Jefferson University Hospitals

Bacterial Vaginosis

The vagina houses both good and bad bacteria. Among the good bacteria are lactobacilli, which are largely responsible for a healthy vaginal environment. In Bacterial Vaginosis (BV), the number of these bacilli is decreased, though it has not been established if this is the cause or the result of the infection.

BV is the most common cause of vaginal discharge in women of childbearing age. The discharge, usually off-white or gray in color, has an unpleasant odor, which is often described as "fishy." Women with BV may also have irritated tissue around the opening of the vagina.

The majority of women with BV, however, have no symptoms at all.

The cause of the infection is not known. Contact with common objects like toilet seats, bedding or swimming pool water, is not thought to be a cause. And though risk factors include multiple or new sexual partners, women who are not sexually active can also get BV. Smoking and douching may make women more susceptible to the infection.

Bacterial Vaginosis Diagnosis & Treatment

Diagnosis is based on a pelvic exam plus laboratory testing. During the physical exam, the vaginitis specialist examines the vagina and surrounding tissue (the vulva) and also collects vaginal secretions for evaluation and lab testing.

In the lab, microscope studies will reveal the presence of "clue cells", abnormal bacteria that adhere to epithelial cells of the vagina, if BV is present. In order to exclude the presence of other possible infections, vaginal secretions collected during the pelvic exam are cultured and also put through polymerase chain reaction (PCR) analysis.

If BV is present, it should be treated. BV rarely clears up on its own, but if symptoms persist, a woman should get treated, though her sexual partner will not require treatment. An antibiotic — in pill or cream form — is the treatment of choice. It is important that a woman complete the entire course of treatment, even if her symptoms resolve before she has taken all the prescribed medication.

If left untreated, a woman runs an increased risk of:

  • acquiring and spreading HIV
  • becoming infected with Herpes, Gonorrhea, or Chlamydia
  • developing a surgical-site infection if a hysterectomy or pregnancy termination is needed
  • delivering prematurely (for those pregnant and symptomatic)
  • developing an infection of the uterus (endometritis) after delivery

If symptoms clear up, no follow-up is needed. However, relapses are not uncommon: 30 percent of women will experience symptoms again within three months; 50 percent within 12 months.

It's not clear why BV returns. "Bad" bacteria might not have been completely destroyed or the "good" lactobacilli might not have been able to reestablish themselves.

If a woman has more than three episodes of BV within a 12-month period, ongoing treatment as well as preventative measures are recommended, such as limiting the number of sexual partners and not smoking or douching.