The Call-On-Doc Guide to Bacterial Vaginosis

Every woman has their own unique vaginal microbiome, where multiple different bacterias reside and keep a delicate balance. When that balance is disturbed, it causes one of the several bacteria to overgrow and cause bacterial vaginosis. (2) Most often resulting from the overgrowth of gardnerella vaginalis bacteria, there are a number of causes behind bacterial vaginosis, including:

• Change in Vaginal pH: The vagina has a slightly acidic pH (around 3.8-4.5) due to the presence of beneficial lactobacilli bacteria that produce lactic acid. This acidic environment helps maintain a healthy balance of vaginal flora. Any factor that disrupts this pH balance, such as douching or exposure to alkaline substances, can create an environment where BV-associated bacteria can thrive. Elevated pH levels provide an opportunity for harmful bacteria to outgrow the beneficial ones.
• Sexual Activity: While BV is not classified as a sexually transmitted infection (STI), sexual activity can introduce new bacteria to the vaginal ecosystem. Having multiple sexual partners or engaging in sexual activity with a new partner can alter the bacterial composition in the vagina. Seminal fluid also has a higher pH, which could temporarily impact the vaginal environment and promote BV-associated bacteria.
• Douching: Vaginal douching involves rinsing or cleaning the vaginal area with water or other solutions. Douching can disrupt the natural balance of bacteria by removing both harmful and beneficial bacteria. It can also push bacteria from the vaginal area into the cervix and uterus, potentially leading to infections like BV.
• Antibiotics: Antibiotics are designed to kill or inhibit the growth of bacteria, and while they target harmful bacteria, they can also affect the beneficial bacteria in the vagina. Prolonged or frequent use of antibiotics can disrupt the natural balance of vaginal flora, allowing BV-associated bacteria to thrive.
• Hormonal Changes: Hormonal fluctuations can influence the vaginal environment. Changes in hormone levels during menstruation, pregnancy, or menopause can impact the growth of beneficial lactobacilli, creating an opportunity for BV-associated bacteria to overgrow.
• Weakened Immune System: A weakened immune system may reduce the body's ability to control the growth of harmful bacteria in the vaginal area. An immune system that is less effective at maintaining balance can lead to an increased risk of BV.

The most common bacteria associated with bacterial vaginosis is Gardnerella vaginalis. While BV is a polymicrobial condition involving multiple types of bacteria, Gardnerella vaginalis is often considered a key player in disrupting the balance of the vaginal microbiome and contributing to the development of BV. Other bacteria, such as Prevotella, Atopobium, and Mobiluncus species, can also be involved in the complex microbial changes associated with BV. The exact composition of bacteria can vary among individuals with BV, but Gardnerella vaginalis is a prominent member of the microbial community associated with this condition.

Recent revelations in the scientific field have discovered that men can carry bacteria associated with bacterial vaginosis. (3) While men do not experience the condition, there is potential for them to pass the condition on from one partner to another in the case that they have multiple female partners and participate in unprotected sex with both. 

Stress itself is not a direct cause of bacterial vaginosis (BV), but it can potentially contribute to the development of BV indirectly. Stress can impact the body's immune system and hormone levels, which in turn might influence the vaginal environment and the balance of the vaginal microbiome.

Bacterial vaginosis (BV) can be asymptomatic, meaning that some individuals may have BV without experiencing any noticeable symptoms. This is actually quite common, as some studies have shown around 80% of women with the condition don’t display noticeable symptoms. For those that do, these are some of the most common:

Unusual Vaginal Discharge: BV often leads to a change in vaginal discharge. The discharge is typically thin, watery, and may appear grayish-white or greenish in color. One of the hallmark characteristics of BV discharge is its distinctive fishy odor, especially noticeable after sexual intercourse or washing with soap. This odor arises due to the breakdown of certain compounds by the overgrown bacteria.

Vaginal Odor: The fishy odor associated with BV is a common and recognizable symptom. It's caused by the release of amines when certain bacteria break down proteins in the vagina. This odor can be particularly bothersome and may affect a woman's confidence and comfort.

Vaginal Itching or Irritation: Some women with BV might experience itching or irritation in the vaginal area. This discomfort can range from mild to more pronounced and is often linked to the changes in the vaginal environment caused by the bacterial imbalance.

Burning Sensation: BV can sometimes lead to a burning sensation or discomfort during urination. This symptom is similar to the sensation experienced during a urinary tract infection (UTI) and is a result of the irritation caused by the imbalanced vaginal environment.

Increased Discharge: Along with the changes in appearance and odor, BV might cause an increase in the amount of vaginal discharge. This discharge can be different from a woman's usual pattern and may contribute to feelings of discomfort or wetness.

When testing for bacterial vaginosis (BV), healthcare professionals may use several diagnostic methods to assess the vaginal environment and determine the presence of BV-associated changes:

• Wet Mount (Microscopic Examination): A wet mount involves taking a sample of vaginal discharge and placing it on a microscope slide with a solution. The slide is then examined under a microscope. In BV, characteristic "clue cells" may be visible. Clue cells are vaginal cells covered with bacteria, indicating an imbalance in the vaginal microbiome. Additionally, the presence of certain bacteria can be observed, helping confirm the diagnosis.
• Whiff Test: The whiff test is a simple diagnostic step where a sample of vaginal discharge is mixed with a potassium hydroxide (KOH) solution. A distinct fishy odor often occurs if BV is present. This test helps identify the release of amines by BV-associated bacteria when they come into contact with the KOH solution.
• Vaginal pH Test: The vaginal pH test measures the acidity level of the vagina. A higher pH level (above 4.5) is often indicative of BV. BV disrupts the normal acidic environment maintained by beneficial lactobacilli bacteria, allowing less acidic conditions to develop.

These diagnostic tests, especially when used in combination, assist healthcare professionals in accurately diagnosing bacterial vaginosis. However, in most cases, a healthcare professional only needs a description and a brief conversation with the patient. 

To check if you have bacterial vaginosis, it's essential to consult a healthcare provider. While some symptoms may suggest BV, such as changes in discharge or odor, these signs can also overlap with other vaginal conditions. A healthcare provider, usually a gynecologist or primary care physician, can conduct a thorough examination and perform specific diagnostic tests.

While bacterial vaginosis is known to reoccur in most cases, it can be effectively treated with specific antibiotics. At the time of writing, there are multiple options, with specific antibiotics, including:

• Clindamycin: Works by inhibiting the growth and reproduction of bacteria responsible for the condition. It interferes with the bacteria's ability to produce essential proteins, effectively disrupting their normal cellular processes. By targeting and suppressing the overgrowth of BV-associated bacteria, Clindamycin helps restore the balance of the vaginal microbiome and alleviates symptoms.
• Metronidazole: Works by disrupting the DNA of the bacteria responsible for the condition. Once inside the bacterial cells, metronidazole interferes with their DNA replication process, preventing them from multiplying and ultimately leading to their death. This antibiotic action helps to reduce the overgrowth of BV-associated bacteria, 
• Tinidazole: Similarly to other options, it functions by interfering with the DNA synthesis and replication processes of the BV-associated bacteria. This disruption hinders the bacteria's ability to grow and multiply, leading to their eventual demise. 

After receiving treatment for bacterial vaginosis (BV), it's important to take specific steps to promote healing and prevent recurrence. Complete the full course of prescribed antibiotics as directed by your healthcare provider, even if your symptoms improve. Practice good hygiene by using mild, unscented soaps and avoiding douching, and wearing breathable cotton underwear. Avoid sexual activity or use condoms during treatment to prevent introducing new bacteria. Monitor your symptoms and schedule a follow up if you notice further signs of the infection. 

• Choose Showers over Baths: Consider choosing showers over baths as showers are generally less likely to disrupt the vaginal environment. Baths can lead to prolonged exposure of the vaginal area to soapy water, which may disturb the delicate balance of the vaginal microbiome and potentially contribute to irritation. Showers allow for gentle cleansing of the external genital area without immersing the entire body in water, minimizing the risk of further upsetting the vaginal pH and bacterial equilibrium. 
• Practice Good Hygiene: Use only mild, unscented soaps or cleansers to clean the external genital area. Avoid douching, as it disrupts the natural balance of vaginal bacteria and can lead to an increased risk of BV. Gently wash the area and avoid excessive washing, as this can strip away the protective mucous layer.
• Avoid Irritants: Refrain from using scented products, harsh detergents, and perfumed feminine hygiene products in the genital area. These products can disrupt the delicate pH and bacterial balance of the vagina, making it more susceptible to infections like BV.
• Safe Sexual Practices: Consistently using condoms during sexual intercourse can help reduce the risk of introducing harmful bacteria from a partner, which might contribute to BV development. Proper lubrication during sex can also reduce friction and irritation.
• Probiotics: Some studies suggest that using probiotics containing Lactobacillus strains can help maintain or restore a healthy vaginal microbiome. These "friendly" bacteria can help suppress the growth of harmful bacteria associated with BV. Probiotics can be taken orally as supplements or used as vaginal suppositories, but it's important to consult a healthcare provider before trying any new supplements.
• Clothing Choices: Opt for breathable, cotton underwear that allows proper airflow. Avoid tight-fitting synthetic fabrics, as they can create a moist environment that promotes bacterial growth. Changing out of wet swimsuits or sweaty workout clothes promptly can also help maintain vaginal health.
• Healthy Diet and Lifestyle: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall immune system health. Regular exercise and stress management techniques, such as yoga or meditation, can help regulate hormone levels and immune function, indirectly influencing vaginal health.

If you notice or suspect that you may have bacterial vaginosis, you can get treated easily online the same day. CallonDoc offers many antibiotics to clear the condition and with a quick consultation, you can get your BV treatment to your pharmacy within a matter of hours!

1. Koumans, Emilia H et al. “The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health.” Sexually transmitted diseases vol. 34,11 (2007), https://pubmed.ncbi.nlm.nih.gov/17621244/. 
2. “Bacterial Vaginosis (BV): Causes, Symptoms & Treatment.” Cleveland Clinic, 6 February 2023, https://my.clevelandclinic.org/health/diseases/3963-bacterial-vaginosis.
3. “IU researchers discover a common bacterial infection can be sexually transmitted.” Indiana University School of Medicine, 22 March 2023, https://medicine.iu.edu/news/2023/03/common-bacterial-infection-sexually-transmitted-research.
4. “What is Bacterial Vaginosis? | Symptoms, Signs and Causes.” Planned Parenthood, https://www.plannedparenthood.org/learn/health-and-wellness/vaginitis/what-bacterial-vaginosis.
5. “Bacterial vaginosis.” NHS, https://www.nhs.uk/conditions/bacterial-vaginosis/.