Bacterial Vaginosis
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
What is bacterial vaginosis?
Bacterial vaginosis is vaginal condition that can produce
vaginal discharge and results from an overgrowth of normal bacteria in the vagina. In the past, the condition was called
Gardnerella vaginitis, after the bacteria that were thought to cause the condition. However, the newer name, bacterial vaginosis, reflects the fact that there are a number of species of bacteria that naturally live in the vaginal area and may grow to excess. The Gardnerella organism is not the sole culprit causing the symptoms. When these multiple species of bacteria become imbalanced, a woman can have a vaginal discharge with a
foul odor.
Bacterial vaginosis is not dangerous, but it can cause disturbing symptoms. Any woman with an unusual discharge should be evaluated so that more serious infections
such as chlamydia and
gonorrhea, can be excluded.
What are the symptoms of bacterial vaginosis?
The symptoms of bacterial vaginosis are vaginal discharge and odor. Usually,
there are no other symptoms. The amount of vaginal discharge that is considered
normal varies from woman to woman. Therefore, any degree of vaginal discharge
that is abnormal for a particular woman should be evaluated.
Many women with bacterial vaginosis actually have no symptoms at all. Others experience an unpleasant fishy odor with vaginal discharge. The discharge is usually thin and grayish white. The discharge is often more noticeable after sexual intercourse.
What causes bacterial vaginosis?
Researchers have had difficulty determining exactly what causes bacterial vaginosis. At present, it seems to be that a combination of multiple bacteria must be present together for the problem to develop. Bacterial vaginosis typically features a reduction in the number of the normal hydrogen peroxide-producing lactobacilli in the vagina. Simultaneously, there is an increase in concentration of other types of bacteria, especially anaerobic bacteria (bacteria that grow in the absence of oxygen). As a result, the diagnosis and treatment are not as simple as identifying and eradicating a single type of bacteria. Why the bacteria combine to cause the infection is unknown.
Certain factors have been identified that increase the chances of developing bacterial vaginosis. These include multiple or new sexual partners, vaginal douching, and
cigarette smoking. However, the role of sexual activity in the development of the condition is not fully understood, and bacterial vaginosis can still develop in women who have not had sexual intercourse.
How is bacterial vaginosis diagnosed?
When a woman reports an unusual vaginal discharge, the doctor will ask her a
series of routine questions to help distinguish mild from more serious
conditions. Additional issues that might indicate the presence of a more
serious condition include fever, pelvic pain, new or multiple sexual partners
(especially with unprotected intercourse), and a history of
sexually-transmitted
infections.
In addition to these questions, the doctor will perform a pelvic exam. During
the exam, the doctor notes the appearance of the vaginal lining and cervix. The
doctor will also perform a manual exam of the ovaries and uterus. The cervix is
examined for tenderness, which might indicate a more serious infection. The
doctor may collect samples to check for chlamydia or gonorrhea infection.
Examining the vaginal discharge under the microscope can help distinguish
bacterial vaginosis from yeast vaginitis (candidiasis) and
trichomonas (a type
of sexually transmitted infection). A sign of bacterial vaginosis under the
microscope is an unusual vaginal cell called a clue cell. Clue cells are believed to be the most reliable diagnostic sign of bacterial vaginosis. In addition to clue cells, women with bacterial vaginosis have fewer of the normal vaginal bacteria, called lactobacilli. A vaginal pH greater than 4.5 is also suggestive of bacterial vaginosis.
Finally, the doctor may perform a "whiff test" with potassium hydroxide
(KOH) liquid. When a drop of KOH testing liquid used in the "whiff test"
contacts a drop of the discharge from a woman with bacterial vaginosis, a
certain fishy odor can result.
Next: What is the treatment for bacterial vaginosis? »
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