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| |    Bacterial Vaginosis by Marjorie Greenfield, M.D. reviewed and revised by Marjorie Greenfield, M.D. Bacterial vaginosis, sometimes referred to as BV, is a vaginal infection with mixed bacteria. These bacteria are present at higher numbers than the normal bacteria found in a healthy vagina and are the "bad" bacteria as opposed to the "good" protective lactobacilli. About half of the women with this infection have no symptoms, but many will notice a peculiar odor, sometimes described as fishy, that may be most noticeable after intercourse. This infection is quite common, observed in 10 to 25 percent of all women. What causes BV? Bacterial vaginosis can occur when normal vaginal lactobacilli bacteria aren't present in large enough numbers to protect the vagina from invaders. Certain factors can upset the balance of the vaginal pH (to make it more alkaline)--douching or frequent unprotected intercourse (since semen is alkaline), for example--and create an environment that is less hospitable to the good bacteria and allow the bad guys to flourish. One of the bacteria that may be present in bacterial vaginosis is Gardnerella (hence the condition's alternative name of Gardnerella vaginitis). However, although Gardnerella was once thought to be the cause of BV, it may or may not even be present in the infection, and so referring to this condition as Gardnerella vaginitis has gone out of fashion. Risks of BV In addition to the bad odor, BV can predispose a woman to some serious medical problems. Research has shown that women who have bacterial vaginosis in early pregnancy are more like to deliver their babies early and are more likely to get an infection of the amniotic fluid called amnionitis. They also have a higher risk of developing an infection in the uterus after delivery called endometritis. Women who have vaginal surgery (like hysterectomy or D and C -- dilation and curettage) are more likely to get a postoperative infection if they have untreated BV at the time of the procedure. Lactobacilli, the good vaginal bacteria, don't cause these sorts of infections. How do you treat BV? Bacterial vaginosis can be treated with antibiotics that are targeted against the bad bacteria but don't affect the lactobacilli. Clindamycin (Cleocin) and metronidazole (Flagyl, Metrogel) are the most commonly used antibiotics and come in different forms--one that can be taken by mouth and another in the form of a cream or gel to be applied as a topical treatment in the vagina. The oral antibiotic is sometimes prescribed to be taken over the course of a week or can be prescribed as a one-time/one-dose therapy. While appealing in its simplicity, the one-time treatment may not be as effective as the topical treatments or the weeklong course. There is also some evidence that in pregnancy, a weeklong oral course works better than the topical preparations. While BV technically isn't a sexually transmitted infection and there is no male equivalent, bacterial vaginosis appears more often in sexually active women than in those who practice abstinence. Some doctors will treat the male partner if a woman has recurrent BV, but it's unclear if this helps at all. Vulvar care measures--in particular, not douching--may help prevent BV.
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