6] |
Frequency | ~ 5% to 70% of women[8] |
Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria.[6][9] Common symptoms include increased vaginal discharge that often smells like fish.[2] The discharge is usually white or gray in color.[2] Burning with urination may occur.[2] Itching is uncommon.[2][6] Occasionally, there may be no symptoms.[2] Having BV approximately doubles the risk of infection by a number of sexually transmitted infections, including HIV/AIDS.[8][10] It also increases the risk of early delivery among pregnant women.[3][11]
BV is caused by an imbalance of the naturally occurring bacteria in the vagina.[4][5] There is a change in the most common type of bacteria and a hundred to thousand fold increase in total numbers of bacteria present.[6] Typically, bacteria other than Lactobacilli become more common.[12] Risk factors include douching, new or multiple sex partners, antibiotics, and using an intrauterine device, among others.[5] However, it is not considered a sexually transmitted infection and, unlike gonorrhoea and chlamydia, sexual partners are not treated.[13] Diagnosis is suspected based on the symptoms, and may be verified by testing the vaginal discharge and finding a higher than normal vaginal pH, and large numbers of bacteria.[6] BV is often confused with a vaginal yeast infection or infection with Trichomonas.[7]
Usually treatment is with an antibiotic, such as clindamycin or metronidazole.[6] These medications may also be used in the second or third trimesters of pregnancy.[6] However, the condition often recurs following treatment.[6] Probiotics may help prevent re-occurrence.[6] It is unclear if the use of probiotics or antibiotics affects pregnancy outcomes.[6][14]
BV is the most common vaginal infection in women of reproductive age.[5] The percentage of women affected at any given time varies between 5% and 70%.[8] BV is most common in parts of Africa and least common in Asia and Europe.[8] In the United States about 30% of women between the ages of 14 and 49 are affected.[15] Rates vary considerably between ethnic groups within a country.[8] While BV-like symptoms have been described for much of recorded history, the first clearly documented case occurred in 1894.[1]
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