Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

• Bacterial vaginosis is not dangerous, but it can cause disturbing symptoms.
• Most women do not experience symptoms of bacterial vaginosis, but when they do they are:
  • vaginal discharge, and
  • vaginal odor.
• In diagnosing bacterial vaginosis, it is important to exclude other serious infections, such as the STDs gonorrhea and Chlamydia.
• Treatment options for bacterial vaginosis include prescription oral antibiotics and vaginal gels.
• Serious complications of bacterial vaginosis can occur during pregnancy, and recurrence is possible even after successful treatment.

What is bacterial vaginosis?

Bacterial vaginosis is a vaginal condition that can produce vaginal discharge and results from an overgrowth of certain kinds of 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 that normally reside in the vagina become unbalanced, 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. Symptoms may also mimic those found in yeast infections of the vagina and trichomoniasis (a sexually-transmitted disease or STD), and these conditions must also be excluded in women with vaginal symptoms.

Bacterial vaginosis is a common condition. It is the most common vaginal complaint in women of child bearing age. Studies have shown that approximately 29% of women in the U.S. are affected. Bacterial vaginosis is found in about 25% of pregnant women in the U.S. and approximately 60% of women who have a sexually-transmitted disease (STD).

Bacterial vaginosis signs and symptoms may include:

• Thin, gray, white or green vaginal discharge
• Foul-smelling "fishy" vaginal odor
• Vaginal itching
• Burning during urination

Many women with bacterial vaginosis have no signs or symptoms.

When to see a doctor

Make an appointment to see your doctor if:

• You have vaginal discharge that's new and associated with an odor or fever. Your doctor can help determine the cause and identify signs and symptoms.
• You've had vaginal infections before, but the color and consistency of your discharge seems different this time.
• You have multiple sex partners or a recent new partner. Sometimes, the signs and symptoms of a sexually transmitted infection are similar to those of bacterial vaginosis.
• You try self-treatment for a yeast infection with an over-the-counter treatment and your symptoms persist.

Bacterial vaginosis results from overgrowth of one of several bacteria naturally found in your vagina. Usually, "good" bacteria (lactobacilli) outnumber "bad" bacteria (anaerobes). But if there are too many anaerobic bacteria, they upset the natural balance of microorganisms in your vagina and cause bacterial vaginosis.

To treat bacterial vaginosis, your doctor may prescribe one of the following medications:

• Metronidazole (Flagyl, Metrogel-Vaginal, others). This medicine may be taken as a pill by mouth (orally). Metronidazole is also available as a topical gel that you insert into your vagina. To reduce the risk of stomach upset, abdominal pain or nausea while using this medication, avoid alcohol during treatment and for at least one day after completing treatment — check the instructions on the product.
• Clindamycin (Cleocin, Clindesse, others). This medicine is available as a cream that you insert into your vagina. Clindamycin cream may weaken latex condoms during treatment and for at least three days after you stop using the cream.
• Tinidazole (Tindamax). This medication is taken orally. Tinidazole has the same potential for stomach upset and nausea as oral metronidazole does, so avoid alcohol during treatment and for at least one day after completing treatment.

It's generally not necessary to treat an infected woman's male sexual partner, but bacterial vaginosis can spread between female sexual partners. Female partners should seek testing and may need treatment. It's especially important for pregnant women with symptoms to be treated to help decrease the risk of premature delivery or low birth weight.

Take your medicine or use the cream or gel for as long as your doctor prescribes it — even if your symptoms go away. Stopping treatment early may increase the risk of recurrence.

Recurrence

It's common for bacterial vaginosis to recur within three to 12 months, despite treatment. Researchers are exploring treatments for recurrent bacterial vaginosis. If your symptoms recur soon after treatment, talk with your doctor about treatments. One option may be extended-use metronidazole therapy.

A self-help approach is lactobacillus colonization therapy — which attempts to boost the number of good bacteria in your vagina and re-establish a balanced vaginal environment — possibly accomplished by eating certain types of yogurt or other foods containing lactobacilli. While current research shows there may be some benefit to probiotic therapy, more research is needed on the subject.

Risk factors for bacterial vaginosis include:

• Having multiple sex partners or a new sex partner. Doctors don't fully understand the link between sexual activity and bacterial vaginosis, but the condition occurs more often in women who have multiple sex partners or a new sex partner. Bacterial vaginosis also occurs more frequently in women who have sex with women.
• Douching. The practice of rinsing out your vagina with water or a cleansing agent (douching) upsets the natural balance of your vagina. This can lead to an overgrowth of anaerobic bacteria, and cause bacterial vaginosis. Since the vagina is self-cleaning, douching isn't necessary.
• Natural lack of lactobacilli bacteria. If your natural vaginal environment doesn't produce enough of the good lactobacilli bacteria, you're more likely to develop bacterial vaginosis.

Bacterial vaginosis is caused by a change in the normal balance of bacteria in your vagina. That's why it's called a "bacterial imbalance".

• The most common form of treatment is with antibiotics, which help restore the normal balance by killing off some of the bacteria that aren't supposed to be there.
• You can also take probiotics (supplements that contain live bacteria) and Lactobacillus acidophilus tablets to help restore the normal balance of bacteria in your vagina.
• Unfortunately, antibiotics don't always work-some women experience recurrent episodes of bacterial vaginosis even after taking antibiotics—and they can also have side effects like diarrhea and yeast infections. So if you're looking for something to help you manage your symptoms while you wait for them to clear up on their own, here are some remedies we recommend:
• The first step in treating bacterial vaginosis is to identify the cause of your symptoms. If you have a yeast infection, you may need to treat that first. Once you have identified the cause of your symptoms, you can take steps to treat the bacteria and prevent it from returning.
• Antibiotic treatment will last anywhere from three to seven days, depending on how severe your case is. Your doctor may also recommend that you get tested for other sexually transmitted infections (STIs) while taking these medications as well.
• Another option is to use an over-the-counter product called metronidazole (Flagyl) gel or cream once a day for five days. This medication doesn't require a prescription from your doctor but should only be used on external areas of skin like those that surround the vagina and anus—not inside the body!
• Some doctors will recommend using vaginal suppositories which contain one of two types of antibiotics: metronidazole or clindamycin; however, this method must be followed.

Symptoms
Vaginal discharge that's white, gray, or green,A fishy odor coming from the vagina,Bleeding after sex or between periods,Abnormal vaginal itching or soreness
Conditions
Common vaginal infection caused by an overgrowth of bacteria
Drugs
Clindamycin (Cleocin),Metronidazole (Flagyl),Tinidazole (Tindamax),Azithromycin (Zithromax)