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Bacterial Vaginosis

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Bacterial vaginosis is a type of vaginal infection caused by bacteria. It is due to the overgrowth of opportunistic bacteria in the vaginal microenvironment. The prevalence of bacterial vaginosis in India is around 24%. A high prevalence of bacterial vaginosis is associated with age, contraceptives, parity, and socioeconomic status.

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What is Bacterial Vaginosis?

The vagina contains various types of bacteria. Some of the bacteria are good, i.e., promote good health, while the others are bad bacteria responsible for the infection. Both types of bacteria reside in the vagina, forming a natural balance in the vaginal microenvironment. However, sometimes, the concentration of bad bacteria increases, and the good bacteria are outnumbered. This results in vaginal infection. This vaginal infection is known as bacterial vaginosis.


Bacterial vaginosis is not a sexually transmitted disease. The condition most commonly occurs in women between the age of 15 to 44 years. It is relatively a common condition, and around 1 in 3 women develop this condition at least once in their lifetime

What Causes Bacterial Vaginosis?

The vagina should have a slightly acidic pH to maintain healthy flora. The normal vaginal pH is 3.8 to 4.5. Lactobacilli (good bacteria) helps in maintaining the acidic pH inside the vagina. Due to various reasons, such as using vaginal deodorant or any other irritating substances, or douching, there is an alteration in the normal balance of bacteria. This also alters vaginal pH and promotes the overgrowth of bad bacteria. This results in bacterial vaginosis.

What Are the Symptoms of Bacterial Vaginosis?

Bacterial vaginosis does not cause symptoms in many women. However, other women may have one or more of the following symptoms:

  • ● Pain and burning sensation while urination.
  • ● Fishy and foul vaginal odor.
  • ● Persistent vaginal itching.
  • ● A watery discharge that is white or grey in color.

How is Bacterial Vaginosis Diagnosed?

There are various methods for diagnosing bacterial vaginosis. Some of the methods are:

  • Medical history: The doctor may ask you about your medical history. You should inform the doctor about any previous development of vaginal infection or any sexually transmitted disease.
  • Analyzing the symptoms: The doctor may determine various possible conditions based on your symptoms. Inform the doctor about all the symptoms you are experiencing in detail.
  • Pelvic examination: The doctor may also perform a pelvic examination. The doctor may investigate the vagina for any sign of infection. The doctor may also insert the fingers into the vagina to determine the presence of any disease.
  • Microscopic analysis: The anaerobic bacteria are the cause of bacterial vaginosis. The doctor advises undergoing the microscopic analysis of vaginal discharge to determine the presence of anaerobic bacteria.
  • Vaginal pH analysis: Alteration in pH increases the risk of bacterial vaginosis. The doctor may also recommend evaluating the pH of the vagina. A pH above 4.5 may indicate the presence of bacterial vaginosis.

How is Bacterial Vaginosis Treated?

Many cases of bacterial vaginosis do not require treatment. The condition disappears of its own. However, some patients require treatment. The doctors may prescribe various medications to manage bacterial vaginosis. The medications may be pills that you can take orally or cream for applying into the vagina.

The medications that your doctor may prescribe for bacterial vaginosis include metronidazole, clindamycin, and tinidazole. Metronidazole is the most common medicine for this condition. When metronidazole fails to provide relief, clindamycin is an alternative for bacterial vaginosis.

You should take your medications strictly as prescribed by your doctor. Never stop taking the medications without consulting your doctor. Stopping them on your own may result in the recurrence of bacterial vaginosis.



Medications are effective in managing bacterial vaginosis. However, current treatment does not prevent its recurrence. After a complete recovery, almost 69% to 80% of patients have a recurrence within 12 months. In case you experience the symptoms again, contact your doctor. If your symptoms recur soon after the completion of treatment, your doctor may initiate metronidazole extended therapy. Some women have chronic bacterial vaginosis that requires long-term treatment.

What Are the Risks Associated with Bacterial Vaginosis?

Bacterial vaginosis is a common condition. However, untreated bacterial vaginosis may cause various complications. Some of the complications are:

  • ● Increased risk of various infections such as HIV, herpes, chlamydia, and HV,
  • ● Premature deliveries with low birth weight,
  • ● High risk of infection after gynecological surgeries such as hysterectomy or pregnancy termination procedure,
  • ● Increased risk of infertility due to pelvic inflammatory disease,
  • ● Loss of pregnancy or postpartum endometritis.

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What are the Risk Factors for Bacterial Vaginosis?

Various factors increase the risk of Bacterial Vaginosis. These factors are:

  • ● Frequently cleaning the vagina with a cleansing agent or normal water (douching)
  • ● Multiple sex partners
  • ● Performing sex with a female partner
  • ● Oral sex or anal sex
  • ● Use of intrauterine contraceptive devices
  • ● Lack of lactobacilli

How to Prevent Bacterial Vaginosis?

There are various methods to reduce the risk of Bacterial Vaginosis. These methods are:

  • ● Restraining the number of sex partners
  • ● Avoid unhygienic touch to the vagina
  • ● Avoid douching. If required, use mild soaps that do not alter vaginal pH
  • ● Minimize your risk of getting sexually transmitted disease by using condoms

Does Bacterial Vaginosis Affect Fertility and the Outcome of Pregnancy?

Bacterial Vaginosis affects fertility. It may cause loss of pregnancy. Bacterial Vaginosis also results in preterm labor and a baby with low birth weight. It causes chorioamnionitis that may lead to early delivery. Bacterial Vaginosis also results in the damage of fallopian tubes. This may cause tubal infertility.

Should I Undergo any Test to Check if My Bacterial Vaginosis had Cured?

It depends upon whether you are pregnant or not. If you are not pregnant, you need not undergo any tests. The disappearance of symptoms indicates that you are free from the disease. However, if you are pregnant, do not take any chances. Undergo a test one month after the treatment to rule out the presence of infection.

What are the Alternative Management Strategies for Bacterial Vaginosis?

Apart from medications, there are some alternative treatments for Bacterial Vaginosis. These include vitamin C, vaginal boric acid, and probiotic supplementation.


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