Definition

Bacterial vaginosis is a condition that occurs due to the overgrowth of normal vaginal flora. Naturally, there are various types of bacteria residing in the female genital organ, the vagina, including "good" and "unhealthy" bacteria. The body usually has a mechanism to control and provide a balanced environment for these diverse bacteria, preventing them from overgrowing and maintaining control.

However, if something causes certain bacteria to grow excessively, bacterial vaginosis can occur. This condition is quite common in women but, if untreated, can lead to complications and increase the risk of sexually transmitted infections.

Women generally report a distinctive vaginal discharge. Bacterial vaginosis is considered the most common vaginal infection found in women of childbearing age, estimated to occur in about 5-70% of cases in women. It is thought to be most prevalent in some African countries and least common in Asia and Europe. In the United States, about 30% of women aged 14–49 are estimated to have experienced bacterial vaginosis.

Causes

Bacterial vaginosis is not considered a sexually transmitted infection (STI) because the bacteria causing vaginosis generally originate from the patient's own vaginal bacteria. This condition can affect women of any age. An imbalance of vaginal flora is the cause of bacterial vaginosis.

There is an increase in the total number of bacteria in the vagina, where other bacteria increase, and the number of Lactobacilli species, which were initially abundant in the vagina, decreases. Gardnerella vaginalis is suspected of creating a biofilm that allows "bad" bacteria to grow in the vagina. Additionally, Gardnerella vaginalis may spread between women who have sexual relations with women through direct contact with mucous membranes or sex toys.

Other bacteria can also overgrow and contribute to bacterial vaginosis. The number of bacteria can grow 100-1000 times more than usual.

Risk Factor

Several risk factors can increase the likelihood of bacterial vaginosis, including:

• African-American race
• Not using condoms during sexual intercourse
• Using intrauterine devices (IUDs)
• Having a history of regularly cleaning the inside of the vagina with water or certain liquids (douching)
• Smoking
• Previous antibiotic use
• Having multiple sexual partners
• Being a commercial sex worker
• Pregnancy

Symptoms

Bacterial vaginosis does not always cause clinical symptoms, so patients sometimes do not have any complaints. In most cases, patients may report a fishy-smelling discharge from the vagina. This discharge can be white or gray.

Other complaints that patients may experience include:

• A burning sensation when urinating
• Itching and pain in the vulva
• Fishy-smelling discharge
• Genital pain that may occur before, during, or after sexual intercourse
• In some cases, the discharge smell can become stronger after sexual intercourse without a condom if semen mixes with vaginal discharge

Diagnosis

The diagnosis of bacterial vaginosis can be made through medical interviews, physical examinations, and additional tests if available and necessary.

Medical Interview

In a medical interview, the doctor will ask about the symptoms currently experienced by the patient. Existing symptoms can guide the doctor toward a specific disease. Therefore, you need to describe your symptoms as completely as possible and include when the symptoms began. Other information, such as your medical history, treatments you have undergone, and your sexual activity, can also be shared. It is important for the doctor to diagnose bacterial vaginosis. Then, the doctor will perform a physical examination and additional tests if needed.

Physical Examination

During the physical examination, the doctor will examine the symptoms experienced by the patient to find clinical signs that are objective indicators of a disease.

In cases of bacterial vaginosis, the doctor can directly observe the discharge on the patient's genitalia or underwear. The doctor can also directly examine the condition of the patient's genitalia and the surrounding body area.

Diagnostic Tests

Diagnostic tests also play a role in confirming or ensuring the diagnosis of bacterial vaginosis. The doctor can take a sample of the discharge to examine under a microscope and observe the microbes causing the disease. Gram staining can also be performed to identify the bacterial strains causing vaginosis, although this test is rarely done in clinical practice.

Management

Some cases of bacterial vaginosis can resolve on their own without treatment. However, in other cases, antibiotic treatment is needed to treat the patient's condition. The doctor may prescribe antibiotic pills or capsules to be taken orally. If your doctor prescribes antibiotics, ensure you complete the full course as directed. If not completed, the bacteria can become resistant to antibiotics, making future treatment more difficult.

Several measures can be taken to help manage bacterial vaginosis, including:

• Consuming probiotic-rich foods like yogurt or probiotic supplements
• Wearing soft, non-tight underwear
• Using fragrance-free soap if possible
• Gently and thoroughly rinsing and drying the genital area, wiping from front to back after using the bathroom

Complications

Several complications can arise if bacterial vaginosis occurs, including:

• Increased risk of other sexually transmitted infections such as HIV, chlamydia, or gonorrhea.
• If you are pregnant and have bacterial vaginosis, you are at risk of preterm labor.

If bacterial vaginosis is not properly treated, a condition known as pelvic inflammatory disease (PID) can occur. If untreated, PID can lead to infertility and increase the risk of preterm labor.

Prevention

Several measures can be taken to prevent bacterial vaginosis, including using protection such as condoms during sexual activity. The interaction between semen and vaginal fluids can increase the risk of this condition. Additionally, avoid douching or using scented products on the genital area, as this can disrupt vaginal pH and allow bacteria to overgrow. Limit sexual activity to only one partner.

When to See a Doctor?

If you experience persistent vaginal discharge or if symptoms worsen, such as severe abdominal pain, pelvic pain, or fever, it is advisable to consult a dermatologist and venereologist. The doctor will conduct a medical interview, a physical examination, and certain additional tests to determine the exact diagnosis of the underlying disease and provide appropriate and necessary treatment.

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