Bacterial Vaginosis 

Bacterial Vaginosis 

Bacterial Vaginosis – What Is It

Bacterial vaginosis is a dysbacteriosis of the vagina. This is a highly common disease among women. The microflora of the vagina is a mobile ecosystem. The basis of the normal vaginal microflora is lactobacilli (Lactobacillus spp.), which have a protective function. Lactobacilli process glycogen (contained in epithelial cells of vagina in large amount) into lactic acid, reducing the acidity of the vagina and form hydrogen peroxide. The acidic environment of the vagina and hydrogen peroxide inhibit the growth of opportunistic microbes, which present in vaginas in small amount of the vast majority of women. If the proportion of lactobacilli decreases, they are replaced by conditionally pathogenic bacteria. As a result, bacterial vaginosis symptoms occur.

What Are the Causes of Bacterial Vaginosis

The cause of this disease is not just the presence of pathogens of bacterial vaginosis (vaginal flora of almost every woman has them at least in small amount), but a change in the ratio of the proportion of lactobacilli and opportunistic microbes that cause bacterial vaginosis. When there is a bacterial vaginosis, the proportion of lactobacilli decreases, and the proportion of pathogens of bacterial vaginosis increases. That’s why bacterial vaginosis is also called vaginal dysbiosis. The reasons of occurrence of such dysbiosis are still unknown. But it is known that many factors can provoke bacterial vaginosis development: they include frequent changes of sexual partners, uncontrolled use of antibiotics, hormonal drugs, hygiene offences or, conversely, too frequent and intense intimate washing or vaginal douching which “washes down” lactic acid bacteria from the vagina, and even a change of water during a vacation trip.

How May BV be Caught?

As stated above, the bacterial vaginosis is caused by overgrowth of pathogenic bacteria in female body rather than just presence of them. In healthy woman, the number of beneficial bacteria exceeds the number of pathogenic bacteria in vagina. But if the number of pathogenic bacteria increases too much, it results in adverse change in bacteria balance which may cause vaginosis.

Bacterial vaginosis is not a venereal disease. The causative agents of bacterial vaginosis (especially Gardnerella vaginalis) are transmitted through sexual intercourse but their transmission is not the cause of the disease. Nevertheless, unprotected sex plays a certain role in the occurrence of bacterial vaginosis. In other words, frequent changes of sexual partners which results in adverse change in the vaginal microflora causes bacterial vaginosis rather than just transmission of pathogenic bacteria during sexual intercourse.

Risk factors for bacterial vaginosis:

  • Vaginal douching and too frequent washing;
  • Contraceptive suppositories and creams containing 9-nonoxynol (“Patentex Oval”, “Nonoxinol”);
  • Condoms processed using 9-nonoxinol;
  • Uncontrolled taking of antibiotics;
  • Frequent change of sexual partners;
  • Previous infections and diseases transmitted sexually
  • Taking oral contraceptives;

Incubation period

It lasts from 12 hours to five days.

Bacterial Vaginosis Symptoms

Bacterial vaginosis is characterized by an unpleasant smell of vaginal discharge, which is compared with the rotten fish. At the same time, the smell intensifies after sexual contact without a condom, since the alkaline pH of the sperm increases the formation of volatile amines. In addition to the smell, vaginal discharge when there is bacterial vaginosis does not differ much from normal discharges. They are not profuse, of homogeneous in consistency, greyish-white color, usually do not leave spots on underwear. Thus Bacterial vaginosis is very often asymptomatic. Some women with Bacterial vaginosis experience itching and irritation around their vulvar lips.

BV Testing

If you experience any symptoms described above, you should consult a health care providing institution to have your vaginal smear tested. When taking a smear the doctor may suspect bacterial vaginosis by a characteristic smell of vaginal discharge. Adding a few drops of 10% potassium hydroxide solution to the vaginal discharge enhances this smell. When there is bacterial vaginosis, the so-called “clue cells” (the cells of the vaginal epithelium covered with a multitude of coccobacilli (Gardnerella vaginalis)) are reveled while lactobacilli are absent when the smear is examined. This procedure allows a doctor to see all bacteria and microbes under microscope. In some cases more than one vaginal smear is required to determine coexistent infections and prevent any their development.

Identification of Gardnerella vaginalis by precise methods detecting single microbes does not play a role in the diagnosis of bacterial vaginosis, as they present in a small amount in most women. The amount of Gardnerella vaginalis matters rather than its presence. When a woman is pregnant, laboratory analysis is especially necessary.


Optimum treatment of bacterial vaginosis is metronidazole (Trichopolum, …) 500 mg  2 times a day for 7 days orally. The drug is sometimes poorly tolerated (causes nausea). It is absolutely not compatible with alcohol. However, systemic treatment reduces the possibility of complications of bacterial vaginosis.

Gel Metronidazole, 0.75% (Flagil, Metrogil) is injected into the vagina with the attached applicator 2 times a day for 5 days. Local treatment is well tolerated, but it reduces the risk of complications of bacterial vaginosis worse than systemic treatment.

But as it is not difficult to recover from this disease, taking antibiotics is not always necessary. pH level restoring doesn’t take much efforts and time. In any case you should consult the doctor before beginning the treatment to prevent any complications.

If bacterial vaginosis is not treated
As a rule, Bacterial vaginosis does not have severe forms. But sometimes, if it is not treated, it can cause inflammation of the alvus and uterine tubes. It is necessary to treat bacterial vaginosis and trichomoniasis, when a woman is pregnant. When you want to use intrauterine device, you must have healthy internal and external genitals. Furthermore, bacterial vaginosis may increase the risk of transmission of HIV and other STD.

Unfortunately there are no reliable methods to prevent bacterial vaginosis development in future. It is difficult to avoid the occurrence of this disease because of its natural origin. The following simple advice can help you to reduce the risk of future Bacterial vaginosis development:

  • There is no need to douche or to clean you vagina with a hard water jet. You should only wash your vulva;
  • Avoid contacting soap, antiseptics and bath preparation and other chemical substances with your vagina while having a bath;
  • Do not use strong detergents when you wash your panties;
  • It is not useful to wash areas around vulvar lips and vagina too often. Do it no more than once a day.

Further Reading