In the initial stages, BV presents with mild signs and symptoms that are often overlooked by affected women. However, in the later stages the symptoms take a severe turn causing great discomfort. The following are the various signs and symptoms of bacterial vaginosis [5]:

• Burning sensation during urination
• Pruritus in the vaginal region
• Vaginal discharge turns thin and watery or the color changes to white or grey
• Foul smell from vaginal discharge especially after intercourse

• Surgical Procedure

  BACTERIAL VAGINOSIS AND SURGICAL PROCEDURES Women with bacterial vaginosis, scheduled to undergo reproductive tract surgery or a therapeutic abortion, should receive treatment with metronidazole. [apps.who.int]

  Having BV increases the risk of getting PID after a surgical procedure, such as a hysterectomy or an abortion. Higher risk of getting other STDs. Having BV can increase the chances of getting other STDs, such as chlamydia, gonorrhea, and HIV. [news-medical.net]

  Treatment Treatment is indicated for: Symptomatic women ( A ) Women undergoing some surgical procedures ( A ) Women who do not volunteer symptoms may elect to take treatment if offered. [web.archive.org]

  It can increase a person’s susceptibility to other STIs BV has been associated with pelvic inflammatory disease (PID) following surgical procedures such as an IUD insertion or an abortion. bacterial vaginosis may put a pregnant person at increased risk [islandsexualhealth.org]

• Recurrent Infection

  Long-term condom use may help to prevent recurrent infection. Women with BV have more frequent infections following gynecologic surgery, and some studies suggest that BV increases the risk of giving birth prematurely if you have it during pregnancy. [ourbodiesourselves.org]

  Recurrence of bacterial vaginosis is possible even after successful treatment. More than half of those treated experience recurrent symptoms within 12 months. It is unclear why so many recurrent infections develop. [medicinenet.com]

  Yet there are many unanswered questions about its aetiology, making management of recurrent infection difficult and often idiosyncratic. This paper discusses the current knowledge and possible management of recurrent BV. [ncbi.nlm.nih.gov]

• Weakness

  The correlation between urinary and vaginal fluid microbiota was generally weak and depending on UT and BV status. [ncbi.nlm.nih.gov]

  Yeast infections can be treated with antifungal medications such as: Butoconazole Clotrimazole Miconazole Tioconazole Terconazole WARNING: Some yeast medicines make latex condoms and diaphragms weak and more likely to break. [ashasexualhealth.org]

  The virus is spread through direct contact with the bodily fluids of a sick person and can cause fever, headache, muscle pain, weakness, fatigue, diarrhea, vomiting, stomach pain and hemorrhage (severe bleeding). [niaid.nih.gov]

  Am J Clin Nutr 80 ( Suppl 6 ): 1678S – 1688S 13 1986 Muscle weakness in infants with rickets: distribution, course, and recovery. Pediatr Neurol 2 : 95 – 98 14 2005 Vitamin D: more than just affecting calcium and bone. [dx.doi.org]

• Confusion

  The confusion may come about because the symptoms of BV are often confused with thrush. Express.co.uk has spoken to experts at Canesten about the condition and how to spot it. [express.co.uk]

  Bacterial vaginosis is also easily confused with thrush (also known as yeast infection). [onlinedoctor.superdrug.com]

  She told me that most of her patients have similar stories about confusing their bacterial vaginosis (BV) for a yeast infection—and erroneously using Monistat. [glamour.com]

  It sometimes can be confused with a yeast infection or sexually transmitted disease, such as trichomoniasis, but it is not an STD. [mayoclinichealthsystem.org]

  The symptoms can be confused with those of trich, though the discharge tends to be creamy white or grayish and is especially foul-smelling (some call it “fishy”), especially after intercourse. [ourbodiesourselves.org]

• Vaginal Discharge

  When symptoms do occur, the most common include: An abnormal amount of vaginal discharge The vaginal discharge is thin and grayish white. [medicinenet.com]

  Symptoms often include an excessive grayish white vaginal discharge and a bothersome "fishy odor" which can be worse after sexual intercourse. BV sufferers describe the discharge as yogurt-like or pasty. [rephresh.com]

  Signs & Symptoms Abnormal amounts of vaginal discharge frequently noted as milky or gray or gray-green in color A fishy smell to the vaginal discharge, often worse after sexual intercourse Mild vaginal irritation Some women have BV without noticeable [shcs.ucdavis.edu]

  Bacterial vaginosis causes symptomatic vaginal discharge and has been associated with preterm birth and with the acquisition of human immunodeficiency virus. [ncbi.nlm.nih.gov]

• Dysuria

  […] prevalence in pregnant US women is in the range of 16% to 29%, and up to 30% of women visiting infertility clinics may be affected by BV. [22] Clinical manifestations include discomfort and pungent odor, a gray, thin, homogenous discharge, but rarely dysuria [medscape.com]

  Rare Symptoms On rare occasions, BV may cause dysuria (painful or difficult urination) or dyspareunia (painful intercourse). These are most often caused by a secondary infection of the urinary tract and vagina. [verywellhealth.com]

  Clinical findings Discomfort; thin, grey, pungent (fishy odour) vaginal discharge; occasionally dysuria; vagina or vulva are generally not inflammed. [medical-dictionary.thefreedictionary.com]

  […] symptoms Typical symptoms of BV include the following: Vaginal odor (the most common, and often initial, symptom of BV); often recognized only after sexual intercourse Mildly to moderately increased vaginal discharge Vulvar irritation (less common) Dysuria [emedicine.medscape.com]

• Vaginal Dryness

  Improvement of symptoms within 1 week was also reported by 81% of women with vaginal discharge without odour, 83% with vaginal itching and irritation, and 76% with vaginal dryness. [sti.bmj.com]

  The women affected may have vaginal dryness, itching, and/or burning, pain during sexual intercourse, and a small amount of bleeding after sexual intercourse. [labtestsonline.org]

Past medical history of the woman is normally taken at the preliminary level of investigation. This would be followed by various diagnostic procedures which include:

• Pelvic exam wherein a thorough physical examination of the pelvic region is carried out to study for the signs of infection. In this examination, the examiner would insert 2 fingers into the vagina, while pressing the abdomen with the other hand to check for unusual characteristics of the pelvic region [6].
• A sample of the vaginal secretions is also tested for bacterial overgrowth.
• Acidity level of the vagina is also tested by placing a pH strip in the vagina. If the pH value is 4.5 or above it indicates presence of bacterial infections.

• Mycoplasma Hominis

  Among women with bacterial vaginosis, the highest risk of preterm delivery of a low-birth-weight infant was found among those with both vaginal bacteroides and Mycoplasma hominis (odds ratio, 2.1; 95 percent confidence interval, 1.5 to 3.0). [ncbi.nlm.nih.gov]

  Bacterial vaginosis is a clinical syndrome resulting from replacement of the normal hydrogen peroxide (H2O2)-producing Lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria, such as G. vaginalis and Mycoplasma hominis. [apps.who.int]

  There is a shift to a less acidic (pH >4.5), anaerobe-dominated environment that is populated by multiple bacterial species, including Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus, and species of Prevotella, Bacteroides, Peptostreptococcus, Fusobacterium [pedsinreview.aappublications.org]

  Anaerobic pathogens that overgrow include Prevotella species, Peptostreptococcus species, Gardnerella vaginalis, Mobiluncus species, and Mycoplasma hominis, which increase in concentration by 10- to 100-fold and replace the normally protective lactobacilli [merckmanuals.com]

• Chlamydia Trachomatis

  Participants were tested for vaginal candidosis, Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae and excluded if positive. [ncbi.nlm.nih.gov]

  Associations between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease. Sex Transm Infect 2003; 79 (2) 154-156 87 Clausen HF, Fedder J, Drasbek M, et al. [doi.org]

  trachomatis, or Neisseria gonorrhoeae, but it is not consistent with BV) 7-10, consistent with presence of a BV. [medscape.com]

• Neisseria Gonorrhoeae

  Participants were tested for vaginal candidosis, Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae and excluded if positive. [ncbi.nlm.nih.gov]

  gonorrhoeae, but it is not consistent with BV) 7-10, consistent with presence of a BV. [medscape.com]

  Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis 2003; 36 (5) 663-668 41 Cohen CR, Duerr A, Pruithithada N, et al. [doi.org]

• Gram-Positive Rods

  […] anaerobic Gram-negative rods. [cmr.asm.org]

  A score of 0 to 10 was assigned on the basis of the relative proportions of easily distinguished bacterial morphologic types (i.e., large gram-positive rods, small gram-negative or variable rods, and curved rods). [doi.org]

  […] staining of vaginal fluid to distinguish normal vaginal flora (i.e., gram-positive rods and lactobacilli) from bacterial vaginosis flora (gram-negative morphotypes) 13 according to the Nugent score. 14 Koch's postulates for establishing disease causation [nejm.org]

  A Gram stain (considered the gold standard laboratory method for diagnosing BV) is used to determine the relative concentration of lactobacilli (i.e., long Gram-positive rods), Gram-negative and Gram-variable rods and cocci (i.e., G. vaginalis, Prevotella [web.archive.org]

Bacterial vaginosisis caused by bacterial infections. A strict antibiotic regime forms the basis of the treatment plan. The following medications are administered to treat BV:

• Metronidazole is an antibiotic which is available to be taken orally or in the form of topical agent to be inserted into the vagina.
• Clindamycin is available in the form of cream which needs to be applied on the affected area.
• Tinidazole medicine needs to be taken orally and has certain side effects associated with it [7].

It is advised to all affected women that they religiously complete the antibiotic course to prevent the recurrence of bacterial vaginosis. Affected women are more likely to suffer from recurrent bouts of BV after 3 months.

Prognosis of the condition is usually favorable with prompt initiation of treatment. However, women are advised to follow certain steps to prevent the recurrence of bacterial vaginosis. It has been seen that women who could successfully get rid of the condition, are found to experience signs and symptoms of BV after 3 months.

Bacterial vaginosis may not be a life threatening condition. It can however lead to several debilitating complications if the condition is not promptly treated. The following are the several signs and symptoms of bacterial vaginosis.

• Sexually transmitted disease (STD): Women with BV are more prone to contract STDs which include HIV, gonorrhea, herpes simplex virus and chlamydia.
• Having BV also significantly increases the risk of developing infections after undergoing surgical procedures [4].
• If pregnant women develop BV, then there are higher chances of preterm delivery of the baby.
• Bacterial vaginosis can also increase the risk of developing pelvic inflammatory disease which in turn can also increase the risk of developing infertility.

The exact cause behind development of BV is not understood. However, researchers believe that certain activities such as frequent douching or having unprotected sex with multiple partners can disrupt the natural bacterial balance of the vagina paving way for bacterial vaginosis.

Women in the age group of 15 to 44 years are likely candidates of bacterial vaginosis. BV is a common condition affecting about 1 in every 3 women in the reproductive age group [2].

Certain groups of bacteria are normal inhabitants of the vagina. The vagina normally consists of 2 types of bacteria: lactobacilli (good bacteria) and anaerobes (bad bacteria). When there is excessive growth of anaerobes the natural balance of the vagina gets disrupted giving rise to an array of unpleasant symptoms. Such a phenomenon causes bacterial vaginosis to develop [3].

It is necessary to prevent the development of bacterial vaginosis as it can give rise to various other secondary complications. The following measures can be adopted to keep BV at bay.

• Women need to comprehend the fact that they need nothing more than soap and water to rinse their vagina. Application of soap to the outer area of the genital regions and rinsing with water would be enough to keep vaginal infections are bay [8].
• It is necessary to stay away from scented tampons and pads.
• Douching is not good for women and its practice should be discontinued.
• It is also advised not to have multiple sexual partners to prevent development of STDs.

Bacterial vaginosis (BV) is caused due to overgrowth of the bacteria which are normal inhabitants of the vagina. Due to such a situation, the natural balance of the bacteria in the vagina is greatly disturbed leading to development of bacterial vaginosis [1]. What triggers bacterial over growth is yet to be figured out; however certain activities are known to give rise to such a condition. Women who are in their reproductive years fall prey to BV.

Definition

Bacterial vaginosis (BV) is characterized by inflammation of the vagina due to bacterial overgrowth. It is common in women in the reproductive age group. It has been estimated that 1 in every 3 women would suffer from bacterial vaginosis at least once in their life time. The condition can be successfully treated with a strong antibiotic course.

Cause

The exact factor that causes bacterial overgrowth is not known. However, it is thought that certain activities such as frequent douching and having multiple sexual partners can predispose women to contract this condition [9].

Symptoms

BV presents with mild symptoms that often go unnoticed. In later stages, women experience vaginal itching, foul smell from vaginal discharge, and color of the discharge changes to white or grey and appear thin or watery.

Diagnosis

Diagnosis of bacterial vaginosis consists of physical examination of the genital region. It is also necessary to carefully examine the pelvic region to determine presence of unusual characteristics. Sample of vaginal secretions are also tested for bacterial overgrowth. In addition, pH of the vagina is also measured using pH strips. A vaginal pH of 4.5 or above, confirms the presence of bacterial vaginosis.

Treatment

A strong antibiotic regime for a specified period is recommended for treating bacterial vaginosis. In addition to oral pills, affected women are also administered topical agents such as antibiotic creams or gels to be applied on the affected area [10].

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3. Marrazzo JM, Fiedler TL, Srinivasan S, et al. Extravaginal reservoirs of vaginal bacteria as risk factors for incident bacterial vaginosis. J Infect Dis. May 15 2012;205(10):1580-8.
4. Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59:1.
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9. Martin HL, Richardson BA, Nyange PM, et al. Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition. J Infect Dis 1999; 180:1863.
10. Martius J, Eschenbach DA. The role of bacterial vaginosis as a cause of amniotic fluid infection, chorioamnionitis and prematurity--a review. Arch Gynecol Obstet. 1990;247(1):1-13.