What is Bacterial Vaginosis?

Women in their reproductive years are most likely to get bacterial vaginosis, but it can affect women of any age. Bacterial vaginosis is the most common vaginal condition in women ages 15-44The cause isn't completely understood, but certain activities, such as unprotected sex or frequent douching, increase your risk. Researchers do not know the cause of BV or how some women get it. We do know that the condition typically occurs in sexually active women. BV is linked to an imbalance of “good” and “harmful” bacteria that are normally found in a woman’s vagina. Having a new sex partner or multiple sex partners, as well as douching, can upset the balance of bacteria in the vagina. This places a woman at increased risk of getting BV. The imbalance of the bacterial flora alters the pH and alkaline to the acidic property of tissues of the vagina, which leads to this particular inflammation. This is not spread through toilet seats, beddings, and or swimming pools. The condition is not dangerous but can cause uncomfortable and unpleasant symptoms. 

Causes of Bacterial Vaginosis

The Gardnerella species of bacteria are the most common ones causing the present condition. But lately, few other groups of bacteria are found to contribute to the condition. These are Lactobacillus, Bacteroides, Peptostreptococcus, Fusobacterium, Eubacterium, and many others. 

There is a reduction in the number of normal hydrogen peroxide producing lactobacilli in the vagina and at the same time, there is an increase in the above-mentioned groups of bacteria that are harmful. 

The predisposing factors for the same include:

• Frequent douching
• Multiple partners for intercourse
• Unprotected intercourse
• Recent Antibiotic Use
• Smoking 
• Using Intrauterine Contraceptive Devices (IUCDs) and birth control pills

Studies show that around 29% of women are affected, around 60% of women who have bacterial vaginosis also have pre-existing sexually transmitted infections and around 25% of pregnant women have reported suffering from this condition.

Symptoms of Bacterial Vaginosis

Sometimes there can be no symptoms at all. When ignored or untreated following presentations are observed:

• Thin, gray, white, or green vaginal discharge
• An abnormal amount of vaginal discharge
• Foul-smelling "fishy" vaginal odor
• Vaginal itching
• Burning during urination
• Pain during sexual intercourse

Risk Factors & Complications with Bacterial Vaginosis

The factors that potentially make it easier for women to have this issue are: 

• Having multiple partners for intercourse. Although the exact association between sexual activity and the inflammation remains unclear.
• Douching which means rinsing out the vagina with water or a cleansing agent (douching) upsets the natural balance of your vagina. This can lead to an overgrowth of anaerobic bacteria (the ones that do not need oxygen to thrive), and can eventually cause bacterial vaginosis. Since the vagina is self-cleaning, douching isn't necessary.
• Natural lack of lactobacilli bacteria. If your natural vaginal environment doesn't produce enough of the good lactobacilli bacteria, the female is more likely to develop bacterial vaginosis.
• Chronic Smoking 
• Sexually active women 
• Women of childbearing age
• Excessive Antibiotic use
• Recent use of a birth control pill or an IUCD
• Frequent scented bubble baths for the vagina
• Irregular monthly bleeding patterns 

Complications:

Bacterial vaginosis does not generally cause complications. Sometimes, having bacterial vaginosis may lead to:

• Preterm or premature childbirth In pregnant women and even have a risk of low birth weight babies. 
• Sexually transmitted infections such as HIV, herpes simplex virus, chlamydia or gonorrhea. 
• Infection risk after gynecologic surgery. Having bacterial vaginosis may increase the risk of developing a post-surgical infection after procedures such as hysterectomy or dilation and curettage (D&C).
• Pelvic inflammatory disease (PID). Bacterial vaginosis can sometimes cause PID, an infection of the uterus and the fallopian tubes that can increase the risk of infertility.
• Infertility 

Diagnosis of Bacterial Vaginosis

An exact diagnosis is made after having a complete medical history, overall physical examination, and doing a pelvic examination, pH of the vagina is also evaluated. Other diagnostic procedures are:

• Whiff Test: Adding a small amount of potassium hydroxide on a microscopic slide containing vaginal discharge. This will release a fishy odor. Adding a drop of sodium chloride will make the clue cells visible under a microscope which is indicative of bacterial vaginosis.
• Amsel Criteria: At least three of the four criteria should be present for a confirmed diagnosis:

               1.Thin, white, yellow, or gray homogeneous discharge

               2.Presence of clue cells under a microscope

               3.ph of the vaginal fluid should be less than 4.

               4.Release of fishy odor when potassium hydroxide is added to the sample of vaginal discharge. 

• Gram Stain:

Evaluation of the bacterial smear of the vagina. They are graded as follows:

Grade 1: Normal. Lactobacillus is more in number.

Grade 2: Intermediate. Lactobacilli is present along with Gardnerella or other bacteria.

Grade 3: Bacterial Vaginosis. More of other species of bacteria is present than lactobacilli

• Nugent Score: It is a score ranging from 0-10 based on microscopic reading on the type of bacteria present. This one is very rarely used owing to the time it takes to read and assess the slides under a microscope. 

Treatment of Bacterial Vaginosis

Antibiotics: 

Typical antibiotics used for this condition are metronidazole or clindamycin. Other antibiotics that may work are macrolides, lincosamides, nitroimidazoles and penicillins

• Probiotics: 

Probiotics that contain a high amount of lactobacilli administered orally are recommended 

• Antiseptics: 

Topical antiseptics, for example, dequalinium chloride, policresulen, hexetidine, or povidone-iodine vaginal suppositories can be applied. \

Online treatment for Bacterial Vaginosis

Portals that provide online treatment for the same are:

• Wisp
• CallonDoc
• DermNet NZ
• GigaPromo
• Doctor Alexa
• Superdrug Online doctor 

Prevention for Bacterial Vaginosis

• Minimize vaginal irritation. 
• Use of mild, nondeodorant soaps, and unscented tampons or pads.
• Reduce or eliminate douching. The vagina can be cleaned with normal bathing also. 
• Be sure there is no undiagnosed sexually transmitted infection
• Avoid the use of IUCDs and birth control pills
• Limit partners for sexual intercourse
• Reduce or eliminate the use of antibiotics. 

Bacterial Vaginosis not a deadly disease, but presents with symptoms and presentations that are uncomfortable. Practicing good reproductive health, frequent assessment for the presence of sexually transmitted diseases or infections in a sexually active woman, and vigilance can prevent the occurrence of this inflammatory condition.