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Bacterial Vaginosis

Symptoms, causes and treatments for BV (bacterial vaginosis) in the UK

Bacterial vaginosis – also known as BV or gardnerella vaginitis – is the most common form of bacterial vaginal infection in the UK.

An outbreak of BV is cured with prescription antibiotics. These are available from HealthExpress after completing an online consultation. It is important to note, it is common for the condition to reoccur, so for further information on bacterial vaginosis, please read below.

Content reviewed on 06-04-21
Dr. Kok Ching Ng Prescribing Doctor MBBS/MRCGP (GMC Reg: 2378125)

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What is BV?

The vagina has a delicate balance of bacteria that are harmless, however when the balance of any of the bacteria is altered (whether increased or decreased it can lead to bacterial vaginosis. As the infection is not dangerous, certain women may not experience noticeable symptoms and in time the BV infection will go away by itself. In most instances though, there are uncomfortable symptoms which require targeted treatment to help restore the natural balance in the vaginal.

Bacterial vaginosis (BV) is the most common infection that produces discharge in the UK with 100,000 fresh cases each year at GUM clinics alone. Whilst the exact causes are still unknown, there are certain triggers you can avoid, and effective treatment you can use.

Although the condition is not serious for the vast majority of women, it is important to report any symptoms that may indicate the presence of BV, as evidence suggests it can have an adverse effect and could cause certain complications if you are pregnant (e.g. premature birth, miscarraige or chorioamnionitis).

Is bacterial vaginosis an STI?

BV is not classified as an STI, as women who are not sexually active can still have the infection. It is however more likely to occur in women who are sexually active or who have multiple partners, as there is a greater chance of a bacterial imbalance. It is best to stay protected at all times and use a condom if you are sexually active and to take an STI test if you think you may have bacterial vaginosis. Although a man cannot be infected with BV, unprotected sex may increase the chance of STI's such as chlamydia and gonorrhoea for both male or female.

What causes bacterial vaginosis?

The medical cause of bacterial vaginosis is the natural balance of bacteria in your vagina altering. The vagina is always slightly acidic to keep it clean and healthy, this is because of the bacteria - lactobacilli. When lactobacillus is lagging, this allows other more harmful bacteria to flourish, causing the unpleasant symptoms of BV.

Triggers of causes of bacterial vaginosis

There is no precise cause of bacterial vaginosis and these signs can differ from one woman to the next so it is advised to keep a note when the infection exposes itself and what factors have differed to prompt a change. Whilst it is not 100% confirmed, there is research to show that the following could be linked to BV :

  • weakened immune system
  • Sexual activity

    Women having regular sex find themselves more susceptible to BV. Having multiple sex partners increases the risk furthermore. Forums and medical research suggests this is the most common cause.

  • Feeling stressed
  • Intrauterine device (IUD)

    This contraceptive device is inserted into the womb and the hormones are released, which could be triggering symptoms of BV, according to a study comparing women with IUD contraception and women without.

  • Smoking
  • Smoking

    Studies have shown that smoking cigarettes alters the bacteria living in the vagina, which could be promoting bouts of BV.

  • Over-cleaning
  • Over-cleaning

    Otherwise known as 'douching', using household products to clean your vagina could be causing the infection. Water, and maybe a little soap, should be used only as the vagina is perfectly capable of cleaning itself.

  • Foreign objects
  • Foreign objects

    Like the IUD, there is a possibility tampons, and other foreign objects, can be interrupting the natural bacteria in the vagina.

  • Personal hygiene
  • Personal hygiene

    Not wiping after the toilet, wiping incorrectly, wearing synthetic fabrics and not changing your underwear often, can all be triggering BV.

What are the symptoms of bacterial vaginosis?

About half of women with BV don't have any symptoms at all. Unlike other vaginal infections, itching and soreness don't usually accompany BV so it is unlikely you will need a cream to soothe any discomfort. However if you are experiencing anything unusual, the main sign of an infection is an unusual vagina discharge. This can be unclear, as most of a woman's discharge is completely normal, however there are some signs it could be something else. In this case, BV infections will have the following symptoms:

  • White or grey in colour
  • Thin and watery in texture
  • An unusual smell (strong fishy odor)

These symptoms may coincide with other factors, such as itching, burning sensation when urinating and irregular bleeding.

If not treated in time, BV can cause PID (pelvic inflammatory disease) which produces pain and discomfort around the pelvic area, swelling in the genital tract and bleeding between periods. This would also need to be treated effectively with a course of antibiotics.

How is BV diagnosed?

Before aiming to treat the problem, it is important to accurately diagnosed first by a doctor or at a health clinic. To diagnose this infection the doctor may:

  • Ask medical questions - this includes understanding when the first symptoms occurred, sexual history, methods of cleanliness, previous STIs or vaginal infections
  • Perform an examination of the area - the doctor will examine the vagina and surrounding area, looking for particular signs of BV infection such as an unpleasant smell and discoloured discharge
  • Take tests/samples - samples will be taken to through swabs of the vagina to test the pH (acidity) levels of the bacteria, usually pH levels higher than 4.5 indicate the presence of BV

How do I treat bacterial vaginosis?

Metronidazole is the most recognisable form of treatment for bacterial vaginosis according to the NHS, and a medication we offer here at HealthExpress. The antibiotic is available in different forms, most commonly as a tablet to be taken twice a day. As with all antibiotic, you must take the full course regardless of whether you are feeling better part, half or mostly the way through. It is also available as one singular tablet of a higher dosage or as a gel applied once a day. A course of antibiotics are generally preferred as side effects are increased with the higher dose tablet and gels are more difficult to apply correctly.

Bacterial vaginosis in pregnancy can still be treated with metronidazole tablets, however when breastfeeding, the active ingredients can affect breast milk so the gel will most likely be recommended in this instance. There are currently no proven natural cures or home remedies for bacterial vaginosis.

Benefits of treating Bacterial Vaginosis

  • Avoid the risk of further health problems
  • Reduced risk of birth complications
  • Treat symptoms and discomfort
  • Lessen chance of other sexual infections

How can I prevent BV?

BV prevention is very similar to avoiding thrush and is linked to the possible causes. For example, practicing personal hygiene (detailed below) and quitting smoking could help. Once you have had bacterial vaginosis once, recurrent bouts are not surprising so making a mental or physical note of what changes have incited symptoms and minimising these risk factors can help:

Wearing natural clothing - Loose cotton underwear may help not only prevent BV but speed up recovery during an outbreak

Natural products - Only use gentle products to clean your genitalia. Many vaginal specific brands still include ingredients that can aggravate the vagina. This includes any washing detergent you may use on your laundry

Limited cleaning - Remember, the vagina cleans itself so you shouldn't have a specific vagina-cleaning regime at all. When you have BV, it may be easy to think that cleaning will help the smell, however, in reality, it could be making it worse. Cleaning just once a day is all your vagina needs

No douching - Steer clear of douching completely. You shouldn't be cleaning inside your vagina, especially pushing water

Quit smoking - It's easier said than done, but once you quit smoking, your BV may go completely, as well as you reaping may other benefits

Practice safe sex - Some research has shown that using condoms can reduce the number of bouts, as well as keeping sexual activity to one partner

Good hygiene - As well as limited cleaning and no douching, wiping from front to back after using the toilet can help

What options do we offer to treat bacterial vaginosis?

To order Metronidazole, you can start a consultation below. This process allows one of our doctors to assess and ensure you are safe to use this antibiotic. We do recommend that you only request a treatment only after you have been diagnosed by your doctor, or if you require a repeat prescription. If approved, you can take advantage of our fast delivery service, with your BV treatment delivered the next day across the UK (when ordered before 4pm).

What should I do if I think I have bacterial vaginosis?

Bacterial vaginosis is a common vaginal infection that can develop as a result of sexual intercourse. It mainly affects women and doesn't always cause symptoms.

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