Something not right down there?

You are not alone – vaginal discomfort and discharge are common complaints of women through all stages of life.1a

Overview of condition

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Bacterial Vaginosis (BV) is associated with a disturbance in the normal vaginal flora.3g It is characterized by an unpleasant vaginal “fishy” odour and off-white, greyish, thin, homogenous vaginal discharge. 2b,5b

Causes and risk factors

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The healthy vagina has a balance of various organisms, both bacteria and yeasts. When conditions change in the vagina (antibiotics, douching) either the yeasts can predominate causing thrush or bacteria, causing bacterial vaginosis. Note these are not sexually transmitted infections/diseases (STI/STDs) per se, which is the introduction of organisms not normally found in the vagina.

Normal vaginal bacteria include a high proportion of bacteria known as Lactobacilli which keep the pH of the vagina acidic.1n,4d It is this acidity that suppresses the overgrowth of organisms normally present, but in small amounts in the vagina.1n Change in the vaginal conditions can lead to a loss of the Lactobacillus dominance in the vagina, leading to alkalization. In an alkaline environment, these lesser bacteria, such as Gardnerella vaginalis, flourish producing the characteristic vaginal discharge symptoms.

Factors that alter the vaginal pH, introduce “normal” bacteria but which upset the balance, or cause microtrauma, increase the risk of developing BV:1i

  • New or multiple sex partners
  • Frequent douching
  • Intrauterine contraceptive devices (IUDs)
  • Pregnancy

Untreated BV can lead to serious risks:3d,4a

  • Increased risk of HIV
  • Increased risk of sexually transmitted infections (STIs)
  • In pregnant women, BV increases the risk of miscarriage, preterm labour and preterm delivery, as well as increasing the risk of complications after birth such as endometritis (inflammation of the lining of the uterus) and wound infections.

Signs and Symptoms

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There are three main types of vaginal infection.

  • Bacterial vaginosis is due to an overgrowth of normal vaginal bacteria
  • A yeast infection (thrush) is due to an overgrown of yeasts natuarally occurring in the vagina
  • STIs (due to various organisms such as Trichomonas, gonorrhea, chlamydia)

How do you know if you have BV?

Compare the symptoms below to see if you may have BV.

Symptoms are typically characterised by: 2b,5b

  • Unpleasant “fishy” odour.
  • Off-white, greyish, thin, homogenous discharge.
  • Itching and inflammation are not usually present.

How the condition impacts quality of life

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  • BV is the most common cause of vaginal discharge or vaginitis in women of childbearing age.2a
  • Bacterial vaginosis (BV) affects 1 in 3 women.1d,3c,4b
  • Many women with BV have no symptoms.4c
  • The majority of patients with vaginal symptoms use over-the-counter antifungal medication which does not treat BV.1c

Treatment

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Antibacterial treatment is available in

  • Vaginal tablets
  • Vaginal cream

As BV is not a sexually transmitted disease, treating male partners is not required as it does not reduce the recurrence of BV in women.

  1. Hildebrand JP, Kansagor AT. Vaginitis. [Updated 2022 Feb 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470302/.
  2. Sobel JD. Vaginitis. The New England Journal of Medicine.1997;337(26):1896-1903.
  3. Bilardi JE, Walker S, Temple-Smith M, et al. The burden of bacterial vaginosis: women’s experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis. PLOS ONE 2013;8(9):e74378. doi:10.1371/journal.pone.0074378.
  4. Koumans EH, Sternberg M, Bruce C, et al. The Prevalence of bacterial vaginosis in the United States, 2001 -2004; associations with symptoms, sexual behaviors, and reproductive health. Sexually Transmitted Diseases 2007;34(11):864 -869. DOI: 10.1097/OLQ.0b013e318074e565.
  5. Mendling W, Weissenbacher ER, Gerber S et al. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch Gynecol Obstet 2016;293:469-484. DOI 10.1007/s00404-015-3914-8.
  6. Minkin MJ, Maamari R and Reiter S.  Improved compliance and patient satisfaction with estradiol vaginal tablets in postmenopausal women previously treated with another local estrogen therapy International Journal of Women’s Health 2013:5 133–139.
  7. Weissmann-Brenner A, Bayevsky T, Yoles I. Compliance to vaginal treatment—tablets versus cream: a retrospective 9 years study. Menopause 2017;24(1):73-76.

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