What is Bacterial Vaginosis?
Bacterial Vaginosis, also referred to as vaginitis or non-specific vaginitis, is a mild infection that is brought about by an imbalance of certain types of bacteria in the vagina. Typically, the vagina has ‘good’ (healthy) and ‘bad’ bacteria; the former being the ones that keep the latter in check. Should the balance of good bacteria and bad bacteria be upset, for one reason or another, leaving the bad bacteria to thrive, BV develops. It is normally characterized by a vaginal discharge with foul odor.
Until recently most healthcare specialists would agree that bacterial vaginosis was caused by Gardnerella Vaginalis – an anaerobic species of bacteria capable of disrupting normal human microflora. Recent research, however, has showed that there are other species of bacteria, besides Gardnerella, that cause BV. This condition is regarded as the most common infection of the vagina affecting women aged between 15 and 45.
Symptoms of BV
Not all women with bacterial vaginosis develop symptoms; however, symptoms associated with BV often include:
- Thin vaginal discharge which ranges in color from grayish white to yellow
- Strong and unpleasant vaginal odor (usually fishy)
- Pain and/or itching inside the vagina
- Persistent itching outside the vagina
- Pain when urinating or during sexual intercourse
These symptoms don’t always occur at once; as a matter of fact, some may never be experienced. It is important to note that a woman can experience BV discharge even during her menstrual cycle; and while normal vaginal discharge does vary from woman to woman, any amount considered abnormal should be checked out by a doctor. Abnormal vaginal discharge is not always a sign of bacterial vaginosis – in some cases it is caused by more serious health conditions, such as sexually transmitted infections (STIs), for instance.
Causes of BV
As mentioned earlier, BV is brought about by an imbalance of bacterial microflora in the vagina. However, more research is yet to be done to figure out what exactly causes this imbalance. So far studies have shown that some of the bacteria species that cause BV include Peptostreptococcus, Lactobacillus, Fusobacterium, Bacteroides and Eubacteria. These bacteria are known as anaerobic bacteria – meaning that they can grow in the absence of oxygen. When they combine and significantly outnumber the normal hydrogen-producing Lactobacilli, BV develops. Treating BV thus becomes not just a matter of identifying and treating a single type of bacteria but a group of different types of bacteria.
Risk factors that increase the likelihood of BV developing in a woman include:
- Having a new or multiple sexual partners
- Having an IUD for birth control
- Vaginal douching
- Using perfumed products on the vagina
- Use of certain types of antibiotics
- Smoking cigarettes
Note that a woman cannot develop BV from using public swimming pools, toilet seats or bedding.
Main Types of BV Treatments and their Differences
Even though there is a decent chance that BV will clear with time without treatment, it is still advisable to seek medical attention as soon as possible in case you notice symptoms possibly related to bacterial vaginosis – especially if you’re pregnant. Since it is ultimately a bacterial infection, antibiotics are used as treatment. The medications usually prescribed by doctors are available in the form of pills, gel or cream. They include:
1) Metronidazole (such as Flagyl and Metrogel-Vaginal)
This medication is the most common and is usually available in the form of pills to be taken orally as well as a topical gel to be applied inside the vagina. It is advisable to suspend any alcohol intake during the course of treatment and at least 2 days after completing the oral medication. This will reduce the risk of developing abdominal pain, stomach upset or nausea. Instructions on medication will be provided by your doctor.
A common side effect of metronidazole is that it may leave a metallic taste in the mouth. It is also advisable to take the tablets after meals to avoid feeling sick.
2) Tinidazole (Tindamax)
This is another medication that’s taken orally. Just like metronidazole, it is advisable to suspend any alcohol intake during treatment to avoid nausea, stomach upset and/or abdominal pain.
3) Cindamycin (Clindesse, Cleocin, etc.)
This medication is available as a cream that’s applied inside the vagina. If you are sexually active you should be aware of the fact that this cream is known to weaken latex condoms. Its effect on condoms can still be experienced up to 3 days after the treatment is complete. You should therefore, not rely on condoms as a means of protection against STIs and pregnancy while on Cindamycin.
Cindamycin tablets are usually taken twice a day for anywhere between five days and seven days. There are some brands that offer a single larger dose to be taken only once. Gels and creams, on the other hand, are typically applied once a day for five to seven days.
Tablets can be taken during pregnancy but if you are breastfeeding, then gels and creams would be the preferred option. It is important to finish a course of antibiotics even if your symptoms go away as this prevents or reduces the risk of recurrence of the infection.
Even though an infected woman’s male sexual partner doesn’t require treatment for BV, this infection is known to spread between female sexual partners. It is therefore important for female sexual partners to seek treatment and take medication as prescribed by the doctor.
As mentioned, completing a course of antibiotics helps prevent resistant strains of bacteria from developing. Multiple studies have shown that such medications as clindamycin, metronidazole and tinidazole have success rates of as high as 90% in treating BV. It should be noted that it is common for BV to return after a few months. However, if the infection reoccurs frequently, it is recommended that you consult your doctor for preventive treatment options.
BV that develops during pregnancy is often associated with a higher risk of stillbirth or late-term miscarriage. Taking antibiotics during this period is crucial to the survival of the fetus. Antibiotics do not affect a pregnant woman’s water breaking timeline in any way – but they should definitely be taken in full accordance with your doctor’s recommendations and under their strict supervision.
Over the Counter BV Treatments
1) Natural Remedies for Bacterial Vaginosis
Natural remedies used to treat BV may not be as effective as prescription medications but some women have had success with them. Some popular ones include:
Yoghurt
One common home remedy is yogurt since it is a natural probiotic – meaning it contains a lot of healthy bacteria. Eating yogurt frequently is a way to introduce Lactobacillus acidophilus into the body. Even though this has worked for some women, studies have shown that dairy bacteria don’t reside in the vagina.
Probiotic supplements
According to a 2014 study published in the US, probiotic supplements can be used to prevent and treat bacterial vaginosis. There’s evidence suggesting that antibiotic medication kills healthy bacteria; therefore, taking probiotic supplements is one way to help the good bacteria in the vagina grow and overcome the bad ones.
Garlic supplements
Another study showed that garlic supplement tablets can be used to treat BV thanks to garlic’s strong antibacterial properties. Additionally, this kind of treatment lacks the adverse effects of therapy with antibacterial medications.
2) Over the Counter BV Medication
BV can be managed and treated with the help a number of OTC treatments. The most common ones are discussed below.
Betadine feminine wash
The antiseptic properties of this product have proven to be quite effective in eliminating germs as well as inhibiting fungal growth. Publications backed by the US National Institute of Health show that the betadine feminine wash not only eliminates germs but also promotes wound healing. Nonetheless, it should be noted that some women have developed vaginal irritation after using this wash.
Vaginal douching
This may seem like a contradiction because we pointed out that douching can cause BV; however, there has been documented success of douches – particularly acidic douches – in treatment of BV. Acidifying the pH of the vagina may serve as a means of eliminating anaerobic bacteria.
Lactobacillus acidophilus
This is a probiotic supplement that is successfully used to treat a number of conditions such as asthma, diarrhea and vaginal infections. It contains anti-microbial agents that kill off bad bacteria whilst introducing healthy ones into the body. Caution should be exercised when using this supplement, especially in people with compromised immune system.
Over the Counter Metronidazole (Flagyl)
Metronidazole is classified as a prescription antibiotic in many countries. Some of the brands it is available under include Metro-Gel, Metro-Lotion, Flagyl, Metro-Cream, Vandazole and Noritate. As discussed earlier, it is used to treat infections caused by anaerobic bacteria – BV being one of them. Even though it requires a prescription in some jurisdictions, it can be purchased OTC in others. While some pharmacies sell metronidazole without any prescription-related hassle, in others you may be required to fill out a form or questionnaire if you are purchasing it OTC or online. A licensed doctor will then review your responses before giving the go ahead to purchase it. It is important to take the medication as prescribed by the chemist or in accordance with the instructions on the package insert.
Bacterial vaginosis is a very common vaginal infection among young and middle-aged women. While the number of sexual partners does seem to play a role in the prevalence and spread of this infection, non-sexually active women can also get infected. There is still ongoing research and studies that aim to pin point exactly what causes the imbalance of bacteria in the vagina leading to bacterial vaginosis.
Being a bacterial infection, BV is treated with antibiotics; the most common one being metronidazole. The condition tends to recur within 6 to 12 months, in which case it is not something to be seriously worried about, but persistent recurrence should be reported to your doctor. While BV can resolve itself over time, seeking over the counter medication is certainly an avenue to explore as it has already worked for many women worldwide.