Bacterial Vaginosis - Diagnosis and Treatment

What is bacterial vaginosis?

Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women during their reproductive years; it is more common than “thrush”. The discharge has a fishy odour, which is intensified after intercourse and during menstruation. Itching and soreness are not features of BV. In 1983 the condition was called bacterial vaginitis but inflammation of the vagina is not a feature and it was renamed vaginosis. There have been other names including non specific vaginitis, haemophilus vaginitis and non specific vaginosis.

A variety of microorganisms have been implicated but we still do not know which are the main culprits. Attention has focused on a bacterium named Gardnerella vaginalis. This organism can be found in more than 50% of healthy women. A thousand-fold increase in concentration of Gardnerella and other anaerobes (bacteria that can thrive at low oxygen levels) is typical of BV. Some suggest that BV is a sexually transmitted condition. Bacterial vaginosis, however, can occur in virgins. Diagnosis is made essentially from the history and the nature of the discharge, which has a typical pattern on direct microscopic examination. Swabs sent for culture are not helpful.

Bacterial vaginosis is likely to occur when the balance between protective organisms (lactobacilli) and potential pathogens (organisms associated with disease) is adversely altered. Excessive vaginal douching, for example, may lead to bacterial vaginosis by removing the lactobacilli. Semen reduces the natural acidity of the vagina and predisposes to BV.

There have been suggestions that BV may be a factor in miscarriage and premature delivery and studies are under way to investigate the potential benefit of antibiotic treatment. The author has introduced the hypothesis that sub-clinical bacteria ascending into the uterus (bacteria endometrialis) may provide a plausible explanation for a variety of gynaecological and obstetric enigmas including unexplained infertility, recurrent miscarriage, excessive vaginal bleeding, and blood pressure problems in pregnancy (pre-eclampsia). A great deal of research will be required to investigate this concept as these conditions probably result from a variety of causes, which will confound analysis. At this time we do not know whether antibiotics will prove to be of value but research has begun.

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