UNC Healthy Heels

What’s up with BV?

Did you know that Bacterial Vaginosis (BV) is one of the most common vaginal infections?  It’s a condition that occurs when the normal balance of vaginal bacteria is disrupted. It can be asymptomatic or symptomatic; when symptomatic, folks often experience vaginal itching, burning, odor and discharge.

I’m sorry, are you telling me there are bacteria in my vagina?

True fact.  There are more bacteria cells in your body than human cells. Some of them populate the vagina. A happy vagina has certain ratios of “good bacteria” and “bad bacteria”; BV occurs when those levels are thrown off.  We classify lactobacilli as the “good bacteria” and anaerobic bacteria as “bad bacteria.” Lactobacilli are believed to regulate the vaginal ecosystem, controlling the growth of other organisms (that’s why yeast infections can occur after taking antibiotics). Lactobacilli also produce “bacteriocins,” proteins that inhibit the growth of bacteria including the anaerobic Gardnerella vaginalis, which is BV-associated and can be transmitted sexually.

So BV is a sexually transmitted disease?

“It’s complicated.”  BV is a condition that refers to a bacterial imbalance; there are multiple ways it can arise. BV is associated with multiple sex partners, but anyone who disrupts the natural balance of vaginal flora can get BV, including virgins.

So, yes, your vagina flora can be disrupted by a sexually transmitted bacteria like G. vaginalis, but it can also by disrupted by non-sexual activity, like menstruation or douching.  Douches are marketed as “hygienic” but this is misleading advertising. Using these products can disrupt the healthy balance of vaginal bacteria so experts recommend that you avoid using them.

Why does BV matter?

BV is not merely a nuisance. Having BV can increase a woman’s risk of infection if exposed to HIV, herpes, gonorrhea, or chlamydia. BV increases viral replication and vaginal shedding of HIV-1 and HSV-2 (HSV is herpes). BV also increases the risk of pelvic inflammatory disorder. BV is particularly concerning in pregnant women, since it’s associated with premature babies and low birth weight.

How is BV diagnosed?

Typically, the clinician will review the medical history, perform a pelvic exam, and collect a sample of vaginal secretions. The clinician may look for “clue cells” in vaginal secretions under a microscope and check the pH.   It’s important to let a clinician evaluate any abnormal vaginal itching, discharge or odor to obtain an accurately diagnosis and treatment. It’s not uncommon for women to think they have a yeast infection and futilely use Monistat at home.

How is BV treated?

Generally, BV is treated with specific antibiotics. Talk to your clinician about partner treatment: generally BV is not spread to male partners and there are varying opinions on the value of male partner treatment, but female partners can definitely transmit BV to each other. Be warned that recurrence of the infection after treatment is common.

What’s the current research saying about BV?

Well, I’m glad you asked because there are some fascinating developments! New technology like rRNA gene sequence-based analysis have allowed for identification of bacteria never before cultivated in the laboratory. Wow! It’s hard to believe that there are bacteria in our bodies we’re just now learning about. This is significant because understanding how the BV-associated bacteria respond to antibiotics can help improve our treatment regimen.  Resolving BV is important for the wellbeing of every vagina!

Sources:

Brotman, R. (2011). Vaginal Microbiome and sexually transmitted infections: A Epidemiological Perspective. Journal of Clinical Investigation, 121 (12). Retrieved from http://www.jci.org/articles/view/57172