What is Bacterial Vaginosis?

Bacterial Vaginosis is benign infection of the vagina. It goes by the names non-specific vaginitis, Gardnerella vaginitis, or simply Gardnerella. It is also referred to by its acronym of B.V.. Gardnerella is the most common bacteria involved. But it can be caused by a large variety of organisms. These are mostly categorized as anerobic bacteria.

Who gets it?
All women. It the common vaginal infection, especially among reproductive age women. But, it occurs in girls, and post-menopausal women as well. It is not considered a sexually transmitted disease. It is seen in virgins. Nevertheless, some vaginal infections recur because the woman's partner harbors them. It is suspected, but not proven that bacterial vaginosis' cure or recurrence rates will improve, if her male partner is treated.

It is a sponataneously arising infection. One or more of the offending bacteria overgrows in the vagina. It is a change in the normal bacteria and organisms of the vagina from aerobic to anerobic. Aerobic vs anerobic simply refers to the bacteria's metabolism -- does it need oxygen or not. (No vaginal bacteria is in there doing Tae Bo). The offending organisms were always there, just the ratios have shifted. It is much like a yeast infection.

Douching, bubble baths, or other solutions women use to flush their vaginas are associated with more Bacterial Vaginosis.

A bad smelling discharge is what usually brings the woman into the doctor. It is described as whitish with a gray or yellowish tint. It is thin and watery. It may get worse after her period or vaginal sex. Some have sensations of itching or burning. Women sometimes confuse this with yeast infections. Yeast does not look, nor smell, nor feel like Bacterial Vaginosis. The reason women mix them up is because they are the two most common vaginal infections.

How Serious Is It?
Still, it is estimated 5%-30% of reproductive age women have it and have no symptoms. It is not currently thought of as a dangerous infection. In typical circumstances, it will not threaten her health, future fertility or life if it is unnoticed or untreated. In most women, it can go away on its own. However, more recent studies are beginning to implicate B.V. in Pelvic Inflammatory Disease. Part of the uncertainty here, stems from the numerous changes in the definition o BV and the uncertainty of diagnosis. And it is known to lead to serious complications in pregnancy or those undergoing gynecological surgery.

The Diagnosis and Test Results and Why
A sample of the discharge is sent to the lab. The test is called a wet prep. Signs of Bacterial Vaginosis can be seen on routine Pap smears as well, but often misses it.

Clue cells. These are the big red flag. Clue cells are actually big globs of bacteria stuck to vaginal wall cells. Once the doctor sees this, she usually stops reading the report and starts writing the prescription.
Bacteria There's 100 to 1000 times more of them. Gardnerella may be mentioned specifically. Also, Hemophilus, or Bacteroides, Mobiluncus, Peptostreptococcus, and Mycoplasm.
pH this indicates the acidity of the vagina. It may be about 5.
No inflammation The types of bacteria called anerobes produce a substance called succinate. This suppresses the normal inflammatory reaction that this huge influx of bacteria would otherwise cause. There are few white cells (WBCs) on the report.

Purulent cervicitis, Trichomonas , and yeast infections must be excluded to diagnose Bacterial Vaginosis. Cervicitis would show signs of inflammation. Trichomonas would show the organism itself and WBCs. Its discharge may be greenish, but also gray or yellowish, so it is hard for the average woman (or average doctor) to tell it from B.V. Trichomonas discharge is described as 'frothy' (good luck knowing that one when you see it!) Yeast would show the organism in the lab sample. The woman experiences itching much more often than with BV and yeast doesn't have much of a smell.

Treatment Options-- Pros and Cons
Metronidazole (brand name Flagyl). By mouth, 500mg, twice a day, for one week. This is the most common regimen. Medicine tends to upset the stomach, leading some women not to finish it. Using generic metronidazole in this way is the most cost-effective treatment. Price about $1.50
Metronidazole (brand name Flagyl) By mouth, a single 2gm dose. The single dose has a bit lower cure rate and the relapse rate is higher. But there is no risk of quitting before finishing. Using generic pills, this is the cheapest treatment.
Metronidazole Gel (Metrogel) 0.75% inserted vaginally twice a day for 5 days. Good as 7 day oral, no stomach upset, but messy and inconvenient. No generic at this point, so it is pricey. About $20.
Clindamycin By mouth, 300mg twice a day for 7 days orally. Clindamycin 2% vaginal cream once a day for 7 days For 100% cure rate: oral (500mg. Twice a day for 5 days) and vaginal ornidazole (500mg/day for 5 days) OR Oral secnidazole (2gm single dose) and vaginal metroniazole (500mg, twice a day for 7 days).

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