Bacterial Vaginosis: Symptoms, Causes, and Effective Treatments

Bacterial vaginosis, commonly known as BV, is a frequent condition where the natural balance of bacteria in the vagina changes. It is not an infection in the traditional sense, but rather a shift in the microbial landscape. In a healthy vagina, 'good' bacteria called lactobacilli keep the environment slightly acidic, which prevents other bacteria from overgrowing.

When the levels of lactobacilli drop, other anaerobic bacteria—most commonly Gardnerella vaginalis—multiply. This change in pH leads to the characteristic symptoms of BV. It is important to note that BV is not a sexually transmitted infection (STI), although it can be triggered by sexual activity, and having it may make you more susceptible to STIs.

Many women with bacterial vaginosis do not experience any symptoms at all. However, when symptoms do occur, they are typically distinct from other conditions like thrush. The most common sign is a change in vaginal discharge. Features include:

• A thin, watery discharge that is white or grey in colour.
• A strong, unpleasant 'fishy' smell, which often becomes more noticeable after sexual intercourse or during a period.
• No significant itching or soreness (unlike thrush, which is typically very itchy).

If you notice a thick, white, 'cottage cheese' like discharge accompanied by intense itching, it is more likely that you have thrush rather than BV. Distinguishing between the two is vital as the treatments are entirely different.

Medical professionals still do not fully understand why some women develop BV and others do not. However, we have identified several factors that can disrupt the delicate vaginal pH balance. These include:

• Using scented products: Bubble baths, scented soaps, and vaginal deodorants can irritate the vaginal lining and kill off healthy bacteria.
• Douching: Washing inside the vagina is unnecessary and harmful; the vagina is self-cleaning. Douching is one of the most common triggers for BV.
• New sexual partners: While not an STI, a change in partner or having multiple partners can introduce new bacteria that upsets the local balance.
• Smoking: Studies suggest that smokers are at a higher risk of developing recurrent BV.
• Intrauterine Devices (IUDs): Some women find they experience BV more frequently after having a copper coil fitted.

While BV is often mild and can sometimes clear up on its own, treatment is usually recommended, especially if symptoms are bothersome. If left untreated, BV can lead to complications, particularly during pregnancy. It has been linked to a higher risk of premature birth or low birth weight.

Furthermore, the inflammation caused by the bacterial imbalance can make it easier for STIs, such as chlamydia or gonorrhoea, to take hold if you are exposed to them. If you are undergoing a surgical procedure, such as a termination or a hysterectomy, untreated BV may increase the risk of developing pelvic inflammatory disease (PID).

According to NICE clinical guidelines, BV is primarily treated with antibiotics that specifically target anaerobic bacteria. The most common treatments issued in the UK are:

• Metronidazole: This can be taken as a tablet (usually a twice-daily dose for 5 to 7 days) or applied as a vaginal gel. It is highly effective but must not be mixed with alcohol.
• Clindamycin: Usually prescribed as a cream to be used inside the vagina.
• Tinidazole: Another oral antibiotic option if metronidazole is not suitable.

For those who prefer a non-antibiotic approach for mild cases, lactic acid gels available over-the-counter can help restore the natural pH balance. However, if symptoms persist, a prescription is usually required to clear the overgrowth entirely.

You should consult a healthcare professional if you notice any unusual change in your vaginal discharge, especially if it is your first time experiencing these symptoms or if you are pregnant. Because BV symptoms can mimic other conditions, an accurate diagnosis is essential for effective treatment.

An online GP consultation is a convenient way to discuss your symptoms discreetly. A GP can help differentiate between BV, thrush, and common STIs by asking targeted questions. They can then issue a private prescription for the appropriate antibiotics, which can be sent to a local pharmacy of your choice. If your symptoms are recurrent (happening more than four times a year), a GP can provide a longer-term management plan.

To reduce the chance of BV returning, consider the following lifestyle adjustments based on NHS advice:

• Only use plain water or unperfumed soaps to wash the external genital area (the vulva).
• Avoid antiseptic liquids or scented oils in your bath water.
• Do not wash inside your vagina (douching).
• Use condoms during sexual intercourse to prevent the pH shift caused by semen.
• Wear breathable cotton underwear and avoid tight-synthetic fabrics.