Bacterial Vaginosis (BV)

Bacterial Vaginosis (BV) is a disease of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or grey in colour. Burning with urination occur and itching is not uncommon. Having BV approximately doubles the risk of infection by a number of other sexually transmitted infections, including HIV/AIDS. It also increases the risk of early delivery among pregnant women.

Abnormal conditions to the vaginal environment include fluctuating hormone levels during the menstrual cycle, pregnancy and menopause. Other influencing factors include antibiotics, sexual intercourse (semen is alkaline), intrauterine devices, douching and smoking increases the vaginal pH above normal (3.8 – 4.5) and results in frequent vaginitis. Vaginitis or vaginal infections, is a medical term used to describe various conditions that cause infection or inflammation of the vagina that can result in unpleasant odour, discharge, itching, dryness and burning.

The most common types of vaginitis are Bacterial Vaginosis (BV) and yeast infections. Bacterial Vaginosis is the most common cause of vaginitis and accounts for approximately 50% of all vaginal infections and affects 29% of the general population. Bacterial Vaginosis (BV) is caused by an overgrowth of bacteria such as Gardnerella or Prevotella Bivia, whereas, yeast infections are caused by an overgrowth of a fungus called Candida. 

Causes of Bacterial Vaginosis

Healthy vaginal microbiota and ecosystem consists of species, which neither cause symptoms or infections, nor negatively affect pregnancy. It is dominated mainly by Lactobacillus species and acidic pH (3.8-4.5). BV is defined by the disequilibrium in the microbiota, with decline in the number of Lactobacill and higher the vaginal pH above normal (4.5). While the infection involves a number of bacteria, it is believed that most infections start with Gardnerella Vaginalis creating a biofilm, which allows other opportunistic bacteria to thrive. One of the main risks for developing BV is douching, which alters the vaginal flora and predisposes women to developing BV. Douching is strongly discouraged by the US Department of Health and Human Services and various medical authorities, for this and other reasons. Other factors include antibiotics treatment, sexual intercourse, intrauterine devices, hormonal imbalance due to menstruation and smoking increases the vaginal pH. 

Signs and Symptoms

  • Vaginal discharge, usually thin and grayish/white in colour
  • Foul – smelling “fishy” odour”
  • Vaginal itching
  • Vaginal burning sensation during urination

    What Are the Possible Complications of Bacterial Vaginosis?

    When left untreated, BV can cause serious complications and health risks. These include:

    • Pregnancy complications: pregnant women with BV are more likely to have an early delivery or low birth weight baby. They also have a greater chance of developing other types of infection after delivery.
    • Sexually transmitted infections: BV increases your risk of getting sexually transmitted infections, including the herpes simplex virus, chlamydia, and HIV.
    • Pelvic inflammatory disease: In some cases, BV may lead to pelvic inflammatory diseases, an infection of the reproductive organs in women. This condition can increase the risk of infertility. 
    • Infections after surgery: BV puts you at a higher risk for infections after surgeries affecting the reproductive system. These include hysterectomies, abortions, and cesarean deliveries. 


    It is important to distinguish between Bacterial Vaginosis and Yeast infections, Bacterial Vaginosis usually recognized by the fishy smell.

    Amsel Criteria

    In clinical practice BV can be diagnosed using the Amsel criteria:

    • Thin, white, yellow, homogeneous discharge
    • Clue cells on microscope
    • pH of vaginal fluid >4.5
    • Release of a fishy odour on adding alkali—10% potassium hydroxide (KOH) solution

      At least three of the four criteria should be present for a confirmed diagnosis. Modification of the Amsel criteria accepts the presence of two instead of three factors and is considered equally diagnostic.

      BV and Pregnancy 

      BV is common in pregnant women and treatment is very important. BV can increase the risk for:

      • Low birth weight babies
      • Early labour and birth

        If you are pregnant and have BV, see your Health Care provider one month after finishing treatment.


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