Bacterial Vaginosis / BV Information & Guidance
” My Vulva / Vagina’s Smelling Fishy / Bacterial Vaginosis Symptoms / BV and HIV / Mycoplasma Genitalium and BV”
Information & Guidance
BV – Bacterial Vaginosis
The following is an extract from
“Sexplained One – Sex & Your Health”
by Helen J Knox © All Rights Reserved
(See links on right side of page)
What is BV?
The full name for BV is bacterial vaginosis.
* Bacterial relates to bacteria;
* Vaginosis means a disease of the vagina.
* Together, the term bacterial vaginosis simply means ‘a bacterial disease of the vagina’.
Other names :
BV was previously called anaerobic vaginosis or Gardnerella.
Some people continue to call it by these names.
Where does BV come from?
The pH or acid-alkaline level of a healthy vagina is 4.5 (slightly acidic).
BV occurs when the pH level (acid-alkaline balance) becomes more alkaline (higher).
BV is the most common cause of abnormal vaginal discharge in women of child-bearing age (producing a fishy smell).
Overall, it’s more common than genital thrush (also called candida or yeast infection).
Because it produces a characteristically fishy smell, women don’t talk about it as openly as they do about other conditions.
A normal healthy vagina contains hundreds of different bacteria that live side by side, in harmony with each other.
BV doesn’t occur before puberty.
It occurs in the presence of the dominant female hormone, oestrogen when there is a reduction or imbalance in the number of ‘friendly’ bacteria, (lactobacillus), which usually protects and maintains the acidic vaginal environment.
Lactobacillus acidophilus, discovered by the chemist and microbiologist Louis Pasteur in 1856, is, technically, a gram-positive, rod-shaped bacteria that produces lactic acid — a natural anti-bacterial — and a substance that can turn milk sour!
It is a normal, ‘friendly bacteria’, which also produces hydrogen peroxide (H2O2).
In the vagina, Lactobacillus prevents other bacteria, of which there are hundreds of different types, from multiplying to a level at which they cause symptoms.
There are H2O2 positive and H2O2 negative lactobacilli.
The positive type appears to be more protective against a range of conditions than the negative.
When Lactobacillus is reduced in number, an increase in the amount of ‘unfriendly’ anaerobic bacteria occurs.
Anaerobic bacteria don’t need oxygen to survive.
Examples of these include:
* Atopobium vaginalis;
* Gardnerella vaginalis;
* Mycoplasma hominis;
* Mycoplasma Genitalium
* Ureaplasma urealyticum;
In turn, the anaerobic increase outnumbers the Lactobacilli and this imbalance causes symptoms to occur.
There are some healthy women, though, who have very few vaginal Lactobacilli but other bacteria which also produce lactic acid, such as Atopobium, Megasphaera, and Leptotrichia that keep their vaginal pH at a normal level.
It appears that the presence of oestrogen, instead of just Lactobacillus, is related to the healthy acidic vaginal pH, although other bacteria may also be involved.
BV is more common in sexually active women, although, rarely, it also affects women who have never been sexually active.
It is particularly common in women who have multiple sex partners or whose partner has multiple partners.
BV is more common in some ethnic groups; particularly those that encourage the practice of douching (rinsing out the vagina).
Risk factors for BV include:
* receiving oral sex (cunnilingus);
* change of sexual partner (particularly if condoms are not used);
* douching / vaginal rinsing;
* using feminine hygiene sprays;
* washing hair in the bath, whilst bathing;
* and use of a copper-containing IUD (intra-uterine contraceptive device or coil). BV can also occur after the use of vaginal lubricants and/or after anal sex.
Finally, women who either have a SAI or PID following a sexual infection are more likely to develop BV.
How common is BV?
Right around the world, BV is thought to be one of the most common causes of abnormal vaginal discharge in women of childbearing age.
Bacterial Vaginosis is more common than genital thrush (candidiasis or yeast infection) and during their lifetime, most women will experience it to some extent.
Many women think they have thrush when they have BV, and vice versa. Although, the two conditions are often found concurrently.
Where is BV found in the body?
BV is only found in the vagina.
Can BV be cured?
BV can be treated with antibiotics, but it may recur – sometimes on a regular basis – while at other times it disappears completely once conditions in the vagina re-balance.
Since symptoms can appear in w and as, for many women, it seems to recur of its own accord, different treatment regimens may be required.
How is BV passed on?
- BV is not passed on — it simply develops.
- Following unprotected sex, BV may occur if the man’s semen is particularly alkaline and the woman’s vagina particularly acidic.
- This can change the normal bacterial balance within the vagina, allowing BV to develop.
- Some women notice a cyclical or regular pattern to the increase and decrease of their symptoms due to changing hormone levels throughout the menstrual cycle.
Vaginal conditions can also become imbalanced, allowing BV to develop:
* during pregnancy;
* after abortion or termination of pregnancy;
* after hysterectomy (surgical removal of the uterus/womb);
* or after other gynaecological treatment.
BV may also develop if a woman uses:
* bubble bath;
* scented soaps;
* feminine hygiene products;
* antiseptic in bathwater;
* or they douche (rinse out) their vagina;
* if they wipe from back to front after opening their bowels this practice can allow E-coli and other bowel germs to get close to the vagina.
Other women who are prone to BV include those:
* who take various forms of hormonal contraception or use an IUD (intra-uterine contraceptive device/coil or IUCD);
* who use steroid or antibiotic creams vaginally;
* who have a weakened or suppressed immune system;
* who are near or have reached the menopause;
* or women who have diabetes;
* all of which can influence a change in the normal vaginal flora (conditions).
How soon after unprotected sex can I be tested for BV?
- if you have symptoms, you can be tested at any time.
How accurate are the tests for BV?
Tests for BV are extremely accurate. if the condition is suspected on clinical grounds, in other words, from what you tell the doctor or nurse about your symptoms, they may offer treatment to relieve symptoms, whilst waiting for laboratory results.
Can the test show how long I’ve had BV?
No. The tests cannot tell how long BV has been present.
If I have BV, should I have tests for other sexual infections, too?
- Sexually active women, who have symptoms or who has the slightest concern about their own or their partners’ sexual health should be screened for other infections.
- Sexual infections tend to ‘hunt in packs’ – they co-exist or travel together and sometimes hide each other. Rather than guess or assume, only a laboratory check can tell if you are free of other infections.
Is there a link between BV and HIV infection?
Yes. There appears to be a link between BV and HIV infection.
For women, the risk of acquiring HIV or indeed any sexual infection from a man is considerably greater than a man’s risk of acquiring infection from a woman.
This is because unless contained in a condom or if he withdraws (pulls out before ejaculation), a man deposits his ejaculate inside a woman’s vagina, the majority of which is then absorbed by her body.
When the body is under attack from infection of any sort, its ‘soldiers’ go to battle to defend it.
In other words, the army of white blood cells that are part of the immune system take over and an inflammatory reaction always occurs at the site of an infection. The tender area is weakened, more prone to bleeding and the inflamed cells are more vulnerable to attack.
To picture this non-sexually, think of a sore throat. It hurts and it’s inflamed for a few days, while the body tries to fight the invading germs.
During sexual infection, the body reacts in a similar way but this usually takes place in the genital area.
Women are particularly vulnerable because, apart from what’s already been said about absorption, the normally acidic vaginal environment, which is designed to destroy potential infection alters during infection.
A normal, healthy vagina has hundreds of different bacteria living in harmony with each other.
Under attack from invading germs, or when the normal balance is upset for other reasons: e.g. douching (when a woman rinses inside her vagina).
This is taught to young women in certain cultures but it is not necessary because the vagina is a self-cleansing area. When douched, the normally acidic vagina merely becomes more alkaline, with an upset bacterial balance.
Different bacteria then ‘fight’ each other for domination. The immune system is distracted and as long as an imbalance of normal conditions lasts, there is greater vulnerability to additional infection.
Further infection has an unguarded entry route through the delicate inflamed area that is trying to heal, while the distracted immune system fights existing infection.
When BV is present, an inflammatory reaction occurs, making the woman vulnerable to further infection.
If I have BV, should I have an HIV test?
- Yes. if you have BV and have been sexually active, you should have an HIV test.
- Everyone should know their up-to-date HIV status and not merely assume they are negative (don’t have the infection).
Do I need to be tested after treatment for BV, to make sure I’ve been cured?
- No. You don’t need to be tested after treatment for BV unless you still have symptoms that worry you.
How much does the BV test cost?
- Depending, where in the world you are and in the interest of public health, tests for BV and SAIs (STIs/STDs) are usually free or at minimal charge. if you are seen privately, charges vary according to tests taken and laboratory used for analysis.
What might men notice if they have BV?
Men cannot catch BV but after contact with BV:
* some experience balanitis, with which the head of the penis becomes inflamed and sore (see Balanitis);
* some men experience irritating symptoms of non-specific
non-chlamydial NGU, if their partner has recurrent BV (see NGU);
* but many don’t notice anything at all.
What might I notice when I have BV?
- Many women who test positive for BV have no signs or symptoms to alert them that they have it.
When present, symptoms may be one or more of the following:
* an increase in vaginal secretions;
* the discharge is described as homogenous. It commonly appears as a thin or runny, grey to yellow-white coloured, ‘flour paste’. This usually coats the walls of the vagina and the introitus (the vaginal entrance/vestibule) in the same way throughout;
* a characteristic fishy or musty smelling odour, which can be quite embarrassing. Unfortunately, this may appear or smell worse after sex; and a partner may notice it first;
* burning when passing urine;
* slight itching and vulval inflammation, although BV is not usually associated with soreness, itching or irritation.
- The range of symptoms can be wide. You may be asymptomatic (not have symptoms). You may be bothered by the discharge. You may be someone who has chronic BV, with recurrent outbreaks that often occur before or after menstruation.
NOTE: if you experience an itching or burning sensation, particularly if you are sexually active, don’t assume you have BV or genital thrush (candida/yeast infection) because several infections can present in a similar way.
It’s ALWAYS safer to let a qualified medical practitioner examine you and decide if you have BV – or something else.
What may complications occur if BV is not treated?
- Complications of BV are wide and varied.
- Due to its irritant effect on the lining of the vagina, BV increases the chance of contracting sexual infections such as chlamydia, gonorrhoea, herpes, syphilis and HIV, other STIs and/or the development of PID (pelvic inflammatory disease. (see PID)
- Many women, who have recurrent BV experience relationship and sexual problems because of the associated malodour.
- Women who have HIV and develop BV are at increased risk of passing HIV to a sexual partner and to their baby. Women who have BV at the time of a TOP (termination of pregnancy/abortion) are at increased risk of developing endometritis (inflammation of the lining of the uterus/womb) after surgery. This could develop into PID if left untreated. (see PID)
- After a hysterectomy, some women who have BV develop complications; but taking prophylactic antibiotics or using lactic acid gel can reduce their risk.
Does BV cause PID?
Yes. Depending on the bacteria involved, BV can cause PID. A high proportion of women who have PID also have BV.
Can BV cause infertility?
No. BV is not directly associated with infertility.
Does BV affect the baby if a woman has it when she’s pregnant?
No. BV doesn’t harm the baby when a woman is pregnant. However, it may increase the risk of miscarriage or of premature (early) delivery.
If I’ve had BV, will I still be able to have a baby?
Yes. You will still be able to have a baby if you have had BV. It is not linked to infertility so it won’t stop you from getting pregnant or being able to have a baby.
- if you have had chlamydia, gonorrhoea or PID in the past, however, with or without BV, you may be at an increased risk of ectopic (tubal) pregnancy and sometimes infertility because of those infections (secondary infertility).
Therefore, it’s sensible for all women to monitor their menstrual cycle, their regularity and types of bleed if they are sexually active.
What treatment is there if I’ve got BV?
BV is treated with antibiotics, either taken orally or administered vaginally as creams or pessaries. However, treatment depends on the severity and frequency of symptoms.
Oral treatment must be taken properly and no alcohol drunk whilst on the tablets or for 48 hours afterwards. They may induce vomiting when mixed with alcohol.
After antibiotic treatment, some women find that the use of lactic acid gel helps to reduce the rate of relapse when it is used around the time of menstruation and following unprotected sex.
Examples of lactic acid gel products include Balance Activ® and Canesbalance®
NOTE: Do NOT wash more to try and get rid of any embarrassing smell. It will only make it worse!
Can BV go away without treatment?
- Yes. BV may disappear without treatment.
How soon will I feel normal again after treatment for BV?
- After BV treatment, it usually takes a few days for vaginal flora (conditions) to return to normal.
What should I do after I finish the treatment for BV?
- After treatment for BV, you can return to your normal routine.
- BV can develop spontaneously and disappear the same way. But if you experience recurrent attacks, especially after unprotected sex with your regular partner, try using a condom to break the cycle and reduce the opportunity for recurrence.
How soon can I have sex after BV treatment?
- To allow enough time for normal vaginal flora to return after treatment, some clinics suggest waiting seven days before having sex again.
- Others say that after BV treatment, sex can be resumed when you feel comfortable again.
Will my partner(s) need to be treated too?
- Some male partners of women with BV notice non-specific symptoms, in which case they should be tested and treated as necessary.
I never knew I had BV before I was tested, so how will I know it has gone after treatment?
- BV is a condition that can come and go, not an infection that needs to be eradicated to protect health.
- It does not always cause a problem and it does not always need to be treated.
- In general, even if you didn’t know you had it, BV disappears in a few days, when normal vaginal conditions return.
If I am not sexually active but I develop BV, are there any home remedies I can try?
Yes. There are several home treatments that aim to rebalance vaginal bacteria and several appear on the internet.
However, if you have been sexually active in the last six months, don’t use any of them without checking with your doctor or a clinic that you just have BV not another infection that is being masked by it – and that you are not pregnant.
Although not a cure for BV and not scientifically proven, some women enjoy varying degrees of success – or at least feel less uncomfortable – by inserting ‘live’ yoghurt into their vagina to replace missing lactobacilli.
They usually do this by dipping a tampon into some live, unflavoured yoghurt before inserting that into their vagina.
They then change their tampon every two to three hours for one or two days.
When bathing, try not to soak for more than 15 minutes and avoid putting scented products like bubble bath, disinfectants, essential oils or other commercial products into the water.
Some women pour a tablespoon of vinegar or a single drop of tea tree oil into their bath which may help to relieve symptoms of BV, although it may not cure. However, showers are generally advised instead of baths if you have BV to minimise the risk of getting soapy water into the vagina.
Antioxidants in vitamins A, C, D and E, as well as B complex, may help; but they are best taken as part of a healthy balanced diet.
Some women feel that avoiding food like cheese, chocolate, sugar, fruit, mouldy or blue cheese; stopping smoking and/or reducing or omitting the consumption of alcohol help.
Finally, worrying and stressing about BV can affect the immune system and health in general. It is best to seek medical advice and support for this embarrassing condition.
If I have HIV, should I use the same treatment?
Women with HIV and BV should have the same treatment as women who don’t.
Can BV come back after treatment?
Yes. Some women get recurrent BV. Why they do is not always clear and it can be extremely upsetting.
How can I avoid developing BV?
Some ways to reduce your risk of developing BV are:
* avoid having unprotected sex;
* make sure you always use condoms;
* if you have more than one sexual partner, reduce the number;
* avoid using bubble bath, scented soap, detergent or any other substance that can upset the normal bacterial balance inside your vagina;
* wear underwear with cotton gussets, rather than synthetic, because cotton can absorb any moisture you produce, rather than encourage your genital area to sweat;
* avoid wearing thongs or g-string underwear;
* wipe from front to back after opening your bowels to prevent E-coli and other bowel germs getting close to your vagina;
* be careful about vaginal lubricants – spermicidal cream or gel can upset the healthy bacterial balance of your vagina;
* if you use a contraceptive diaphragm or cap, make sure you follow the instructions, then wash and dry it carefully after each use.
Keep your genital area clean but be careful – some women use genital moisturisers and antiseptic wipes after sex but it is better to wash with water only. However, if you do this, do it very carefully and just around your vulval area. Don’t insert any moisturising fluid into your vagina.
Make sure you wash any sex toys carefully after use – and be mean! – don’t share them. When cleaning sex toys, instead of using soap and water, some people prefer to use sterilising fluid, similar to that used to prepare babies’ bottles and rinse very well after use.
Don’t douche! – don’t rinse your vagina out with anything. It’s a self-lubricating and a self-cleansing passage. By inserting substances into it, you can upset the normal bacterial balance and start an outbreak of BV.
Is there a vaccination against BV?
- No. There is no vaccine against BV. It is merely an imbalance of normal vaginal conditions, not a viral infection – and vaccines only work against a selection of viral infections.
Can I become immune to BV or can I get it again?
- No-one can become immune to BV. Once you have been treated, you may develop BV again.
If I get BV again, will it present the same way?
- Probably. Recurrent BV tends to present the same way.
What about foreplay and BV?
- BV is not passed through foreplay or mutual masturbation. However, some of the lubricants used during this activity may interact with normal vaginal flora and encourage BV to develop. Water based lubricant is better.
What about oral sex and BV?
- if going down on a woman without an oral dam or another barrier, it is logical to assume that mouth bacteria could enter the vagina and upset the normal environment. if this happens, BV could occur.
- Studies are ongoing about why there appears to be a higher incidence of BV among women who have sex with other women.
What about vaginal sex and BV?
- Some women feel that using condoms during vaginal sex helps to reduce recurrent BV.
What about anal sex and BV?
- BV only occurs in the vagina, not in the anus or rectum.
- However, since BV is due to an imbalance of normal vaginal conditions and bowel germs can upset this, change the condom before entering the vagina after the anus.
Can a woman catch BV if she has sex with other women?
- BV is quite common among women who have sex with other women. Exactly why is not yet clear.
Can a man catch BV if he has sex with other men?
- No. Men don’t get BV. It is a vaginal condition.
Can a child get BV?
- No. Children do not get BV. It is associated with women whose menstrual pattern is established and whose vaginal environment is more acidic than that of girls before puberty.
Is there a link between BV and cervical cancer?
- No. BV is not associated with cervical cancer.
What about BV and using condoms?
- Be careful using condoms: latex condoms can react with oil-based vaginal medication, weaken the latex and cause the condom to break/tear.
- if you are given treatment and this information is not clearly stated on the packet or treatment insert, check with the prescriber, a pharmacist or the manufacturer of the treatment about whether the contents interact with latex.
- if there is any doubt, assume it does and use a non-latex condom or avoid sex until you are better.
- if you experience condom failure after using vaginal treatment, and there is a risk of pregnancy, seek medical advice and consider taking emergency hormonal contraception within 72 hours of intercourse.
- It is better to take it than to run the risk of an unplanned or unwanted pregnancy.
If I use hormonal contraception, will the treatment interfere with my protection?
- See the section on Safer Sex.
Helen J Knox© – Knox Publishing – use assigned to Sexplained Limited / WillyWorries.com
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