Despite the fact that bacterial vaginosis (known as BV) accounts for 40 percent of all vaginitis-related office visits, this common disorder is still not well understood. Indeed, as researchers have attempted to sort out the causes, it has been renamed several times. Originally called "non-specific vaginitis," it was later redubbed "Haemophilus vaginalis vaginitis" and then "Gardnerella vaginalis vaginitis."
For most women, BV is more a nuisance than a significant health threat. However, there is some evidence linking it to an increased risk of pelvic inflammatory disease (a bacterial infection of the uterus, fallopian tubes, and ovaries) and of contracting HIV. In pregnancy, BV appears to markedly increase the risk of premature rupture of the membranes (bag of waters) and premature birth. Most doctors now routinely test and treat pregnant women for this vaginal infection. All expectant mothers with symptoms of BV should be treated, and even some women without obvious symptoms may benefit. Recently, large trials have found that treatment of asymptomatic pregnant women at high risk for BV (having previously delivered a premature baby) provides a measure of protection from premature delivery. However, treating asymptomatic women at low risk for BV (no previous preterm delivery) makes no difference.
About half of all women with BV have no symptoms. The most common tip-off is a thin, white/gray vaginal discharge with an unmistakable, offensive "fishy" odor. Because the odor is strongest when the discharge is exposed to an alkaline substance such as soap or semen, it may be most apparent in the shower or after intercourse. Itching and irritation are absent or mild.
BV is so common that many people wrongly believe vaginal odor to be normal in adult women. This misunderstanding has given rise to a host of "put-down" jokes and has inspired the manufacture of many useless "feminine hygiene products."
Yeast Infections: Your Treatment Alternatives
| Medication | Dosage | |
| Femstat 3 | 5 grams in the vagina every night for 3 days | |
| Diflucan | One 150 milligram tablet as a single oral dose | |
| Gyne-Lotrimin | One 100 milligram vaginal tablet at bedtime for 7 days, or One applicatorful in the vagina at bedtime for 7 days | |
| Monistat | One Monistat 7 vaginal suppository every night for 7 days, or One Monistat 3 vaginal suppository every night for 3 days, or 5 grams of Monistat 7 vaginal cream every night for 7 days | |
| Mycelex-G | One 500 milligram vaginal tablet 1 time | |
| Mycelex-7 | One 100 milligram vaginal tablet at bedtime for 7 days, or One applicatorful in the vagina at bedtime for 7 days | |
| Nizoral | One 200 milligram tablet taken orally once or twice daily for 7 to 14 days | |
| Nystatin | 1 vaginal tablet every day for 14 days | |
| Terazol | 1 vaginal suppository every night for 3 days, or 5 grams of Terazol 3 Cream in the vagina every night for 3 days, or 5 grams of Terazol 7 Cream in the vagina every night for 7 days | |
| Boric Acid | One 600 milligram vaginal capsule every day for 14 days |
One of the major players in BV is the bacteria Gardnerella vaginalis. This organism appears to be present in 30 to 40 percent of all women. But in order to cause infection, it must interact with at least three other bacteria, and the entire group must proliferate sufficiently to wipe out healthy organisms such as the Lactobacillus. Although we do not yet know the cause of this burst of growth, researchers suspect it has something to do with sexual intercourse.
When BV is suspected, your doctor will take your history, examine your pelvic organs, and study a few drops of your vaginal discharge under the microscope. If the diagnosis is uncertain, or if you are pregnant, a vaginal culture may be necessary. A DNA test has been approved for detecting BV, candida, and trichomoniasis from a single specimen. A test that uses a pH system also can detect BV within a few minutes.
The main goal of therapy is symptomatic relief. Treatment involves five to seven days of antibiotics taken orally or inserted in the vagina. Oral metronidazole (Flagyl) is the best known and most effective medication currently prescribed. It is also available in a vaginal gel (Metrogel). If you are allergic to metronidazole or have active liver disease, bleeding, or seizure disorders, several other antibiotics work reasonably well. One good alternative is Clindamycin 2% cream applied intravaginally at bedtime for seven days.
Most authorities recommend treating a male sexual partner only if the female becomes re-infected after completing her medication and resuming intercourse. Many doctors, however, are now treating couples simultaneously at the outset in order to avoid the need for a second course of antibiotics. There is currently no test available to detect BV in men. Although they may carry the infection, they often show no symptoms. In any case, BV presents no danger to their health. For lesbian couples, a test of the partner is recommended. If she is positive, both women should be treated to avoid reinfection.
