Causes of Bacterial Vaginosis (BV)
- BV is caused by a disruption to the natural balance of healthy bacteria (lactobacilli) found within the vagina: a reduction in lactobacilli combined with an overgrowth of bacteria that are usually present in small numbers (anaerobes) may result in a change in the normal discharge.
- This is not a sexually transmitted infection and can be related to a raised vaginal pH, which happens normally after sex or a period.
- BV is likely to come back if you wash the genital skin too much or with something too strong and is commoner in smokers.
- More than half of women treated for BV with antibiotics will get it again within 3 months.
Symptoms of BV
If 100 women without any symptoms had a vaginal swab taken at random, approximately 50 of them would have signs of BV on that swab. It is important to remember that if there are no symptoms, no treatment is required.
Symptoms include:
- Fishy or unpleasant odour
- Greyish-white, watery discharge
- Worsening of symptoms after sex or during your period
- Itching, irritation, burning
- Sometimes painful urination.
Prevention of BV
BV is more likely to come back in people who smoke or have oral sex.
Having sex with a condom (which prevents the rise in vaginal pH caused by semen) can also reduce the chances of BV coming back.
Wash with a soap substitute rather than soap – please see the patient information leaflet on female genital washing.
Avoid anything that could upset the natural bacterial balance in your vagina, such as:
- perfumed soaps/shower gels
- bubble baths/bath products
- washing hair in bath
- vaginal deodorant or other feminine hygiene products
- wet wipes on the genital skin
- scented tampons pads or pant liners
- performing vaginal douching (cleaning out the vagina).
- fabric softener or 2 in 1 clothes washing products.
Treatment of BV
Over the counter pharmacy products to restore the normal vaginal pH and improve symptoms can be bought and all are equally good. All of these products are topical treatments and put inside the vagina. Using a vaginal probiotic may stop the BV from coming back for longer.
Please see the East Regional Formulary for standard antibiotic approaches to treating a single episode.
Partner treatment in Bacterial Vaginosis
The treatment of male sexual partners is not routinely done, however could be considered in specific circumstances in cases of recurrent BV. These patients must have proven BV (on microscopy) on attendance to sexual health services. They should receive appropriate genital washing advice, as well as treatment. If symptoms recur after treatment and they are proven to have BV again on microscopy and they have adhered to washing advice, we could consider offering treatment to male partners. The relationship must be monogamous.
The patient should ask their partner to contact Lothian Sexual and Sexual Reproductive Health Services and book in to organise treatment after their own second attendance. They should be made aware of side effects of treatment using both topical Metronidazole and oral Metronidazole (nausea, metallic taste, skin reactions). Even after both patient and partner are treated, there remains a risk of recurrence (35% versus 63% in cases with non-treated partners). Male partners would be treated with oral Metronidazole 400mg twice daily for seven days and topical 2% Clindamycin cream twice daily for seven days to penile skin following specialist assessment.
C.M & D.R – 04-05-26
