What is Bacterial Vaginosis?
Bacterial Vaginosis (BV) is the most common cause of abnormal vaginal discharge in women of childbearing age. It occurs when the natural balance of bacteria in the vagina is disrupted, leading to an overgrowth of certain types of bacteria.
In a healthy vagina, Lactobacilli are the dominant bacteria, keeping the vaginal pH below 4.5. This acidic environment helps to prevent the overgrowth of harmful bacteria. In BV, the vaginal pH rises to above 4.5, sometimes reaching 6.0. Although Lactobacilli may still be present, they are vastly outnumbered by anaerobic and facultative anaerobic bacteria, including:
- Gardnerella vaginalis
- Prevotella spp.
- Mycoplasma hominis
- Mobiluncus spp.
- Atopobium vaginalis
- Clostridiales spp. (BV 1-3)
- Leptotrichia spp.
- Sneathia spp
Recent research has also identified a biofilm—a thin, sticky layer—mainly composed of Gardnerella and Atopobium, which is believed to play a crucial role in the development of BV.
Signs and Symptoms of BV
BV is often asymptomatic in nearly 50% of women. However, when symptoms do occur, they typically include:
Symptoms:
- Offensive, fishy-smelling vaginal discharge
- Not usually associated with soreness, itching, or irritation
Signs:
- Thin, white, homogeneous discharge that coats the walls of the vagina and vestibule
- No significant signs of inflammation
How Common is BV?
The prevalence of BV varies widely:
- Around 5% in asymptomatic college students
- Up to 50% of women in some rural communities
- Approximately 12% in pregnant women attending antenatal clinics in the UK
- Around 30% of women undergoing termination of pregnancy
What causes BV?
BV is caused by a disruption in the vaginal bacterial balance. This can happen due to:
- Overwashing the vagina or using perfumed soaps and washes
- Douching (cleaning inside the vagina)
- New or multiple sexual partners
- Use of intrauterine devices (IUDs)
- Smoking
It’s not fully understood why these things cause the imbalance.
Is BV an Infection or an Imbalance?
There is ongoing debate as to whether BV is purely an imbalance of vaginal bacteria or if it is triggered as a sexually transmitted infection (STI). Regardless, certain factors can increase your risk:
- Vaginal douching
- Receptive oral sex (cunnilingus)
- Recent change of sexual partner
- Smoking
- Presence of other STIs (e.g., chlamydia or herpes)
- Ethnicity – Higher prevalence has been observed in Black women
How is it diagnosed?
Your healthcare provider may:
- Ask about your symptoms
- Do a vaginal swab to check the pH and look at the bacteria under a microscope
- Rule out other conditions like thrush or STIs
How is BV treated?
BV is usually treated with antibiotics, such as:
- Metronidazole tablets (usually for 5–7 days)
- Metronidazole or clindamycin gel or cream inserted into the vagina
Even if symptoms improve quickly, it’s important to finish the full course.
Avoid alcohol while taking metronidazole, as it can cause unpleasant side effects.
Can BV come back?
Yes, BV can recur, sometimes within a few weeks. If this happens often, your doctor might suggest:
- Longer courses of treatment
- Vaginal probiotics (though evidence is still limited)
- Avoiding triggers like fragranced products or douching
What happens if BV is left untreated?
While BV often causes mild symptoms, if left untreated it can increase the risk of:
- Pelvic inflammatory disease (PID)
- Complications in pregnancy (e.g. preterm birth)
- Increased susceptibility to STIs, including HIV
If you’re pregnant or undergoing a gynaecological procedure, it’s especially important to treat BV.
How can I prevent BV?
- Avoid douching and perfumed products in or around the vagina
- Wash only with warm water or mild, unperfumed soap
- Use condoms to help reduce risk
- Limit the number of sexual partners
- Avoid smoking
When should I see a doctor?
See a healthcare professional if:
- You notice a change in vaginal discharge
- You experience a strong or unusual smell
- You’re unsure if it’s BV or another condition (like thrush or STI)
- You have recurring episodes
How We Can Help at WWWW
At WWWW, we provide:
- Comprehensive assessment and diagnosis of vaginal health concerns
- Tailored treatment plans to restore healthy vaginal flora
- Expert advice on lifestyle changes to reduce recurrence
Our dedicated team is here to support your gynaecological health with sensitivity, expertise, and the very best in modern care.
Book a consultation with us today and take control of your vaginal health with confidence.